Doc On The Run Podcast
852 episodes - English - Latest episode: about 1 month ago - ★★★★★ - 80 ratingsRunning injury tips on self-diagnosis and self-treatment. Simple strategies for rapid recovery of running injuries.
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Episodes
Can I use a bone stimulator for a broken toe?
March 25, 2024 11:59 - 4 minutes - 5.99 MBYesterday, I was doing a consultation with an athlete who broke one of her toes when she accidentally kicked a piece of furniture. If you fracture your toe, and you just run and ignore it, it can turn into a painful nonunion (non-healed fracture). As a runner, you want to speed the healing as much as possible. One of the ways to stimulate fracture healing is with a thing called a bone stimulator. This particular athlete actually happened to already have a bone stimulator. Her question w...
Medial calcaneal neuritis vs Baxter's neuritis in runners with heel pain
March 22, 2024 11:59 - 4 minutes - 5.96 MBIf you're a runner with heel pain you may think you have plantar fasciitis. But if it is not getting better, your heel pain may be caused by "neuritis." I was just giving a lecture to a group of physicians getting their continuing medical education credits at the International foot Medical Foundation medical conference in Lake Tahoe. I was giving a lecture called “When Heel Pain is NOT Plantar Fasciitis in Runners.” One of the conditions I was talking about was "medial calcaneal neuritis....
How dress shoes with long toe box act as a lever to stress plantar plate
March 20, 2024 11:59 - 3 minutes - 5.35 MBI recently did a consultation with a runner who had gotten a plantar plate injury. He had been getting better by using some of the tricks I teach in the Plantar Plate Course For Runners. He got better, he was protecting it, he reduced the stress and strain on the ligament, and he got back to running. He was doing great. But then he had a setback when he went to the synagogue. He was dressed up and wearing some fancy dress shoes, and he started to get plantar plate pain again. Today on t...
Can a Cortisone injection as stop gap for plantar fasciitis in runner
March 18, 2024 11:59 - 4 minutes - 6.3 MBI was just at the International Foot & Ankle foundation meeting in Lake Tahoe listening to a lecture given by a Professor of Biomechanics and Podiatric Medicine at Barry University. He said that a cortisone injection can be used as a "stop gap treatment" in heel pain caused by plantar fasciitis. The idea is that some runners may need pain relief sooner than would normally be expected. It is true that corticosteroid injections can reduce the inflammation in and around the plantar fascia an...
Worse exercise for plantar plate when building uphill strength
March 15, 2024 11:59 - 4 minutes - 5.47 MBI just had a conversation with a runner who has a plantar plate injury. He got the plantar plate sprain trying to build his uphill running strength in preparation for a trail race. This is no rookie mistake. He is a longtime ultra marathoner with lots of experience. But he made a common mistake determined runners can make. Today on the Doc On The Run Podcast, we're talking about one of the worst exercises you can do if you have a plantar plate sprain and you've been trying to build you...
How to patch test for tape allergy
March 13, 2024 11:59 - 5 minutes - 6.86 MBTaping is one of the oldest and simplest ways to treat foot pain and injuries to the toes, feet and ankles. There is a specific way to take your ankles after an ankle sprain so you can start running earlier. If you have a plantar plate sprain you might try taping the toe to decrease some of the stress and strain on the plantar plate ligament when you run. If you have a broken toe, buddy-splinting with tape can really help hold the broken bone still so it can hurt less and heal faster. ...
What is hyperemia in medical imaging of shin splints?
March 11, 2024 11:59 - 5 minutes - 6.9 MBI recently saw an elite runner who had what he thought was shin splints. One of the findings on the MRI report was something called "hyperemia." He asked me: “What does that mean? Does that mean I have a stress fracture? Does that mean I have shin splints?” What does hyperemia mean when you see it on an MRI report or an ultrasound report and you have something like shin splints or a tibial stress reaction? Well, good question and that's what we're talking about today on the Doc On The R...
When is fracture boot really needed with metatarsal stress fracture?
