Doc On The Run Podcast

Doc On The Run Podcast

#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?

That’s a great question. Today on the Doc On the Run Podcast we are talking with the Bionic Runner about running 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.

Today on the Doc On The Run Podcast we’re talking about why runners who have high arches need cushioning running shoes.

#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.

#183 Put the trouble in the middle of the 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.

#182 The #1 Riskiest Running Activity

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.

#176 My foot hurt when I ran today…what do I do NOW?

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.

#174 Runners take note of Doctor’s F.E.A.R.

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.

#136  If you’re not moving, you’re actually getting more injury-prone

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.

#135 Runners fast forward healing

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.

#134 Don’t have high hopes for healing if you have downhill habits

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.

#133 Last week’s healing won’t heal you today.

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.

#132 Why runners heal faster

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.

#131 New Pain 10 Days Before Marathon Should I Run Now?

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.

#130 Should I Taper Or Keep Training Before My 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.

#129 The #1 Book Runners Should Read In 2019

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.

#128 Are Black Toenails Really A Big Deal For A Runner?

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.

#127: Who Will You Be 1 Year From Now?

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.

#126: What Is The Difference Between Tendinits And Tendinosis In Runners?

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.

#125: Goals For Healing Your Running Injury

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.

#124: How Long Will It Take To Heal A 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.

#123: 5 Causes Of Big Toe Joint Pain In Runners

Bunion picture from San Francisco's PodiatristToday 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.

#122: Collagen Healing- Is It Working For Or Against Your Running Injury

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.

#121: What’s The Difference Between A Doctor And A Librarian?

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.

#120: The One Small Shift You Need When You Aren’t Healing A Running Injury

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.

#119: Can I Run With A Split Peroneal Tendon?

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.

#118: 7 Steps When A Runner Is Not Healing

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.

#117: Top 10 Myths About Plantar Fasciitis In Runners

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.

#116: Is Running Risky?

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.

#115: Should A Runner Ice To Treat Soreness?

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.

#114: Inflammation Management: Keys For Runners

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.

#113: Inflammation In Runners- Sometimes It’s Good And Sometimes It’s Bad

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.

#112: 7 Healing Limiters That Slow Runners Down

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.

#111: 2 Reasons Runners Should NOT Get An MRI

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.

#110: Sub-Fibular Impingement Syndrome In Runners

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.

#109: Sinus Tarsi Syndrome In Runners

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.

#108: Extensor Tenosynovitis In 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.

#107: Why Doctors Misdiagnose Runners

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.

#106: Bone Stimulators For Healing Metatarsal Fractures

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.

#105: 3 Keys To Less Time On Crutches

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.

#104: Avoid Foot Fungus Around Swimming Pools

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.

#103: Why You Aren’t Healing Like A Professional Runner

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.

#102: Injury Recovery With Elite Triathlete Christiann Arbini

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.

#101: How Can A Runner Heal A Plantar Plate Sprain?

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.

#100: 100% Recovery Means Free Speed

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.

#99: How Can A Runner Heal A Stress Fracture

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:

  • Inflammation within the bone
  • Tissue damage to the bone
  • Too much stress preventing healing

You have to address all three if you really want to get better quickly and get back to running!

D#98: Can I Run With A Stress Fracture In The Heel Bone?

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.

#97: Can I Run With A Partial Rupture Of The Plantar Fascia?

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.

#96: How 2 Days In A Fracture Walking Boot Can Help You Decide If You Can Run A 100 Mile Race

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.

#95: Can I Run With A Metatarsal Stress Fracture?

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.

#94: Can I Run With Plantar Fasciitis?

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.

#93: How A Runner Got His Physical Therapy Aimed At His Running Goals

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.

#92: Can I Run With Peroneal Tendonitis?

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.

#91: Why Doctors Tell You To Stop Running

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.

#90: 4 Types Of Injured Runners Who Won’t Get Back To Running Quickly

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.

#89: 5 Plantar Fasciitis Treatments Your Doctor Is Selling That Runners DON’T Need

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!

 #88: The Only 3 Steps Runners Need To Heal Plantar Fasciitis

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.

#87: Top 3 Mistakes Runners Make When Getting A Second Opinion

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.

#86: Hope… An Invaluable Commodity

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.

#85: The Power Of Meditation To Relax And Heal With Jason Stephenson

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.

#84: Not Running Is Optional

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.

#83: There Is No Key To Healing. It’s A Combination.

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.

#82: Can You Fix The Plantar Fascia After Surgery? Question from a Runner

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.

#81: From 400 Pounds To Running 100 Miles

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.

#80: Stress Related Eating And The Consequences For Injured Runners With Stephan Guyenet, PhD

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.

#79: Mindfulness For 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.

#78: What Is Synovitis In Runners?

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.

#77: Muscle Atrophy After Recovering In A Fracture Walking Boot

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.

#76: Sleep – The Recovering Runner’s Secret Weapon

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.

#75: Communication Is The Key

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.

#74: How Injured Runners Should Focus On The Goal

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.

#73: Running Doesn’t Cause Running Injuries

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.

#72: How X-Rays Show Metatarsal Fracture Healing

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.

#71: How You Can Tell When To Resume Running With A Stress Fracture

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.

#70: Marla Explains How To Shift Your Mindset, Reset Your Expectations And Recover After An Injection Fails To Help A Running Injury

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.

#69: Paternalistic Medicine Fails Runners

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.

#68: Should A Runner Get An MRI For A Stress Fracture?

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.

#67: How A Pain Journal Can Help You Get Back To Running Sooner

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.

#66:  Can I Run After Wearing A Fracture Boot?

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.

#65:  Hormone Disrupters

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.

