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Today on the doc on the Run podcast, we’re talking about where you should start first when you have a stress fracture or a stress reaction and you’re trying to get back to running.
This episode actually comes from a discussion I had with a runner on a stress fracture strategy call. Now, this is a ten minute call where we can get on and talk about the things that you’re missing and mistakes you might be making, and figuring out the fastest, straightest line between where you are right now to actually completing your race.
So if you’re a runner who has a stress fracture or a stress reaction, you have a race on the calendar and you’re afraid you’re going to have to miss it or cancel it or defer your enrollment. This is where you should start, for sure. If you have a stress reaction or a stress fracture, then a doctor diagnosed you with. Yet, in spite of the things the doctor told you to do, you’re not really improving. Or worse, you’re even getting worse. This is definitely the place to start. And if you’re a runner who has a stress fracture and you’re losing your running fitness and you’re worried that you’re going to be weaker, and when you actually return to running, you’re definitely in the right place. We’re just going to talk about stress fracture strategy based on a discussion that I had with a real runner who has a stress fracture that’s not getting better. And so I took some notes and I actually asked very specific questions during this, um, this stress fracture strategy session. I’m going to discuss some of that stuff with you so that you can understand better what you should do.
Now, if you sign up for a ten minute stress fracture strategy, call with me, one of the things you’re going to get is a screen that says what this call is not:
A ten minute call with me does not make me your doctor. This is not establishing a physician patient relationship, neither with you watching this video. But I’m not going to assess you. I’m not going to make a diagnosis or recommend treatment for you during that call, and I’m certainly not going to recommend treatment based off a report from another doctor who interpreted the MRI without me actually looking at it. But what I promise I will try to do on any stress fracture strategy call is three things. What those three things are. I’m going to try to help you figure out where you really are in your journey back to running. Right now, I’m going to try to help you maintain your running fitness and figure out the things you might be able to do without making it worse, no matter what it is. And I’m going to try to help you uncover the missing pieces that may have fallen out of the discussion between you and your doctor.
Now, when we got on this call, the very first thing I said is what is the problem? And when you go to the doctor, they’ll usually describe this as chief complaint. And they want to know what hurts. Right. You know, chief complaint would be I have a headache or my big toe hurts. And what she said was, it’s been five weeks and the pain is getting worse. And I just said, okay, well, so that’s a progression of the condition. I don’t know what’s actually wrong with you. And she said the doctor gave me a boot and a walking shoe and it’s getting worse. And I was like, what is it? And she said, I was diagnosed with a stress reaction. And I was like, okay, which foot? Both feet or just one foot?
And what was interesting then is that in trying to get this information, she gave me a lot of very specific details. Now, that is a good thing. It’s only a good thing if your doctor can use those details. And so what she said was, um, that, you know, I was it’s only my right foot. And I have been diagnosed with a stress reaction, a stress fracture. But I said, on what date did it first begin? And she said on the when answer to that question, on the third day, I was running in new eight millimeter drop shoes, where I had previously been running in four millimeter drop shoes. I actually had a ten mile PR at an 815 pace. That’s a lot of detail. That’s good. That means that you, as a runner, are able to pay attention to all these different things that might actually matter, but your doctor is almost never going to ask you about those kind of things or those kind of details. But you have them. You remember them. In fact, when I said, okay, that’s great, that’s useful. But what was the actual date that started? Like, I want to know how long it’s been, not how long you’ve been running those shoes.
And she said it was 46 days ago when I started having pain, and I stopped running. And I asked, did you completely stop running that day when the pain started? And have you not been running for a month and a half now? And she said, yes. I said, okay, great. That’s helpful. Have you been exercising since that day? Yes, I’ve been doing an exercise bike. Okay. So what else are you doing? Well, I’m doing some core stuff. I’m doing some arm stuff, but mostly the bike. Okay. So then I asked her about her current goal and she said, well, my goal is to walk without pain. And I just said, well, I can’t help you with that. It sounds like you’re walking already. And I don’t know why we’re on this call, because what I do is I try to help injured runners figure out how they can actually run. I don’t help walkers. And she said, well, uh, actually. Okay, so I do. I’m signed up for a marathon on May 18th. That’s about a month from now.
