The #1 Podcast For Injured Runners.
This podcast is for injured runners. Those who have been told (or worry) that running is at the root of their trouble.
If you are listening to this podcast you’re probably a runner. And you have probably been told by your friends, your family and maybe even your doctor that running is the cause of your trouble and that you need to run less.
But deep down inside you don’t just like running you feel like you have to run in order to be healthy, fit and sane. This podcast simply helps injured runners understand their condition better, and keep running.
I was recently doing a webcam call with an injured runner who wanted to know whether or not he should try to work on his running form.
He got injured and he started to get better. But the injury kept coming back. He was in a cycle of yo-yo healing. Better, then worse, then better again.
After a big race he got a lot worse. His question was whether or not working on his running form might help halt the recurring running injury cycle.
Should an injured runner work on running form?
Well, that depends and that’s what we’re going to talk about today on The Doc on the Run podcast.
One thing that’s really demoralizing if you get a stress fracture is to spend a bunch of time in a fracture walking boot and then go get something like an MRI and be shocked and horrified when the doctor says, “Well, not only do you have a stress fracture in that bone, it looks like you’ve got a stress fracture in another bone as well.”
If you think this stress fracture might have spread well, it could.
But not the way an infection would spread.
There is a way that stress related inflammation in a neighboring bone can spread after getting the original stress fracture.
Can a stress fractures spread from one bone to another?
That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with an injured runner who’s been having trouble for a couple of months. He wanted to know what to do next.
The very next step in most cases is getting baseline numbers so you can figure out where you really are with your fitness, your injury, and your recovery…or lack thereof.
You’ve got to take an honest inventory!
The whole key to getting recovered as quickly as possible is letting the injury heal…while you work to maintain your running fitness so that you can get back to running faster.
Today on the Doc On The Run podcast, we’re talking about taking an honest inventory when you’re a runner with an injury who’s trying to get back to running.
If you’re a runner with running pain on the top of the foot, it could be lots of different things.
The actual diagnosis depends on what happened, what you did, and what it feels like now.
There are a couple of really common things causing pain in the top of the foot in runners.
Let’s talk about two common causes. It may be either a tendon or a nerve on the top of your foot.
Today on the Doc On The Run Podcast, we’re talking about how a runner can tell tenosynovitis from neuritis in the top of the foot.
If you’ve got an overtraining injury, but you’re trying to figure out how to stay fit, a lot of people are going to think that you’re not normal.
But if you ran 50 miles you are not normal.
If you signed up for a marathon, you’re not normal.
If you are a runner, you are not normal.
Don’t think you will be told you’re normal when you are injured, in pain, but still working out.
But that’s exactly what all the rapidly recovering injured runners do.
I call them injury hackers.
Today on the Doc On The Run Podcast, we’re talking about how injury hackers are not normal.
I just saw a comment on our YouTube videos from a runner named Mary. She viewed the video on permanent calf atrophy, and how that can happen if you spend way too long in a fracture walking boot or a cast.
Mary replied and basically said, “Great. Now you depressed the crap out of me. Thanks. Ugh.”
Realizing that you have lost fitness to the point of atrophy can be really upsetting for any runner.
Well, I’ve got some good news and some bad news for you, and that’s what we’re talking about today on the Doc On the Run podcast.
If you’ve been diagnosed you with a Jones fracture, you’re probably really worried right now because you may have been told you might wind up in surgery.
If you’re considering whether or not you could run with a Jones fracture, you really have to think about what a Jones fracture is, where it’s located, why it’s so scary, and what you can do about it.
Can I run with a Jones fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This may seem like a crazy question when you first think about it, because skiing seems like a high stress activity. But I have had lots of runners who have asked me this question, and usually when they do, they have thought about it, and they point out that a ski boot is a very stiff and very protective piece of equipment.
The question though is not really, if it’s safe for you to wear the boot, the problem is, is it safe for you to ski with the boot and that leads to several questions that you’ve really got to ask yourself if you want to think about whether or not it’s actually safe for you to do it.
Can I ski with a metatarsal stress fracture? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
If you rest long enough any overtraining injury will eventually calm down.
But if you rest too long, you will lose all of your running fitness.
The difference between elite athlete who get better fast, and average runners who take forever to recover are the daily activities they focus on while recovering.
Today, on the Doc on the Run podcast, we’re talking about the two most important questions for recovering runners.
Let’s say you’re out on a run and you start noticing this weird aching pain in your foot and so you suspect you have a metatarsal stress fracture. I often get consultation calls and webcam visits, and I even do house calls for athletes who have metatarsal stress fractures.
The good news is that a lot of the times, if you actually do something, when you first notice that aching pain in your foot, when you’re running, it may not actually be a true stress fracture.
Today on the Doc On The Run podcast we’re talking about the five most important things you can do for first aid for a metatarsal stress fracture if you’re a runner.
I often get questions from runners and this is actually a common one that I get from runners when they have either enrolled in the plantar plate sprain treatment course for runners, or if they’ve signed up to do an individual webcam consultation.
Everybody seems to think that an MRI will give you a crystal-clear image of what’s going on inside your body and in some sense, that’s true. It is amazing, the amount of detail you can get when you get an MRI. However, you have to remember that the plantar plate ligament is a very small structure and when you get an MRI, it doesn’t necessarily show everything.
Is it okay to run before I get an MRI of a plantar plate sprain? That’s a great question and that’s what we’re talking about today on Doc On The Run Podcast.
I lecture at medical conferences about stress fractures, trying to teach physicians the difference between a stress response, a stress reaction, which is basically an irritated and inflamed metatarsal bone, and a stress fracture where there’s actually a crack that can cause real trouble.
One of the questions doctors ask me is what’s the best way and the worst way to tell a stress reaction from a stress fracture, because it does make a difference.
What is the worst way to tell a stress reaction from a stress fracture? Well, that’s what we’re talking about today on the Doc On The Run podcast.
If you only get one thing from this episode, let it be this…Thank you!
From the bottom of my heart I am grateful for you as a listener of the show!
More than 10 years ago I started writing a blog talking about running injuries, and the various treatments that we as physicians offer. A few years later, at which point I had actually only listened to a few podcasts myself, I thought it might be useful to start recording a podcast to talk about foot and ankle injuries in injured runners.
Well, its hard to believe but today is episode #500 and that’s what we’re talking about on the Doc On The Run Podcast!
Every time I do a second opinion consultation with a runner who has a plantar plate injury, I hate to tell you this, but I hear the same story over and over and over.
Basically they call me and they say, “Well, I have a plantar plate sprain. I know I have a plantar plate sprain. I went through the plantar plate sprain course and I’ve been doing some of those things to actually try to get it better and it’s starting to improve, but I was misdiagnosed with another condition.”
We’re going to talk about why runners get misdiagnosed so frequently when they have plantar plate injuries and why it can be difficult to figure out whether or not that’s actually a problem in the first place.
Today on the Doc On The Run Podcast, we’re talking about why plantar plate injuries get misdiagnosed so frequently in runners.
Metatarsal stress fractures are one of the most common overtraining injuries afflicting runners. Much of the time the stress fracture is preceded by what we as doctors call a “stress reaction.”
If you ignore the warning signs of a stress reaction and keep on running in the same way, applying the same stress, the stress reaction will advance to a full on stress fracture they can keep you out of training for months. Most people think and X-ray of the foot is the best way to tell the difference between the stress fracture and a stress reaction. But that assumption is false.
If you’re trying to figure out whether or not you’re in the early phases of the stress fracture injury process you have to take action to figure out what is going on immediately. This episode will explain that process.
Today on the Doc On The Run Podcast we’re talking about the difference between stress fracture and stress reaction.
This question came up from somebody in the coaching groups who wanted to make sure that she wasn’t going to get re-injured.
She wanted to know which running shoes she should use to reassess her pattern, and make sure that she’s working her way out of this compensation pattern, where she’s essentially limping because of this prior injury and that’s a really useful thing to do.
Today on the Doc On The Run podcast, we’re talking about which running shoes show running form wear patterns best.
An MRI can be very helpful when you have a strange injury that doesn’t seem to fit in any of the common running injury boxes.
I just had a call from a runner in that very situation. He is someone who has an injury and has something kind of strange going on.
He actually had an abnormal finding on an MRI from a little more than three years ago.
At the time that he had that previous MRI that thing that was a little weird on his MRI wasn’t really causing a problem, but now his pain is in exactly that same spot.
Today on the Doc on the Run podcast, we’re talking about why runners should always get the second MRI at the same imaging facility.
Today’s episode actually comes from a second opinion telemedicine visit with a runner who wanted to know more about a tarsal coalition.
He had an X-ray and the doctor found this thing called a “C-sign.”
The “C-sign” is an abnormal appearance on an x-ray that suggests a tarsal coalition. When you look at the lateral view of the foot X-ray, a bridge of bone can form, partially encircling the talus bone and the calcaneus or the heel bone. It creates a bridging bright white thing that looks like the letter C on your X-ray.
A C-sign is abnormal, and it is one of the classic signs of a tarsal coalition.
How can a tarsal coalition start causing pain in a runner? Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from an injured runner who saw a doctor, got x-rays and found what looked like bone fragments in the peroneal tendons.
We were doing a telemedicine second opinion consultation, and she wanted to know whether or not she should have surgery to take the bone chips out of the peroneal tendon.
That’s a great question!
How did bone chips get in my peroneal tendon? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a second opinion telemedicine call with an injured runner.
She had a recurring injury that was still keeping her from running.
Unfortunately, that injury first started eight years ago.
When you have an injury, and you get x-rays, an MRI or a CT scan, or any kind of medical imaging study that shows more detail than the x-rays, you should always get a copy of that disc.
This runner’s story is a great example of why you need those images.
Today on the Doc On The Run podcast we’re talking about why runners should always get copies of the x-ray or MRI imaging disk.
Today’s question comes from a telemedicine visit second opinion for a runner.
She was asking if she should have surgery to remove bone fragments.
I said, “Well, let’s talk about what’s going on with you first.”
Anytime we see something abnormal on an x-ray or an MRI, we often think that it’s pathologic. We presume something is wrong, just because it doesn’t look right.
We think if something’s wrong, we should go cut your foot open and fix it.
Should a runner have surgery to remove bone fragments? Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run podcast.
The other day I was talking to a runner who had some abnormal findings on the x-rays.
What we could see was calcification in the Achilles tendon that looked like bone chips.
She wanted to know if she should have surgery to remove the calcification or little bony chips that were inside her Achilles tendon.
Now, the interesting part of the story is that the Achilles calcification was discovered from an x-ray where she had a stress fracture in one of the metatarsals….in a completely different part of her foot!
The pain she was having when running didn’t even come from an Achilles tendon problem.
Today on the Doc On The Run Podcast, we’re talking about the difference between pathologic versus abnormal findings on x-rays and MRIs in runners.
Today’s episode comes from a runner who was having some weird aches and pains when running.
One doctor suspected he might have a thing called a “tarsal coalition.”
A tarsal coalition is an abnormal union or connection between two bones.
He was even told me might need surgery to remove the tarsal coalition.
He asked me whether or not an injection, like a stem cell injection, might actually help a tarsal coalition.
You have to think about the runner’s goals, and we expect different injections will actually do to figure out which is best for you.
Today on the Doc on the Run podcast, we’re talking about two opposite ways injections could help a tarsal coalition in a runner.
A podcast listener sent in a great question for the Doc On The Run Podcast.
Sandra asked, “Is there a best way to ascertain if a person has a leg length discrepancy? MRI, measuring, what is it?”
“Limb length discrepancy” just means one leg is a little bit longer than the other.
There are lots of different ways to figure out whether or not you have a limb length discrepancy.
Figuring out how big that difference might be is really important if you want to fix it.
Today on the Doc On The Run Podcast, we’re talking about three different ways to determine limb length discrepancies in a runner.
Today’s episode comes from a discussion in our Monday, Wednesday, Friday coaching group.
This was someone who actually had a metatarsal fracture and had graduated from using crutches to using the boot and was transitioning out of the boot and she asked me a great question.
She said that her foot was hurting a little bit as she was transitioning out of the boot. She wanted to know if that was normal. Or was the aching associated with walking in a normal shoe something to be concerned about.
Today on the Doc On The Run podcast, we’re talking about why healing fractures might hurt after you stop using the boot.
Today’s discussion actually comes from a question from a runner in the Monday, Wednesday, Friday Coaching Group.
This is a runner who has a condition called “hallux rigidus.”
He wanted to understand the best way to assess your running shoes. He also wanted to know whether or not it was possible to identify hallux rigidus just by looking at the soles of a runner’s running shoes.
When you get hallux rigidus, your big toe doesn’t actually “dorsiflex” or come up away from the ground enough to allow you to walk or run without doing something to compensate. That shift in the way you walk creates a characteristic wear pattern on the sole of the shoe.
Today on the Doc On The Run Podcast, we’re talking about running shoe wear patterns with hallux rigidus.
Today’s episode comes from a discussion I had with a runner in person who had some foot pain, it was kind of weird.
He’s an elite runner and he started developing this symptom that he couldn’t figure out and it was in a weird spot.
He got an evaluation and part of his evaluation was X-rays of his foot. When we got the X-rays of his foot and we were looking at him, he had this thing that we call talar beaking and he wanted to know what that was.
What is talar beaking on the X-ray of a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every treatment in medicine has pluses and minuses. Applying ice is no different. Ice can make some things better, and some things worse.
If you ice something, in general it will calm that inflammatory response, reduce the pain and make you more comfortable.
But your goal is to get back to running as quickly as possible, not to just make you feel better.
Today on the Doc on the Run podcast, we’re talking about whether or not an injured runner should ice a broken toe.
Every day I do telemedicine calls with injured runners. They often ask questions that remind me of things learned in the past, that help them understand what to do right now.
It’s interesting how many times I actually think of this guy that was my mentor when I was racing motorcycles. His name is Fred Provis. Everyone called him “Motorhead Fred.”
Fred and I raced together and won an endurance championship, and he taught me a ton of stuff about life (not just racing).
Much of what Fred told me, I never would’ve thought about doing on my own.
I did what Fred said, because I trusted him.
Today on the Doc On The Run Podcast, we’re talking about why you need to trust in a real expert.
Ankle sprains are incredibly common in runners.
Sprained ankles account for about 10% of all musculoskeletal injuries that show up in the Emergency Room.
But there is another injury that can seem sort of like an ankle sprain, but doesn’t respond to treatment the same way.
This sprain is not in the ankle. It is a sprain of the joint under the ankle…the subtalar joint.
It’s called a Subtalar Joint Sprain.
What is a subtalar joint sprain in a runner? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you suffer a severe running injury, some doctors will give you crutches to speed up the recovery process.
Healing any running injury is a race against time.
All overtraining injuries will eventually heal.
But if you take a long time to heal, you’re going to lose a lot of running fitness. You will get weaker, stiffer and develop a loss of coordination.
That loss of fitness will make it very difficult for you to achieve your running goals after you fully recover. The goal isn’t to heal. The goal is to run without re-injury.
Today on the Doc On The Run Podcast, we’re talking about the best and worst ways to stop crutches if you’re an injured runner.
This podcast episode comes from a telemedicine visit second opinion with a triathlete and runner who was having pain as he ramped up his mileage.
It turns out he had what we call a limb length discrepancy, where you actually have one leg that is a little bit shorter than the other.
This is something we see a lot in runners who are starting to get problems as they increase mileage during training.
Today on the Doc On The Run podcast, we’re talking about three signs of limb length discrepancies in runners.
This is a great question from a runner I’ve been helping in the Monday, Wednesday, and Friday coaching group.
She had a fifth metatarsal fracture and wanted to know if this could actually cause posterior tibial tendonitis.
Since they’re on the opposite sides of the foot, a lot of people think that it won’t cause the same kind of problem, because you wouldn’t expect to have problems on both the left and right sides of the same foot.
Can a fifth metatarsal fracture cause posterior tibial tendonitis? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A runner in the in the recovering runners coaching group asked a great question.
She had just broken her toe and could barely walk on it. She was really worried that she was going to have to use a fracture walking boot for a month or month and a half to get the toe fracture to heal.
She wanted to know specifically when she could start running.
Today on the Doc On The Run Podcast, we’re talking about what happens if you run on a fractured big toe before it completely heals.
I just got a great question from somebody who said he went rock climbing over the weekend, and he got a huge blister on his big toe from his climbing shoes.
He didn’t really complain that much about the blister, in fact, he’d even been running. But then he said he was getting peroneal tendonitis. He was having this pain on the outside of the ankle where the peroneal tendons go down around the back of the fibula bone.
He wanted to know if it was somehow related to the blister on the big toe.
Can a blister on the big toe caused peroneal tendonitis? Well, that’s what we’re talking about today on the Doc On The Run podcast.
I recently got a great question from a runner who was calling me for a second opinion during a telemedicine visit.
She wanted to run but had a partial rupture in the plantar fascia.
When we were talking about her history, she told me that she had had a couple of corticosteroid injections (or cortisone) injections for the plantar fascia when she had plantar fasciitis.
Is a cortisone injection malpractice if it causes a plantar fascia rupture in a runner? Well, that’s what we’re talking about today on the Doc on the Run podcast.
I got a call from a runner who has a really interesting situation.
He’s been doing lots of running, but he’s been getting pain in his ankle whenever he runs.
He gets a little bit of swelling in the ankle at the end of the day.
But when he wakes up, the swelling in the ankle is completely gone.
The ankle swelling is completely resolved and he seems fine the next morning.
So his question was, “Can I run with arthritis in my ankle?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This is a great question I got from a runner during a recent telemedicine visit and this was a runner who actually called me for a second opinion because she had a tear in the plantar fascia.
She felt like it was healing, and she wanted to get back to running. She was really hoping to get some kind of real positive affirmation or confirmation that she was okay to run and wanted to know whether or not she should get a repeat of the MRI that she had previously that actually discovered she had a partial tear in the plantar fascia and not just plantar fasciitis.
Now, this is a great question and it’s a completely reasonable one. In fact, I just discussed this with doctors last week at the International Foot and Ankle Foundation meeting, where I was actually lecturing on runner’s heel pain.
Should I get an MRI of my healing plantar fascia tear before I start running? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just doing a call with a runner who started running before his fracture was healed on the x-ray.
In fact his regular doctor said he couldn’t run on it until the x-rays showed healing.
I let him start running on it, in a very structured way.
Now he is back to full running.
If the bone is always getting stronger while it is healing, do you really need to wait until the x-ray finally proves it has fully healed?
Today on the Doc On The Run Podcast, we’re talking about whether or not you can run if you fracture is not yet healed on x-ray.
This episode actually comes from a question I got during the live question and answer period at the end of a talk I was giving at the International Foot and Ankle Foundation meeting in Hawaii.
The question was about one of the conditions that can often be misdiagnosed as plantar fasciitis, and that’s a condition called medial calcaneal neuritis.
With this condition a nerve on the inside of the heel becomes inflamed and painful.
In short, the patient had alcohol injection under ultrasound guidance by another doctor, but the condition dod not get any better.
The question from the doctor in the audience was basically asking me what my opinion about that procedure using ultrasound.
Today on the Doc On The Run Podcast, we’re talking about heel neuritis in a situation where a doctor did an alcohol injection with ultrasound and another doctor wanted to know if that was a scam.
A doctor at a medical conference asked me a great question!
I was giving a lecture at the International Foot and Ankle Foundation meeting in Hawaii on runners heel pain, specifically about the differential diagnosis or the things that can cause runners heel pain.
In that talk I was also teaching about the differences in treatments between runners like us, and non-runner patients with heel pain.
At the end of that lecture a doctor wanted to know which kind of imaging study was better for a runner with a suspected small tear in the plantar fascia ligament.
Today on the Doc on the Run Podcast, we’re talking about MRI vs Ultrasound. Which is better for Plantar Fasciosis or Partial Rupture in a runner?
Today I got a question from a doctor who wanted to know what I would do with a runner after surgery to remove non-healing sesamoid fractures in both feet.
You have two sesamoid bones under the big toe joint in each foot. When one of them develops a stress fracture, it can break.
If it breaks into two pieces, it can be difficult to get the broken sesamoid to heal completely.
If it doesn’t heal, becomes arthritic and turns into what we as doctors call a “sesamoid fracture non-union” your doctor may recommend surgery to take it out.
Today on the Doc on the Run Podcast, we’re talking about what to think about when a doctor is trying to rehabilitate a runner after tibial sesamoid non-union removal surgery in both feet.
I was just giving a talk at the International Foot and Ankle Foundation’s 40th Annual Hawaii Seminar.
And at the end of the session, we got a couple of questions from the audience during the live Q&A for the doctors.
A doctor in the audience she had a runner who is one of her patients.
This runner had been basically running on a mild stress fracture, which I would really consider a stress reaction, for a period of about two months but wanted to do a race.
Today on the Doc on the Run Podcast, we’re talking about what a doctor should do when she is helping a runner with a stress fracture who has been running on it for 2 months and still wants to run a race.
IThis episode comes from a question from a runner I saw in person during a second opinion house call.
She had a metatarsal stress fracture and felt like it was more comfortable when she was barefoot.
The more you can reduce the stress and strain to the injured metatarsal bone and the healing stress fracture the faster it will heal.
The types of shoes you wear during the recovery can change those stresses for better or worse depending upon which shoes you are wearing.
You need to focus on protecting and healing that metatarsal stress fracture if you want to get back to running as fast as possible.
Today on the Doc on the Run Podcast, we’re talking about whether or not it is better to go barefoot with a stress fracture.
If you want to get back to running faster after a foot fracture (or any overtraining injury), the whole key is make sure that you are increasing your activity to get stronger, instead of just sitting around and waiting, while you get weaker.
But the only way you can do that is with constant readjustment based on how you feel and what happens in response to that activity during that recovery process.
This episode is about runner with a healing fracture who was told by a doctor, “don’t run.” Instead he was supposed to wait for another x-ray to prove it was healed.
And after I did a consultation call with him, I actually cleared him to start running now.
Today on the Doc on the Run Podcast, we’re talking about a recovering runner with a fracture who wants to ramp up his intensity today.
A podcast listeners wrote in and she asked,
“How long do I need to stop running or take it easy after taking five doses, meaning two and a half days, of Cipro?
I told my doctor I was a runner, so I didn’t trust their opinion on when or how I should run.
I haven’t run since finding out the side effects two weeks ago, and the Achilles feels weak and a little thicker than the other side.”
This is a great question, and she is right to be concerned because the FDA issued a black box warning because of an association between Cirpo antibiotics and Achilles tendon ruptures.
Today on the Doc on the Run podcast, we’re talking about a runner with Achilles tendon worries after taking Cipro antibiotics.
A little over a couple of weeks ago, I was working on my motorcycle, and I accidentally cut myself open.
Long story short…I let a middle school kid put the stitches in the wound.
In this episode we talk about how that turned out.
We also talk about how that story applies to running injury recovery.
Which is more important when you have surgery to heal a running injury?
Is the actual procedure done by the surgeon the most important?
Or is the process of injury recovery after the surgery more important?
Today on the Doc On The Run podcast we’re talking about procedure vs process in healing faster.
A new runner was having some aching in pain in the shins and he asked,
“I just started running. I started having shin splints. Some people told me I have to stop. Some people, say I don’t. What do I have to do?”
Obviously, if you started running, you’re starting to develop some fitness and you’re finally getting to the place where you can run consistently, the last thing you want to do is give up your running routine.
The good news is that in some cases you don’t have to stop running just because you have aching pain in your shins. You just have two figure out whether or not it is really a big problem or something that can improve with minor changes in your running routine.
Do I have to stop running to cure shin splints? That’s what we’re talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation over webcam with a runner who had an overtraining injury.
She was really worried that she could to lose all of her fitness while waiting to heal.
It is just not okay for a runner to sit and wait for weeks, or months, to heal an injury.
If you don’t exercise at all, you will lose your base of aerobic fitness, the neuromuscular connections that keep you coordinated and help you maintain good running form.
You start to lose it all at a very fast rate compared to how long it takes to build that running fitness.
Today on the Doc On The Run Podcast, we’re talking about how healing running injuries is a race a against time.
I just did a second opinion consultation with a runner who called and said she was diagnosed with a grade five stress fracture.
The doctor didn’t actually explain what that meant. He just said it was serious.
Stress fracture severity is rated grade 1 through a grade 5. Grade five is obviously the worst to runner.
She wanted to know if she needed a bone stimulator since her stress fracture was serious.
That’s what we’re talking about today on the Doc On The Run podcast.
I was just doing a second opinion consultation with a runner who was really stressed out.
She said, “I’m going to lose all my aerobic fitness. I’m going to get weaker. I’m going to get stiff or my running form is going to be terrible!”
There are some mental tricks you can use that will be very helpful anytime you get an over-training injury, whether it’s a stress fracture, Achilles tendonitis, or any injury.
If a doctor tells you, you have to rest and sit still, that can be stressful. But all runners have the tools to navigate it, whether you have ever been injured or not.
Today on the Doc On The Run Podcast, we’re talking about how you should think of your over-training injury recovery, as an extended rest day.
The fifth metatarsal bone goes from your midfoot out to your little toe. And if you break it, it could be one of three things.
You could have a shaft fracture, which heals pretty uneventfully, most of the time.
You could have an evulsion fracture, where it actually rips a piece of bone off when your peroneus brevis tendon tries to pull so hard to keep your foot under you, that it actually cracks the bone.
Or you could get this thing called a Jones fracture. Now, if you have a Jones fracture, that is a bad thing. Out of those three, it is definitely the worst.
But sometimes a doctor will say you have something called a pseudo-Jones fracture, which implies it’s kind of like a Jones fracture, but not really as bad.
What is a pseudo-Jones fracture? Well, that’s what we’re talking about, today, on the Doc On The Run podcast.
This episode actually comes from a YouTube comment. This runner saw an image from when I was running a 50 mile trail race wearing Hoka trail running shoes.
He said, “I would never take advice from a coach, a biomechanics expert, or a running injury expert who was wearing Hokas.”
Would you take your running coach seriously if he was wearing clown shoes?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode actually comes from a podcast listener who had a question:
“I got an MRI just to give me the green light to resume training and it showed a grade three stress reaction of the left tibia. Do you think I can run?”
Deciding whether or not you can run with a stress fracture really depends on understanding how bad it was when it started, and how bad it is right now.
How bad is a grade three stress fracture? Well, that’s what we’re talking about today on the Doc on the Run podcast.
Today’s episode comes from a podcast listener with a stress fracture and wants to get back to running.
Jennifer says, “I went to see my doctor again today for my MRI results.
He told me that I still have a stress fracture.
I was a bit confused, because after 10 weeks without running I thought there would have been more signs of healing.
So I asked if he could see a fracture line and he said, ‘Yes and that I should stop running immediately!’
(I guess my doctor forgot that I had stopped a long time ago).
I want to get back to running and I don’t believe my doctor is truly getting me there. Prior to this appointment, I was feeling confident that I could continue with my walk/jog routine as long as there was no pain.
However, now I am feeling scared because he could still see the fracture.”
In short, it sounds like Jennifer is saying, “I don’t trust my doctor.”
Well, that’s what we’re talking about today on the Doc On The Run podcast.
I had a really great question from a patient on a second opinion webcam visit.
“I have a partially torn plantar fascia. Can I keep running and let it heal later?”
He had purchased The Runner’s Heel Pain course and based on his self-diagnosis, he concluded that he definitely did not just have plantar fasciitis. It was more likely plantar fasciosis with a small tear in the plantar fascia.
Unfortunately, the treatment that we would normally do and normally recommend for somebody with a partial tear in the plantar fascia, well, he just cannot do right now. He does not have time to actually take off of his activity and stop running completely right now.
Today on the Doc On the Run podcast, we’re talking about Torn Plantar Fascia: If I run can it heal it later?
It’s no secret..I like to talk about running injuries!
But after so many years working with injured runners, helping runenrs race after they get an injury, and showing them how to maintain their running fitness while injured: I have uncovered a couple of “secrets” that really help injured runners most.
If you have a running injury and you’re trying to figure out what to do, if you’re confused why the doctors are just telling you to sit around and wait, this episode may help you understand it.
Today on the Doc on the Run podcast, we’re talking about the top three running injury recovery secrets.
Extensor tenosynovitis is one of the running injuries doctors don’t often talk about simply because it’s a relatively rare condition.
But extensor tenosynovitis can be really painful when running.
Sometimes it’s actually misdiagnosed as a stress fracture, both by doctors or by the runners themselves.
Any misdiagnosis can force you to take time off of running unnecessarily.
Today on the Doc On The Run Podcast, we’re talking about three foot types that are prone to extensor tenosynovitis.
Just this weekend, I got a call from somebody who said that she was out on a run, she felt a pop in the back of her heel, she went to the emergency room and she was told that she has a partial tear in her Achilles tendon.
I’m not really sure if they did x-rays or an MRI or an ultrasound or anything to confirm that, but the doctor seemed very confident that she had torn her Achilles tendon.
And so, she said that all they did really was they gave her some crutches and they told her to see a specialist, which is why she called me.
She asked me “I just found out that I tore my Achilles tendon. The emergency room physician gave me crutches. What should I do?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every day I talk to injured runners who ask me to help them recover faster so they can run sooner. Some runners call me for a one-time, one-hour consultation. Some runners call me and hire me to literally coach them day-by-day for a full month.
Others who don’t want to spend that kind of money, simply join a coaching group where they can get advice for an entire month and join group web-cam sessions every Monday Wednesday and Friday for 4 weeks in a row.
In those sessions recovering runners get to pick my brain to see what they might be able to do to recovery faster and get back on course sooner.
Today on the Doc On The Run podcast, we’re talking about why some runners should never pay for advice.
Today’s episode actually comes from a question that is a real-world situation.
Should I take Lovenox after an ankle fracture? I broke my ankle. The doctor gave me a prescription. Should I take this thing or not? Is this appropriate for me?
This is actually a great question and it points out a couple of things I think are worth hearing.
Today on the Doc On The Run podcast, we’re talking about whether or not you should take Lovenox after an ankle fracture.
Most of the runners who call me when they are inured have hired a running coach. Some of them don’t realize they have a running coach.
A coach is someone who one who instructs players in the fundamentals of a sport and directs strategy.
When you sign up for online coaching, and get a marathon training plan, you hired a coach.
When you go to the doctor and ask for help with a stress fracture you hired a coach.
Both of them are supposed to be helping you (in different ways) get to the finish line.
Today on the Don On The Run podcast, we’re talking about how to pick your running coach wisely.
A body at rest remains at rest.
Now that is a law of physics. That’s not something I came up with, but it definitely applies to running injuries.
This is what I see happen over and over and over. Somebody gets a stress fracture, they go to the doctor, the doctor takes an X-ray, they don’t see a crack. They don’t see anything on the X-ray. And they say, “Well, I don’t see anything, but you have a stress fracture.” Here’s a boot, wear it for four weeks, we’ll see you in a month. Come back and we’ll do another x-ray.
You leave there thinking, “Wait a minute, you didn’t see a crack. You didn’t see anything. In fact, I’m not even so sure that you know it’s a stress fracture, because you said there was no crack on the X-ray yet you gave me a boot and you told me to sit around for a month and then do another X-ray. Like, what does that mean?”
Today on the Doc On The Run podcast, we’re talking about running injury truth number five, a body at rest tends to remain at rest.
If you want to get back to running as quickly as possible you need 3 essential ingredients:
Recovery, Strength and Balance
When something is weaker because it is still recovering, this approach is all the more important.
NEWSFLASH: you can work on recovery, building strength, and better balance at any stage of injury.
Get moving now!
Today on the Doc On The Run podcast, we’re talking about the 3 Ingredients required for rapid recovery from running injury.
The action you and ONLY YOU take are all that matters now.
I can show you the way, but I can’t carry you there.
It takes work. Lots of work. It’s like training for a marathon, without cheering crowds or medals.
The speed with which you return to running ONLY depends on how much effort you put into your recovery.
Today on the Doc On The Run podcast, we’re talking about how no one can save you.
There is NO over-training. There is ONLY under-recovering. You did not run too much. You made a mistake in the order of your workouts or the intensity of one workout or in the strategy you used to rebuild tissue.
That is EXACTLY the same mistake runners make when they get injured again after “healing” an injury.
Today on the Doc On The Run podcast, we’re taking about running injuries can happen to everyone.
The premise is that your crazy physical activity is the problem.
The promise is that you will heal if you simply sit still.. long enough.
The hope is that recovery will magically take place through sacrifice like a perverse form of penance for your exercise sins…crazy.
But a prescription of 100% Rest only guarantees 100% loss of fitness.
Today on the Doc On The Run podcast we’re talking about the advice to rest is a lie.
If you’re a runner with a running injury, you need to listen up.
The biggest problem with running injuries is not that you have a broken bone, not that you have a sprained ankle, and not that you have Achilles tendinitis.
The biggest problem is that you’re going to lose your running fitness while you recover from that injury, if you’re not really proactive.
Today on the Doc On The Run Podcast, we’re talking about muscle atrophy, and whether or not it’s reversible.
I was recently doing a presentation about how runners go wrong.
They know all of this stuff about training, running biomechanics, running form and nutrition. And that’s not enough.
Runners still get injured and have to call me…even after they’ve seen other doctors.
Today, on the Doc On The Run Podcast, we’re talking about the number one cause of confusion in injured runners.
This episode comes from Amanda who wanted to know how to tell the difference between contact dermatitis and athlete’s foot.
It’s summertime, she’s been running, her feet sweat a lot, and she noticed a bunch of peeling skin on her feet.
She assumed it might be athlete’s foot, but one of her friends said it might be dermatitis.
This is a great question!
How can a runner tell athlete’s foot from contact dermatitis?
Well, that’s what we’re talking about today on the Doc on the Run podcast.
