This podcast is for injured runners. Those who have been told (or worry) that running is at the root of their trouble.
If you are listening to this podcast you’re probably a runner. And you have probably been told by your friends, your family and maybe even your doctor that running is the cause of your trouble and that you need to run less.
But deep down inside you don’t just like running you feel like you have to run in order to be healthy, fit and sane. This podcast simply helps injured runners understand their condition better, and keep running.
One of the problems with being a runner is that you have a higher pain threshold.
If you have a minor attack of gout, it may not bother you as much as it would other people and what Gout is, is that you get painful crystals forming within a joint like the big toe joint.
If you have what we call sub-acute gout, meaning it’s not really killing you, it’s just kind of a minor thing that’s building up gradually, then the condition might actually sort of fly under the radar.
You might be gradually building up crystals in the joint that you’re not really aware of at all.
How can gout lead to hallux rigidus?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
A runner called me to follow up and asked:
“I’ve been doing the routine that we discussed during our first call and I’ve got no pain, I’ve got no tenderness. How can I tell if I’m really ready to run now without hurting it?”
You have to realize that if you run and you are weak and unstable, you are at higher risk. Those gaps in recovery create unnecessary risk.
You have to figure the pieces you haven’t really considered that could put you at risk of re-injury.
Find the gaps between where you are and your running.
That’s what we’re talking about today on the Doc On The Run Podcast.
Your doctor might recommend custom orthotics if you’re an athlete, and you happen to be pregnant.
When you get pregnant, you have lots of hormones going through your systems that can cause ligamentous laxity.
The reason that’s a problem if you’re a runner is that you have rapid weight gain during pregnancy. That weight combined with additional relaxation in your feet can accentuate mild foot problems and even cause deformities that persist later after the pregnancy is over with.
When does a pregnant runner need custom orthotics?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today we’re talking about the Yasso 800’s developed by a guy named Bart Yasso.
I was lucky enough to meet him after he gave a talk before the Salt Lake City marathon back when I was in residency about 20 years ago.
In any event, this workout is a useful way to analyze your fitness and determine your marathon pace. Yasso 800’s can be really helpful to an injured runner who’s returning to running when trying to figure out how fast you should run your post-injury marathon.
Today on the Doc On The Run Podcast we’re talking about how to use the Yasso 800s to test your marathon fitness after you’ve recovered from a running injury.
Today’s episode comes from one of the YouTube viewers who was watching a video called “Can I run with a split peroneal tendon?”
I was trying to explain the circumstances when you can run with a split tendon, and when you really shouldn’t.
He wanted to know if his doctor could tell whether or not he needed surgery just by looking at his ankle.
“The MRI tells me I have a split tear. So, presumably as a tear in the peroneal tendon, but I don’t know which one.”
Can my doctor tell me if I need surgery on my peroneal tendon just by looking at my ankle?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
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.
Today’s episode comes from Benda, who was watching a video called “12 steps to healing and running with a metatarsal stress fracture” on the Doc On The Run YouTube channel.
She asked a question,
“I’m so confused. I don’t have a stress fracture. It was an acute injury. I have a half marathon in early December. Is there hope for me?”
I got injured five weeks out from my half marathon. Is there hope?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I recently got a comment from Michael on a video on the Doc On The Run YouTube channel which was about how fracture walking boots are one of the worst treatments for an injured runner.
He posted an interesting comment which is really a valid question. He said,
“What is the boot for? Is it for protection? Is it for immobilization? Is it to keep weight off?”
What does a fracture walking boot actually do?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I recently got a great que
stion from someone who was watching one of the videos on sesamoid fractures.
Underneath the big toe joint, you have two little bones called sesamoid bones.
Sometimes you can get a fracture or crack in the bone that doesn’t heal. Then it turns into what we call a non-union.
Some people have sesamoids called “bi-partite” sesamoids. It looks like a fractured sesamoid. But its’ normal. The two pieces are connected by soft tissue. But that soft tissue connection can become injured or sprained.
What’s the difference between a sesamoid fracture non-union and a disrupted bipartite sesamoid sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
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.
If you are a runner struggling with a plantar plate sprain, it is probably going to be extremely frustrating trying to get it to heal so you can get back to running.
The plantar plate a very small ligament. It does not have a great blood supply. Every time you take a step, you put pressure on the plantar plate. Every time your heel comes up off the ground when you walk, you stretch the plantar plate.
Because it is so difficult to heal, runners typically have frustrating setbacks.
That state of discouragement makes it pretty easy for a doctor to talk you into plantar plate surgery.
When should a runner just give up and have plantar plate surgery for a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Just last week, I was giving a lecture at the International Foot and Ankle Foundation meeting in Hawaii. The lecture was on Conservative Management of Ankle Sprains in Runners Who Want to Run.
One of the worst things that can happen to a runner with an ankle sprain is that you can lose what we call proprioceptive ability. But that is preventable.
What would you do if I told you, you can reduce your risk of the number one most common musculoskeletal injury by 35%?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
In toda
y’s podcast episode we’re talking about fracture healing versus skin healing.
This talk comes from a discussion I had at the International Foot and Ankle Foundation meeting in Hawaii where I was recently giving a lecture on Runner’s Heel Pain to a whole roomful of doctors.
A doctor asked me a question about how to get a runner back to running as quickly as possible after injury.
What do injured runners do that makes about as much sense as picking at a healing skin incision?
Well, that’s what we’re talking about today on the Doc On The Run Podcast
If you get a fracture of one of the metatarsal bones in your foot, you are not going to be able to run until it heals.
But as soon as it’s healed, you will want to start running again.
You may have recently seen the episode that I did where I was talking about how ultrasound may show signs of healing sooner than X-rays.
How much earlier can ultrasound show healing of a fracture as compared to X-ray?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just lecturing at the International Foot and Ankle Foundation meeting in Hawaii. One of the podiatrists came up to me and asked me a question after one of the sessions.
He said that he was going to be working with a local high school cross-country team.
He wanted to know what I thought would be the most important things to share with cross-country runners to try to reduce their risk of injuries amongst the team throughout their cross-country season.
What information would I want to share with a high school cross-country team?
That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a trail runner or a marathon runner or an ultra-marathoner, well, the last thing you want to do is get a fracture.
If you break something, you have to sit still until it heals, and that can take a long time.
What is a common cause of fracture in a trail runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Bruised toenails are extremely common in runners. Many consider black and blue toenails a rite of passage when training for your first marathon.
However, if a bruise under the toenail appears without any trauma, it can be worrisome.
A solitary dark linear streak is alarming to dermatologists and podiatrists. Because if you get a solitary linear bruise that doesn’t drift out like a typical bruise under the nail usually does, your doctor might be concerned that you have something called acral-lentiginous melanoma.
If your doctor performs a tissue biopsy of the nail matrix to make sure you don’t have cancer, well, you might be worried that your nail is going to be deformed.
Can the toenail grow back normally if you remove part of the root of the nail because you had a biopsy?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get a fracture of the metatarsal, you have to make sure that it’s healed before you start running on it.
It doesn’t matter if it’s a stress fracture, or a traumatic fracture where you stepped in a hole, tripped or fell off a ladder.
Deciding when it appears to be healed enough to withstand the forces of running is the key.
The most common way doctors decide when the fracture is fully healed is by taking an X-ray.
When can I start running after a metatarsal fracture if I have no healing on the X-ray?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
Plantar plate injuries are one of the most difficult injuries for runners.
The reason is that they can take a long time to get better. Every time you take a step, you’re applying direct pressure to the plantar plate ligament.
Every time your heel comes up off the ground, you bend the toes, and you’re stretching the plantar plate ligament.
The plantar plate ligament doesn’t really have a great blood supply, and they can be extremely frustrating for runners. So the big question is:
When can I start working out if I have a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was on a call with a marathoner who had a cuboid fracture.
He was getting better, and he was trying to figure out how he could start running.
The cuboid bone is an irregular bone at the base of the metatarsals, and it’s sandwiched in between the fourth and fifth metatarsal bones and the heel bone. It is a bad bone to break. So he had a valid question:
Is it risky to run with a cuboid fracture?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
I don’t like it when I hear a doctor said, “Don’t run.”
What the doctor should say is, “Let’s figure out how you can run.”
And if you’re injured, that’s what you should be thinking about too.
Not, “When can I run?”
But, “How can I work out right now?”
When can I run if my doctor says “don’t run” because of an injury?
That’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
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.
Today’s episode comes from the question-and-answer session at the International Foot & Ankle Foundation meeting in Las Vegas. I was lecturing on Medical Imaging Strategies in Runners to Avert Misdiagnosis.
