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On this page, we'll try to answer your questions
and provide some nuggets of wisdom. Keep in mind that diagnosis of injury is the responsibility of your physician. Comments
posted here should not be misconstrued as medical advice! Please refer to the
publications page of this web site for informative articles on flexibility and strength exercises, common injuries, and other
useful tips.
Ask the Coach
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Wednesday, July 26, 2006
Left Buttock pain - Sean
I have a strain in left upper buttock. It is actually to the left of the ischial bone. Could
this be a hamstring strain or are some other muscle/tendons at work here? Thanks. I just hope it's not sciatica.
Reply - Janet
There are several possible explanations. Was there an incident you were aware of - a strain?
If not -- perhaps your pain is a referred pain from irritation of a nerve in your lower back. Generally "sciatica" is
felt more in the center of the buttock and the symptoms radiate down the leg. Other nerve roots besides the sciatic
could be involved. Have you seen a PT for an evaluation of your lower back? If there wasn't a known hamstring injury,
I'd be more inclined to look at the back as a culprit. Just some food for thought.
Janet Hamilton, MEd, RCEP, CSCS
Monday, July 24, 2006
Quad & Hip flexor pain
I have a question for you. I run and lift weights. I'm an an endurance freak.
My hip flexor keeps me from running more than 3 miles now. I can jump rope run stairs with no pain. It's only
when running or sitting on the motorcycle. Now the top of my Quad hurts. I never hurt it. It wakes
me up like a dull pain. What can I do without a bunch of test and no results.... Thanks karol
Reply - Janet
You don’t
mention anything about any previous injuries to other areas but your symptoms might be due to something OTHER than the hip
flexor. You don’t say how old you are – but pain in the anterior hip region which is often attributed to hip flexor
is sometimes a degenerative hip joint condition. Sometimes it’s a referred pain from the lower back (and the low back
need not be hurting to cause referred pain elsewhere!). Sometimes it’s a muscle strain… there are lots of possibilities.
The fact that it hurts when sitting makes me lean toward the referred back pain theory. Perhaps you could see a physical
therapist for an evaluation and get some guidance that way. Hope this helps
Janet Hamilton,
MEd, RCEP, CSCS
Thursday, July 20, 2006
A new look and a new coach!
I've been thinking for
a long time that the website needed a huge overhaul, but didn't take the time to do the work needed. I've finally begun
that process and it's been an interesting exercise in cleaning out old stuff and adding new stuff. Along the way, one
of the items that had to go was our Forum. Many of you took time over the past several years to post your questions
there, and I think we all learned a lot from each other. Unfortunately, someone began to use the forum as a vehicle
to post spam -- and I couldn't keep up with them. They were posting faster than I could delete! I gave up, shut the forum
down and pondered my options. I've been told that blogs are bit better at stopping spammers - so I'm going to give it
a try and see what happens. I hope this place will resume its former level of activity because I really found the dialog
to be fun! I've tried to "prime the pump" a little by re-posting some old forum messages below - so please feel free
to peruse them and if your topic isn't one of the ones covered then feel free to post. If I find the blog getting spammed
again, I'll make it a "register to post" type blog. We'll just have to see what happens. Thanks for stopping by
- and please feel free to look around and ask questions.
Those of you who've visited
before will see that there's a new face on the coaches page -- Mike Broderick, coach in the Washington DC area is Running
Strong's newest addition. Read all about him over on the "about us" page.
Best wishes everyone -
Janet Hamilton, MEd, RCEP, CSCS, Running Strong coach
Friday, July 14, 2006
Groin Pain - Paul
I have been experiencing groin pain after running. While I am running, I do not have pain unless I take a break for an
extended period. After completing a run and sitting around for a few minutes, any lateral movement, such as getting out of
a car results in pain on the left side. Ready to see a Doc, any ideas? Thanks, Paul
Reply - Janet
Seeing your physician is a great idea. They will be able to perform various diagnostic tests to determine if your injury
is serious enough to warrent time off (a stress fracture). If no direct cause is determined from the diagnostic tests, request
a referral to a good orthopedic PT so that they can evaluate you further and determine if muscle strength/flexibility imbalances
or gait abnormalities are the causative factors. The PT will also want to evaluate your back since its not uncommon for lower
back dysfunction to refer pain to the groin. Hope this helps -- get in to the doc, then get that referral! Janet Hamilton,
MEd, RCEP, CSCS
Achilles heel & foot pain problems - Charlie
Hi: I'm in the midst of training for a marathon and I've ran into
a problem, as of this morning during an 18 miler. I had some tightness in my achilles tendon during the run, but by doing
some calf stretches (every three miles or so), things seemed to be fine. Unfortunately, I'm now getting some pain in achilles
heel in my right leg that's really worrying me and, for some reason, the right front part of my right foot is aching big time.
