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I am 41 and training for my first marathon, which is in 4 weeks. I have been a runner all my life, but just started doing long distances about 18 months ago. I've run three half marathons with no significant injuries. Once I hit 14 miles in my training, I started getting moderate pain in the left hip (which eventually radiates to the glute and quad). It's been diagnosed by my chiropractor and ART as tendonitis. They are telling me not to run on it. I have decided to run through the pain and just suck it up. Has anyone trained for and completed a marathon with tendonitis in the hip? Am I being realistic? I don't care about my time in this race; I just want to finish. I am doing it as a fundraiser for my autistic son's school and don't want to back out under any circumstances.I am stretching, icing, foam-rolling, and using the electrical impulse machine.
I once worked a race alongside a chiropractor who was using ART, and I had the opportunity to observe and chat technique as we took on one athlete after another. One thing I noted about ART is its emphasis on removing adhesions between critical structures like tendons and neighboring tissue, using a trap and stretch technique that involves a lot of positioning and active movement of the athlete in order to free up damaged tissues that have adhered to one another.
While this by no means prevents ART from being used in other ways, it puts the practitioner in an ideal position to observe inflammation along tendons and their sheaths, so a diagnosis of tendonitis may be as good as money in the bank in this case. Not all medical personnel get that close a look before this often overused assessment is made. Bear in mind though, that aside from overuse, a diagnosis of tendonitis raises a number of important questions about the genesis of your condition that need to be addressed. Simple overuse and a prescription for rest may not be explanation and treatment enough.
At this point I will say that 18 months is not out of the ballpark, as a timeframe for an overuse injury like tendonitis to develop, but that is not the only result of overtraining you can expect. While electronic muscle stim technology helps with pain control, it does little to affect the actual physiology of the muscle. Ditto for ice and stretching. Rolling is helpful maintenance for muscles that have not yet reached the tipping point, but is not sufficiently specific for all damage your marathon training is likely to cause. It helps too, to do a little troubleshooting before treating areas with a scattershot approach.
Try standing on one leg, then switch sides, even if you've done this before. Differences in how well and how long you can hold this position have more to do with muscle strength than tendonitis when the position is held without friction. In a case where a tendon is actually damaged rather than inflamed (tendonosis), inflammation and pain may not enter into the picture the same way. In cases where the actual muscle is to blame, the symptoms may be similar to tendonitis. The important difference is to see whether the muscle can hold. If it can't, you need to direct your attention there.
Overused muscles tend to place more strain on tendons, bursa, and joints. While problems with the softer tissue are frequently overlooked, they are often to blame for tendonitis, bursitis, and joint pain, by placing unrelenting pressure on these structures. In the early stages though, pain from the muscles involved often manifests as a problem with the structures they affect, before major damage is done. You can thank your muscles for being whiners before they tear the rest of you apart. In the mean time though, their health and strength are critical to smooth injury-free running.
If you've had deep tissue or trigger point massage to the gluteal and other pelvic muscles attached to these tendons, you want to bear in mind that massage as a comparatively non-invasive therapy, often has to be repeated several times before any changes to the soft tissue will hold. This does not mean you have to shell out a lot of cash for repeat treatments, but it does mean you should follow up with self-care and other TLC to get the effects to hold. For example, it would be better to work the area three times a day for 5 minutes at a time, than for 15 minutes all at once. This is inconvenient to arrange with a professional, so you need to follow up the good work with some approximation you can do on your own, using a tennis ball or knobber, etc. to keep things moving. Happier muscles will lead to great relief for the other structures involved. If it took 18 months to crank them up, you can't expect them to get released overnight. Stay with it.
Back to our test, the ability to stand easily and painlessly on one leg depends heavily on the health of your minor glutes, which bear several time your body weight with each footstrike when running. For the newbie marathoner, these can be among the first to go.
Check out this popular interactive tool for locating and assessing muscle function:
Make certain that your hip pain is a soft tissue problem (tendonosis). Over use injury to hip can be a stress fracture. Trying to run through a stress fracture of the femoral neck is very risky. With most stress fractures the worst thing than can happen if you try to run throught it is that it hurts and it hurts so bad that you compensate and develop additional over use injuries in adjacent areas. If you try to run throught a stress fracture of the femoral neck can lead to a overt fracture, and avascular necrosis of the femoral head (dead bone).
Damien Howell PT, DPT, OCS - www.damienhowellptcom
You both give fabulous advice. James, how long should I be able to stand on each leg? I did it for one minute each leg with no pain, just some wobbling in the calves. I stopped because I was bored and losing balance, not because it hurt. Also, the pain in my hip wakes me up in the middle of the night, around 2 or 3. It is not a stabbing pain, but feels like burning. Advil helps it.
Oh, and the chiropractor used a metal thingy on my hip to rule out stress fracture. Also, I am seeing an MD next week to ask for an MRI.