March 08, 2024 11:59 - 4 minutes - 6.62 MBI believe the most commonly prescribed and most overprescribed treatment for injured runners is probably a fracture walking boot. The big question for your doctor is... Is the fracture walking boot really necessary or not, given my stage of injury recovery? When is a fracture walking boot really necessary for a metatarsal stress fracture? Well, that's a great question and that's what we're talking about today on the Doc On The Run Podcast.
Overtraining injuries are caused by weakness
March 06, 2024 11:59 - 4 minutes - 6.02 MBWhen you get an overtraining injury from running, it's not because you did too much, because you were too strong or too motivated. You got injured because you were too weak. You were too weak to sustain the stress applied to that piece of tissue, that one injured piece of tissue that got injured when you did one workout. That's what really happened. If you get injured, you have to understand how to correct that specific weakness. Understanding this is crucial. Overtraining injuries i...
What is cortical thickening that precedes a stress fracture?
March 04, 2024 11:59 - 4 minutes - 6.12 MBThere are a lot of confusing things you can see on an MRI report, on an x-ray report or an ultrasound report when you're a runner with pain that you think might be a stress fracture. One of those findings that may be reported on your medical imaging study is a thing called "cortical thickening." I want to explain what that is so you can better understand it in case you happen to see it on an MRI report, x-ray report or in your doctor's notes. What is cortical thickening that precedes a s...
Why Stress Fracture Grading is BS for Runners
March 01, 2024 11:59 - 5 minutes - 7.82 MBI just had an interesting call with an elite runner, who's a high school cross country runner. He developed a tibial stress fracture, or stress reaction. But he thought it was shin splints. When I looked at it with ultrasound, I saw some stuff that made me really worried about it. So, I got an MRI to confirm. The first question he had was, what's the grade? Grading scales cause confusion. Today on the Doc On The Run Podcast we're talking about why stress fracture grading is BS for r...
What is periosteal elevation in tibial stress reaction?
February 28, 2024 11:59 - 4 minutes - 6.43 MBWhen you get a stress fracture, one of the earliest visible indications on an X-ray or an MRI or a CT scan is a thing called periosteal elevation. Your doctor might see it on ultrasound, x-rays or MRI studies....way before your ever see a crack in the bone. Since it's one of the earliest changes in the bone when you start to get a stress fracture, I thought it might be useful to talk about the term "periosteal elevation" really means. What is periosteal elevation in a stress fracture in...
Why variety makes you stronger as a runner
February 26, 2024 12:59 - 5 minutes - 7.01 MBI got an interesting question in the Injured Runners Aid Station, “Should I run without my custom orthotics to strengthen my feet?” It seems logical that stronger runners are less prone to injury. The premise behind this question is whether or not orthotics may cause weakness in your feet or legs. Never ignore your doctor's advice. But you have to ask your doctor the right questions about treatments like custom orthotics. You also have to understand when a little variety might help you be...
My Stress Fracture Framework simplified
February 23, 2024 11:59 - 5 minutes - 7.87 MBIf you're a runner and you get a stress fracture, the number one most important thing that you do is get it to calm down while you maintain your running fitness. Based on those ideas, I built a framework that I've been using for years with injured runners who want to heal and want to get back to running. In this episode we will go through my stepwise process of how I do it. Today on the Doc On The Run Podcast we're talking about my stress fracture framework simplified.
The most important ingredient for healing a stress fracture
February 21, 2024 11:59 - 4 minutes - 5.94 MBPain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run. How you track your pain is important. One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue. You cannot run without under...
Is the pain from injury or inflammation?
February 19, 2024 11:59 - 4 minutes - 6.37 MBPain is the most useful and likely most underutilized tool available to any runner who is tired of waiting for doctors to give them permission to run. How you track your pain is important. One of the critical components in the running injury secrets framework that I discussed in the first episode of the members only podcast in the Injured Runners Aid Station is about pain caused from damage in the tissue versus pain caused by inflammation around the tissue. You cannot run without under...
