Ow Ming! Is Yao Ming's Basketball Career Over From a Foot Fracture?

Ow Ming!

Houston Rocket's Yao Ming's career may be over due to a non-healing foot fracture. He was sidelined during the playoffs on May 8th with a hairline fracture of his navicular. As of today, this has not healed properly. The nature of his non-union and his prognosis is being kept quiet by the team physicians, but it is evident that there is a problem. Most stress fractures heal completely in 6 to 8 weeks. This is not the 7 foot 6 inch center's first fracture. He has been out portions of the last three seasons with stress fractures in his leg and foot. Perhaps his lanky frame just can' handle the stress of the NBA? Why is it that some fractures don't heal?

Looking at his present injury, stress fractures of the navicular (the cornerstone of your arch) are often slow to heal due to three factors, blood supply to the bone itself, underestimating the extent of the initial fracture so delaying aggressive treatment and too much abnormal stress on the healing bone. Other medical issues can delay bone healing like lack of Vitamin D, poor calcium uptake and many other systemic problems like diabetes, hypothyroidism and peripheral vascular disease. Many of these fractures are actually missed due to lack of specific x-ray findings. Many fractures are actually misdiagnosed for months. Plain film x-rays are often read as normal so the fracture is missed until symptoms increase. Early symptoms can be diffuse and non-specific so the index of suspicion is also low. A bone scan, MRI or CT scan can identify the specific fracture. CT scan is often the most helpful in identifying the extent of the fracture and guiding treatment. For a non-displaced stress fracture, cast immobilization is the first line therapy. Studies have shown that non-weight bearing immobilization in a cast for at least 6 weeks is usually around 80-86% successful. For those that do not heal this way, surgical fixation of the fracture can be helpful and a bone graft may be needed for long standing non-unions. New technologies like electronic and ultrasonic bone stimulators and injectable platelet rich plasma can help even the most stubborn fractures.

Follow up care for a navicular fracture often includes physical therapy and custom foot orthotics. Abnormal biomechanics of the foot often are one of the causes of these fractures, so biomechanical control is crucial to distribute the abnormal stress so an athlete can return to sports and have a lower risk of recurrence.

Yao Ming has had multiple stress fractures during his career increasing the likelihood of traumatic arthritis from avascular necrosis (not enough blood supply to heal so the bone crumbles) in his foot causing him to retire. The next few months will tell the tale for this multi-million dollar All Star. Can he heal his fracture and return to sport? The Rocket's fans are praying for divine intervention to cure their dominant center.

Train Smarter In the Summer Heat!

I declared myself heat tolerant this weekend in my recent Twitter. I did a 3 hour bike ride in 99 plus heat at 5pm in the Texas heat and could still spit when I was done! That’s a success in my book! It definitely took 2 full weeks of suffering in the heat and a good hydration plan to finally feel like my body had made the transition to feeling relatively comfortable in the soaring Texas summer heat.

Dehydration, heat stroke and hyponatremia are your biggest worries while training in the summertime. Whether you are in Texas or Rhode Island, when the temperature soars over 90 degrees, heat illness can seriously hamper your endurance training. Most of us have an “A” race on the calendar in the fall and require a lot of base training in the summer. No way around those long runs and even longer bike rides in the heat. The average triathlete can sweat up to one liter of fluid an hour while training and sweat contains about 3 grams of salt per liter. How can we conquer the heat? Preparation and constant hydration! Diligence is the key! Always stay one step ahead of the hydration curve. Remember that heat illness really can kill you and hyponatremia has taken out more than one healthy marathon runner and triathlete!

Here are some simple tips that will help you train safely in the heat:
1. Hydrate all day long. Drink water throughout the entire day. Most people actually start their training runs already dehydrated. Especially when the temperature reaches triple digits, it is important to always have that water bottle near by.
2. Prepare for your longer training runs and rides. This means dropping water bottles along the route before you start or making the route circle around many times so you can stop and pick up more water at your starting point.
3. Drink a mixture of sports drink and water. Definitely mix it up. I always have a bottle of each on my bike.
4. Consider salt tablets if you are running or biking more than 2 hours. Unless you can carry salty pretzels on your run, salt tablets are a must if you are sweating heavily.
5. Never be afraid to get off your bike and run through a stranger’s sprinklers! You may look like an idiot, but cooling off and wetting your clothing can only help you stay cool! Putting ice down your shirt can also be helpful!
6. Listen to your body. Especially in the beginning of your heat training, listen to the symptoms of heat illness. If you are nauseous, cramping, can’t spit, have dry mouth, notice your hands and wrists are getting puffy and you are starting to feel goofy; STOP! Go home to run or ride another day.
7. Avoid anti-inflammatories if you can. Ibuprofen and Tylenol actually can affect your kidney function. This can increase you chances of suffering from hyponatremia.
8. Sunscreen, sunscreen, sunscreen. A bad sunburn will thwart your normal heat-regulation system. Heavy duty 70 plus water-proof sunblock is your friend!
9. Weigh yourself before and after your training. Replace your weight loss with more fluids.
10. Carry money. You never know when you may get lost and need to stop at a store for more sports drink or water.
11. Train with a friend. They may notice your symptoms of heat-illness way before you do. Denial is never a good companion.