Standing for a minute is a good sign, but not conclusive. Tredelenburg's Test requires checking to see if the hips are level during this time. A difference from side to side indicates possible dysfunction in the Glute Medius of the standing side when the opposite hip dips downward. Not having a stress fracture is a very good sign. Now we're left with some question marks, but dysfunction of the gluteal and other pelvic muscles can be involved. Does your Lumbar spine have a deep curve that is difficult to straighten? Is it easy to rotate your thigh inward as well as outward? I would like to see Damien weigh in on this one some more. Sometimes, it is difficult to do these things on the internet, but there are more questions that need to be asked.
Do you have difficulty bending over to touch your toes?
Touching opposite hand to toe?
Going up stairs?
Changing position while seated?
Getting out of a chair?
Turning in bed?
Rotating from side to side?
Standing with knees locked rather than bent slightly?
My hunch is more the gluteal than other muscles, though you would be surprised at the range of muscles affecting the above symptoms. A burning rather than stabbing pain is an important clue.
I dug up a study on gluteal tendonopathy for another poster but would have to pay to post it here. the banner states:
"'Greater trochanteric pain syndrome is commonly due to gluteus minimus
or medius injury rather than trochanteric bursitis. Gluteal tendinopathy
most frequently occurs in late-middle aged females,' scientists writing
in the journal European Radiology report."
I don't know if this applies in your case, but there are geometric differences in the female pelvis that lead to excessive strain on the involved musculature, with increasing likelihood after child-bearing. I don't think that is a death sentence for running, but an indication that greater care needs to be taken to insure the actions of these muscles do not place abnormal stress on the other structures of the hip. Even when the bone is not fractured, wear to the ball joint of the hip and degrading of the labrum are not uncommon. Enough damage in the wrong places can lead to the kind of pain that will wake you at night, which for many leads to surgery, but for me points to unbalanced muscular stress. It is important to rule out common muscular causes for deep pain before going down that road, because all damage is eventually going to be traced to how those hips are moved. I'd rather this discussion were a stitch in time than an academic post-mortem exercise, so to speak.
Some good reading courtesy of Medscape can show you how involved a complete medical diagnosis for your condition can be, and shows how your docs earn their money...http://emedicine.medscape.com/article/87169-overview
Often, some of the therapeutic services that practitioners like Damien and myself provide are prescribed when your condition can be traced to musculoskeletal causes, and reversed or ameliorated by therapy. My motivation in the Med Tent community is to enable the athlete to be a proactive partner in their healthcare by addressing likely musculoskeletal causes for common sports injuries and pain, before they become a more serious pathology. Familiarity with these injuries can save a lot of time, money, and misery, but there is always more to know.
Meanwhile, I am inclined to think that many years of running often leads to lots of accumulated muscle dysfunction. Treated in time, these soft tissue injuries do not have to become major catastrophies going forward. Your job is to treat the easy injury before it becomes harder to solve, and to avoid making it worse during this process. We as runners are constantly injuring ourselves in some way, and we are by nature competitive. If we must compete with our injuries, the best course is to make sure our recovery outpaces our injuries.
I have heard of using a "tuning fork" to screen for stress fracture. I assume that is what you mean by a "metal thingy". The validity of using a "metal thingy" to rule out stress fracture is very questionable. To truely rule out a stress fracture requires a radiograph or bone scan.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
Damien, yes it was a tuning fork. Would you say it's worth my time to get an x-ray and/or MRI?
And James, I had done the test for hip alignment and neither side dips. I did have babies when I was 31 and 33.My sports chiropractor did some of the tests you mentioned and found nothing significant. The only question I can answer yes to is difficulty turning in bed. I think your hunch about the gluteals being involved is well founded. I have been doing lunges with hand weights for years and do some other strength training, but I can say that when my ART works on me, the gluteals are the ones that make me scream! He mentioned gluteus medius. So, I've been stretching and foam rolling those. What I am hearing from both of you is that running through the pain (although it is tolerable) could potentially cause irreversible damage. I did rest for over a week, and my hip felt good, but as soon as I got to about 2 miles, it hurt again. Since then, I've only done short runs (5 miles) and it starts to hurt at the same point. To make up for lost time at this point, I would have to have a pretty brutal training schedule to run the OC Marathon on May 1.
I know this sounds crazy, but what if I rested for the next month and just went to the race and tried to run it? At least then I'd only get the damage from the race and not the training.
Thank you again for being willing to give your expertise and knowledge so generously!