This episode actually comes from a visit with a runner where I was asked to check her foot.
This runner happens to also be a physician.
She assumed that she was having plantar fasciitis because she had some pain in her heel when she was running, and after her run, she would have a little bit of pain when she was just walking around.
Because she was having this occasional weird twinge of heel pain, she asked me to see what I could figure out.
Today on the Doc On The Run Podcast, we’re talking about how you really need to check your shoes whenever you have pain from running.
I know blisters are not really an exciting topic. You probably want to hear something that’s going to make you stronger and faster and finish your marathon better.
But I can tell you one thing for sure, if you’re running a marathon and you get a blister, it is going to wreck your performance. You cannot perform at your best if you’re thinking about some little stinging aching pain that you’re getting because of a blister, and it really can make a real dent in your training too.
Today on the Doc On The Run Podcast, we’re talking about the causes of blisters in runners.
I just spoke with a runner during a telemedicine visit who has been having some pain that is flaring up in a couple of different workouts.
He’s now a little worried that he’s going to wind up with something that sidelines him.
He remembered that he was told he had some kind of “limb length discrepancy.”
Today on the Doc On The Run Podcast, we’re talking about limb length discrepancy compensation in runners.
Today’s episode comes from a recent group coaching call for recovering runners. All of the runners on these calls have been injured and they’re getting back to running, and today’s call will help you understand several things.
Even if you don’t have cuboid pain, even if you didn’t have flatfoot surgery, this will help you think about your pain differently and help you look for opportunities to maintain your running-specific strength as you continue to recover from your overtraining injury.
Today on the Doc On The Run Podcast, we’re talking about cuboid pain with running after flatfoot surgery.
I had a recent group coaching call for recovering runners, and the main point of this episode is that you’ve got to do more frequent follow-up. Even if you manage that follow-up recovery process on your own, it needs to be frequent.
This particular runner was someone who was having an improvement in her injury. She was actually running, but she still had some foot pain when running and she had one of the best and most common questions I get:
“Should I just keep running and see what happens?”
Well, if you’re in that spot, you don’t want to miss this episode.
Today on the Doc On The Run Podcast, we’re talking about whether or not you can just keep running and see if the foot pain gets better.
This episode comes from a live group coaching call where recovering runners get to ask me anything they want.
Today on the doc on the run podcast we’re talking about whether or not you can get a stress response in your good foot when you’re wearing a fracture walking boot on your bad foot to treat a stress fracture.
Today’s episode comes from a live Q&A. We hold these sessions for runners enrolled in the self-diagnosis courses, and those in group coaching sessions, who just want to make sure that they’re staying on track and getting back to running as quickly as possible.
We were talking about why injured runners should ask better questions.
Today on the Doc On The Run podcast, we’re talking about how to ask better questions at the doctor, for an over-training injury.
This episode actually comes from a recent live Q&A I did with recovering injured runners and during these calls you can come on and you can ask me anything that you want about your specific situation.
This was a really great question that came from one of the runners on the call and he was concerned about this discomfort he was getting in his foot a full year after he had a metatarsal stress fracture.
Today on the Doc On The Run Podcast, we’re talking about what can cause aching pain in the top of the foot a year after a metatarsal stress fracture?
I recently did an episode where I was talking about the causes of black toenails in runners after long runs, and I got a lot of comments and questions about, “Well, what should I do?”
We did talk about a couple of different things during that episode, where I was telling you how to check and make sure that you have sufficient space at the end of the shoes, that your running shoes aren’t just too small or how to make sure that if you do have a lot of room in the shoes or if it seems like they’re big enough.
But if those two things are not your issue, then it’s more likely that when you’re swinging your foot through, during what we call the swing phase of gait.
Today on the Doc On The Run podcast, we’re talking about the top three tips to avoid getting black toenails from your long runs.
I just had a discussion with a runner during a telemedicine second opinion.
She rolled her ankle and went to the emergency room. They gave her a brace to stabilize the ankle and an ACE wrap to compress it.
She started some rehab exercises, and frankly she improved a lot.
But when she got back to running, she had intermittent pain in the back of her ankle.
This was not the same spot where she got the sprain.
She called because this pain has now been going on for a long time, and when she got an x-ray someone told her she might have a posterior process fracture of the talus.
She asked me, “What exactly is a posterior process fracture?”
Today on the Doc On The Run Podcast we’re talking about posterior process fractures of the talus.
Today’s episode comes from a discussion during a recent television fitness segment interview where I was actually asked about black toenails in runners.
If you’ve been running for a long time, undoubtedly you’ve had this happen at least once. I’ve had it happen multiple times.
I realized, after many years of racing, that if I did any run longer than about 20 miles, and I didn’t do some specific things to really provide care for my nails and protect them, I would wind up with one of my second toenails bruised, discolored and painful.
Today on the Doc On The Run podcast we’re talking about the top three reasons runners get black toenails after long runs and races.
This was a great question from a runner enrolled in the metatarsal stress fracture course. She wanted to know whether or not a bone stimulator would really be helpful.
Can a bone stimulator help a stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run podcast.
I was just on a telemedicine call with a recovering runner. He asked me about different forms of training that he could do to maintain his running fitness, while he fully healed the injury.
He asked a question I get all the time, “Is cycling really helpful or not?”
Well, the short answer is yes, it is very helpful for several reasons.
Today on the Doc On The Run podcast, we’re talking about whether or not cycling will help maintain your running fitness while you’re injured and recovering.
This episode actually comes from one of the live Q&As I did with course members who are actually enrolled in courses like the Plantar Plate Sprain Course for Runners or the Metatarsal Stress Fracture Course.
“One of my friends said that I could get an injection to help my planter plates sprain heal faster. What is that injection?”
Today on the Doc on the Run podcast, we’re talking about what kind of injections might help a plantar plate injury.
This is a question sent in by a listener to the Doc On The Run Podcast and this is someone who’s had a stress fracture, and it’s now turned into what the doctor called a delayed union.
She said, “My doctor has told me that my stress fracture is now a delayed union”.
What does that really mean? What is a non-union? What’s a delayed union?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
The anti-inflammatory medications you can get over the counter at the pharmacy do a great job at decreasing musculoskeletal healing, but there is a little bit of a problem.
There’s some research that actually shows that some anti-inflammatories, particularly non-steroidal anti-inflammatories, may slow down healing of tendon to bone junctions.
Today on the Doc On The Run podcast, we’re talking about should I take ibuprofen when I have a plantar plate injury?
I was just having a discussion with a runner about the things that she could do to accelerate her running injury recovery.
She has been yo-yoing through a cycle or workouts and short runs when she feels good, then does a little bit too much.
That’s when she gets re-injured.
She is aggravating the injury over and over. The real problem isn’t her injury. She’s just pushing her recovery too fast.
Today on the Doc On The Run Podcast, we’re talking about how you have to slow down if you want to speed up.
A runner just asked a great question about when runners should get a plantar fasciitis injection so she can run.
If you’ve signed up for the Runner’s Heel Pain Course, or you’ve listened to the podcasts on Runner’s Heel Pain about plantar fasciitis in runners, you’ve probably heard me say that I don’t inject most runners with cortisone when they have plantar fasciitis.
The way I break it down is that it depends on one of three different scenarios.
“Should I get a plantar fascia injection so I can run?”
That’s what we’re talking about today on the Doc On The Run Podcast.
If you get injured, you’re going to need help.
If you want to maintain your running fitness and get back to running as quickly as possible, sometimes you’ve got to talk to an expert.
I’m an expert on running entries. I do telemedicine visits, but telemedicine does not work for everything or everybody.
You don’t have to talk to me. You can find somebody else.
There are several ways to figure out whether or not your local expert might be able to help.
Today on the Doc On The Run Podcast, we’re talking about three tips for finding a local expert on running injuries.
I just did a telemedicine second opinion consultation with a runner over webcam who was worried about fat pad atrophy causing heel pain.
Fat pad atrophy in itself does not cause pain. But the plantar calcaneal fat pad that cushions your skin under the heel bone really does prevent the skin from getting squished. So, yes, you can definitely get pain if your fat pad gets atrophied.
Does calcaneal fat pad atrophy cause pain when running?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This is a great question from one of the people I was just working with on a telemedicine visit.
Does running really make me nicer?
She actually said, “It’s been really tough being injured, because it seems like when I can’t run, I’m not nearly as nice as I usually am.”
Well, if you’re anything like me, it probably does and that’s what we’re talking about today on the Doc On The Run podcast.
This is a great question from one of the YouTube viewers.
Can I do calf raises with hallux rigidus?
He wanted to know whether or not calf raises might cause more damage to the big toe joint. He wants to make sure that condition does not get worse.
This runner wanted to know whether or not it was safe.
And that’s what we’re talking about today on the Doc On The Run Podcast.
This morning I was interviewed as a guest expert on a television program for a health and fitness segment. We were talking about how running shoes are really your only piece of injury protection equipment as a runner.
The only thing between you and the ground is your running shoe. When you are training in them just a little bit too long, they start to get worn out.
Today on the Doc On The Run Podcast, we’re talking about the best three ways to tell when to replace your running shoes.
This episode comes from a question on the Doc On The Run YouTube channel.
“Can I do leg presses with a plantar plate sprain?”
Maintaining your running fitness is critical when you get an injury that takes a long time to heal…like a plantar plate sprain.
The 2 keys are consistently decreasing the pressure and tension to the plantar plate.
Today on the Doc On The Run podcast, we’re talking about whether or not you should do leg presses with a plantar plate sprain.
This episode comes from a podcast listener who is training for the High Lonesome 100 mile race.
Kate wrote in to ask:
I rolled my foot at my child’s field day. I heard a crunch and immediately saw swelling and discoloration on the lateral midfoot area of my left foot. An x-ray was negative. A week later there is no change. I have not run but it is not healing. Could it be broken?
That’s a great question and that’s what we are talking about today on the Doc On The Run Podcast!
I was speaking with a runner who had an over-training injury and she wanted a second opinion. And the reason she called was that she went to see a doctor and the doctor recommended a specific treatment for her.
So she went home and she started doing some online research, and she started thinking that maybe this treatment might actually be bad for her as a runner.
Everything in medicine is about risk versus benefit.
We take every treatment that we offer to a patient that we recommend to someone who has an injury or an illness and we have to decide, is this treatment actually going to make the person better as a whole, or could potentially make them worse?
Today on the Doc on the Run podcast, we’re talking about whether or not this treatment is bad for runners.
This episode comes from a house call I just did with a runner who actually has some heel pain. It wasn’t plantar fasciitis.
Haglund’s is a problem where you get inflammation and irritation at the back of the heel. There is a little bursa in between the Achilles tendon, where it attaches on the back of the heel, and that little part of the heel bone that can protrude on the back.
He had a really great question.
If I have bursitis of the heel, should I do aggressive Achilles tendon stretches with wedges for my Haglund’s deformity?
That’s what we’re talking about on the Doc On The Run podcast.
I was just doing a telemedicine visit for a second opinion with a runner who’s had a longstanding plantar plate sprain. These can be very frustrating injuries because if you don’t treat them appropriately or you ramp up your activity too early, well, it can recur and they can go on for a really long time.
It had been a long time since he’s running, he needed a second opinion, he wanted to know whether or not the PRP injection, or a stem cell injection, or dry needling, or some other procedure might actually help him.
I’ve had one myself I was very cautious about reducing the stress and strain to the plantar plate ligament while I continued to maintain my running fitness as I recovered from that injury.
Today on the Doc On The Run Podcast, we’re talking about whether or not you might need crutches after a PRP injection for a plantar plate injury.
What does Goldilocks and the Three Bears have to do with running shoes?
This morning I was doing an interview for a television program explaining some basics about running shoe selection based on your foot type.
There are really three things you need to think about.
It’s a lot like Goldilocks and the Three Bears. You don’t want it to be too hard. You don’t want it to be too soft. You want it to be just right for you, and that depends upon your foot type.
Well, you’re going to find out because today we’re talking about running shoe selection basics and your foot type on the Doc on the Run podcast.
When you’re recovering from a running injury, the most important thing you can track is your pain.
Changes in pain level is what tells you whether or not you should move from one activity level to the next.
Although many doctors will ask you in your initial interview, “What is your pain on a scale of one to 10? How much does it hurt?” They very rarely ask you many more specifics about that pain.
Today on the Doc On the Run Podcast, we’re talking about pain point measurements that are crucial for recovering runners.
How is it that a runner can actually have a stress fracture that was never even broken in the first place?
Well, this is a real-world situation that I had with a runner who called me for a second opinion.
It was a runner who thought he had a stress fracture, who even had an MRI that showed a stress fracture. The doctor said it was a stress fracture. But it wasn’t actually a stress fracture at all.
Today, on the Doc On The Run podcast, we’re talking about a runner with a stress fracture that was never broken.
The number one question I get on social media from runners, whether it’s a direct message or an email, or even a comment on a YouTube video is:
“My doctor said I can’t run. Is it okay for me to run my race this weekend?”
And I’ll always scratch my head a little bit and wonder, “Does this person really think it makes sense to ask a complete stranger, who has absolutely no idea about what’s going on with them, whether or not it’s okay for them to run, particularly when their doctor told them to not run?”
Today on the Doc on the Run Podcast, we’re talking about why I don’t tell runners whether or not they can run over social media.
This episode comes from a discussion I had at a medical conference last week, which was the International Foot and Ankle Foundation meeting in Sonoma, California.
I was asked to give a couple of different lectures on running injuries. One of them specifically was about runner’s heel pain and the differences that I see in those who are actually just normal everyday patients, and those that are runners with heel pain.
Today on the Doc On The Run Podcast, we’re talking about the top five differences between normal patients with heel pain and runners.
No runner wants pain.
However, when injured and trying to recover, pain is actually one of the most useful tools at your disposal.
I often tell injured runners and doctors at medical conferences something you should think about:
Pain is the most abundant and most underutilized evaluation tool available to runners when they’re trying to get back to running.
Today on the Doc On The Run Podcast, we’re talking about how pain is the most underutilized tool for recovering runners.
This episode comes from a lecture I was giving at a medical conference just last week.
One of the lectures was on the differences between stress response, stress reaction, and stress fractures in athletes.
There are really just a few main points doctors need to understand when treating runners with stress fractures.
Today on the Doc On The Run Podcast, we’re talking about the top three stress fracture takeaways from the International Foot and Ankle Foundation meeting in Sonoma, California.
There is no hope on a downward slope.
I know that sounds really negative and terrible, but it’s true.
A recovering runner recently called for a called me for a second opinion telemedicine visit. Her doctor had told her to wait…to wait to get better. In fact, she waited for 12 weeks and she did exactly what she was told: nothing. She did no exercise for 12 weeks.
If you just think about the last time you were really fit, and if you just stopped exercising completely, right then for three months, how fit would you be at the end of that 12 weeks?
Today on the Doc On The Run Podcast, we’re talking about how there is no hope on a downward slope.
In the last week alone I had telemedicine calls with two different runners with different types of stress fractures who asked what it means when they have no pain, but an MRI that “shows a stress fracture, but no crack in the bone.”
It gets really confusing when it comes to classifying stress fractures based only on medical imaging like x-rays or MRI.
If you wonder…
Can I run if my MRI shows a stress fracture, but I don’t have any pain?
That’s what we’re going to talk about today on the Doc On The Run podcast.
This episode comes from a discussion I had recently with a recovering runner during a telemedicine visit. She was asking me what to do.
She is stuck in a cycle of getting frustrated, she gets better, and then gets injured again when she actually gets back to running.
She seems to have a tendency to get re-injured, with different injuries.
To recover from injury, you have to make sure you don’t rot while you wait.
Today on the Doc on the Run Podcast, we’re talking about how to make sure you recover and don’t rot when you have a running injury.
I got a call from a runner who asked me about staying fit while training with a femoral neck stress fracture. What is interesting to me is that this person has seen a qualified sports medicine orthopedist who told her that she should not train or should not run with this femoral neck stress fracture.
I’m a podiatrist, I treat foot and ankle problems specifically in runners, but I do not treat femoral neck stress fractures. However, I can tell you what I would do if I had a femoral neck stress fracture.
How can I train with a femoral neck stress fracture? Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Recently I was interviewed on a television program about telemedicine, who it helps and who it doesn’t help. I do a lot of telemedicine visits with athletes.
Meeting with a doctor via telemedicine can be very helpful because you can get quick access. You can get immediate answers from an expert.
There are three kinds of runners for whom telemedicine is actually incredibly helpful.
Today on the Doc On The Run Podcast, we’re talking about the three types of runners who get the most from telemedicine visits.
This episode comes from a question sent in by a runner who was listening to the Doc On The Run podcast.
This is a runner who had an Achilles tendon issue and was recovering and getting back to running.
He has recovered enough that he is back to running, he’s doing better, he’s running without any pain, but he wanted to incorporate some strength training in the form of either hill repeats or running stairs.
He wanted to know…
Which is worse for my Achilles tendon, running hills or running stairs?
Today on the Doc On The Run podcast, we’re talking about which is worse for your Achilles tendon, running hills or running stairs.
I was just doing a telemedicine consult with a runner for a second opinion. He has so much pain in his foot he actually can’t even walk on the foot, much less run on it.
One of the questions I asked him was whether or not he was doing single leg squats to try to maintain some of the strength in his non-injured foot.
He actually said he wasn’t doing any single leg strengthening because he didn’t want to get “wonky.”
Today on the Doc On The Run Podcast, we’re talking about why wonky is better than weak in a recovering runner.
A bunion deformity is a really common problem.
When a runner develops a bunion, the big toe moves over and starts pushing against the second toe. Over time that can get bad enough that the big toe actually sits on top or underneath the second toe.
Many runners get a bump of any kind around the base of the big toe and mistakenly think they have a bunion. That’s exactly what happened with this runner when I did his second opinion consultation.
Today on the Doc On The Run podcast, we’re talking about a runner who said that he thought he had a bunion, but his big toe was straight.
I just did a telemedicine call with a runner who had a very interesting complaint.
Many runners with heel pain have plantar fasciitis, but this was one of those cases where somebody had heel pain that was not plantar fasciitis, and was definitely something else.
He said he was at a standing desk conducting Zoom meetings all day long.
In this case, the runner’s heel pain came from simply standing at a desk all day during webcam calls.
Today on the Doc On The Run Podcast, we’re talking about aching pain in the heels from standing at a desk during the pandemic.
I was doing a telemedicine, second opinion consultation with an elite triathlete who got a stress fracture.
This is actually a very common sort of discussion that I have with runners who schedule telemedicine visits, who call me for coaching calls and second opinion advice.
This guy has been athletic his entire life and he was ramping up for an event and then he got a metatarsal stress fracture and you would think that it’s pretty simple.
In this particular case, the doctor looked at his x-rays and told him that she thought she saw a crack in the x-ray and so she thought there was a crack in the bone but she wasn’t really a hundred percent sure. Now he asked me a really great question.
He said, “Well, if it doesn’t really hurt that much, is it okay if I walk on it?”
Today on Doc On The Run Podcast, we’re talking about if your hand was broken, would you walk on it?
A question came up during a recent telemedicine visit I was doing with a runner who has hallux rigidus.
He wanted to know whether or not it was a good idea or a bad idea to inject the big toe joint with cortisone to treat his hallux rigidus.
Now, there is nothing free in medicine. For every good thing, there’s a bad thing. For every risk, there is a benefit. And everything in medicine, the doctor is basically looking at your circumstances, trying to figure out what you really want short-term and long-term, and then figuring out whether or not that treatment is actually appropriate and really best for you given your circumstances, given your condition, and your goals.
There is nothing that is risk-free in medicine. So when you have a cortisone injection in the big toe joint for hallux rigidus, what’s happening is you’re doing the corticosteroid injection to reduce the inflammation. It’s very effective at that. Corticosteroids, however, are also very effective at breaking up collagen bonds.
Today on the Doc On The Run podcast, we’re talking about whether or not cortisone injections are good or bad for hallux rigidus.
This episode comes from a question sent in by one of the Doc On The Run Podcast listeners, and she wanted to know whether or not it was okay to jump rope if she has shin splints?
Well, the short answer is, is you can do whatever you want. You just have to be willing to pay the consequences and you can have a couple of different consequences from jumping rope with shin splints.
But if you’re sure that you just have shin splints, if you’ve done a telemedicine consultation with an expert on running injuries, or if you’ve seen your doctor and your doctor poked around on you and was sure that you really and truly only have shin splints, then in that case, it is probably safe for you to do it and just see what happens.
Today on the Doc On The Run Podcast, we’re talking about whether or not it’s okay to jump rope with shin splints.
I was just doing a telemedicine call with a runner with a long history of plantar fasciitis, that has not been getting better. She had been doing stretches, icing, and even an injection of corticosteroids around the plantar fascia.
We were doing a second opinion telemedicine call to talk about what’s really going on. We talked about her whole history. She had been keeping track and has kept a pain journal.
During this one hour second opinion call, we figured out that she had been misdiagnosed.
We figured out she actually had bursitis on the bottom of the heel.
Today on the Doc On The Run podcast, we’re talking about plantar heel bursitis, misdiagnosed as plantar fasciitis.
Just this morning I was interviewed on a television program about telemedicine. Since I have been doing telemedicine for a little more than 10 years they invited me to come on as an expert to talk about the changes in telemedicine resulting from the pandemic.
During the interview, we were discussing all the different ways telemedicine can be more helpful than in-office visits. At the end, I was asked an interesting question, and I remembered that I actually created a check-list years ago for runners to actually take to their in-person doctor visits. That same list can help make telemedicine visits more helpful as well.
Today on the Doc On The Run podcast, we’re talking about why you need to make a list for your telemedicine visit.
This episode comes from a discussion I just had with a runner during a telemedicine visit where I was helping her figure out a second opinion and what to do about her hallux rigidus. So she was very confused because she’s been diagnosed with hallux rigidus.
She’s been told that that’s what’s causing the pain in her big toe joint when she runs and she was a little confused because she said the doctor explained to her that she might want to get some kind of plate to put in her shoe to make it stiffer.
But at the same time said that she has high arches and because she has high arches and what we call a neutral foot type that have in part, led to her hallux rigidus, that she needs to have more cushioning in her running shoes.
Today on The Doc on the Run Podcast we’re talking about running shoes for hallux rigidus. Should they be hard or soft?
This episode comes from a discussion I just had with a runner during a telemedicine visit. This person brought up a great idea that really seemed like it would make a great episode and something that would be really helpful for you to understand.
When you get injured, your goal is to actually recover as fast as possible and maintain your running fitness while you heal that specific injury.
Now, everybody wants some timeline, like two weeks, four weeks, six weeks, something that says this is how long I have to wait for it to be healed and me to get back to running safely. But it never works out that way consistently. What you have to do is you have to figure out how you can push your timeline and how you can actually speed things up.
Today, on the Doc on the Run podcast we’re talking about how you need to find your line if you want to recover from running injury faster.
On this episode, we’re just giving you a quick tip on how you can actually reduce some of the stress and strain on the plantar fascial ligament when you have plantar fasciitis and you want to keep running.
If you stop running you’re going to lose your running fitness. That’s not really confusing.
But what you really need to understand is that plantar fasciitis is not really self-limiting.
It does not miraculously go away like a cold virus. It hangs around if you continue to aggravate it because the stress and strain to the plantar fascia that makes it irritable and causes this condition called plantar fasciitis, is a consequence of excess stress and strain.
Today on the Doc On The Run Podcast, we’re talking about repositioning your heel bone so you can run with plantar fasciitis.
The number one question I get on social media is can I run with this injury?
So the problem with this is that whenever I get this question, whenever somebody says, “Can I run?” what’s really never disclosed to me in that runners question is how bad is it?
The thing that determines whether or not you can run is whether or not you can reduce the stress and strain on that injured piece of tissue enough that you’re not going to make it worse by running.
I get this same question for people with Achilles tendonitis, with plantar fasciitis, with metatarsal stress fractures, plantar plate strains, you name it.
The thing everybody wants to know is can I run right now or not.
Today on the Doc on the Run Podcast, we’re talking about question number one, how bad is my injury?
I just got off a telemedicine second opinion call with a runner who thought she had a stress fracture. She got an MRI. Then her doctor said she has “fraying” of several plantar plate ligaments. She wanted to know if this was serious.
Part of the difficulty lies in determining the severity of plantar plate injury and making the call on when you can run. Most runners want a clear answer. Often times an MRI is performed in the hopes of getting a clear picture of the plantar plate damage.
Sometimes the MRI report not only suggests damaged to the plantar plate that hurts, but may mention “fraying” of other plantar plate ligaments that don’t hurt at all.
This often creates even more confusion and more frustration in recovering runners.
Today on the Doc On The Run Podcast, we’re talking about plantar plate fraying on an MRI a runner with a stress fracture.
Is there any proof that you don’t have to stop running when you get a metatarsal stress response in your foot?
When a runner gets an overtraining injury and goes to a doctor, the doctor’s only priority is healing the injured tissue. Most runners also think healing the injured tissue is the highest priority.
I just got off a telemedicine call with a runner who wanted to know why she sometimes feel popping and clicking in the ball of the foot after she runs.
She saw a doctor and was diagnosed with a neuroma.
The doctor gave her some metatarsal pads, which made the neuroma feel better.
But she could not figure out why she seemed to only get this weird popping and clicking sensation after she went for long runs and hill repeats.
Today on the Doc On The Run Podcast, we’re talking about why a neuroma will pop or click after you run.
One of my favorite podcasts is called The Not Your Average Runner Podcast.
I recently sat down with Jill Angie, who hosts that show.
Self-criticism heals no wounds!
When you have an injury, and you have been training hard, it is very easy to beat yourself up. Jill is the best person to explain how we can take an injury and reframe it so we don’t beat ourselves up when we are injured.
Today on the Doc On The Run podcast we’re talking about how self-confidence and self-love beat finish times, every time with Jill Angie from The Not Your Average Runner Podcast.
I get questions all the time on social media from people who want to know if they can run, and at the base of their question is really, how long does it take for some particular injury to heal?
There’s actually a wide variety of timelines on how long it takes for all of different injuries to different types of tissues to heal, even depending upon anatomic location.
Your age plays into the timeline for healing running injuries.
Today on the Doc On The Run podcast we’re talking about how long tissue takes to heal so you can run.
This episode comes from a question sent in by an injured runner who was listening to the Doc On The Run Podcast.
“I am 30 with medium arches. No prior injuries. 7 months ago I began having left med ankle pain at the calcaneal insertion.
MRI confirmed a plantar fascia rupture of med cord. I was told to just ice and stretch.
I have a distal 4th fracture on the right. Both feet at once?!
What should I do? It hurts!”
Today on the Doc On The Run podcast we’re talking about what a runner should do when you have a rupture of the plantar fascia and metatarsal stress fractures.
This episode comes from a question from a runner, who wanted to know what it means when calf muscles are tight and you have metatarsal stress fractures.
He wrote in and said, “Hey doc, I meant to inquire about stress fractures in the metatarsal joints and how you can tell. I have a friend who’s experienced a stress fracture, and he says his calves seemed to tighten up when the pain developed.”
There are really two ways tight calf muscles can be related to metatarsal stress fractures. One is the cause. The other is an effect.
Today on the Doc On The Run Podcast, we’re talking about how tight calves are related to metatarsal stress fractures in runners.
This episode comes from a question from one of the Doc on the Run YouTube channel viewers who wanted to know about “bilateral bipartite sesamoid bones” and what that really means.
I get these kind of questions all the time, when somebody really wants to know what a term means, and what the implications are for them as a runner. Usually the runner is trying to figure out how to keep running while the sesamoid heals.
Sometimes the concern is a sesamoid stress fracture or a condition like sesamoiditis where you start to get pain under the big toe joint.
If you see a doctor, they look at your x-rays, they may tell you, “Oh, you have bilateral bipartite sesamoids.”
I was just doing telemedicine visit with a runner who has a red, painful big toe joint.
Gout is an accumulation of painful sharp crystals in the joint.
Gout certainly can cause your big toe joint to become red, hot, swollen and painful.
But gout is only one of three different conditions that might cause big toe joint pain.
The pattern of redness around the big toe joint can help you decide which condition might be causing the problem if you are a runner.
Today on the Doc On The Run Podcast, we’re talking about whether or not a painful red big toe joint means a runner has gout.
The other day I was doing a telemedicine visit with a trail runner who asked me, “Which is better, soft or hard trail running shoes?”
If you’re thinking about getting some new trail running shoes, you have to really think about what’s going to be best for you.
When comes to how stiff or how soft the shoes should be depends upon three variables:
1. Your foot type.
2. How hard or soft is the trail.
3. How steep is the trail.
If you keep these 3 variable in mind the you go to your local running shoe store, you are much more likely to end up with a very best trail running shoes for you.
Today on the Doc On The Run Podcast, we’re talking about which is better: soft or hard trail running shoes.
A runner with pain under the big toe joint said she was told she had a problem with the sesamoid bones in her foot.
The doctor said maybe it was sesamoiditis, or a sesamoid stress reaction or possibly even a sesamoid stress fracture.
Her question was, “What exactly are the sesamoid bones in the foot?”
Today on the Doc On The Run Podcast, we’re talking about these weird little things called the sesamoid bones in the foot.
A plantar plate ligament sprain can cause aching pain in the ball of the foot when you run.
Plantar plate sprains are caused by excess stress applied to the ligament at the base of the toe.
If you want to heal it and keep running, you have to decrease the stress and strain on the plantar plate, and address the root cause of the injury.
A runner with a plantar plate sprain, and tight calf muscles, had a great question:
Does the plantar plate ligament cause tight calf muscles, or can a tight calf muscle cause a plantar plate sprain?
Today on the Doc On The Run Podcast, we’re talking about whether a plantar plate sprain causes tight calf muscles in runners, or other way around.
Shin splints and tibial stress fractures can feel similar when you run.
Most runners understand there is a huge difference between shin splints and a tibial stress fractures.
I recently did a telemedicine second opinion call with a runner who had a tibial stress fracture.
What she did not understand, and what her doctor had not explained is why some tibial stress fractures are very low risk of breaking, and another is very high risk of landing a runner in the operating room.
Today on the Doc On The Run Podcast, we’re talking about different types of tibial stress fractures in runners.
I was just doing a telemedicine call with a runner with a stress fracture, and he had a really interesting question.
He said, “Look, I just really want to know if I really have a stress fracture because my doctor took an x-ray and there was no crack in the bone. I looked it up myself and the definition of a fracture is a visible crack.”
Do I really have a stress fracture, or not?
This is a great question, it brings up a really interesting point.
Today on the Doc On The Run Podcast, we’re talking about whether or not a runner can have a stress fracture, if there is no crack in the bone.
Raynaud’s Phenomenon is an interesting condition in which spasms of small blood vessels cause changes in the skin color of the hands and feet. Raynaud’s phenomenon can also cause pain in the feet. Foot pain is also very common in runners.
Raynauds is one of those conditions that isn’t typically diagnosed with a blood test or and x-ray. The diagnosis is typically made “clinically” meaning the doctor hears your story, listens to your history and decides you probably have the condition, because nothing else fits.
The question is whether or not a runner who gets an MRI because of foot pain, might have something show up on the MRI images that can indicate Raynaud’s is contributing to the runner’s trouble.
Today on the Doc On The Run Podcast, we’re talking about wether or not you can see see Raynaud’s Phenomenon on an MRI in a runner.
#373 How stress can help your Achilles tendon recover faster and get stronger
When you get any stage of Achilles injury and you’re a runner, you’re trying to figure out what you can do to get it to heal as quickly as possible.
The biggest concern with runners when they have an Achilles tendon injury is that the tendon is going to continue to degenerate, turn into Achilles tendinosis, and then potentially even rupture.
But the good news is that stress, when actually applied in the right way, can help your Achilles tendon recover faster, become stronger, so you can get back to running, possibly even with less risk of re-injury.
Today on the Doc On The Run Podcast, we’re talking about how stress can actually help your Achilles tendon recover faster.
There are the three forms of stress that can affect you and the injured tissue when you actually get back to running after you’ve been injured and you feel like you’ve recovered.
I was just recently doing a telemedicine visit with someone who had an injury and was getting better. She was told to start running, but she wasn’t really given any specific instructions.
She was told, “You can go and just kind of run a little bit and see how it feels.”
If you’re a runner and you haven’t been running for weeks because of an injury, you’re probably going to feel so good when you start running that you’re going to do too much. If you do too much, and then you start having pain, you’re going to completely freak out because you’re going to be worried that you’ve completely set back your injury.
Today on the Doc On The Run podcast, we’re talking about the three forms of stress when you start running after injury.
Just a couple of days ago I was doing a telemedicine call with a runner who wanted to know what it meant to have “thinning of the plantar plate ligament on his MRI.
He asked, “What does ‘thinning’ really mean? Do I really have a plantar plate tear? Is it a problem? Will I be able to continue to run?”
“What is the issue with this idea of thinning of the plantar plate ligament, and why does it happen?”
Today on the Doc On The Run Podcast we’re talking about thinning of the plantar plate ligament on an MRI in a runner.
When you break down the goal of running a marathon, it really only has 3 key elements.
You are crystal clear on the distance, the starting point and the end point.
All you have to do to compete the marathon successfully is break your training down into the daily and weekly stages of growth to establish the fitness required of your body on race day.
Running injuries are difficult because they lack the clarity and simplicity of training for a marathon. But make no mistake. The process is just the same.
Today on the Doc On The Run Podcast we’re talking about the 3 key elements of marathon training and running injury recovery.
Metatarsal stress fractures are one of the most common injuries in runners. Unfortunately for runners, 4 weeks to 6 weeks in a fracture walking it boot is the common recommendation from doctors.