At the end of this talk that I was giving, one of the doctors, Dr. Brad Hayman, asked a great question,
“A lot of us doctors who are not runners have a very difficult time relating to some of these runners because we don’t necessarily get why it’s so important that they’re doing a particular race.”
What can doctors do to relate to injured runners?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from the question-and-answer period when I was lecturing at the International Foot & Ankle Foundation Medical Conference in Las Vegas. The talk was Conservative Management of Ankle Sprains in Runners Who Want to Run.
During that talk, I explained to the doctors everything that I do with runners who have ankle sprains. Afterward I got a great question from Dr. Bryan Markinson, who is a prominent physician from New York.
He said:
“Okay. Is this stupid or is this not stupid? Because, I get runners who really want to run. I figure when they’re in good shape, it’s okay for them to run in an ankle brace. Is that really a thing that you recommend or not?”
Can I let runners run in an ankle brace after they’ve had an ankle sprain?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
All injured runners realize it’s a problem.
You’re not working out when they get an overtraining injury. You’re told to sit still. But the problem is not that you’re going stir crazy because you feel like you need to exercise.
The problem you notice is that you’re getting weaker, you’re losing your fitness. And although I know that you’re worried about losing your fitness, there is another problem you may not see.
You should work out while you’re waiting to heal.
And that’s what we’re talking about today on the Doc On The Run Podcast.
I just got a great question from a runner with a cuboid fracture. He signed up for four weekly coaching calls as he was returning to running.
He just wanted to make sure that he didn’t make the fracture worse as he was actually getting back to activity.
He asked, “Once I start running outside, can I use the Alter-G treadmill to add miles and speed while lowering overall tissue stress?”
Can I use the Alter-G treadmill to add miles and speed while lowering overall tissue stress after recovering from an injury?
That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
I got a question on one of the Doc On The Run YouTube channel videos about insertional Achilles tendinitis.
Kevin asked:
“For a few weeks, I had insertional Achilles tendinitis. I have read that doing heel raises over a step could make the situation even worse. Some suggest doing it on barefoot in a flat zone. What do you think?”
Can heel raises make insertional Achilles tendinitis worse?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
When I see a runner who’s had a sprain or a trip or a fall or something, the #1 concern is to make sure no bones are broken.
Most of the time, what I do is I take a portable ultrasound unit with me so that I can look at the foot on the spot and try to figure out whether or not there is a fracture.
I had a question about this as a comment on one of the Doc On The Run YouTube video episodes where I was talking about ultrasound imaging in the foot when you’re a runner.
The question was, “Can you get a false negative? Can you get a false positive?”
Can you get a false negative if you’re looking for a fracture with an ultrasound unit?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question on the Doc On The Run YouTube channel. We were talking about how bone callus shows up as evidence of healing after a fracture in a runner.
Her question was:
“If there was no visible gap in between the bones where the fracture is, will the callus still be visible on the X-ray ? How will the callus show for non-displaced fractures on imaging? Thank you so much for creating this channel and for sharing all your expertise to the world.”
How does callus show healing on non-displaced fractures?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a webcam call with a runner who signed up for an initial consultation and then decided to get a few weeks of additional coaching where we just check in every week to make sure that he’s not making any big mistakes that are going to cause a re-injury.
We were talking about how the whole goal is to keep running without slowing down the healing.
The way you do that is that you stay below your threshold for re-injury or re-fracture of the bone.
Today on the Doc On The Run Podcast, we’re talking about how you should audit your stress level to avoid re injury when you start running after you’re recovering from an overtraining injury.
Plantar fasciitis is the most common cause of foot pain that might keep you from running.
But some treatments that help “normal” patients may cause lingering trouble in runners.
It seems like most of the runners who call me for help have made at least one, if not two of the three biggest mistakes runners can make with plantar fasciits.
Today on the Doc On The Run Podcast we’re talking about the top three mistakes runners make with plantar fasciitis.
Today’s episode comes from Olivia who asked a question on the Doc On The Run YouTube channel:
“I believe I’m dealing with an interstitial tear. Would supplementing collagen help the healing process?”
An interstitial tear just means you have little bitty tear on the inside of a tendon or ligament.
You can get these types of injuries in the plantar plate ligament, the plantar fascia, or any tendon. All of those tendons and ligaments are made of collagen.
So, it seems reasonable that collagen supplementation might help the healing process. But is it proven to work?
Would collagen supplementation help an interstitial tear and a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Compression socks are a useful tool when recovering from a running injury. Just a little compression can gently squeeze all that inflammatory fluid out of your foot, your ankle and your leg.
I was talking to a runner yesterday who asked me about the best compression sock sizing. She was worried that if the socks were too tight, they could hurt her fracture when she was pulling the socks on. That is a totally valid concern!
If it hurts when you’re pulling on compression socks, you might actually be stretching, straining, and stressing the injured tissue. All that added stress could prolong your recovery.
But if the compression socks are too loose, then you don’t get much benefit. Size matters.
What size compression socks should I buy if I have a running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you got injured, but you’re trying to get back to running, one of the most important decisions you can make is which doctor you choose to see.
And it is entirely your choice.
I just got off a call with a runner who had a really serious issue.
She rolled her ankle. She treated it like a normal ankle sprain.
But about six weeks later, it was still a little bit puffy. It still hurts. It was still bugging her, and she wanted to get a second opinion.
She did the right thing. She went and saw an orthopedic surgeon to get a second opinion.
When we were on the call yesterday, there were three things that I saw as definite red flags and definite signs that this woman was seeing the wrong doctor.
What are the top three ways you can be sure you’re seeing the wrong doctor?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from one of the Doc On The Run YouTube viewers.
Casey wrote in and he said,
“This year I suffered from this problem after switching to zero drop running shoes and I was finally running pain free. The zero drop running shoes made me into a forefoot runner instead of a heel striker. I was doing great but then I started having pain in the ball of my foot from a callus. I then started having this pain and I did exactly what you said to do in this video and it worked great and specifically this video showing how to remove a callus in a specific way with a specific technique.”
He also said, “Great information here, everything I was researching kept saying it was metatarsalgia but my pain was different. Thank you for the great video.”
Many runners get unfairly stuck with a metatarsalgia diagnosis.
What is the intractable dubious metatarsalgia diagnosis?
Well, that’s what we’re talking about today but the Doc On The Run Podcast.
I get lots of questions about “sinus tarsi syndrome” in runners.
It seems like most runners who call me don’t even really know what it is.
The sinus tarsi is not a structure, so much as a space.
That space contains some structures that can cause pain after an ankle sprain. The sinus tarsi may also ache in flatfooted runners as well.
The sinus tarsi confuses many runners because it is kind of in the ankle, but kind of in the foot as well.
What is the sinus tarsi?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I had a question on one of my YouTube videos in which I was trying to explain the procedure for broken toes called “closed reduction.” That’s the fancy term for popping the broken bone back in place or “re-setting the fracture.”
You may have heard someone say, “Well, I had a fracture and the doctor had to “set it” or the doctor had “put the broken bone back in place.”
There is a risk and a benefit to everything. Even with non-surgical fracture treatment.
Putting a fractured piece of bone (in a broken toe) back where it belongs is more likely to make it heal in the right position, because you put it back in the right position.
If you leave the broken bone in the wrong position, it may heal and then cause problems later because it’s crooked.
Today on the Doc On The Run Podcast we’re talking about the biggest danger with popping a broken toe back in place.
Today’s episode comes from a second opinion discussion with a runner suffering with a nagging plantar plate ligament injury.
She was considering surgery for a plantar plate sprain.
Truth is, her plantar plate sprain was not really that bad.
It’s pretty common when runners have trouble healing a plantar plate sprain, the doctor may recommend a number of different surgeries.
One of those surgeries is where we actually shorten a bone in an attempt to decrease the tension and pressure on the plantar plate ligament.
Should a runner have surgery to shorten a long second metatarsal bone?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question from one of the Doc On The Run YouTube channel viewers about fibular stress fractures.
There are only tow bones between your knee and your foot: The Tibia (or shin bone) and the fibula bone, which is much smaller.
The fibula bone supports very little of your weight when you run. Your knee is at the top of the tibia bone, and the other end of the tibia sits on top of the talus bone at the top of your foot.
The tibia is the bone that really takes the pressure from your knee and redistributes it to your foot. The fibula bone is a stabilizing bone on the outside of your leg, it is not a weight bearing bone and it really does not support your weight or hold a lot of vertical force.
