Is It a Stress Fracture or Not?

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[00:01:19] Welcome back to Untold Physio Stories.

[00:01:20] I'm your host, Dr. E with Modern Manual Therapy, Edge Mobility System, and Modern Rehab Mastery, our four-month online mentoring program.

[00:01:29] So, I did a 65-mile, three-day pilgrimage two weekends ago.

[00:01:38] Last year, I definitely was not prepared to walk 20 to 25 miles a day.

[00:01:43] We didn't have nearly enough electrolytes.

[00:01:46] I was dehydrated on the first day and I barely felt like I could walk.

[00:01:50] Every single muscle in my body hurt.

[00:01:52] I thought, hey, I'm in good shape.

[00:01:53] I run.

[00:01:55] You know, I train regularly.

[00:01:57] This is just walking.

[00:01:59] I realized that there's no amount of training you can do unless you are walking 20 to 25 miles a day on the same side of the road because you're not allowed to switch.

[00:02:08] Again, we're walking with between 700 and 900 other pilgrims.

[00:02:14] And it's a very organized caravan that's over half a mile long.

[00:02:19] There's no way you can train for that.

[00:02:21] And, you know, even running on the same side of the road eventually adds up.

[00:02:24] Imagine what it does when you're walking on the left side of the road for 20 miles.

[00:02:30] Your back ends up hurting.

[00:02:31] Your hip ends up hurting.

[00:02:32] I mean, I was surprised.

[00:02:33] My hip flexor hurt.

[00:02:34] My shoulders hurt.

[00:02:36] Everything hurt last year.

[00:02:37] So this year, we wanted to make it different.

[00:02:40] Again, I didn't really train, but I made sure I got myself an amazing pair of shoes.

[00:02:44] They're somewhere out of Columbus, Ohio.

[00:02:48] American company.

[00:02:49] They come with two pairs of memory foam insoles.

[00:02:52] The best pair of walking shoes I ever bought.

[00:02:54] I didn't even want to say it this year because the only thing that hurt was my right ankle right around my sinus tarsity.

[00:03:02] And then eventually, like my lateral forefoot, it would hurt.

[00:03:05] The first two days, I was okay.

[00:03:07] I was able to run a lot.

[00:03:08] Every time you go to the bathroom, the pilgrims keep on marching on and on and on.

[00:03:13] And you either have to take a shuttle to catch up or you run.

[00:03:16] So I was feeling good.

[00:03:17] And I was running to catch up the majority of the time.

[00:03:20] On day three, my ankle was, again, bothering me a bit.

[00:03:26] Probably about five out of ten by the end of day two.

[00:03:28] Two to three out of ten at the end of day one.

[00:03:30] On the third day, which is the final day, I took a pretty long shuttle because shuttles tend to be pretty full on the third day.

[00:03:38] I ended up sitting for maybe a little over 20 minutes.

[00:03:43] And due to a lot of different unforeseen circumstances.

[00:03:47] When I got out of the shuttle, my ankle hurt probably about an eight out of ten.

[00:03:52] I had noticed a little bit earlier that I was able to modulate a lot of this ankle pain.

[00:03:56] Because it's in like the L5S1 dermatome.

[00:04:01] And if I walk more upright with an anterior tilt, that pain part reduced maybe 25 to 50%.

[00:04:08] So I thought, oh, is it lumogenic or is it some sort of ankle issue?

[00:04:11] I also noticed that if I did ankle resets, particularly lateral tibial glides, that that also felt a little bit better.

[00:04:21] Or if I did ankle dorsiflexion and eversion, that also felt better.

[00:04:25] But after the shuttle ride, I could barely walk.

[00:04:28] I mean, I tried running.

[00:04:30] Because sometimes when you use different muscles, you land in a different footstroke pattern.

[00:04:34] It's actually easier after doing all that walking.

[00:04:38] So again, I just had to take a shuttle.

[00:04:40] But I was very prideful and I thought, I really want to finish this pilgrimage since I was doing so well this year.

[00:04:46] Much better than last year.

[00:04:48] So I did a stupid thing.

[00:04:50] I basically took eight 200 milligram ibuprofen, numbed it all up, and was able to finish really strong.

[00:04:57] I was able to run at the end after going to the bathroom.

[00:05:02] And I just felt great.

[00:05:04] So the next couple days were pretty rough.

[00:05:07] Again, just like as expected.

[00:05:08] I could barely walk.

[00:05:09] I took a couple days off.

[00:05:10] Super sore all over.

[00:05:12] But then when the rest of my body, and particularly my legs, started recovering, by Wednesday, I noticed that my pain in my ankle wasn't really getting better.

[00:05:20] It was actually getting worse.

[00:05:22] Every morning I would wake up, I would have severe pain in my fifth metatarsal.

[00:05:26] And I thought, oh man, do I test positive for the Ottawa foot and ankle rules?

[00:05:31] And the thing is that I only tested positive for the one rule about not being able to weight bear without severe pain for more than a couple steps.

[00:05:40] I didn't have any ankle tenderness.

[00:05:42] Nowhere were it hurt in my fifth metatarsal or at the base of the fifth metatarsal was it tender to touch.

[00:05:47] Plus, I noticed that I could modulate it with lumbar repeated motions, particularly side glides to that side.

[00:05:54] So I thought, okay, maybe in the back of my mind, I'm giving a 50% chance of stress fracture.

[00:06:01] Another day goes by, I noticed that if I put an H-wave stim on my lumbar spine, that it actually modulates it.

[00:06:08] So I did that for a bit.

[00:06:10] And it's kind of like a super fancy TENS unit that you cannot accommodate to and you can turn it up all the way and it doesn't cause titanic contraction.

