Today on the Doc On The Run podcast we’re talking about Collagen- is it working for or against your running injury.
Collagen HealingNow look, I know I talk about this a lot but collagen is one of the most critical things when you’re healing any running injury. If you have a tendon, ligament, fascia that’s injured. All that stuff is made of collagen.
Your plantar fascia is a huge sheet of collagen on the bottom of your foot. The Achilles tendon is the largest structure in your body that’s a tendon made up almost entirely of collagen and all the ligaments that bind the bones together which of course are made primarily of collagen.
So if you get an ankle sprain, you get an Achilles tendon tissue, you get a peroneal tendon tissue, you get plantar fasciitis, any of those things, it’s all an issue with collagen and all of those structures have to heal.
The thing is like you think all you need to do is form collagen, that’s not really the whole story. The fact is that when you get one of these injuries, the collagen and the formation of collagen in your body to try to heal that tissue can actually be working for or against you when you’re a runner.
What I mean by that is if you look at the structure of the collagen in these things, we’re talking about tendons and ligaments. The collagen, it all goes in a specific direction much like the Golden Gate Bridge cables that hold up the bridge. If you look at it, it’s a huge round cable but that huge round cable is made up of a bunch a little strands of wire that all run in exactly the same direction, all parallel. The reason for that of course is that they have to go in a specific direction to hold up the bridge. If they run in any direction at all, they’re not as strong because they’re not resisting the force.
The tendons and ligaments are the same in your body. So why is that important? Well the deal is, is that when you get an injury and you have like let’s say you have a partial tear in your Achilles tendon or you tear one of the ligaments in your ankle and you’re starting to heal it. Well healing is a good thing but healing it basically means that you’re going to have collagen forming to bridge that little gap where the injury has happened.
Now if you just sit still, what happens is you get collagen forming in all kinds of directions. It’s very haphazard though. It’s sort of like a wrapping a bunch of strands of water and duct tape around a broken stick.
If you do that, it will actually reinforce it in some way. They can actually make it a little bit more stable. There’s like a boy scout trick if you have someone with a broken leg, you can wrap a whole bunch of strands of cloth around the leg and they’ll actually stabilize it enough that you can transport the patient to actually get real medical care. But that’s not really structurally sound, it’s not even going in the right direction but it does help.
So when you get all of this haphazard scar tissue formations kind of working against you, it’s not really strengthening the way that’s the best and most efficient and in the end it can actually complicate things because indiscriminate collagen formation is really what we refer to a scar tissue and when you get scar tissue forming after surgery or after an injury, after a sprain, after a tendon tear, any of that, well that actually restricts motion because it keeps that one structure from moving freely.
One of the biggest problems with the Achilles tendon for example is when you get little strands of collagen forming between the long collagen bundles and the fibers that have to move past each other when your Achilles tendon is moving and part of the Achilles stretches that we give to people that are called eccentric stretches that are designed actually to break up cross-linking.
But when you’re sitting still, you’re going to get more and more cross-linking. So doctors often tell patients that they have to sit still so that they can actually form these little strands of collagen without ripping apart. That makes sense except you have to remember that if you get collagen that forms in the wrong direction, well then it’s working against you. It makes you stiffer and it actually binds those things that need to move freely and that could actually increase your risk of another over training injury later.
The reason I bring all this up is many times doctors will tell you all you have to do is sit still and recover and tell us runners we need to calm down, we need to relax and there’s some truth to that but you don’t have to necessarily stop all activity. You need to find that fine line of immobilization or inactivity that actually allow things to heal but enough motion that you can actually stimulate the cells that form collagen to form that collagen strand in the right direction and resist that applied force so that, that structures is actually going to be as strong as possible when you do get back to running.
So you have to be thoughtful about it and don’t just accept that if you just sit still and don’t do anything, wear a cast, wear a boot for a long period of time, that’s all you have to do to get these things to heal because that’s not the whole story. If that’s not the whole story, you have to remember there’s something else you can ask your doctor.
When you talk to your doctor and they tell you that you just need strict immobilization and you need to really just take it easy, not do any exercise at all, you need to prod them in need to ask them specifically. What is it that I can do? What can I do right now that’s actually going to help me heal? What is it that I can do right now that’s not really going to put this injury at risk? What can I do right now that will not only allow these structures to heal properly but prevent that indiscriminate collagen formation that refers to as scar tissue and make sure that doesn’t form and restrict my motion in a way that’s going to make it more difficult for me to run without more re-injuries later?
That’s the big key here so make sure that you get the clear answers from your doctor whenever you have a running injury and you’re trying to figure out how to get some structure made of collagen to heal as quickly as possible so you can keep running.
If you have a question that you would like answered as a future addition of the Doc On The Run Podcast, send it to me PodcastQuestion@docontherun.com. And then make sure you join me for the next edition of the Doc On The Run Podcast!
Dr. Christopher Segler is a podiatrist and ankle surgeon who has won an award for his research on diagnosing subtle fractures involving the ankle that are often initially thought to be only ankle sprains. He believes that it is important to see the very best ankle sprain doctor in San Francisco that you can find. Fortunately, San Francisco has many of the best ankle sprain specialists in the United States practicing right here in the Bay Area. He offers house calls for those with ankle injuries who have a tough time getting to a podiatry office. You can reach him directly at (415) 308-0833.
But if you are still confused and think you need the help of an expert, a “Virtual Doctor Visit” is the solution. He has been “meeting” with runners all over the world and providing just that sort of clarity through online consultations for years. He can discuss your injury, get the answers you need and explain what you REALLY need to do to keep running and heal as fast as possible.
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