Part of the reason you get the boot for 4-6 weeks, is that you didn’t give your doctor enough information to recommend anything else. The doctor wants you to heal. The way you tell your stress fracture fracture story leaves the doctor imaging the worst possible scenario and you get the worst possible treatment as a result.
To heal a stress fracture you need to stop stressing the bone. You need to stop causing damage. It is that simple.
Today on the Doc On The Run Podcast we’re talking about why doctors prescribe 4-6 weeks in a fracture boot for stress fractures in runners.
This weekend, I was giving a lecture at a medical conference that was specific to running injuries.
During the question and answer period, one of the physicians in the audience asked a completely valid question.
She asked, “Why wouldn’t you just begin with a prescription medication if you’re 100% sure that medication had the highest probability of reducing the patient’s symptoms?”
The difference between the treatment options really lies in what is best for a runner long-term, versus what may best in the short term.
Today on the Doc On The Run Podcast we’re talking about why runners should not start running injury treatment with prescription medications.
Think back to the last time you really remember getting a second wind. Maybe it was 2 miles into your fastest 5K. Maybe it was mile 18 or mile 22 of a marathon.
Just when you felt you really couldn’t got on, just when you hit an all time low, your energy started to grow. You felt revived. Energized, you pressed on the the finish, thrilled with the boost of energy moving you forward.
Every runner recovering from a running injury will have dark days. The energy vaporizes and is replaced by frustration. If not careful, despair can set it.
On these days in your recovery it is crucial you dig deep.
Today on the Doc On The Run Podcast we’re talking about finding your second wind in running injury recovery.
A few minutes ago I was on a second opinion telemedicine call with runner who was told he had an MRI showing an “osteochondral defect.”
The doctor told him to stop running.
If a joint surface gets damage, you may develop a little soft-spot called an “osteochondral defect.”
Just because you have an osteochondral defect, it doesn’t necessarily mean you have to stop running, but you do need to figure out whether or not it’s actually a problem that could get worse if you don’t address it.
Today on the Doc On The Run Podcast we’re talking about osteochondral defects in runners.
I just got off a telemedicine call with a woman who was an elite runner in college.
She has been having a difficult time getting back to an acceptable level of activity after recovering from her overtraining injury.
When you have been doing a certain run at a certain pace, as a part of your training for years, you always fell like you can do that workout.
But when you get a running injury and take time off, unfortunately, your sense of reality is off in that moment. What you sense about your fitness is off.
Today on the Doc On The Run Podcast we’re talking about how your sensor is broken.
If you over-stretch any nerve it can become inflamed and painful.
If you roll your ankle on a trail you can get a condition called traction neuritis.
Most of the time when I am on a telemedicine or second opinion call with a runner with traction neuritis, they have been misdiagnosed with some other condition.
If you understand how to tell the difference, you can understand how to get back to running sooner.
Today on the Doc On The Run Podcast we’re talking about traction neuritis in a runner and what it really means.
If you hire a running coach, your coach is going to design a program that is going to actually test you physically and mentally, and push you to your physiologic limits on a regular basis to make you stronger.
Any running coach will give you a series of workouts to execute.
And when you do runs correctly then what happens is that you do the maximum amount of tissue damage that your body can sustain and rebuild before your next workout.
Today on the Doc On The Run Podcast we’re talking about why runners need to flirt with overtraining injury.
Osteophytosis is a common finding on foot and ankle x-rays of runners.
Bone spurs can form anywhere bone is irritated or otherwise aggravated by jamming, jarring motion.
Most often, osteophytosis is found in the heel, big toe joint and ankle joint.
The real is question is whether or not the osteophytosis a problem that needs to be removed, treated, or even prevented.
Today on the Doc On The Run Podcast we’re talking about osteophytosis in the foot and ankle in a runner.
#361 The 3 most important days in healing
The biggest mistake any runner can make when seeing a doctor for a running injury is leaving the office without a clear picture or how bad the injury actually may be.
If you don’t have a clear idea of your state of injury, you (or your doctor) are only guess- ing at how long it will take to get better and return to running. Part of the lack of clarity is your fault.
You have to communicate what really happened when you got injured, what happened between the injury and the day you show up in the doctor’s office, and your running goals.
Without doing all of that, you cannot get an accurate baseline on your injury or expect to use it for comparison as you maintain your fitness now and ramp up your running later.
Today on the Doc On The Run Podcast we’re talking about the 3 most important days in healing any running injury.
The chances are good a lot of your friends secretly admire your ability to run. Unfortunately it seems a lot of people who want to start running, but don’t think of themselves as runners find it very difficult to start.
Sooner or later one of your friends is going to call you or talk to you and ask for some advice.
The real challenge and helping one of your friends begin running is to get them to go for the initial run, and be proud of themselves for doing it.
I really believe that we as runners to understand how good it makes us feel have an obligation to be as encouraging as possible to our friends, when they want to start running as well.
Today on the Doc On The Run Podcast, we’re talking about the 3 steps you can give to any friend who wants to start running.
I am sure that you have heard your running buddies use an analogy:
“We just banked another long run.”
“We got another hard workout in the bank.”
All these efforts and investments in our training add up. They create this great store of energy for us. The accumulation of fitness is what prepares us for a marathon an Ironman, or an ultra-marathon.
Today on the Doc On The Run Podcast we’re talking about how running injuries are a lot like a savings account.
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Snowboarder’s fracture is a small fracture in your foot that is often misdiagnosed as an ankle sprain.
The injury occurs when you break a portion of the talus bone called the lateral process.
The lateral process of the talus sits at the outside of your foot and ankle.
You break it when you roll your ankle running on a trail or stepping in a pothole while running on the road.
These fractures are much more common that previously taught.Not surprisingly, if you think you have an ankle sprain, but you really have a lateral process fracture, it won’t get better.
Today on the Doc On The Run Podcast we’re talking about what a snowboarders fracture really is, and why runners need to know about them.
Many times doctors look at you cross-eyed when you tell them how much you run, how far you run and how much you want to run now. They tell you that you ran “too much” and got injured. The snap recommendation is to stop running.
Doctors want you to heal your running injury. Many times doctors recommend the “safest” path…stop running. Be patient. Wait for healing.
Slower treatment is not always better, and isn’t even always safer.
The goal for most injured runners is not to just heal the injury.
The goal for most recovering runners is to get back running.
The critical piece is to not lose sight of what “not running” does to your longevity as a runner. Time is of the essence.
Today on the Doc On The Run Podcast we’re talking about how the safest path to healing is the slowest.
A runner with a stress fracture called me for a telemedicine visit because she was confused. The doctor told her that she has a stress fracture. But there was no crack on the x-ray.
The doctor said she only had a “periosteal reaction” which suggested she had a metatarsal stress fracture. She wanted to know if a periosteal reaction meant the foot was really broken, or not.
The periosteal reaction is one of the earliest findings that you can see on your x-ray when you have a stress fracture in one of the metatarsal bones in your foot, before you even see a crack.
Today on the Doc On The Run Podcast we’re talking about periosteal reaction in a runner with a stress fracture.
If you’re not actually healing as fast as you want to it is just not a priority.
I talked to a runner who said that he was trying to lose some weight, but he already felt like he was off track, yet it’s only a couple weeks into the new year.
The fact is that if you can’t get up and exercise, if you can’t take the time to prepare meals and eat food that is not junk food or whatever, it’s just not a priority for you. That’s not a judgment, it’s just a fact.
Whatever we prioritize gets priority in our lives.
If we are not really taking the time to pay attention to how we sleep, how we eat, how much stress we have applied to the injured tissue, for not doing all of those things it’s because it’s not a priority.
The sesamoid bones are two little bones that sit under the big toe joint. Interestingly, when I show X-rays to someone who has a stress fracture many times the first thing they say is “what are those two things” and they’re pointing to the sesamoid bones.
Sesasmoid bones very small and they don’t have a great blood supply. So if you get a problem with the sesamoids and you get sesamoiditis, it gets flared up and gets worse and worse and worse.
A lot of times it’ll turn into a sesamoid stress fracture which is very serious because it can actually crack and break.
Today on the Doc On The Run podcast we’re talking about why sesamoiditis is so serious in a runner.
The sesamoid bones are two little bones that sit under the big toe joint. Interestingly, when I show X-rays to someone who has a stress fracture many times the first thing they say is “what are those two things” and they’re pointing to the sesamoid bones.
Sesasmoid bones very small and they don’t have a great blood supply. So if you get a problem with the sesamoids and you get sesamoiditis, it gets flared up and gets worse and worse and worse.
A lot of times it’ll turn into a sesamoid stress fracture which is very serious because it can actually crack and break.
Today on the Doc On The Run podcast we’re talking about why sesamoiditis is so serious in a runner.
I recently got a great question from a runner…
Why are flat feet less stable when you run?
Pronation of the foot happens as your arch collapses and the foot elongates. You do that every time you land as you run. You need pronation to absorb impact and decrease forces.
Supination is the opposite of pronation. Supination transforms your foot from a flexible, force-absorbing adapter to a rigid lever to propel you forward as you run and push off.
One of my best friends has pain and swelling in his Achilles tendon, right in the watershed region that we know develops Achilles tendinosis and can even rupture.
He was understandably worried. He asked me, “Does my Achilles tendon need a PRP injection or Stem Cell injection?”
I explained to him that he was asking the wrong question.
I said, the right question is, “Do I need an injection at all.”
Next I gave him access to the Achilles Tendon Course where he could go through the 5 step process I teach in the Achilles Tendon Course for Runners so he could figure out how serious your Achilles tendon really may be.
Problem solved…no stem cell injection no PRP injection. No stem cell injection. No fracture walking boot. No cast. No surgery. Today he is running.
When you get any kind of over-training injury, something also incredible happens. You limp.
You compensate to remove all of the pressures and forces and friction that goes through that injured structure by “compensating.”
But the reason compensation is a problem is that if you think about holding your foot in an uncomfortable and natural position, what you’re doing is you are strengthening one thing and you’re stretching and weakening something else.
I was recently doing a call with an athlete who has a sprain of the plantar plate ligament. Now there are a couple of problems with this because he went and got an MRI. In fact, he got a couple of MRIs. The MRIs were different. They may have been done in different facilities. But the problem is that you don’t get a clear comparison on the healing that’s happened in the months that happens in between those two imaging studies.
The other thing is that when you get an MRI and you see a tear on the MRI you assume a couple of things. The first thing you assume is that the tear on the ligament was not there before your foot started hurting. You have to think about that for a minute because one of the things that happens all the time with runners is we get an MRI, we get a study, sometimes just for what we suspect is a plantar plate sprain.
We always want obvious signs when we are healing form something like a metatarsal stress fracture, Achilles tendinitis or peroneal tendinitis or any injury that is keeping his from training as much as we would like.
But the results aren’t always obvious.
Think about your pace, what it feels like.
Think about how those feelings of pace, perceived exertion and heart rate keep you on track.
These are are performance clues when training and racing. We also have to look for performance clues when recovering.
I was just talking to a runner in one of the sessions where people call in who are taking the One Run Away challenge. In that challenge course, I’m helping you try to figure out what is the step that you’re not taking that is holding you back from recovering as quickly as possible. So this is the thing that goes on and every few days I do calls and let people ask questions
directly to me over webcam.
I 
was just doing a telemedicine visit with a runner who has had an injury to the plantar plate ligament with pain for months.
He’s been getting better slowly, but he was trying to figure out how bad it really is. And one of his first questions he asked me was what I see on the x-rays.
Can you see anything about the plantar plate where it’s torn, where it’s injured or anything else?
Most of what doctors see on a foot x-rays are changes that imply ligament damage.
But there is really only one thing on an x-ray that truly indicates that you probably have a tear or rupture of the plantar plate ligament.
I was just doing a telemedicine visit with a runner who has had an injury to the plantar plate ligament with pain for months.
He’s been getting better slowly, but he was trying to figure out how bad it really is. And one of his first questions he asked me was what I see on the x-rays.
Can you see anything about the plantar plate where it’s torn, where it’s injured or anything else?
Most of what doctors see on a foot x-rays are changes that imply ligament damage.
But there is really only one thing on an x-ray that truly indicates that you probably have a tear or rupture of the plantar plate ligament.
I just got off a telemedicine call with a runner and she asked me an interesting question, she said, “I just want to know, am I on the right track?”
When a runner calls me for a telemedicine visit, after they’ve seen two or three or four other doctors, I do something differently.
What I do differently is something you can do on your own right now, you don’t even have to talk to me. Just look at your results.
If you track those results, you look at those results, you will know what’s going on and then you can change course faster.
Today on the Doc On The Run Podcast we’re talking about how you can tell whether or not you’re on the right track when you’re recovering from a running injury.
#344 Hip Pain in Runners with Dr. Duane Scotti
Dr. Duane Scotti, host of the Healthy Runner podcast was one of the guest experts at the 2-Day Runner’s Rapid Recovery Summit.
This replay is a recording of his session on Hip Pain in Runners is one you won’t want to miss. Here is some of what we’re going to cover:
The top 3 most common causes of hip pain in runners.
What exactly is the labrum and how does it get injured in runners?
How does joint laxity or hip instability contribute to hip injuries?
What is the number one indication that somebody has a tear of the labrum and should seek medical attention before continuing to run?
Today the Doc On The Run Podcast, we’re talking about hip pain in runners and some simple things you can do to address it, improve it and keep it from getting worse.
#343 Is my healing timeline realistic?
I was just doing a telemedicine visit with a runner who needed a second opinion for a metatarsal stress fracture.
She wanted to know if her healing timeline was accurate and if her estimate on getting back to running was realistic.
The healing timeline for any running injury always depends upon what you do. Not what you read, and not what your doctor said.
The “realistic” part is based on what you do, not arbitrary timelines.
Today the Doc On The Run Podcast, we’re talking about whether or not your healing timeline is realistic.
#342 You are not getting better. Great!
If you’re a runner who’s been injured, recovering, and you feel like you’re plateaued or you’re not really getting anywhere, I have some very good news for you today. That’s awesome!
Most of the runners who call me for a telemedicine visit, they’ve hit a plateau.
Although that can be really frustrating, I can tell you from experience, this is very, very good news.
What’s going on is really simple.
The changes you need to make, they’re all around you, they’re right in front of you, and they’re available to you right now. You just have to notice them.
Today the Doc On The Run Podcast, we’re talking about how it is actually great if you’re not getting better.
#341 From Broken Heels to Whole Champion Barbara Edelston Peterson
Just for a moment I want you to imagine something. You made a decision to become a champion. And after years of continual effort and constant training you have won a World Championship.
Today you are packing and getting ready to travel to Switzerland to defend your European title. And then you fall and break both heel bones. In that painful moment everything changes.
You aren’t getting on a plane to go to defend your European title. Instead you’re going to the emergency room.
The question is what would you do to rebuild your life and your own self-perception as an is athlete immediately after that kind of injury.
Today the Doc On The Run Podcast, we’re talking with Barbara Edelston Peterson about what she
#340 3 ways to run hills without rupturing Achilles
One of the worst possible injuries you could get as a runner would be a rupture of the Achilles tendon.
Because if you tear the Achilles, whether you have surgery to repair the Achilles tendon or you if don’t have surgery and allow the tendon to heal without surgery, even if it heals, I can promise you, you are never going to be the same.
Running hills puts a lot of stress on the Achilles.
If you have Achilles tendinitis, Achilles tendonosis or just mild Achilles irritation, understanding what to do to avoid rupturing the Achilles will also help you avoid aggravating the tendon when running hills.
There are really three simple things that you really need to do when you’re going to run up hills so that you don’t put yourself at risk of an Achilles tendon rupture.
Today the Doc On The Run Podcast, we’re talking 3 ways to run hills without rupturing Achilles tendon.
#339 You are only one step away
Almost all runners who call me fro a telemedicine visit just need to take one step to change course. My job on that call is to help you identify and recognize the step you are missing.
Every run begins with one step. Right now, you are doing one of two things. Either you are getting stronger. Or you are getting weaker. You are never staying the same. That is the biggest problem with recovering from an injury.
Doctors typically tell you to stop running and then you get stuck in a trap of decreasing fitness, increasing stiffness and you actually become more prone to re-injury.
Most recovering runners are missing the key step that will change everything.
Today the Doc On The Run Podcast, we’re talking about how you’re only one step away.
#338 4 Steps to Achilles Tendon Rupture When Running
This morning I was just talking to a recovering runner, from my inner circle coaching private group. This guy was having some trouble and tenderness in his Achilles Tendon.
We talked about his plan for running tomorrow. It turns out he had a plan of actually going and running on a winding, hilly trail.
If you have Achilles tendon pain and want to make it worse, do 4 things in succession. Because Achilles ruptures happens when you take 4 very specific steps in a specific way. Those 4 Steps put your aching Achilles Tendon at risk of further injury.
Today on the Doc On The Run podcast, we’re talking about the 4 steps to Achilles tendon rupture when running.
#337 Running Injury Testing 1, 2, 3.
As an injured runner who wanted to run the worst piece of advice of I ever received from a doctor, was, “Go run and see how you feel.”
Sometimes, we as doctors take what we think will work for most people in and we apply it to everyone, including runners.
But walking is not running. If you check yourself and do a little self evaluation you can be more confident you won’t hurt yourself and have a setback.
Today on the Doc On The Run podcast, we’re talking about how running injury testing is as simple as 1, 2, 3.
#336 Running injuries caused by running during isolation
Earlier today, I was doing a telemedicine call with a runner who has been injured.
She actually mentioned that she thought she might have started getting this injury back when the whole COVID shutdown happened.
Because she started running with a mask.
She started trying to stay away from people and she was socially isolating.
Today on the Doc on the run Podcast, we’re talking about how you need to be careful when you’re dodging other runners out on a run during this period of social isolation.
#335 Time does not heal running injuries
“Time heals all wounds.” Or at least that is the saying.
But medically speaking I can tell you that is completely false when it comes to running injuries.
It does take time to heal running injuries, but a tincture of time is not enough. I just spoke to an injured runner so I helped over a telemedicine visit.
Her question was, “I sprained my ankle two months ago and I still have pain. Is this normal?” The answer is no. It’s not normal to have pain anytime, much less two months after you sprain your ankle running on a trail.
Today on the Doc On The Run podcast, we’re talking about how time does not heal running injuries.
#334 Achilles injury healed then got a stress fracture
I just got off a coaching call with a guy who I’ve talked to a number of times over the years with a number of different running injuries. This guy is not a new runner.
He is a running coach and he understands how to train and what to do to make sure that he decreases his risk of getting an over-training injury by recovering appropriately after all of his workouts. So this guy is not a novice.
But running injuries are a fact of life, if you are going to be a lifelong runner. You are always pushing to see if you can get stronger and faster and in the course of that process, it is easy to get an over-training injury. That happens.
Today on the Doc On The Run podcast, we’re talking about how someone can heal an Achilles tendon injury and then get a stress fracture.
#333 What is capsulitis in the big toe joint?
Yesterday, I was seeing someone who is a long-time athlete and she had pain in the big toe joint and she was given a diagnosis of capsulitis.
I was seeing her for a second opinion.
When we started talking, she was a little dismayed because she said that she was given this diagnosis of capsulitis and she felt a little bit like it wasn’t a real thing, it wasn’t a real problem.
She didn’t see how “capsulitis” was a diagnosis with an actionable treatment.
Today on the Doc On The Run Podcast, we’re talking about capsulitis in the big toe joint.
#332 Neuroma treatment considerations for minimalist runners
I just got off a telemedicine call with a runner who had a question about neuroma treatment for somebody who likes to use minimalist shoes. And he had a really good question.
He said he went and saw another doctor who made a couple of recommendations, but he was a little concerned about the neuroma treatment options that were given to him.
Runners have to realize that runners are different. And I don’t think most runners should want to jump to a drastic neuroma treatment, especially not when the neuroma is first beginning.
Today on the Doc On The Run Podcast, we’re talking about 3 Neuroma treatment considerations for minimalist runners.
#331 Secret to healing like a pro runner
When pro runners get running injures, they get different treatment.
Elite athletes and professional athletes all have, if not better medical care, they certainly have more consistent follow up, earlier interventions and better access to medical specialists than the average person.
So we know that something is different when someone is a professional athlete.
But its not just better, faster care, it is also the approach pro runners take to the recovery process that helps them accelerate their recovery from a running injury.
Today on the Doc On The Run Podcast, we’re talking about the secret to healing like a pro runner.
#330 3 times a runner should NOT get an MRI for stress fracture
If you’re a runner with an injury, you may want an MRI.
But you often have to wait for some period of time before you can get and MRI scheduled.
Sometimes, you have to wait for your insurance to improve the MRI and give you prior authorization for the MRI, and then frankly, when you get the MRI, it can give you some information that might actually lead you off course and keep you off of running longer than necessary.
Today on the Doc on the Run podcast, we’re talking about whether or not you should run on a treadmill when you’re recovering from a stress fracture.
#329 Grade 1 stress fracture is NOT a stress fracture
Today’s episode comes from a runner named Gordon who asked a question during a live webinar entitled “Am I Ready to Run? How to tell if its safe to start running again.”
He asked, “Is it okay to run on a treadmill? I’m returning from a stress fracture injury. I read that a treadmill gives the exact same stress with every step versus, say a trail, but with COVID-19 and smoke, running outside is a challenge and all that.”
That is a great question! Because, there is a lot of evidence that treadmills cause the same repetitive stress in the same way that might lead to stress fractures in the foot.
Today on the Doc on the Run podcast, we’re talking about whether or not you should run on a treadmill when you’re recovering from a stress fracture.
#328 Use your running success to plan your injury recovery
The most difficult thing about being injured is not having a plan to follow.
As Mark Spitz once said, “If you fail to prepare, you’re prepared to fail.”
So if you’re an injured runner and you’re trying to figure out how to get back on track and get back to running the most important thing you can do right now is to plan your injury recovery.
Prepare for your journey ahead, by looking back at past successes.
Today on the Doc On The Run Podcast we’re talking about how you can use your running success to plan your injury recovery.
#327 Do I need a PRP injection for my Achilles Tendon?
I just got off a telemedicine call with a guy who has an Achilles tendon injury and called me specifically because he wanted me to do a PRP injection on his Achilles tendon.
This guy is a physician. He understands injuries. He understands athletics. He actually had a PRP injection before. He’s even had surgery in the past for his Achilles tendons.
So this is an athlete and a doctor who actually really understands and knows all of the stuff that goes into the decision process when you’re thinking about getting a PRP injection for an injured Achilles tendon.
Today on the Doc On The Run Podcast we’re talking about some of the ways you can tell if you really need a PRP injection for an injured Achilles tendon.
#326 3 mistakes runners make with ankle sprains
I was just on a telemedicine call with a patient. We were doing a webcam call and she had been running on a trail, rolled her ankle, and had a really bad ankle sprain.
Her ankle was black and blue, swollen, and really painful. She was having trouble walking. This is a really active runner who wants to get back to running as quickly as she can.
Running on trails is obviously a little more difficult and puts you at a little more risk of having another ankle sprain just because it’s an irregular, undulating, unpredictable surface.
So in my discussion with her, I realized that there are three major mistakes that runners often make when they roll an ankle running on a trail and want to get back to running after they heal.
Today on the Doc On The Run Podcast we’re talking about the three biggest mistakes runners make with ankle sprains.
#325 Put your best foot forward on stairs when injured
I just got off a webcam call with an injured runner who has pain and swelling in her foot. We were on a recovering runner coaching call talking about all of the little things that can help you recover and heal faster.
During our discussion she asked a great question. She kind of laughed and said she was confused about something as simple as going up the flight of stairs to her bedroom.
How do I go up steps when my foot is painful? Do I start with my good foot or my bad foot?
Today on the Doc On The Run Podcast we’re talking about how to go up stairs when you are recovering from a running injury.
#324 Can I run on a treadmill after a stress fracture?
Today’s episode comes from a runner named Gordon who asked a question during a live webinar entitled “Am I Ready to Run? How to tell if its safe to start running again.”
He asked, “Is it okay to run on a treadmill? I’m returning from a stress fracture injury. I read that a treadmill gives the exact same stress with every step versus, say a trail, but with COVID-19 and smoke, running outside is a challenge and all that.”
That is a great question! Because, there is a lot of evidence that treadmills cause the same repetitive stress in the same way that might lead to stress fractures in the foot.
Today on the Doc on the Run podcast, we’re talking about whether or not you should run on a treadmill when you’re recovering from a stress fracture.
#323 The 3 biggest mistakes injured runners make
Every day, all day, I help injured runners get back to running. I have noticed runners consistently make crucial mistakes in each of the three phases of injury recovery. These are simple avoidable errors in recovery that can slow the process of returning to running, or increase the chances of getting re-injured once you get back to full training. Avoid these mistakes to make sure that you heal your running injury as quickly as possible and then don’t get re-injured when you’re returning to running. Today on the Doc On The Run Podcast we’re talking about the 3 biggest mistakes injured runners make when recovering from an overtraining injury.
#322 Stress fracture: Can I start a walk run program?
One of the biggest problems when you get a metatarsal stress fracture is deciding when it’s safe for you to go to the next level of activity.
I just got a great question from a high school cross country runner who is healing from a stress fracture and wanted to get back to running as quickly as possible.
The question was whether or not it was okay to begin a walk/run program at four weeks of stress fracture healing?
Today on the Doc On The Run Podcast we’re talking about whether or not it is okay to begin a walk/run program when you are well on your way to healing a metatarsal stress fracture.
#321 Question every timeline of running again after injury
What does it mean when your doctor says you might be able to run in 3 weeks, depending on what your x-rays shows?
If your doctor guesses that in three weeks, you’re going to have something appear on an X- Ray, that assumes the bone is going to be stronger at that time you get the x-ray. Right?
So what that also really means is that until three weeks from today, every single day, healing happens. Tissues are getting stronger. More collagen is forming. The osteoblasts and osteoclasts are working in conjunction to remodel the bone. More bone is getting laid down. Tissues are getting stronger.
But every single day, if you get stronger, then in theory, every single day, you could do a little bit more activity.
Today on the Doc On The Run Podcast we’re talking about why you should question every timeline of how long it’s going to take to get back to running after an injury.
#320 Can I run after broken ankle surgery?
A runner broke her ankle and foot in five places and had surgery. She wrote in and wanted to know if she might run again:
“I’m 34 years old. I had a bike accident 4 days ago. I broke my tibia bone at the medial malleolus, distal fibula bone, and metatarsal bones 2, 3, and 4. The surgery went well. I was a runner. I used to run 4 times a week. Is there any chance I can run again?”
Today on the Doc On The Run Podcast we’re talking about what whether or not there is any chance you can run again after breaking five bones in your foot and ankle, and recovering from ankle fracture surgery.
#319 Two perspectives for recovering runners
Everything about the process of training is inherently inspiring and aspirational. It is all positive, and with each step of the process we get the opportunity to make a conscious decision to move forward.
Overcoming a running injury is inherently negative. It just feels like damage control mode. Running injuries feel more about digging yourself out of a hole, and less about accomplishing something significant.
Every over training injury is unique and can have a unique healing timeline. But it all depends upon what you do.
How can you make the mental shift between a coaches plan a doctor’s plan?
Today on the Doc On The Run Podcast we’re talking about two perspectives for recovering runners.
#318 You already know the path to recovery
I was recently watching the Wizard of Oz with my kids.
There’s this one scene, where Glenda tells Dorothy that she already had has all the ability to get home. That all she has to do is click her heels together and say, “There’s no place like home” and she’ll be transported there.
Dorothy had that power all along.
When I see runners who have had running injuries, they’ve been injured. They’ve been on this long journey of seeming like running through the haunted forest and trying to dodge the wicked witch and trying to get over this running injury.
All injured runners really do already have the power to get better.
Today on the Doc On The Run podcast we’re talking about how you already know the path to recovery.
#317 Most painful part of a running injury
There’s nothing worse than being in a race, and you feel like your stomach is upset. You’re sick to your stomach and you’re keeping on pace, but then suddenly, because you literally have an upset stomach, and you start losing pace.
You know that your competition is getting further ahead, and you’re getting further behind. That is what’s really painful.
Most doctors think runners like you call me because I can help you heal your running injury. I know that those doctors are wrong. It’s not really that foot pain that stops you from running. It’s not that pain that gets you to call me. That’s not really the real reason that most runners call me for a telemedicine visit or consultation call.
Today on the Doc On The Run podcast we’re talking about the most painful part of a running injury.
#316 Questions that make a stress fracture more or less likely in a runner
Earlier today I was talking with a runner who felt some pain in her foot during a run yesterday. So she got worried she might have a metatarsal stress fracture in her foot. So she booked a consultation call and we had a discussion on the phone about the possibilities.
Here is what she asked:
“I had an aching pain for a few steps during my run yesterday is that a stress fracture? The aching pain was on the top of my foot for a few steps today…I want to know if it could be a stress fracture?”
So I thought it might be useful to talk about some of the questions I asked her to help figure out whether or not her foot pain might actually be a metatarsal stress fracture, or something else.
Today on the Doc On The Run podcast we’re talking about questions that make a stress fracture more, or less likely in a runner.
#315 How a runner with a plantar fascia rupture talks himself into surgery
A partial rupture of the plantar fascia can be a truly debilitating injury for a runner.
It’s much worse than plantar fasciitis. You take time off. It starts feel better. Then you run and it starts to feel worse again.
Because it can be so frustrating it becomes very easy to convince yourself that you need surgery.
In fact I was just having a conversation with an athlete who started to talk himself into surgery, even though he has absolutely no desire to have surgery one the plantar fascia.
His story highlights how easy it is to become frustrated, and how to overthink a mild setback in your recovery.
Today on the Doc On The Run podcast we’re talking about how a runner with a plantar fascia rupture talks himself into surgery,
#314 Pain is not a setback in your injury recovery
Whether you are conscious of it or not, when you are recovering from a running injury you are probably a little bit gun shy.
Every runner who has ever had to cancel a race or abandon a training plan because of an over- training injury understands how demoralizing and frustrating it is to lose all of your fitness and start training just so you can rest and heal.
If you suffered through that routine it shouldn’t really be surprising that you probably have some trepidation in the back of your mind. Although it’s probably been pushed into the deepest corners of your brain you have fear holding you back.
Injured runners become afraid of pain.
Today on the Doc On The Run podcast we’re talking about how pain is not a setback in your running injury recovery.
#313 Skip a day to skip ahead in your injury recovery
Yesterday I was speaking to an ultra-marathoner who had a metatarsal fracture.
Fortunately, the broken bone has been healing well and she’s back to running.
But during our discussion yesterday she revealed something interesting. She was running every day. Just 3 miles…every day.
During that discussion I was trying to help her understand how it is that running every day, even short distances, in fact, extremely short by her standards as an ultramarathoner, those every day runs could actually put her at risk of re-injuring the metatarsal fracture.
Today on the Doc On The Run podcast we’re talking about how you should skip a day to skip ahead in your injury recovery.
#312 Injured runner underdog advantage
In the pursuit of any running goal you really are only in competition with yourself.
When you become injured, you immediately give yourself an underdog status.
You start to think about all of the problems that your injury presents to prevent you from completing the workouts that you previously believed would make it possible for you to achieve your goal.
Of course, none of that is true. All of those problems we call “reasons” are really just excuses.
There is always a way.
One thing I know for sure. Every runner I have ever worked with you got injured and then set a new P.R. working from an underdog advantage.
Today on the Doc On The Run podcast we’re talking about the injured runner underdog advantage.
Can you get faster by not running?
Can get stronger by not working out?
If you’re a runner and you’re listening to this my guess is that you’re clear answer to both of those two questions is “NO!”
And if your answer both of those questions is no…
Why do doctors call rest a treatment plan?
The brutal truth is that rest is not a treatment plan.
Today on the Doc On The Run podcast we’re talking about how rest is an atrophy plan.
#310 3 keys to recovering at a faster pace
Healing after a hard workout and recovering from a running injury are basically the same process.
But when a runner gets an over training injury everything goes sideways.
We become confused about what has happened and we start to confuse ourselves about what what should happen next. We get off course. We forget the basics.
Out self induced confusion delays our recovery, hampers our healing and keeps us from getting back to running as quickly as possible.
Today on the Doc On The Run Podcast we’re talking about Today on the Doc On The Run Podcast we’re talking about the 3 keys to recovering at a faster pace.
#309 How can you work with injured runners all day?
I was just invited to give a lecture at the International Foot & Ankle Foundation’s 42nd Seattle Seminar. I was asked to give a lecture entitled “Potential Complications of Returning Athletes Back to Activity After Injury.”
The very last question of the entire weekend seminar was directed to me.
“Dr. Segler…How can you work with injured runners all day?”
Today on the Doc On The Run Podcast we’re talking about the 3 reasons I love working with injured runners.
#308 Letting go of your Identity as an Injured Runner with Toni Kengor
Your identity as a runner is crucial to your running goals. You cannot run a four hour marathon if you cannot imagine it, cannot visualize it and cannot believe it is possible.
You must believe to achieve any goal.
It’s interesting to me that so many runners understand how visualization of achieving the goal is absolutely critical to finishing a marathon within a specific goal time.
Yet these exact same individuals will almost develop the exact opposite negative visualization and intention setting by identifying ourselves as injured runners who are unable to achieve goals. That negative focus can keep you stuck in a cycle of running injuries.
Today on the Doc On the Run Podcast we’re talking with Toni Kengor about letting go of your identity as an injured runner.
#307 Surviving Sesamoiditis and getting back to marathon training
Sesamoid injuries can be serious and can keep injured runners from running.
Sesamoids are small fragile bones and if they become inflamed and turn into a stress fracture they can crack, break and become permanently damaged. If you have surgery to remove a permanently damaged sesamoid bone, your foot will never be the same.
Our guest today went through a long battle with a sesamoid injury and then got back to marathon training.
