Q: I’ve been a runner for 20-plus years with no significant injuries until after I completed an Ironman 2 1/2 yrs ago. Six weeks after, I developed bursitis in my right hip and have had a series of issues on that side including pain along the hip flexor. For more than a year my derriere hurts constantly and although I can run through the ache, I cannot go fast and climbing hills is torture. I saw a sports medicine physician who believed that it was a tightening of the ischial tendon in my hamstring due to aging. A recent MRI showed mild arthritis in my lower back but no tendon or ligament damage. I‘ve tried massage, chiropractic and physical therapy, rest, ice, cross-training, and a plasma injection but it still hurts(even just sitting) and has inhibited my true love, running. The left side is unaffected. Is this a bio-mechanical problem or something I have to live with as a get older? Please help!
A: I don’t use age as an excuse as many physicians use it because they can’t figure out a problem so they pass it off as the ageing process – so it’s their excuse, not yours. Now you may suffering more health issues as you age, but that is a whole different story. Since your “derriere” hurts a lot that most likely means you strained your glut max muscle (which is your derriere) or your psoas muscle, which is your deep hip flexor. If you have problems sitting straight up from a lying flat on your back position, then it is probably your psoas. For the psoas, look for tender spots deep in your belly, about 2-3” lateral from your navel, above and below another inch or so. You have to push deep in your abdomen for this one. And check both sides – the left side where you feel no pain might actually be the problem side but the right side is trying to compensate. For the glut max, look for deep tender spots around your glut max which actually extends all the way down the back of your thigh (3/4 of the way) and is often confused with hamstring pain. Once you find the sore spots, rub them out with deep pressure as I show in some of the Sock Doc videos. Also check out how to deal with bursitis here: http://www.drgangemi.com/healthtopics/injuries/#3
Q: ShutUpandRun said... Of course I'm going to ask about stress fractures. I have had two in one year, both while marathon training. Neither time did I think I was overtraining. I never increased speed/distance/frequency more than 10 percent per week, I fueled well and I never ran more than four days per week. My calcium/vitamin D levels are good, I cross train and have decent bone denisty. Am I just destined to get these or is there something else I can do? Mamarunsbarefoot said... You know my question! 5 stress fractures in 4 years! My bone density is normal, I'm not underweight either. Stress fractures to tibia four times and one to my femur.
A: Stress Fractures – for these you have to consider the two sources of stress – mechanical and nutritional. Mechanical often means the footwear you’re running in. I’ve seen even moderate-supporting shoes cause stress fractures in runners. They throw off your gait, and disperse stress in isolated areas where it’s not meant to be. Eventually, you break down, literally. So wearing minimalist shoes is very important when you run, and when you’re not, going barefoot should be routine. Remember to gradually work your way into the minimalist shoes if you’ve been wearing supportive running shoes for some time. Nutritional -You both mention that your bone density is good but that's not necessarily the case. If you have a stress fracture, it likely not good. Don’t think that because a bone density scan gave you a good report you necessarily have healthy bones. After all, that test measures only quantity of bone in certain areas, not quality of bone and it is not a reflection of overall health. There’s a lot more to bone than just calcium and vitamin D too. Probably the most important nutrient that is overlooked for bone health is the mineral manganese. Your body needs a lot of Mn when bone is injured; I sometimes give a patient 50-100mg of Mn a day for a couple weeks if they have a bone injury. Other nutrients like magnesium, copper, zinc, and silicon are also important for bone health. In regards to calcium, most people don’t need more calcium, but rather they need to stop pulling it from their bones. So you may think your calcium level is good, because either you take a supplement or the level looks normal in your blood, but you could be robbing from your bones. The body pulls Ca from your bones when the blood and tissues are too acidic, which happens when your diet is high in caffeine and/or refined carbohydrates, as well as when there is too much of the stress hormone cortisol – a result of training too hard or other excess stress in your life.
Q: Rose @ Eat, Drink, and Be Meiri said... Best Title Ever. I want to be a sock doc. If I don't have any comfort/blister issues running in normal socks, is there any reason for me to use fancy running socks?
A: Thank you! And no, wear whatever you like, or no socks at all. Actually if you wear socks that are too thick it’s not good for foot proprioception anyway. Thanks to the sock doc for taking the time to answer these questions. Like I said, we may answer more in a future post, so don't fret if yours wasn't included this time through. I hope everyone learned a bit from his answers--I know I did!