2 ways capsulitis can lead to plantar plate rupture
February 16, 2024 11:59 - 5 minutes - 7.01 MBIf you get a plantar plate sprain, it can take a long time to heal, particularly if you're not paying close attention. And because of that, many runners get frustrated. I see 2 responses to that frustration: 1) go to the doctor and hope for some kind of quick fix. 2) just ignore it and run on it because it doesn't really hurt that bad. Both of those are bad ideas with plantar plate injuries in runners. What are two ways capsulitis can actually lead to a plantar plate rupture? We...
Osteoblast vs Osteoclast battle rebuilding bone after stress fracture
February 14, 2024 11:59 - 4 minutes - 6.23 MBWhen you get a stress fracture, you need the little bitty crack in the bone to heal. How do you do that? First, you have to stop bending or torquing or twisting the bone in a way that led to the crack in the first place. Second, you have to let the healing process take place. After the inflammation goes away, and after you get some collagen sealing up the healing crack, you start to get "ossification" of the bone where it turns into hard solid bone that you can run on. That happens t...
How long will it take my overtraining injury to heal?
February 12, 2024 11:59 - 5 minutes - 6.92 MBHow long does it take you to get fit enough to run a 3 hour marathon? Well, that depends on what? It depends on what you would actually do. Not how long you wait. How long it takes for you to heal your overtraining injury all depends on what you do, and which variables you choose to control. Not how long you wait. Believe it or not, every injured runner who calls me for a consultation has control over far more of these variables than they think. How long will it take my overtraining inj...
3 running drills that can cause plantar plate sprain
February 09, 2024 11:59 - 6 minutes - 8.27 MBIf you're a runner with a plantar plate sprain, I can understand why you're frustrated. You have some minor vague aching pain in the ball of the foot, and you're trying to get back to running, but you're getting lots of conflicting advice. In my experience, it's very rare that a runner gets a plantar plate injury from what I call "overtraining." Plantar plate ligaments don't get sprained because you ran way too much, or ran too many miles. It doesn't really happen that way. But they do g...
Who’s fault if a runner is not getting better?
February 07, 2024 11:59 - 4 minutes - 5.49 MBIf you're trying to improve and you don't improve, whose fault is it? Before we talk about running injuries, let's talk about when you're not injured. You hire a coach. You know the coach is qualified, You know your coach has given you a valid training plan, and you know that you can execute. But then something goes sideways. Your baby gets sick. You get an additional work project. You are sent away out of town on work. Something happens, and you miss some workouts. If you don't commun...
What is the most important ingredient to a runner after a plantar plate sprain?
February 05, 2024 11:59 - 6 minutes - 8.5 MBI often get nutrition questions from runners who have overtraining injuries involving tissues made of collagen like the plantar plate ligament. At the heart of these questions is what is the most important ingredient to add in their diet to speed recovery. In this episode we are briefly discussing the key ingredients your body needs to repair collagen. If you are missing these, you might have a slower repair process if you have a partial tear of the plantar plate ligament itself. What is ...
Do not ask me if you do not know your pain numbers
February 02, 2024 11:59 - 3 minutes - 4.92 MBIn the Injured Runners Aid Station, I get questions from injured runners that stop me in my tracks. “I got this injury while running. I had a stress fracture. It was grade two stress fracture. It's been six weeks. How much longer will it be before I can run?” Every injured runner wants to know when it will be safe to run. But, I cannot make that decision based on that information. It seems crazy, but "how long until you can run" is never just about "how long since the injury started." Do ...
Tall fracture boot vs Short fracture boot, which is better for runners?
January 31, 2024 11:59 - 3 minutes - 5.13 MBIt's no secret that I truly believe fracture walking boots are overprescribed, overused and used for way too long for many injured runners with many different kinds of overtraining injuries. But sometimes I recommend runners use a fracture walking boot for a short period of time. Then teh question becomes which kind? Short boot or Tall boot? A tall fracture walking boot versus a short fracture walking boot. Which one is better if you're an injured runner? Well, that's what we're talking ...
