Why do I even go to doctors for running injuries?

Here's my little story.

Was marathon fit, running 30 mile training runs, then got a sore knee; couldn't even go 1 mile.

Went to my GP, referred me to sports medicine Dr at local university, who recommended going to physio.

Physio, like they all do, said strengthening. I'm not as stupid as I look, even I know that's generic bullshit.

I go back to my GP who refers me to another sports doc at an adjacent university. That sports doc at least has the balls to admit he doesn't know what is wrong.

I go back to the first sports doc and insist he refer me up to an Orthopedic specialist.

Now it's 3 months later and I've lost all the fitness I had.

I go see the specialist who instantly says it's ITBFS, shows me a simple stretch to fix it, that I can do while running. She recommends starting with short runs doing the stretch every mile and working up from there.

Problem solved.

I never did get back to full marathon fitness, probably never will.

These days just getting work is enough hassle.

But anyway I think it shows that so-called Sports Medicine Doctors, who indeed are MDs, are not really all that smart.

You have to keep looking until you find someone who actually knows something.

The toughest part, as with everything, is to be able to spot people who are (supposed to be experts but who are actually) stupid and not get screwed up by them.

Captain Oblivious wrote:

You're deliberately hurting yourself, you shouldn't be allowed to see a doctor.

A doctor is for sickness and accidents not people hurting themselves as a hobby.

This.

Physicians should be much more concerned with concussions, dehydration, hyponatremia, and compound fractures. Athletes should understand that there is no quick fix for most injuries that result from training. A physician's focus should be to identify those injuries that can be dealt with non-operatively. Often for these injuries, I think docs are quite smart to recommend physical therapy. Most running injuries result from muskuloskeletal imbalances. The physician should also be able to identify those injuries that require operative management and proceed accordingly. Beyond this, I am not sure what type of magic athletes expect from doctors.

I know it's frustrating when doctors recommend "rest" without further testing, but in most cases further testing won't be of help. When a doc recommends rest, suggest referral to a physical therapist as therapy may help you to recover and prevent future injuries. Physicians, however, are not physical therapists and shouldn't be expected to act as physical therapists.

A long trail of sports orthopedists gave me orthotics, then they modified the orthotics, then compression sleeves. They had me wear "stable" shoes, then "flexible" shoes. Finally they sent me to see the renowned Stan James. He said, more or less, that there was nothing he could do except surgery to relieve the supposed "compartment syndrome." I stopped seeing orthopedists at that point.

GP's are oriented toward the high blood pressure / high cholesterol / diabetes crowd. If you get a decent one, they won't do you harm ("Rest it"). The main thing you have to watch out for is one that is overly influenced by the constant stream of drug salesmen. I had one that prescribed an unneeded antibiotic (fluoroquinolones) which is known to cause ruptured tendons up to a year after one use.

The other thing to watch out for especially as you get older are unnecessary surgeries. An old lady down the street kept getting useless foot surgeries (5? 8?) after which she would recover back to her normal state of walking reasonably well with a cane.

By far the best diagnoses and results I've had were from going to chiros. My daughter was a competitive swimmer and lifeguard and she had the same experience regarding shoulder injuries. She became a chiropractor as a result of finding them to be helpful.

If you get a doctor who doesn't want you to run, switch doctors. The first cardiologist I had wouldn't let me run and over-prescribed medicine. He had me on too much BP medicine and Plavix even though I didn't have a stent. I switched to a cardiologist who reduced my medication and doesn't mind me running ultras.

Sorry for the geriatric content but that's where I am.

Charlie Stache wrote:

What a complete waste of time. Does anyone find that ortho's or sports medicine doctors actually helped you with a running injury?

My visit today confirmed that I'm best sticking to the Letsrun search tool & home remedies.

Where do you live?

Archimedes wrote:Rest rarely will "cure" any overuse injury other than fractures. Sure your IT band pain (or whatever) may go away, that is, until you start running again.

rest has always cured injuries for me so far. *knock on wood lol* the trick is taking time off before the injury becomes chronic.

the same with IT band pain - using your example -, rest fixed it. then I figured out that I did need to engage certain muscles more when running to avoid the pain coming back.

there was some other injury coming on once that was due to the bad kind of shoes. I noticed that because I had another pair of shoes and when wearing those, I didn't have the issue.

so yes of course if the injury has a special cause, it needs to be found.

but plain overuse injuries don't have a cause other than overuse and so they just need rest.

ofcourse, knowing when to return back to running and how gradually to do that is also tricky but you can learn that too.

a well structured training plan should be the best injury prevention however.

jojojo wrote:

Archimedes wrote:

Rest rarely will "cure" any overuse injury other than fractures. Sure your IT band pain (or whatever) may go away, that is, until you start running again.