[00:06:19] So if you've never heard about that, maybe do a webinar on it sometime soon because I really, really think it's great.

[00:06:28] And so I tried the next time the H-wave on my calf and I thought, hey, you know, maybe I'll use it with the ankle to kind of flush out any swelling.

[00:06:38] There's a low mode and a high mode.

[00:06:40] The high mode is more of like a modulating TENS.

[00:06:42] The low mode does really small like ankle or I'm sorry, pumping contractions, very similar to using E-STEM with dry needling.

[00:06:53] You get those like little, little contractions that's kind of like flushes out, waste metabolites, et cetera, any kind of inflammatory soup.

[00:07:01] So I thought, well, this will help.

[00:07:04] Even though I felt okay when I was done, it was a little bit more sore, but it was more muscular soreness.

[00:07:09] So I left it on for about 30 minutes.

[00:07:11] The next morning I woke up, which is Friday.

[00:07:13] I could barely walk.

[00:07:15] I mean, it was, it was so painful.

[00:07:19] My calf was so sore.

[00:07:21] I just thought, oh man, like I, I did something wrong.

[00:07:23] I didn't, I did not know.

[00:07:26] I thought, oh man, I have a stress fracture for sure.

[00:07:28] Even though, again, my ankle was not tender in any of the spots that you would particularly expect,

[00:07:34] according to Ottawa foot and ankle rules or, nor was it actually tender anywhere where I actually had pain.

[00:07:41] So I went and got an x-ray, even though I know an x-ray wouldn't show it, a stress fracture this close up.

[00:07:46] And I had a PA, orthopedic PA examined it.

[00:07:49] No way where he palpated actually was tender either.

[00:07:54] And again, the strange thing, I remember my dog went to step on it.

[00:07:58] He's a golden retriever.

[00:07:59] And I thought, oh man, is it going to hurt?

[00:08:00] But it actually felt better with some A to P pressure.

[00:08:04] So I started resetting my ankle.

[00:08:06] And I also found that that day when my calf was so sore, I thought, hey, you know what?

[00:08:12] I'm just going to use like a massage gun and relax some of this tone in my calf.

[00:08:16] Because it felt like I had done maybe 100 calf raises after all that 30 minutes of low-level contraction.

[00:08:23] So I got rid of the tone and the tenderness.

[00:08:25] I had several trigger points, things I never really take any account of.

[00:08:30] I look at Terrell and Simon's old, you know, like trigger point graphs.

[00:08:36] And I noticed, oh, there's like a trigger point somewhere in the posterior calf that refers exactly to where I have pain.

[00:08:41] I took the massage gun to that.

[00:08:45] And not only did that relieve my pain almost 100%, but then I thought, well, I don't have an ultrasound.

[00:08:54] I don't have a tuning fork.

[00:08:57] Actually, my kids do.

[00:08:57] And I was going to let them use it.

[00:08:59] But I was like, hey, maybe I'll try to vibrate my foot with the massage gun and see, you know, if it's painful, then I'll think, oh, maybe I do have a stress fracture.

[00:09:07] I was able to use the massage gun all around the dorsum and the plantar aspect of my forefoots, around where I have pain, where I don't have pain.

[00:09:15] It didn't hurt at all.

[00:09:17] I was able to walk that day completely pain-free for probably the majority of the day.

[00:09:23] But then the most discouraging thing was that every morning I would wake up and I would be limping again.

[00:09:29] And I thought, I would think, do I have a stress fracture?

[00:09:33] Do I have a stress reaction?

[00:09:34] As the ortho PA called it.

[00:09:37] I'm not entirely sure.

[00:09:38] Again, nothing was tender.

[00:09:39] So the next couple of days, I also figured out that if I do plantar flexion and eversion of the forefoot, that completely modulates it.

[00:09:50] And I'm able to go the majority of the day without any pain.

[00:09:54] And just to kind of, you know, help things along, I also decided to start taking B-complex and some turmeric for some anti-inflammatory.

[00:10:04] And, you know, it's possible that dosing that with having effects similar to NSAIDs, that that also kind of helps decrease the pain sensitivity.

[00:10:12] So at this point now, it's a Monday, one week after I came home and started having this severe lateral forefoot pain.

[00:10:21] And today's the first day, especially after me realizing that I can do these plantar flexion and eversion resets.

[00:10:29] I had some sustained when I was kneeling a lot yesterday in church.

[00:10:33] Today's the first day that I was able to get up in the middle of the night and get up in the morning with having only 2 to 3 out of 10 pain at the worst.

[00:10:40] I do notice that with prolonged stepping or prolonged walking, that I have a little bit of discomfort.

[00:10:48] So at this point, again, I'm not ruling out a stress reaction, but I no longer think it's a stress fracture.

[00:10:54] It's been kind of a crazy ride, though, because I also noticed last night and past couple nights that I sleep on my left side, I have pain and peristhesia in my right lateral forefoot and posterior to my right lateral malleolus.

[00:11:13] So I sleep on my right side, which I started doing.

[00:11:16] I also wake up feeling better.

[00:11:18] So I just wanted to get your guys' thoughts on this.

[00:11:21] I know that that seems like a really long story, for I went from stress fracture to not a stress fracture, back to a stress fracture, to now I think it's lumbogenic and maybe a stress reaction kind of combined with both of that.

[00:11:32] Let me know what you guys think or if you guys have ever heard or experienced anything like this.

[00:11:36] It's been pretty crazy and a wild ride for me.

[00:11:40] If you enjoyed this podcast, let me know what you think.

[00:11:43] Make sure to please rate Untold Physio Stories 5 stars where we listen to podcasts, especially Spotify and Apple, as that helps our discoverability.

[00:11:51] And as always, you guys have a great day.