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6947 Views 23 Replies Latest reply: Apr 20, 2011 3:44 PM by mahotmama 1 2 Previous Next
mahotmama Amateur 10 posts since
Jun 29, 2009
Currently Being Moderated

Mar 28, 2011 8:03 PM

hip tendonitis/marathon training

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.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Mar 29, 2011 9:58 AM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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:

    http://www.getbodysmart.com/ap/muscularsystem/thighmuscles/posteriormuscles/menu/menu.html

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    2. Mar 29, 2011 5:41 PM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Mar 29, 2011 5:56 PM (in response to Damien Howell)
    Re: hip tendonitis/marathon training

    I agree with Damien above. Don't run through this pain, especially in a Marathon. You son's school is important, but you are even more important to your son.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Mar 29, 2011 8:29 PM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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?

    Leaning backward?

    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.

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    6. Mar 30, 2011 4:32 AM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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 Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    8. Mar 30, 2011 9:13 AM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    9. Mar 30, 2011 10:05 AM (in response to mahotmama)
    Re: hip tendonitis/marathon training

    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!

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    10. Mar 30, 2011 9:55 AM (in response to JamesJohnsonLMT)
    Re: hip tendonitis/marathon training

    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.

  • JamesJohnsonLMT Legend 1,167 posts since
    Aug 23, 2009
    Currently Being Moderated
    11. Mar 30, 2011 10:12 AM (in response to njrunningva)
    Re: hip tendonitis/marathon training

    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.

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    12. Mar 30, 2011 10:11 AM (in response to njrunningva)
    Re: hip tendonitis/marathon training

    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 

  • njrunningva Rookie 7 posts since
    Dec 29, 2010
    Currently Being Moderated
    14. Mar 30, 2011 12:18 PM (in response to JamesJohnsonLMT)
    Re: hip tendonitis/marathon training

    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.

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