Understanding the leg bone anatomy can help you understand the stresses that may cause a stress fracture in either one of the leg bones.
Can I still run after I heal of fibular stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just speaking with a runner who scheduled a second opinion consultation. He asked, “what is the best way to tell if my foot is broken.”
I said, “Well, there’s the fast and easy way and then there’s the fast and cheap way.”
Today on the Doc On The Run Podcast, we’re talking about fast and easy versus fast and cheap ways to tell if your foot is broken.
Today’s episode comes from a comment on Doc On The Run YouTube channel.
Colin watched the video explaining: “Bone bruise vs stress reaction in a runner.” He posted a question asking what he should do after a frustrating 10 months off from running, without improvement.
I’ve had a bone bruise for 10 months and I’m still not running. What does that mean?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I just had a conversation with a runner who signed up for one of the self-help courses. She booked a short call just to get a jumpstart, prioritize and figure out what she really needed to do first, so she could get better as quickly as possible.
She asked me a really interesting question at the end of our call and she said,
“Okay, based on what we talked about, are you sure that my ligament is not going to just rip apart if I start running?”
I said,
“No, I’m not sure of that at all. In fact, we didn’t even talk about your injury. You told me that you think you have this injury. But you (and your doctors) are not even 100% certain you have a ligament injury. You don’t even know what’s really wrong. Right now, you don’t know where you are, because you have no reliable data.”
You cannot run early without data.
And that’s what we’re talking about today on the Doc On The Run Podcast.
Perhaps the most nagging injury, and most difficult to deal with if you’re a runner, is something called a “plantar plate sprain.”
The plantar plate ligament is on the bottom of the foot, usually at the base of the second toe.
I got a question from a runner who actually had a plantar plate injury. She also happened to have bunions. So, she asked:
“Do bunions cause plantar plate sprains in runners?”
That’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from Janet ,who posted a comment and question on the Doc On The Run YouTube channel.
She said,
“I got a healed stress fracture, returned to running. I got into cross country and it started to flare up and hurt around the tibia again, is this normal or should I be concerned?”
Is returning pain normal when returning to running after a healed stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
The peroneal tendons help stabilize your foot. They’re kind of your landing gear when you run. They keep you from wobbling or swaying out of control.
When you start to roll your ankle, the peroneal tendons pull your foot back under you.
If you ignore irritation and aggravation of those tendons, they can get weaker, tear or split apart.
The sudden trauma of suddenly rolling your ankle can cause them to split as well.
If you see a doctor when you suspect a split peroneal tendon, one of the first things you may find is that the doctors say this is a surgical problem. You may hear that you must have surgery to repair a split peroneus brevis tendon.
That’s not always true and I will explain why.
Does a split peroneal tendon always mean you have to have surgery if you’re a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a discussion I had with a runner who is only five weeks out from a marathon.
She has been injured and super-aware that she could lose her fitness fast!
Her main goal on our call was to make sure that she is ready for the starting line, but more importantly, make it to the finish line fast enough to qualify for Boston.
Maintaining your running fitness when you’re injured is a delicate dance.
And that’s what we’re talking about today on the Doc On The Run Podcast.
There really are three basic steps that doctors use when you have a broken toe.
The medical term for this procedure is called “closed reduction.”
We don’t cut the broken toe open, look at the bones and put them in place.
Instead, we leave the skin closed and manipulate the toe to pop the fracture back in place.
This is a very common procedure doctors do. I even have done it many times in people’s homes, most often with a runner who has a broken toe that really hurts.
I am going to explain the basic steps…but do not do this on your own!
What are the basic steps if you have a broken toe, it’s crooked and you want to put it back in place?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
One of the questions I get most often from runners with stress fractures is…
“How can I get it to heal better? How do I get back to running faster?”
The best way is to remove the stress so that the stress fracture can actually heal as fast as possible. That sounds obvious, but most runners aren’t doing that.
I talked to a runner just a couple of days ago who was not running on it, but she was walking on it…a lot.
She told me, “Well, I have a fracture walking boot, but I’m walking in it and my foot hurts.”
My first response was, “Why aren’t you using crutches to take the stress off of it? If walking is making it hurt, you’re not going to get better quickly. It’ll get better eventually, probably, but certainly not as fast as possible.”
Do I have to use crutches if I have a fibula stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Plantar plate injuries are very common, and they are extremely annoying.
I get lots of questions and comments both from the podcast and from the Doc On The Run YouTube channel about plantar plate sprains.
Today’s episode comes from a question posted by Jason on the Doc On The Run YouTube channel. He asked…
“Can MRI miss a plantar plate strain?”
The short answer is yes, and I’m going to try to explain why.
Can an MRI miss a plantar plate strain?
Well, that’s a great question and that’s what we’re talking about today on the Doc On The Run Podcast.
Almost all runners who call me for a consultation have one thing in common.
The number one thing they want to get out of their discussion with me is “How can I start running sooner? I want to get back to running so I don’t lose all my running fitness.”
There is one free and highly effective tool you can use as an injured runner, but most of the runners I talked to seem to be completely neglecting and ignoring it.
What is the single most effective but most often neglected tool injured runners can use to get back to running sooner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have ankle pain and you push around on that lump of bone on the outside of your ankle, you may realize that you have pain on the bone specifically.
If so, you might become worried that you have a thing called a fibular stress fracture.
If you start trying to figure out what to do, one of the first things you may find is a lot of discussion about something called a “stress reaction” instead of just a “stress fracture”.
What’s the difference between a fibular stress reaction and a stress fracture in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
This may seem like a strange episode, but I just had a conversation with a runner who is not just a forefoot runner, but she is really a forefoot runner. Like running-on-your-tiptoes kind of forefoot runner.
One of the things that I brought up in our discussion were some research studies that have actually calculated the amount of pressure in the forefoot when a woman is wearing high heels.
What does an elephant, a woman in high heels and a forefoot runner have in common?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’ve been running, training for a marathon or an ultra-marathon and you start to get pain on the outside of your ankle, you do have a reason to be concerned.
There are really four things that seem to cause pain on the outside of the ankle the most. We’re going to talk about those today.
What are the four main causes of lateral ankle pain in runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have been told you have a plantar plate sprain, you’re probably already really frustrated.
Even minor plantar plate tears can be nagging injuries that are very difficult to get better while you’re running on them.
The bottom line is, you’ve got to make sure that the plantar plate ligament improves because (in general) plantar plate sprains are either getting worse or they’re getting better.
One of the questions I get all the time from runners is what is really the best study for a plantar plate injury.
What’s the best imaging study for a runner who is suspected of having a plantar plate injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re out on a run and you roll your ankle, you need to know how you can test the ankle to figure out what is wrong.
More importantly, what tests can tell you how likely it is that you’re actually going to get back to running and not have an ankle sprain again.
There are several tests doctors use in evaluating injured ankles. Some are more important than others.
What is the single most important test for a runner with an ankle sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
There are times when you might have a suspected stress fracture in your foot. If so, your doctor may order an X-ray.
There are other times when it’s extremely unlikely that you have a broken bone at all, but it is almost certainly just a soft tissue injury.
One of the questions I get a lot from runners with plantar plate sprains is how to make sure the pain is not from a stress fracture.
I have only seen one case where somebody had fracture pain in the exact same spot you would have pain when you had a plantar plate injury.
Can a fracture in the metatarsal seem like a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you are running with foot or ankle pain, and you’re trying to figure out what’s wrong, the first step is deciding if it is a bone injury or soft tissue injury.
It might be useful to talk about the thought process I use when trying to figure out whether or not you have bone versus soft tissue injury.
How do you rule out soft tissue versus a bone injury when you’re a runner and you’ve rolled your ankle?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I recently did an episode where I was talking about Lister’s corns.
If you missed it, a “Lister’s corn” is really just a callus or thick skin that looks like the pinky toenail or the little toenail has a split in it.
That edge of the nail that looks like a completely separate piece of nail.
But it’s not a nail at all, it’s callus.
I just saw a runner who had this problem where his Lister’s corn was really painful. It hurt so much he thought the nail might be ingrown. He asked,
Why does a lister’s corn hurt when I run?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
All overtraining injuries are difficult.
The problem is that you’re trying to not lose your running fitness while giving the injured part enough of a rest so it can actually heal.
A runner asked me an interesting question the other day, he actually said, “Okay, if I have bruising and swelling, does that mean I’m more likely to have a bone injury or a soft tissue injury?”
What are the key differences between a soft tissue injury and a bone injury in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was recently doing a second opinion consultation with a runner over a webcam to review the MRI of his foot.