#306 How to assess reviews of new running gear with Jonathan Ellsworth
As runners we are always looking for newer, better running shoes and other forms of gear to help us enjoy training and running, just a little more.
Today on the Doc On The Run Podcast we are talking with Jonathan Ellsworth, founder and Editor in Chief at Blister.
He is also the host of the Off The Couch Podcast.
Today were are getting to hear his thoughts about how we can assess running gear reviews, decide when we should try something new, and how new gear isn’t always better, just because it is different.
#305 Melody Dowlearn on trail running recovery and ultra injury prevention
Ultra-marathon by definition means running lots of miles on trails. That’s a lot of opportunity to get injured!
One of the best parts of running is social interaction. But it’s not always easy to find the right group of runners for you. If you find a local running group you’ll get advice, encouragement and guidance that may help you train harder, run longer and avoid injuries.
If you want to build a huge base of fitness for endurance events like ultra-marathons you need to be able to put in the miles, recover faster make sure you don’t get injured.
Today on the Doc On The Run Podcast we are talking with Melody Dowlearn, the host of “She Runs Trails” podcast about trail running, recovery, and injury prevention when training for ultras.
#304 Change plans and shift gears with Coaches on Couches
Sooner or later, all of us will have to deal with some uncertainty and adversity in making it to the finish line. Right now, obviously there’s a lot of uncertainty for athletes in training…having difficulty just making it to the starting line.
Many runners have to cancel events a goal race because we get sick or injured. Overtraining certainly has a much higher probability to disrupting your goal race then another pandemic.
Today on the Doc On The Run Podcast we are talking with the hosts of the podcast Coaches on Couches about changing plans, modifying training and how to shift mentally when races are cancelled and training as we know it evaporates.
#303 Martha Runs The World on hip arthritis and running goals
Arthritis of any type can cause a lot of pain when you run. The word “arthritis” really and truly just means inflammation within a joint. There are lots of different kinds of arthritis.
But in general when a runner hears a doctor deliver a diagnosis of “arthritis” it’s pretty easy to start thinking your running days are numbered.
But sometimes you just need a shift in perspective.
If you’re runner and you’ve been worried that you might have arthritis in your hips or your knees or anywhere else I can assure you…you’re going to love hear from Martha today.
Today on the Doc On The Run Podcast we are talking with Martha Hughes about how hip arthritis has impacted her running and how she has been able to gain a different perspective on her running goals.
#302 Intention Setting to Run and Recovery with Purpose When Plans Go Sideways with Jonathan Flores
Find your why. Write it down. Just live towards that.
Jonathan Flores is the host of the Run With Purpose Podcast. He is also a runner who set out to run 50 marathons in 50 states, which obviously requires a lot of effort and a knowledge of running recovery to avoid injury.
Jonathan understands how to recovery, how to stay on track when plans go sideways, particularly through intention setting and making plans that turn dreams into experiences.
Today on the Doc On The Run Podcast we are talking with Jonathan Flores, host of the Run With Purpose Podcast about intention setting for runners when race plans change and training schedules plans go sideways.
#301 Get after it, run fast, recover faster with Carrie Tollefson
Carrie Tollefson is by any standard and elite runner. Olympian. 13-time State Champion. National record holder for the most consecutive cross-country titles. First person in NCAA history to win both the 3,000 and 5,000 meter titles. 5-time NCAA. NCAA Indoor Track Athlete of the year. And if all that isn’t enough, Carrie has been on the cover of Runner’s World magazine 5 times!
She has ben running and setting records for decades, and yet still, just last year ran a marathon under 3 hours. Today she is going to help you understand a little better how you can GET AFTER IT, without getting injured.
Today on the Doc On The Run Podcast we’re talking about how to GET AFTER IT and recovery faster with Carrie Tollefson.
#300 Recovery For The Long Run with Jonathan Levitt
I am sure most of you listening know Jonathan Levitt as the host of the podcast For The Long Run.
Fortunately for all of us, he is taking time out of his schedule and away from his microphone to join us here and provide his insights on rapid recovery for ultra runners.
Today on the Doc On The Run Podcast we are talking with Jonathan Levitt about the strategies he uses to recover quickly after hard training blocks, or an Ultra before resuming training.
Part of what I find so inspiring about Kim is the way in which she has pulled it out and come back in the final meters and final seconds of races to secure the win.
We’re really fortunate to have Kim on the show today to share some of her strategies and tactics that have helped her stay fit, train hard and recover after all those hard workouts throughout her career.
Today on the Doc On The Run Podcast we are talking with Kim Conley, about the strategies she uses to recover quickly after hard training blocks, or when resuming training after a world-class event.
#298 Ultra Injury Prevention with Running Stupid host Ken Michal
If you want to complete an ultramarathon, you will have to put in lots of training. One of the big keys to successfully training for an ultra-marathon is to log lots of miles without getting sick or injured.
Ken Michal has stood on the starting line of almost every significant ultra, including Western States 100 and multiple rounds of the HURT 100.
And when I asked him about what it takes to successfully train for these kind of ultras, he says, “You’re going to hate me for saying this, but its risk and reward.”
Today on the Doc On The Run Podcast we are talking with Coach Ken Michal, host of the Running Stupid Podcast about recovery, rehab and injury prevention when training for ultras.
#297 Ultra-Recovery with Lucy Bartholomew
Lucy Bartholomew went from running with her dad at age 15 to finishing on the top of the podium at some biggest ultras around the globe, all while setting course records in the process.
Not surprisingly, her travel, training and race schedule keeps her pretty busy so it has taken almost a year of trying to get Lucy on the show, but with some luck we are able to have her here today to talk about her strategies and tactics on staying healthy, and recovering effectively while training for ultra-marathons.
No one can clock the times and distances Lucy does without riding the fine line between training and overtraining. Obviously she knows how to get the full benefit of her training sessions by effectively recovering.
Today on the Doc On The Run Podcast we are talking with Lucy Bartholomew about the strategies she uses to recover quickly after an Ultra before she resumes training for the next event.
#296 Top 3 Ways Runners Can Avoid the Coronacloud
When I was running yesterday, we were noticing a couple of things that may put people at risk. And so, I was thinking about three simple ways you can really decrease your risk of exposure and keep true social distance, which I believe should be more than six feet.
There’s a couple of simple ways to think about this. The first thing is to stay away from people. And then, the second thing is that when you do encounter people to make sure you’re far enough away from them. And so, I came up with three simple tips that may help you avoid what I call the “coronacloud,” which is being within that pocket of air that could be contaminated.
Today on the Doc On The Run podcast, we’re talking about the top 3 ways runners can avoid the “Coronacloud.”
#295 Are you motivated enough to recover
The biggest difference in speed of recovery is motivation. Your motivation leads to the actions required to heal and recover as quickly as possible.
Healing is not a passive process.
If you’re just sitting around waiting for some specific timeline to make your injury go away, you’re making a big mistake.
The only guarantee in the waiting-to-heal-plan is that you’re guaranteed to lose all of your running fitness. But there is a better way. Just think of your recovery the same way you think of training.
Today on the Doc On The Run podcast, we’re talking about whether or not you are motivated enough to recover.
#294 Stress reduction is critical during coronavirus lockdown downtime
I listen to lots of podcasts and I recently have heard lots of other speakers in all genres talking about how important it is to stay healthy and avoid illness, and reduce your risks or contracting Covid-19.
All of these people are right. Now, more than ever it is important to maximize your immune system.
In thinking about that, I realized that all of these same strategies people are talking about to help you avoid a viral illness can also help you heal from training, prevent over training and maximize recovery after hard workouts.
Today on the Doc On The Run podcast, we’re talking about how stress reduction is critical during coronavirus lockdown downtime for runners.
#293 Top 3 Coronavirus mistakes for runners
Right now all of us are inundated with rapidly changing circumstances and a wide variety of news stories about the coronavirus. With all of the uncertainty, none of us really knows what we are supposed to do.
As a doctor who focuses completely on helping injured runners get back to running, most of what I do Is recognize mistakes in training and the recovery process causing failure.
But what I do know is that right now, all over social media, I am seeing examples of completely avoidable mistakes which could have serious consequences.
Make no mistake, I think runners should keep running, even when they began to encounter an overtraining injury. But it’s all about taking a sensible approach. It’s about managing risk. In some activities are riskier than usual right now.
Today on the Doc On The Run podcast, we’re talking about the top 3 coronavirus mistakes for runners.
Runners deserve better than the standard of care! I had the honor of sitting down for a guest interview featured on The Highly Functional Podcast.
On this episode, Dr. Brianne Showman and Dr. Christopher Segler had a great conversation about injuries, specifically, running injuries.
We discussed what the standard of care is when it comes to these injuries and why we need to be more aggressive in treatment of these injuries in athletes.
Check out this episode on the Highly Functional Podcast!
#292 Coronavirus lockdown unless you are a runner
Yesterday I was looking at the latest news story about the coronavirus lockdown in Italy. Strict lockdown.
Don’t go out of your house.
Government orders.
And the representative image in the news story showed a street scene of beautiful Italian architecture in Florence Italy.
There was only one person on the street. And that person was a runner, who was running.
So while we are afraid to go to the grocery store, or that someone might cough on us while we’re getting gas, we all want to go out for run. Even under the threat of personal harm or imprisonment…we want to run.
Today on the Doc On The Run podcast, we’re talking about the coronavirus and how it has you on lockdown, unless you’re a runner.
#291 How oxidative stress slows running injury recovery
I was on stage at the International Foot & Ankle Meeting in Lake Tahoe this weekend and was giving a presentation designed to help doctors understand why running isn’t the problem with running injuries….why they as doctors shouldn’t always tell runners to “stop running” as a way to decrease stress.
Running is only one form of stress. Running is biomechanical stress.
But one of the most helpful strategies in recovering runners is managing oxidative stress. So, I gave a brief Biochemistry 101 explanation of what “oxidative stress” means, why it is so important and why recovering runners need ti think about it.
Today on the Doc On The Run podcast, we’re talking about how oxidative stress slows running injury recovery.
#290 Should a runner take steroids for chronic tendinitis?
Any diagnosis ending in “-itis” means inflammation.
If you have inflammation in the tendons, a short course of oral corticosteroids will help to shut off the inflammatory response and reduce the inflammation.
It took me nine years to get my spot at the Ironman World Championships. And unfortunately I got pneumonia right before the race. I had to take oral corticosteroids preceding and during Ironman Hawaii.
Now to be clear, I did the race, but I did not run at all for two months after Ironman Hawaii. I wasn’t resting. I wasn’t recovering. I was concerned that I would develop an Achilles tendon problems as a consequence of running immediately after having finished the course of oral corticosteroids.
Today on the Doc On The Run Podcast we’re talking about whether or not a runner should take steroids for chronic tendinitis.
#289 Top 10 Reasons injured runners procrastinate
An over training injury is one of the worst possible things that can happen to a runner.
You’ve been working toward a goal, hard, making sacrifices and then disaster strikes and you get injured.
Of course the best thing to do is to start healing and get back to training as fast as possible.
There are lots of reasons I see runners procrastinate and unnecessarily put up their own roadblocks between them, healing, and getting back to running.
Today on the Doc On The Run podcast, we’re talking about the Top 10 reasons injured runners procrastinate.
#288 Ironman taught me about running injuries
The Ironman triathlon is widely considered to be one of the worlds most grueling single day athletic events. 2.4 mile swim, 112 mile bike ride and a full 26.2 marathon, all in the same day.
My Ironman journey taught me a couple of really important lessons. Because I know what it feels like, when you think you can’t run, even worse, when a doctor says, you can’t run…but deep down inside, you know you can.
The most important thing Ironman taught me about running injuries is that you, injured runners have a goal. And that goal is important!
Today on the Doc On The Run podcast, we’re talking about what Ironman taught me about running injuries.
#287 3 causes of sinus tarsi syndrome in runners
If you are a runner and you have a weird aching pain, and you’re not really even sure if it’s in your foot or your ankle you may have a condition called sinus tarsi syndrome.
“What is Sinus Tarsi Syndrome?”
When a doctor tells you that you developed a case of sinus tarsi syndrome, it just means you have irritated and inflamed the lining of the subtalar joint.
So of course as a runner suffering from this condition and trying to figure out what to do, so you don’t get it again.
It may be helpful if you can understand the three common causes of sinus tarsi syndrome in runners.
Today on the Doc On The Run podcast, we’re talking about three causes of sinus tarsi syndrome in runners.
#286 Best decision and worst actions for injured runners
The best decision is the decision to take the right action.
The second best decision is to take the wrong action.
And the worst decision of all if you are an injured runner is make a decision to take no action at all.
More often than not, when an injured runner limps into a doctor’s office, the doctor tells the runner she has to stop running. We as runners are told to rest. These well-meaning doctors are trying to heal the one specific injury but they are doing so at the risk of ruining your ability to run permanently.
When we sit still we get weaker, stiffer and our fitness vanishes. Believe it or not, we as injured runners often do the same thing to ourselves. I get messages all the time from injured runners who are trying to find the best decision before they will take any action.
Today on the Doc On The Run podcast, we’re talking about the best decision and worst actions for injured runners.
#285 Cortizone injections for sesamoiditis in runners
Just today I got an interesting question from Victoria, who has been suffering with a bad case of sesamoiditis which has been keeping her from running.
She saw an orthopedic surgeon who who thinks there is scar tissue around the sesamoid bone restricting the range of motion and causing the pain under the big toe joint.
The doctor explained to her that one other conservative option, which might help her avoid sesamoid surgery would be a corticosteroid injection which is sometimes also called a Cortizone injection.
So her question was:
“How exactly do steroid injections help? Do they break up scar tissue? The orthopedic surgeon told me to be cautious about doing steroid injections, but I never got a clear explanation as to why.”
Today on the Doc On The Run podcast, we’re talking about the good and bad of cortizone injections for sesamoiditis in runners.
#284 Wishful thinking can kill recovery from a running injury
Just today I was talking to a runner who has an injury and although this injury has gone on for a long time, I thought that she would know exactly whether it’s improving or not.
She said she thought it was improving, but we don’t really know if it’s improving, because there is no data.
It is easy for us as runners to tell when our fitness is getting better, we feel stronger, we feel better.
But unfortunately we don’t really want to think about pain.
We don’t want to think about injury. We don’t want to think about setbacks. Today on the Doc On The Run podcast, we’re talking about how wishful thinking can kill recovery from a running injury.
#283 Indecision prevents running injury recovery
The single most important thing you can do when you think you have a running injury is to make a decision, quickly.
You only have two choices.
1. Realize and admit you are injured and get about the business of recovery.
2. Confirm you aren’t really injured and then adjust your course to continue your training.
But what most runners do is something in between. We want to believe we are not injured. We want to think we can continue training.
And instead of just kidding about the business of recovering and then training, we just make things worse.
Today on the Doc On The Run podcast, we’re talking about how indecision prevents running injury recovery.
#282 Ankle brace vs air cast after ankle fracture
I got an interesting question sent in from a runner, who said…
I fractured my left ankle. I have been in an air cast ever since. So, should I continue with the air cast for another three weeks or try out an ankle brace?
Obviously when you want to get back to running, you think the key is always to advance as quickly as possible from one stage to the next, and that is true.
You definitely want to try to advance as rapidly as possible.
Today on the Doc On The Run podcast, we’re talking about when a runner can use an ankle brace instead of an aircast when healing from an ankle fracture.
#281 If a treatment is best for most, is it best for a runner?
The idea that one given treatment will work for one condition, when the people are different is absurd.
Runners are different than normal people.
Risks of certain treatments are much higher for runners then they are for other people.
Some treatments that are not risky at all for a runner, might be very risky for the average non-runner.
Today on the Doc on the Run Podcast, we’re talking about if a treatment is best for most people, is it best for a runner?
#280 When is surgery better for metatarsal fracture in a runner?
No treatment is best for every runner.
Not even metatarsal fracture surgery.
Your task as an injured runner who wants to run is to figure why a treatment is right for you…or not right for you…even if it gets recommended by a doctor or surgeon.
When a comes to surgery to fix metatarsal fracture in your foot there a few considerations runners need to think about.
Risk of NOT healing with or without surgery. Risks of surgery themselves and risks related specifically to your running goals.
Today on the Doc on the Run Podcast, we’re talking about when surgery is better for a metatarsal fracture in a runner.
#279 Everything in medicine is bad for runners
Doctors sometimes prescribe treatments than can be bad for runners.
If you wear a fracture walking boot, your muscles get weaker, your tendons and ligaments get stiffer, your bones start to lose calcium.
If you take ibuprofen during a race you can get gastrointestinal upset that complete wrecks your nutrition plan. In the the worst cases you could even get kidney failure.
If you break a bone and a doctor puts a cast on your leg you could get “cast disease.”
Even an adhesive bandage can cause trouble.
Today on the Doc on the Run Podcast, we’re talking about how everything in medicine is bad for runners.
#278 Runners need Aggressive Healing
Most runners are aggressive by nature.
Planning, training, eating, analyzing, reaching for goals in way that your friends may label…“obsessed.”
Sometimes we are so aggressive we make a mistake, do too much and get an injury.
The bad news is that we are now inundated with an air of “self-care” mentality that backfires.
The good news is that you already know how to heal. It is the same as recovery when training.
You need to be just as aggressive in your healing plan as you are in your training plan.
Today on the Doc on the Run Podcast, we’re talking about how injured runners need aggressive healing.
#277 Are Crutches Bad For Injured Runners?
I just had a consultation with an injured runner who asked…
“Are crutches bad for injured runners?”
The correct answer is yes, crutches are bad for injured runners, especially if you use crutches any longer than it takes to heal your injury enough to start walking without crutches.
But if you needed crutches, and you avoid them, that could be even worse for you as a runner.
Nothing in medicine is black and white. Everything is gray. And crutches are no exception.
Today on the Doc on the Run Podcast, we’re talking about what injured runners should think about when injured and offered a pair crutches in a doctors office.
#276 My toenail hurts when I run
I just had a consultation with a woman who has been having pain in the toes and the end of the big toenails just after running.
The pain in the big toes has been getting worse.
She was also getting some numbness or tingling around the corner of the toenails.
She wanted to know… “Am I doing something wrong with my shoes?”
“Am I cutting my toenails wrong?” “Is there really something wrong on the inside of my toe?”
Today on the Doc on the Run Podcast, we’re talking about what you need to think about if your toenail hurts when you run.
#275 Injured Runners must Learn or Earn to Recover
Every runner who is injured and has been told to stop running wants to get back to running as quickly as possible.
We all want a secret path to healing and a fast track to return to recovery.
When it comes to getting better after you get an over training injury there are really only two possibilities if you want to get back to running as quickly as possible.
Today on the Doc On The Run podcast, we’re talking about how injured runners must learn or earn the knowledge and experience necessary to recover from an overtraining injury.
#274 Can I Run With Shin Splints?
Today a runner asked a great question…”Can I run with shin splints?”
The short answer is yes, you can run on shin splints for a short period of time…if it shin splints.
The problem is, is that there are a couple of different conditions that are often called “shin splints” that could be something else.
The real questions are:
If I stop running because of shin splints will I lose all of my fitness?
Can I run with shins splints and still heal?
Can I run with shinsplints without getting worse?
Today on the Doc On The Run podcast, we’re talking about whether or not you can run and train with shin splints.
#273 Do I need a surgery second opinion as an injured runner
Today I heard a great question from a runner…
She asked…
“A doctor told me that I have a neuroma in my foot and I need to have surgery to remove it because it hurts when I run. Should I get a surgical second opinion?”
There is really one clear indication of when you really need to seek a second opinion when a doctor recommends surgery.
Today on the Doc On The Run podcast, we’re talking about whether or not how to tell if you need a surgery second opinion as an injured runner.
#272 Will A Bone Stimulator Help Sesamoiditis?
Do bone stimulators help with sesamoiditis?
Will a bone stimulator help the sesamoids, if the bone is not fractured?
Is there clinical evidence that bone stimulator will help sesamoiditis?
Today on the Doc On The Run podcast, we’re talking about whether or not bone stimulator might help sesmoiditis in a runner.
#271 Minimalist running shoes do Not cause stress fractures
I was just on a consultation call with the runner who got a metatarsal stress fracture after a long run in minimalist running shoes.
The question asked was, “do minimalist running shoes cause stress fractures?”
Minimalist running shoes do not cause stress fractures.
In fact. running doesn’t even caused stress fractures.
Today on the Doc On The Run podcast, we’re talking about how minimalist running shoes do not cause stress fractures.
#270 Do I have to stop running to rest a metatarsal stress fracture
Do I have to stop running to rest a metatarsal stress fracture?
Let’s imagine 10 rowers in a boat.
If one rower gets tired or injured, does the boat have to stop?
Do all 10 rowers have to stop rowing, park the boat and sit on the shore?
When you have 10 metatarsal bones in your feet and only one bone is injured you don’t have to necessarily stop all activity.
Today on the Doc On The Run podcast, we’re talking about whether or not you have to stop running to rest a metatarsal stress fracture.
#269 If you are injured and want to run define your goal
You cannot plan a trip without a destination.
And you cannot expect to heal as fast as possible if you do not have a clear goal and a defined timeline.
The quality of the medical advice you get will depend on the clarity
of your running goals.
Running injury treatment needs to be tailored to you, your specific injury, the severity of your injury and your unique running goals.
Today on the Doc On The Run podcast, we’re talking about why you should define your goal if you are injured and want to run.
#267 Bulge in metatarsal bone stress fracture on x-ray
A runner with a stress fracture just called me for a phone consultation.
He was concerned because he got an X-ray and saw a bulge in the bone.
The question was whether or not this bulging area of healing bone in the stress fracture was a good thing or a bad thing.
More than anything else he just wanted to know if the lump of bone on the x-ray was an indication that it was okay to start running.
Sometimes a lump of bone on your x-ray is good thing, but sometimes a bad thing.
Today on the Doc On The Run podcast, we’re talking about whether or not a bulge in your metatarsal bone on an x-ray of a stress fracture tells you if it is healed enough to start running.
#266 Plantar plate sprain vs tear vs rupture in a runner
If you’re a runner who has had aching pain in the ball of the foot you may have been diagnosed with a plantar plate sprain or a plantar plate tear. Or maybe you were told you had a plantar plate rupture.
The most important factor to a runner is how quickly you can heal the plantar plate injury and get back to running.
The chances are good your doctor didn’t really discuss this component of your treatment plan. When you get a plantar plate injury many doctors will simply tell you to stop running and let it heal. That plan can take months.
If you’re a runner with a plantar plate injury you need to understand the differences between the terms used to describe the condition so you can better understand what you need to do to heal and get back to running.
Today on the Doc On The Run podcast, we’re talking about the difference between a plantar plates sprain vs. a tear vs. a rupture when you are a runner.
#265 Should I run when I am sick?
It’s cold and flu season and one question that comes up this time of year is, “Should I run when I am sick?”
The obvious concern is that if you have a training schedule and marathon on the calendar your fitness will suffer. You don’t want to lose ground. This is a valid concern.
If you stop, it can wreck your training. But you have to understand something that seems to get lost on most sick runners in training. Not running when sick isn’t nearly as bad as not running when injured.
Today on the Doc On The Run podcast, we’re talking about whether or not you should run when you are sick.
#264 Focus on what you can do today to recover
When you are sick or injured, you may feel like you are helpless.
You think you can’t run.
You think you can’t build your running body.
You think that you can’t do anything to help the situation.
If you’re injured, you’re probably sitting around thinking, “Well, I can’t do anything. I can’t run. I can’t go to the gym. I can’t do anything.”
But that’s not true. You just have to think about what can you do today. You have to focus on what you can do today.
Today on the Doc On the Run Podcast, we’re talking about how you should focus on what you can do today if you want to recover from an over-training injury.
#263 5 overtraining indicators that precede running injury
Many runners seem to be surprised when they get an overtraining injury.
However, once we start talking about the injury, they almost always know something is wrong days or weeks before they actually get the real injury.
Every runner in training should pay attention to the subtle signals that tell you when you are heading for an over training injury.
If you get the sense you are in an overtrained state, you can talk to your coach, or just back off from one or two of your workouts to allow your body to recover and make sure you don’t wind up injured, when you should be training.
Today on the Doc On The Run podcast, we’re talking about the 5 overtraining indicators that precede running injury.
#262 Eat like you are racing and recover like a champion
Every time you go out for a run you deliberately damage the muscles, tendons, bones and ligaments just enough to stimulate healing response that makes them stronger.
An overtraining injury is nothing more then a little bit too much tissue damage, in one particular tissue.
That damaged tissue doesn’t fully repair itself before you run and injure it again with the next work out on your training calendar.
That’s when muscle soreness turns into a muscle strain. It is when a normal stress response in your metatarsal bone turns into a metatarsal stress reaction or full blown stress fracture.
If you are training for a marathon, your number one priority is to make sure you are recovering fast enough to avoid an over training injury.
If you are an inured runner, your number one priority is rebuild that injured tissue so you can get back to running.
I get asked all the time about what runners need to eat in order to rebuild tissue. And recently I was thinking about how it’s not really so much what you eat as how often you eat.
Today on the Doc On The Run podcast we’re talking about how if you eat like you are racing you will recover like a champion.
#261 The best diet for runners is Consistency
If you are runner trying to get down to your race weight, you may be considering a new diet.
If you are a runner trying to build more muscle, or build tissue faster after workouts to recover faster, you might need to modify your diet.
I get questions about diet nutrition all the time from injured runners. Do you really need more protein? Do you really need to eat like a cave man?
Do you really need to build protein with protein? Do you have to eat protein or meat to build protein?
Today on the Doc On the Run Podcast, we’re talking about how the best diet for runners is consistency.
#260 Angry about lost time from running in a fracture boot
Fracture walking boots are over-prescribed and often worn for way too long by many injured runners.
Nobody who’s a runner wants to be injured or wants to have to wear a fracture walking boot.
It’s really easy to get angry and resentful about feeling like you wasted time in a fracture walking boot while you are recovering.
You be upset just because you’ve been sitting around recovering. You may be angry because you feel like a boot is the standard routine and deserve something better.
Maybe you think your doctor hasn’t been proactive enough and you haven’t been able to get back to running fast enough.
Today on the Doc On The Run podcast, we’re talking about being angry about having lost time from running in a fracture walking boot.
#259 4 Risky times for running injuries
Running injuries are not random.
Over training injuries are actually very predictable.
Runners get injured as a result of too much stress, applied at the wrong time.
Certain life circumstances can coincide with stressful blocks of training that put you at risk of developing an over training injury.
If you’re training for a marathon and you want to make it to the starting line in tact, you need to know what to watch out for during these dangerous times.
Today on the Doc On the Run Podcast, we’re talking about the 4 risky times for running injuries.
#258 How endurance leads to marathon failure
Endurance athletes are uniquely prone to self-sabotage.
Ironically the destruction rises out of the very skill that lends us the strength to finish a race like a marathon.
Success comes from being strong.
Healthy runners are fast runners.
No one runs their marathon as fast as possible when injured.
No one gets a new PR with pneumonia.
Today on the Doc On the Run Podcast, we’re talking about how endurance leads to marathon failure.
#257 One critical mistake runners make when flying to a race
A runner and a listener to the podcast recently sent in a question regarding how long it takes to heal an old fracture versus a new fracture.
There are many risk factors for developing problems with healing a broken bone.
Each year there are about six million broken bones the United States.
Somewhere between 5% and 10% of all of those fractures do not heal as quickly as we would hope and turn into what is called a fracture non-union or a delayed union.
A “fracture non-union” is just what it sounds like. It means to the fractured pieces of bone did not unite.
They did not get back together and the fracture just did not heal.
A “delayed union” is a broken bone that isn’t healing as quickly as we would expect.
Today on the Doc On Run Podcast we’re talking about the difference in healing time of an “old fracture” vs a “recent fracture.”
#256 4 Trends injured runners should track
Every runner in training tracks progress to monitor for improvement.
Heart rate, wattage, mileage, pace, and perceived exertion are all commonly tracked by athletes in training.
So many athletes preparing for an event, so diligently track and record metrics which reassure us and provide visual confirmation that we are on track toward our goals.
Yet, many of these same athletes simply stop recording any data at all when they get injured and abandon their training plans.
You have to think of healing just like training. You need to see progress. You need to track improvement.
There are a few metrics which you should record on a daily basis when you’re injured and trying to get back to running as quickly as possible.
Today on the Doc On Run Podcast we’re talking about 4 trends injured runners should track.
#255 3 Torn plantar plate treatment options
A torn plantar plate can be one of the most frustrating injuries for a runner.
A runner who has been following many of the suggestions regarding ways to reduce the stress and strain on the plantar plate ligament, has been treating the injury on her own and was getting better.
Then she recently got a set back and understandably got super frustrated.
But like most strong runners, she is focusing on the possible solutions instead of wallowing in self pity.
She wrote in and said…
I am desperate to be able to even walk barefoot without pain, to be able to run on the treadmill and jump !! I am wondering whether it is worth trying the following :
1. Massage
2. Ultrasound therapy
3. Plasma Therapy
Today on the Doc On Run Podcast we’re talking about 3 different torn plantar plate injury treatment options worth considering.
#254 Difference In Healing Time Of Old Fracture Vs Recent Fracture
A runner and a listener to the podcast recently sent in a question regarding how long it takes to heal an old fracture versus a new fracture.
There are many risk factors for developing problems with healing a broken bone.
Each year there are about six million broken bones the United States.
Somewhere between 5% and 10% of all of those fractures do not heal as quickly as we would hope and turn into what is called a fracture non-union or a delayed union.
A “fracture non-union” is just what it sounds like. It means to the fractured pieces of bone did not unite.
They did not get back together and the fracture just did not heal.
A “delayed union” is a broken bone that isn’t healing as quickly as we would expect.
Today on the Doc On Run Podcast we’re talking about the difference in healing time of an “old fracture” vs a “recent fracture.”
#253 What Is The Standard Routine For A Partial Tear Of The Plantar Fascia?
A runner with a partial tear of the plantar fascia asked…
“I am struggling with a partial tear – going on 6 months of pain with running. I’ve tried everything – PT, rest, PRP, and most recently embryonic membrane injections.
This injection was four weeks ago – with crutches for 5 days after and boot for two weeks.
I’ve also had four weeks of no running at all and still have the pain.
I would love to know what your “standard routine” is for this condition.”
Today on the Doc On The Run Podcast, we’re talking about the standard routine for healing a partial tear of the plantar fascia in a runner.
#platarfascia #partialrupture #partialtear #runnersheelpain #heelpain #running #recovery #runningdoctor #runninginjury
#252 How long to heal stress reaction vs stress fracture in a runner?
Is there a difference in healing time when there is a crack in the bone visible on x-ray, compared to when a runner has a “stress fracture” with no visible crack on x-rays.
What do you think?
Would it take less time to return to running if you have a stress fracture with no crack visible on an x-ray than if you do actually have a crack visible on an x-ray?
The answer surprised many doctors a medical conference where I as just lecturing and it may surprise you, too.
Today on the Doc On The Run Podcast, we’re talking about how long it takes to heal stress reaction vs stress fracture in a runner.
#251 Sesamoid stress fracture surgery in runners
If you’re a runner and you start having pain under the big toe joint and you develop this thing called a sesamoid stress fracture, you may get really worried.
In fact, if you go to see a doctor, you’re probably going to get a lot more worried because the doctor’s probably going to tell you these things can be very, very difficult to heal.
Well, it is true.
For years I’ve been lecturing to doctors at medical conferences about running injuries.
One of the things I often talk about is that sesamoid stress fractures are one of the very few problems a runner can get that really does warrant a serious dial back in activity to make sure that you can take the stress off of that sesamoid bone.
Today on the Doc On The Run Podcast, we’re talking about surgery for a sesamoid stress fracture in runners.
#250 Does running increase or decrease oxidative stress?
Oxidative stress is something that normally occurs in all runners.
But we know free radicals and the consequences of an imbalance of oxidative stressors can delay tissue healing.
Anytime you have an overtraining injury and you are trying to get back to running, you have to make sure you are healing as quickly as possible.
The big question is whether or not exercise, such as running, has a positive or negative affect on oxidative stress.
Today on the Doc On The Run Podcast, we’re talking about whether running increases or decreases oxidative stress.
#249 Execute your healing plan with the same tenacity you execute a training plan
When you decide to sign up for a race, you start training.
You follow a specific plan that you know will get you stronger and stronger, day-by-day.
You make a plan to get to your race, prepared to achieve your goal time.
But what happens when you get injured?
You basically do something completely opposite, completely different, and not at all in alignment with the strengthening process that you know works when you’re training.
Today on the Doc On The Run podcast, we’re talking about why you need to execute your healing plan with the same tenacity you execute a training plan.
#248 Every step is a Win when recovering from running injury
If you’re a runner and you get injured, you’re certainly going to be bummed out, and it is really, really easy to get frustrated.
In my experience when working with injured runners when I do consultation calls, is that most runners beat themselves up unnecessarily.
You have to look for every possible opportunity to view something as a success, as a victory, as a win when you are recovering from an injury and trying to get back to running.
You have to look for the wins when you’re training and you’re working toward a goal.
The same holds true for when you have a running injury.
Today on the Doc On The Run podcast, we’re talking about why every step is a win when recovering from running injury.
#247 Which stress fractures are low risk in runners?
Stress fractures are a common overtraining injury in runners.
But if you want to run on a stress fracture, its simple.
You better be sure that choice is not going to ruin your ability to run in the future.
You have to figure out whether or not your stress fracture is low risk, or high-risk.
Today on the Doc On The Run podcast, we’re talking about which stress fractures are low risk for a runner.
#246 What makes a stress fracture high risk for a runner?
If you get a stress fracture your first question is probably whether not you can just keep running.