Heat-illness is real! Be smart while training this summer! Follow these tips, heat acclimatize over a period of several weeks and be diligent about your hydration plan while training in the heat. Let’s get to those fall races stronger and without any heat-related training drama! See you on the run!

Denna Kastor Talks About Taking a Break After Breaking Her Foot at the Olympics

There was a good Q & A in Running Times talking to Deena Kastor about her foot fracture at the Olympics. I think it's funny that she broke the same bone I did last year. Her discussion about the need for rest and recharging sounded like an echo. I think it is so important for us to realize we need rest after an "A" race or marathon. Also, as women, we need to understand the relationship between Vitamin D and the uptake of calcium. To read more about Deena's injury click here for the complete article. For more on metatarsal fracture in runners, click here.

Run Happy! Rest easy....and more than anything else...run forever my friends!

To purchase a copy of Dr Crane's new book "If Your Running Feet Could Talk" click here.

Running With Arthritis

Running Forum Questions:

I recently received this email from a runner in Virginia asking a good question on running with arthritis:

“I have been running since I was 13yrs old and I am 42 now. Friday I was diagnosed with osteoarthritis after 6 weeks of no running but cross training on the elliptical. The doctor thought it was tendonitis but after not getting better he decided a MRI would be appropriate. The MRI confirmed it was osteoarthritis. I am starting physical therapy on Monday 3x a week.

My question: Is it possible for a runner who has osteoarthritis to be able to run again. I feel like my world has been rocked and shaken. Running is HEAVEN for me and nothing compares. It is my total stress reliever and if I do nothing else in a day if I've run my day is totally complete. I am the mother of 3 great kids and I guess I should be thankful I can do the cross training now because I get cranky when I don't get to do something. I just feel like this means my running career is over. My mileage before getting injured was about 25 a week.

Please let me know your thoughts. I have searched the internet for help on other runners who are going through what I am and have osteoarthritis of the foot with no luck so far. Thank you so much for taking my comment. I'm praying for a miracle. I know it's not life threatening but it's my mental state I'm concerned about.”

RunDoc Answers:

Let me start my answer with a story. I have a runner in his late 30’s as a patient who had the unfortunate luck to be blown up in the Desert Storm conflict while he was serving in the Marines. He has severe arthritis in both feet from his injuries. He has had at least 5 foot surgeries including a fusion of his subtalar joint in one foot. He ran the 2008 Marine Corps Marathon in less than 41/2 hours. If he can run a marathon on feet that are that bad, I am confident that you can get back to some kind of running.

The name of the game is accommodation. You will need a great pair of orthotics made by a podiatrist that knows what they are doing and specializes in biomechanics. They can fabricate a device that will transfer the stress from the arthritic area to a strong, healthier part of your foot. That coupled with physical therapy, core strengthening exercises and a good pair of running shoes will get you back on the road! For more information on living with arthritis click here!

Run Happy! And Pain Free!

How to Cope With Race Day Jitters!

It’s just a few days from a big race and I’m already anxious. What am I afraid of? Running a bad time? Totally bonking? Looking stupid in front of my friends and patients? Drowning in the open water swim? Getting a flat tire? Perishing on the street? Where does all this performance anxiety come from? After 30 years of competitive running you would think I would have conquered race day jitters, but they are always there…kinds like an old friend…or a fungus….

So, how do I cope with race day jitters? Positive self-talk, preparation, visualization and organization!

A race is just another long training day in the company of a few hundred, or sometimes a few thousand, of your closest friends. Most anxiety comes from fear of the unknown and lots of negative self-talk. Reality – your friends and family really don’t care what your time is, whether you place or not, and the world will not end if you run a bad time! My patients are just amazed this old lady is still racing! Times are irrelevant! Setting high goals will just stress you out! Focus on running your best race that day! Relax! Have fun! Go into the race realizing you have nothing to lose and everything to gain. I treat every race as a learning experience. Even if you get kicked in the face in the swim and lose your goggles, get a flat tire or totally bonk on the run; you learn something you can use another day!