Do I have to wait for a callus to go away before I can run?
January 29, 2024 11:59 - 3 minutes - 4.33 MBI just saw a woman with an extremely painful callus on the bottom of her foot. She got a type of callus doctors call an "intractable plantar keratosis." When you get one of these calluses, it turns into a tiny rock hard callus embedded deep in the skin on the bottom of the foot. It hurts. It's like having a little rock taped to your foot. In theory, you can start running as soon as the callus is removed. But the real question is whether or not running right away will increase the probabil...
How can I tell if I should have surgery to remove a big toe fracture fragment?
January 26, 2024 11:59 - 3 minutes - 4.53 MBIf you get a fracture in your big toe joint it can be easy to get talked into surgery. Especially if you see fragments on an X-ray. Your doctor may call old broken bone pieces by a number of terms: "Osteophytes" "Fracture fragments" "Loose bodies" "Surgical targets" If your doctor points them out and starts talking about surgery, the chances are good that you're going to want to have them removed. But there are times when surgery is totally unnecessary. How can I tell if I really n...
Best imaging study to assess non-union stability
January 24, 2024 11:59 - 3 minutes - 5.11 MBIf you get a metatarsal fracture and it does not heal, doctors call it a "non-union." Sometimes, even if you have a non-union you can still run. Maybe without surgery. The single most important consideration with a non-union is stability. The more stable the bone is, the more likely the fracture will heal. The more stable the bone is, the less likely it will cause pain. The more stable the bone is, the sooner you can start running. The more stable the bone is, the less likely you w...
Is two weeks on crutches better than one week with a tibial stress fracture?
January 22, 2024 11:59 - 3 minutes - 4.31 MBI just got a great question from a runner with a tibial stress fracture that had been misdiagnosed with shin splints. She wanted to know how long to use the crutches. Is two weeks on crutches better than one week when I have a tibial stress fracture? Well, that's what we're talking about today on the Doc On The Run Podcast.
Last chance option to avoid non-union surgery in a runner
January 19, 2024 11:59 - 3 minutes - 5.14 MBToday's episode applies to any injured running pondering surgery. I just spoke to a runner who was told she might need surgery to fix a non-union of a metatarsal fracture. I said, “Look, you have two choices. You can have surgery or not have surgery.” We talked about what it meant if she did have surgery in terms of her recovery. And we also talked about how she could potentially get it to heal without having all the risk associated with surgery. What is the very last option you can d...
Minimal restrictive intervention is the goal with runners
January 17, 2024 11:59 - 4 minutes - 5.55 MBIf you are an injured runner, you are probably limiting your activity. Doctors who don't understand how important it is for you to get back to running tend to limit runner's workouts more than necessary. They're more restrictive than necessary. And it costs you. You lose more fitness, you get weaker, you get stiffer, you get neuromuscular changes that damage your running form, and disrupts your coordinated firing of muscle units that makes you efficient. All of that gets damaged over th...
I had a sudden injury but my doctor called it a stress fracture
January 15, 2024 11:59 - 4 minutes - 5.85 MBPlease change the podcast descriptions, Aweber email and Clickfunnels email to: I had an interesting question from an athlete who asked, “I had an injury, I went to see the doctor and got an X-ray. There was no crack on the X-ray, but my doctor called it a stress fracture. So, I'm confused.” “I thought that a stress fracture happens when you run too much, too far, too soon, it overloads the bone, and you get a little crack in it. I didn’t do that. It was trauma, a sudden injury, not a bu...
Fix the original pain first
January 12, 2024 11:59 - 4 minutes - 5.58 MBI recently did a webcam consultation with an athlete who has had a lot of trouble for a long time. He was very, very athletic. He started having pain and a whole lot of trouble that ensued afterwards that severely changed his athletic picture in only a couple of years. After years of seeing experts and not getting any better, he asked me to help him to do a second opinion and help him reassess where he was and what he might be able to do. The way I think about this is really simple. Many ...
Is there any difference healing a stress fracture vs. traumatic fracture?
