Multidisciplinary Care Helps Young Athlete Run Again Following Two Hip Fractures

A doctor who could relate to her 

Suffering two hip fractures two years apart at such a young age couldn't be a fluke, Tessa thought. Following the second surgery, she was determined to take the necessary steps to prevent another injury. A friend suggested she contact Mass General Brigham sports medicine doctor Adam Tenforde, MD, medical director of the National Running Center.  

"My friend had been seeing Dr. Tenforde and said, 'He's great. He won't accept that this was just a fluke. He'll dig and he'll be on your team.' That was exactly what I needed," Tessa said.  

Dr. Tenforde was an All-American runner at Stanford University, where he contributed to three NCAA national team championships and later qualified for the Olympic trials. As such, he can empathize with what injured runners like Tessa are going through.  

"Running injuries are very personal for me, as I've experienced a number of them," he said. "I understand how an injury affects your overall health and sense of well-being. Some orthopedic or sports medicine providers tell runners that the solution for a running injury is to just stop running. That's like telling another athlete who sustained a significant injury like an ACL tear not to play their sport anymore. I try to convey to patients that our team is in their corner and willing to do everything we can get them back to sport." 

A comprehensive running evaluation 

Three months after her second surgery, Tessa saw Dr. Tenforde for the first time. He reviewed her scans and lab tests, and asked about her goals. When she expressed a strong desire to return to running—but uncertainty about how to do so safely—he emphasized they would find a way, together.  

Tessa's treatment plan started with a referral to the National Running Center, one of the only programs in the United States devoted to the diagnosis, treatment, and prevention of running injuries in athletes of all ages and abilities. In addition to runners, the team cares for participants in running-intensive sports, like field hockey, lacrosse, and soccer.  

At the National Running Center, Tessa underwent a comprehensive running evaluation under the watch of lab manager, Logan Gaudette. This included a gait analysis, which uses video and motion analysis to identify small adjustments runners can make to their running form to relieve pain, reduce injury risk, and improve performance.  

"We spend about 90 minutes with the patient to understand the root of their injury and then to examine how their running mechanics may have contributed to their injury," said Lindsay Wasserman, DPT, FAAOMPT, OCS, a physical therapist at the National Running Center. 

Lindsay subsequently developed an individualized running plan for Tessa. It included gait retraining as well as strength training to ensure Tessa's tissues could withstand the rigors of running.  

"As I often say, I'm only going to be as successful as my physical therapist is," Dr. Tenforde said. "I determine the injury, but the hard work of teaching someone to move differently and get stronger and more flexible falls on the physical therapist."   

The National Running Center is at the forefront of running-related injury research. Dr. Tenforde and his colleagues have published dozens of peer-reviewed studies exploring how lower-body structure and gait mechanics are related to common running injuries. 

With cutting-edge research informing their clinical care, Dr. Tenforde noted, the team continuously refines its treatment approaches while contributing to the growing field of sports medicine.  

"I joke that if I'm providing the exact same recommendations in five years, then I'm failing as a doctor," he said. "We constantly challenge ourselves on the best evidence-based strategies for helping injured runners." 

Many factors can contribute to injury 

Lindsay noted that with bone stress injuries like Tessa's, uncovering the root causes of injury—and how to prevent reinjury—can be challenging.  

"The injury itself is often just the tip of the iceberg," she said. "There are all these other factors below the water, like strength and conditioning, motor control movement, diet, stress, sleep, and biomechanics (the study of human body movements and forces). You have to consider all these components to optimize health and reduce the risk of another injury." 

Accordingly, Dr. Tenforde and his colleagues—many of whom are also runners—take a multidisciplinary approach to patient care. When Dr. Tenforde first saw Tessa, she was very worried about getting injured again. Recognizing how deep-rooted this fear can be, he referred her to Rachel Vanderkruik, PhD, MSc, a sports psychologist with Mass General Brigham Women's Sports Medicine. 

"Dr. Vanderkruik has helped me deal with the uncertainty and learn to trust that my body is in a much better place than it was after the surgeries," Tessa said.  

Another member of Tessa's care team is Olivia Morgan, MS, RD, LDN, CNSC, CSSD, a clinical registered dietitian specialist with Spaulding Outpatient Center Boston. Olivia has offered advice on how Tessa should eat before and during runs to decrease injury risk and boost performance. She has also monitored Tessa's lab results and seeing her iron status was below optimal, suggested ideas to increase her iron intake. 

"Having access to sports psychology and nutrition underscores the support I'm getting and the resources I can lean on if something goes awry," Tessa said. "I'm really grateful that everyone appreciates my personal needs as a runner and takes a holistic view of my care." 

Hard work yields encouraging results 

Tessa, now 32, is nearly two years past her most recent surgery. A model patient, she has worked hard to apply the lessons she has learned from her Mass General Brigham care team. That has meant incorporating physical therapy techniques and strength training recommendations from Lindsay and following guidance on fueling and hydrating from Olivia.  

Thanks to her hard work, Tessa is feeling strong physically, mentally, and emotionally. Two months ago, she competed in the Cambridge Half Marathon, the longest race she has run since her second fracture. It was a meaningful milestone that she credits Lindsay for making possible.  

"Lindsay helped me think through a running plan that would allow me to increase my mileage incrementally without being too aggressive," she said. "She built in down weeks, layered in strength training, and looked at my biomechanics throughout. And now that we're in the offseason, she's helping me do targeted strength training that I can embed into my life to make me a stronger runner."  

Dr. Tenforde, who continues to see Tessa every few months, is pleased with how far she has come.  

"It's rewarding for me to see athletes like her get back to what they love to do," he said. "I'm incredibly proud of all she has accomplished, and I know she understands she has an ongoing partnership with our team to do what it takes to keep her running healthy."