Interdisciplinary Case Miles

19: Navicular Stress Fractures in Runners: Why Foot Pain Lingers and What You Might be Missing

Foot pain that lingers, comes and goes, or never fully heals can signal something more serious especially in runners. Episode 19 of Interdisciplinary Case Miles centers on a high school track athlete dealing with a navicular bone stress injury that persisted for nearly a year. This type of injury is one of the most challenging in running due to limited blood supply, high biomechanical demand, and the need for strict management early on. This case highlights how bone stress injuries develop from a combination of training load, biomechanics, and nutrition especially low energy availability in adolescent athletes. It also addresses why navicular injuries require careful progression, non-weight bearing phases, and long-term follow-up to avoid delayed healing or recurrence. You’ll hear how foot mechanics, posterior tibial function, and arch control influence stress at the navicular, along with how strength, mobility, and confidence all play a role in returning to sport. The conversation also emphasizes the importance of fueling, growth demands, and the unique challenges faced by youth and first-generation athletes navigating high training loads.  Whether you’re a runner dealing with stubborn foot pain, a parent supporting a young athlete, or training in high-impact environments like track, trail, or jumping sports, this episode provides clear direction on preventing and managing navicular stress injuries. 00:00 – Intro to Interdisciplinary Case Miles Overview of the podcast and today’s complex case. 01:05 – Case Overview: High School Athlete with Persistent Foot Pain Track athlete with a year-long navicular bone stress injury. 03:10 – What Is the Navicular Bone & Why It Matters Location, function, and role as the “keystone” of the arch. 06:00 – Why Navicular Stress Injuries Are High Risk Limited blood supply and challenges with healing. 09:20 – The Perfect Storm: Load, Biomechanics & Nutrition How multiple factors combine to create bone stress injuries. 12:40 – Low Energy Availability in Young Athletes How underfueling impacts bone health and recovery. 16:30 – Growth, Development & High Calorie Needs Why adolescent runners require more fuel than expected. 20:10 – Practical Fueling Strategies for Busy Athletes Snacking, meal timing, and closing energy gaps. 24:00 – Posterior Tibial Function & Foot Mechanics How pronation control affects stress at the navicular. 27:45 – Physical Therapy Approach to Navicular Injuries Strength, mobility, stability, and load management. 31:20 – Confidence & Fear in Return to Sport Mental barriers after long-term injury. 35:00 – When to Repeat Imaging & Monitor Healing Using MRI and clinical signs to guide progression. 38:40 – Surgical vs Conservative Treatment Options When athletes consider early intervention. 42:10 – Athlete Stage Matters: Youth vs Elite Decisions How treatment varies by age and competition level. 45:30 – Key Takeaways from Each Expert Education, fueling, and whole-athlete care. Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support [https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support?utm_source=rss&utm_medium=rss&utm_campaign=rss]. If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case. Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com.

18: Chronic Ankle Instability in Runners: One Overlooked Cause of Hip and Back Pain

