When Is It Time to See a Doctor?

Does this sound like you? Fueled by vitamin I (ibuprofen), you go for a run despite nagging pain. You’ve adopted a regimen of ice and more vitamin I post-run. Eventually, nothing eases the pain, so you rest. Your friends recommend visiting practitioners ranging from traditional MDs to the shrunken-head shaman. After a couple of weeks, the pain fades, but your patience fades even more from lack of exercise. You lace up your shoes and head to your favorite trail for a run. Your glorious freedom lasts only until the first twinge of pain returns. You repeat this cycle, sometimes for months or years.

John E. McDonald, M.D., a Steadman Clinic fellowship-trained orthopedic surgeon with Texas Orthopedics, likens such injuries to a bonfire: Let the fire burn down to embers and then throw on more wood, and it reignites. Let the fire go cold and throw wood on the pile of ashes, and nothing happens.

Mistaking embers for ashes is a good way, as the saying goes, to dig yourself into a deep hole. At any given time, you’ll find a gathering of athletes in this injury hole. Why? Athletes train their brains to dismiss pain and push through it, sometimes at any cost. No pain, no gain, right? But the mentality that leads to personal records when healthy doesn’t serve well when injured. When you find yourself in a hole, the first rule is to stop digging.

Pain serves a vital purpose: It’s the body’s way of saying, “WHOA!” When pain is dismissed—or, worse, when vitamin I is used to take the edge off for an extended period—both time and the opportunity to get a proper diagnosis are lost while the chance of long-term damage is increased. Dr. McDonald suggested a rule of thumb for chronic overuse-type injuries: Trying a reasonable alternative therapy is fine, but don’t let the cycle continue for more than six weeks before seeing a physician. (Note that this guideline does not apply to acute trauma, in which case you should see a physician immediately.)

Fear traps athletes in the cycle. You fear you won’t be able to train as you’re accustomed to, or you’ll be told to rest indefinitely, or, worst of all, you’ll need surgery. But delaying a visit to a physician is throwing wood on those embers, resulting in further (and sometimes permanent) damage; a simple overuse injury that morphs into something more difficult to treat; or a date with the operating table.

It’s time to break out of the cycle and put out the fire. Why? Your future athletic endeavors and health depend on it.

According to Dr. McDonald, “Many of the injuries I see could have been treated with modifying activities at an earlier stage; they might not have been as persistent had they been treated sooner. For example: Stress reactions that occur in bones can turn into stress fractures that are difficult to treat.”

Here’s the conundrum: How do you differentiate chronic pain caused by simple overuse from a more complex mechanical issue? To distinguish between these, you need a physician’s evaluation. Many overuse injuries can be treated with rest and physical therapy (PT), a viable option to prevent surgery. In Texas, your physician’s prescription is your only ticket to PT. Conversely, mechanical issues (including meniscal tears, full thickness rotator cuff tears, loose bodies in a joint, and ligament injuries) often won’t resolve without surgery. Do yourself a favor and get a clear diagnosis. Early intervention can even help you avoid surgery.

What about choosing a physician? Standard guidance includes inquiring about recommendations and looking at resumes and training. In addition, ask yourself these questions: Does the physician

• listen without preoccupation?

• communicate information about your injury in an understandable way?

• suggest other ways to stay fit?

• discuss goals with you?

• make you feel like a person rather than a number?

• respond to questions with information instead of blank stares?

Finding a trusted physician who listens with the compassion and presence of a wise friend and possesses the knowledge and experience of a sage will put your fears at ease.

But what do you do if your doctor has been giving you blank stares for months regarding your problem? Whether out of pocket or through insurance, you are paying for a professional service. If you aren’t satisfied or are frustrated by lack of progress, seek a second opinon; a good physician will encourage this, and seeing the wrong physician doesn’t save you time or money. Every physician wants the best for his or her patient, so have another set of eyes review your case.

Does this sound like a healthy dose of tough love here? Perhaps, but now you’re armed with a plan when pain strikes. Avoid the injury hole by seeking professional help when chronic pain forces a change. And always remember to take care of yourself the same way you’d take care of the person you love most.