From the July 2012 issue of Runner’s World

Rehab not working? Here are six signs you should seek out another expert’s opinion

By Winnie Yu

John Mayer had been an avid runner since high school. But at age 45, in 2005, a pain in his knee was getting worse, so he went to see a doctor. “This fellow came highly recommended,” says Mayer. After diagnosing a torn anterior cruciate ligament, “he told me there was nothing to do. He was so respected, so convincing, and so definitive that I didn’t even bother to get a second opinion.”

Mayer was crushed and didn’t lace up for six months. When he tried to run again, the pain came back. Finally a friend suggested he see another doctor, who confirmed the problem but recommended arthroscopic surgery and physical therapy. Mayer’s pain eased, and he’s since run eight marathons.
Not every treatment plan requires a second opinion. But when you’re under- going rehab – and anxious to run again – it’s important to know when to seek a different perspective.

1 You’re told that there’s nothing to be done
Almost all running injuries are treatable. So if a doctor tells you he can do nothing for you, make an appointment with another expert. That diagnosis most likely means “there’s nothing more that that doctor can offer,” says Michael Ross, M.D., medical director of The Rothman Institute Performance Lab. And while some conditions, such as severe arthritis in the hip, ankle, or knee, could certainly curtail your career, you’ll want to confirm a diagnosis like that with another physician before you quit running altogether.

2 You’ve developed a new pain
Sue Walsh was a month from her first marathon in 2008 when she developed an IT-band injury and visited a physio. “The IT band got better, but my hip flexor on that same side started to hurt,” says Walsh, 33. “I couldn’t get it together for the marathon.”

An appropriate treatment plan should not cause new aches. “A patient who is experiencing increased pain or pain in new locations is likely getting therapy that is overly aggressive for their condition, or was misdiagnosed and should be reassessed,” says Michael Chin, medical director of The Running Institute.
Another doctor later diagnosed Walsh with femoroacetabular impingement, a bone deformity of the hip that required surgery. She finally got back to running two years after the initial IT-band issue.

3 You notice no improvements after two to four weeks
Most injuries should improve and pain should diminish after four to six sessions of therapy, says Dr Chin. If they don’t, the rehab plan may be too conservative. David Bakke, 45, was diagnosed with runner’s knee a week after he started bounding up a set of nearby steps. He was told to do some stretching exercises and rest for seven to 10 days. After two weeks, when he’d noticed no improvements, Bakke went to see another doctor who prescribed exercises to strengthen his quadriceps. “In about 10 days, I was finally able to resume my full workout,” says Bakke.

4 Your injuries keep recurring
Repeat injuries – or a series of different injuries – suggest you may have an underlying health problem that isn’t being addressed, says Lewis Maharam, M.D., a sports-medicine doctor and author of the Running Doc’s Guide to Healthy Running. Dr Maharam says he once treated a woman who had recurring fractures in her hip and feet every three months. “She was biomechanically sound, and her bone density test was normal,” he said. “But we did a blood test, and found she had a parathyroid tumor.”

5 Your doctor doesn’t ask about your overall health status
When you go to a doctor complaining of a running injury, it’s easy to focus exclusively on the body part that’s hurt. But a skilled doctor will also ask questions about your health habits and try to gauge your fitness level. Runners who aren’t getting enough sleep, for example, may be prone to injuries. A diet deficient in calcium and vitamin D may make you vulnerable to stress fractures. Inexperienced runners may be trying to do too much too soon. If your doctor doesn’t take the rest of your health into account, consider getting a second opinion.

6 You haven’t been given other ways to stay in shape
A good rehab plan should include exercises to help you stay fit while you’re on the road to recovery. Sometimes runners don’t realise they need to take a break and do some cross-training. For example, a runner in treatment for recurrent ankle sprains should work on strengthening her core and upper body while she isn’t running. Even more important is that the doctor understands your goals. Knowing you’re weeks from a marathon, for example, your doctor may attempt a more aggressive treatment plan. But if you’re months away, you may have the time to rest and heal without additional testing or interventions. If your doctor doesn’t ask you about your fitness goals, consider seeing another doctor who does.

WHO DO YOU CALL?
Reach out to the right help

Primary doctor
Unless you have an established doctor-patient relationship with a sports-physician specialist, call your primary doctor first, says Michael Ross, M.D., of The Performance Lab, because he or she knows you.

Physiotherapist
While straightforward injuries, such as a mild ankle sprain, can be easily managed by your general practitioner, many running pains are the result of muscular imbalances, overtraining or overuse, or poor running mechanics. A physio can tailor a rehab plan to fit your needs and goals. To find a physio in your area visit physiotherapy.asn.au.

Sports Specialist
If you’ve closely followed a rehab plan but aren’t seeing result – or if you have complex running problems – it’s time to seek a doctor who’s done an accredited fellowship in sports medicine, says Lewis Maharam, M.D. These are doctors who’ve been trained in running mechanics and who can spot the underlying problems that are the cause of many injuries. “The doctor should look at how you run and be able to advise you on things like gait and preventive measures,” he says. Find one at acsp.org.au.

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