What if your hip pain is actually coming from your ankle? Episode 18 of Interdisciplinary Case Miles follows a 38-year-old ultra marathon runner with lateral hip pain, back discomfort, and a long history of recurring ankle sprains. What many runners dismiss as “no big deal” can lead to instability, altered mechanics, and long-term performance limitations. This conversation connects chronic ankle sprains to changes in the kinetic chain, showing how foot and ankle instability can drive hip and back pain. It also highlights the role of ligament health, balance, and neuromuscular control in keeping runners strong and resilient. Nutrition and hydration are also key factors especially for ultra and trail runners. Fueling, collagen support, and electrolyte balance all influence healing, coordination, and injury risk. Whether you’re running trails in the mountains, training for your next ultra, or dealing with nagging injuries that won’t go away, this episode offers practical, evidence-informed strategies to improve stability, prevent setbacks, and optimize performance.  00:00 – Intro to Interdisciplinary Case Miles Meet the team and today’s focus on real runner cases. 01:10 – Case Overview: Ultra Runner with Hip & Back Pain A 38-year-old athlete presents with lateral hip pain, but there’s more to the story. 03:15 – The Overlooked Clue: Chronic Ankle Sprains Why “it doesn’t hurt” doesn’t mean it’s not a problem. 06:20 – Hip Impingement vs. Kinetic Chain Dysfunction How foot and ankle issues can drive hip pathology. 09:10 – Hypermobility vs. Tightness Explained Why some joints are loose while others compensate. 12:00 – What Happens When You Keep Spraining Your Ankle Ligament damage, collagen breakdown, and loss of stability over time. 15:30 – The 2% Stability Loss Rule Why repeated ankle sprains create long-term dysfunction. 18:40 – How Ankle Instability Causes Hip & Back Pain Connection between foot mechanics, glutes, and loading patterns. 22:10 – Physical Therapy Strategies for Ankle Stability Balance training, foot control, joint mobilization, and plyometrics. 27:00 – Collagen, Nutrition & Ligament Healing What runners need to know about fueling and recovery. 30:15 – Electrolytes, Hydration & Injury Risk How dehydration affects reaction time, coordination, and proprioception. 34:40 – Trail Running Risks & Cognitive Fatigue Why fueling impacts decision-making and injury prevention. 38:10 – Shoe Choice & Terrain Considerations Stack height, stability, and trail-specific risks. 42:20 – When an “Ankle Sprain” Might Be More Serious Recognizing fractures and complications. 45:00 – Key Takeaways from Each Expert Simple, actionable advice to prevent and manage ankle instability. Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support [https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support?utm_source=rss&utm_medium=rss&utm_campaign=rss]. If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case. Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com.

17: Low Back Pain in Runners: When Hormones, Sleep, and Core Stability Collide

Is your low back pain coming from running or is it something else entirely? In this episode of Interdisciplinary Case Miles, Dr. Sara Raiser, sports medicine physician and running medicine speicalist, Dr. Kate Mihevc Edwards, orthopedic physical therapist and running PT, and sports dietitian Kelsey Pontius walk through a runner case involving low back pain during the perimenopause transition. The case involves a 41-year-old female physician and half-marathon runner who initially seeks help for nutrition during perimenopause. During the consultation, she casually mentions intermittent low back pain, poor sleep, and high work stress, factors that can all influence recovery and musculoskeletal health.The conversation expands into a deeper discussion of how hormonal changes, sleep quality, fueling habits, biomechanics, and pelvic floor health can all play a role in back pain for runners. We explain how shifting hormones like estrogen, progesterone, and testosterone influence collagen health, tendon recovery, muscle repair, sleep quality, and energy levels. For active women, these changes can show up as slower recovery, stubborn body changes, and nagging aches that weren’t there before.In this episode, we discuss: * Why low back pain in runners is often multifactorial * The impact of perimenopause and hormonal changes on recovery and connective tissue * How sleep and fueling patterns influence injury risk and healing * Why runners with back pain should evaluate core stability, breathing, and pelvic floor function * How hip mobility and running mechanics can affect the lower back * When back pain requires medical evaluation—and when runners can safely stay active * Strategies to keep running while managing back discomfort If you're a runner dealing with low back pain, sleep disruption, hormonal changes, or training stress, this episode explores how all of these factors intersect and what you can do to stay healthy and keep running. If you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives. This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners. 00:00 — Podcast Introduction Meet the hosts and overview of Interdisciplinary Case Miles. 01:05 — Case Introduction: Perimenopausal Runner. A 41-year-old half-marathoner experiencing body changes, sleep issues, and intermittent low back pain. 02:30 — Nutrition & Hormonal Changes in Perimenopause How hormonal shifts affect recovery, metabolism, and nutrition needs. 05:10 — Addressing Body Changes & Sleep First Body neutrality, sleep quality, and fueling regularly during busy workdays. 08:00 — Medical Evaluation of Low Back Pain Dr. Reiser explains axial back pain, possible causes, and clinical screening. 11:00 — Physical Therapy Assessment Core activation, breathing patterns, pelvic floor health, and movement mechanics. 14:00 — Running Mechanics & Back Pain Hip mobility, posture, and how running form can influence back stress. 17:00 — Training Modifications & Staying Active When runners should modify activity instead of stopping completely. 20:00 — Managing Persistent “Niggling” Pain Understanding chronic discomfort and avoiding unnecessary interventions. 22:00 — Pre-Run & Post-Run Strategies Simple mobility and activation exercises that may reduce pain. 23:30 — Key Takeaways from Each Expert Back pain management, nutrition mindset during body changes, and pelvic floor considerations. 24:45 — Episode Wrap-Up Closing thoughts and invitation to follow and share the podcast.   Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support [https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support?utm_source=rss&utm_medium=rss&utm_campaign=rss]. If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case. Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com.

