Does this sound like you? Fueled by Vitamin I (ibuprofen), you go for a run despite nagging pain. You’ve adopted a regimen of ice and more Vitamin I post-run. Eventually, nothing eases the pain, so you rest. Your friends recommend visiting practitioners ranging from traditional MDs to the shrunken-head shaman. After a couple of weeks, the pain fades, but your patience fades even more from lack of exercise. You lace up your shoes and head to your favorite trail for a run. Your glorious freedom lasts only until the first twinge of pain returns. You repeat this cycle, sometimes for months or years.

John E. McDonald, MD, a Steadman Clinic fellowship-trained orthopedic surgeon with Texas Orthopedics, likens such injuries to a bonfire. If you merely let the fire burn down to embers and then throw on more wood, it reignites. If you let the fire go cold and throw wood on the pile of ashes, nothing happens.

Mistaking embers for ashes is a good way to dig yourself a deep hole. When you find yourself in a hole, the first rule is to stop digging.

At any given time, you’ll find a gathering of athletes in this hole. Why? Athletes train their brains to dismiss pain and push through it, sometimes at any cost. No pain, no gain, right? But the mentality that leads to PRs when you’re healthy doesn’t serve you well when you’re injured.

Pain serves a vital purpose. It’s your body’s way of saying, “WHOA!” When you dismiss pain or, worse, take the edge off with Vitamin I for an extended period, you’re losing time and an opportunity to get a proper diagnosis while increasing your chances of long-term damage. So when is it time to see a doctor? Dr. McDonald suggests a reasonable rule of thumb for chronic overuse-type injuries: Trying a reasonable alternative therapy is fine, but don’t let the cycle continue for more than six weeks before seeing a physician. This guideline does not apply to acute trauma, for which you should see a physician immediately.

Fear traps athletes in the cycle too. You fear you won’t be able to train as you’re accustomed to, or you’ll be told to rest indefinitely, or, worst of all, told you need surgery.

You must break out of the cycle, but why? Simply: Your future athletic endeavors and health depend on it.

Delaying a visit to a physician resembles gambling with the odds stacked against you. You risk further (and sometimes permanent) damage, and what may be a simple overuse injury can morph into something more difficult to treat, or you could end up on a date with the operating table.

Dr. McDonald says, “Many of the injuries I see could have been treated with modifying activities at an earlier stage; they might not have been as persistent had they been treated sooner. For example, stress reactions that occur in bones can turn into stress fractures that are difficult to treat.” Sometimes, early intervention can even help you avoid surgery.

Pedaling a bike 24-hours post-arthrofibrosis surgery at The Steadman Clinic

Here’s the conundrum: Your chronic pain may be caused by simple overuse or a more complex mechanical issue. To distinguish between these, you need a physician’s evaluation. Many overuse injuries can be treated with rest and PT (physical therapy), a viable option to prevent surgery. In Texas, your physician’s prescription is your only ticket to PT. Conversely, mechanical issues often won’t resolve without surgery. Examples may include meniscal tears, full thickness rotator cuff tears, loose bodies in a joint, and ligament injuries. Do yourself a favor and get a clear diagnosis.

What about choosing a physician? Standard guidance includes asking around for recommendations and looking at résumés and training. I would also emphasize: Does the physician listen without preoccupation; does the physician communicate your injury in a way you can understand; does the physician have suggestions for other ways you can stay fit; does the physician discuss goals with you; does the physician make you feel like a person or a number; does the physician return questions with blank stares? Finding a trusted physician like Dr. McDonald who listens with the compassion and presence of a wise friend, but with the knowledge and experience of a sage, will put your fears at ease.

With my doctor, Dr. Steadman (Dr. McDonald’s mentor)

But wait–your doctor has been giving you blank stares for months. What do you do? Directly or indirectly (through insurance), you are paying for a professional service. Each physician-patient relationship is significant, but it’s also professional. If you aren’t satisfied or are frustrated by lack of progress, a good physician would want you to seek a second opinion. Sometimes the best option is to have another set of eyes look at your case. Seeing the wrong physician doesn’t save you time or money. At the end of the day, every physician wants the best for his or her patient. Do the best for yourself and get a second opinion.

You’ve received a healthy dose of tough love here, but now you’re armed with a plan when pain strikes. Picking up the phone on the first ring when pain calls will save you untold time on your recovery journey and put you back in the game faster. Always remember to take care of yourself the same way you’d take care of the person you love most.


  1. I might add that a great Nurse Practitioner or Physician Assistant with ortho training, or working in connection with an ortho MD would be a great resource too (you don’t have to be held to seeing a “physician”). Great perspective, and great advice in this article.

    • Missy,
      Great insight you offer! Nurse Practitioners and Physician Assistants with ortho training are like gold. Thank you for adding a different, and very important, perspective. And thank you for your kind words. I appreciate you.

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