But I’m getting worse. I’ve been getting worse over the last five weeks, and so obviously I can’t do that.
But my next goal would be the New York City Marathon in November if I get in and I said, okay, wait, why is it obvious that you can’t do this race in a month? And she said, well, because I’ve been getting worse. And I was like, okay, you know, one of the things I think it was Henry Ford, I don’t really remember, but I think the quote is, whether you think you can or you think you can’t, you’re probably right. And so if it takes no more energy to believe that you can versus believing that you can’t, why not believe that you can?
You have to make sure that you stay focused on your goal. And the only way that I help runners do that is I help them figure out how severe something is, figure out what the possibilities are. Work backward from that specific date of that specific race, and figure out what it would take for you to do the race on that day. I do this over and over, and so I explain to her, I said, okay, look, number one, are you in New York? And said, no, I have to find out. I’m like, okay, so now you don’t even have if you can the race in May, which you could, you don’t even have a race on the calendar yet. So that’s not really going to motivate you to get better as fast as possible. And so what I’m thinking is that, you know, if you have a race in May, it might be possible. And so I said, okay, let me give you like a one minute example of somebody that I helped who was able to do this.
This woman called me. She had excruciating pain in the middle of an eight mile run. She had to have her husband pick her up. She could not bear weight. When she got out of bed the next day, she was wearing a fractured walking boot for more than a week using crutches. And when she called me, the Tokyo Marathon was 12 days away and she wanted to run three hours at the Tokyo Marathon in 12 days, when she’s on crutches, when she can’t even walk on it. Does that seem reasonable? And the runner on this call said, no, that sounds crazy.
And , it does sound crazy!
However, here’s what happened. She did do the Tokyo Marathon, and when I talked to her the morning of the race, I said, this is what you’re going to do. You’re going to go down there now. And we talked about a whole bunch of stuff in that 12 days before them. But the morning of the race, I said, okay, put on your running shoes. Do you have any pain? No. Okay. I want you to go down to the starting line. I want you to start the race. You’re going to walk the first mile. If you have no pain after the first mile of walking, you can jog. If at the end of the second mile when you have jogged for one mile, you have no pain. You can ramp up to your desired race pace, and you can hold that pace all the way to the finish line, as long as you have no more pain. She finished that marathon in three hours and nine minutes. So if it’s possible for her with a calcaneus stress fracture in 12 days to finish in three hours and nine minutes, then why is it impossible for you to think that in a month from now, more than twice that amount of time, you might be able to get past this and be able to do the race? It might be possible.
I’m not telling you it is possible, and I’m not telling you to just ignore what your doctor told you and just like, keep doing what you’re doing, get worse and then go run. That’s not what I’m saying at all. I’m just saying that you have to at least entertain the possibility that it might be reasonable and possible for you to do it. And so if you’re in that circumstance right now, you’re just not sure you have to start thinking about this differently. If you really want to change things. And just staying focused on it’s not possible will only make it impossible for you.
My next question to her was how severe is it right now? And she said, I was told I have a stress reaction by the doctor. I’m like, okay, what does that mean? How severe is it? How bad is it? She said, I don’t know, but it’s in a high risk spot. I said, what is a high risk spot? And she didn’t even know what that was. And so I said, okay, would you agree or not agree that your doctor did not really tell you how severe it is, meaning how fast it’s going to heal or how soon you can get back to running, or what the possible bad consequences are if you don’t heal it.
She said, “No, I wasn’t told any of those things.”