+1

it might get you back on your feet temporarily. but if you don't fix the reason you got hurt in the first place, you will be out again.

see what I just wrote to Archimedes, that answers you too

+1 you put it so well.

Some countries require GP visit before gaining access to a specialist or imaging tests, both of which are required for diagnosis and treatment of non-self-treatable injuries like labral and meniscus tears, stress fractures and osteoarthritis. Unfortunately it can take a long time, e.g. average time for labral tear diagnosis (not including treatment) is 2 years in USA.

Beyond that the most commen running injuries are generally self treatable when armed with the right knowledge. If your PT or Dr says to RICE, they're behind the the times, it's now "POLICE" - Protection, Optimal Loading, Ice, Compression, and Elevation. optimal loading is the key, which means don't completely Rest, instead, start with gentle loading until strong enough to return to normal activities.

Here are the most common injuries and treatments, those with * are based around relatively new concepts/research of tendon remodelling, and seem like the worse thing you could do but are highly effective as proven by clinical studies. POLICE applies to all these injuries.

1) *Achilles tendonosis - Alfredson heel drops

http://img2.timg.co.il/forums/1_115845356.pdf

2) *Patellofemoral pain syndrome/chondromalacia aka Sore knees:

http://www.runningwritings.com/2011/09/injury-series-tendon-remodeling-part-ii.html

Plus regular foam rolling of your IT band and avoid downhill running until ready.

3) Plantar Fasciitis - towel pulls with toes, golf ball rolls, pen/penny drill, plantar stretch, toe clench. Avoid uphill running until ready.

4) Pulls, tears, tweaks - POLICE plus rolling. ART and Graston techniques can help, but many PTs think ART is a scam that doesn't address the usual underlying issues of core strength and balance.

In all cases examine your running history - did you ramp up mileage too quickly, too much speed work? Are shoes old? To quote Constantina Dita, there is no such thing as overtraining, just under-resting.

Older runners are strongly recommended to include strength training, esp eccentric muscle contraction, as that decreases much faster with age compared to concentric strength.

Lastly, the term tendonitis is generally incorrect/incomplete because it only includes inflammation. Tendinopathy is a better description for chronic injuries as it includes inflammation, pathological tissue remodelling, as well as impact to local histology, nerve function and proprioception. If your Dr says it's just tendonitis and gives you anti-inflams that don't help, time to seek better advice.

hippo wrote:

Captain Oblivious wrote:

You're deliberately hurting yourself, you shouldn't be allowed to see a doctor.

A doctor is for sickness and accidents not people hurting themselves as a hobby.

This.

Physicians should be much more concerned with concussions, dehydration, hyponatremia, and compound fractures. Athletes should understand that there is no quick fix for most injuries that result from training.

I saw orthopedists for 3 years, was I expecting results too quickly?

Sports medicine should be a higher priority than it is, not lower, because fit people are less likely to suffer from other, more expensive illnesses.

Bad Wigins wrote:

fit people are less likely to suffer from other, more expensive illnesses.

Source?

please cite wrote:

Bad Wigins wrote:

fit people are less likely to suffer from other, more expensive illnesses.

Source?

How about we start with the spectrum of ailments and diseases associated with obesity? Would that be of interest to you?

Mean Mr. Mustard wrote:

please cite wrote:

Source?

How about we start with the spectrum of ailments and diseases associated with obesity? Would that be of interest to you?

What would interest me is a link to a study showing that fit people are less likely to suffer from other more expensive illnesses. I thought I made that pretty clear when I asked for a source from a poster who said that fit people are less likely to suffer from other more expensive illnesses.

I'm willing to believe it if I see a study, but I don't think it's as clear cut as most runners like to believe. Obese people and smokers often die of illnesses that progress rapidly, or even kill nearly instantly. Runners may be more likely to live long enough to have increased odds of dying of cancers and neurological disorders that progress slowly and require years of treatment.

No arguing either way, and I could believe either argument. I'd just be interested in seeing a source backing up the claim.

well I am a doctor and I can tell you that most running injuries are soft tissue injuries (muscle, tendon, cartilage, ligament) that need time to heal. We don't really have the ability to accelerate the healing process. When someone says "I did X for 2 weeks and it got better" you should ask yourself what the control group was. Maybe it would have healed in 2 weeks without doing X. Maybe it would have healed in 1 week without doing X!

