Monday, October 21, 2013

Running and hip pain

Running and Hip pain

(PLEASE use the links throughout this blog!!)

I hate to run... always have, probably always will.  What I like is how it makes me feel AFTER I'm done.  Like I've actually accomplished something fantastic... something the fat Debi was unable to do...  even all the way back in high school, when I was was skinny and malnourished at only 90 lbs, I still hated running!!  Since it was always so difficult for me, I just hated it.  
Ease into 5K app

However, once I lost my weight late 2011... I wanted to try running since the AF fitness test demands it.  So, I came across a program called Couch to 5K (C25K) and downloaded an app that would allow me to play music while a disembodied voice called out to me when to walk and when to run.  The PT in me LOVES the intervals it uses in order to get someone like me used to running.  ALL workouts are 30-40 minutes long.  I liked that as it could definitely fit into my day.  I also liked that as soon as I felt like I was out of breath and could not possibly run another step, it dinged and I'd be told to walk.... a little bit later, as I was recovering from the run, a voice would tell me to run again.  Slowly, over 9 weeks, it gets you prepared to run a full 5K... still with a 5 minute warm up and 5 minute cool down sandwiched around the running.  The PT in me liked that even more!  

When I started the program in 2011, I did so on the treadmill.  It was running, but it is NOT the same as running outside or on a non-moving surface.  Though I knew that, it was wintertime and I needed the comfort of working out inside my house.  Treadmill it was.  However, as I hit the 9th week and ran... for the first time in my life, a distance of 5K (3.1 miles), I noticed left iliac crest pain.  Not really hip pain, as it was higher than my hip, but wasn't my side.  I looked it up and realized it was a strain of the muscles of the hip that attach on the iliac crest and of the side of the trunk that help lift the hip and also attach at the same spot.  It got so painful that I had to stop my running and walking workouts all together.  Definitely soft tissue as I could replicate the pain.  (more on that later)
Random photo showing results paying off on the running!

Well, I've run on and off since then, but never got to the point of running greater than 10 minutes at a time until we moved away from Japan to Hawaii.  I started it (the couch to 5K program) all over again, determined to be able to do my physical fitness test doing the run portion.  I mean, shoot... I'm in Hawaii now... beautiful weather 365 days a year.  OK.  GPS was working on the non-usable Japanese iPhone... all my music on there... good to go.  So, I went... outside and started running from week 1 again.  I even continued when I went back to the mainland USA for my reserve 2 weeks this summer and visited family.  Everyone was impressed and I was feeling invincible !  I even looked forward to my time alone... I was actually beginning to ... *gasp* ... enjoy running!!  

I took my time through the 9 week program as I really wanted to run faster for my fitness test... so, instead of doing more time, I did more intervals and then hung out at the 6th and 7th weeks that would get me to my goal of under 12 min/miles to do even better time for my run.  Well... two weeks ago, I was running and noticed pain in my left hip.  NOT the same as the previous left hip/iliac crest pain.  This was in the groin.  That's not usually a good thing.  I iced and rested for 4 days, then ran again.  No pain... even added a little time and felt great.  The next day?  PAIN.  again.  Farther on in the run, but worse.  This time, no relief in 2 days, so I tried some stretches in standing that my husband showed me (they were interesting stretches... I figured I'd try them even though our bodies are incredibly different and he's no PT)... since they were in standing, they were weight bearing.  

Its the runner's stretch we've all seen with crossing the legs at the ankles, knees locked and leaning to the side.  OH MY HOLY LORD!!!  The pain caused me to fall to the floor and cry.  Seriously.  Not.   Kidding.  Problem was, the pain was not on the side of my leg (that's an ITB/TFL stretch for the lateral leg/hip), but in the groin extending almost to the iliac crest.  DEEP, searing pain... ice... ice... heat... ice... heat... ice... hot bath... ice for the rest of the day.  

Needless to say, since it's been 5 days now and I'm just now walking with a minor limp, I'm not running anytime soon.  So... let's look at the ITB or the Iliotibial Band.  It's one of the most frequent causes of hip and knee pain in runners.  Why?  It's stressed something huge with running and needs to be stretched.  Why in me?  Well, I have a shorter right leg, putting the ITB on stretch on that side.  My pain most likely comes from a slack ITB and overworked Tensor Fascia Lata (a small muscle in front of the ITB).  So.  What does one do for an ITB that's NOT tight?  

Well, you don't stretch it... you have to tighten it.  See where the TFL is?  It's very intimately positioned with the ITB.  Therefore, strengthen the TFL, and the ITB should tighten up a little.  ALSO... look on the opposite side and see what's tight.  Yep, you got it.  My right ITB is very tight.  

Nope... not me, got it from Runnersworld.

My favorite stretch is for the Vastus Lateralis (lateral quadriceps muscle) and the ITB... I call it the pretzel stretch.  Obviously, I did not come up with this one myself.  However, my right ITB has been tight since I had a soft tissue surgery at 18 yrs of age... it created a band of scar tissue along the lateral side of my patella (knee cap).  So... for YEARS I did other stretches, but finally figured this one out and NEVER do any others for my right side as this one takes the cake.  Absolutely works the BEST for my leg.  

I really like this next graphic as it shows how to get yourself into the pretzel position... it's extremely important to pull the leg back BEFORE adducting (pulling your knee toward the other knee) as it allows the ITB to stay overtop of the greater trochanter on the femur (the graphic 2 above has a RED spot over the greater trochanter as this is the area that hurts when the ITB rubs over it in most people... if you don't extend the hip before adducting, the ITB stays in front of this spot and doesn't get a good enough stretch!).  

From Laurel Chiropractic 

The next thing is to strengthen weak TFL AND the gluteus medius.  The Glut Med is a SERIOUSLY important muscle... it stabilizes your pelvis when you are weight bearing on that leg.  So... each time your foot hits the ground and you take your other foot off the ground, it's responsible for keeping your bootie from dipping down and staying in midrange... No, you don't want to shake your booty while running!!  Ha ha!  The graphic on the right is to strengthen the abductors of the hip.  Note that in two of them, your foot is pointed straight ahead... the last one, the leg is slightly rotated outward and you're moving diagonally backwards.  This one gets the glut med the best.  You can do this in lying on your side, standing and with lunges.  Since I cannot seem to exercise bearing weight right now, it's lying down for me!!  

Are there other things that can cause hip pain from running?  Yes!!  I've just pointed out the most common ailment.  There's also femoral neck stress fractures (very uncommon), psoas tightness, adductor tightness, and a few other muscular issues.  Yes, you can get bursitis in the hip, though that tends to be rarer in runners (in my clinical experience) and more in the middle aged, semi to very sedentary person.  Can a tight ITB cause bursitis... absolutely!  Deal with the ITB before it causes the bursa (a pillow-like structure that keeps the ITB from rubbing against the boney prominence of the greater trochanter) to inflame.  

One quick word on inflammation versus mechanical pain.  Inflammation hurts when you are just sitting there... it can be caused by a mechanical issue (such as a tight ITB).  However, if you're not inflamed (which is a chemical process), you don't really need to worry about anti-inflammatories like aspirin, ibuprofen (Motrin), or naprosyn (Aleve) or use ice.  How do you know you don't have an inflammatory process going on?  The pain goes away when you stop using it.  Like me, the pain goes away after I sit down and take the weight off my leg.  Thus the reason I'll heat it, too!!  

I hope I've enlightened you a touch about hip pain and possible cause from running.  

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