My Injury Series articles detailing the causes and treatments backed by scientific research for the most common running injuries are some of the most popular posts on my blog. Of the readers who are drawn to these articles, perhaps half of them are newly-injured runners who are looking to read up on what they need to do to recover. The other half are runners who have suffered through the injury for weeks or months, having already been to and been disappointed by one or more doctors or physical therapists. The medical community, like all trades, has a distribution of talent: there are some great doctors, a lot of mediocre doctors, and some very bad ones. While many injuries can be successfully cured without ever seeing a doctor or physical therapist, there are definitely a lot of cases where it’s in your best interest to see a medical professional. When to seek out a doctor’s help for an injury is mostly up to you; my own general rule is if a few days’ time off and some “self therapy” doesn’t help at all, and I can’t figure out what the problem is, it’s time to see a doctor or physical therapist.
The focus of this article will be fairly narrow: How do you find a good doctor or physical therapist? I won’t really cover the functions of individual specialties like podiatry vs. orthopedics and when to use them, but that’s something you can probably figure out on your own. And if not, it’s a topic I’ll be covering in my third booklet, which I hope to release sometime in 2013! In any case, I think it’s advantageous for you as a runner or as a coach to build a network of medical practitioners who can help you out if you come down with an injury. I say “network” because even the best doctors won’t be able to take care of all injuries. Many top sports orthopedists have a special interest, be it the hip or the knee or a particular type of injury, so the person you’d see for a recalcitrant case of plantar fasciitis is probably not the same one you’d see for a perplexing case of groin pain. Likewise for physical therapists: some are especially gifted in the function of a particular body part or particular type of injury, so the PT who can help you get over a high ankle sprain might not be the one best-suited for recovering from a hip flexor strain.
Possibly the best and most direct way to find out who are the top sports doctors and physical therapists in your area is to ask people you know and trust in the local running community. Long-time high school or college coaches have had many athletes who have seen many different doctors and can give a decent evaluation of the treatment they received; likewise, top local runners will also have had experience with many different injuries and will probably have some “go to” doctors or physical therapists that they can recommend. The owners or managers of locally-owned running stores are also a good source, though be aware that doctors and therapists often advertise their services to running stores, so your results may be more variable here.
Even if you’ve gotten a great recommendation for a doctor or therapist from a trusted source in the running community, it will pay off to do your research online before making an appointment. “Doctor review” websites are almost worthless, since you’ve got no idea who the reviewer is and no clue whether they are telling the truth. There’s also the “incentive problem”: patients who had a bad experience are disproportionately likely to go online and trash-talk the doctor. But on the other hand, there is also the problem of medical practices interfering with online ratings systems. In fact, you can even hire a consulting company to “manage” your online reputation! This can entail sending threatening letters and takedown notices to these review websites, or simply manipulating search engines to hide bad reviews, which further mars the reliability of these sites.
One place that is surprisingly helpful at finding a good running doctor is LetsRun.com. If I am new to an area and want to get an idea of who’s popular in the running community, I’ll do a special Google search to find threads where people have asked for recommendations of local doctors. So, if I were moving to Chicago and wanted some ideas on respected doctors in the area, I would search for: site:letsrun.com Chicago running doctor. To get good results you might need to change up your search terms; some alternatives you might try could be Illinois doctor, Chicago orthopedist, Chicago podiatrist, Chicago hip doctor, etc. While I’ve found this method somewhat more reliable than doctor review sites and a LOT more helpful than searching the entire internet, since it narrows your search to more serious runners and is not as likely to be interfered with by reputation management firms, you’re still trawling the dredges of the internet hoping for useful information.
Instead of looking at third-party review sites, I prefer to look at the online biography of the doctor in question. Virtually all practices have websites, and one of the core components on the website is the biography of all of the doctors and/or therapists on staff. There is a lot of info on these that are not very helpful. Among these are:
· Where the doctor or therapist went to undergraduate or medical school. Injury treatment and diagnosis are skills that are developed mostly by doing, so whether your doctor went to a top medical school or not is mostly irrelevant.
· Professional affiliations like the American Academy of Orthopaedic Surgeons or the American College of Sports Medicine. Membership in these is mostly fluff and serves chiefly as a way to add more letters to your title. Leadership experience in these associations shows more dedication to that particular specialty, but does not have much significance for you as a patient beyond that. And from what I hear, these are fairly easy clubs to join.
