Dr. Brian Fullem practices at Elite Sports Podiatry in Clearwater, FL. He ran 14:25 for 5K while at Bucknell University. This is the continuation in a series of articles by Dr. Fullem, educating us about injury care, injury prevention & other health topics for athletes at all levels of performance.
I once went to see an Orthopedic surgeon regarding a knee issue, one of his first comments was that running is bad for your knees. This was a huge red flag for me and should be for any athletic patient that you might be in the wrong office. You are forming a relationship with the Physician and it is important that they support your choice of sport for exercise.
Sometimes patients are placed in a boot for an extended period of time and/or are told not to run without a diagnosis. For the athlete, every day in that boot adds another day you have to strengthen the area that is immobilized after the boot is removed. A stress fracture is one of the few times that immobilization may be required.
Another red flag is being asked to return multiple times to the office for treatments and tests that can be performed in one visit. Some Doctors see dollar signs when an athlete, such as a Triathlete, walks in the door. Custom orthotic devices are not a cure all for every ailment and some patients are wrongly placed in devices that are not necessary. Patients should not be afraid to question treatment plans, it should be a collaborative effort. If an X-ray is taken then it should be reviewed that visit, not dangled as a carrot to try and capture another co-pay and office visit from the patient.
Patients should not be afraid to question treatment plans
If a patient has an important competition in the near future they should expect the Doctor to offer a more aggressive treatment program, if the injury lends itself to this possibility. The sports medicine professional must understand that a college athlete only has 4 years of eligibility and a HS athlete may be trying to win a college scholarship. However, one must temper that aggressiveness if there is a possibility of long term harm to the patient. It can be a difficult dilemma sometimes. Recently I treated an athlete with pain in a muscle one month before a championship race, the athlete wanted me to inject cortisone and I considered it. I advised the patient that it could lead to a complete rupture (it was not the Achilles, that is one area I would never inject cortisone into) and I asked if she planned to continue racing professionally after the Championship was over, her affirmative response led me to deny the injection and an MRI revealed a muscle tear, at which point no running was an important part of recovery. For times when an athlete must rest alternative ways to maintain fitness such as the AlterG Treadmill, ElliptiGO and Aqua jogging can often be utilized without inhibiting the healing process.
Be wary of the latest and greatest treatments
Insist on evidence based medicine to treat your injuries. Platelet Rich Plasma (PRP) injections are always in the news due the use in high level athletes such as Kobe Bryant (photo from his surgery below). PRP has excellent potential for helping people heal but there are ZERO high level evidence based studies that proves it works better than placebo in the Achilles or any other location in the foot or leg. With a large price tag being passed on the patient, it is unethical to propose this treatment without informing the patient of the lack of evidence supporting PRP. Extracorporal Shock wave therapy is one treatment that has significant evidence in the literature supporting use for soft tissue injuries such as plantar fasciitis and Achilles tendinosis.
PUBMED.org is an excellent resource for reading abstracts and articles about almost any topic that is published in a medical peer reviewed journal. It is important to always look critically at every study, consider the level of evidence based medicine (Level 1 studies are the best as they remove the most bias) and see who supported the funding of the study. Be wary of press releases touting an article in the lay press.
Athletes are typically well informed patients and ideally they are given credit for this knowledge by their Physician and are allowed to properly collaborate in their treatment.
Keep checking back for Dr. Fullem’s next article, addressing those dreaded Achilles Tendon injuries.