There are many things you can do to stay relaxed. Here are just a few I have learned along the way:

1. Be prepared! Have a pre-race checklist of everything you need. Set out all you clothes and gear the night before and go through the list. This includes checking your bike tires and inflating them. Finding a flat the morning of the race will send your heart rate through the roof. I set everything out on the living room floor then pack my bag. The bike goes on the car the night before after a thorough check. My nutrition is all set out and the coffee pot is prepped!

2. Never change anything the day of the race. This is not the time to try that new pair of Newtons! Stick with your routines. Treat this as just another long training day! Eat what you would normally eat before a long workout. Extra sleep always helps, so go to bed early!

3. Go to the race with a friend. Having your peeps with you can really help diffuse anxiety. Travel to the race together and help each other calm down. DO NOT let your friends make you crazy. Some people actually feed off others anxiety. If this is you, you may be better off with your Ipod as your friend while you set up your transition!

4. Visualize finishing. Visualize the entire race the night before. Go to the race website if you are not completely familiar with the course. Visualize a nice calm swim, a smooth transition, an awesome bike and a killer run! See yourself run a PR. My best races have been played over in my mind a thousand times before they ever happened. Remember what it felt like the last time you had a great race! Embrace that feeling!

5. Get to the race early. Get organized! Find the bathroom and then relax. Warm up and keep up the positive self-talk! Remind yourself that you have done the work and the race is just a celebration of how hard you have pushed yourself and your mental toughness! Claim your reward!

Race day jitters can completely derail your race before it has even started. Don’t let the negativity ruin all your hard work and preparation! Relax! Follow these tips and remember to banish the negative, and stay positive throughout the race! Try to have fun! Whether this is your first marathon or your 100th triathlon, remember to celebrate your training and have a great race!

Fat Parents Have Sick Kids!

I heard a statistic today that startled me. If you are born after the year 2000; you have a one in three chance of having diabetes. One in three! That is truly scary!

A second frightening statistic is that this is also predicted to be the first generation of Americans that will not live longer than their parents.

Why? Both of these sobering statistics are a direct result of childhood obesity and a sedentary lifestyle. What are we doing to our children? We owe them a better future. Politics aside, we are already mortgaging our children's future with our current economic issues and national debt. We are also dooming them to suffer from many chronic illnesses by the lifestyle we are teaching them by being lazy, fat Americans.

The typical American diet has substantially changed in the last generation. We no longer sit down to family dinners and tend to look for quick, often drive-through solutions. Our generation has more food choices than ever before; but tends to choose the fast, more often less healthy, alternatives. Why? Laziness! We are so busy trying to be super-productive that we don't take care of ourselves or our families. Our children are mirroring our behaviors when they make their food choices.

Exercise? Not most Americans. The minimum recommendation is to engage in moderate exercise at least five days a week or 20 minutes of vigorous exercise (aerobic activity) three days a week, plus to do strength training twice a week. A recent polling showed that only 17% of Americans managed to find the time to lift weights at least twice a week and engage in vigorous exercise three times a week or at least moderate exercise five times a week. Only 50% exercise at all three times a week! What kind of example is this for our children?

Many parents feel our children get their exercise from physical education classes in school, but less that 50% of school children have some kind of physical activity every day in elementary school. This number worsens as they progress in the school systems. Our children's activity level has plummeted dramatically in the last generation due to lack of physical education, lack of unsupervised play, computers, Internet, video games, etc. We can not depend on the school systems to teach our children to exercise and eat right. This must come from the example set by their parents. Right now, most Americans are setting a poor example!

Americans are not suffering from a lack of information. Most know what to do, yet choose not to. Since the early 1980's, the benefits of exercise has been preached on every street corner, yet we don't listen. Nevertheless, the cultural changes in the past decade have been so staggering in terms of decreasing physical activity in every sector of life and increasing the intake of garbage calories and fast food, that nothing short of a major paradigm shift is necessary!

Bottom line: a combination of obesity and lack of exercise contributes to more than 300,000 deaths each year in the United States as a result of heart disease, stroke, diabetes and other conditions. The statistics for the next generation are even more onerous. Only through changing our behavior patterns can we influence our children's future behaviors and reverse this trend.

Dr Crane's New Book Available Now!

Dr Crane's new book : If Your Running Feet Could Talk now available on Amazon.com

Click on the title for more information.

Dr Crane has written a prescription for surviving and avoiding injuries on the run. This book provides practical advice and resources to the running community to keep you running healthy and strong. It is meant for the novice and intermediate runner who needs solid advice on getting started, training programs, aches and pains, and recovery. Persistence and determination is the key to surviving then ultimately avoiding most running injuries. This book couples years of blood, sweat and tears on the pavement with sound medical advice for all runners.

Please enjoy and send your comments for the next version to contactme@myrundoc.com

Run Happy!