Notable exceptions are stress fractures (because the diagnosis alters the treatment, esp if they are in the hip / femur) and tendon ruptures such as the achilles. These may need surgical repair.

It is true that most of the time the doctor can't help make you better faster. The sad truth is that probably nothing will help you heal overuse injuries quicker and these comprise probably 95% of running injuries.

My best medical advice to stop beating on obvious problems when they start. That is denial. It feels like you are getting more training by doing this, but you end up missing 15 runs because you refused to miss 3.

Muscle Phys! I loved that class. Simplified version, leaving out the details of DHPR receptors (L-type voltage-gated Ca++ channels), ryanodine receptors, troponin-C, SERCA pumps, calsequestrin, etc.:

An electrical signal (action potential) travels down a nerve cell, causing it to release a chemical message (neurotransmitter) into a small gap between the nerve cell and muscle cell. This gap is called the synapse.

The neurotransmitter crosses the gap, binds to a protein (receptor) on the muscle-cell membrane and causes an action potential in the muscle cell.

The action potential rapidly spreads along the muscle cell and enters the cell through the T-tubule.

The action potential opens gates in the muscle's calcium store (sarcoplasmic reticulum).

Calcium ions flow into the cytoplasm, which is where the actin and myosin filaments are.

Calcium ions bind to troponin-tropomyosin molecules located in the grooves of the actin filaments. Normally, the rod-like tropomyosin molecule covers the sites on actin where myosin can form crossbridges.

Upon binding calcium ions, troponin changes shape and slides tropomyosin out of the groove, exposing the actin-myosin binding sites.

Myosin interacts with actin by cycling crossbridges, as described previously. The muscle thereby creates force, and shortens.

After the action potential has passed, the calcium gates close, and calcium pumps located on the sarcoplasmic reticulum remove calcium from the cytoplasm.

As the calcium gets pumped back into the sarcoplasmic reticulum, calcium ions come off the troponin.

The troponin returns to its normal shape and allows tropomyosin to cover the actin-myosin binding sites on the actin filament.

Because no binding sites are available now, no crossbridges can form, and the muscle relaxes.

As you can see, muscle contraction is regulated by the level of calcium ions in the cytoplasm. In skeletal muscle, calcium ions work at the level of actin (actin-regulated contraction). They move the troponin-tropomyosin complex off the binding sites, allowing actin and myosin to interact.

P.S. Lots of Ca++ is stored in the SR, just waiting to be released when we go running :-)

please cite wrote:

I'm willing to believe it if I see a study, but I don't think it's as clear cut as most runners like to believe. Obese people and smokers often die of illnesses that progress rapidly, or even kill nearly instantly.

At least as often, they are ill for many years before they die, with ailments like diabetes, HBP and COPD.

And because the ailments strike them at a younger age, they spend less time making a net contribution to the insurance pool before they start permanently drawing more instead.

But it's a trivial point anyhow. Scroll back and you'll see I was replying to a comment about what doctors should treat. Fitness is a worthy medical goal in and of itself whether it saves money or not.

If you want a link, register a name and then maybe I'll go find one. Otherwise why should I care if you have an issue with a minor part of my post?

Donkey Balls wrote:Beyond that the most commen running injuries are generally self treatable when armed with the right knowledge. If your PT or Dr says to RICE, they're behind the the times, it's now "POLICE" - Protection, Optimal Loading, Ice, Compression, and Elevation. optimal loading is the key, which means don't completely Rest, instead, start with gentle loading until strong enough to return to normal activities.

Oh I didn't know that people finally realized POLICE is better than RICE. I never followed RICE myself. I do the first three letters of POLICE, I will admit I don't do the rest just like I didn't with RICE either.

I would also add another letter into the acronym for fixing muscle imbalances. Suggestions? :)

To quote Constantina Dita, there is no such thing as overtraining, just under-resting.

Nice but oversimplified. But sure, the importance of recovery needs to be stressed - active and passive recovery alike.

madmandoc wrote:It is true that most of the time the doctor can't help make you better faster. The sad truth is that probably nothing will help you heal overuse injuries quicker and these comprise probably 95% of running injuries.

Rest is important but I want to add that when someone mentioned the POLICE acronym, the word "protection" to me also means that you should avoid anything that makes the pain come on or makes it worse. Including attention even to the position you sleep in at night. I find attention to these things - and the rest of POLICE, I guess - help a lot.

ES student wrote:Myosin interacts with actin by cycling crossbridges, as described previously. The muscle thereby creates force, and shortens.

Must it always shorten? What is different for cases when the muscle creates force without shortening?