I’ve decided to vent a little. This particular scenario has happened too many times to count. For whatever reason I’ve reached a breaking point and decided to write a few things down. The story begins back in April(ish) when a runner enters my office with sudden onset of sharp hip pain.
After seeing her primary care physician, a referral was made for physical therapy for a hip flexor strain. I saw this patient a week later. Without getting into the details of the evaluation process, I sent the patient out for imaging a few days later. My underlying suspicion was correct—a stress fracture at the femoral neck.
Unfortunately, the imaging I requested was delayed for various reasons, leaving said patient “walking” around with a hip stress fracture. By the time she snuck her leg into an MRI, the stress fracture progressed. Within 36 hours the patient was in the operating room to fixate her fracture.
What happened next is an all too common occurrence. It happens after countless injuries and surgeries. Hell, it happens with nearly every patient who has ever suffered a stress fracture. The old “take it slowly” and “you should be fine” are the farewell words as the patient leaves the office after they’re “healed.”
My patient had a pin placed in her hip followed with the standard six weeks of non-weight bearing. My (read your) problem now begins—after the obligatory rest period. It comes with the farewell “take it easy and slowly resume normal activity.” A farewell that leaves you with zero direction and quite frankly, in a spot to do more damage.
A research review pulished in the Journal of American College of Sports Medicine reported between 6-40% strength loss in normal men when placed on 4-6 weeks of bed rest.1 Adding insult to your injury, bone density is also effected. One study reports that bone density was not fully restored in able-body men (19-52 years old) after six months of normal weightbearing activity.2 Don’t get me wrong, some surgeries or injuries require you to do nothing. But what about after you’re finished protecting your injury? Shouldn’t you work to restore your balance, bone density, and muscle strength?
“Should I go to physical therapy” my patient asks. “No,” says the surgeon. “Just take it easy for a few months and start back slowly.” Wait… what? This patient had a pin placed in her hip. She hasn’t walked or used her leg muscles in the past six weeks (not counting the dysfunction pre-surgery). She’s given zero direction and leaves with “call me if there’s a problem.”
There’s no worse scenario for a runner. Most runners are self-destructive by nature. We see recovery as a challenge. After all, who doesn’t want to PR their recovery? The problem arises when we view an injury at a tissue level, but not a functional one. Sure, the x-ray showed that her hip (your knee, ankle, stress fractured) has healed, but what about identifying the cause or impairments that arise from the injury. Afterall, you were injured for a reason.
Look at the all too common stress fracture. I’d say upwards of 90% (my own assumption) of runners diagnosed with a stress fracture are given the “take it slow” treatment protocol after running is deemed safe. The protocol completely ignores two important pieces. First, why did your bone break and what’s going to stop it from fracturing again? Second, are you restoring the function (strength, range, etc) that was lost while you protected the injury site?
I’m happy to report that my patient was advocate for herself. She took the initiative to start physical therapy despite the direction provided by her surgeon. I need you to be an advocate for yourself, too. I’m certainly not encouraging you to visit your doc with a list of demands, but your long term health depends on restoring function—not only to run, but to move well for the rest of your life. No one cares about your health as much as you. Be an advocate for yourself.
1. Bloomfield SA. Changes in musculoskeletal structure and function with prolonged bed rest. The American College of Sports Medicine. 29(2):197-206, 1997.
2. LeBlanc, A. D., V. S. Schneider, H. J. Evans, D. A. Engelbretson, and J. M. Krebs. Bone mineral loss and recovery after 17 weeks of bed rest. J. Bone Miner. Res. 5:843-850, 1990.