16: Plantar Fasciitis in Runners: Are You Hobbling to the Bathroom in the Morning?

Are you hobbling to the bathroom in the morning because of heel pain? Many runners with plantar fasciitis ignore that early symptom for months until it starts affecting every run. In episode 16 of the Interdisciplinary Case Miles Podcast, Dr. Sara Raiser, sports medicine physician and running specialist, Dr. Kate Mihevc Edwards, orthopedic physical therapist and running PT, and sports dietitian Kelsey Pontius break down a case involving chronic plantar fasciitis that slowly worsened over time. The case involves a 42-year-old runner who runs 3–5 miles nearly every day to manage work stress. For over a year she ignored classic plantar fasciitis symptoms, morning heel pain and stiffness after sitting because the pain would improve once she started moving. Eventually, the pain began showing up during her runs and getting worse halfway through, forcing her to finally seek help.In this episode, the team explains why plantar fasciitis often becomes a chronic plantar fasciopathy, why morning heel pain happens, and why runners often wait far too long before addressing the root causes.You’ll learn: * Why morning heel pain and hobbling after sitting are classic plantar fasciitis symptoms * Why many runners develop plantar fasciitis after months or years of subtle warning signs * Why foot strength and running mechanics matter more than stretching alone * The role of calf mobility, great toe motion, and the kinetic chain in plantar fascia loading * When treatments like shockwave therapy, PRP, or injections may be appropriate * Why plantar fasciitis rehab can take 6–9 months for chronic cases * How nutrition, protein intake, vitamin D, and micronutrients support connective tissue healing * The mental side of injury when running is your primary stress relief * How long rehab realistically takes If you're a runner struggling with heel pain, plantar fasciitis, or foot pain when you first step out of bed, this episode will help you understand what’s really happening and how to recover without giving up running. If you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives.This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners. 00:00 — Podcast Introduction Meet the hosts and overview of Interdisciplinary Case Miles. 01:05 — Case: Chronic Plantar Fasciitis A 42-year-old runner dealing with persistent heel pain. 03:20 — What Plantar Fasciopathy Means Why this injury is usually chronic rather than inflammatory. 05:40 — Evaluation & Diagnosis Gait analysis, imaging, and identifying root causes. 08:40 — Treatment Foundations Strengthening the foot and addressing biomechanics. 11:20 — Physical Therapy & Rehab Timeline Why recovery may take several months. 14:10 — Running Mechanics & Foot Function Key mobility and strength factors affecting the plantar fascia. 17:00 — Nutrition for Healing Protein, collagen support, and key micronutrients. 19:30 — Vegetarian Diet Considerations Ensuring adequate amino acids and nutrients. 21:10 — Mental Side of Injury Managing stress and staying engaged during recovery. 23:20 — Key Takeaways Final advice from each expert. 24:40 — Episode Wrap-Up Closing thoughts and how to submit a case. Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support [https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support?utm_source=rss&utm_medium=rss&utm_campaign=rss]. If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case. Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com.

15: High Hamstring Pain in Runners: Do You Need PRP or Is Rehab the Real Fix?

