“Well, there’s your problem right there”
Most people can picture a car mechanic saying this to them at some point in their lives. A leak in the exhaust pipe, a cracked hose, a tire with no tread left, a filter that’s full of grit and grim. As a car owner, those statements come with a feeling of shame sometimes.
How did I let this (insert car broken part here) get this bad? Were there signs that I should have seen that this was coming? Is this going to be expensive to fix? How do I prevent this from happening in the future?
We frequently use car comparisons in our office to get some fancy, intellectual learning points across to our patients. We try to make sure that the comparisons don’t come with that same feeling of shame. They will still raise some of those thoughts though.
How did I let this (insert foot/ankle injury here) get this bad? Were there signs that I should have seen that this was coming? Is this going to be expensive/time consuming to heal? How do I prevent this from happening in the future?
The following statements are not meant to criticize certain vehicle types. Don’t blame me that a Toyota Camry is historically more reliable than a Cadillac (Consumer Reports Car Reliability Rankings)
There is typically a recommended maintenance plan for cars. Generally speaking, recommended oil changes are 7,500 miles. Change the air filter every 10,000 miles. Rotate the tires when you change the oil and check the pressures regularly. Clean the windshield and change wiper blades when they get streaky. If you hear a squeak or clunking sound, you should go get it checked by an expert. In many ways, people are a lot like cars. We may require frequent maintenance and tuning up to prevent wear and tear.
Some of my patients are like the Camry; Reliable, bordering on indestructible, even with a certain amount of abuse or neglect. Generally speaking, they don’t break down very often. Even if those patients skip certain maintenance things, they may never break down. They can wear a pair of running shoes for too many miles. They never stretch or foam roll. They never go to physical therapy. They never ice or do contrast baths. They can jump out of bed and go full speed in the morning and never have to worry about it. They don't need to use many tools in the toolbox to stay moving.
Some of my other patients are like a Cadillac; finicky, bordering on non-functional for their intended purpose, even with perfect maintenance. These are folks that require a towel stretch before they put their foot down in the morning. They need to foam roll once a day. If they run, they may need to do a contrast bath daily. They have to go to physical therapy because they have alignment issues. Always a few miles away from a potential disaster that will be very time consuming or expensive to fix. They need every possible tool in the toolbox to stay moving.
I will say that most of my patients are somewhere in the middle. They will come to the office with an injury, much like a car is taken to the mechanic when something is broken. We fix the problem and send them on their way. But if there is continued neglect, even the Camry-patients will probably break down.
We are big advocates for individualized maintenance plans for our patients. Given that there is a spectrum from super durable Camrys to the fragile Cadillacs, every patient’s plan should be a bit different. Take me for example. I’ll call myself a Tesla from the chart above. I’ve got a lot of mileage on my frame from collegiate running. My alignment isn’t great thanks to a limb length inequality, and I’m busy so I tend to neglect myself. I’m also kind of stubborn and ask my body to do things that it doesn’t want to do (read: run faster than I should, far too often). As a result, I break down if I don’t do certain maintenance things.
My maintenance plan includes:
- Orthotics in my running and work shoes.
- Do a towel stretch EVERY morning before getting out of bed.
- Dynamic warm up before running.
- Eccentric heel drop exercises up a flight of stairs after every run.
- Stretch for about 10 minutes after running.
- Foam roll my calves every 3rd
- Physical therapy based circuit training once per week.
- Single leg balance exercises once per week
- Nerve flossing once per week.
That is a lot of tools from the toolbox. Even that can’t keep me from breaking down sometimes. I will tune myself up with shockwave therapy or frequent visits to our physical therapy gurus. I supplement a lot of my running mileage with road biking now. I can certainly get away with some deviation from the plan here and there. I’ll wear sandals at the beach, but I will sometimes pay for it later with pain in my Achilles tendon. I don’t always bring the foam roller on vacation, but I also run less on vacation.
After an injury, we will get you fixed and start you on a road to recovery (see what I did there?). We’ll give you a maintenance plan, but you can’t take us or the mechanic home with you. You will have homework and are accountable only to yourself to do it. A super intensive plan may be required for some people, while a minimal plan is needed for others. I typically recommend starting with a very aggressive plan for about 2 weeks for most injuries, but as time goes on it is OK to reduce the frequency or number of the items as long as you are still functioning well. If a pain or injury starts to creep back in, be diligent about putting out that small fire by doing all of the treatments again to prevent a raging inferno. Don’t just ignore it.
Lastly, keep in mind that as we get older, we may need more maintenance.
Unlike car tires, you can’t just go out and get new feet. If you want to keep your body functioning in tip-top shape, you have to take care of the one and only vehicle that you have for life: your feet!