Before you can answer that question, you have to figure out whether or not the particular stress fracture you got as a consequence of over training is a high risk stress fracture or a low risk stress fracture.
If there’s a high risk your stress fracture is going to break, you may not want to run on it.
If there is a high risk your stress fracture just won’t heal if you run on it, and you probably want to back off.
Today on the Doc On The Run podcast, we’re talking about what makes a stress fracture high risk for a runner.
#245 Is it risky to keep running with shin splints?
Shin splints are a common overtraining injury among runners. That aching pain in the front of the leg can be really annoying.
Some common questions from runners with shin splints are…
Can I run with shinsplints?
Will I get a tibial stress fracture if I run the shinsplints?
Is it really risky to keep running if I just have shin splints?
Today on the Doc On The Run podcast, we’re talking about whether or not it risky to keep running with shin splints.
#244 There is no shame in a running injury unless you make it shameful
It is widely accepted among athletes that our mindset, visualizing a specific outcome and working toward that specific outcome are all interconnected.
No one wins a race without believing they can win.
And I believe no one heals unless they believe they can heal.
Whether you have a metatarsal stress fracture or an Achilles tendon injury, you have to understand that your mindset will either help or hinder your recovery.
Being injured is not always the worst thing.
Today on the Doc On The Run podcast, we’re talking about how there is no shame in a running injury unless you make it shameful.
#243 Do I need a fracture boot for a tibial stress fracture?
Shin splints are common among runners your ramping up their mileage.
Unfortunately, stress fractures are also common.
If you have an aching pain in the front of your leg you may be misdiagnosed with shinsplints and later find out you have a tibial stress fracture.
If that happens, your doctor might panic and want to put you in a fracture walking boot.
But it may help you to understand why of fracture walking boot help some fractures and how a fracture walking boot might (or might not) help reduce the stress in your shinbone when you have a tibial stress fracture.
Today on the Doc On The Run podcast, we’re talking about whether or not you really need a fracture boot for a tibial stress fracture.
#242 Why did my doctor NOT have the right answer?
One time I saw a guy who actually flew all the way from New York to San Francisco to see me.
He had seen a bunch of doctors, he’d seen very qualified people.
He had gotten an MRI, a CT scan, some x-rays, all kinds of different tests.
He had a number of different evaluations and none of his doctors made the correct diagnosis.
After I watched him run on a treadmill and did a couple of diagnostic injection, I easily made the correct diagnosis.
He became really upset and said, “Why can’t my doctor in New York figure this out?”
Today on the Doc On The Run podcast, we’re talking about why your doctor didn’t have the right answer.
#241 When a runner should and shouldn’t do the hop test for a stress fracture
I was recently lecturing at The International Foot & Ankle Foundation’s annual scientific meeting in Las Vegas.
The conference is all for podiatrists, foot and ankle surgeons, and sports medicine doctors, to figure out how to treat foot and ankle injuries better.
I was doing a lecture on stress response, stress reaction and stress fractures in athletes.
One of the main points of that talk, one of the take home points for physicians, was about the hop test.
Today on the Doc On The Run podcast, we’re talking about when a runner should and shouldn’t do the hop test for a stress fracture.
#240 How doctors classify stress fractures in runners
Some stress fracture classification systems use MRI, some use CT scans and some use X-rays to try to determine how bad your injury happens to be.
Of course, the point of a classification system is to help you decide when and how to get back to activity quickly by helping your doctor make decisions.
Is this stress fracture going to heal quickly?
Is this stress fracture going to heal slowly?
Is this stress fracture something that’s high risk, or low risk?
Today on the Doc On The Run podcast, we’re talking about how doctors classify stress fractures in runners.
#239 When Can I Run With Stitches?
If you have an accident and cut the front of your leg open, you may have to have stitches to sew the skin back together.
Of course, most doctors will probably tell you that you should avoid exercise until your skin fully heals and the stitches are removed.
Depending upon the location of the stitches, it could take two or three weeks for the skin to heal.
Most runners don’t want to wait two or three weeks with no exercise while waiting for stitches to be removed.
Today on the Doc On The Run podcast, we’re talking about when you can run if you have stitches.
#238 Can I Run My Race With An Ingrown Toenail?
Ingrown toenails can be painful.
Particularly if you’re getting ready to run a marathon or some other goal race.
I recently got a call from a runner who called and asked…
“Can I run my race with an ingrown toenail?”
It seems like wanting to know whether or not she should wait until after her race to have her ingrown toenail removed, was a reasonable question.
But the answer may surprise you.
Today on the Doc On The Run podcast, we’re talking about whether or not you should wait until after your race to fix an ingrown toenail.
#237 Top 3 clues of a plantar fascia rupture in a runner
Plantar fasciitis is by far the most common cause of arch pain in runners.
Not surprisingly, most runners who get heel pain or arch pain think they have plantar fasciitis.
But sometimes runners have a more serious injury where there is actually a rip, a tear or what doctors referred to as a partial rupture of the plantar fascia ligament.
The problem with this more serious injury is that it doesn’t get better with the same treatments that will help plantar fasciitis.
Today on the Doc On the Run Podcast, we’re talking about the top 3 clues of a plantar fascia rupture in a runner.
#236 Should I just try a more aggressive treatment for my Achilles tendon?
Today was on a consultation call with a runner who is had a long history of Achilles tendon problems.
She’s recently tried some new things that made an improvement.
But the problem is she’s not really certain the improvement is from the new treatments she’s been doing. Because she simultaneously decreased her activity a bit.
So now she’s in this place where she is trying to figure out what to do next.
Should she continue with some simple conservative treatments that aren’t very risky?
Or should she try to just do something riskier to try to get it to finally heal, or heal faster?
Today on the Doc On the Run Podcast, we’re talking about or not a runner should try a more aggressive treatment for an aching Achilles tendon.
#235 How Can I Get from Custom Orthotics to Minimalist Running Shoes?
Some runners become concerned that if they run in custom orthotics they may become weaker and unable to run without the custom orthotics working as a sort of crutch.
Theoretically, if you have been running for a long time with custom orthotics support your feet may be accustomed to, or in some sense even dependent upon that external stability and support.
The question is…do orthotics provide relief from symptoms only, or do they support you so much you could actually get weaker?
Today on the Doc On the Run Podcast, we’re talking about how a runner can get from wearing conventional running shoes with custom orthotic inserts to running without orthotics in minimalist running shoes.
#234 Perils of Rapid Success with Champion High Jumper Julia Curran
Running injuries only happen in two scenarios:
1. We do something stupid. We do something we know that was foolhardy and we shouldn’t have done it.
2. We sustain an injury while pushing for progress. We are getting stronger. We are pushing ourselves to the limit. And we just push a little too far.
But anyone can get injured. In fact, for those athletes who do experience rapid success, it can even be more difficult to restrain yourself when you are getting subtle clues from your body that you may be heading for an over training injury.
Today on the Doc On The Run Podcast we are talking with Julia Curran who is an age-group National High Jump Champion about preventing running injuries as you experience rapid athletic success.
#233 Failure To Trust Causes Running Injuries
All overtraining injuries are the result of too much tissue damage, without enough recovery to fully heal, before the next workout “causes” a running injury.
My personal belief is that most running injuries are the result of failing to trust your training plan and your coach.
You need a coach to help you stay on track.
I think a coach is someone who can quiet your fears when its time to push the limits. Someone who truly know the difference between fear, pain and real danger.
But you have to trust your coach if you want to ride that line.
Today on the Doc On the Run Podcast, we’re talking about how failure to trust causes running injuries.
#232 Most Runners Lack The Discipline Required For Minimalist Running Shoes
No one trains for long distance events, nor successfully completes a long distance event without a great deal of discipline.
Most experienced runners can run a long way, regardless of footwear.
And it is mostly highly experienced runners to start investigating the idea of barefoot running or running in minimalist running shoes.
There are many reasons minimalist running shoes appeal to endurance runners. But running in minimalist running shoes requires an advanced level of discipline.
Today on the Doc On The Run Podcast we’re talking about why most runners lack the discipline required for minimalist running shoes.
#231 Can I run after total joint replacement surgery with the BionicRunner
When a runner’s joint wears out, one option is to remove the damaged cartilage and replace the joint through artificial joint surgery. The problem is, artificial joints typically wear out a lot faster than normal joints.
The base assumption is the running will wear out an artificial total joint replacement.
More than 25 years ago an orthopedic surgeon told me that I should stop running.
He said if I didn’t stop running I would have to have an artificial joint replacement. He also said if I ran on that artificial joint I would destroy the joint replacement surgery, ruin the implant and would have to have yet another surgery.
Can I run after total joint replacement surgery?
#230 Why runners with high arches need cushioning running shoes
Most runners wear running shoes when they run.
And the type of shoes you choose can help protect you from the forces of running.
If you have high arches, in general at your feet are more stable and more rigid.
A rigid foot type generally translates to higher peak forces when you run, and particularly when you land as a heel striker.
Cushioning type running shoes can help protect your feet from the pounding forces of running, if you have high arches.
#229 Why fleet feet need motion control running shoes
If the running shoes are perfect for you, they will help provide support and cushioning to protect you from the pounding forces of running.
In theory, running shoes should protect you from overloading structures in a way that could lead to an over training injury.
If you have flatfeet, you may have flat feet, you need “motion control” running shoes.
Motion control running shoes, pronation control running shoes, and stability running shoes are all basically the same thing. These are all shoes designed to stabilize unstable feet.
Every runner needs the very best running shoes. Every runner pronates. But it is when and how much you pronate that actually matters.
In general, people with flat feet pronate more than people who do not have flat feet. But not all runners need pronation control running shoes.
Today on the Doc On The Run Podcast we’re talking about why flat feet need motion control running shoes.
#228 Running Injures Are Optional With RunRx
Very few things are worse to a runner than a running injury.
If you have ever been injured it is devastating. To add salt to the wound, while you sit on the couch recovering, but getting weaker, you realize it is preventable.
Listen closely…
When you run, pain is mandatory, but running injuries are optional.
Today we have a special guest on the show.
We are talking with the RunRx founder Valerie Hunt about the importance of developing better running form and strength for runners to prevent running injuries.
Today on the Doc On The Run Podcast we are talking about the importance preventing preventable running injuries.
#227 Find the value in exercising with pain
Every cloud has a silver lining. If you’re injured right now, you need to look for the value in the discomfort right in front of you.
If you have pain when you are exercising there is a risk you will do damage to the healing tissue.
That’s why doctors tell you to stop running. Doctors don’t necessarily want you to lose all of your fitness, but they don’t want you to make the injury worse.
If you have been injured you have probably done some exercises in the past few days or weeks that cause pain.
When you are injured you have the possibility of making assessments with immediate feedback.
Today on the Doc On The Run Podcast we’re talking about how you can find the value of exercising with pain.
#226 Grey areas are really slowing you down
“All in moderation.”
I’m not sure who said that, but it definitely was not an endurance athlete.
Unfortunately the idea of training in moderation, treatment of running injuries in moderation and everything in between has infected the recovering runner’s world.
We do our speed work too slow and our base training too fast.
As a consequence of that moderation of our workouts we do not reap the full benefit nor the intended purpose of either of those workout sessions.
Today on the Doc On The Run Podcast we’re talking about how the gray areas in training and the gray areas in healing are what is really slowing you down.
#225 Mark Allen 6-Time Ironman World Champion On Preventing Overtraining Injury
“If you’re not training, you’re not getting more fit.” – Mark Allen
The very best way to lose all of your running fitness is to get injured and be forced to stop training.
Today on the Doc On The Run Podcast we are talking with 6-Time Ironman World Champion Mark Allen about the importance of preventing preventable running injuries.
In this episode Mark is going to share with you three and truly useful ideas:
1. The keys to competing at a high-level for decades – and never have a serious injury.
2. The shift it takes to make a difference between losing and winning.
3. Simple changes any athlete can make today to stay healthy, get stronger and run longer.
#224 Can low aerobic fitness cause a running injury?
A runner who was listening to the Doc On The Run Podcast asked about the association between low aerobic fitness and running injuries.
Any runner who gets an injury does so simply because the tissue has not performed the way it should.
The harder your tissues work when you exercise, the more oxygen they require.
When you are working hard and simultaneously depriving your tissues of oxygen, you’re putting yourself at risk in a number of ways.
Today on the Doc On The Run Podcast we’re talking about how low aerobic fitness can lead to a running injury.
#223 What runners can learn from ballet dancers
Runners want to run. Ballet dancers want to dance.
But runners just run. Ballet dancers, don’t just dance.
Ballet dancers practice the basic moments that make them better dancers.
I just recorded a new Doc On the Run Podcast interview with Valerie, the founder or RunRx.
That interview is coming out soon (so watch for it), but she made such a great point, I thought you should hear about her ballet/runner analogy now.
Today on the Doc On The Run Podcast we’re talking about what runners can learn from ballet dancers to help prevent running injury.
#222 What if I run and my broken toe does not heal?
When you get injured, you can lose ground very, very fast.
You don’t have to lose all of your fitness just because you’re in the recovery process.
Don’t throw in the towel.
Don’t give up.
Do something.
Stay fit through the injury recover process.
Today on the Doc On The Run podcast we’re talking about the two rules from Warren Buffet that can help injured runners.
#221 The 2 rules from Warren Buffet that can help injured runners.
When you get injured, you can lose ground very, very fast.
You don’t have to lose all of your fitness just because you’re in the recovery process.
Don’t throw in the towel.
Don’t give up.
Do something.
Stay fit through the injury recover process.
Today on the Doc On The Run podcast we’re talking about the two rules from Warren Buffet that can help injured runners.
#220 Weakness causes running injuries
Races really don’t injure runners.
Any runner who gets injured in a race really did the damage long before the actual running event.
During the build phase, you actually feel really strong. Your muscles are getting stronger. Your aerobic fitness is in good shape.
But your tendons, ligaments and bones don’t build strength as fast as the muscles.
They are all actually more prone to injury during that phase. The big build phases of training are also where you happen to ramp up your workout intensity and your running volume.
And that’s when most people get injured, not surprisingly.
Today on the Doc On The Run podcast we’re talking about how races don’t cause running injuries.
#219 Worn out running shoes cause running injury
Why do you wear running shoes?
Running shoes are supposed to cushion when you land.
Running shoes are supposed to prevent some of the damaging forces when you run.
Running shoes are supposed to supposed to support your feet when you run.
Running shoes are supposed to supposed to protect you when you run.
Today on the Doc On The Run podcast we’re talking about how worn out running shoes cause running injury.
#218 Races do not cause running injuries
Races really don’t injure runners.
Any runner who gets injured in a race really did the damage long before the actual running event.
During the build phase, you actually feel really strong. Your muscles are getting stronger. Your aerobic fitness is in good shape.
But your tendons, ligaments and bones don’t build strength as fast as the muscles.
They are all actually more prone to injury during that phase. The big build phases of training are also where you happen to ramp up your workout intensity and your running volume.
And that’s when most people get injured, not surprisingly.
Today on the Doc On The Run podcast we’re talking about how races don’t cause running injuries.
#217 Do not look for a cure through a clouded lens
Runners should be believe in medical research.
I am absolutely convinced that if the study or clinical trial shows a high likelihood you will have an adverse event like a heart attack or stroke when you take a medication, you probably should not take that medication.
Clinical research can show you very clearly what you should not do.
Clinical research however does not always show you so clearly what you should do.
And that is where things start to get cloudy.
Today on the Doc On The Run podcast, we’re talking about why runners should not look for a cure through a clouded lens.
#216 The 8 places where runners foot fungus lives in your home
Toenail fungus is gross!
And believe it or not, toenail fungus, the stuff that causes athlete’s foot, it’s all the same, and it lives in your home.
If you get toenail fungus or if you get athlete’s foot and you’re treating either of those fungal infections on your feet and you’re a runner, you have to make sure that you get rid of all of the fungus in the areas in your home where it accumulates if you really want to get rid of it for good.
Otherwise, if you spray some stuff on your skin, if you apply some stuff to your toenails, if you get laser treatment for your toenails or any of those things, and you don’t eradicate all of the fungus from your home, you’re just going to re-expose yourself to it, and you’re way more likely to get reinfected later.
Today on the Doc On The Run podcast, we’re talking about the 8 places where runners foot fungus lives in your home.
#215 Plantar Fasciitis First Aid for Runners
When plantar fasciitis first starts, doctors call that an “acute case” of plantar fasciitis.
Acute plantar fasciitis (which just started) should be treated differently than chronic plantar fasciitis (that has been around for months).
There are 2 common mistakes runners make with plantar fasciitis.
There are also 3 things runners should so do right when plantar fasciitis begins if you really want it heal and get back to running as quickly as possible.
If you do everything right, you should notice a huge improvement in just a few days.
Today on the Doc on the Run podcast, we’re talking about first aid for plantar fasciitis in runners.
#214 Will I run again after broken metatarsal surgery?
If you’re a runner and you’ve been injured, you need to challenge your doctor to do better.
You are going to probably feel like challenging your doctor would have to be somewhat confrontational.
That doesn’t mean you have to be offensive.
But you have to do something different if you really want to get your doctor on board with a rapid return to running.
Today on the Doc On The Run podcast, we’re talking about how you should challenge your doctor to better when you are a runner.
#213 Can I run with this injury? No. Maybe. or Probably.
Most of the time when runners go to the doctor with a running injury, the doctor tells you to quit running.
The doctor is simply trying to pick the simplest fastest way to reduce the stress and strain on the injured tissue.
But of course, runners want to run.
Whenever runners call me for a consultation and it is always because they really want to know the answer to one specific question:
“Can I run with this injury?”
The answer is never as simple as either yes or no.
Today on the Doc On The Run podcast, we’re talking about the difference no, maybe and probable, an injured runner and you’re trying to figure out whether or not you can run and still heal.
#212 What is a displaced vs non displaced fracture?
If you are a runner in training and you break one of your toes, or snap a metatarsal bone, you may worry about hoe long you need to stop running.
When you are get a fractured bone, you probably want to know what it will take to heal the bone and how quickly it is going to heal.
One of the ways doctors classify broken bones in the feet and toes is whether it is a “displaced fracture” or a “non-displaced fracture.”
Today on the Doc On The Run podcast, we’re talking about the difference between a displaced vs non-displaced fracture, and what it means if you are a runner.
#211 MRI or CT scan of my foot which is better for a runner?
Yesterday I was talking to a runner who had an ankle sprain that didn’t improve.
After about a year of not be able to run, having pain when walking and becoming really frustrated with not being able to run, he called me for a second opinion.
During that discussion he asked me whether or not it would be better to get an MRI or a CT scan to evaluate the bone, joint and surrounding soft tissue to determine what was really going on and preventing him from getting back to running.
Today on the Doc On The Run podcast, we’re talking about whether an MRI or CT of your foot is better when you have a running injury.
#210 The #1 Mistake runners make in the first week of a running injury
If you’re a runner and you’ve been injured, you need to challenge your doctor to do better.
You are going to probably feel like challenging your doctor would have to be somewhat confrontational.
That doesn’t mean you have to be offensive.
But you have to do something different if you really want to get your doctor on board with a rapid return to running.
Today on the Doc On The Run podcast, we’re talking about how you should challenge your doctor to better when you are a runner.
#209 How to tell a bruise under the toenail from toenail fungus
Runners often get dark discoloration in the toenails. That discoloring can happen after long runs, trail runs, wearing ill-fitting running shoes or trauma.
The question is whether or not the dark brown, blue or black area in the toenail is just a bruise or something more ominous.
If you get a bruise under the toenail, it will gradually get better.
If you get toenail fungus, it will gradually get worse.
Today on the Doc On the Run podcast we’re talking about how a runner can tell a bruise under the toenail from toenail fungus.
#208 Challenge your doctor to do better when you are a runner
If you’re a runner and you’ve been injured, you need to challenge your doctor to do better.
You are going to probably feel like challenging your doctor would have to be somewhat confrontational.
That doesn’t mean you have to be offensive.
But you have to do something different if you really want to get your doctor on board with a rapid return to running.
Today on the Doc On The Run podcast, we’re talking about how you should challenge your doctor to better when you are a runner.
#207 There is no healing without risk
Everybody wants to believe that there is some best practice, some standard of care, some safest way for you to heal when you get a metatarsal stress fracture or achilles tendinitis or peroneal tendinitis or plantar fasciitis or any other common overuse training injury when you’re a runner.
But there is nothing that is risk-free.
Nothing is free in medicine.
It’s not free in terms of costs, and it’s not free in terms of risk. And for most runners, the risk part is the bigger part of the equation.
Today on the Doc On The Run podcast, we’re talking about how there’s is no healing for a runner without risk.
#206 How long do I have to take off from running to recover?
How much time do I need to take off from running after my race?
The time you need to take off from running after race all depends on how long the race is and how hard you ran.
How much time do I need to take off from running if I get a running injury?
That depends upon your physiology and the status of your healing machine today.
You need to think about how fast you think you can heal, based on your fitness, physiology and level of training.
Today on the Doc On The Run podcast, we’re talking about how long you should take off running.
#205 The risk free way to heal a metatarsal stress fracture and other unicorns
A runner with a metatarsal stress fracture recently asked…
“Isn’t it true that a fracture walking boot and crutches is the risk-free way to heal a metatarsal stress fracture?”
Although I hope you won’t tell my daughter, there are no unicorns.
And there is no risk-free way to heal a metatarsal stress fracture.
Today on the Doc On The Run podcast, we’re talking about how the risk free way to heal a metatarsal stress fracture and other unicorns.
#204 Rock climbing is a lot like sports medicine
This weekend I was rock climbing in Joshua Tree National Park with my son.
At one point he started climbing up to a point where we were going to practice rappelling.
He chose to climb up a way I knew was more difficult than necessary. But he wanted to proceed, so I let him.
You have to know whether or not you can proceed with the given activity without getting hurt.
Today on the Doc On The Run podcast, we’re talking about how rock climbing is a lot like sports medicine.
#203 The 3 most important ways runners prevent foot fungus
Toenail fungus may be gross but it’s common, especially in runners.
Running shoes are perfect little incubators for foot fungus.
The inside of shoes are hot, dark and moist. Running shoes can be the ideal environment for fungal infections. And you want to make sure you don’t get a toenail fungus infections, you need to make sure you keep the fungus out of your shoes.
But there are three simple precautions you can take to make sure you don’t have a fungus farm in your running shoes.
Today on the Doc On The Run podcast, we’re talking about the 3 most important ways runners prevent foot fungus.
#202 if you haven’t taken an action you haven’t made a decision
Many years ago I heard a quote from Tony Robbins. He said, “Remember, a real decision is measured by the fact that you’ve taken new action. If there’s no action, you haven’t truly decided.”
When you’re an injured runner you can’t just wait for it to heal like a normal patient because the whole time you’re waiting, things are getting worse. You are losing your aerobic fitness, you are getting weaker, you are losing your neuromuscular connections. Your form is falling apart.
If you have an overtraining injury and have decided you want to heal faster than the average patient, you have to take action.
Today on Doc On The Run Podcast we’re talking about how if you haven’t taken an action, you haven’t made a decision.
#201 3 Ways a runner can confirm a self diagnosis of plantar plate sprain
There are only two cases in which a metatarsal stress fracture needs surgery.
Before we get into that, I want to stress one point.
If someone tells you you need surgery, you need a second opinion.
Never, ever, ever have surgery when only one person tells a runner should have metatarsal surgery!
Today on the Doc On The Run Podcast, we’re talking about the only 2 times a metatarsal stress fracture needs surgery.
#200 Should an injured runner be patient?
I just got an email recently from someone who is a runner and one of the things he asked, he said,
“Should I be patient, and are the chances good that the pain will subside after four to six weeks on its own, of just not running?”
Well, that’s a good question, but that depends.
The first thing that you have to think about when a doctor tells you, you just should take off running, and stop activity, stop doing everything for four to six weeks, you have to ask yourself several questions.
Today on the Doc On The Run podcast, we’re talking about whether or not an injured runner should just be patient.
#199 How do trail runners get chronic ankle instability
If you go to the doctor, and you tell the doctor that you run on trails, you’ve sprained your ankles before, and you seem to roll ankles frequently, the doctor will tell you that you are suffering from “chronic ankle instability.”
f your ankle just feels unstable when you’re on uneven ground, when you step on a root, or rock, or something, if your ankle sort of flips out from under you a little bit, it seems like you’re spraining your ankle (but it doesn’t even hurt), well that’s something that we call “chronic ankle instability.”
Today on the Doc on the Run Podcast, we’re talking about how trail runners get chronic ankle instability, and what you can do if you have it.
#198 Healing a running injury is an active process
Training for a marathon is an active process. You have to think about what you’re going to do, you have to come up with a plan.
You have to design a training program that will get you stronger, get you faster, get you more fit and better prepared for your event, if you’re going to finish your race on time.
When you get injured, healing itself from that injury is an active process, but unfortunately by default, people revert into a passive process.
Today on the Doc On The Run Podcast, we’re talking about how healing a running injury is an active process.
#197 The Only 2 Times A Metatarsal Stress Fracture Needs Surgery
There are only two cases in which a metatarsal stress fracture needs surgery.
Before we get into that, I want to stress one point.
If someone tells you you need surgery, you need a second opinion. Never, ever, ever have surgery when only one person tells a runner should have metatarsal surgery!
Today on the Doc On The Run Podcast, we’re talking about the only 2 times a metatarsal stress fracture needs surgery.
#196 Lack Of Discipline Causes Running Injury
This episode is probably going to rub a lot of runners the wrong way.
No runner wants to think they lack discipline. Running is all about discipline.
Running is about getting up early in the morning, about going for long runs in the dark, running when it’s raining, running when it’s hot, running when you just don’t feel like running.
For most people who are runners, we feel like and we believe that we have lots of discipline. We do what most people will not do, and that’s why we can run and we can do events and finish them successfully.
But, lack of discipline does contribute to running injuries. Let me explain…
Today on the Doc On The Run Podcast, we’re talking about how lack of discipline causes running injury.
#195 What runners should do before getting custom orthotics
Lots of runners who are in the midst of training, for some reason, they want to get custom orthotics.
I know that we, as runners, we’re always looking for the tools, the latest training techniques, the newest, coolest shoes, the best kind of socks, the newest heart rate monitors, whatever…to help us train better and be faster.
There are a lot of misconceptions about custom orthotics and there are a lot of things that you should understand before you get custom orthotics.
Today on the Doc on the Run Podcast, we’re talking about what runners should do before getting custom orthotics.
#194 Does a Jones fracture need surgery?
A few days ago, I got an email from a runner who wanted to know whether or not he should have surgery to fix his Jones fracture.
Well, the first thing you have to know about this is that you should only have surgery if you believe that is the only way you’re going to heal appropriately.
When you’re a runner, you really have to think about surgery very carefully. Because when you have surgery, your healing actually doesn’t begin until after you’re done with surgery.
The healing process is always taking place, and you don’t get any credit for anything that happens before the time you have surgery.
Today on the Doc On The Run podcast, we’re talking about whether or not a Jones fracture needs surgery when you’re a runner.
#193 Arch supports make my arch hurt worse
A couple of days ago I saw a runner who started having some arch pain in his left foot after he was did a run.
After he noticed this arch pain, he got some arch supports, and they actually made his arch hurt a lot worse.
Arch supports are supposed to take pressure off of the arch.
They are supposed to support the arch. They are supposed to make you feel better.
But sometimes, arch supports can actually complicate another problem and make you feel a whole lot worse.
Today on the Doc On The Run Podcast, we’re talking about why arch supports might actually make your arch hurt worse.
#192 Top 3 weapons against poison oak for trail runners
It’s that time of year, and here in California there is tons of poison oak out on the trails!
I recently ran the American River 50 mile Endurance Run, and I got poison oak on that run.
Now, I’ve had many episodes with poison oak. I also see lots of runners who get it on these long events, I see lots of runners that get it on their normal trail runs on Saturday or Sunday.
In the first place, you don’t have to get poison oak. But you can also do something about it if you do get poison oak.
Today on the Doc On the Run Podcast, we’re talking about the top 3 weapons against poison oak for trail runners.
#191 Top 3 Reasons Doctors Hate Treating Runners
For about 15 years now, I’ve been teaching other doctors about running injuries. Every time I speak in a medical conference now, I ask doctors why they don’t like treating runners.
I know some runners are actually surprised to hear this, but if you are a runner, yourself, and you’ve been to the doctor and you’ve had some doctor look at your intake form or some nurse look at your intake form, and said something like, “Do you really run that much?” or “Why do you exercise so much?” or “Are you obsessed?” or “Are you some kind of exercise addict?””
Well if you’ve heard any of these things, you probably understand not all doctors like to see runners.
But when I am at medical conferences, I always ask doctors, “Why is it that you guys don’t want to treat runners? What’s your problem with them? Why is it that you think it’s difficult to treat them? Do you think they’re unreasonable? What is it?”
Today on the Doc On the Run Podcast, we’re talking about the top 3 reasons doctors hate treating runners.
#190 Why fracture boots fail to heal plantar plate sprains in runners
If you are runner and you started having pain in your foot and you concerned you have a metatarsal stress fracture, you may think you need to get an x-ray of your foot.
But why?
You probably want to know how bad it is!
You probably also want to know whether or not you can run, right now.
But you may be surprised to hear that x-rays of your foot will not really help answer either of those two questions if you are a runner and suspect you have a metatarsal stress fracture.
Today on the Doc On the Run Podcast, we’re talking about the only 2 reasons you should get an x-ray for a metatarsal stress fracture.
#189 The only 2 reasons to get an X-Ray for metatarsal stress fracture
If you are runner and you started having pain in your foot and you concerned you have a metatarsal stress fracture, you may think you need to get an x-ray of your foot.
But why?
You probably want to know how bad it is!
You probably also want to know whether or not you can run, right now.
But you may be surprised to hear that x-rays of your foot will not really help answer either of those two questions if you are a runner and suspect you have a metatarsal stress fracture.
Today on the Doc On the Run Podcast, we’re talking about the only 2 reasons you should get an x-ray for a metatarsal stress fracture.
#188 The slope of 2 lines you need to compare when running after an over-training injury.
When you’ve been injured and you are starting to run again you have a very delicate balance to maintain.
Your number one goal is to increase your fitness without stressing the injured tissue enough to inhibit the recovery.
The goal is to get stronger without slowing the healing process.
That healing process is always in motion. Every day the healing tissue gets stronger. And every day for healing tissue can withstand a little bit more activity than the day before.
Today on the Doc On the Run Podcast we’re talking about the slope of 2 lines you need to compare when you’re returning to running after an over-training injury.
#187 Top 3 conditions misdiagnosed as a stress fracture in a runner
A metatarsal stress fracture, is probably one of the most common running injuries that you could get when you’re training for a long distance event like a marathon, or an ultra marathon or if you’re relatively new to running.
But the problem, of course, is that not all running injuries that seem like stress fractures are actually stress fractures.
If you think you have a metatarsal stress fracture, but you have something else…it probably won’t get better.
Today on the Doc On the Run Podcast, we’re talking about the top 3 conditions misdiagnosed as a stress fracture in a runner.
#186 Periodization in recovery and healing running injuries
For most runners, when they’re training for a marathon training program, or an Ironman the period of growth is usually about three weeks.
You take a period where you are increasing your activity, then you back off and start increasing again from a lower point, to allow yourself to recover fully and decrease your risk of sustaining an overtraining injury.
You should do a similar thing when you are recovering from a running injury, but that period can be much shorter because your increases are happening during a period where you’re actually healing and recovering from a running injury.
Today on the Doc On the Run Podcast, we’re talking about periodization in recovery and healing running injuries.
#185 Avoiding injury on mixed trail runs
Sometimes it’s hard to do a trail run and have that run be only on a trail surface.
You can’t always run a trail run…entirely on a trail. What I mean by that is that you have some pavement, some asphalt, some road, or whatever, that you have to run on in order to get to the actual trail part.
It ends up being a mixed trail run.
Mixed trail runs can put you at risk of an over-training injury.
Today on the Doc On the Run Podcast, we’re talking about avoiding injury on mixed trail runs.
#184 Why the Hop Test is the worst test for a runner with a stress fracture
You have to remember that the most important goal when you have a stress fracture that’s healing, and you want to get back to running, is to match the healing of the metatarsal bone with the stress you apply to that bone so you can continue to very deliberately ramp up your activity without making the stress fracture worse.
The worst thing you can do after you’ve been healing with a stress fracture is to re-injure the bone.
Obviously when that happens, you have a huge setback, you’ve just lost weeks of training, you’re going to lose more fitness, and in some cases you might have to start over again with the fracture walking boot. You don’t want to do that.
Today on the Doc On the Run Podcast, we’re talking about why the “Hop Test” is the worst test for a runner with a stress fracture who thinks the metatarsal bone has healed enough to run.
If you think about most of your runs, you do a warmup, you do the body of the workout, and then you do a cool down.
One thing that is interesting is I have recently noticed a number of runners who have gotten injured by doing runs where they’re finishing on the hardest part of their run.
That can put you at risk of an over-training injury.
Today on the Doc On the Run Podcast, we’re talking about why you should put the trouble in the middle of the run.
The harder you train during your big build blocks just before a marathon, the more risk you will sustain an over training injury. Because that’s when you are using harder.
The more activity you do when you are healing an injury, the more risk you will slow the healing process. Because you might stress the tissue too much.
But some activities inherently have a lot more risk than other activities.
Today on the Doc On the Run Podcast, we’re talking about the #1 riskiest running activity.
#181 After-Weekend Recovery Tip: Legs up the Wall Pose
If you killed it this weekend on your workouts, congratulations! But, if you put a lot of into that effort this weekend, there is some possibility you are really treading close to that threshold for injury that could push you over into an over-training injury.