January 10, 2024 11:59 - 4 minutes - 6.29 MBI saw a runner who had a traumatic fracture, but she had been told it was a stress fracture. This did not make sense to her, because her injury wasn't from training for a race. She was trying to understand the difference in healing between a stress fracture with a crack when compared to the healing time of a traumatic fracture with a similar crack. It's important to understand they were talking about similar cracks in similar bones that remain in a similar position. We're not talking abou...
Should I take NSAIDs for a non-union in a runner?
January 08, 2024 11:59 - 4 minutes - 5.8 MBA metatarsal fracture "non-union" is what doctors call it when you broke the bone, it started to heal, but then the fracture kind of quit healing. Usually it means you got a bunch of scar tissue between the ends of the bone. Sometimes that happens without you or your doctor realizing it. The problem gets worse if you start running on it. The question is, "should I take non-steroidal anti-inflammatory drugs (or NSAIDs)? NSAID's are medications like ibuprofen and naproxen. These drugs a...
What causes most of the pain when I have a stress reaction?
January 05, 2024 11:59 - 4 minutes - 5.7 MBIf you get a metatarsal stress fracture, the first thing that you're going to notice is not that you have a broken bone in your foot. You are going to notice pain. Typically, the feeling starts as a little vague discomfort in your foot that progressively gets worse as you continue to train and run on it. The soreness gets worse the longer you run, feels worse when you walk barefoot on hard surfaces and becomes more notable going up and down wooden stairs. As I explained this to a run...
When is a boot better than crutches for tibial stress fracture in a runner?
January 03, 2024 11:59 - 3 minutes - 4.91 MBA stress fracture in your tibia, or shin bone, is a bad injury. You definitely don't want the crack to grow to the point where it could break. The big question is what will make a tibial stress fracture better, faster...crutches or a fracture walking boot? When is a fracture walking boot better than crutches for a tibial stress fracture if you're a runner? That's what we're talking about today on the Doc On The Run Podcast.
3 ways to tell if a fracture non-union is stable without imaging
January 01, 2024 11:59 - 2 minutes - 4.03 MBThis episode comes from a discussion I called with a runner who called me for a second opinion. She had a stress fracture non-union and somebody had remained recommended that she have surgery. I was looking at her CT scan and she asked me an interesting question. She said, “Does it look stable?” And I said, “Can't tell.” It looks like a non-union. It looks like it’s broken and never healed. What are the three ways you could tell whether or not a metatarsal fracture non-union is st...
What is a phalanx avulsion fracture in the big toe joint?
December 29, 2023 11:59 - 4 minutes - 6.07 MB50% of your body weight goes through the big toe joint when you run. So, If you get a fracture in the big toe joint, it can be a serious problem. One type of fracture in the big toe joint is called an avulsion fracture. I was just doing a consultation with a runner who had a phalanx avulsion fracture in the big toe joint. I wanted to show you what it really is and so that you can understand it better and what it might actually mean in terms of your returning to running. What is a phalanx...
What is better than NSAIDS for a stress fracture in a runner?
December 27, 2023 11:03 - 4 minutes - 5.79 MBNon-steroidal anti-inflammatory drugs (or NSAIDs for short), like Ibuprofen and Naproxen, what we call are extremely popular with runners because they get rid of lots of aches and pains. We often think inflammation results from hard exercise, so it stands to reason a non-steroidal anti-inflammatory will actually help after a long run. I don't normally recommend runners take NSAIDs as a part of a training routine. But there are a couple of alternatives that I would recommend over non-ste...
Difference between a mild stress fracture and a serious stress reaction in a runner?
December 25, 2023 11:59 - 4 minutes - 5.59 MBI had a call with a runner who asked me an interesting question about the difference between a mild stress fracture and a serious stress reaction in a runner. She wanted to know if the difference was based on the amount of tenderness or pain that she had. Although it stands to reason that the more tenderness, the more pain you have, the worse it must be. However, that is not really what differentiates a mild stress fracture from a serious stress reaction. What's the difference between a ...
