Ask The Doctor: What Is The Best Way To Evaluate Injury?

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Dear Doc,

I've been having this pain in my right leg and it's getting worse. It all started about a month ago. I thought that it would just go away but after each of my runs, it's throbbing even more and if I take ibuprofen, it keeps hurting. I'm afraid to tell my parents and coaches because track season just started and they may make me stop running. Should I just try to run through the pain?

Thank you,

Morgan

Pain with running can range from a minor strain in the muscle or ligament that resolves briefly with time to a significant stress fracture on the bone that needs more medical attention. As I like to tell patients, you are the only one who is with your body 24/7. It's up to you to use your intuition on whether the pain that you are feeling is something that seems simple and will improve over a few days or needs further evaluation. 

The test for an acute (short-term) pain and a chronic (long-term) injury are the same. Try to rest it and see if it gets better. That may be a day or two or it could mean weeks to months of rest depending on the extent of an injury. What you do not want to do is to continue to run on a chronic injury. Even though there are anecdotal (and sometimes true) stories of those who have run on an injury and it has healed, this will not work for the majority of athletes. The goal is to have an extended quality running career so if that means taking off a season to heal from a stress fracture, it is necessary to continue the success of your long-term goals in running. 

What to expect if you think that you have a stress fracture:

For most insurance companies, you will have to go to your primary care doctor first for an exam before any imaging of your pain is performed. The doctor will get your history and do a physical and order an xray. For the vast majority of x-rays, a stress reaction (precursor to a stress fracture) or stress fracture will not be visible. From there, a radiologist specializing in imaging of the body, will suggest ordering an MRI (Magnetic Resonance Imaging), PET (Positron Emission Tomography) scan or CT (Computed Tomography) with IV contrast. Fortunately, you can leave the technicalities of which test you need to the experts. What you need to know is that it is a process. 

What if the results show a stress reaction or stress fracture? 

The key is that the only thing that will heal it is to stop running and take pressure off the injury. Depending on the extent of your injury, you may have to wear an orthopedic boot for several weeks. It's also important to understand why you developed a stress fracture. Take inventory on your nutrition and what you could be lacking. What are your sleep habits and training schedule? Did you have weekly rest days into your training? 

Cross-training while healing:

During that time, you may be able to incorporate cross training. With zero impact, swimming will be your greatest option before you are allowed on your feet again. As an Ironman friend of mine tells me, "Swimming is like running while breathing through a straw.' It's excellent for cardiovascular conditioning. With permission to return to minimal impact, the elliptical machine can supplement your endurance training. Compared to running, it's not the same, but with high intensity and prolonged time on the machine, you can really challenge yourself. Remember that this is time to stay conditioned and invest high-intensity training. Which means a time to put away the phone and all of the distractions and remember how badly you want it.

Happy Healing! Wishing you a great outdoor track season of running healthy and strong.

Dr. J's Disclaimer:

While I am a US-licensed doctor, the information presented in this website is for the purpose of information only. Yes, I am a doctor, but I am not your doctor and we have not established a patient-doctor relationship (although I'm so glad you are reading the information in my posts!). Conclusions drawn from the information in this website are entirely your own, created from your own perception, knowledge, and understanding. Actions that you decide to take based on those conclusions are done by your own judgment and of your own accord. Nothing read on this site should be relied upon to replace or overrule a licensed health care professional's judgment or clinical diagnosis

Dr. Johnson is a traveling physician, ultramarathoner, yoga teacher, mother of a college and high school runner and an all-around adventure-seeker.


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