I recently went to a motion control shoe to try to get my calf problems (they were tightening up on me a lot) but I don't
know if that has anything to do with this. I've got a feeling that I may have pulled my achilles tendon and, while it's not
hurting that much, I don't want to do anything to make it rupture. I'm thinking of backing off of the full marathon and
doing one of their shorter races instead. Do you have any suggestions on where I should go from here? thanks :)
REPLY - Janet
Without knowing a lot more about your specific flexibility, strength
and gait pattern it's hard to say whether the motion control shoes are a good solution or part of the problem. I think
your willingness to consider changing your race goals shows a great deal of maturity and sensibility... and would likely be
a wise choice. If the issue is a strained Achilles, then it could take anything from a few days to several weeks to
settle down. It is never wise in my opinion to run a marathon on an injury or even a recently "healed" injury -- it's
just too risky. Taking a few days off running is a good start, and be consistent with your strength work for your hips,
your flexibility work for all your muscles (though be extra gentle with the Achilles) and perhaps this will resolve in time
for you to do a shorter race on your target day. Best of luck to you. Janet Hamilton, MEd, RCEP, CSCS
Stages of Dealing with an Injury - Janet
Most of us have heard of the "stages of grief" that follow a traumatic event like the death of a loved one. These
are: Denial, Anger, Bargaining, Depression, Acceptance. What many don't realize is that we go through these stages not
only in times of deep loss but also with annoying things like a dead car battery or running out of gas.
Let's take a look at how an injured runner evolves through these stages. Runner has an injury, for example a stress
fracture:
Denial -- "this can't be a stress fracture; let me go out and run and see if it still hurts" Yep, it hurts.
Wait two days, repeat. Wait two more... repeat.
Anger -- "This is SO not fair for me to have a stress fracture!" "I was in training for my major event!" "Who/what can
I blame for this stress fracture?"
Bargaining -- "If I can only make it through this upcoming event, I'll do anything!" "Can't you just give me a
shot or a pill and make it better?"
Depression -- "If I can't run this event, why bother running at all? What's the purpose in life if I can't run?"
Acceptance -- "OK... I've got a stress fracture. What do I need to do to get through this and insure I don't get
another one?"
Now, keep in mind that not everyone goes through these stages in this order, and some people skip stages along the way.
The goal is to get all the way to acceptance that you do indeed have an injury, because only when you get to this stage will
you begin to move forward in dealing with the underlying CAUSE for the injury. Until then, you're just spinning your
wheels looking for a way out! Keep in mind that lots of runners get hung up in the various stages long enough for physiological
healing to take place because they physically can't run and they're forced to rest. Lo and behold, one day they get
a wild hair to try it again... and it doesn't hurt! YIPPEE... I'm healed, right? NO. Your bone may have
healed, but the underlying causes for the initial injury may or may not have been addressed. At some point in the future
when the athlete does too much too fast - the symptoms will be back, or another symptom will arise.
It isn't until you ACCEPT the injury and acknowledge it, that you can move forward with the proper steps to address it.
The best thing to do is to get to acceptance quickly when you realize you have an injury -- blast through those other stages,
but get to acceptance as soon as you can so that you can start making headway in addressing the cause and getting to a real
solution.
Healthy running everyone! Janet Hamilton, MEd, RCEP, CSCS
Monday, July 3, 2006
Severe bone bruise - TDM
After prolonged period of pain in my knee from running, I went to Orthopedic Surgeon. MRI shows no tears, but he said "severe
bone bruise" which he pointed out to me in the MRI and there seems to be some confusion as to the cause. They kept asking
me if I had experienced any trauma to the knee and I kept saying no and they can't explain the bruising. He said something
about sickle cell anemia but that it is uncommon in caucasians. They are sending my MRI results to another colleage for his
opion and they said they would get back to me by the end of the week. What are your thoughts and suggestions for a course
of action?
Reply: Janet
I've heard of instances where runners have been diagnosed with bone bruising and it's usually following some sort of ramp
up in their training (started training for a marathon and ramped up distance, or started an aggressive build up of hill work
or speedwork). Have you had a biomechanical evaluation by a good orthopedic PT? If you have issues with degree or timing of
pronation, or if you've muscle imbalances (strength or flexibility) this can increase the load on your knees. Likewise if
you're not in the correct shoe for your foot and it's not supporting you well, this too can increase the stress on your knees.
I would encourage you to seek out someone to do a biomechanical eval on you. Go to the bottom of this page of this website
and click on the link for "find a certified specialist PT". Look for an "OCS" (orthopedic certified specialist) and then narrow
your search to your geographic region. Hopefully you can find an OCS who specializes in lower quarter biomechanical analysis.
Best of luck to you -- the course of rehab will depend on the factors that were involved in the onset of symptoms. Hopefully
your PT and orthopedist can guide you. Janet Hamilton, MEd, RCEP, CSCS, Running Strong coach
Sunday, July 2, 2006
Stress Fracture vs. Shin Splint - how can you tell?