What we found was that he had what looked to be attenuation and a partial tear in the plantar plate ligament on his MRI.
There was a lot of inflammation in the foot around the ligament, not just within the ligament itself.
He asked me was really good question:
“Could my plantar plate ligament been have injured long before I ever got an MRI?”
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every runner who gets injured is in a race against time.
It is a race to not lose your running fitness.
You know you are going to get weaker. You know you’re going to get stiffer. You’re probably really concerned that you’re going to lose all that aerobic fitness that took months or years building up.
Running injuries are like compound interest but in reverse.
That’s what we’re going to talk about today on the Doc On The Run Podcast.
I just saw a runner who sprained her ankle. It’s been about a month and she’s still having pain. Pain and swelling persisting a month later, are not good. There are a couple of reasons that that can happen.
Anytime doctors see persistent swelling and pain after an ankle injury, they become concerned there might be a fracture.
When should a runner who rolled an ankle be concerned that there might be a fracture like a lateral process fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you are a runner with pain in the ball of the foot at the base of the second toe and start researching online, you may become concerned you have a thing called a plantar plate injury.
If so, you may be wondering whether X-rays or MRI imaging may be needed to tell what is wrong. Before seeing a doctor, it may be helpful to understand which are helpful, and which imaging studies are a waste of time.
What is the worst possible medical imaging study you could get if you’re a runner with a suspected plantar plate injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Just this week, I got a call from an injured runner about a new problem. I’ve seen him before for some other issues, but in this case.
He said that he thought maybe he actually had an ingrown toenail on his pinky or that the toenail itself had split in half and it was bugging him a little bit.
I said “Well, send me a picture. I’ll take a look and see.”
My pinky toenail split in half. Is that a problem?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
Today’s episode comes from a YouTube viewer who posted a question,
“I have a low risk grade stress reaction in my posterior tibia. Interestingly, there is some research discussing the benefits of weight bearing bone building exercise once tolerated pain free, like hops jumps and step ups. Do you have any advice on when and how to integrate these types of exercises into a rehabilitation program?”
When is it okay to add weight bearing exercises when you’ve had a bone injury like a stress reaction?
That is what we are talking about today on the Doc On The Run Podcast.
Today’s episode comes from a YouTube viewer named John, who wrote in with a question about nerve pain vs. peroneal tendon pain.
He said ”I’m experiencing discomfort in my fifth metatarsal/peroneal tendon below the ankle. There is no swelling. However, upon hamstring stretch, especially in a downward dog position, this area feels like it’s on fire. The fact that I cannot do downward dog right now, with my right heel down. I’m starting to think this may be a nerve. It’s been hurting for about 10 days.”
Could peroneal tendon pain really be a nerve problem?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s question comes from one of the YouTube viewers. Tasnim, wrote in and wanted to know whether or not “stress reaction” is the same terminology that is used in the UK for the term “metatarsalgia”.
This question points out how confusing these two terms can be when you have forefoot pain that might be a stress fracture, might be a plantar plate sprain, or could even be a neuroma.
Are stress “reaction” and “metatarsalgia” the same terms?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
You’re out on a run, and you suddenly start having extremely sharp heel pain.
You think it’s plantar fasciitis.
But when you look at your foot, you see a huge bruise.
That’s not plantar fasciitis. That’s where you ripped something.
Is there always bruising with a partial rupture or a tear in the plantar fascia?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
One of the most powerful ways to reduce stress and strain on any piece of injured tissue is to get completely off of your feet. Bedrest can do that.
I was talking with a runner recently who asked a great question,
“Should I just do bed rest?”
I answered,
“Bed rest is like chemo for runners.”
With chemotherapy, we’re basically giving you a powerful drug.
But is it going to kill the tumor first, or is it going to kill the patient first?
Bed rest is like chemotherapy for runners, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today I was on a call with an injured runner who was told she had plantar fasciitis.
She was confused and she started doing some research. She enrolled in the Runner’s Heel Pain Course because she was trying to figure out why her “diagnosis” didn’t seem to match her gut instinct.
She suspected her diagnosis was wrong.
If you have heel pain, and you call for a ride instead of finishing your run, it’s not plantar fasciitis.
And that’s what we’re talking about today on the Doc On The Run Podcast.
If you want to run as soon as possible after an injury, you may need aggressive treatment like immobilization in a cast or a fracture walking boot.
When I lecture at medical conferences, I talk a lot about why I believe fracture walking boots are over-prescribed, overused and often used way too long in many injured runners for common overtraining injuries.
In talking to another runner the other day, I was thinking about the specific goals that are in conflict between you and your doctor.
Today on the Doc On The Run Podcast we’re talking about doctor’s goals when they give you a fracture walking boot versus your goals when you’re wearing a fracture walking boot and you’re a runner.
I was just on a call with a runner who has had this condition called “hallux rigidus.” and it’s where your big toe joint starts to get stiff, becomes rigid, and it doesn’t move as much.
Hallux rigidus is a progressive condition, especially if you continue to irritate the joint. You can damage the joint cartilage. The stiffer the big toe joint gets, the more pressure on the cartilage when the big toe is trying to fight that stiffness. Sometimes that movement hurts.
He was asking me about the options on different injections.
What are the risks between an injection like a PRP or platelet rich plasma injection versus something like a cortisone injection when you have hallux rigidus?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Have you ever been to the doctor and heard this, “You must be allergic to running because you get injured every time you go running.”
A recovering runner and I were on a call talking about how she could get back to running and how to “just go for a run” without getting re-injured.
We were talking about this approach of getting her running fitness back now, and returning to running faster without just sitting around waiting.
She told me something I had never heard.
Today on the Doc On The Run Podcast we’re talking about running allergies and injury recovery.
Plantar fasciitis is one of the most common conditions that affects runners.
In fact, foot pain consistent with plantar fasciitis accounts for about 40% of all visits to the podiatrists in the United States each year.
Unfortunately, just because you think that you have plantar fasciitis, and you started doing some simple things to treat it, it doesn’t necessarily mean that it’s going to get better.
If you are a runner, and you think you have plantar fasciitis, you must realize there are some avoidable mistakes you could make when trying to self-treat runner’s heel pain.
Today on the Doc On The Run Podcast, we’re talking about the top five reasons runners heel pain doesn’t get better.
I just had a discussion with a really interesting patient. He was a pro triathlete. He had some difficulty getting past a particular injury.
We were talking about all of the ways that you can encounter barriers to healing. And how you can start making progress in spite of them.
We were talking about two different things, logical and psychological barriers.
What’s the difference between logical versus psychological barriers to healing injuries in runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Every runner with a stress fracture wants to know “when can I run?”
How soon you can start running after a foot fracture really depends on when you have enough strength in the bone so that the healing fracture will withstand the forces applied during running without breaking the bone again.
It all depends on what you do to speed up (or slow down) the bone healing process. The rate of fracture healing depends on your physiology, and it depends on stages of bone healing.
But it does NOT depend entirely on generic timelines.
How long is each stage of fracture healing when you have a broken bone?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
The first thing any runner should do when you roll your ankle is protect the ankle from further injury. In fact, the algorithm doctors use to treat ankle sprains is P. R. I. C. E.
P stands for Protection, meaning don’t roll it again. Don’t make it worse. Then, Rest it. Ice it. Use Compression to keep it from swelling. Elevate it to get the fluid out if it’s really swollen.
So, what happens is, you’re a runner, you’re out on a trail and you roll your ankle. What happens if you don’t follow the PRICE method?
It just might take a whole lot longer before it gets better.
What are the most common three ways I see runners lose all their fitness after they get an ankle sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
There are three key indications that tell me that somebody may not have plantar fasciitis, but probably have something else.
If you think you have plantar fasciitis, you may have a different form of runner’s heel pain. Treating the wrong condition will not get you back to running. Understanding the ways plantar fasciitis shows up can help you make sure you don’t have something else causing your heel pain.
What are the three best signs that your heel pain is not Plantar fasciitis?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I got a specific question about a recent episode on calluses in runners.
The question was, “Well, if you have that pattern of callus, and reduce the thickness of the callus so the callus is going away, does that mean there is less pressure there?”
You may have checked out the episode on the three callus patterns that I see in runners at high risk for getting a plantar plate injury.
Does callus reduction reduce your risk or decrease the risk that you’re going to get a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with an interesting elite athlete, and he’s been injured.
He had one particular injury in his foot and then started having a completely different injury, as soon as that injury in his foot was starting to heal.
We were talking about how disappointment can lead to more and more setbacks.
The phrase he used struck me.
He said, “I think it might be traumatic disappointment.”
