Too Much. Too Soon.

On November 16, 2009, in Lower Extremity, by jcubos

An “older” woman walks through your door complaining of pain in the legs that started when she moved to a new neighborhood. She reports a history of daily mall-walking and says she ALWAYS completes 20 full laps.

A thorough history reveals that she also recently changed malls (double the size but also has stairs).

A “younger” woman walks through your door complaining of pain in one leg that started when she signed up for marathon training at a local running store. She reports a 5-year history of daily treadmill running and says she always completes 20 minutes.

A thorough history reveals that her first 2 weeks of training consisted of 40 minute daily runs with only 1 rest day.

Do your thought processes change for each patient? Do you tell your runner to add more rest days immediately? Do you tell the older lady that she should consider eliminating the stairs? Or did you actually tell her to do 10 laps and gradually build up to 20 in the new mall instead?

Both seem to have been doing “TOO MUCH TOO SOON” but how many of you would actually consider a stress fracture in the first patient? Obviously both will need imaging (likely a bone scan to start) but just remember…

It can happen to anyone.

$Hula stress fractures$