RUnning Injury

What happens when a highly conditioned collegiate swimmer transitions into marathon training too quickly? In this episode of Interdisciplinary Case Miles, a 23-year-old former swimmer increases weekly mileage from 15–20 miles to 40 miles, adds hills and speed work, and begins to worry about low ferritin when performance stalls. What initially appears to be an iron concern reveals a broader picture involving low energy availability, fueling gaps, training load errors, and bone stress injury risk, ultimately resulting in a diagnosis of femoral shaft stress fracture. Dr. Sara Raiser (running medicine physician), Kelsey Pontius (sports dietitian), and Dr. Kate Mihevc Edwards (physical therapist) discuss: Why ferritin is often a marker of a larger issue The relationship between nutrition, iron stores, and bone health Unique injury risks when transitioning from non-weight-bearing sports How cardiovascular fitness can exceed musculoskeletal readiness Rehabilitation principles, plyometric loading, and safe return-to-run progressions This episode is essential listening for runners, clinicians, coaches, and endurance athletes navigating performance concerns, injury prevention, and the demands of marathon training. 00:00 – Welcome to Interdisciplinary Case Miles Meet the hosts and the evidence-informed approach behind real runner cases. 02:10 – The Case Introduction A former collegiate swimmer increases mileage from 20 to 40 miles/week while marathon training. 04:45 – “Is It My Ferritin?” Why athletes fixate on iron and ferritin when performance plateaus. 07:30 – Ferritin vs Iron Explained What ferritin actually represents and why it changes slowly. 10:15 – Red Flags for Low Energy Availability Sleep, libido, GI symptoms, recovery, and early warning signs of REDs. 15:40 – Nutrition, Bone Density, and Stress Injury Risk How low ferritin, low energy intake, and bone health intersect. 18:30 – Thigh Pain Isn’t “Just a Quad Strain” Why distance runner thigh pain raises concern for femoral stress fractures. 22:15 – Diagnosing a Femoral Shaft Stress Fracture Why this injury matters and how it differs from higher-risk stress fractures. 26:40 – The Swimmer-to-Runner Problem Cardio fitness vs bone loading, gravity, and anti-gravity sports. 31:50 – The Three Pillars: Nutrition, Training Errors, Biomechanics A framework for evaluating bone stress injuries. 36:20 – Training Errors That Add Up Fast Mileage spikes, speed work, lack of rest, and life stress post-college. 41:10 – Starting PT Before You Run Again Strength, education, and early rehab during protected weight-bearing. 45:30 – Plyometrics, Bone Loading, and Return-to-Run Why jumping matters and how bones adapt to force. 50:40 – Bone Geometry, Density, and Multi-Directional Movement Why specialization matters—especially in adolescence. 55:30 – The “Engine vs Chassis” Problem When cardiovascular fitness outpaces muscles, tendons, and bones. 59:20 – Why Return-to-Run Feels So Hard Managing athlete frustration while protecting long-term health. 1:02:30 – Final Takeaways from Each Expert Big-picture thinking, history matters, and don’t self-coach in isolation. 1:06:00 – Wrap-Up & How to Submit a Case #running #runninginjuries #runninginjury #sportsmedicine #physicaltherapy #enduranceathletes #nutitioncoach #wellness #wellnesstips #injuryprevention #pt

Welcome to Interdisciplinary Case Miles, a podcast where real runner stories meet clinical expertise. In this episode, Dr. Kate Mihevc Edwards (PT), Dr. Sara Raiser (MD), and sports dietitian Kelsey Pontius present a common but often misdiagnosed case of glute tendinopathy in a female runner during the menopause transition. This case goes over running biomechanics, hormonal changes, nutrition, sleep, and recovery. The team explores how perimenopause and menopause-related hormonal shifts particularly changes in estrogen can affect tendon health, joint lubrication, gut function, nutrient absorption, sleep quality, and overall healing capacity. This episode discusses misconceptions around weight, health, fueling, and aging, emphasizing that bodies are meant to change and that under-fueling, overtraining, and “black-and-white” health advice can slow recovery and increase injury risk. The hosts discuss why glute tendinopathy is often misdiagnosed as bursitis, how to properly evaluation lateral hip pain, and why a stepwise, individualized approach to care is essential. Some of the main topics include: -The role of hormones in tendon health and injury risk -Why weight is not a reliable indicator of health -The importance of adequate fueling, including carbohydrates, during midlife transitions -How sleep, stress, and digestion impact healing -Why interdisciplinary care leads to better outcomes for runners This episode reinforces a core theme of the podcast: there are no one-size-fits-all answers in medicine or performance. By understanding the whole person and working with the body rather than against it runners can recover more effectively, reduce injury risk, and continue doing what they love. 00:00 Welcome to Interdisciplinary Case Miles 01:25 Meet the Hosts & Their Clinical Roles 04:00 What We’ve Been Working On Lately 06:15 Kelsey’s New Ebook: Miles & Meals 09:30 Outreach, Education & Bridging the Gap in Running Medicine 13:10 Returning to Running After Health Challenges 16:20 Introducing the Case: Lateral Hip Pain in a Midlife Runner 19:45 Nutrition, Hormones & Gut Health in Perimenopause 24:30 Bodies Are Meant to Change 28:40 Weight Is Not Health & The Risk of Under-Fueling 33:20 Why Glute Tendinopathy Is Often Misdiagnosed as Bursitis 38:10 Estrogen, Collagen & Tendon Healing 43:50 Biomechanics, Hip Load & Physical Therapy Considerations 49:30 Pelvic Floor, Core Health & Hip Pain 53:40 Sleep, Stress & Recovery During Midlife Transitions 57:45 Doing Less to Heal More 01:01:30 Key Takeaways from Each Expert 01:04:10 Final Thoughts & How to Connect with the Team #sportsmedicine #runninginjury #running #sportsnutrition #nutrition #hormonehealth #hormones #sleep #stress

