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Friday, May 3, 2019

Putting the Pieces of the Injury Puzzle Together

My practice of medicine has much to do with trying to put pieces together of a puzzle. The puzzle being why an injury or pain syndrome occurred, or how to fashion a successful rehabilitation program for a patient. The image below can also stand for all the members of a team gathered to help a patient.

When a patient presents with pain, the Rule of 3 holds reign in establishing why something happened. The Rule of 3, and commonly 4 or 5, stand for the factors that had to exist for a problem to develop, a sort of perfect storm. One simple example is from a patient I saw yesterday. The patient has a tibial stress fracture from running. The injury occurred in clear overuse fashion (Cause #1). The injury, which is to a bone, occurred during a time of low Vitamin D (Cause #2). The runner is a overpronator who had recently prior to the injury switched from Stability shoes to barefoot technology shoes which proper transitioning period or running style changes (probably Causes #3, #4, and #5). By putting these pieces of the puzzle together, the patient was be successfully rehabbed, and the injury will not reoccur. 


  1. This comment has been removed by the author.

  2. My question is not on this particular subject, but I didn't know where to post it.
    I am 65 years old and in 2018 I had a sudden onset of tendon pain that grew increasingly worse over the course of nearly a year; and during that timeframe I was treated for UTIs with Cipro by 3 different doctors.

    I recently became aware of the relation between Ciprofloxacin and tendon ruptures and mentioned it to my podiatrist today, but he was reluctant to make a correlation of cipro and my injury and discouraged me from exploring that possibility. Why?


Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.