Your orginial post was " I have decided to run through the pain and suck it up". Because of the location of your pain I would suggest you ask for a radiograph to rule out stress fracture of the femoral neck. A radiograph still does not solve your problem of hip pain. Take a look at Symmetry - Asymmetry: Problem Solving Repetitive Use Injury. I am not a big fan of stretching exercise as a soultion for repetitive use injury. Take a look at Should you stretch it out, Hip pain and stretching exercise, and IT Band Controversey Regarding Stretching Exercise. You may facilitate the healing process by discontinuing all the stretching exercise, massage, and ART. Also take a look at Are you a half ***? - Stretch Weakness of Gluteal Muscles Contributing to Pain.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
You make a good point about the marathon alone being less potential damage than the marathon+marathon training. I've heard of people doing this, if they don't expect a particularly good time. You would probably suffer though, with no long runs within three weeks of the event. Your feet would probably get pretty sore from loss of conditioning, and you might react with a few compensations to protect them along the way, that could cause other problems later with the hip and lower legs.
I see this means a lot to you, so you are willing to sacrifice your health, hopefully only short-term, to acheive this goal. Missing the event could bother you for quite some time, I'm sure, but you understand our position as healthcare practitioners has to reflect some professional integrity. I think we agree that the marathon is almost certain to damage your body. They damage healthy people! The only questions in your case are: how much, and can you recover? If you really do have a stress fracture, we might have to show up on race day and tie you down. If the results of more accurate tests are clean or inconclusive, you could possibly tenderfoot your way through the thing. It's your body, after all.
Imagine though, what pain starting at 2-5 miles is going to feel like after 20 more! Yes, this event certainly means a lot to you, and I admire and respect your decision either way. Just make darn sure that scan is clean!
Ethically I can't recommend you do this either way, so perhaps you can shop the idea to other segments of the Active Running community to see if there have been similar stories. You've heard our take. Maybe somebody who has been in the same position can talk you out of this, in a way that you can live with a decision to stand down. Are you thinking this might be your last marathon too, and you want to make it count? A guy died at the finish line of a marathon where I PRed in 2006. I had a great day. He left behind a wife and three kids. Neither he nor his wife, who had run 8 other marathons with him and was running that day too, expected the worst to happen. Most of the time, it doesn't, but nobody sees it coming. Who knew?
Another story: A couple years ago I was crumbling under a load of high mileage training, but was only a little over six weeks away from my target marathon. I could only get up to 13 miles without excruciating pain at this point in my training. With a 26 miler scheduled one week later, I was suffering from some horrible ITBS, a repetitive motion injury that had me limping to the car after each run over a few miles. I had a guy tape me up, and I worked on my own injury relentlessly, making liberal use of topical magnesium (Epsom salts, etc.) during my runs. Did the 26 without pain that weekend, and qualified for Boston at my event 6 weeks later. A miracle? Nah. It just works that way sometimes - if you are very lucky and know what you are dealing with.
Meanwhile, continue to treat in expectation of some kind of miracle. You do not have much time for scan results to be interpreted accurately. If you are somehow cleared to run one more super-easy long (with walk breaks) next weekend, the losses may be minimal. Just don't let your heart get too far ahead of your body!
JamesJohnson I have self diagnosed myself with hip tendonitis due to glut weakness. I am now trying to rehab it and was wondering if you had any good suggestions. I have been retrowalking on a treadmill and have actually had my gait analyzed. On my injured side I "knee dive" my guess is due to glut weakness so I also attempt to run externally rotated on a treadmill with an incline.
NJrunning.. Sounds like you have a plan, but has anyone assessed you for a leg length discrepancy? It's true that a glute Medius in spasm can draw up the hip to make a leg appear shorter, but an actual measurement would be helpful. Also, laying on a table with hips brought even, elevating the knee can determine if the thigh (femur) or lower leg (tib/fib) are longer. Even so, a collaped arch in one foot is another way to effectively shorten the leg and cause glute problems. The cause of your original dysfunction needs to be determined.
Do a browser search for "strengthening exercies for gluteus medius" and you will find volumes of examples and books on the topic. What I would add is avoid habitual stretching of gluteus medius. Stop stretching the gluteus medius. Take a look at Are you half ***? If you need additional assistance Find a Good PT.
Damien Howell PT, DPT, OCS - www.damienhowellpt.com
OK, guys, I feel like you've given me really good information and advice. My plan is to keep doing short runs, icing and stim machine until I get the bone scan. Damien, I will stop stretching the glute and pray for a miracle. My gut feeling is that there is no stress fracture. I feel the tendon pop when I lift my leg (like when putting pants on). I also just let my son's principal know that I may have to send an announcement to all the donors and let them know if I can't participate in the race due to injury, they can have their money back (which I'm sure they wouldn't ask for!). The bottom line is that I am a life-long runner and I love it too much to let this one race take it away from me forever. You guys are awesome and I will keep you posted!
p.s. Damien, I just read your article and now I understand. I will try to become a "complete ***".
Thank you for your help. I do not have a leg length discrepency but have not checked my tibia or femur specifically. I was looking into getting orthotics.....would that solve the problem as far as collapsed arches? I know I pronate with both feet. I was doing hill sprints when it started bothering me. I try to correct my gait and think about keeping my knee from pointing in but that seems to bother my gluts more. This happened to me in the fall as well and after 2 frustrating months I was able to get it better. Now it is back again.