I get calls all day from people who do a lot of stuff and push the limits a little too far on the weekends. But if you do some simple things to accelerate your recovery right after those big workouts, it can make a huge difference to avoiding an over-training injury.
Today on the Doc On The Run Podcast we’re talking about the Legs Up The Wall Pose to speed your recovery after your weekend workouts.
#180 How to do your first Test Run outside
Once your injury is clearly improving, you will want to run. I know you want to run. You are runner! I get it!
Many recovering runners blow it and get a set-back just because the very first run is too much.
Before you can resume training and ramping up your running, you have to make sure running will be safe. That’s where the “test run” comes in.
Today on the Doc On The Run Podcast we’re talking about how to do your first test run outside.
#179 How bad is my stress fracture 4 critical steps to deciding
When you get a metatarsal stress fracture, and you want to get back to running, you have to make an assessment on how bad it really is.
The only other options is to stick with the standard treatments of “don’t do anything for 4 to 6 weeks.”
To do to figure out how bad your stress fracture really is…
Today on the Doc On The Run Podcast we’re talking about 4 critical steps to deciding how bad is my stress fracture.
#178 Cycling workouts for recovering runners
Resting is not all healing. If you rest too much, you’ll get weaker.
If you want to get back to running, as soon as you’re healed, you need to do something to prevent all of the changes that can slow you down and put you at a higher risk of re-injury once you actually do get back to running and training.
Gravity and the pounding forces associated with running…that’s only one of a half a dozen contributing factors that can prevent healing of a running injury.
Today on the Doc On The Run Podcast we’re talking about cycling workouts for recovering runners.
#177 Achilles early warning signs in runners?
The Achilles tendon is the largest tendon in your entire body, and if it gets injured, you’ve got a real problem.
The Achilles tendon is what allows you to pull your heel up, off the ground, push off and accelerate when you run.
What many runners don’t understand is that the Achilles tendon also helps slow you down and decelerate when you’re trying to slow down, absorb force as you’re landing while you’re running.
Today on the Doc On The Run Podcast we’re talking about Achilles tendon early warning signs in runners.
I received and email from a runner who wrote, “I ran today and my foot hurt when I ran. What should I do right now?”
You want to take the quickest course of action that you can when you get an injury, and most people miss this.
Many times what we do instinctively is we stick our head at the sand.
We just could say, “Okay, well I’m just going to wait and see how bad it is tomorrow.”
But when you do that, you’re actually missing some crucial steps. There are really a few things you need to do right now.
Today on the Doc On The Run Podcast we’re talking about what to do now, if your first just started hurting when you ran today.
As an athlete I’m sure you know that it’s important you believe you can accomplish your goal.
What’s interesting to me is that many patients, many injured runners don’t really think that much about how important it is that you actually believe in the treatment you’re being offered.
If you feel uneasy about the treatment, you shouldn’t do it.
If you you don’t think the treatment plan makes any sense, you shouldn’t do it.
If you you don’t think the treatment is going to work for you, even if you trust the doctor, you shouldn’t do it.
Today on the Doc On The Run Podcast we’re talking about how if you don’t think it will work, you shouldn’t do it.
There are lots of things that you as an injured runner may hear in a doctor’s office that really can be false evidence. Something that the doctor presents to you, that you then accept as fact.
“All fractures take six weeks to heal.”
”I treat all my patients with this particular time on crutches and it always works.”
“In my hands, this particular surgery works well for this condition.”
“You just have to take this pill, if you want to get better.”
Or, my favorite, “You have to stop running to heal.”
Today on the Doc On The Run Podcast, we’re talking about how runners should take note of Doctor’s F.E.A.R. False Evidence Appearing Real.
“First, do no harm.”
This basic idea is at the foundation of medicine. Doctor’s are sworn to the Hippocratic Oath, and they want you to get better. Even if that means preventing you from harming yourself when you are injured.
As a runner you may feel like the very treatment offered to you will permanently harm your ability to train, run and perform…forever.
But there is way to turn this idea around and get the doctor to buy-in to your concerns.
Today on the Doc On The Run Podcast we’re talking about how the Hippocratic Oath can help you get back to running sooner.
Two very common causes of foot pain in runners are neuroma and capsulitis. Some treatments help both conditions. But some treatments will only help one and not the other.
If you have pain in the ball of the foot when you run, you need to do do 3 things to heal quickly:
Accurate treatment
Accurate diagnosis
Aggressively do the things that help and avoid the things that slow your recovery.
Today on the Doc On The Run Podcast we’re talking about pain in the ball of the foot in runners and why the right diagnosis matter.
Remember, injuries aren’t caused by running too much!
Running injuries are caused by applying too much stress to specific structures like the fourth metatarsal bone, Achilles tendon, peroneal tendon or your posterior tibial tendon when you’re running on a slope or changing direction.
If you want to reduce the risk of getting over training injury, mix things up and run the other way.
Today on the Doc On The Run Podcast we’re talking about about why you should reduce your risk for injury and run the other way.
Which is more likely to cause an injury….running fast, or running slow?
Explosive speed workouts can put you at risk of injury. True.
Running at your limit can put you at risk of injury. Also true!
But believe it or not, if you spend too much time running slow, you may actually increase your risk of an overtraining injury.
Today on the Doc On The Run Podcast we’re talking about about how slow may be your injury speed.
Morton’s neuroma is a common cause of pain in the ball of the foot in runners.
Doctors often tell runners to stop running when when they get a neuroma. Sometimes doctors even tell runners they need surgery to remove the inflamed nerve.
But don’t be confused. Runners should always figure out how to keep running!
This episode is inspired by Cathy, who sent a comment which all runners with Morton’s neuroma should find encouraging.
Today on the Doc On the Run Podcast, we’re talking about how you should not let Morton’s neuroma stop you from running.
Lots of running injuries are aggravated by bending of the toes.
Plantar plate sprains, sesamoiditis, and Morton’s neuroma all get irritated when you bend the toes too much while you run.
If you have any of these conditions it may help if you add some stiffness to your running shoe.
One way to help decrease pain in the big toe joint and the ball of the foot is too add a carbon fiber insert to the running shoe.
Today on the Doc On the Run Podcast, we’re talking whether or not you should add carbon fiber stiffening insoles to your running shoes.
When you get an over training injury, what happens?
It’s too much stress applied to one structure over too shorter time without enough recovery to actually let it fully heal before the next workout.
There are a few things that you can pay attention to that often signal the possibility of an injury that’s coming on.
Today on the Doc On the Run Podcast, we’re talking about signs to look out for that may signal you are heading for a running injury
Are your running shoes the best for your run today?
You and I both know there are lots of different kinds of running shoes on the market. You can buy neutral running shoes, pronation control shoes, somewhere in between with structured cushioning, minimalist running shoes, maximalist running shoes.
There are all kinds of running shoes, and they are all built for different runs, different foot types, and different runners. Every shoe has its place.
Every runners longs the one perfect running shoe.
Everybody wants the best running shoe…built just for you.
Today on the Doc On the Run Podcast, we’re talking about how to choose the best running shoes for the run.
Are your current running shoes putting you at risk for a stress fracture?
One common reason for too much bone stress is that a runner didn’t have enough cushioning because they were using a shoe that was too stiff, or wasn’t padded enough, or soft enough, and they were running on concrete or asphalt.
That run, in those particular running shoes, beat up the bone too much and then the bone started to crack and develop into a stress fracture.
Today on the Doc On the Run Podcast, we’re talking about what the worst running shoes for stress fractures.
I was recently at a medical conference and I asked all the doctors in the audience … I said, “What causes stress fractures?”
A doctor raised his hand and the very first thing he said is, “Running too much.”
Well, that is just not true.
“Running too much” is the default answer, but that doesn’t make any more sense to me than telling you that not running will cure your stress fracture.
Today on the Doc On the Run Podcast, we’re talking about what really causes stress fractures.
#163 How much rest does your body need?
The number of hours you sleep really has a direct correlation with your risk for running injury.
Running injuries never happen because you ran too far. Injuries happen because you loaded one structure too much, you beat it up too much, and you didn’t let it recover enough before the next workout.
You don’y have to run less. But you have to rest more.
It’s not necessary to spread your workouts farther apart. But you must maximize the recovery.
Today on the Doc On the Run Podcast, we’re talking about how much rest your running body really needs.
Barefoot running injuries don’t happen to novice runners.
Most runners who decide to run in minimalist running shoes or run purely barefoot, they don’t take up running and decide to do that in minimalist shoes or barefoot right out of the gates.
Most of the people I see, most of the runners I talk to, most of the runners who call me for a consultation and want to ask questions about their barefoot running injuries, they are experienced runners.
Today on the Doc On The Run podcast we’re talking about the number one mistake runners make with minimalist running shoes.
Barefoot running injuries don’t happen to novice runners.
Most runners who decide to run in minimalist running shoes or run purely barefoot, they don’t take up running and decide to do that in minimalist shoes or barefoot right out of the gates.
Most of the people I see, most of the runners I talk to, most of the runners who call me for a consultation and want to ask questions about their barefoot running injuries, they are experienced runners.
Today on the Doc On The Run podcast we’re talking about the number one mistake runners make with minimalist running shoes.
Broken toes are common, but they can really hamper your training when you’re getting ready to run a race.
If you break your toes a few weeks before a big race the question is always whether or not you will be able to run your race.
Today’s episode is based on the questions sent in for a runner who broke a couple of toes and wants to know whether or not she’s going to be able to run her race in a few weeks. This episode will help you understand the questions to ask if you fracture your toes and you still want to run.
Today on the Doc On the Run Podcast, we’re talking about whether or not you can run your race with broken toes.
It’s no big secret that I really don’t like fracture walking boots for runners.
I think doctors over prescribe them. When you use fracture walking boots for too long, it causes weakness, stiffness, decreased bone density, loss of neuromuscular connections, and a whole bunch of unnecessary increased risks where you getting another different overtraining injury when you’re actually back to running and full training.
Today on the Doc On the Run Podcast, we’re talking about the 3 times you really might need a fracture walking boot if you’re a runner with a metatarsal stress fracture.
If you’re a runner who gets tightness in your calves and develops Achilles tendinosis it can be very difficult to get it to heal and it can be very frustrating.
Some runners fail multiple treatments including stretching, home exercises, physical therapy, braces, PRP injections and many other treatments. You just have to figure what it will take to get the Achilles tendon to heal so you can get back to running.
Today’s episode is based on a question sent in by a runner who has failed many different treatments for Achilles tendinosis…but still wants to run.
Today on the Doc On the Run Podcast, we’re talking about chronic Achilles tendinosis treatment failures in a runner.
If you have pain and swelling in the toes after a run, you might be worried you have a stress fracture in the toes.
But you have to figure out if the injury is in one of the bones of the toes, or if you have a metatarsal stress fracture instead. Because stress fractures in the metatarsals are common in runners, but stress fractures in the toes are rare.
But you also have to make sure you don’t have a plantar plate sprain.
Today on the Doc On the Run Podcast, we’re talking about toe stress fractures from running.
If you are running with pain in the ball of the foot that seems like a stress fracture, it could be a plantar plate sprain.
If you get a plantar plate sprain right before a race, the obvious question is whether or not you should do the event.
If you have a sprain of the plantar plate ligament, you may still be able to run.
You just have to decide how bad the injury is, what your long-term goals are, and how badly you want to to participate in the event.
Today on the Doc On the Run Podcast, we’re talking about whether or not you can run with a plantar plate sprain.
Hydration is one of the limiters for many runners. It seems like often-missed, low hanging fruit that has the potential to boost performance in long events like marathons and ultra-marathons.
I know as runners we all want to focus on working harder, suffering more and trying to come up with some new technique or training plan that’s going to get us faster and stronger. But in many cases when we are already training at a high-level there are very few gains to be made by working harder. Some of the biggest gains actually come from small changes in other areas, like improving nutrition, improving the quality of our sleep or by maintaining a state of optimal hydration.
Today on the Doc On The Run Podcast, we are talking about staying hydrated during your long runs with Josh Sprague, endurance athlete, and founder of Orange Mud.
How often should you get new running shoes? That depends on how quickly they wear out! Some runners get new running shoes every few months. Some running coaches tell runners to replace running shoes every 200 to 500 miles. If you keep running in worn out shoes, you may be putting yourself at risk of an over training injury.
But a lot of different variables can affect how quickly your running shoes wear out. If you understand the variables that can affect how long your running shoes last, you can make much better decisions about how frequently you need to replace your running shoes.
Today on the Doc On the Run Podcast, we’re talking about how often you should replace worn out running shoes.
Do you really need custom orthotics if you’re a runner?
If you’re a runner and a doctor suggests custom orthotics, you may need orthotic inserts, but you may not. At least not forever.
Many runners just need custom orthotic therapy for a short time to help heal an injury and keep running.
Today on the Doc On The Run Podcast we’re talking about whether or not you really need custom orthotics for running.
When we run, we feel better. But what happens when you get busy, or even worse you get injured and you’re not really able to run.
Do you get bummed out? Do you get anxious? Do you get depressed?
In this episode we have a fantastic interview with William Pullen who literally wrote the book on Dynamic Running Therapy.
Today on the Doc On the Run Podcast we are talking with William Pullen the author of Running With Mindfulness about how Dynamic Running Therapy can improve low mood decrease anxiety decrease stress and help depression.
If you are a runner with a metatarsal stress fracture, you can simply stop running and wait for the bone to heal.
The other option is to figure out how to heal it faster and keep running while the stress fracture is still healing.
If you do that, you can get back to running a lot faster!
The process for healing and getting back to running is not that complicated.
Today on the Doc On The Run Podcast, we’re talking about the 12 Steps to healing and running with a metatarsal stress fracture.
If you are running and you get plantar fasciitis, you probably want to get back to running as soon as possible.
Many doctors will tell you to quit running. Doctors may also recommend lots of other treatments for plantar fasciitis like cortizone injections, custom orthotics, icing, elevation, supportive shoes, physical therapy, non-steroidal anti-inflammatory drugs, and even surgery.
Most runners with plantar fasciitis simply don’t need most of these treatments.
Today, on the Doc On The Run podcast we’re talking about the single best treatment for plantar fasciitis in runners.
Running with a stress fracture might be risky. But so is medicine. The treatments doctors recommend to runners with stress fractures are also risky. Just different kinds of risk.
Medicine is all about risk versus benefit. Everything in medicine has risk.
There’s risk with everything. There is risk with running with a stress fracture. There is risk with using a fracture walking boot when you get a metatarsus stress fracture. If you do use a boot, you’re may be more at risk of other over-training injuries later. So there’s risk even with not running!
Today, on the Doc On The Run podcast we’re talking about how running with a stress fracture is all about risk management.
Should you ramp up your running training when your healing injury doesn’t feel like it does not hurt much worse while running?
As soon as the healing stress fracture gets a little bit stronger, you should start ramping up your fitness so you don’t just lose all of your running fitness.
The big question is, is whether or not it’s okay at that point to really ramp up training, keep running longer, keep running harder when it seems like the very mild, barely-noticeable foot pain isn’t really getting worse.
Today on the Doc On The Run Podcast, we’re talking about whether or not you should ramp up your running when it doesn’t feel like it doesn’t hurt much worse when you resume running after an injury.
Any over-training running injury is caused by too much stress applied to that one structure.
Once it starts to heal and you are trying to return to running, you have to keep the overall amount of stress applied to that one healing structure low enough so it can continue to heal even while you ramp up your activity.
There are lots of different ways to remove pressure. Just remember, you have got to do it in a graduated fashion, but the goal is to actually increase the amount of stress applied to that healing structure right at the time the healing tissue is strong enough to take it.
Today on the Doc on the Run podcast, we’re talking about the stress reduction you need in your foot to heal while you continue to run.
The reason I like out in back runs when I’m doing long runs is it makes me committed. But out and back runs can actually put you in a really vulnerable position when you’ve been injured. If something starts to hurt during your run, if you’ve noticed some new odd sensation, you still have to get home.
The whole key with training through an injury or returning to running sooner when you’ve had an overtraining injury is to make sure that you’re doing as much activity as you can do without making the injury worse.
Today on the Doc On The Run Podcast, we’re talking about why injured runners should avoid the out and back.
A pothole is a classic road hazard. It is an obstacle in the road that can cause trouble. If you are going fast in your car and you hit a pothole, it can actually blow out your tire. If you are running and you step in a pothole, it can break your foot.
Road hazards are avoidable dangers in your path that cause trouble.
Hazards are avoidable for drivers of automobiles and they are avoidable true for runners as well.
Today we are going to talk about the top three road hazards for runners.
Equinus Brace
A tight Achilles tendon can cause a variety of problems for runners. A night splint is a brace that is supposed to help stretch a tight Achilles tendon by holding the foot in a corrected position while you sleep.
A night splint is often recommended to runners when they get plantar fasciitis or Achilles tendonitis.
But there actually is a brace that I think is really much better than a night splint. It is not actually a night splint, but it is something called the “Equinus Brace.”
Today on the Doc On the Run Podcast we are talking about the best night splint for runners.
As soon as you sign up for a marathon you start to think about what it will take to finish it. You know you will have to build an enormous amount of fitness to finish. You come up with a plan. You design a series of of workouts. And you realize you are going to have to suffer.
Before you even begin you first workout, you convince yourself that success will require pain and suffering.
But if you maintain your marathon mindset and you just tell yourself you’re supposed to suffer you will suffer yourself right into an over training injury. And then you won’t have days of workouts to reorganize. You may wind up with weeks or months of completely avoidable time on the couch.
Today on the Doc On the Run Podcast we’re talking about how a marathon mindset can predispose you to injury.
This weekend I was speaking at the International Foot & Ankle Foundation meeting in Lake Tahoe, lecturing to a group of physicians, podiatrists, foot and ankle surgeons, all about running injuries.
At the end of one of the lectures, there was a question and answer session. One really interesting question that came from Dr. Thomas was whether or not there is something to do differently when doctors negotiate with athletes. And specifically, she asked, “What do you do exactly when a runner basically tries to renegotiate their activity level with you, the doctor?”
Great question and critical for any runner to understand this…When you’re injured, you have to face it. You have to shift your mindset. The most important thing you can do as an injured runner is to remember that your most important goal is to finish your race on time.
Today on the Doc on the Run Podcast, we’re talking about the one goal you should have when you get a running injury.
This is the first question I get from runners when they get a stress fracture like a metatarsal stress fracture in the foot. This could also apply to other kinds of stress fractures, like a tibial stress fracture or a calcaneal stress fracture, or any other stress fracture in your foot.
The short answer is this, you can run as soon as the metatarsal bone has healed enough, becomes stable enough, to withstand the stress you apply to that bone when you run.
Today on the Doc on the Run Podcast, we’re talking how long it should take before you can run on a metatarsal stress fracture.
If you want to get back to running sooner, you have to figure out a way to maintain the maximum level of activity your healing tissues can withstand without causing any further damage and without impeding healing process. There is a fine line between healing while your running fitness diminishes and healing while simultaneously advancing your fitness.
When it comes to healing and trying to figure out the line between too much activity and not enough activity, pain is your guide.
Today on the Doc On The Run podcast, we’re talking about how pain can be used as a tool to recover faster from running injury.
Is it dangerous to run on a stress fracture? Well that’s a great question. Stress fractures are one of the most common problems runners get when over training. When injured, stress fractures can keep you off running for a really long time.
Runners are often running on stress fractures. Sometimes knowingly, sometimes unknowingly. You have to figure out whether or not you’re going to really cause any permanent damage to the bone, or disrupt your long-term goals before you can decide whether or not it’s dangerous to run on a stress fracture.
Today on The Doc On The Run Podcast we’re talking about whether or not it’s dangerous to run on a stress fracture.
If you get pain and swelling in the ball of the foot you might become worried you have a fracture. Let’s face it. When runners get an aching pain in the foot at the first thing we worry about is probably a stress fracture.
The good news is that in the overwhelming majority of cases where you have pain in the ball of the foot at the base of the toes, it is not usually a broken bone. But it can happen. In today’s episode we have an interview with Coach Craig Moss who is a 46-time marathon finisher.
Today on the Doc on the Run podcast, we’re talking about a fracture in the ball of the foot and what it takes to get back to running with Coach Craig Moss.
You get a running injury because you made a mistake in over-training. You tripped over something. You did just a little too much in your workout. Something went wrong. It was an accident.
But healing does not happen by accident. Healing a running injury has to be intentional, just like your training.
Think about what you do in training. You have a very, very specific plan to make sure you stay on track, but it is not by accident.
And it’s the same way with the healing process after you have an over-training injury. Don’t forget, when you get an over-training injury, all it really is is an exaggerated form of the same tissue damage that you get in normal training when you’re running.
So, you can use that same sort of active plan being very intentional about when you’re going to heal, and how quickly. All of that must be deliberate, but you can’t have mistakes in healing the same way you can’t have mistakes in your workouts.
Today on the Doc on the Run podcast, we’re talking about how healing a running injury does not happen by accident.
If you’re not moving, you’re more injury-prone. If you got an over-training injury from running, and you’re not moving, if you’re not exercising, things are actually getting worse for you. You are actually getting more injury-prone, not less.
This is the misconception: if you get injured, you have to sit still. You have to rest. You have to ”take care of yourself,” and you have to heal. And that is what physicians feed us runners most of the time; this idea that they should just calm down, sit down, chill out, relax, recover, take it easy…whatever. But you know as an athlete, there are only two possibilities: Either you’re getting stronger, or you are getting weaker. And if you’re getting weaker, you’re actually more injury-prone.
But that all quickly changes, because you are healing. What you have to do is determine when you’re ready for the next phase of healing. How do you do that?
Today on the Doc on the Run podcast, we’re talking about how if you’re not moving, you’re actually getting more injury-prone.
Faster means “faster.” It means making decisions quicker. And forward means you and your doctor are making decisions more frequently so you can shorten the recovery time and move forward towards running and your next marathon, your next iron man, next trail run, whatever it is, faster.
Runners really can fast-forward their healing process, but that requires you doing all the right stuff, not just the stuff the doctor tells you to do.
So how does that really work? Today on the Doc On The Run podcast, we’re talking about how runners fast-forward healing.
The key with recovering from running injuries faster than normal patients is to identify what it is helping your healing, and what may be hindering your recovery. Runners don’t choose the rate of recovery. Runners choose our habits, and our habits choose our rate of recovery.
What happens a lot of times is that when we’re in training we’re really religious and diligent about maintaining good habits. We protect our sleep. We make sure we get enough sleep. We go to bed earlier. We hydrate. We’re eating all the right foods. We’re protecting our nutrition, our health, and the recovery process. Then when we get injured, a lot of that changes.
Today on the Doc On The Run podcast, we’re talking about why you shouldn’t have high hopes for healing if you have downhill habits.
How does healing change on a weekly basis? It’s going to continue to change throughout the healing process from day to day. No, it’s not going to change a great deal in one day, but it’s going to change a lot in a week, and it’s going to change a whole lot more in two weeks.
Everything’s getting stronger: your muscles, your tendons, your bones, your ligaments, everything. You’re getting stronger and stronger the whole time you’re training and the whole time you’re healing.
Today on the Doc On The Run podcast, we’re talking about how last week’s healing won’t heal you today.
Why do runners heal faster? Simple…You are not a normal patient if you’re a runner.
Not only do you exercise more, you eat better, you sleep better. You as a runner are a well-primed healing machine and this is the bottom line. If you think about it, if you’ve been a lifelong runner, what have you been doing? You go out and you train. You do tissue damage and then your body rebuilds it. So you have been teaching your body, physiologically priming that system, to heal. Your body knows how to heal.
Today on the Doc On the Run podcast, we’re talking about why runners heal faster.
This morning I got a call from Amy in Houston, and she’s running a marathon in 10 days. She’s doing the Houston Marathon. Today is Thursday, so a week from Sunday she is running the marathon. She has pain, and she’s 10 days out, and wants to know if she can run now. That’s the thing. She says, “I got this new pain, and I wanna run and finish my training.” She admits that she didn’t really train effectively, so she didn’t train as much as usual. She normally is prepared for the marathon, but this year a bunch of stuff happened, just didn’t get to train as much. Her plan was to try to run 10 miles today, on Thursday, and then maybe do a final 18 mile run on Saturday, and then maybe a few runs next week, you know, five, seven miles, or six miles, or whatever a couple of times next week, leading up to the marathon next Sunday.
So, her question is whether or not she should run. She has this weird pain, this weird soreness. She’s not sure what it is. She’s done a bunch of marathons, but she doesn’t know what it is. Is it a good idea to run or not? All right. So, just to back up, let me tell you, the first thing you have to know is that if she goes and sees a doctor, they’re almost certainly gonna tell her to not run. Right? Why? Well, doctors tell you to not run, because they assume you wanna heal. Now, that sounds kind of simple, but that’s the thing. When you’re a runner, we know that that’s not always the only consideration and certainly, in many cases, not even the primary consideration. They’re not assuming your goal of finishing a marathon, an ultra marathon, an Ironman Triathlon, anything. They’re not assuming that that goal of finishing is actually more important than your overall goal of making sure that you don’t make your injury worse. Listen and I will explain…
Today we’re talking about whether or not you should run when you have pain about 10 days out from a marathon.
The purpose of a taper, is to really get prepared physically to do your best, actually perform your best, on race day. You should always taper if you have been sticking to your marathon plan, if you’re fully trained, if you’re fit, if you’ve really got all of your training in, then you can taper with confidence. But if you’ve done less than optimal training, i you didn’t stick to your plan, well what are you going to taper from?
And somewhere in between there is where most people fall in. They missed a couple of workouts here and there, they want to extend the training period into that taper period, and that’s where you start getting into trouble. And if you had any kind of injury and you extend your training into your taper period, you are really playing with fire. That part I don’t think anybody would disagree with.
So you just have to decide, given your scenario, how much training you did and how closely you stuck to your plan, whether or not you can push your taper a little bit, or if you should skip it all together. But that’s something you’ve got to talk with your coach and you have figure out what to do.
Remember, the goal is to make it to the race, make it through in one piece, and then continue resuming in whatever training is and you have to think about what your goal is after that event to really make a clear decision.
Today on the Doc On The Run podcast, we’re talking about whether or not you should taper or just continue training when you have soreness right before your marathon.
Can’t Hurt Me by David Goggins
I may be going out on a limb here, but I’m going to recommend the number one book you need to read if you are a runner. I think this is going to be the best book for runners for 2019. And truthfully, it’s not actually just a running book. The book is actually David Goggins’, “Can’t Hurt Me.”
I actually met David Goggins about 10 years ago or so. And he probably won’t remember me because I’m just a run-of-the-mill runner. But I met him at this event. It was a race in Chattanooga, Tennessee called the Wauhatchie Trail Race. Since that time, David Goggins has gone on to do some pretty amazing things! But, the truth is, what most people don’t know is he did lots of amazing things before that…And that is what this book is all about.
If you want to achieve big things this year, read this book. Get it wherever you get books. You’ve gotta read, “Can’t Hurt Me.”
Today on the Doc on the Run podcast, we’re talking about the number one book every runner should read in 2019.
Are black toenails really a problem if you’re a runner? Well, that depends. The truth is, NO!…black toenails are not really a problem. They’re just ugly and maybe a little bit painful. But if you are a runner black toenails are pretty common. I mean, let’s face it. Who hasn’t declared their black toenails as some kind of badge of honor when you’re doing your first marathon or you’re finished an ultra marathon?
I understand why people do allow themselves to get black toenails. Let’s face it. Runners are tough. We’re driven. We have goals. We really want to achieve them and we’re not going to let something like an ugly, sore toenail get between us and the finish line. But you have to really think about the real long term risk abuse leading to black toenails.
Today on the Doc on The Run Podcast, we’re talking about black toenails from running.
I’m recording this episode right around the start of the New Year, and this time of year everybody starts talking about their goals. Most people talk about where they want to be. What they want to accomplish, where they want to be, but I what I really think you have to think about is who are you going to be. Who are you going to be in one year, because … You know, it’s interesting.
You would never expect your son to go into third grade and come out of third grade without having changed tremendously both physically, socially, athletically, intellectually…in every way. That kid’s going to change a lot in one year. We expect our kids to change a lot all the time. They’re growing, they’re changing, they’re improving, but then we grow up and what do we do? We get a house. We get a job. We have kids. We get locked into a job, and then some of that development stops, right? Now, if you’re a runner that’s probably not true. You probably have goals that you’re trying to improve on all the time. If you’re a doctor and you have a practice you’re probably trying to improve your practice in the way that you take care of patients through the value that you’ve provided them. You’re probably trying to prove all of that at the same time.
Today on Doc on the Run podcast we’re talking about who you’re going to be one year from now.
This question comes up a lot for runners with Achilles tendon injuries. But it can happen with any kind of tendon. The difference between an injury to a tendon which has been labeled “tendonitis” versus “tendinosis” is really a difference in the amount of time that you have the condition and the amount of damage to the tendon itself.
There’s been a long running debate about this. I was lecturing at a medical conference in Iceland this the summer. Specifically, it was a lecture on tendon injuries in athletes. One of the key points was that the old research claims inflammation does not play a role in the development of tendinosis is wrong.
In this episode I will explain the difference between tendonitis and tendinosis.
Let me ask you a question. Do you set goals when you are training for a race? What about when you are injured? I mean let’s face it, if you are training for a marathon you probably have a really specific goal right?
You want to do a specific race on a specific day. You want to start at a specific time and you want to end at a specific time. So then you have a whole bunch of goals to try to get you to that particular outcome.
But how about when you get injured? I see runners all the time and they seem to just completely get off track when this happens. All of their goals go out of the window. They cancel the race, they don’t have any goals for their next race and many times they have no goals at all for their healing.
Today on the Doc On The Run podcast we’re talking about goals for healing your running injury.
The number one question I get from runners is “How long is it going to take me to heal this injury?” It could be a metatarsal stress fracture, it could be plantar fasciitis, it could be an Achilles tendon injury. Then the follow-up question is always “How soon will I be back to running?”
The whole underlying premise of those questions is completely absurd. All of us want to believe it takes some certain given timeline for every given injury to resolve. And that’s just crazy! I get this question from doctors at medical conferences and they’ll ask me,”How long does it take for a fourth metatarsal stress fracture to heal in the average runner and how long would it take for them to get back to running.” But that doesn’t make sense. It’s not that simple…
In this podcast episode we’re talking about how long it will take to heal a running injury.
Today on the Doc On The Run podcast we’re talking about the 5 causes of big toe joint pain in runners.
If you are a runner and you have pain in the big toe joint, the first step in treating it is figuring out what is actually causing the problem. There are lots of different causes of pain in the big toe joint, but there are really five that affect runners most often. These are the most common that I see in runners, so I’m going to explain all 5 of the conditions to you.
But not all these conditions mean you have to stop running. There’s whole range of conditions in the big toe joint, but you have to figure out which one of these is most likely to be causing your pain, to decide whether or not you should stop running, or whether or not you can keep running and get it to calm down while you’re still running. You just have to make sure you know which is causing the problem to figure out if you can keep running.
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.
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.
If 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.
Today on the Doc On The Run podcast we’re talking about Collagen- is it working for or against running injury.
In an ideal world, we would have research that actually studies everything, every variable, every possible scenario and then helps you know conclusively what will work and what will definitely not work. The problem is that research studies really don’t work out that way. There’s almost never a study that shows that something is 100% effective for everybody, all of the time, given all of the variables that can go into a patient’s given circumstances.
When you’re a runner, that’s even way more complicated because you don’t just get injured and want to heal a specific injury like a metatarsal stress fracture or Achilles’s tendonitis. You want to run. You don’t want to just heal the thing, you want to run. You want to heal it as quickly as possible, so you can keep running. And you want to figure out why the injury happened in the first place so it doesn’t happen again.
Unfortunately, there are many doctors who hide behind their stack of research articles and they don’t really help you understand what the real possibilities are for you. When you’re a runner you have to look at every possibility.
In this podcast episode we’re talking about the difference between a doctor and a librarian.
You’re never staying the same. You’re never the same person. You’re not the same person you were a year ago, and you’re not the same person now. You’re certainly not the same person you were 10 years ago either. And what you’re doing professionally, you’re probably not the same sort of person you were a year ago or 10 years ago with that either. The truth is pretty much nothing stays the same in life. And running injuries, they have a life of their own. But they’re never staying the same either. And today we’re going to talk about that.
Now the other day somebody called me and they said, “You know, my injury just isn’t getting better. I have a metatarsal stress fracture and it’s pretty much just staying the same.” But the deal is is that, again, your injury is never the same. So you have to think about what’s changing, what’s getting better and what’s getting worse.
Today on the Doc On The Run podcast, we’re talking about how your running injury is never staying the same.
Can I run with a split peroneal tendon? Well, yes. There are two cases in which you can run with a split peroneal tendon. Number one. If you’re certain running will not make the peroneal tendons worse or if you can accept that you may make the injury worse and it’s worth the risk to you, given your specific goals. Today, we’re going talk about what all that means if you’re a runner with a longitudinal tear or a split in the peroneal tendons.
This whole episode is basically based on a couple of questions that a runner sent to me on Twitter. The first question was, “Is surgery the only option for runners when they have a split peroneal tendon?” And second, “If it’s possible to run? What a runner must do after running?” And then third, “What kind of exercises are good? “
So, based on those questions, we’re going to put together this episode to help you understand split peroneal tendons and what that means for you as a runner.
Today on the Doc On The Run Podcast, we’re talking about the seven steps a runner should take when you’re not healing.
You’re probably a runner and you’ve probably been injured for some time. You probably just didn’t get injured last week when you were running a race, but you probably got injured a while back, and then a lot of things happened. You probably took a little bit of time and kind of took care of yourself, took off a few days from running. Maybe you iced it. Maybe you changed your routine a little bit, tried to do a little bit shorter runs, tried to in some way kind of slow down your training, slow down the intensity, and see if you could just get back on track.
