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764 Views 4 Replies Latest reply: Jun 17, 2013 2:36 PM by RobinfromMaine RSS
RobinfromMaine Pro 162 posts since
Dec 6, 2008
Currently Being Moderated

Jun 15, 2013 5:20 PM

If there's no pain is it still an injury?

Three days ago, at about 3 1/2 miles of a planned 6 1/2 mile run, I developed a feeling of instability in my left lateral thigh. There was no pain, either while running, or later, just a sense that the leg might give way, although it never did. I run with a fast cadence, with speed determined by varying stride length, and mid-foot strike, so I slowed down for greater stability, and cut my run short at five miles (which was when I arrived home; normally I would have continued past for an additional 1 1/2 out and back). I would have the sensation for a few strides, then it would go away, but recur, somewhat unpredictably. That night I waited to find out what was going to hurt or feel tight, but everything felt normal, including post run stretches, and the exercises I do in the morning. Thursday was supposed to be a longer run, so I ran a couple of minutes on the treadmill to test out the situation, and when nothing happened, went out for my run, cautiously and slowly, and had no problems for the first 1 1/2 miles, and then it started happening again. Because I hadn't had any sequelae the night before, I continued my run, but slowly. I noticed that I was most likely to have a problem running downhill, especially when I had just transitioned from uphill or level, and it seemed to be less of a problem the second half of my ten mile run. Friday was a scheduled off day, and again I didn't notice any particular problem, other then maybe a few small migratory twinges. It was a very busy day at work, with a lot of time on my feet, which normally makes my legs feel heavy, but otherwise all was normal. This morning I ran 6 1/2 miles at a ridiculously slow pace (and enjoyed myself way too much as a result). Once again I had a little problem at 3 1/2 miles, but not as much trouble as Wednesday -- but I was going very slowly. I was running on a back country road, with very little traffic, on the left side, and normally I just move close to the shoulder for oncoming cars, as the drivers are very good at giving runners plenty of room, but I side-stepped onto the shoulder and ran in tall grass once because the oncoming car was a police cruiser; I moved almost directly laterally, and on moving back to the pavement had the strongest sensation of the whole run, although it still went away after several steps. After the run I went on a determined search for trigger points and didn't even find the most common ones I have in the distal lateral calf; only a minimal soreness in the proximal lateral calf -- nothing in thighs, glutes. I have no pain, no numbness or tingling. I can walk, go up and down stairs, jump up and down, stretch, do donkey kicks with no problem.

 

I am 62, running for five years, and after managing to maintain a 30 mpw, running five days a week, through the past year despite the challenges of a Maine winter, I have gradually increased my mileage over the past two months, and for the past four weeks have been running 40 mpw, running five or six days a week, all outdoors. I have had one significant injury three years ago which affected my left leg, and had to take eleven weeks off. Coming back from that injury, and in the early spring last year when I had some twinginess in my L glutes have been the only times I have actually be able to run as slowly as I have the last few days. That first Wednesday I had run around 5 p.m. and had to do more than the usual side stepping the first 7/10 of a mile when I was on a main road. I alternate between two pair of shoes, neither of them either new or too old, and run the same sets of routes, with a fair number of hills.

 

A week from tomorrow is a half marathon on a very flat course. I have been considering racing, but am not committed to it. In fact, I thought work was going to preclude even the possiblity, but the project I thought was going to take up next weekend was moved up, hence the overtime yesterday. I don't seen any point in running if I can't race, and at this point I'm thinking that that's not a wise idea. My sense is that what I have is some sort of injury, and that I should be grateful to be able to run slowly, which is my intention until it either starts causing pain, or stops happening.

 

Anyone else experience this or have any thoughts?

 

Thanks,

 

 

Robin

  • lenzlaw Community Moderator 10,387 posts since
    Jan 18, 2008
    Currently Being Moderated
    1. Jun 16, 2013 9:17 AM (in response to RobinfromMaine)
    Re: If there's no pain is it still an injury?

    I don't have a diagnosis or remedy.  But I have had this sort of thing happen (also to my ankle). It never lasts long - a few strides usually - though it may happen again a few hundred yards down the road.  But then I somehow shake it off, maybe walk a few strides and it's gone, pretty much for good. I usually put it down to a mis-stride or planting my foot wrong.





    Len

  • JamesJohnsonLMT Legend 1,155 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Jun 16, 2013 5:14 PM (in response to RobinfromMaine)
    Re: If there's no pain is it still an injury?

    Robin, the answer to your title question is yes, there can be injury without pain, disease without sequelae, early cancer being a fine example, though not applicable in this case. My first thought as I read your account is that knee instability, or a vague feeling that the knee will give out, is a primary symptom of dysfunction in the medial quad (v. medialis), which can (not must) result from problems under the kneecap. In some cases, minor swelling under the patella causes an autonomic reduction in contraction force of the medial quad, with knee instability as a result.

     

    To test this hypothesis, trigger-point the medial quad a couple inches proximal to the knee cap, in the belly of the medialis muscle. I was lucky to find a good article on the subject at this link: http://www.positivehealth.com/article/bodywork/treating-trigger-points-reduces-pain-from-knee-osteoarthritis

    Here is the graphic:

    http://www.positivehealth.com/img/phfiles/Issue_189/Issue_189_Articles/vastus_medialis_sw.jpg

    Advice on technique for handling trigger points varies widely, according to one's individual physiology and psychology. Use trusted methods that have worked for you in the past to work this point. Though a pain-referral pattern is possible, pain is not always present, as noted in the article.

     

    One point I want to drive home is that medial quad weakness can be an early sign of hidden pathology in the knee, which is worth following up on. I'm near your age, and am of the opinion that upping your mileage from 30 to 40 is more dramatic a change than from 20 to 30. I know that most serious marathoners consider 40 miles a minimum weekly mileage, but I always remind people that I've been able to BQ on 20 miles a week average, so there is no point in beating yourself up for Half Marathon training.

     

    Another age-related item to point out is that many people over 50 are on statin meds, which can result in muscle weakness and/or atrophy in many cases. My view is that these meds, though they may have an overall positive net effect on sedentary populations, are redundant - even counter-productive - in the active crowd. Exercise alone, at modest levels, has the salutary effect on cholesterol levels and ratios sought by the use of these drugs. I think statin use, beyond lifestyle changes, by active seniors is uncharted territory, and needs to be studied further.

     

     

     

    A video discussing other quad trigger points:

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