Hi there janet, I have recently gone to my dr about pain in about the middle of my lower leg and he said it can either be A. Severe case of shin splints or B. Stress fracture, I am going in for a bone scan tomorrow but i am just wondering considering that i have about maybe 1 month left to go in my cross country season is that if i do have a stress fracture will i be out for the whole season and i'm sure that you have had a bunch of these happen to many of your patients but this is very quite new to me and i am just wondering if i will be out for the whole season and how long i will be out of running for? I do tend to train during the winter for my track season. Also if it is a severe case of shin splints, which i am not very sure what they are some clarification would be great and some help would be awesome. It usually tends to get better when i rest but than when i do a quick 100m sprint or do any type of running the pain comes back very fast to the point where i basically am limping on it. Please help :)
Reply - Janet
James, your doc will give you guidance on how long to rest once your diagnosis is clear.  It would be normal for you to need a minimum of 6 weeks of no running to allow the bone to initiate healing if it is a stress fracture.  If you've caught it before it got to that stage, then perhaps your time off will be shorter. When it comes time to return to running, make SURE you've dealt with the underlying causes of the injury (lack of flexibility? lack of hip strength? biomechanical issues? training errors?).  Also when you resume running you would be wise to do a period of base building to allow the tissue time to build strength (connective tissue adaptation isn't fast) and this generally takes anywhere from 6-12 weeks. Only then would resuming high intensity training and intervals be sensible.  I think your cross country season will likely be done. Make sure to ask your orthopedist for some detailed guidance on what you can and can't do while your injury heals. Then follow that guidance!  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Writing again from a couple weeks ago about the pelvic stress reaction. Turns out I did have a labral tear as well that was explained to me originally by my doctor as general wear and tear, but which I now see was called a labral tear in the MRI report which I have now read myself for the first time. Guess I need to get an opinion from another doctor, but what's your experience with runners with labral tears? Have I been doing more damage by running on it for the last 6 months (I mean my doctor did give me the OK to go back to running having read the MRI report!)? What has been the success/failures of runners with having an arthroscopy for such an injury? If it might fix it so that I can train for long races and fast times consistently again it's totally worth it to me but if it could jepoardize my running career totally I don't know how I would feel about it since I can run now. Thanks.
Reply - Janet
The labrum, as your doc probably explained, is a fibrous connective tissue that essentially continues beyond the bony edges of the joint socket - to somewhat deepen it and increase the stability of the joint.  Your doc desribed the damage to your labrum as wear and tear, because that's often the case - the connective tissue gets damaged over time.  If the tear is in such a position that the torn tissue is getting caught or interfering with the hip joint movement, then perhaps surgery to remove that torn segment or repair it is in order but you need to see a surgeon who has done LOTS of these on athletes.  I can't point you to one surgeon, but perhaps a search on the American Association of Hip and Knee Surgeons directory will help point you in a direction for a second opinion? http://www.aahks.org/index.asp/fuseaction/patients.locator Make sure to interview the physician carefully and ask about prior favorable and unfavorable results.  I think with the right surgeon and the right rehab/return to running program you'll do just fine.  Best of luck - Janet Hamilton, MA, RCEP, CSCS, RRCA-Certified coach

a few months ago I was running on the treadmill and noticed that i i was losing control of my right knee...it felt very unstable, like it wanted to give out. i could feel the tightness in my calf and lower leg trying to make up for my lack of knee strength. it's a very strange feeling, no sharp pain, and it seems to be most noticeable on a treadmill and not so much when i run outside. the area on the inside of my knee and up into my inner thigh is very tender. i don't recall injuring my knee at all except for hitting my knee into something really hard, but the pain didn't last too long. i thought i might have strained my mcl? but i honestly don't know if my knee is the culprit or my hip or lower leg. do you have any ideas?
Reply - Janet
Are you running a faster pace on the treadmill than you do over ground? Thats a common mistake.  What about the incline? do you keep it cranked up? Have you had any twisting or sudden trauma to the knee other than banging it?  It might be a good idea to check in with the orthopedist just to rule out the ligament strain, though that would be pretty unlikely from just hitting your knee into something.  Do you have any back pain? If so, perhaps your nerves in your lower back are compromized by muscle spasming and the signals to your leg aren't getting through as easily?  It's kind of an odd presentation of symptoms so I think your best bet is to see someone.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hey janet, me again. So i just ran a 5k and after the race i could barely walk on my left leg. I talked to a phsyician about it and he said i have a tendon inflamation aka tendonitious in that leg, Can you give me some advice on how to treat this and have u ever had any athletes with this problem? Thanks much.