But, something didn’t work. You didn’t get better. You maybe started to improve, felt like you were getting all better. Maybe even got to the point you were pain free, but then you started running again and the pain ramped back up. And now you’re sitting here wondering why it is that you’re not better and trying to figure out what to do next, and you’re probably incredibly frustrated because all of your fitness has dwindled away over this whole course of really half training and not really doing what you need to be doing in order to maintain all your running fitness.
So, there are always things you can do, but you have to really figure out what you can really do if you’re not healing. And today we’re going to talk about that.
Today on the Doc On The Run podcast, we’re talking about the top 10 myths about plantar fasciitis in runners.
There are a lot of myths surrounding plantar fasciitis, and plantar fasciitis is common, but you have to understand when you’re a runner that not all the stuff you read is true.
You can check out the course on runner’s heel pain if you’re really worried about this or you really want to keep running, you really want to figure out how to take care of it, everything’s in there. We created this monster course, it’s like two and a half hours of videos and it walks you through every step of the process of self diagnosis and self treatment of runner’s heel pain.
I recently went to pick up my 10 year son Alex from an after school program. He and all his classmates were playing on the playground. The camp administrator that runs the program actually approached me as I was walking across the playground.
He said, “Alex doesn’t make good decisions for his safety.”
I looked over and Alex who was standing up on the tire swing. He was swinging so high that he was almost horizontal at the top of the arc.
I looked at the Camp instructor and said, “That may be true. But it looks to me like he makes awesome decisions in terms of adventure!”
I will openly admit that I may be defined or labeled as a “risk taker.”
I raced motorcycles professionally. I fly a paraglider. I’ve climbed mountains in Alaska. I have done lots of solo big rock climbs in Yosemite and Zion national Park. I’ve even free soloed routes, climbing over a thousand feet off the ground, alone, with no rope.
When Alex was little we used to ride motorcycles together. He would often ask me to ride wheelies while he was on the motorcycle with me. Does that seem risky to you?
A lot of people think that motorcycles in and of themselves are risky or dangerous. But is riding a motorcycle dangerous?
What about someone riding a motorcycle on a road, somewhere in the countryside with no other traffic or no cars around. Does that really seem risky to you?
Look, the point here is that some things are just more risky than others.
If you are a runner and you’ve been injured you have to think about risk. There is risk in everything!
In this podcast episode we’re talking about whether or not running is risky.
I recently got a great question from a runner in San Francisco.
“I just want to make sure that I’m not heading for an over training injury and want to make sure to reduce the inflammation. When I have soreness following a hard workout, should I apply ice?”
Overtraining injuries happen because you have too much tissue damage, and not enough healing of that injured tissue before your next workout.
If you want to make sure you never get an over training injury all you have to do is make sure that all of your soreness completely subsides before you do your next workout. Obviously that just makes sense. But it’s also an absolute impossibility for any training endurance athlete.
I would be willing to bet that almost all actively training and racing endurance athletes are almost always in some state of soreness. You’re going to be stiff. You’re going to be achy. That’s a normal consequence of the normal tissue damage sustained during a workout. You’re always going to be healing and recovering. That’s part of getting stronger.
Today on the Doc On The Run Podcast we’re talking about whether or not a runner should apply ice to treat soreness.
Today we’re talking about how inflammation management can make you slower.
After giving my lecture in Las Vegas a couple of weeks ago I’ve had so many different questions about inflammation that I thought we should do an entire series of episodes about inflammation management in runners.
One of the things you have to understand first and foremost is that you don’t always have to prevent inflammation. Runners think that inflammation is bad. We hear all this stuff about inflammation, about how it causes chronic Achilles tendon problems and chronic disease. But inflammation is a normal consequence of training.
You run, you train and when you do, you get tissue damage. That’s part of the process. You damage the muscles, you get little micro-tears and then your body repairs them and you get stronger.
Inflammation is the very first step to repairing any tissue damage when you’re training and is the first step to getting stronger. So you have to have the inflammation as that initial response to the injury that you inflict on yourself when you’re training.
So today we’re going to talk about some basic guidelines about inflammation management.
Inflammation word cloud on a white background.
Just about a week ago I was giving a lecture in Las Vegas at the 24th Annual Scientific Program of the International Foot and Ankle Foundation and this is a medical conference where podiatrists, foot and ankle surgeons, sports medicine doctors go to get their continuing medical education credits.
One of the lectures I was asked to give there was entitled “Inflammation in athletes – The good, the bad and ugly” and in that talk I was trying to go through and explain to doctors what really happens and why is inflammation such a big problem.
There’s lots of stuff written now and it’s been going on for a long time in way back in 20014 there was the cover of Time magazine. It was the secret killer and this link between inflammation and all these other chronic diseases that really cause trouble.
We think of inflammation as this inherently bad thing. In fact if you do a search and you’re looking up inflammation, you’re trying to learn about inflammation, you can actually find where doctors have written that inflammation is a pathology that has to be treated. And that may seem like its true because there’s so many different things related to inflammation and particularly in chronic inflammation.
Today on the Doc On The Run podcast we’re talking about inflammation, sometimes it’s good and sometimes it’s bad so you don’t always have to treat the inflammation.
Today I was out on a run and it was a great day. I was running in the sun and I was just trying to think about like what are the things that really slow runners down in terms of healing because the whole key with training efficiently is to avoid an overtraining injury and to really train as hard as possible, to do as much tissue damage as possible and then rebuild that tissue before you do your next hard workout so that you can actually increase your fitness, increase your strength, increase your speed and continue training.
All of that back fires when you get injured. So if you listen to this you may be one of those runners who is actually recovering from an actual overtraining injury. But if you’re not then you’re probably recovering from the last workout.
The whole point here is that there are really a bunch of things that we can do. I’m thinking about the really simple limiters. The things that we all do that we can easily capitalize on that. We can easily take into our training, into our daily routine and actually recover faster.
And that is true for you whether you have a true overtraining injury that sidelined you or if you’re actively in training and you’re trying to make sure that you avoid one of those overtraining injuries by making sure that you recover before your next key workout.
In this episode we’re talking about seven healing limiters that slow runners down.
An MRI is an interesting diagnostic tool and we often think that an MRI is the best thing to show you what’s going on inside your body when we suspect you have some kind of injury and your doctors have a difficult time making a diagnosis. But the truth is there are two really good reasons runners shouldn’t just jump to an MRI and try to get an answer when they’re injured we’re going to talk about that today.
The first reason is that MRI’s can lead you down the wrong path. The second problem with MRI is instead of showing you something that maybe is worrisome that you even know existed, it can actually falsely make you think that nothing is wrong at all.
Today we’re talking about 2 reasons you may not want to get an MRI if you’re a runner.
Flat foot
In this podcast episode we’re talking about sub-fibular impingement syndrome.
Why do runners get sub-fibular impingement syndrome? How can you tell if you have sub-fibular impingement syndrome?
That may sound confusing to you but I am going to explain it. I’m going to talk about what this condition is, the signs and symptoms, what you can do about it.
We are going to talk about this in detail but the reason runners get sub-fibular impingement syndrome first of all is that you have a relatively flat foot type that’s unstable and can roll over and smack into the heel bone and into the fibula. That’s the first thing, so if you really have high arches probably do not have sub-fibular impingement syndrome.
What is sinus tarsi syndrome? I mean it sounds like a complicated name but it’s not really a complicated condition. The “sinus” means basically like a tube or a passageway and “tarsi” refers to the rear foot bones in your foot. So the tarsal bones are the big bone in your rear foot like the calcaneus heel bone or the talus that sits on top of the heel bone and sits underneath your tibia and your ankle joint. Those are the greater tarsal bones.
Sinus Tarsi is actually a tunnel that runs between the talus and the heel bone. Your subtalar joint, the joint under which is important and runs under the neck of the talus in your subtalar joint and it’s a little cavity that has some fat, it has some nerve endings and it has some fluid that lubricates the joint.
But sometimes you can get inflammation on the tissue that lines that joint and when you get inflammation of the lining of that joint and it hurts, that’s sinus tarsi syndrome.
Today on the Doc On The Run podcast were talking about Sinus Tarsi syndrome on runners.
Why runners get extensor tenosynovitis?
Basically what happens is that you get this problem from a number of things. The most common thing is overuse. When you get inflammation of the tendon sheath injury it’s usually because you work the tendons too hard. But with the extensor tendons, it really doesn’t happen that much unless you do a lot to hill repeats. But it’s not the tendons that get injured, it’s the inside of the tendon sheath that becomes inflamed and that’s what causes pain.
The first thing is what exactly does that mean? All these medical terms you hear like extensor tenosynovitis, they all sound very long and they sound very technical or important but I think that’s because most doctors just want to charge you by the syllables.
In this episode we’re talking about Extensor Tenosynovitis.
Today on the Doc On The Run podcast we’re talking about why doctors misdiagnose runners.
All I do is talk to runners who are injured and want to run and ninety nine percent of the time when a runner calls me for advice is because they aren’t getting better and they want a second opinion.
Well much of the time the runner has been misdiagnosed. If you don’t have the right diagnosis, you will be doing the right treatment for the wrong problem and you’re not going to get better.
In this session we’re going to talk about the top six reasons doctors come up with the wrong diagnosis when you’re injured.
I spend a lot of time talking to runners who have metatarsal stress fractures. Let’s face it, they’re common. And a metatarsal stress fracture may be one of the most disruptive injuries to you as a runner can encounter.
The reason metatarsal stress fractures are so worrisome to you is that most doctors will tell you it takes six weeks for bone to heal. And whether or not that’s actually true is entirely different episode.
I was recently in Reykjavik Iceland giving a talk on stress fracture healing strategies in runners. All of the people in the audience were physicians.
The main point of that lecture was to help doctors understand not everybody needs six weeks to heal a metatarsal stress fracture. And every single patient has the potential to significantly accelerate the healing process depending upon a number of factors.
What you eat, how much you sleep, what you’re doing to activate the recovery process can all influence the rate of healing when you have a stress fracture.
One of the super tools I recommend doctors consider for their patients is a bone stimulator. And in this episode I’m going to help you understand how a bone stimulator might help, if you get a metatarsal fracture.
Let’s Face it…Crutches Suck!
It’s still hard for me to believe that the same crutches, the same design that doctors hand out to patients today are more or less the same kind of crutches handed out to injured soldiers during the Civil War.
And although crutches are truly terrible, they can be a useful treatment to help any injured runner heal faster.
But you as a runner have to understand there’s a very high price to pay for using crutches. With one week of immobilization and non-weight-bearing on crutches you will have a 17% reduction in the muscle diameter size in that lower extremity. At six weeks, the damage is 60% and you actually can wind up with permanent atrophy as a result of being on the crutches too long.
That’s right. You can actually get permanent weakness as a consequence of using the crutches.
Today on the Doc On The Run podcast we’re talking about 3 keys to less time on crutches.
Yesterday I was talking to my sister, who is of course, also a marathon runner. She has been running marathons way longer than me and she is always fit.
She runs in the morning and then swims later in the day.
Swimming is a great way to cross train, supplement your aerobic fitness, strengthen your core fitness and frankly stay cool and relax in the summer.
But I got an email from a runner who had a bout of toenail fungus that was severe enough to need laser treatment to kill the fungus in the toenails.
After the treatment she said:
Now that I’m feeling “fungus free” – new mindset, a few days on the oral meds, new shoes, new yoga mat, flip-flops for the health club – I’m wondering: Is it OK to go back to swimming? This is one of my favorite leisure and workout activities at my health club (Club Sport). I take it that I should wear flip flops to and from the pool, etc. Any other advice or precautions?
Yes! You can swim. You just have to make sure you don’t pick up any more fungus.
The fungus doesn’t just jump up and attack your toenails. Runners and triathletes can get it, first in the form of athletes foot.
Today on the Doc On The Run Podcast, we’re talking about how to avoid getting infected with foot fungus from swimming pools.
I actually did some research recently in preparation for a presentation I was going to be giving on running injuries at the International Foot & Ankle Foundation medical conference in Seattle.
When I went to Medline, which is the search engine that catalogs medical research articles for the National Center for Biotechnology Information, I entered the search terms “running” and “injury.” That search produced 5,093 articles that were published in authoritative medical journals around the world. So not only do a lot of runners get injured, apparently a lot of researchers are writing scientific articles about running injuries.
The primary objective of that research study was to figure out the true incidence of lower extremity injuries among distance runners. Basically they wanted to figure out how often runners really get injuries like shin splints, stress fractures, Achilles tendinitis, and plantar fasciitis.
In this episode we’re talking about why you aren’t healing like a professional runner.
Today on the Doc On The Run podcast we’re talking with Christiann Arbini about injury, recovery and what it takes to bounce back to national championship racing after a doctor told her she was done.
For years I’ve been saying you should fire your doctor when they try to rob you of hope and Christiann was a great example of how are you can succeed even if the conventional medical wisdom is not really on your side.
Christiann qualified for the 2018 USA Olympic distance national championship triathlon race and that’s not really the awesome part. The best part is that she did that after she suffered a serious injury while skiing and was told she might have to hang up racing altogether. Not only is she racing but she also has a thriving coaching business for athletes.
Christiann Racing is both a wellness coaching business which is dared to be fit for life and through that Christiann encourages athletes to reach for big goals, inspires them to succeed and helps you to become the best version of yourself.
A plantar plate sprain is an overstretched, possibly even partially ripped ligament on the bottom of one your little toe joints in the ball of the foot.
When you get a plantar plate sprain, there are really 3 issues:
Inflammation
Tissue damage
Stress preventing healing
You have to address all three if you really want to get better quickly and get back to running.
Today on the Doc On The Run podcast we’re talking about how a runner can heal a plantar plate sprain.
Are you recovering at 100% capacity?
Are you doing truly everything you can to maximize your capacity for healing after your workouts? If you’re not, you’re wasting a lot of time when you’re training.
On Friday I was lecturing at the International Foot and Ankle Foundation meeting in Seattle. This is a medical conference where foot and ankle surgeons, podiatrists and sports medicine physicians go to get their continuing medical education. One of the lectures I was giving was on recidivism in runners and what doctors can and should be doing differently to help reduce the risk of re-injury.
One of the concepts I was trying to explain to doctors is the idea that there is no overtraining, there is only under-recovering.
Today on the Doc On The Run podcast we are talking about how a runner can heal a stress fracture.
When you get a metatarsal stress fracture, there are really 3 issues:
You have to address all three if you really want to get better quickly and get back to running!
Today on the Doc On The Run podcast we’re talking about whether or not you should run when you have a stress fracture in the heel bone.
The heel bone is an irregular bone. It’s an odd shape. It’s not tubular. It’s not square. It’s very thin on the outside and squishy on the inside. It’s really kind of like a hard boiled egg.
A hard boiled has a hard shell on the outside and if you drop it cracks, but it does not really deform. That’s usually what happens with heel bone when it actually fractures. But if you drop it hard enough, it will completely explode. The shell bursts outward in a bunch of little pieces and then we have to go and try to put it back together.
In this session I’m going to explain to you about whether or not it’s a good idea and how you might be able to run with a stress fracture in the heel bone.
Today on the Doc On The Run podcast, we’re going to talk about whether or not you can run with a partial rupture of the plantar fascia.
Can I run my race if I have a partial rupture of the plantar fascia? Well that’s a question I’ve got in a number of times from runners who’ve been to the doctor, they thought they have plantar fasciitis, they were told they had a partial rupture or a tear in the plantar fascia and then they want to know if they can do their race.
In this session we’re going to explain how you can decide whether or not you really can or should run when you have a partial rupture in the plantar fascia.
That may seem like a silly thing like you think if you’re wearing a fracture walking boot, there’s no way you’re going to run a hundred miles. But there is a patient I just had a consultation with yesterday on the phone and we were talking about this because she’s actually signed up for a one hundred miles trail race, she wants to do this ultramarathon and she’s having a problem.
The task is to figure out really is it safe for her to do this run which is a hundred miles basically a month away or not. So we have a long talk about this and it was really interesting because she’s very smart. She’s had a couple of injuries over the years. She totally understands running. She’s a multiple sort of level endurance athlete. She has had a number different races, she has done lots a races and all kinds of races, strictly running, triathlon, all kinds of events and so she knows a lot about the process.
In this lesson we’re talking about how a couple of days in a fracture walking boot can actually help you decide whether or not you might be able to run a hundred miles.
Stress fractures are extremely common. But first thing is that if you’re going to figure out how to run the race, if you should run the race, whether or not it’s a good idea to run a race, you have to really understand what really is metatarsal stress fracture.
Doctors want to put everybody in the same little bucket of “You have a metatarsal stress fracture. You can’t run.” That’s not true at all. In fact I have had lots of patients who have actually had not only done an Ironman but I had one that actually had her fastest Ironman ever, four weeks after she was diagnosed with a metatarsal stress fracture and she was told to wear a boot for six weeks.
Today on the Doc On The Run podcast we’re talking about whether or not you can run your race if you have a metatarsal stress fracture.
Can I run my race if I think I have plantar fasciitis? That’s a good question. In this session what we are going to talk about is whether or not you can or should run if you think you have plantar fasciitis.
A lot of doctors tell you stop running if you have plantar fasciitis. Well, the idea is that you’re stressing the plantar fascia when you’re walking on it and of course when you’re running.
Today on the Doc On The Run podcast we’re talking about whether or not you should run when you think you have plantar fasciitis.
Today on the doc on the run podcast we’re talking with Patrick about how to stay on track when you see a doctor or physical therapist and make sure that they focus on your running goals.
The main reason I wanted to have him on the podcast today is he actually had this experience with physical therapy that can help people understand how to better get your physical therapists and doctors more on track with your goals instead of just focused on the injury.
One of the million dollar questions I get from runners is whether or not you can run when you have this specific injury. Just today I was on a remote consultation call on Skype with a runner who is an ultramarathoner. He is training for a huge trail race in the Dolomites and he wants to be able to run.
Well it turns out that he got a little bit peroneal tendonitis, he got some pain and swelling around the ankle and it was starting to bug in. So his big question is “Can I do the race if I have peroneal tendonitis?”
Today on the Doc On The Run podcast we are going to talk about whether or not you should run with peroneal tendonitis.
I think when a doctor tells a runner to quit running it doesn’t make any more sense than telling an accountant to quit working with numbers. Running is what we do. And running should be the goal. You have to work with a doctor who will help you get back to running. And no matter where you are, you should be able to find a doctor who will help you heal AND get back to running.
I talk to runners all over the world. Of course most of them are injured runners. The main reason injured runners call me when they want to get answers to all of their questions is they are frustrated by doctors who tell them to quit running.
In this Podcast we’re talking about the five main reasons doctors tell you to stop running.
Healing takes time. The longer you take to recover the more fitness you’re going to lose. But when you’re an injured runner the less time you spend healing the sooner you are going back to running. So we all want to heal as quickly as possible.
When doing virtual doctor visit consultations with patients over the phone or via webcam, just about every patient who comes to me for running injury advice is trying to figure out how to get better faster.
After many years of working with runners I have identified a few types of runners who seem to take a lot longer to get better. So it may help you to think about each of these different types of runners who don’t get back to running as quickly as possible and see if you have any these characteristics yourself.
In this episode we are talking about 4 types of injured runners who won’t get back to running quickly.
If you are a runner with plantar fasciitis, you don’t need to watch hundreds of different videos to get better. You just have to do some simple things at home consistently and your heel pain will go away. If you do the right things, but you’re not getting better, then the chances are good you probably don’t have plantar fasciitis and have been misdiagnosed.
Runners are so frequently misdiagnosed with plantar fasciitis that I even wrote an entire book on Runners Heel Pain that you can get on Amazon. Even after I wrote the book on heel pain, runners kept calling to schedule virtual doctor visit consultations on Skype where they can actually talk to me and ask me questions. I pretty quickly realized they were all asking the same questions about what I do to diagnose and treat runners when I see them in person.
In this podcast episode we’re talking about 5 Plantar Fasciitis Treatments Your Doctor is Selling that Runners DON’T Need!
Today on the Doc On The Run Podcast we’re talking about the only three steps runners need to heal plantar fasciitis.
You don’t need to watch a hundred of different videos to get better. If you do these three things and you really have plantar fasciitis you should start getting better. In this episode we’re going to talk about the only three treatments needed to heal plantar fasciitis in almost every runner. If you’re not getting better, then the chances are good that you probably don’t have plantar fasciitis and have been misdiagnosed.
This problem is so common that I even wrote an entire book on Runners Heel Pain and you can get it on Amazon. Even after I wrote the book on heel pain, runners kept calling to schedule Virtual Doctor Visit consultations on Skype where they can actually talk to me and ask me questions. I pretty quickly realized they were all asking the same questions about what I do to diagnose and treat runners when I see them in person.
So then, we even created an online course on Runner’s Heel Pain that teaches runners like you how to do their own self-diagnosis and make sure your are doing the correct treatment once you know which condition is really causing your heel pain. We’ve put links to the book and the course at the bottom of the show notes for this episode. Check those out if you’re confused about whether or not you actually have plantar fasciitis.
But you don’t really need the book on Heel Pain or the course on Heel Pain if you just have plantar fasciitis. Let’s talk about what plantar fasciitis is, and what you as a runner have to do to get rid of plantar fasciitis.
Today on the Doc On the Run Podcast were talking about how runners can get the very best second opinion.
The other day I had an interesting conversation with a runner who has had a really difficult time recovering. The bottom line is that she had a couple of surgeries that didn’t work out exactly the way she expected and now she is still having trouble.
So we were having a conversation about how she can make sure that her current treatment plan is the best plan to get her back to running. We talked about all different kinds of surgical options, different approaches and how the doctor’s decision making process works. And through the course of that conversation I realized that many runners just don’t understand how they should approach a doctor when they’re getting a second opinion.
Your goal when you are getting a second opinion is to make sure you are getting an unbiased perspective on where you are right now and where you want to end up.
Have you ever had a race that you really only made it through just because you believe you can do it?
Sometimes you get to a place where it seems like all you have left is hope and when you get to that place it seems like hope is really all that you need.
Today I was doing a remote consultation call with a frustrated runner in Texas. We worked through her problem and came up with some options that should help her figure out what’s really going on and get her back on track.
After the call, she sent a really nice email to me in which she said,
“Thank you also for the understanding and hope… an under-appreciated but invaluable commodity.”
That was a really nice thing to say but it really brought up a lot of things for me because I realized a lot of doctors do not offer hope. In fact, they do quite the opposite.
Today on the Doc On The Run podcast were talking about hope an underappreciated, but invaluable commodity.
Today on the Doc On The Run podcast we are talking about how you can use the power of meditation to relax and heal.
Jason Stephenson has been involved in the meditation and relaxation field for over fifteen years and he even has a YouTube meditation sleep music channel that has over 700,00 subscribers with over 90 million views.
For whatever reason when runners become injured they don’t really seem to recognize the value of meditation. Maybe it’s just that they’ve lost their focus and they kind of forgot about it. Maybe they’re distracted because they’re kind of upset that they signed up for race they don’t think they’re going to get to run it. But in this episode Jason’s going to help us all understand a little bit more about meditation, living in the moment and how meditation has helped him and how it maybe can help us runners as well.
Every day I talk to runners who tell me their doctor said they have to stop running. Just stop and think about that for a minute. A runner is told to stop running.
A runner has pain in her foot. Maybe it’s a metatarsal stress fracture. Maybe it’s a plantar plate sprain. Maybe it’s plantar fasciitis. But the runner wants to run and not have foot pain.
So the runner makes an appointment with a supposed expert (a doctor), sits in a waiting room, then sits in a second waiting room waiting for the doctor to actually come in to do something.
Finally, the door swings open and you tell the doctor that you have this pain in your foot when you’re running. And then the doctor tells you to stop running.
So what just happened? Did the doctor not understand that you’re a runner? Did the doctor not understand you actually want to keep running? Does the doctor think running is not important to you? Or does the doctor really think you showed up to have somebody in a white coat tell you you should trade your running shoes for a bike helmet or a pair of swim goggles.
That doesn’t really sound like much of a solution to you, does it?
In this episode we are talking about how not running is optional.
Today I was on a 15 minute Virtual Doctor Visit call with a runner who has been trying to get over a nagging case of Achilles tendinitis and still wants to do well in the Boston Marathon.
It may not surprise you to hear that he is worried about how skipping long runs to protect the Achilles tendon will make it very difficult for him to have a good run in Boston.
He’s been doing all the right stuff. He has taken the right steps to remove the inflammatory fluid around the Achilles tendon. He’s been doing the right supplementation routine to help rebuild the collagen. He’s been doing the right workouts to help break up cross-linking and reorganize the collagen alignment in the Achilles tendon.
He has been improving but, he had very mild setback, got a little swelling and it made him worried. So, he just wanted to have a quick call to talk about his progress and figure out whether or not he needed to stop running or shift to some different activity.
In 15 minutes we were actually able to come up with several different ways he could augment his training to add some longer workouts that wouldn’t put as much stress on the Achilles tendon.
This episode is based on a question sent in from one of our listeners and she actually wrote in and said “I mistakenly had “plantar release” done to my right foot 16 years ago. I am no longer able to run because my arch has collapsed and my foot now rolls inward significantly with every step. I’m in constant pain in both of my knees (because of the change in my gait) as well as my foot as a result. A Mayo Clinic orthopedic surgeon recommended fusing the first and second metatarsals above my arch to reduce pain affected by the release but who knows if I’ll ever run again, which is what truly breaks my heart. My main questions are could stem cell therapy help me run again and can it decrease pain in the long term? Long shot question- is it remotely possible to “replace” (using that term very loosely) the cut ligament or it’s role in the foot, also allowing me to run again? (which is most important to me honestly).”
Today on the Doc On The Run Podcast we’re talking about what a runner can do to help the plantar fascia after plantar fascia surgery.
Today on the Doc On the Run Podcast we’re talking about the special considerations overweight runners need to think about when they want to get to their goals without getting injured.
I am really excited to have Gary Stotler on the show today and Gary is a guy who is truly inspirational.
He actually went from 400 pounds to running 100 miles.
I’m really excited to have Dr. Stephan Guyenet as a guest expert today. Dr. Guyenet spent 12 years at the University of Washington as a neuroscience and obesity researcher. Much of that time he was studying the role of the brain in eating behavior and body fatness. His publications have been cited more than 1,400 times by other scientists and in peer-reviewed scientific publications. He is the author an intriguing book entitled “The Hungry Brain” which explores the neuroscience of overeating, focusing on the following perplexing question: Why do we overeat, even though we don’t want to?
One of the reasons I wanted to have him on the show is that I have noticed many injured runners and triathletes let their diets slide a little bit when they get hurt. When we talk about this it quickly becomes apparent that these athletes understand nutrition. They understand the value of quality ingredients going into their system. They know what they need to eat to recover from hard workouts.
Today on the Doc On The Run Podcast we’re talking about Stress Related Eating and the Consequences for Injured Runners.
Today on the Doc On The Run podcast we’re talking with Linda Hall about meditation and how to focus on the mind-body connection and stress management as a tool that runners can use to recover faster, decrease the risk of running injury and hopefully even recover from overtraining injuries.
This week I got a couple of calls from runners who had various different forms of foot pain and they both said the doctor they saw said they had a condition called synovitis. They were both understandably confused because neither one of them really understood what “synovitis” really means.
Synovial tissue is the tissue that makes the fluid that lubricates your joints. The fluid on the inside of your joints is called “synovial fluid.”
This is the stuff that lubricates and nourishes the cartilage on the inside of your knee joint, your ankle joint and all the other joints in your body. This fluid not only helps to lubricate the joint it also nourishes and keeps the cartilage healthy.
On the inside of the joint you have this soft squishy tissue, called synovial tissue, that makes that lubricating fluid. Sometimes you may hear it called synovium. Synovium and synovial tissue are synonymous. They’re both the same thing but they are different terms your doctor may use interchangeably to further confuse you.
Today on the Doc On The Run Podcast we’re talking about synovitis in runners.
Today on the Doc On The Run Podcast we’re talking about muscle atrophy after recovering in a fracture walking boot, and what runners can do to prevent it.”
I recently met Kim and she was explaining to me that she had an Achilles tendon rupture and then developed this same kind of muscle atrophy we all become concerned about. Fortunately for all of us, she was willing enough to come on the show and share her experience.
We are also going to talk about some strategies for avoiding all of the weakness if you ever have to wear fracture walking boot.
Sleep may be the most valuable, most abundant, least expensive, and yet most underutilized resource available to a recovering or injured runner.
If you are a runner, you are always recovering. You do tissue damage every time you run. If you run a little too much, or you run a little too far, you might get an over training injury. That overtraining injury is really nothing more than an exaggerated version of the intentional injury you are attempting induce when you are training.
Sleep Helps You Heal, Running Doesn’t Help You Heal.
Sleep is crucial for proper immune function, tissue healing and consequently healing after any hard workout or running injury. Sleep disturbances reportedly occur in one third of the U.S. population. Problems with sleep are so pervasive and detrimental that the Centers for Disease Control has declared insufficient sleep as a public health problem.
Interestingly, elite athletes have actually been cited as a group having poor sleep quality and reduced quantity of sleep in comparison to the general population. Why is that?
Today on the Doc On the Run Podcast we’re talking about how sleep is the recovering runner’s secret weapon.
The problem with running injuries is that they are easy to ignore. A little tightness here or little achiness there is nothing compared to the pain you feel in those final few miles of a marathon. Runners are used to ignoring pain. One of the most important elements of training for endurance sports is learning how to endure. After all, enduring is the name of the game. You have to learn how to keep running when your quads tell you to quit. You learn to ignore the burn, tune out the noise and keep going. You have to learn how to suffer.
It is just not surprising that runners ignore the early sensations they can signify the start of a running injury. What we have here, is failure to communicate. Your running injury didn’t start the day you called a doctor for help. Your running injury started weeks or months before you told anybody about it.
But I would be willing to bet that you knew it was there. Deep down inside, you knew something was wrong. Maybe you didn’t want to see it. Maybe you didn’t want to feel it. Maybe you didn’t want to acknowledge it. But I’ll bet you had some subtle clue trouble was brewing.
Today on the Doc On The Run podcast we’re talking about how communication can help prevent running injuries and help running injuries heal faster.
A goal is not a fantasy. A goal is not a dream. It’s a place you clearly want to end up. If that goal is important to you, I believe you can get there. No matter how far-fetched, outlandish, or seemingly difficult to achieve, there is always a way to get there.They set all kinds of goals for themselves, their families, their finances, and of course, their athletic goals as well.
For most people the process of goal setting includes some analysis of the past. Maybe your just look at how fast you have run historically. Maybe you look at how much money you made last year. Maybe you look at how much time you spent with your family. In all likelihood your goals are partly based upon your past performance.
Part of the reason we base or future upon our past achievements is that we want to make sure that our goals are achievable. After all, no one enjoys failure.
Today on the Doc On the Run Podcast we’re talking about how injured runners should focus on the goal.
Over and over patients tell me their doctor has told them to quit running. The doctor has said that running is at the root cause of the running injury. B.S.!
Breathing doesn’t cause lung disease. Eating doesn’t cause stomach upset or heart disease. Driving doesn’t cause automobile accidents. Spending money doesn’t cause bankruptcy.
Running doesn’t cause running injuries. Running isn’t the problem. It’s the choices we make when we are running (and recovering) that leads to a problem.
If you’re a runner it’s important you understand first and foremost that running does not cause running injuries. And if you happen to get injured and you seek treatment for your running injury it’s important you understand how to talk to your physician and convince your physician that running is not the problem.
Rodney asked about a non-displaced fifth metatarsal fracture. He said “Hi, it’s been 8 weeks and my orthopedic doctor says it’s healed. Even though the x-ray doesn’t look like it’s healed. There is still a black in the gap where it was broken. He says that line will be there. Is this possible?”
Metatarsal fractures are extremely common. In fact metatarsal bones are fractured more often than any other bones in the foot among runners. Because these little bones happen to be the longest bones in your foot they’re also crucially important to the stability and structure of your foot. So you have to make sure they heal before you can get back to running with confidence.
X-rays are the most frequently used diagnostic tool to evaluate the positioning and state of healing of fractured metatarsal bones. But there’s a lot of variability in the appearance of a fractured bone when you’re looking at it on an x-ray.
In this week’s podcast were talking about how x-rays show metatarsal fracture healing.
Today on the Doc On The Run Podcast we’re talking about how you can tell when it’s okay to resume running with a stress fracture.
A runner named Whitney recently sent a great question to me on Twitter. Whitney asked “if you suspect a stress reaction/fracture how do you know when it’s healed enough to resume running? Thanks for your podcast!”
As we all know stress fractures in the foot are one of the most common overuse injuries among runners. But just because stress fractures are common, it doesn’t necessarily mean that every runner who gets an aching, throbbing pain in the ball of foot has a stress fracture. And even if you do have a stress fracture you have to figure out what that really means. So, here are the 10 steps to use when you’re trying to figure out whether or not your stress fracture has healed enough to resume running.
Today on the Doc On The Run Podcast I’m really excited to have Marla on the show to talk about her experience with recovering from a running injury.
Running injuries can be really difficult for lots of reasons and one of the reasons I think they seem to be so difficult is that the standard of approach in medicine is to first tell you to “stop running”. Sometimes the standard medical approach, or the “standard of care” as we like to call it, can send you spiraling down this path of frustration and despair and it becomes more and more difficult to actually get yourself out of that spiral.
But Marla has a really great perspective on everything involved and trying to navigate the whole medical system and actually recover, not just using the standard approach which is usually offered to us when we get injured, but really trying to step back and look at all these different components of recovery from an injury and then try to really change what she was doing, assess what she was doing and make changes as she went throughout the course of recovery to try to really get the best improvement as quickly as possible.