What is traumatic disappointment and what kind of effect can it have on delayed healing in an injured runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Yesterday I called a recovering runner, just to check in and see how he was doing, because he had done the Fast Track Challenge 2 months ago.
He’s doing great. He has recovered and gotten past his injury.
He said he learned a lot in the Challenge and has applied it to his training.
He’s on track for running ultra-marathons this year. He has a coach. Training is in full swing with no limitation from the injury and got him into the Fast Track challenge.
Something he said on that call actually kind of shocked me.
I asked him, “Is there anything that you wish you could have done differently if you went back?”
He answered, “Yeah, I would have called you sooner for a consultation.”
If you ever run into injury many times, your first step is to sit still and wait. Sometimes that’s a problem and that’s what we’re talking about today on the Doc On The Run Podcast.
If you are a runner and you get pain in the ball of the foot, particularly at the base of the second toe right. It could be a plantar plate sprain.
Whenever I see a runner on webcam who has pain that sounds like a plantar plate sprain, the first thing I do is look for any callus pattern in the skin that suggests they have too much pressure and friction at that area that could injure the plantar plate ligament underneath the skin.
This episode will help you understand how certain callus patterns relate to some basic foot mechanics when you’re trying to figure out what is causing your ball of foot pain.
Today on the Doc On The Run Podcast we’re talking about three callus patterns I often see that can suggest you have a risk for getting a plantar plate sprain if you are a runner.
Everybody’s short on time. This is true for runners in training, but it’s also true for injured runners.
If you’re trying to make progress as fast as possible, you really have to do the things that will give you the most progress in the least amount of time.
Many runners I talk to on a second opinion consultation webcam call really want to know which stretches will help them. Specifically, which two or three stretches will help the most.
What are the most valuable stretches you can do after a running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have a condition called “hallux rigidus” or “hallux limitus,” the name tells you what’s wrong.
“Hallux” means big toe.
“Rigidus” means the big toe joint doesn’t move at all.
“Limitus” just means the big toe joint movement is limited and stiff.
There are three problems with hallux rigidus, which are: 1) damage to the cartilage, 2) bone spurs around the joint and 3) restriction of the soft tissues such that the toe doesn’t move up and down the way it should.
Those three reasons that cause the condition are the same reasons that can fail if you have a cheilectomy surgery.
Today on the Doc On The Run Podcast we’re talking about three reasons for cheilectomy failure after hallux rigidus surgery.
Let’s say you have a nagging tendon injury that’s really been painful. It’s been bugging you a lot when you run.
You have had persistent pain either on the side of the ankle that just won’t seem to go away, even if you run less.
You see the doctor and she says, “Look, we tried everything. We should do surgery. Your tendon is not really torn, but we should do this surgical procedure called a “synovectomy” to get it to calm down so it will finally stop hurting.”
What is a tendon synovectomy surgery?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you’re out on a trail run, you roll your ankle and sprain it. So what do you do?
You limp home, you get back to the car, you ice it, you take some pressure off of it, you elevate it, you do all the right stuff. But, it’s really painful and swollen the next few days.
Then, maybe a day or two later, it’s black, it’s blue and swollen. But even worse, you look down and you’re kind of dismayed because your toes are swollen like sausages.
Believe it or not, I have had a number of patients who called me, not because they sprained their ankle, but because they were actually worried they may have broken toes as well.
Is it possible to break your toes at the same time you get an ankle sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a discussion I just had yesterday with an athlete. He had a metatarsal fracture non-union.
A “fracture non-union” can develop when there is a crack in the bone that moving a little bit too much and doesn’t completely heal.
Non-unions can happen if you get a stress fracture, and you keep running on it and you’re tough and you’re strong and it doesn’t really hurt that bad.
If you keep running and repeatedly stress that crack, it can’t heal.
Should I get a CT scan or should I test walking to see if my fracture is healed?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
When you get an injury to a bone like a metatarsal stress fracture, you can develop a thing called a “bone callus.”
You might even see it as a lump visible on the x-ray in your doctors office.
Whether the lump is made up of hard bone, fibrocartilage or something in between, it may help you to understand the significance of that lump in your foot.
When the bone callous appears, and the size of the bone callous itself, can tell your whole lot about your progression of healing, and whether or not you might get other problems in the future.
What is a bone callus in a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On the Run Podcast!
Achilles tendon injury on one leg and a calf muscle strain on the other leg?
Talk about a bummer: 2-for-the-price-of-1 overtraining injuries! Yes, it is possible to get similar running injuries on opposite legs, at the same time.
Today I had a conversation with a runner who has developed both of these injuries from running. These are actually just opposite ends of the same biomechanical spectrum at work. During the call I was explaining to him how it can happen, and how he could make some simple changes to prevent it from happening again in the future.
How can running on the road cause Achilles tendinitis in one leg and calf strain on the other?
Well, that’s what we’re talking about today on the Doc On The Run Podcast!
What would be worse than not being able to run because you had foot pain that didn’t get better for a year or two?
I know one thing that would be worse… Having foot surgery to treat a problem that was not actually even located in the foot.
Think about that. You had pain in your foot for two years. Then some doctor convinces you to have surgery, only to find out there was no problem with the tendon.
You stop running. You have surgery. You wait for your stitches to heal. You have to stay off your feet until the incision is all healed.
And your foot pain does not change at all.
Sounds crazy, but this can happen. And it’s most likely to occur when you have something called referred pain. The pain in your foot might be actually caused by nerve compression deep to your glues maximus…that’ right…in your butt.
Today on the Doc On the Run Podcast we are talking about foot pain that is truly a pain in the butt!
If you just got injured, your number one goal is to not lose your running fitness as your running injury heals.
If you were diagnosed with a running injury a while ago, you stopped running and now you’re just getting back to running after taking some time off, in that case your primary goal is to resume running without sustaining another overtraining injury. Especially right when you start running again.
What I teach runners in the Fast Track Challenge is how to find their unique fastest path back to running. The process is all about methodical testing.
Methodical testing is the key to running after injury.
And that’s what we’re talking about today on the Doc On The Run Podcast.
This morning, I was on a call with a recovering runner who signed up for a series of coaching calls to get back to running after a long-standing injury.
This is an elite athlete who had multiple setbacks, and encountered difficulty getting over the hump a number of times.
If you’re going to get back your fitness, and if you’re going to get back to training as fast as possible, you’re going to have to endure some discomfort, some risk, and frankly, a little bit of anxiety every time you bump up against your limits. But that is part of the recovery process.
Are you scared of re-injury after trying to build strength when you’ve had a running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you have been injured. You’ve been a good little patient. You waited around, you have done nothing. You have endured a frustrating period of boredom. And you finally started running again. That’s great!
Today’s episode came from a webcam call I did with a recovering runner. She has a stress fracture but her foot was good enough to run outside.
The question was about whether or not an injured runner should keep using something like an AlterG treadmill to maintain running fitness while continuing to heal and recover from a stress fracture.
After healing a stress fracture, should I use the AlterG treadmill even after I’ve started running outside?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
Today I was out on a run and I was thinking about treadmills versus running outside. To be fair, I was actually running outside during this run.
It seems like most of the runners who sign up for the Fast Track challenge, or who call me for a second opinion, the majority of them like to run outside.
I have a question for you.
If you got an overtraining injury like a metatarsal stress fracture, calcaneal stress fracture, or a tibial stress fracture, plantar plate sprain, the question is… Are you running on a treadmill to ease back into running, or are you just running outside, to see how running feels after your injury?
Are you using a treadmill for returning to running after an injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Let’s say you’re out on a run and you start getting some aching pain in the ball of the foot. It persists for a while.
It’s not really that bad. Your foot is not killing you. But it starts to bother you more and more over the course of a few weeks.
Being proactive, you see a podiatrist. The podiatrist tells you that he thinks you have something called a Morton’s neuroma. So he does an x-ray of your foot and what do you see? Well, nothing. Why is that?
When are x-rays useful for a runner with a Morton’s neuroma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Have you ever had black toenails after a long run?
Have you ever lost a toenail after a marathon?
Have you tried using goopy skin lubricants, or worn bigger shoes that make you feel like you’re wearing clown shoes?
If you have, but you’re still having problems beating up your toenails in your running shoes when run, I’ve got a simple solution that may actually help.
Today on the Doc On The Run Podcast we’re talking about the best way to file your toenails if you’re a marathon runner.
If you’re a runner with plantar fasciitis, you probably have heel pain when you get up and step out of bed.
If that’s gone on for months, you tried icing, you’ve tried stretching, and you’ve become frustrated, it starts to become pretty easy for your doctor to talk you into surgery.