Reply - Janet
Treatment should include addressing the causes. Things to look into include - lack of adequate flexibility (especially calves), lack of adequate strength (especially hips), biomechanical issues (usually excessive or poorly timed pronation that's not being adequately controlled by your shoe or shoe/orthotic combination), and the big one - training errors!  Look into each of these and see if you can make some progress on treating the cause and not just the symptoms. In my  experience, if you treat the cause you'll have good success.  Hope this helps - Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have very high arches, a narrow heel and a relatively wide toe-box. I got myself fitted with running shoes at a Fleet Feet store and for short distances (4 miles or less) they're fine. But as distance/time increases my toes go numb and the balls of my feet and toes start to hurt. Eventually even my arches hurt (though my heels are fine). This has been a problem that I've always had with running shoes but I've only started running longer distances (6+ miles)in the last 8 months or so. I've competed in two half ironman distance triathlons - one in May and one yesterday. While preparing for the race in May I was diagnosed with peroneal tendonitis in my left foot and my podiatrist gave me full-length orthotics to put in my shoes. The orthotics, NSAIDs, taping my foot and alternating sides of the road cleared it up but the numbness and pain at longer distances got worse. My feet started to hurt at mile 4 of my half-marathon yesterday and I was in complete agony by mile 7. At mile 11 I took the insoles out and just ran with empty shoes (no liner of any kind) and I felt like a new woman! Most of the pain and numbness subsided. So my theory is that when my feet start to swell there is just not room in there for an insole of any kind (especially an orthotic which is a little thicker than the regular insole) and my feet. I really don't think that length is an issue. Having high arches means that the top of my feet are also higher than normal so I think that the pressure of the laces/yanks on the top of my feet causes all the pain/numbness (no matter how loosely I tie them). What do you think about theory? And do you know if there are any companies who make shoes that are designed for people with regular sized but "tall" feet? I've tried googling it and just can't seem to find anything useful. Thanks for your help - I just can't repeat yesterday ever again!
Reply Janet -
I think your theory sounds pretty good.  My suggestion would be to make sure when shopping for shoes that you take your orthotics with you - and slip them into the shoe to make sure you have a good match and enough room.  Also - talk to the podistrist who made them to see if a thinner topcover can be substituted.  One other thing - you may want to focus some time stretching your calf muscles. I often find people with very high arches do not tolerate any loss of flexibility in their calves and it's not unusual for you to lose flexibility as your training miles increase unless you do something to maintain it.  Tight calf muscles can not only contribute to the pain & numbness symptoms you've had but also may have contributed to the previous issue with peroneal tendinopathy. As for what make and model of shoe... I don't know where to point you except to say that you probably won't find your match in the Nike line-up.  In my experience they don't have as much width in the toe box as others.  I know all the manufacturers now make at least one shoe in a wider width but it may not be the right type of control or cushioning for you.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified Coach

I initially went to rehab/PT for runners knee in March. I am 30 and a casual runner who had stopped running as frequently for a couple of years (a couple years ago was doing races - 5ks, 10ks, half was longest but have run more sporadically in recent years). When I restarted in the beginning of the year, I felt some pain and thought it would go away. I kept running on treadmill as it was winter and then realized it was not going away. I went to an ortho who gave me a PT. We did the stretches and quad excercises. I stopped running and doing any form of real exercise for 2 months and had PT over about 6 weeks during this. I ran again for 2 - 3 months through end of July. I then had some personal training sessions which were free through my gym so I did 3 sessions. Unfortunately I had stopped doing all recommended exercises except the IT band stretches. The personal trainer also was more or less a newer one and he overworked me each time, including deep knee lunges with weights which I now know are a no-no for me. The same knee pain came back. I took of 2.5 weeks entirely doing no exercise and went back to ortho who said i had some inflammation based on xrays. I still had the movie theatre sign when i went to the theatre. I started back up after the 2.5wks with recumbent bike for 2 weeks. After this period I decided to try a slow 3 mile run this weekend. I iced my knee after but i can see that a small part of the knee cap is sensitive to touch. I also have that dull ache when I am sitting with knees bent. I want to get over this entirely. I was completely fine with no signs following my PT so I am very upset that the personal training sessions got me back to square one. Advice? Thoughts?
