I 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 Run Podcast. 

I 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. 

When 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 in runners are actually caused by weakness.

And that's what we're talking about today in the Doc On The Run Podcast.

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

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

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

What is cortical thickening that precedes a stress fracture? 

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

I 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 runners. 

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

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

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

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

I 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 become a stronger runner. 

Why variety makes you stronger as a runner?

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

If 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. 

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

How you track your pain is important. 

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

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

Is the pain from injury or just inflammation? 

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

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

How you track your pain is important. 

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

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

Is the pain from injury or just inflammation? 

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