If you’ve had plantar fasciitis for a long time and your doctor is trying to convince you need surgery, you should listen up!
When is plantar fascia surgery really necessary for runners?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get aching pain in your ankles when you’re running, and it seems to lag and doesn’t just go away, you might not have ankle pain at all.
There’s a thing that I see often in runners complaining of ankle pain, but when I actually look at the runner’s feet, it’s a different condition altogether.
That condition is something called “sinus tarsi impingement.”
Today on the Doc On The Run Podcast, we’re talking about ankle pain versus sinus tarsi impingement when running.
Plantar plate ligament sprains are a tough injury for runners. Plantar plate tears can cause a lot of pain in the ball of the foot. Unless you treat them correctly, that pain can persist for a long time. As a result plantar plate injuries can be super frustrating.
Unfortunately, plantar plate tears are often diagnosed when you get an MRI of the foot. I often get questions from runners asking me whether or not they have to wait for another MRI before they can run.
Does the plantar plate ligament need to heal on an MRI before I can run?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s episode comes from a question posted as a YouTube video comment.
That video was explaining how using crutches for a short period of time can help injured runners.
I wasn’t talking about months of crutches, not many weeks, but a short period of time to try to accelerate the process of healing over-training injuries.
In the comments someone posted and said, “How long would you use crutches for this…?”
How long should I use crutches?
Well, that’s a million-dollar question! And that’s what we’re talking about today on the Doc On The Run Podcast.
WARNING: You may not want to listen to this topic while you’re eating.
I’m going to tell you a story that goes along with dinner.
Believe it or not. One time we went out to a restaurant with a bunch of friends.
A member of our dinner party took off his shoes and he said, “Hey, what do you think of this?” He was literally showing me warts on the feet right there in the restaurant.
Plantar warts are on the bottom of the foot. Warts on the feet can be difficult to treat because the skin is so thick.
To make matters worse, he had a more severe type of warts called mosaic warts. They were all over the feet. That makes treatment even more difficult.
Today on the Doc On The Run Podcast, we’re talking about plantar wart treatment options in runners.
Whenever I speak to a runner who wants to know if they can run with a bone bruise, I get confused. If you were “diagnosed” with a bone bruise, you should be confused, too.
A bruise is a very simple thing. You fall down and land on your knee and you get a bruise. You get a bruise because your kneecap crushes the skin against the ground and you get bleeding in the skin that you see as discoloration that we call a bruise.
You can’t see that in a bone. When you get diagnosed with a bone bruise, you have to think of it in terms of bone injury, like a stress fracture. The continuum of bone injury includes stress response, stress reaction and stress fractures.
You have to understand the severity of the bone injury before you can decide whether or not to run.
What is the difference between a bone bruise and a stress reaction in a runner?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have pain at the bottom of the big toe joint, up along the arch, just above the plantar fascia, you may have been told that you have this thing called FHL tenosynovitis.
“Tenosynovitis” just means that you have inflammation of the tendon sheath or tube that carries the flexor tendon down to your big toe. It helps you pull your big toe down when you push off while running. When the tendon sheath gets inflamed, it can be painful.
If you have tenosynovitis, your doctor may recommend a cortisone injection, or a Platelet Rich Plasma (PRP) injection.
So what’s the difference between these two injections and why would you want one versus another?
Today on the Doc On The Run Podcast we’re talking about FHL tenosynovitis injections, corticosteroids versus PRP injection.
It’s no secret that I enjoy Ironman triathlons. I did 15 of them, and the last one I did was the Ironman World Championships. That doesn’t mean I’m fast. It just means I’m stubborn.
But when I was a kid, I was obsessed with Ironman Hawaii and I decided that I was going to do Kona.
You never know what good or “bad” things can happen to help you fulfill your dreams.
Long story short, the day before I was going to leave for Hawaii, literally the day before I was getting on the plane, I was in my doctor’s office and he said that I could not possibly do Ironman Hawaii because I had pneumonia.
But it turns out the Universe is always conspiring to make dreams come true.
Today on the Doc On The Run Podcast, we’re talking about how pneumonia made my Kona dream come true.
If you’re a runner you may be wondering what in the world something like “subungual melanoma” has to do with running injuries.
There are a couple of reasons.
Subungual melanoma is commonly mistaken for a bruised toenail. What runner has never had a dark spot under the toenail?
Subungual melanoma is actually extremely deadly. You’re not necessarily likely to get it, but there is a reason that this might be pertinent to you as a runner.
Repeated trauma from running and beating up your toes could possibly increase your odds of getting this form of cancer.
What is subungual melanoma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have pain under the big toe joint, it could be an injury called sesamoiditis. Sesamoid bones are like a pair of tiny little kneecaps under the big toe joint. They are about the size of kidney beans. If irritated enough, sesamoid can develop stress fractures.
Any inflammation of the sesamoid bones is called sesamoiditis.
But pain in the sesamoid area can also result from inflammation of the tendon sheath that goes around the flexor tendon. The flexor tendon sheath is just a tube around the tendon that actually helps the tendon glide as your big toe moves up and down.
The flexor tendon sheath is very close to the sesamoids. Sometimes it is hard for a runner to tell the two conditions apart.
There’s a big difference between the two conditions and a big difference between the way that you would treat them.
What’s the difference between flexor hallucis longus tenosynovitis and sesamoiditis?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I recently got a question on one of the YouTube videos about hallux rigidus.
He gave me a long description about how there aren’t good treatment options for runners with hallux rigidus, and he’s actually starting to have pain when he runs.
His big toe joint is red, it aches, and he knows it’s inflamed. He is trying to choose some different running shoe options.
Today on Doc On The Run podcast we’re talking about hallux rigidus shoe traits for runners.
When you sign up for a marathon, your coach gives you a really clear plan on what to do. All you need to do is complete all of those workouts as scheduled.
You can’t jam them all in at the end, or you will get an overtraining injury.
We all know that and when you have an injury, a doctor tells you to sit still. So, you do exactly that.
You’re a good little patient, so you sit still and you get weaker.
You get stiffer. Bad things that happen that put you at risk of another over-training injury later.
You can work out now, or you can work out more later. Those are your two choices.
And that’s what we’re talking about today on the Doc on the Run Podcast.
In this episode, we’re talking about tibial stress fractures.
Tibial stress fractures can be mis-diagnosed. Sometimes you just think you might have shin splints or ankle pain, or even a sprained knee.
Stress fractures can affect different places in the tibia. But the exactly location of the stress fracture is really the most critical piece when you’re trying to figure out whether or not it’s safe for you to run.
Today on the Doc On The Run podcast, we’re talking about how the most important tibial stress fracture detail is location.
Today on the Doc On The Run Podcast, we’re talking with Andrea. She just ran the Tokyo Marathon in 3 hours and 9 minutes.
I know for most people, they’re going to think, “Wow, 3:09 is really fast!”
But what’s really impressive is that Andrea ran a marathon with a calcaneal stress fracture. In case you don’t know what that is, “calcaneus” is a fancy word for heel bone.
Andrea was told she couldn’t run. She was told to wear a boot.
Instead of just accepting that fate, she figured out how to run, went to Tokyo and finished the sixth of the World Major Marathons.
Andrea’s story is going to be really helpful if you have an injury, you’re told you can’t run, or you think you can’t run.
One of the worst questions you can ask any doctor is, “when can I run?”
Believe it or not, I get these questions every single day…from total strangers.
They get injured and go to the doctor. The doctor says, “You can’t run.” Then they will call me and ask, “When can I run?”
Why am I going to give you the magic answer, if I don’t even know you?
There is a better way.
The best questions that you can come up with are the ones that direct your doctor to start thinking about how to help you get back to running a whole lot faster.
If you got a running injury and you’re trying to figure out how to run and you go to the doctor, don’t ask them when you can run, ask them how you can run.
That’s what we’re talking about today on Doc On The Run Podcast.
An interesting runner called me for a second opinion. He had a couple of things going on that created a pretty confusing picture.
He had a plantar plate sprains (at least he was told he had plantar plate injuries) because his MRI showed evidence of injuries to the plantar plate ligaments of toes two, three, and four.
He also had some nerve type symptoms. But on the bottom of the foot, he also had this very interesting ridge of callus.
So what was REALLY causing all of his trouble when he ran?
Today, on the Doc On The Run Podcast, we’re talking about a runner with a plantar plate injury and deep perineal neuritis.