Okay, so then, how severe is it based on medical imaging? She said I had an MRI and I said, okay. Did the doctor tell you anything about a grading scale like the Katie Miller grading scale? Was it a grade 1-2-3-4-5? Any of those things? Did you hear any of those terms? No. Okay, so based on the medical imaging, you don’t actually know how severe it is. Did you did the doctor explain to you about there was a crack or not a crack? No. No. Discussion of severity based on the medical imaging. What about on your self-exam? How severe is it based on your self-exam? And she said, well, I don’t really know. And I said, okay, well how bad is it right now? If we said a one is like basically nothing. Did you look at the Stress fracture severity worksheet? And she said, I looked at it, but I didn’t do it. And my thought was, okay, if you’re training for a marathon that’s a month away and your coach told you to go to the track and do mile repeats and you, you and then a week later when you talk to your coach again, the coach says how the mile repeats go. And you say, well, I went to the track and I looked at it. What are the odds you’re going to do well at your marathon? Probably not very good, right? And this is an opportunity.
That’s a one time opportunity to have a discussion with me. And we could have taken a lot of useful information from the Stress Fracture Severity worksheet, but it wasn’t even completed. You know, it was the runner didn’t fill it out. And so if you have that information when you go to your doctor, it’s going to help your doctor make decisions because they’re questions your doctor probably will not ask you. But you’ve got to make sure that you do the work to do the stuff to get better as fast as possible. But if you do that, the way that I go about this with strategy is very, very simple. The most important thing is the severity of the injury.
The reason that’s important is that you, as the runner, then have power to make decisions on your own without waiting for another X-ray, another MRI, another visit with the doctor, some other thing that’s off in the future that’s making you sort of preparing to prepare, to get ready, to get ready to get better. Instead, you can make decisions immediately based on what you yourself see, and then you can do some things to get the right assessment, like if you know what your pain level is, and then you try some things to reduce the stress and strain on the bone and your pain goes down. Obviously that’s an improvement, right?
What that implies is that you have an ability to do more exercise and maintain your running fitness, potentially without making it worse. The way that you tell if it’s making it worse is based on those things either getting better or worse, based on what you’ve seen in the Stress Fracture Severity worksheet. So if you know it’s getting better and you add some exercises and you’re working out and your pain level does not go up. You do not have more swelling. You don’t have any of the bad things happening basically. Then you know you’re going to be moving in the right direction. And if you get worse, then obviously you should not do these things. So this particular runner on this call for five weeks has been using a presumably a post-op shoe or a fracture walking boot and not running for five weeks and yet getting weaker and stiffer, but still getting worse in terms of the pain level getting worse, that is a bad thing.
At one week in a fracture walking boot and on crutches, you’ll get a 16% reduction in the muscle diameter, size and that lower extremity, at least based on published research. And then at the end of four weeks, it’s 60%. That’s huge muscle atrophy. So at five weeks you’re in a serious danger zone and you really need to take quick action. But it starts with figuring out how bad it is. So if you want to get the Stress fracture severity worksheet and try to work through that on your own, it’s going to be on this episode at DocOnTheRun.com under the podcast tab, you can get it, you can download it for free, and you can try to go through it and make an assessment on your own.
And if you don’t understand what that stuff means, and obviously you can go to your own doctor, or you could even get on a stress fracture strategy, call with me. One thing that’s really important to understand is I’m not going to make a diagnosis or recommend your treatment unless we’re working together, and I can really assess your condition myself. I never, ever recommend treatment to somebody who says, I got an MRI. The MRI said this what should I do? I don’t know, I don’t know any of your story. I’m not going to make that decision because that would probably be the wrong decision. And I don’t want to make you worse. But if you get the stress fracture severity worksheet and you go through it, it’s going to give you a lot of things to actually think about.
Remember, the goal is to get better as fast as possible. Maintain your running fitness while the thing heals, and make sure that you’re returning to running as soon as that bone is able to withstand the stresses that you apply to.
That does not mean waiting for an x ray to prove that it is healed. It does not mean waiting for weeks at a time.
The bone is always getting stronger if you’re doing the right things, the right thing means track the severity of the stress fracture, reduce the stress on the bone, work out and strengthen everything you can without increasing the stress on that one bone that has a stress fracture.
If you really and truly don’t know how bad your stress fracture is right now, go get the Stress Fracture Severity Worksheet. You can download it for free StressFractureSecrets.com
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