Do You Need PRP or Is Rehab the Real Fix? In Episode 15 of the Interdisciplinary Case Miles podcast, we discuss a case involving a 40-year-old age group runner whose long-standing hamstring tendinopathy became acutely aggravated after a slip on ice revealing the layered challenges of acute-on-chronic tendon pain in runners. This case highlights why proximal hamstring injuries require precise diagnosis and an individualized treatment plan. Dr. Sara Raiser(MD) explains how to differentiate high hamstring tendinopathy from lumbar spine or nerve-related pain, when imaging such as MRI or diagnostic ultrasound is indicated, and how to determine whether a partial tear is present. The conversation also covers when regenerative medicine options like platelet-rich plasma (PRP) injections or percutaneous tenotomy may be appropriate, and why they are rarely first-line treatment. Dr. Kate Mihevc Edwards(PT) takes us through the rehabilitation process, including early integration after PRP, the role of blood flow restriction (BFR) training, and why eccentric strengthening remains the gold standard for tendon rehabilitation. She emphasizes addressing the entire kinetic chain hip mobility, lumbar and thoracic spine mechanics, neural tension, gait changes, and stiffness patterns that often contribute to chronic hamstring overload. You’ll also hear practical insight into return-to-run timelines, common pain spikes around the six-week mark post-PRP, and how to safely reload a healing tendon. Sports dietitian Kelsey Pontius rounds out the discussion by explaining how nutrition directly influences tendon healing and regenerative outcomes. The team discusses energy availability, protein targets, iron status, collagen-supporting micronutrients like vitamin C, zinc, and copper, and how fueling strategies can optimize recovery after procedures like PRP and during BFR training. If you’re dealing with chronic hamstring pain, considering PRP for a running injury, or navigating a return to running after a proximal hamstring tear, this episode offers evidence-informed guidance from a running medicine physician, physical therapist, and sports dietitian working collaboratively to support runner health and performance. If you’re enjoying these conversations, please follow the podcast and take a moment to rate or review it. Sharing it with a runner, coach, or healthcare provider helps us reach the people who can make the biggest difference in athletes’ lives. This podcast is for runners at every level, the coaches guiding them, and the healthcare professionals who care for them. We believe interdisciplinary care leads to better outcomes  and stronger runners. 00:00 – Welcome to Interdisciplinary Case Miles Hosts introduce the case-based, evidence-informed discussion format. 02:00 – Case Presentation: High Hamstring Pain After a Slip 40-year-old runner with chronic hamstring tightness that became acute after slipping on ice. 05:00 – Why This Case Is Tricky Chronic symptoms masked until an acute event; athletes often keep training through early tendon pain. 08:00 – Medical Evaluation Priorities Rule out lumbar spine and nerve involvement; assess for proximal hamstring tendon injury vs referral. 12:00 – Timeline Matters: Acute on Chronic Injury Long-standing tendon changes increase the likelihood of partial tearing with sudden load. 15:00 – Imaging Decisions: When and Why MRI used to confirm tendon involvement and rule out hip pathology that can mimic hamstring pain. 18:00 – Why Rehab Comes First Conservative care focuses on progressive loading, not rest, to restore tendon capacity. 21:00 – Key Biomechanics: Hip Extension Drives Load Limited hip extension shifts demand to the hamstring, increasing strain and injury risk. 24:00 – When to Consider PRP or Tenotomy Procedures introduced after failed rehab; choice depends on presence and size of tendon tear. 27:00 – PRP vs Tenotomy: Clinical Decision Making PRP for larger tears; tenotomy for smaller or degenerative tendon changes 30:00 – Post-Procedure Management Initial protection followed by gradual return to loading and early reintroduction of rehab. 33:00 – Rehab Progression After Intervention Isometrics → eccentric loading → return to running with controlled progression. 36:00 – The Biggest Mistake Runners Make Relying on passive treatments instead of structured strength and loading progression. 39:00 – Final Takeaways Sara: Rule out spine and confirm diagnosis early Kelsey: Recovery requires supporting the whole system Kate: Tendons don’t heal with rest—they need progressive load 42:00 – Closing and Where to Learn More Outro and resources for runners dealing with hamstring pain. Become a supporter of this podcast: https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support [https://www.spreaker.com/podcast/interdisciplinary-case-miles--6623567/support?utm_source=rss&utm_medium=rss&utm_campaign=rss]. If you enjoyed this episode, don’t forget to follow and subscribe so you never miss a case. Have a question or a case you'd like us to explore on the show? We’d love to hear from you. Reach out anytime at runcasemiles@gmail.com.