Welcome back to Interdisciplinary Case: Miles, where real runner stories meet clinical expertise. In Episode 8, Dr. Sara Raiser (MD), sports dietitian Kelsey Pontius, and physical therapist Dr. Kate Mihevc Edwards (PT) team up to break down an especially complex case: a mid-30s female roadrunner and backpacker navigating persistent butt pain, posterior leg symptoms, and unexpected GI challenges. This episode uncovers why seemingly simple running injuries often have not-so-simple causes and why a whole-body, interdisciplinary lens matters. In this case study, we explore: Buttock and posterior thigh pain, what “sciatica” really means, why it’s often misdiagnosed, and how nerves, joints, tendons, and biomechanics interact The nervous system connection how an injury high up (like the hip or butt) can contribute to issues farther down the chain, including the Achilles The hidden role of nutrition & gut health, IBS, GI testing, microbiome insights, nutrient absorption, and how underfueling impacts nerve healing and recovery Breathing, stress & recovery why parasympathetic activation, rest, and mindful eating support both performance and injury resolution Clinical decision-making differential diagnoses, red flags, when imaging is needed, and how PT, nutrition, and sports medicine intersect Real-life biomechanics like hiking with a backpack, running form, posture, core engagement, nerve mobility, and how everyday habits amplify or relieve symptoms This episode takes a comprehensive look at the messy, interconnected reality of running injuries where gut function influences glute activation, posture affects nerve mobility, and stress and recovery can make or break healing. Whether you’re a runner, clinician, or coach, you’ll walk away with: A clearer understanding of butt and posterior leg pain Practical insights on GI issues, fueling, and stress management A roadmap for thinking holistically about athlete health 00:00 – Podcast Intro & Hosts Overview of Interdisciplinary Case Miles and introduction of the three clinicians. 01:35 – Case Overview: Mid-30s Female Road Runner Runner background, hiking/backpacking at altitude, work-from-home lifestyle, inconsistent meals. 03:40 – Initial Presentation: Butt & Posterior Thigh Pain Why the PT flagged nutrition as a possible barrier to healing. 05:30 – GI Symptoms & IBS-C / IBS-D Explained Connection between alternating constipation/diarrhea, discomfort after meals, and training disruption. 07:40 – Why Gut Health Matters for Injury Recovery Micronutrient absorption, inflammation, and nerve healing considerations. 09:40 – Nutrition Interventions: Eating Enough & Consistently Hydration, missed meals, work-from-home challenges, and fueling basics. 12:00 – Gut Testing & Microbiome Findings Trail runner risks, lab testing, microbiome imbalance, and implications for healing. 14:20 – Polyphenols, Probiotics & Fiber Strategy Green tea, targeted probiotics, fibers, and supporting beneficial bacteria. 16:20 – Chewing, Digestion & Parasympathetic State Why slowing down eating and breathing matters for gut regulation. 18:10 – Exercise Load vs Recovery (The “90-Minute Rest Day”) Why constant training prevents healing and nervous system recovery. 19:50 – Medical Perspective: Diagnosing Butt Pain Hip vs spine vs nerve vs tendon; complexity of posterior chain pain in runners. 22:20 – Red Flags & Imaging Decisions When imaging, injections, and stepwise diagnostics are appropriate. 24:45 – What “Sciatica” Really Means Why true sciatica is uncommon and often misdiagnosed. 26:30 – Sciatic Nerve Anatomy & Referred Pain Lumbar roots, piriformis myths, nerve pathways, and distal injury risk. 29:45 – Nerve Loading: Hiking, Backpacks & Downhill Stress How posture, stride length, and load affect nerve irritation. 32:10 – Nerve Mobility & Gliding Concepts Why nerves get “stuck” and how that mimics muscle tightness. 34:10 – PT Assessment Priorities Single-leg control, posterior chain loading, core and hip coordination. 36:30 – Piriformis Syndrome: What’s Really Going On Secondary pain generators, trigger points, and referral patterns. 39:00 – Gut Health, Core Control & Pelvic Floor How GI distress, surgeries, trauma, and bloating affect muscle engagement. 42:00 – Medications, Microbiome & Bone Health PPIs, acne meds, absorption issues, and injury risk. 44:30 – Manual Therapy & Anterior Chain Considerations Abdominal work, hip flexors, visceral restrictions, and pain patterns. 46:40 – Recovery Is the Missing Link Sleep, relative rest, nutrition, and why breakdown exceeds adaptation. 48:40 – Key Takeaways: Nutrition Perspective Seeing experts, gut health beyond trends, mental health, and mindfulness. 50:20 – Key Takeaways: PT & Biomechanics Running gait, hiking mechanics, backpacks, unloading the nerve. #sportsmedicine #runninginjury #runnning #runnertips #runnerhealth #sciaticarelief #sciatica #lowerbackpain #movementscience #gaitanalysis #biomechanics #runnersofyoutube #podcast

