Reply - Janet

Wow... what an unusual set of symptoms you've presented! To be honest, I haven't a clue what to tell you except that perhaps a visit with a neurologist for some nerve conduction velocity tests might be revealing.  The visible and palpable popping of your biceps femoris tendon is very odd and makes me wonder about a fabella, or perhaps some scar tissue from a previous hamstring injury?  The fabella is a diagnosis of a small sesamoid bone sometimes found in a hamstring tendon that can be seen on diagnostic imaging (like MRI?) and this can be removed surgically if that's the problem... but I'd have thought the orthopedist that you saw would have ruled this out.  The foot drop makes me wonder about nerve root compression or irritation in the lumbar spine or in the muscles of your low back or buttocks -- but again - the PT or chiropractor would have been able to rule these in or out. Perhaps a second opinion from another PT - one that's an Orthopedic Certified Specialist - might reveal something the first one missed?  You can find a certified specialist in your geographic area by clicking the link in the top paragraph of this page.  Hope this helps - when you get it diagnosed, come back and let us know what it was!  We can all learn from this stuff...  Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach

Reply - Janet

Your son's lower back pain could easily be the result of the dramatic change in activity pattern and intensity.  If he didn't run much before joining cross-country and they just threw him into a race with only a couple of weeks of running under his belt, there's a very good chance his body wasn't used to the activity yet.  Basketball is a very intermittent sport, with lots of direction changes, starts & stops and very short sprints. Cross country is a continuous sport that doesn't resemble basketball in any way. If he's been playing basketball a long time, he has the fitness and strength and flexibility that would be appropriate for a basketball player... not a long-distance runner! Four things to look into - flexibility - especially tight calves, hamstrings and hip flexors;  strength - weakness primarily in lateral hips, lower back and abdominals;  training errors - adding mileage too quickly or more likely... adding speedwork (racing) before an adequate mileage base has been built; and finally -- shoes -- make SURE the footwear he is using is designed for running and that he's in the correct shoe for his gait pattern.  Take him to a technical running shoe store (ask the coach if he/she knows of a technical running shoe store in your town) that will watch him running in several different pairs of shoes and help you choose the one that's going to offer him the best support.  Hope this helps!  Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach

Reply - Janet

Joe, I think a second opinion might be a good next step.  I'm not a fan of injections as the cortisone has side effects when used locally as well as when you take it systemically (pills).  Bottom line -- if all you do is treat the symptom (a possible nerve irritation... though I'm not sure I agree with that assessment) and don't treat the CAUSE - then you'll likely not get the ideal long term result.  Factors to evaluate when trying to determine the cause: strength imbalances - particularly weakness in the lateral hips, flexibility issues - particularly calves and hamstrings, and training issues - too much too soon, too much speedwork... or the more common one: going out the door too close to target race pace on every run.  Finally -- have you had a gait analysis done? Did your podiatrist assess your running gait or just your walking gait?  Are your shoes correct for your foot type and do they work well with any orthotics you might be wearing?  Bottom line: if the choice is between oral cortisone and injectible cortisone - I choose "none of the above" -- they don't address the cause for the problem so any "solution" they offer will likely be temporary at best.  Hope this helps. Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach

Reply - Janet

The theory I've heard is that when you strap them on, they provide a "counterforce".  The IT band moves forward and back over the condyle of the femur as the knee flexes and extends with every step.  Supposedly the strap places a bit of tension/pressure on the band and perhaps this affects the degree to which it can move back and forth? The other theory is that the pressure of the strap stimulates various receptors in the tendon (called proprioceptors) and this changes your perception of the sensation? All I know is that they work well for some people some of the time -- and not at all for others.  If you've had good luck with them that's great.  Don't forget though that the key issues in many cases of IT band syndrome are tightness in the calves/hamstrings and weakness in the lateral hips, combined with poorly timed pronation in the feet.  It's more complex than it seems!  Best of luck to you.  Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach

Reply - Janet

Could be any number of things but the first thing to check is your footwear.  If you're new to running, you may not be aware of the fact that all shoes are not created equal!  Depending on your foot type and gait pattern, you may need cushioning shoes or you may need stability (think supportive) shoes.  Most of the time, numbness in the feet is due to not enough support from the shoe, or perhaps the shoe not fitting your foot well.  Laces should be snug, but not so tight that the pressure on the top of your foot is noticeable.  If the shoes you're wearing are not running shoes (i.e. cross trainers, or aerobics shoes) then first step is to get to a good technical running shoe store and have them fit you in the proper shoe for your gait pattern.  The typical discount shoe store won't have what you need.  If you ARE in running shoes, check their age... if they're older than 6 months it's time for a new pair. Finally - make sure you're doing some exercises to maintain leg flexibility because as you transition into running your calves and hamstring muscles are likely to lose a little flexibility and they can contribute to the foot numbness thing. One last item -- if you've ever had back problems -- that could play in the mix as well. Even if your back isn't symptomatic, it can refer symptoms down to the bottom of the chain.  Best of luck - hope this helps.  Janet Hamilton, MEd, RCEP, CSCS, Running Strong Coach

Reply - Janet

There are a couple of things that pop into my mind for you - and you may have already tried these.  1) make sure she's getting an adequate cool down after her race (not standing around).  That may mean doing some slow jogging or perhaps walking around sipping on some water for 10-15 minutes.  2) monitor her food intake before her meets. Make sure that the food she's taking in is easily digestible and that she isn't eating anything in the two hours before her meet... certainly not in the last hour before.   Any meals in the 12 hours before the meet need to be healthy, and easily digested -- and of course is should be obvious but I'll say it anyway -- no candy or sugary foods in the period before the race.  If you've tried all this, perhaps a visit to the doc to make sure that everything is OK would be a good idea.  Hope this helps -- glad you're being supportive of her running! Janet Hamilton, M.Ed., RCEP, CSCS, Running Strong Coach

Reply - Janet

If I read your post correctly your son has only been running for about a month and he's already competing? This is one of the problems with doing cross country in school -- if you don't have a foundation of mileage to start with - the season gets cranked up as soon as you get in to school!  He was "fit" perhaps as a soccer player but soccer bears little resemblance to the stresses involved in running.  Soccer = lots of sprints, stops and direction changes and a fair amount of time standing.  Running X-country = continuous running with a few direction changes and no time spent standing around.  Just because he's a good soccer player doesnt mean he has the muscular strength to compete in cross country events with only a month of training under his belt.  Common wisdom says that 6-10 weeks of base building followed by 6 weeks of sharpening (speedwork) is necessary to optimize race performance.  Can he get by on less?  Sure... but the risk of injury is higher with no base of mileage to build on.  Apparently his pain is pretty noticeable if it's changing his gait pattern.  I'd get him to an orthopedist to rule out enthesopathy or other bone-related injury -- and then have him evaluated by a good orthopedic PT to asses whether those "weak ankles" you refer to are a part of the puzzle.  You can find a good orthopedic certified specialist PT (OCS) by scrolling to the bottom of this BLOG page to the footer and click on "Find a Certified Specialist PT".  From that page, click on "view directory" which will take you to a search engine.  Put "orthopedic" in the Specialist field, and your state in the state field.  Click search -- if you get a ton of hits, narrow it to your nearby town, then narrow as needed by looking for a specialist whose practice focus is "lower quarter biomechanical assessment".  Hope this helps.  Get him seen to rule out the bad stuff -- then get to a good specialist who can evaluate him.  Janet Hamilton, M.Ed., RCEP, CSCS

Reply - Janet

Not your typical presentation of an injury that's for sure! You mention that it hurt during that initial bike ride - perhaps a partial tear? The fact that it has lingered this long makes me think along the lines of a partial tear rather than an inflammatory process -- also because you didn't have any relief with the anti-inflammatories.   You mention you've stretched -- hopefully your PT had you stretching something OTHER THAN the injured tissue?  Hopefully they worked on flexibility in all the other areas.  Has your doctor done diagnostic imaging to rule out anything bizarre like a bone tumor? did the PT and/or chiropractor rule out any involvement of your spine?  Was there any change in your training or your equipment prior to the injury? Any mechanical thing like a different set of pedals or change in your bike fit? The strengthening exercises -- hopefully were NOT knee extensions and curls on the machine at the gym but instead were focused on more functional and hip-focused exercises? Have you seen a massage therapist to rule out any areas of scar tissue or adhesions in the muscle?  Sorry -- I seem to have way more questions than answers!  Hopefully though this will be food for thought.  Feel free to e-mail me if you have more questions. Janet Hamilton, M.Ed, RCEP, CSCS