stress fracture Archives - DOC

#861 Chronic stress reaction versus acute on chronic stress reaction in a runner

I just had a consultation with a runner who had foot pain that she thought might be a stress fracture that had been coming and going for about a month.

She had been increasing her training volume and doing strength exercises that are supposed to build her running fitness.

The pain seemed to be volume related. The more training she did, the more she would notice the discomfort in her foot.

But when we x-rays of her foot, the radiologist suggested this could be an “acute on chronic” stress reaction.

What does that mean?

What is the difference between a chronic stress reaction, or an acute on chronic stress reaction in a runner?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#842 What is cortical thickening that precedes a stress fracture?

There are a lot of confusing things you can see on an MRI report, on an x-ray report or an ultrasound report when you’re a runner with pain that you think might be a stress fracture.

One of those findings that may be reported on your medical imaging study is a thing called “cortical thickening.”

I want to explain what that is so you can better understand it in case you happen to see it on an MRI report, x-ray report or in your doctor’s notes.

What is cortical thickening that precedes a stress fracture?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#840 What is periosteal elevation in tibial stress reaction?

When you get a stress fracture, one of the earliest visible indications on an X-ray or an MRI or a CT scan is a thing called periosteal elevation. Your doctor might see it on ultrasound, x-rays or MRI studies….way before your ever see a crack in the bone.

Since it’s one of the earliest changes in the bone when you start to get a stress fracture, I thought it might be useful to talk about the term “periosteal elevation” really means.

What is periosteal elevation in a stress fracture in a runner?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#837 The most important ingredient for healing a stress fracture

Pain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run.

How you track your pain is important.

One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue.

You cannot run without understanding the difference, at least not safely.

Is the pain from injury or just inflammation?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#834 Osteoblast vs Osteoclast battle rebuilding bone after stress fracture

When you get a stress fracture, you need the little bitty crack in the bone to heal.

How do you do that?

First, you have to stop bending or torquing or twisting the bone in a way that led to the crack in the first place.

Second, you have to let the healing process take place.

After the inflammation goes away, and after you get some collagen sealing up the healing crack, you start to get “ossification” of the bone where it turns into hard solid bone that you can run on.

That happens through a combination of two different types of cells in the bone called osteoblasts and osteoclasts.

Osteoblast versus osteoclast, the battle that’s rebuilding bone after a stress fracture.

That’s what we’re talking about today on the Doc On The Run Podcast.

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#819 Is there any difference healing a stress fracture vs. traumatic fracture?

I saw a runner who had a traumatic fracture, but she had been told it was a stress fracture. This did not make sense to her, because her injury wasn’t from training for a race.

She was trying to understand the difference in healing between a stress fracture with a crack when compared to the healing time of a traumatic fracture with a similar crack.

It’s important to understand they were talking about similar cracks in similar bones that remain in a similar position. We’re not talking about broken bones that are displaced.

If you jump off a ladder, you break the bone and it’s moved out of position, that is a completely different story. Stress fractures don’t generally get displaced as much as traumatic fractures.

If there’s a crack in the bone because of a stress fracture, the bone is not displaced. But how does that compare to similar (non-displaced )traumatic fracture?

Is there any difference in healing between a stress fracture versus a traumatic fracture?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#817 What causes most of the pain when I have a stress reaction?

If you get a metatarsal stress fracture, the first thing that you’re going to notice is not that you have a broken bone in your foot.

You are going to notice pain.

Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it.

The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs.

As I explained this to a runner in the Injured Runners Aid Station, she asked “What really causes the pain?”

What causes most of the pain when you have a metatarsal stress fracture?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#798 How big toe position can help sesamoid stress fracture or bipartite sprain

This episode comes from a consultation call on webcam with a runner with a sesamoid stress fracture.

Interestingly, his doctor wasn’t even sure what it was, if it was really a crack in the bone that wasn’t healing, or if it was what I call a “sprain” of the bipartite sesamoid.

Today on the Doc On The Run Podcast we’re talking about how big toe positioning can actually help a medial tibial sesamoid stress fracture or bipartite sesamoid disruption.

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#794 The #1 question for a runner with a second stress fracture

Stress fractures are the most common overtraining injury I treat in runners.

If you’re a runner with a stress fracture, your first question is probably “When can I run?”

Since the answer is always, “When it is healed enough to withstand running…”

Your second question is likely “What can I do to heal a stress fracture as quickly as possible.”

But if you heal it, get back to running and then get another stress fracture, a recurrent stress fracture, your number one question should be “why”.

What is the number one question for a runner with a second stress fracture?

Well, that’s what we’re talking about today on the Doc On The Run Podcast.

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#782 How likely is a setback if I run while stress fracture heals?

Today I got a great question from a runner who had a 4th metatarsal stress fracture while training for a marathon. He wanted to know how likely it was to get a setback, or re-injury, if he is running while the stress fracture heals.

How likely is a setback if I run while my stress fracture heals?

Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.

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