Today on the Doc On The Run podcast we are going to discuss how Paternalism fails runners.
During a sermon one Sunday morning in 1896 in Dayton, Ohio, Bishop Milton Wright said, “If man was meant to fly, God would have given him wings!”
Lucky for us, his sons didn’t listen. Had Wilbur and Orville actually taken their father’s admonitions to heart, it would certainly take us a lot longer to get from San Francisco to New York.
As a father myself I cannot believe the good bishop was hoping to crush his children’s dreams. I can only assume he wanted to protect his boys. He wanted to protect them from what, to him, seemed to be a foolish idea of propelling themselves through the sky. He didn’t want them to die in the process of seeking an adventure.
In retrospect, it is clear Bishop Wright had the wrong idea. His kids wanted to fly. And so they did. The doctor wants to protect runners from further injury. It’s part of the Hippocratic Oath: “First, do no harm.” It’s part of what they have sworn to do. But doctors should also encourage you to fly. They should look for new ways to get you from point A to point B. They shouldn’t look at the old methods of healing and recovery and think it’s enough for an injured runner.
Nobody wants to ride a donkey from San Francisco to New York. It’s the doctor’s job to help you look to the sky. It’s the doctor’s job to help you fly.
Stress fractures are one of the most common running injuries. And every runner who gets a stress fracture has to, at least in same capacity, reduce their activity to heal. Sometimes the runner has to stop running for a brief period of time. Sometime you can just run less, modify the way that you run, or come up with some creative strategies to keep running.
You never get a second chance to do your first marathon, so you certainly need to do everything possible to stay fit and not lose all that effort you put into training. You also need to make sure that your injury is not just healed enough that you can start running, but then get sidelined a few weeks before the race. Obviously that would be heartbreaking.
Today on the Doc On the Run Podcast talking about whether or not runners need to get an MRI when they think they have a stress fracture and want to get back to running.
Pain is a part of running. There is a saying often lauded by athletes and we have all heard, “Pain is just weakness leaving your body.” We affectionately call our training studios “Pain Caves.” We bask in the discomfort of pain, knowing it will make us stronger. In training we embrace pain as an ally.
But when you get an over-training injury, pain when running is no longer your friend. The pain forces you to run slower or run shorter distances. Pain forces you to skip workouts. Pain is wrecking your training schedule. Pain is in the way. Pain is your enemy.
In this episode we’re talking about how a pain journal can help you get back to running sooner.You can keep track of that pain and use it as a tool to recover as fast as possible and get back to running.
A few days ago a guy named Vito sent in a great question.
“I was in a walking boot for 6 weeks due to ankle fracture, no surgery. I am out of the boot and doing physical therapy to restore flexibility and strength. Can I safely being running again after a period of time?”
This is a very common question I hear from runners simply because one of the most common treatments for running injures like stress fractures, stable ankle fractures, Achilles tendinitis, peroneal tendinitis and even chronic plantar fasciitis is a fracture walking boot.
The truth is that a fracture walking boot is very effective at immobilizing the foot and ankle. That immobilization can certainly help many common running injuries heal faster.
Today on the Doc On the Run Podcast we’re talking about when you can start running after wearing a fracture boot.
Today on the Doc On The Run podcast I’m really excited have Dr. Vinh Ngo from Smart Medicine San Francisco. Doctor Ngo is going to explain hormone replacement as a way to make sure your training at full capacity and at lowest risk of injury. Dr. Ngo is a UCSF trained physician and he is an expert in men’s health and hormone optimization. So today I’m really excited that he’s here to share his integrative approach which can help athletes train harder by looking at hormonal limiters to identify changes that can be managed to improve the overall health and resilience of an athlete’s body.
A few days ago I was doing a phone consultation for a patient who had a fracture in his fifth metatarsal. I was trying to help him understand how important it is to reduce inflammation to speed healing. During our call he asked a great question.
“Should I wear compression socks if I have a running injury?”
In this episode were talking about whether or not you should wear compression socks when you have a running injury.
Today on the Doc On The Run podcast we have Tina Deane who is the owner of Massage Works in Los Gatos.
This episode will help you understand how runners and triathletes can use massage as a tool to simply run more, train more, train harder, workout more, build your fitness more with a lower risk of injury.
Discipline is the difference between choosing what you want now and what you want most.
The problem with discipline is that most runners often seem to perceive discipline and hard work are synonymous. After all, it does take lots of discipline and hard work to become a strong runner. We learn to suffer. Through discipline we learn to put on our running shoes and run in the dark. We run in the rain. We run through aches and pains because we have, through years of training, developed discipline.
So it’s not really surprising that when an overuse injury stands between where we are now and where we had planned to be, many runners think they can just tough it out, power through and keep running anyway.
In today’s podcast, we’re talking about discipline and what it takes to recover from running injuries.
My ankles pop and click all the time. They have for years. I am going to help you understand whether or not you might have subluxing peroneal tendons and whether or not it’s a problem.
If you think you have peroneal tendon subluxation you probably have some popping or clicking sensation or maybe even pain at the outside of the ankle. So what causes all of that noise?
Today on the Doc On The Run Podcast we’re talking about peroneal tendon subluxation in runners.
Today on the Doc On The Run Podcast we’re talking about peroneus longus tendinitis, and what runners can do about it.
Whenever I do consultations for runners who have peroneal tendinitis, they seem to be confused. Even though many of them have already been seen by an emergency room physician or their primary care doctor, they seem to be really unclear about what exactly is going on in their foot and ankle. If you aren’t clear on what is wrong, it’s hard to be clear on what you need to do to heal, and run without further injuring the tendon.
Part of the confusion lies in the fact that there are two different tendons (the peroneus brevis and the peroneus longus) which both run down the side of the leg and then attach to your foot. But they attach to your foot in different locations and they both do different things. Because they have different functions, they can become injured in different ways.
If you want to get back to running as quickly as possible it’s extremely important to figure out exactly which one of the two tendons is bothering you. Understanding which one is injured will give you a better chance of getting the tendon to heal faster, and get back to running sooner, without re-injury.
In the earlier episodes we explained that peroneal tendinitis is just inflammation of one of two tendons on the outside of your ankle: peroneus brevis and peroneus longus. In most runners these are overuse injuries.
Although they have similar names and they’re both in a similar location they each have very different functions when you run. In the simplest terms, they work together to act as your landing gear when your foot hits the ground and you decelerate. They both stabilize your foot.
But these two tendons stabilize your foot in very different ways. In this episode we’re going to focus specifically on the peroneus brevis tendon, how it works, how it becomes inflamed, and what you can do to make sure that you calm it down. We will also discuss how you can strengthen the peroneus brevis so it doesn’t become a problem again that could disrupt your running in the future.
If you are listening to this, you’re probably a runner and you probably also have pain on the outside of your ankle. You may have already been to see a doctor, or you may just be trying to figure this out on your own. Either way, either you or someone else has suggested that you have a problem with the peroneal tendons. And you’re probably worried that it’s going to screw up your ability to run at least for the next several weeks.
Your doctor may have told you, or you may have read, continuing to run with peroneal tendinitis can result in permanent damage to the tendons. So a diagnosis of peroneal tendinitis can and should be concerning. The most important thing is to figure out whether or not you actually have peroneal tendinitis or you have another condition that might be easier to treat, like peroneal tenosynovitis.
Today on the Doc On The Run podcast we’re talking about peroneal tenosynovitis in runners.
I recently had the honor of being interviewed by Runner’s Connect to contribute my thoughts on peroneal tendinitis in runners. This live recording was part of the 4-Day Injury Prevent Summit where Runners Connect interviewed 25 of the world’s most renowned running injury experts.
This episode is going to be an overview on peroneal tendon injuries in runners. For most of you listening this, it will give you all the information you need to figure out what’s going on with your peroneal tendons and get back to running. Make sure you go to the show notes page and I’ll explain how you can also get access to the corresponding video lecture that was presented during the 4-Day Injury Prevention Summit.
In Part 1 of our series on Achilles tendinitis we talked about how runners with mild forms of Achilles tendon injuries can decrease the inflammation, decrease the stress and tension on the Achilles tendon, get better and keep running.
But we also talked about the unfortunate reality of some runners having a tendency to ignore these injuries when they are in there earliest stages. Because many runners have a high pain threshold you may not even notice the first stage of Achilles tendinitis.
If you don’t notice there is a problem, it’s unlikely you will treat the problem. So you may be one of those runners who just really didn’t realize you were developing a problem with the Achilles tendon. You might have noticed some weird sensations that went on for months.
If so, you may have developed one of the more severe forms of Achilles tendon injury.
In today’s podcast we’re talking about how runners with severe cases of Achilles tendinitis keep running without surgery.
Today on the Doc On The Run Podcast we’re talking about how runners with Achilles tendinitis skip the doctor visit and keep running.
The Achilles tendon is the biggest tendon in the body. So when the Achilles tendon gets injured, the runner has a really big problem. If you neglect the early sign of problems with the Achilles tendon and develop a severe form of Achilles tendinitis, you can be crippled temporarily and have your running form altered permanently. In short, you may never run the same way again.
If you’ve been running with an aching pain in the back of your leg down near your heel and you worry you have Achilles tendinitis you’re probably freaked out and concerned that you’re going to have to stop running. But don’t worry. I’m going to explain to you exactly what runners do that helps them get over those early forms of Achilles tendinitis without ever seeing a doctor.
Today on the Doc On The Run Podcast we’re talking with legendary orthopedic surgeon Kevin Stone about runner’s knee and knee preservation strategies for runners.
Although many of our guests have some incredible accomplishments, that list is usually pretty short. But that’s not the case with Dr. Stone. We could truthfully use the entire time normally allotted into the podcast just reading his list of patented surgical devices, advances in orthopedic surgical technique and ongoing research and advances of Orthopaedic knee surgery.
As a grossly abbreviated introduction I will simply say that Dr. Stone completed medical and surgical training at both Harvard and Stanford University and then went on to additional fellowship training and further specialization in knee surgery directly under the founder of the world famous Steadman Clinic. All that experience alone would make him one of the world’s best rated knee surgeons. But that was only Dr. Stone’s start in the specific area of knee surgery. Dr. Stone has developed and patented dozens of medical devices and surgical techniques. He’s also been actively involved in orthopedic biomedical research and published dozens of studies relate to knee surgery in a variety of period review medical journals. Because he has such a high level of expertise and experience, particularly in the realm of knee surgery, he gets invited to travel to medical conferences all over the world to teach other orthopedic surgeons the specifics of his joint preservation research and knee surgery techniques.
Today on the Doc On The Run podcast we’re talking about Lyme disease.
I was recently out for a run on the Dipsea Trail which goes from Stinson Beach to Mill Valley California. It is really beautiful and strenuous, but like most trail runs, it goes through the woods and there are a lot of critters living in the wood including ticks.
While I was on that run, my legs were constantly dragging through brush, tall grass and limbs. I kept thinking about ticks and I kept thinking about someone I met a few years ago at Ironman Cozumel and she has been on a terrible, yet truly inspiring journey with Lyme Disease.
In thinking about all she has gone through with this horrible disease it occurred to me that many runners are simply unaware of the real risks associated with tick-borne illnesses and for that reason I thought it would be great if we could have her on the show to discuss everything she has learned about chronic Lyme disease and how to prevent it. Fortunately for all of us, she agreed!
Today on the Doc On the Run Podcast, we’re talking about what a runner should do if you’re worried the pain under the big toe joint might be a sesamoid stress fracture.
Sesamoid stress fractures may be one of the very worst injuries affecting runners. In fact, of all overtraining injuries that could actually seriously put your future of running at risk, it may be the sesamoid fracture that has the potential to ruin your ability to run forever.
Pain in the ball of the foot under the big toe joint can have a few causes.
The key of course is to make sure you know which condition is causing the trouble.
So first and foremost, you want to make sure that you don’t miss a sesamoid injury.
Summer has a dirty little secret…
If you get injured and wander into the hospital in the summer months you are more likely to end up with a bad result. Believe it or not, statistically, you are even more likely to die.
Your chances of dying in a hospital are highest in July. A study published in 2010 in the Journal of General Internal Medicine exposed one of medicine’s dirty little secrets. All medical internships, surgery residencies, and fellowships begin on July 1st every year. Because of this, July is simply the riskiest month have foot surgery or any other surgical procedure associated with hospitalization.
This is not complicated. After eight years of sitting in college classrooms and medical school lecture halls, the wet-behind-the-ears medical intern is just itching to try out all of those skills he or she has read about. The problem is, they have a lot of learning left to do.
You don’t really want to be the first person when a new foot doctor tries to make a surgical incision on your foot. You also don’t want that new, nervous, over-worked and sleep deprived intern fumbling through a pharmacy handbook while writing your medication orders at 4:00 a.m. You are far more likely to have a bad outcome in July for several reasons.
In this episode, I will discuss the 5 tips to avoid surgery complications in July.
If you’re a runner, the chances are good at some point in your running career you have had an aching, throbbing sensation in the front of your shins. And chances are also good if you talk to your running buddies they would quickly explain to you that you have a case of shin splints.
Shin splints may be common, but they can also be confusing.
As I have said in many other episodes, you have to know what you are treating, before you can treat it correctly. If your doctor has misdiagnosed your condition, or if you have misdiagnosed yourself, you may be using the “right treatment” on the “wrong problem.” Of course if you do that, it’s unlikely you will improve.
In this episode we are going try to eliminate some confusion so you can know what to do if you get a case shin splints that doesn’t seem to go away.
Is over-resting slowing your recovery? It might be. Sitting still is a killer for athletes. Not only does it bum you out, but a long period of immobilization can actually increase your chances of having another injury later.
A few days ago I got a call from an athlete who had been unfortunate enough to have a serious injury that required surgery. So when he called me, he already had surgery and was well on the way to recovery.
After six weeks of rest he felt like the rest was killing him. And he had just been told by his doctor that he needed another month or so of rest before he could start regaining strength and becoming active again.
Understandably, he became frustrated.
Today on the Doc On The Run Podcast we’re talking about how over-resting can actually slow down your recovery from a running injury.
Let’s face it, the primary tool used by runners are running shoes. Although we often think about heart rate monitors, GPS watches and all sort of fancy fabrics for our running clothes, nothing will affect your performance as much as the very best, properly chosen running shoes.
Given I am a sports medicine podiatrist with a practice catering solely to helping runners run, and I like to run, you can rest assured I always run in the very best running shoes.
And not surprisingly, other doctors, and lots of runners ask me which running shoes are the best. That’s not an easy answer. Of course the short answer is that the best running shoes are the ones that work best for you. But you have lots of variables. Your foot type is probably different than mine. Chances are good that you’re a faster runner than me. You also probably have a different training regimen and set of goals for this year. Your running shoes are supposed to help you run further, decrease your risk of injury and protect you while you train.
The very best running shoes are always an accurate reflection of the runner’s particular biomechanics, running form, training regimen and particular goals. So in this episode we’re going to talk about some of the ways you might want to reconsider your running shoe choices.
Whether you’re training for your first 5K, a half-marathon, Ironman triathlon or 100 mile ultramarathon, you have to put in lots of miles. To keep logging miles, increasing your speed and building your strength…you have to avoid injury.
The real game with building strength and fitness in long distance running is to systematically stress your tissues so those muscles, bones, tendons and ligaments all have to rebuild themselves and become stronger.
So whether you are self-coached, you purchased an online training program, or you have hired a professional coach to help you, the task is to help you choose workouts that will deliver the maximum amount of tissue damage that your body is capable of rebuilding before your next key workout.
But if you do more tissue damage than your body is capable of rebuilding, and then you do another hard workout, you get an over-training injury. In this podcast we’re talking about overtraining myths, and other B.S. that you need to know to avoid an overtraining injury.
This week I was invited to lecture on Runners Heel: Pearls for Podiatric Physicians at the International Foot & Ankle Foundation Meeting at the Swedish Medical Center in Seattle, Washington.
The attendees to this conference included podiatrists, foot and ankle surgeons and sports medicine specialists. The lecture was on runner’s heel pain and I was discussing the differences between plantar fasciitis, infracalcaneal bursitis, neuritis and stress fractures of the heel bone.
The goal was to try to explain to doctors the ways that they could tell the difference between all these conditions in runners how they can help their patients continue running even if they have a partial rupture of the plantar fascia or plantar fasciitis.
As a runner, you will find the main lessons of this talk helpful…
Today on the Doc On the Run Podcast we have a truly inspirational guest: the Iron Cowboy, James Lawrence who is famous for settling two world records: both the number of Half Iron Distance triathlons done in one year and then in 2012.
He also set a new world record for the number of full Iron Distance triathlons done in one year.
But then, he did 50 Ironman distance triathlons in 50 days, and in all 50 states!
The very fir
st step in healing a plantar plate sprain is to make sure that you don’t make the condition worse. Because it’s a tiny little ligament and it’s easy to make it worse!
In many cases you can continue to run and still heal a sprain of the plantar plate. But this depends on many different factors. However, there are some exercises which I believe are much more stressful than running when it comes to the stresses applied to the plantar plate. If you do these exercises you can rest assured that a tear in the plantar plate is going to continue to get worse.
So without further ado here are the top five worst exercises for a plantar plate tear.
One of the less common ways you can get pain in the ball of the foot is if the cushioning within the foot becomes diminished. If that happens it can feel like you’re walking on rocks or standing right on the bones on the ball of the foot.
If you think about it, when you stand up, your skeletal system, primarily the bones and everything that hold the bones together is what supports you. Obviously, you have a lot of bones in your foot. The bones are resting on top of the skin. So if you think about all that weight pressing down on the skin, what is it that prevents the skin from hurting?
Well, it’s your fat pad. It’s the natural cushioning or padding between the bones and the skin at the ball of the foot.
Today on the Doc On the Run podcast we’re talking about fat pad atrophy in runners.
If you’ve been training for a marathon or any other event and you suffer a running injury the first thing that happens is that you become concerned that your foot is going to hurt and slow you down during your training. But then as things get worse you actually realize it may not just hurt when you’re running. You may have to change your training schedule or even stop running to get it to heal.
If you’ve ever suffered this sort of contemptuous delivery of healthcare, you may have become concerned your doctor really doesn’t have your best interests at heart. Maybe she just doesn’t understand you or fully appreciate how important running is to you.
There are many reasons why doctors will tell runners to stop running. And although sometimes it is necessary to briefly pause your training when you get injured, you have to be on guard for those times when it seems like your doctor really isn’t on your team.
Is your doctor on your team?
Today on the Doc On The Run podcast we’re talking about 5 signs your doctor may not be on your team.
Ankle sprains are one of the most common injuries that brings an athlete to the emergency room. Of course, as we talked about before, the emergency room may be the very worst place to go when you actually have an ankle sprain.
Since many runners are starting to learn that they don’t need to sit around all day in the emergency room it’s important to understand what is a myth and what is reality when it comes to a sprained ankle.
If you understand a few simple things about ankle sprains you can make the best decisions about how to care for your ankle so you can get back to running as soon as possible.
In previous episodes we talked about the different causes of pain in the ball of the foot in runners. We talked about the differences between Morton’s neuroma, plantar plate sprains, and osteochondritis.
But a great question occurred to one of our listeners. Why didn’t you include metatarsal stress fractures in this series of discussions? After all, the metatarsal stress fracture can also cause pain in the ball of the foot in runners.
So today we’re going to talk about how you can tell the difference between metatarsal stress fractures, Morton’s neuroma, plantar plate sprains and osteochondritis.
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble. This episode is the third of a three part series that explains what you need to think about if you’re a runner seeking treatment for these problems. Previously we talked about pain in the ball of the foot caused by plantar plate sprains and neuromas.
Today, we’re going to talk a little bit about another condition which is in a similar location in the ball of the foot and can also cause pain in runners.
In this episode we’re talking about pain in the ball of the foot in runners caused by a condition called “osteochondritis.”
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble. This episode will be the second of a three part series that explains all of the things you need to think about if you’re a runner seeking treatment for any of these problems. Last week talked about neuroma treatment in runners. Today I’m going to explain a little bit about another condition which is in almost the exact same location as a neuroma.
The plantar plate is a small ligament on the bottom of the joints located in the ball of the foot. It is really just a thickening of the joint capsules. Because the plantar plate is located between the heads of the metatarsal bones and the ground, you’re basically standing on the plantar plate whenever you walk or run. If the ligament comes sprained it can be very painful. Often times, runners and even some doctors confuse a plantar plate sprain with a Morton’s neuroma.
If you are a runner and you have pain in the ball of the foot there are really only a few conditions that could be causing the trouble.
This episode will be the first of a three part series that explains all of the things you need to think about if you’re a runner seeking treatment for any of these problems.
The most common cause of pain in the ball of the foot is most likely a neuroma.
So in this episode we’re going to talk about neuroma treatments and give you some things to think about, and to discuss with your doctor…before you receive any potentially damaging treatment.
Overtraining injuries come in lots of different forms. Metatarsal stress fractures, Achilles tendinitis, peroneal tendinitis, and plantar fasciitis, they all may affect different structures but what they all have in common is an impending inflammatory response.
When you feel any aching sensation in your foot or your ankle and you think you have an overtraining injury, you want to take steps to control the damage and prevent things from getting any worse. Believe it or not there are a lot of simple things you can do to speed the healing and then get back to running as quickly as possible.
In this episode we’re talking about the first steps you should take when you think you have an overtraining injury.
If you are a runner and you start having pain in the ball of your foot, you might be worried that you have a stress fracture. So you have a couple of choices. One option is to go see your local orthopedist or sports medicine podiatrist. The second option is to stop running and see if the pain gets better.
If you’re listening to this podcast right now you are likely not very interested in option number two. After all, most runners want to run. So you might try to figure out a third option such as trying to treat the problem yourself. Although I believe it is truly possible and reasonable for most runners to figure out the problem and attempt to address it themselves, this episode is going to discuss what happens when you actually go to a doctor with pain in the ball of your foot and you are diagnosed with a condition called “metatarsalgia.”
The unfortunate reality is that every single day, over 10,000 suspected ankle sprains show up in the ER.
While an emergency room may be the best place for someone with a heart attack, it isn’t the best place to get treatment for a sprained ankle.
Today on the Doc On The Run podcast we’re going to talk about the first things you should think about if you believe you need treatment after you sprain your ankle on a trail run.
Today on the Doc On The Run podcast we’re talking with sports nutritionist and triathlete Heidi Buttery about Good Fat, Bad Fat and Fat Fueling as a way to fuel better and avoid running injuries.
She will discuss what she knows as a nutrition coach, how that’s all tied together and to give idea of her approach, where she came from and what she’s up to now.
Last night I did a remote consultation for a patient who had a broken toe and wanted to get back to running.
That discussion generated several thoughtful questions that I have heard before. These are all excellent questions for an injured runner!
So we’re going to talk about all of the things that you should consider if you’re a runner and you break one of your toes, but want to keep running.
Minimalist running shoes, maximalist running shoes and barefoot running, they’re all some of the more recent trends in running and running shoe technology.
There’s a lot of debate around these different kinds of running shoes as well as different running forms and I was recently invited to give a lecture at the International Foot and Ankle Foundation meeting in Lake Tahoe on February 17, 2017.
Today on the Doc On The Run podcast we’re talking about the differences between minimalist and maximalist running shoes.
If you are a runner, and you got a running injury, you may have been to the doctor. And let me guess, your doctor told you to stop running.
Today on the Doc On The Run podcast we’re going to talk about the ways stopping running can place you at higher risk of running injuries down the road.
Today on the Doc On The Run podcast we’re speaking with Brad Beer, legendary physical therapist and Amazon best-selling author of “You Can Run Pain Free! A physio’s 5 step guide to enjoying injury-free and faster running”.
In this episode you’re going to learn about Brad’s approach to decreasing overused injuries that plague endurance runners and long-distance triathletes.
If you are runner, you probably like to run. If your get injured, you probably still want to run. You need a doctor who will be on your team, not the other way around.
Times in medicine have changed. It used to be that there was this very paternalistic attitude among doctors. Whenever the patient would seek treatment, the doctor would simply tell the patient what to do. The patient was expected to do as he was told.
But in the last few decades the power has clearly shifted back toward the patient. Patients expect good customer service, expert advice and expect to get better. The advent of the internet has done more than any other single factor to shift the power of healing back toward the patient. In today’s podcast, I will discuss the top five reasons runners should fire their doctor.
Today on the Doc On The Run podcast we’re talking with Darin about his history of issues with the plantar fascia and being an athlete and what it takes to get back to training and recovery and survive these types of injuries.
He shares his experience as a runner with a partial rupture of the plantar fascia who was able to get back to running and training.
The other day I got a call from a patient who had an injury and briefly she explained her scenario and then she asked me the million dollar question, “Do I really have to stop running to get better? More importantly, is it possible that I might actually have to stop running forever because of this injury?”
That’s the big concern we all have as runners. It is a pretty common question when runners get injured. So today I’m going to share my opinion about when people should stop running and not stop running.
All of the information I’m going to present to you today is based upon on a lecture that I first presented to doctors at the International Foot & Ankle Foundation meeting at the annual medical conference in Lake Tahoe.
Today on Doc On The Run podcast we’re talking about everything that runners should need to know about surgery on the plantar fascia.
It’s really important that you understand what all the different surgical procedures mean in terms of the procedures themselves but also what that mean to you as a runner.
I personally believe that my entire job is to help runners continue running and so I have a perspective that’s a little different than some other surgeons. So we are going talk all of the special considerations that you need to take into account if you’re considering surgery on the plantar fascia.
Which is better…clear healthy toenails or thick, yellow, black and blue or missing toenails? Running can be hard on the feet. We all know that lots of runners bash their toes.
But neglected tootsies can lead to discolored toenails and even lost toenails if you’re not careful.
In today’s podcast, I will discuss the Top 5 Mistakes Runners Make with Their Toenails.
Jess is an amazing athlete. She got a Kona slot in only her second Ironman and then in 2011 became the 2011 70.3 Ironman World Champion and since that time she’s been racing Pro.
On the past year Jess has had some major life shifts and I think that her experiences can help all athletes understand the importance of priorities and focus as life unfolds. She recently started coaching full time, she had a baby and then she got right back to racing.
In this podcast, Jess is going to discuss about all the special consideration surrounding running, training and maintaining fitness before and after pregnancy.
Dr. Mayo holds a Ph.D. in Exercise Physiology and is a registered dietitian (RD). He is an associate professor and has published close to 50 articles in lay and scientific journals regarding various aspects of fitness and nutrition.
Also, Dr. Mayo has been quoted in magazines such as Men’s Health and US Weekly. Don’t worry, he doesn’t just write about this stuff…he walks the talk, too. JJ has done ultramarathons, he qualified for the Boston Marathon and he has finished 10 Ironman triathlons. He knows what it takes to use nutrition and apply it directly to putting miles on the road.
Today, he shares his expertise about nutrition and what it takes to fuel athletes not only in races, but in the recovery process.
One of the biggest concerns of injured athletes returning to activity is whether or not they should be concerned about pain when they start to run.
This is a great question and certainly a valid concern.
Pain is your body’s indicator that something is not right. But you have to figure out which pain is acceptable and which pain is unacceptable.
In this episode, we are talking about how to discern good pain from bad pain when returning to running after you heal an over training injury.
Today we’re talking with nutritionist and PRO triathlete Kim Schwabenbauer about the importance of a nutrition assessment for runners as well as tips for enjoying the holiday season without guilt.
Kim is a long time athlete. She ran cross country in high school, she was Team Captain of both her cross country and track teams at Penn State. She has been doing triathlons for over 10 years. She’s won lots and lots of races. She was the amateur champion at Ironman Cozumel and Ironman Lake Placid. She’s even raced at the Ironman World Championships in Kona Hawaii 4 times. And she is fast, fast fast…she actually clocked a 3:01 Ironman Marathon time.
Every day I get calls from injured runners. Whether their foot is aching when they run and they think they have a stress fracture or if they twisted an ankle on a trail, the number one question I get is, “should I get an x-ray?” Whether or not you need an x-ray depends upon several things.
But x-rays don’t always tell the whole story. And there’s also a widespread misconception that if an x-ray doesn’t show anything then you need an MRI or Ultrasound to figure out what is going on with your foot. Frankly there’s just a lot of misunderstanding about X-rays and running injuries. So in this episode we’re going to talk about all of the myths about x-rays and running injuries.
Last week we talked about how you can choose a running surface that will decrease the stress and strain on your foot.
The one component of running surfaces that we did not address in that episode was how hard a certain kind of surface can be on your feet.
Today we’re going to talk about concrete, asphalt, grass, sand and all the different running surfaces.
Considering the different traits of the path you choose is important if you are hoping to avoid injury, or return to running after an injury and make sure you don’t get re-injured.
If you are a runner with an injury that affects one side of your foot more than another, like plantar fasciitis, picking the right running surface can make the difference between being able to run and still heal, or running and making your plantar fasciitis much worse.
San Francisco running expert, podiatrist and Ironman triathlete Dr. Christopher Segler explains how to pick the right surfaces to decrease the stress on your plantar fascia when you run with heel pain.
Today we’re talking about how runners use stem cells to get back to running faster.
In this episode I am going to discuss how stem cells have the potential to transform into any and all of the cells necessary to help speed the healing process.
Today we’re talking about the 5 biggest mistakes runners make when they think they have a neuroma.
We’re going to discuss the most common mistakes I see runners make when they start to develop a neuroma in the ball of the foot.
Today we’re at A Runners Mind speaking with Dawson, who is a true running shoe expert.
We’re going to discuss the ways that runners can troubleshoot these injuries and keep running.
Today we are featuring a recorded portion of an interview with Dr. Segler for an injury prevention seminar for RunnersConnect.
In this episode you’ll learn about the importance of vitamin D as it relates to muscle strength, not just bone density.
You’ll also learn about strategies for listening to your body that will help you when you might be developing a running injury.
Today we are featuring a recorded portion of an interview with Dr. Segler for an injury prevention seminar for RunnersConnect.
In this episode you’ll learn some strategies to modify bad habits so you can heal faster and get back to running.
To most runners an over-training injury is their worst nightmare. The reason that these injuries are so terrible to most runners is that they happen at the worst possible time.This often happens 4 to 6 weeks out from your race.
So just as you start to see the light at the end of the tunnel, just when you start dreaming of your taper, disaster strikes. You get injured.
But all is not despair.
Today we are talking about why runners have an unfair advantage when it comes to healing an injury, and how those advantages can help you recover faster than the average non-runner.
Fracture walking boots are one of the most often prescribed treatments for running injuries such as stress fractures and tendinitis.
But runners have a much higher price to pay for immobilization.
In this episode we are going to explain why fracture walking boots are one of the worst treatments possible for an injured runner.
Today on the Doc On The Run podcast we are at A Runner’s Mind speaking with Dawson Alexander, who is a wicked fast runner and a bona fide running shoe expert.
In this interview you get the dual perspective which will combine Dr. Segler’s knowledge of running injuries with Dawson’s experience and knowledge in running form analysis and running shoe selection.
Together they will help you understand how your running form and proper running shoe selection can help you continue running even if you have plantar fasciitis.
Felicity Joyce is a well known inspiring endurance athlete. She was the youngest female to win the Australian National 24-hour Track Championships and earned the young Australia Rising Star Award from Athletics Australia and Sports Person of the Year. She also knows how to overcome injuries. Early in her career she had a terrible bike crash that left her almost crippled and unable to walk. Yet she was still able to qualify for the 70.3 World Championships in 2011 and 2012. Then in 2012 she won her age group at Ironman Louisville and qualified for Kona.
In today’s podcast, Felicity shares her experience and mindset in racing, coaching and getting back to racing shape after injury.
Barbara Peterson’s story is truly inspirational!
Less than a year after she broke both heel bones (bilateral calcaneal fractures), she was out of her wheelchair and on the starting line in Hawaii at the XTERRA World Championship where she won yet another title.
Today she shares how that experience shapes her approach in racing, life, and her work with other athletes.
Metatarsal stress fractures are common in runners, and so are the myths that surround them.
Do I really need X-rays?
Do I really have to stop running to get a stress fracture to heal?
Does it always take 6 weeks?
Can I keep training?
Doc On The Run debunks the metatarsal stress fracture myths.
Ice is often used by runners to decrease inflammation.
Believe it or not, there is a right and wrong way to ice running injuries.
Learn best strategies for icing and how Doc On The Run uses specific contrast bath, routines to remove swelling from the foot and ankle and speed healing after a running injury.
Ibuprofen is the most commonly consumed anti-inflammatory drug.
Many runners take it and even call it “Vitamin-I.”
If inflammation is part of the problem, why not take ANTI-inflammatory drugs?
Learn why, when and how runner’s use anti-inflammatory medications to get relief…and perhaps even more importantly, when runners should NOT take these drugs.
Did you know that in the overwhelming majority of cases doctors will recommend that you perform simple home treatments before they prescribe medications or consider more invasive procedures like injections or surgery?
When you need to fast-track the recovery process, it always helps to try some simple treatments at home before you see the doctor.
This podcast explains how doctors (or even a runner who hasn’t been to the doctor) can treat heel pain with simple treatments that can be performed at home without ever seeing a doctor.
Plantar fasciitis may be the most common cause of runner’s heel pain, but it is not the only cause.
If you are a runner and you think you have plantar fasciitis but you actually have another condition entirely. As a result, you may not get better.
You must understand how runners make the wrong call and fail to get better…and get back to running.
This podcast explains the main reasons runners with heel pain don’t get better, even if you think you have the correct treatment.
If you have foot pain that’s interfering with your running or training, don’t worry, there is help! You don’t have to stop running! Discover the approaches that help elite athletes get better even while they keep running. This podcast will explain how to get started on the right foot!