#64: Should I Wear Compression Socks If I Have A Running Injury?

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.

#63: How Massage Helps Runners Run More And Avoid 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.

#62:  Discipline And What It Takes To Recover From Running Injuries

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.

#61:  Peroneal Subluxation In Runners

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.

#60:  Peroneus Longus Tendinitis 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.

#59:  Peroneus Brevis Tendinitis In Runners

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.

#58:  Peroneal Tenosynovitis Is The First Peroneal Tendon Problem In Runners

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.

#57:  Peroneal Tendon Injuries In Runners: An Overview From The Runners Connect Running Injury Summit

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.

#56:  How Runners With Severe Achilles Tendinosis Heal Without Surgery

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.

#55:  How Runners Heal Achilles Tendinitis Without A Doctor And Keep Running

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.

#54:  Runners Knee Preservation Strategies With Dr. Kevin Stone

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.

#53: Lyme Disease

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!

#52: Sesamoid Injuries Are Risky For Runners

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.

#51: 5 Tips To Avoid Surgery Complications Common In July

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.
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#50:  Shin Splints: What To Do If Your Shin Splints Won’t Go Away

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.

#49:  How Strict Rest Can Actually Make Your Running Injury Last Longer

How Strict Rest Can Actually Make Your Running Injury Last LongerIs 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.

#48: You Need New Running Shoes

you need new running shoesLet’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.

#47:  Overtraining Injury B.S.

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.

#46:  Lessons On Plantar Fasciitis for Runners

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…

#45:  Iron Cowboy… 50 Ironmans In 50 States In 50 Days

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!​​​​​​​

#44:  The Top 5 Worst Exercises For A Plantar Plate Tear

The very first 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.

#43:  Fat Pad Atrophy In Runners

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.

#42:  5 Signs Your Doctor May Not Be On Your Team

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.

#41:  Top 5 Ankle Sprain Myths For Runners

Top 5 Ankle Sprain Myths for RunnersAnkle 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.

#40:  Difference between metatarsal stress fractures, Morton’s neuroma, plantar plate sprains and osteochondritis

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.

#39:  Osteochondritis In Runners

Doc On The Run PodcastIf 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.”

#38:  Plantar Plate Sprain In Runners

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.

#37:  Neuroma Treatment Is Different In Runners

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.

#36: PRICE The First Steps When You Have A Running Injury

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.

#35:  What Does Metatarsalgia Mean To A Runner?

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.”

#34:  What If You Sprain Your Ankle On A Trail Run?

sprain your ankle on a trail runThe 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.

#33:  Fat Fueling For Runners: Sports Nutritionist And Triathlete Heidi Buttery

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.

#32: Can I Run With A Broken Toe?

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.

#31:  Minimalist Vs Maximalist Running Shoes

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.

#30:  Why “Not Running” Is A Terrible Treatment For Running Injuries


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.

#29:  Interview With Brad Beer – Legendary Physical Therapist And Amazon Best-Selling Author Of “You Can Run Pain Free!”

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.

#28: Top 5 Reasons Runners Should Fire Their Doctor

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.

#27: Running After Partial Rupture Of The Plantar Fascia


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.

#26: When Do Injured Runners Really Have To Stop Running?

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.

#25: What Every Runner Needs To Know About Plantar Fascia Surgery

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.

#24: Top 5 Mistakes Runners Make with Their Toenails

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.

#23: Pro Triathlete Jess Smith On Training And Racing During And After Pregnancy

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.

#22: Dr. JJ Mayo On Race Day Nutrition Planning And Making Sure You Get Enough Protein To Prevent Running Injuries

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.

#21: Should I Worry About Pain When Running After My Injury Heals?

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.

#20: Pro Triathlete Kim Schwabenbauer On Nutrition Assessments For Runners And Enjoying The Holiday Season Without Guilt

14495522_10210271981652876_2092774839229352890_nToday 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.

#19: Myths About X-rays And Running Injuries

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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.

#18: Which Running Surface Is The Hardest On Your Feet?

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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.

#17: Choose a running surface to Heal Faster, Run longer and Heal Running Injuries

e-_doc-on-the-run_watermerk-images_preview-full-choose-the-best-running-surfaceIf 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.

#16: Can Stem Cell Therapy Help Runners Heal Faster?

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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.

#15: 5 biggest mistakes runners make when they think they have a neuroma

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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.

#14: Troubleshooting the Top 5 running injuries: plantar fasciitis, metatarsal stress fracture, Achilles tendinitis, shin splints and IT band syndrome

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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.

#13: Vitamin D, Muscle Strength And How A Runner Can Listen To The Body To Prevent Running Injuries

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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.

#12: Stresses and lifestyle habits that slow healing of the most common running injuries

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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.

#11: Why runners have an unfair advantage when it comes to healing an injury

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.

#10: Fracture walking boot: one of the worst treatments for a 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.

#9: A Runner’s Mind on Plantar Fasciitis, Running Form and Shoe Selection

arm-group-runsToday 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.

#8: Ironman Champion Felicity Joyce on the power of mindset in racing, coaching and getting back to racing shape after injury

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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.

#7: From 2 broken heel bones to running at a world-class level- An interview with 6-time XTERRA World Champion Barbara Peterson

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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.

#6: Metatarsal stress fractures six weeks of no running and other myths

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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.

#5: The best way for runners to ice when they have plantar fasciitis

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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.

#4: Should runners use NSAIDs when they have plantar fasciitis?

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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.

#3: Can home treatment heal runner’s heel pain?

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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.

#2: Why some runners with plantar fasciitis never get better

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.

Doc On The Run Podcast #1: The podcast for injured runners

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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!