I got a great question from a runner who wanted to start running on an Alter G Treadmill. What she said was:
“I’ve been getting out of the boot. I started running on an Alter G Treadmill, and everything’s been going great. I feel good. I feel like a million bucks because I’m finally moving again. Is it okay for me to run every day?”
What if you had a friend, who was not fit at all, who wanted to run a marathon? Imagine she wanted to do her very first marathon, and you were going to help her train? Would you tell her to run every single day?
Can I run every day on an Alter G Treadmill?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today’s question actually comes from Elizabeth who explained she rolled her ankle, and sustained a fracture of the fibula bone. She wanted to see if she could get some advice.
She said, “I’m a 27-year-old female. I twisted my ankle and I was rushed off for x-rays and discovered a spiral displaced fracture of my fibula in my ankle joint. I’m dying to get back on the road and going a bit stir crazy. It’s been 10 or 11 weeks post-break now. I want to know if I will do damage by starting to run in increments to gain back some fitness and cardiovascular fitness or if it’ll be okay.”
Can I run after a spiral fracture of the fibula?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
One of the worst injuries you can get when you’re a runner is a plantar plate sprain. It’s a stretching, a straining, a tearing of this tiny little ligament at the ball of the foot called the plantar plate.
Every time I do a second opinion consultation over webcam for a runner with a suspected plantar plate sprain, I ask them to do one simple thing.
I want to look at the insert in their running shoe: “Go get it, right now, preferably one you’ve been running in for a long time, not a brand new one.”
Pull out the insert and let’s see what the wear pattern shows us.
Today on the Doc On The Run Podcast, we’re talking about how your running shoe insert can actually show whether or not you’re at risk of a plantar plate sprain.
During a recent call with a runner who signed up for a series of phone calls, we were trying to figure out exactly what happened to cause his foot pain.
The way that doctors are taught to think goes something like this: Come up with a particular name called a “diagnosis” and then do a “procedure” that the insurance covers.
Doctors focus on making sure the diagnosis code matches the insurance requirements so they will send a check.
This process does not serve runners well. Runners need to focus on how they got injured…so they do not do it again.
How an injury happened is much more important than what happened.
Does that make sense?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
One of the most common nerve related running injuries is a thing called Morton’s neuroma. A “neuroma” is just an irritated nerve.
A “Morton’s neuroma” occurs specifically in the foot between the 3rd and 4th toes.
When a neuroma first starts, the nerve is just a little bit irritated, and it may feel a bit weird.
In one of the original descriptions of Morton’s neuroma, it described a sensation or feeling of wet leather being stuck to the bottom of the foot. That odd sensation is the result of the nerve getting aggravated. It starts to send little erroneous signals to your brain.
If the nerve is getting irritated, you want to make sure your running shoes are not making it worse.
What are the four worst traits of a running shoe if you have a Morton’s neuroma?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you have a soft tissue injury in your foot related to overtraining, you (or your doctor) may be thinking about getting an MRI.
If you have a ligament injury, plantar plate sprain, partial tear of the plantar fascia, an Achilles tendon partial rupture, Achilles tendinosis, or peroneal tendinitis, the timing of the MRI is extremely important.
MRIs can be really useful tools. They give you over a hundred images of your foot. Because you have so many pictures, the detail can fool you into believing the MRI is a complete picture, but it is not.
When is an MRI most reliable for a soft tissue running injury?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
I was just on a call with a runner who has a plantar plate sprain. A plantar plate sprain is an injury to a very small ligament right at the base of the toe, usually the second toe, right where it attaches to the metatarsal at what we call the metatarsophalangeal joint.
That sprain typically causes aching in the ball of the foot.
These are tough injuries to get better.
I have had one myself, and when you get them, they’re really annoying.
It seems like they get better very, very slowly, but you can make them worse very, very quickly.
It’s really important when you get a plantar plate sprain to identify the one thing that caused the injury so you stop doing it.
Today on the Doc On The Run Podcast, we’re going to talk about my advice for a flat-footed runner who has a plantar plate injury that started from running on a treadmill.
I just got off the phone with an elite athlete recently who asked a great question.
He called me and said, “I have custom orthotics and I know they support my foot better. So the question is, can I use a broader range of shoes?”
What he really wants to know is whether or not he can ONLY use motion control shoes.
He was really asking, “Since I have an unstable foot that’s now stabilized by the custom orthotic supporting the foot, does that mean that I can wear shoes other than something like a true motion control shoe?”
Can I wear softer shoes when running with a custom orthotic?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
One of the things about getting an MRI has to do with timing of the injury.
What do I mean by that?
Well, it means timing in terms of when the MRI is done relative to how long it has been since you actually beat it up and injured that structure.
When is an MRI most reliable for a bone running injury like a stress fracture?
Well, that’s what we’re talking about today on the Doc The On Run Podcast.
Every time I talk to a recovering runner who is trying to figure out how to run, and help figure out what’s causing all their trouble, I ask them to keep a pain journal.
Why do you think that is?
Pain is the lowest cost, most abundant, and most underutilized diagnostic resource available to help an injured runner guide the recovery.
Imagine a contest between doctors trying to get injured runners back to running faster.
If I could only use pain as a diagnostic tool, but other doctors could use MRIs, X-rays, CT scans, and all the medical imaging they wanted (but could not track the runner’s pain), I bet I would get runners back to running faster.
Find the one thing that causes the most pain when you’re running.
That’s what we’re talking about today on the Doc On The Run Podcast.
When you get a stress fracture, you have to remember that it is a stress related injury.
That’s why it’s called a “stress” fracture.
It is not a “run-too-much” fracture. It is not a “ran-too-far” fracture. It is a “too-much-stress” fracture.
So, if you want to know whether or not you’re at risk of getting one as you ramp up your training, one of the simplest things you can do is look at your running shoes. More specifically, your running shoe insert.
How can your running shoe insert show you whether or not you’re at risk for a metatarsal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you get an overtraining injury and your doctor tells you to stop running, so you sit still doing nothing, lots of bad things happen.
If you stop running, you will feel terrible physically. Zero exercise makes athletes feel worse.
Additionally, you’re probably going to get super grumpy.
Don’t be surprised if your spouse, your kids, and your friends start to think you’re being a little bit of a jerk. That is because you’re in a really terrible mood all the time… because you’re not running.
You also start to lose your identity as a fit runner.
We all feel good when we run. We feel good when we accomplish goals. We feel good when we do a long run at a good pace.
But all that gets washed away when you’re sitting around recovering from an injury.
Your identity needs to be that of a recovering runner.
That’s what we’re talking about today on the Doc On The Run Podcast.
A runner with a calcaneal stress fracture has a problem. So we got on a call.
The problem with calcaneal stress fractures is not healing. The heel bone “heals” fast!
Runners with calcaneal stress fractures really have 2 problems:
1. How do I let the heel bone heal fast
2. How can I fix the scarring that happens during step 1?
I was recently doing a call with a real runner who had a calcaneal stress fracture. She was having some issues because she was returning to running. The problem was not the heel bone.
She noticed a lot of stiffness and irritation around the ankle joint, because she’d been immobilized and off of the foot for quite a long time. Anytime you use a boot or crutches, you get lots of indiscriminate scarring. You can’t run unless you fix that.
Is stretching safe with a calcaneal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you recently got an MRI and then looked at the MRI report, it may seem like a bunch of gibberish.
What you really want to see is a picture of the actual injury.
So you do the most reasonable thing…you try to look at the actual MRI images to see if you can see the stuff mentioned in the report.
You put your MRI disc in your computer, or you go on an online viewing portal and you pull up your MRI images to try to make sense of it.
You’re trying to figure out if it really picked up your injury or not.
Did the MRI miss my plantar plate sprain?
Can the MRI show me the actual crack in the bone?
Where is the tear in the tendon or ligament?
This episode on the size of the slices might help you. It will also help you a lot if you’re going in to get an MRI because you have an injury and your doctor is going to order an MRI.
Today on the Doc On The Run Podcast, we’re talking about MRI essentials for runners, slice size matte
Let’s say you’re out on a run and you start feeling some aching pain in your foot. The next day you wake up, it really hurts when you step out of bed.
You go see a doctor and you’re told you have a stress fracture.
Being told you have a stress fracture is a real bummer because the doctor will probably tell you it will take about six weeks to heal. Then things get worse…
You are told you need to wear a fracture walking boot for about four to six weeks, and of course, you can’t run during that time.
After you wallow in tears, you decide to be a “good patient.” You go with the plan.
You sit around in the boot.
You don’t do anything.
You don’t take the boot off.
You don’t run.
You don’t exercise.
And a month or two later…you finally get clearance to run!
