Wednesday, August 20, 2014

See a Doctor

I belong to a few running clubs that have Facebook groups.  From time to time, I see a post that begins, “I have [insert injury here]…” and goes on to ask for advice on how to treat it.  More troubling, I also sometimes see posts like, “I’m experiencing [insert symptoms here], what do I have?”

Posts like this usually come from runners who are new to the sport.  Since some of these groups have thousands of members, there are usually numerous responses from more experienced runners.  While the responses are well-intentioned, they’re not always helpful.  They don’t necessarily come up with the correct diagnosis.  As for treatment recommendations, they’re all over the board.  I often see many different suggestions, some of which are contradictory.

It’s tempting to want to help.  If someone has an injury that I’ve had in the past, and I know how to treat it, I’m tempted to offer advice.  Similarly, if someone describes the classic symptoms of a common running injury, I’m tempted to tell them what I think it is.  It’s only after seeing all the conflicting advice posted by other runners that I realize it’s not helpful.

In the future, my advice will be “See a doctor.”

There are several things a doctor can do for an injured runner.  The most important is to give a correct and definitive diagnosis.  Before anyone can come up with a good treatment plan, they need to know what they’re treating.  The first problem with seeking medical advice from an online forum is the risk of an incorrect diagnosis.  If the diagnosis is incorrect, the treatment may be ineffective, or worst yet, harmful.  There’s no substitute for getting the correct diagnosis.  The best way to do that is to see a doctor.

Collectively, an online forum with thousands of experienced runners has a lot of experience.  The people answering questions, however, are individuals.  Each one has limited experience.  Their answers will be biased according to their own experiences.

Let me give an example.  Suppose someone is experiencing knee pain when they run.  I have experience with a common running injury called chondromalacia of the patella.  It’s more commonly called “runner’s knee.”  I’ve had this injury twice.  I know the cause, I know the symptoms, and I know the treatment.  If I hear someone describing knee pain, I’m going to ask myself, “Do they have runner’s knee?”  If they do, I could give some helpful advice.  If they don’t, I can’t.  I’m not familiar with other knee injuries, so if the symptoms sound similar, I’m going to be biased toward assuming they have the injury I know about.  There may be dozens of other knee conditions I know nothing about.  Some may have similar symptoms.  I don’t have a broad enough background to distinguish between them.

When you ask a question online, you’ll get multiple answers.  If five people say you have runner’s knee and five other people each suggest different injuries, you may assume that runner’s knee is the correct answer.  Why else would so many people agree?  Here’s why.  The more common the injury, the more people in the group will know about it.  You’re likely to see a distribution of answers that corresponds with the frequency of that injury among the population of runners.  What if you have a less common injury?  What if your injury wasn’t caused by running?  It may be related to a pre-existing condition or a recent trauma.  Your online audience doesn’t know your medical history.  Because of their individual biases, they’ll sometimes get the diagnosis wrong, in spite of their vast collective experience.

Doctors have years of education and experience.  They’re familiar with a wide variety of different injuries, and they’re trained to be able to differentiate between them.  They have more tools at their disposal.  Besides asking questions, they can physically examine the site of the injury.  They can also run diagnostic tests, such as X-rays or MRIs.  It’s their job to be able to give you the correct diagnosis.  They also have a professional (and legal) responsibility to not give you a misdiagnosis.  If they can’t give you the right answer, they’ll refer you to someone else who can.

There are a number of reasons why people ask friends (or strangers) for advice, rather than going to a doctor.  It’s quicker, it’s easier, it’s more convenient, and it’s free.  Seeing a doctor involves making an appointment.  You may have to take time off from work.  Even if you have insurance, you probably have a copay and/or a deductible.  In my experience, it’s worth both the time and money to get a correct diagnosis.

They second thing a doctor can do is recommend a treatment plan.  I emphasize the word recommend, because you’re under no obligation to follow their advice.

I suspect the main reason some runners don’t want to see a doctor is because they’re afraid the doctor will tell them they have to stop running – not just for a few days or a few weeks, but forever.  In my experience, the treatment may involve rest, but only for a few days or at worst a few weeks.  It’s unlikely your doctor will tell you to give up your sport.  More importantly, if they do, you can get a second opinion.  Their treatment plan is a recommendation.  It’s generally a good idea to follow their advice, since they understand your injury better that you do.  It’s important to remember, however, that you don’t have to.

The third thing a doctor can do is educate you.  They can explain why you got injured and how to prevent the same injury from recurring in the future.  Not all doctors do this, but the best ones do.  If they don’t, you should ask.

I’ve been running for 34 years.  I’ve experienced many of the most common running injuries at least once.  With experience, I’ve learned to distinguish between “normal” discomfort (e.g. sore muscles after a strenuous effort) and the symptoms of an injury.  I’ve learned to recognize the symptoms of injuries I’ve had in the past.  I’ve learned how to treat them.  I’ve also learned how to prevent them or minimize my risk.  Finally, I’ve learned to recognize early warning signs, so I can treat a minor injury before it becomes serious.  Sometimes, a single well-timed rest day is all it takes.

If I self-diagnose an injury, it’s only because I’ve had the same injury before.  It’s easier to do that when you know your full medical history and are personally experiencing the symptoms.  It’s much harder to diagnose someone else.  That should be left to the medical profession.

If I have symptoms that are unfamiliar, I’ll see a doctor.  The first time I had runner’s knee, I saw a doctor.  That was 31 years ago.  The second time, I diagnosed and treated it myself.  That was 30 years ago.  There was never a third time.  I learned how to prevent it.  I’ve followed similar patterns with other injuries.  I’m currently experiencing a mild case of Achilles tendonitis.  I didn’t see a doctor, only because I’ve had it before and was able to recognize the symptoms.  Part of my treatment is rest.  I don’t like to rest, but it’s an investment.  Resting a few days this week will hopefully prevent me from having a longer layoff.


  1. One other aspect: treatments change over the years. I had recurring back trouble and when I first saw a doctor in the late 1970's, I got PT and they prescribed the Williams Exercises. Now in 2013, I went back and it turns out that the McKenzie exercises that I was taught worked much better...for the condition that I have. We have more data, and without a visit to a doctor, I never would have gotten access to it.

    1. That's something I hadn't considered. If I've had an injury before, I think I already know how to treat it, but there may be newer, more effective treatments that I don't know about.

  2. Agreed. I will steer clear of trying to diagnose anyone. But if a runner says they have plantar fasciitis and asks what worked for me when I had it, I will tell them. But of course, that's just what worked for ME. And it's not just injuries that runners ask other runners about, it's other medical conditions. I recently saw an online post in which a runner was asking other runners for diagnosis and advice regarding bloody urine when she runs. For goodness sake, get to a doctor, lady!

    1. It's hard to resist the temptation to give advice. It only recently occurred to me that if someone says they have PF (or some other injury), I shouldn't assume they're correct. If they got that diagnosis form a doctor, they should have also been told how to treat it. If they didn't, it might not be the correct diagnosis.