Worst time to check gout with a blood test (when you have pain)
December 22, 2023 11:59 - 3 minutes - 4.25 MBIf you get gout, it's going to be painful. It hurts because you get so much uric acid buildup in your bloodstream that it starts to crystallize, forming little bitty needle shaped crystals in the joint. They are pointed, they're sharp and they are poking the tissue on the synovial tissue inside of the joint, and it hurts. When is the worst time to check for gout with a blood test? Well, that's what we're talking about today on the Doc On The Run Podcast.
Can EPFR get me back to running?
December 20, 2023 11:59 - 3 minutes - 5.38 MBEvery runner who has heel pain wants it fixed. A lot of us think about this in the way that we fix automobiles. The alternator goes out in your car, you go get a new one put in. Your battery dies, you go get a new battery. But your foot doesn't work this way. So unfortunately, when you have surgery, you're trading one problem for another. I have done endoscopic plantar fascia release surgeries, but not on any runners for more than a decade. Why do you think that is? Can an endoscopic pl...
Best way to avoid 2nd tear in the plantar fascia
December 18, 2023 11:59 - 4 minutes - 6.18 MBIf you have a tear in the plantar fascia, you probably know what a frustrating injury it can be. If you think it's better, and you're going to start running, one of your big questions is probably, “How do I avoid a second tear in the plantar fascia?” That's a great question and that's what we're talking about today in the Doc On The Run Podcast.
Most ignored part of a gout diet for runners
December 15, 2023 11:59 - 2 minutes - 2.96 MBIf your doctor said you have gout, you might have heard about a gout specific diet. A gout diet is not a specific diet in terms of a plan. It's avoiding foods that are high in purines that can contribute to high blood levels of uric acid. What is the most ignored part of a diet for somebody who's a runner and thinks they have gout? Well, that's what we're talking about today on the Doc On The Run Podcast.
Partial credit vs pass or fail with running injuries
December 13, 2023 11:59 - 3 minutes - 5.29 MBDon't ever forget that when you get a running injury, the goal is not to heal the injury. The goal is to get back to running. If you heal the injury and you get so weak and so stiff, that you wind up getting another overtraining injury, that is a failure. The thing you have to really think about as you're returning to running isn't just about the possible other injuries you could get but incomplete healing. The goal is to always strengthen everything as much as possible without obviousl...
Add stress systematically after running injury (DAY 3)
December 11, 2023 11:59 - 3 minutes - 4.23 MBWhy would you want to add stress? We're not talking about psychological stress. We're not talking about the stress of a screaming baby or a boss yelling at you. We're talking about stress on the tissues that will actually stimulate a healing response that makes them stronger later, just like working out. If you're an injured runner who's getting back to running, you need to add stress systematically. And that's what we're talking about today on the Doc On The Run Podcast.
Is it a big deal if I run with a partially torn plantar fascia?
December 08, 2023 11:59 - 3 minutes - 5.39 MBOne of the problems with the plantar fascia is that you may think you have plantar fasciitis, but eventually you find out that it was not really fasciitis at all. It's actually a partially torn plantar fascia ligament. That can be a problem since it is the largest ligament in your foot. When somebody says: “Can I run with a small tear in the plantar fascia?” I say that depends. Is it a big deal if I run with a torn plantar fascia? Well, that's what we're talking about today on the Doc...
Every run is test run after healing an injury (DAY 2)
December 06, 2023 11:59 - 3 minutes - 4.64 MBWhen you have a running injury and you know what your goal is you are halfway there. But if you're trying to get back to running, you've really got to do three things. You have to start moving, not make the injury anything worse, and you've got to get fit as fast as possible. Every day is a test run after you've healed a running injury. That's what we're talking about today on the Doc On The Run Podcast.
How can gout lead to hallux rigidus?
December 04, 2023 11:59 - 3 minutes - 4.2 MBOne 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 grad...
Find the gaps between you and running (DAY 1)
December 01, 2023 11:59 - 2 minutes - 3.88 MBA 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...