But when you first go for your run, everything feels super stiff!
Your running form is terrible. You feel really slow. But more than anything else, you really notice how super stiff everything feels around the ankle.
Today on the Doc On The Run Podcast, we’re talking about how ankle stiffness can lead to another stress fracture in a recovering runner.
An injured runner called me with a problem. “I rolled my ankle and it hurts HERE. The explanation from my doctor didn’t make any sense, because the pain on the top of my foot is not where the trouble was on the X-ray.”
I asked for some pictures showing where he felt the pain. And then it started to make sense.
Ankle ligaments are not the only structures that get injured when you roll your ankle!
If you are a runner with an injury and you want to get back to running you really need to understand what structure could be damaged. Then you can decide whether or not it’s dangerous for you to ramp up your activity.
If a doctor gives you a vague answer that usually tells me that the doctor doesn’t know what’s going on.
But if you really think about where the pain is, AND the mechanics of rolling your ankle during an ankle sprain event… you can figure it out!
I rolled my ankle and my foot hurts here. What is it?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner who got injured and got an MRI, I’ll bet that you’ve already tried to look at it…but you have simply no idea what you’re looking at.
You see there are more than a hundred images of your foot on the MRI. So, you’re not even sure where to start. MRI’s can be really overwhelming!
But MRI images are not really that complicated.
In this series on how to read your own MRI, I’m going to break it down and help you understand your own MRI images, especially if you want to see what was in the MRI report from the radiologist.
Today on the Doc On The Run Podcast, we’re talking about MRI Essentials for Runners, T1 versus T2 Images.
If you’re injured, you really need to have a goal.
If you were to call me for a private consultation or a house call, I would not accept “I want to get over my foot pain” as a goal.
But interestingly, when injured runners call me, that’s often what they say.
Think about this. When you sign up for a race, it’s really easy to get motivated. It’s easy to decide on your training plan and just get to work.
But when you are injured, you think the process has to stop.
Today on the Doc On The Run Podcast, we’re talking about why injured runners need a goal race.
Today’s episode comes from a recent question from a runner who I advised to begin running on this thing called an AlterG treadmill.
First of all, I do not own an AlterG treadmill. I do not own the company. I don’t own stock in the company. I do not get paid a referral fee or anything else if you use one.
I’m not pitching the AlterG treadmill because I get paid for it.
But the AlterG treadmill is a tool that I not only use frequently with athletes who are returning to running, but it is a tool that I teach physicians at conferences to use with their patients as well.
How can you get access to an AlterG treadmill when the physical therapy place says no?
That’s what we’re talking about today on the Doc On The Run Podcast.
You and your brain are supposed to be on the same team. You work hard with long runs, tempo runs and speed work to get your brain used to the idea of letting you run fast.
But sometimes your mind can work against you. This is especially true when you first return to running after a foot injury.
Your brain remembers your pre-injury ability. If not restrained, your brain instinctively wants to get you back to running at that same pace.
If you just started running post-injury, a little more detail may help you avoid a common trap.
You need to understand how powerful your mind is when it comes to your pace, your return to running and staying below your threshold for re-injury.
Your brain can be your adversary when you first start running after an over-training injury.
That’s what we’re talking about today on the Doc On The Run Podcast.
There are only a few occasions when you might want to get an MRI on both feet.
Truthfully, getting an insurance company to agree to pay for an MRI on both feet is not easy to do.
A few years ago I helped a runner who was training for marathons when he got injured. He was super fit. But on a long, super steep run in Yosemite he did some damage to tendons in both of his feet.
He really needed an MRI on both feet. So, I wrote an order for his MRI’s.
But, when the MRI facility tried to get prioritization, the insurance company denied the MRI request.
That just didn’t make any sense to me.
Is it valuable to get an MRI on both feet?
That’s what we’re talking about today on the Doc On The Run Podcast.
When you’re trying to get back to running, you have to think about all of the variables that can increase the stress and strain to your injured tissues.
Your “threshold for recovery” or your “threshold for re-injury,” are really the same.
When I lecture at medical conferences, I always tell doctors there are 3 variables you have to play with.
And you do have to play with the variables if you want to get an athlete back to running as quickly as possible.
What are three variables you can modify when you’re starting to run after you’ve had an injury?
Well, that’s what we’re going to talk about today on the Doc On The Run Podcast.
Yesterday it started to snow. So I decided to go out on a trail run on the trail in this picture.
I only saw one deer and two people.
As I ran around a corner under a cliff two climbers approached wearing jackets, with fleece hats under their helmets and all their climbing gear.
I stopped, looked at them and I asked, “Isn’t it too cold for climbing?”
One of the climbers smiled and said, “Isn’t it too cold for a trail run?” We all started to laugh.
The reality is that it is never too cold to go for a trail run. But excuses for getting stronger abound.
This is true when you are injured, too.
You got injured because you were too weak.
That’s what we’re talking about today on the Doc On The Run Podcast.
One of my Elite Access patients sent me a message. He was having pain from an inflamed Tailor’s bunion bursa at the base of the pinky toe.
He got a bigger shoe with a wider toe box that decreased the pressure. But when he was running, his foot was sliding around in the shoe, and it was still causing a problem.
He asked me if there was any solution. And yes, there is…
Today, on the Doc On The Run Podcast, we’re talking about how you can lace your running shoes differently when you have bursitis pain from a tailor’s bunion.
When you get injured, a lot of things go wrong.
1. Because you have pain, you suspect you have to stop training.
2. When you see a doctor, they confirm your fear and tell you that you really need to rest.
You translate that into really strict rest, doing nothing basically. You stop exercising. You stop training.
All kinds of bad stuff starts to happen. It is a lot more than just losing aerobic fitness.
Today on the Doc On The Run Podcast, we’re talking about how it is that the longer you wait, the more pain you can expect when you actually return to running after you get an over-training injury.
Today we’re talking about metatarsal fracture, nonunion surgery versus no surgery.
I know some people will think that I probably should have gone straight from #665 to 667 because frankly, there are some negative connotations surrounding those three letters, 666…the number of the beast.
But I decided to do this episode anyway. And, I decided to dedicate this one to a buddy who is a beast.
He’s tough, he’s active, and he happens to have a metatarsal nonunion that hasn’t stopped him from doing a whole lot of fun, active things.
I’m hoping in this episode you can learn a little bit about the different options you have when you get a metatarsal fracture nonunion.
Do I need surgery if my nonunion starts hurting?
Well, that’s a great question, and that’s what we’re talking about today on the Doc On The Run Podcast.
A calcaneal stress fracture is a terrible injury.
What is a calcaneal stress fracture?
“Calcaneus” is the medical term for heel bone. When you get a stress fracture in the heel bone, doctors call it a calcaneal stress fracture. When you run with a calcaneal stress fracture there is a risk the bone can actually shatter and break apart.
That obviously would be bad.
But there are three really interesting facts about the heel bone that you should think about.
Is a fracture walking boot the best thing when you have a calcaneal stress fracture?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
Today I went out for a run, but truthfully I wasn’t really excited about it. It was cold, it was pouring rain, and I had a lot of stuff to do. I could have easily justified not putting on my running shoes, not going out and slogging through a bunch of mud puddles.
I also hate to admit that part of the truth is, I had new running shoes. I just didn’t want to get them all nasty and dirty running in the rain, because they were brand new.
But I did run.
I enjoyed that cold wet run more than I thought that I would. But that’s almost always the case when you’re not really wanting to go out and workout, but you do anyway. Right?
When you’re injured, and you’re not exercising, you may wonder, “When should I start to exercise?”
Remember, the best time to plant a tree was 100 years ago.
Today on the Doc On The Run Podcast, we’re talking about how runners who recover faster workout before the perfect time.
I just got a great question from a runner who had been using a thing called a dancer’s pad.
A dancer’s pad is sometimes used to help an injury to these little bones under the big toe joint called the “sesamoid bones.”
If one of the sesamoids is painful and irritated and you’re trying to take the pressure off of it, an easy way to do that is to place a dancer’s pad in your shoe.
How can a dancer’s pad lead to a plantar plate sprain?
Well, that’s what we’re talking about today on the Doc On The Run Podcast.
If you’re a runner and you are listening to this, you probably have some kind of injury that’s doing one of two things.
Either it’s keeping you completely off of your feet and you’re not running at all, or you are basically running in a halfway fashion.
You are not really doing your full workouts. Your workouts are not really gratifying. And you don’t really feel like you’re making progress.
You have to remember here, the enemy is time.
Today on the Doc On The Run Podcast, we’re talking about how uncertainty costs injured runners.