How can you tell if you have shin splints or a stress fracture? What are the sympoms common to each? Are there any warning
signals for a stress fracture? Can shin splints hurt even when not running? Thank you so much for your help. Thomas
Reply - Janet
The best way to determine if you have a stress fracture is with some form of diagnostic imaging like a bone scan or MRI.
x-rays won't usually show a stress fracture until it's well healed. Stress fractures often show a highly localized pain, whereas
medial tibial stress syndrome (periostitis, tendinosis, tendinitis, etc) can have a little more diffuse pain pattern. Pain
at rest is often a symptom associated with a stress fracture. Your best bet is to get in to your doc and get some diagnostic
tests done. Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach
Pelvic Stress Fracture - Louanne
I was diagnosed with a pelvic stress fracture last year and have not run since. I have been biking alot, and sometimes
feel pain in the pelvic area. Is it possible to refracture the pelvis simply biking, or is there not enough weight bearing/impact
to do so? thanks
Reply: Janet
Stress fractures are not JUST the result of impact forces, but are also the result of tension forces where muscles attach
to bone. For this reason it is quite possible to sustain stress fractures in a sport that has lower impact (biking) -- especially
if your bone density is low, and your biking intensity was relatively high. The best way to know whether or not the pain you're
experiencing is related to a stress fracture is to go see your orthopedist and have diagnostic imaging in the form of a bone
scan or MRI. Best of luck to you -- get it checked out. Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach
Stress Reaction in tibia
Hey Janet, I had an MRI 2 weeks. Doctor says I have a stress reaction in my tibia. I have not been running for two weeks
now and i don't really feel any pain during the every day activities anymore. Am I good to go? Are stress reactions dangerous?
How long should one stay off them? Thanks
Reply - Janet
Stress reactions are a precursor to stress fractures and yes they are a serious injury. Whether or not you're "good to
go" is up to your physician. Ask the person who read your MRI and gave you the diagnosis about what a reasonable timetable
is for returning to activity. I would be surprised at anything less than 4 weeks. When you return to activity make sure you've
dealt with the CAUSE for the stress reaction (tight muscles? weak muscles? wrong shoes? training errors?) or you're doomed
to a repeat injury of this area or some other. Talk to your doc and use this "down time" wisely to investigate and treat the
cause. Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach
Stress fracture not healing - Dave
I was diagnosed with a hip stress fracture about 18 weeks ago. I still have a dull ache in my hip area every few days and
it doesn't seem to be from doing anything at all. The only activity I do is walking on the treadmill about three days a week
(I started this about three weeks ago). Does this mean I still can't start a walk/run program until I feel absolutely no ache
at all?
Reply: Janet
Dave, I'd be cautious about starting back to a run/walk progression until things are feeling a bit more back to normal.
A general rule of thumb is that the closer the stress fracture is to your core, the longer it will take to heal. In other
words, the smaller bones of your foot will heal from a stress fracture in about 6-8 weeks, a tibia make take 8-10 (or more)
and a femur or pelvic stress fracture doesn't surprise me when it takes 6 months to heal. Talk to your doctor about a recommended
time frame for a safe return to a gradual build up to running. You're apparently on the right track, having started with walking.
Make sure you've dealt with the underlying factors that lead to the stress fracture in the first place: things like flexibility
and strength imbalances, biomechanical issues like excessive or poorly timed pronation that's not being supported by your
shoes or shoe/orthotic combination, and of course the common training errors like adding mileage too quickly or doing too
much intense running. Hopefully a follow up bone scan or MRI will show good progress in healing and the soreness you're feeling
is just related to the tissue getting used to the training load again. Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach
Return to running after ankle surgery - Bailey
Hi Janet, I posted a while ago re: ankle surgery. Well, I finally had the surgery (a scope chondroplasty talus ,medial
malleolus synovectomy.) thankfully, he didn't have to repair any tendons. My question is have you had anyone that has had
this surgery return to running marathons? The surgeon said it is too early to tell, but he doesn't that will happen. He said
probably 15K at the most. (Why only 15K I don't know) Thanks for any information. Bailey
Reply - Janet
The type of surgery you had (even though it was done through an arthroscope) is no minor thing and I kind of agree with
the physician that marathons may not be in your best interest long term. It's not the 26.2 that will kill you... it's the
training needed to do 26.2! In order to run a marathon, most people need to log a minimum of 40 miles a week (and that's just
to survive well, not to really "race" well). That amount of cumulative trauma on a joint that has had surgery to the articular
surfaces is pretty risky. I would encourage you to look at WHY you want to do marathons, and see if perhaps you can adjust
your goals to something a little less risky to the long term health of your joint. Perhaps you can do multi-sport activities
like duathlons where you do some running and some biking, or perhaps events where running and kayaking are involved? There
is a good chance you can get back to running, but you need to make sure you've covered ALL your bases so that the environment
you're running in is a healthy one. Make sure you've got flexibility and strength issues addressed, make sure the shoes/orthotics
you're using are correct for your gait pattern, train smart not hard! Best of luck to you -- Janet Hamilton, MEd, RCEP, CSCS,
Running Strong Coach
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Running Strong* 191 Crossing Dr* Stockbridge, GA * 30281 Phone/Fax: (770) 957-0986 Or 678-357-6406
Contact coach Mike Broderick in Gaithersburg MD * (240) 338-2210
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