· Patient testimonials. I’d hope that you could have guessed this already, but any doctor can pull up some good patient testimonials to make himself or herself look good. The FTC even scrambled to draft up guidelines after it discovered that a large number of them are completely made up. The presence of patient testimonials is not a bad thing, though—it’s likely just something put up so the marketing guys don’t have a heart attack.
Some things that are important and useful, however, include:
· Years of experience. When it comes to identifying and treating injuries—especially recalcitrant or unusual ones—nothing replaces clinical experience. Many lesser-known injuries don’t have any real scientific treatment protocol, so the only thing a physician can rely on is practical experience. This does not mean that younger doctors are always a bad choice, as they may be more up to date with current research and treatment ideas. It’s also true that older doctors can sometimes get a bit of hubris and gloss over a rare injury masquerading as a common one (misdiagnosing FHL tendonitis as plantar fasciitis, for example) and may not have the tenacity and drive to stay on top of recent developments in treatment. Regardless, years of practice are a huge advantage.
· Residency or fellowship experience at prestigious institutes or under a renowned doctor. Another way to become a great doctor is to learn from one. When learning from a master practitioner, you can draw on a body of clinical experience and expertise much greater than your own. A doctor who has studied hip arthroscopy at the Steadman Clinic (a well-known center in Colorado for hip injuries in athletes), for example, would be much more credible to a runner with a labral tear than the local guy who does ten hip replacements a month.
· Published research. Doctors who spend time publishing research papers and giving talks at conferences tend to be more knowledgeable and passionate about their area of interest than those who do not. What type of research a doctor has published can also clue you in to what his or her area of interest is. Just because a doctor has published many papers on knee replacements, for example, does not necessarily mean he’d be the best doctor to treat patellofemoral pain in a runner. It’s probably safe to say that most doctors do not publish a whole lot of research. Again, this does not mean they are bad doctors—in fact, they might even argue that they are better because they spend more time treating patients vs. writing papers—but doctors who publish papers are also more likely to read them, which is especially important given the rapid development of our understanding of many running injuries. A lot of the research I cite on this blog is less than ten years old, which partially explains why a lot of medical literature out there—even on sites and in books most people would consider reputable—is flat out wrong.
· Being a team physician or therapist for a high school, college, or professional sports team. This shows a true interest in treating sports injuries in serious athletes, and also guarantees that the doctor will have been exposed to a good number of high level athletes before, so he won’t fall out of his chair when you tell him you were running 90 miles a week before you got injured.
· Being an attending or volunteer physician at a major sporting event like a marathon, championship event, or tournament. This often goes hand-in-hand with being a team physician and shows a passion toward treating sports injuries. However, it does not guarantee exposure to treating and managing overuse injuries, as being an attending physician at an individual event usually entails more treatment and diagnosis of acute injuries.
· Involvement with the local running community, either as a competitor or in donating volunteer time to do injury screenings at running stores or races. Again, seeing a doctor dedicate his or her time to the running community indicates the presence of passion for the sport, which is definitely a good thing.
You may also find other useful tidbits on the internet like news stories about the doctor or “top doctor” ratings from magazines and newspapers. These can also attest to the dedication or popularity of a doctor, but it’s a lot less reliable than the above info. Doctors themselves can also give a pretty good recommendation, but only if they don’t have any vested interest in the issue themselves. You’d be a lot more likely to get a good recommendation for a hip doctor from a podiatrist than from another hip doctor—he’d probably recommend himself!
You can expend a lot of money and energy running around to different doctors, so it pays to do your research beforehand. You’ll be more likely to dodge the all-too-common “take a month off and then we’ll do some diagnostics” experience that a lot of runners have when they take a scattershot approach to picking a doctor. Ultimately your own experience will play a role in which doctors can best help you, though it’s also important to remember that nobody’s perfect: even great doctors will miss a diagnosis once in a while. So if you don’t find an answer to your injury problems with one doctor or PT, don’t hesitate to seek out another one. Sometimes a different perspective is all it takes to uncover the root cause of an injury and set you on the path to recovery.
If you yourself are a doctor or physical therapist (as at least a few of the regular readers of this blog are), you can read this as an article on how to become a better practitioner. Many of the things I look for in a doctor or PT, like publishing research and being a team physician for a local high school or college, will both build your reputation and improve your medical skills. Ultimately this will be better for business and better for the running community: when there are more doctors and therapists who can accurately diagnose and properly treat injuries, everyone wins.