In this episode of Interdisciplinary Case Miles, hosts Dr. Sara Raiser(MD), Kelsey Pontius RD , and Dr. Kate Mihevc Edwards PT break down a complex real-world case of a male marathoner caught in a cycle of injury, underfueling, and recovery. When multiple stress fractures, low testosterone, and low ferritin collide with emotional stress and high training volume, the team dives deep into how Relative Energy Deficiency in Sport (RED-S) affects performance, hormones, and bone health. Kelsey unpacks the concept of within-day energy deficits and the athlete’s struggles with reactive hypoglycemia. Dr. Sara Reiser highlights why femoral neck stress fractures are among the most serious running injuries often requiring urgent imaging and complete rest. Dr. Kate Mihevc Edwards PT shares the detailed process of returning safely to running, from load management and biomechanics to rebuilding strength and confidence. This episode showcases the power of an interdisciplinary approach where nutrition, medicine, and physical therapy work together to help runners heal fully and sustainably. Episode Highlights 00:00 Welcome & introductions 01:10 Kelsey presents the case: male runner with recurring stress injuries 07:45 Understanding reactive hypoglycemia and RED-S 10:20 Dr. Raiser explains femoral neck stress fractures & key lab work 16:50 Dr. Edwards on rehab, biomechanics, and safe return-to-run 23:30 The importance of interdisciplinary collaboration 28:40 Top takeaways for clinicians & athletes Submit your cases: runcasemiles@gmail.com Follow, share, and review to support the Interdisciplinary Case Miles community.

A 32-year-old female runner and triathlete presents with deep anterior hip and groin pain that worsens with sitting, cycling, and running. Dr. Kate Mihevc Edwards (PT), Dr. Sara Raiser (Running Medicine Physician), and sports dietitian Kelsey Pontius dig into a complex but common clinical picture: when hip impingement (FAI), labral irritation, or soft tissue overload may be compounded by pelvic floor dysfunction, hormonal shifts, or fueling gaps. The team breaks down differential diagnosis—how to distinguish hip joint pathology from lumbar referral, hip flexor pain, or femoral stress—and explores gait mechanics, breathing patterns, pelvic floor “piston” function, and nutrition’s role in muscle health and recovery. Practical strategies include what to look for in gait analysis, single-leg squat, and functional movement, plus how to modify training. This conversation is built for athletes, coaches, and clinicians alike—anyone navigating stubborn hip pain that doesn’t resolve with rest or generic rehab. Timestamps 0:00 – Welcome & why anterior hip pain is often misdiagnosed 4:30 – Case intro: 32-year-old runner/triathlete with hip & groin pain 8:15 – Red flags: femoral neck stress fracture vs. hip flexor vs. FAI 13:00 – Pelvic floor clues & the diaphragm–pelvic floor piston 18:45 – Gait mechanics, arm swing, and hidden rotation issues 23:30 – Nutrition, hormones & pelvic floor muscle health 28:50 – Lever system: managing load while rehabbing hips 33:10 – Final takeaways: physician, dietitian, and PT perspectives 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. A big thank you to our sponsor, Lever Movement — a treadmill-based body weight support system used by clinicians, coaches, and athletes around the world. Whether you're rehabbing from injury, managing training load, returning postpartum, or focusing on performance, Lever is a versatile tool that helps keep runners running. As a listener, use the code CaseMiles for 20% off any of their 3 units. Thanks for joining us on Interdisciplinary Case Miles — real runners, real problems, real solutions.