Reply - Janet
it sounds like you just overshot the mark a little bit with that 3 mile run. If you had been off running for 4.5 weeks and started back with a "slow 3 mile run" - that was way more than your body could tolerate.  Runner's knee often is the end result of a combination of factors like tight calves and hamstrings, weak hips, poor biomechanics and possibly training errors.  It sounds like you had started to deal with the strength stuff in PT but eventually quit doing those exercises.  Perhaps you could start back, and also consider doing a walking program for a few weeks before trying to resume running.  This may give your body time to heal and to adapt a little better.  Best of luck, let me know if I can help.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I have had a lot of snapping and clicking going on in my hip area for the last couple of months and some moderate pain while running and while sitting---I have been told by some that this sounds like a possible labral tear? What are some of the other typcial symptoms and telltale signs?
Reply - Janet
I think you would be wise to go to an orthopedist and have the diagnostic imaging done to confirm or rule this out - the symptoms sound consistent with a labral tear.  It could also be that you have a thickened tendon that is being rubbed somewhere, or it could be articular cartilage degeneration - but the bottom line is you need to see an orthopedist and get some form of diagnostic imaging tests (MRI?) to determine what you're dealing with. Continuing to run on this isn't a good plan, no matter what your final diagnosis is! Janet Hamilton, MA, RCEP, CSCS, Running Strong coach

I'm a 22 year old male who suffered a pelvic stress reaction after running my first marathon last November. I actually had two MRIs--the first of which diagnosed the stress injury and the second of which two months later confirmed that it had healed but also showed wear and tear to the hip cartilage, apparently more than should have been there for someone my age. My doctor told me I could slowly return to running but should consider picking up another form of exercise and mix in more cross training in the long term. I have returned to running over the last 5-6 months with mixed success, while in fact set a 5K PR at just over 18 minutes earlier in the summer from doing tons of cross training and strengthening my left leg doesn't feel or run the same way as my right leg. My left hip flexor area constantly feels like it needs to be stretched and doesn't seem to move as fludily as my right side. I wouldn't really call it pain and I seem to have on and off weeks which don't always correlate to how much running I have done. Now I want to run longer and more frequently without worrying too much about speed over the winter so that I can run half-marathons again next year and hopefully get back to at least 40-50 mile weeks. Will the two sides ever feel the same? If they don't does it matter if it doesn't really hurt. I'm worried I must be compensating somehow since the sides feel different a lot of the time. Should I just run and buildup mileage and see what happens?
Reply - Janet
You're right to be concerned about the two sides not moving symmetrically - you WILL compensate for that somewhere and that sets the stage for another injury.  Did you ever see a PT for instruction on exercise to get your muscles back in balance?  If not - that would be a first step.  There's a search engine link at the top of this page for how to find a certified specialist PT.  Click on that link and follow the instructions - search for an OCS (orthopedic Certified specialist) and hopefully you'll find several to choose from in your area.  Look at their practice focus and find one that specializes in lower quarter biomechanics if possible.  Your lingering symptoms, though mild, are a concern though.  Have you been back to the orthopedist for a recheck? The reason I ask is that sometimes the underlying cause for the first pelvic stress reaction wasn't fully addressed and you may be looking at another injury.  Second reason is to rule out a labral tear - since some of your symptoms kind of sound like that might be a possibility.  Best of luck to you, hope this helped a little. Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi Coach - I am training for my first marathon (NYC - 11/4) and am struggling with ITB (which I have had in the past). Ran a half on 8/5 and it really acted up around mile 8 then. Now I cant run more than 3 miles without it shutting down on me. Two questions: what can I do to get myself to the start line in November and ultimately to the finish line. Second, I can not seem to find out the root cause of the ITB. Any referrals in NYC that I can talk to. I have been through years of PT, strength, stretching, orthotics etc. Thanks for your help
Reply - Janet
Wow... with such a short time to go to your marathon, things are definitely not looking good.  We're only 7 weeks from your target marathon. You'll need a taper of probably 3 weeks which means your peak mileage is in these next 4 weeks -- if you can't run even three miles, this is serious.  The most important goal should be not necessarily getting to the marathon but instead getting healthy and getting your gift of running back.  The fact that you've seen PT's and you've been doing the stretching, strengthening and have orthotics means you've been dealing with this for awhile. Depending onWHAT you've stretched, you may have missed some things.  Depending on WHAT and HOW you did strength training you may have missed some key things.  Depending on your orthotics (custom or over the counter?) you may not have the right correction.  Finally the training issue -- how quickly did you ramp up for this first marathon and what was your mileage base when you started?  Short answer is - I don't have any names in NY to give you, but you can use the search engine at the top of this page to find a certified specialist PT near you.  Look for an OCS (orthopedic certified specialist) and narrow your results by looking for one that specializes in lower quarter biomechanics.  Another option - which may be more affordable to you - is I'll try to take a shot at helping you.  I'd need to know a lot more about you, your injury history and your training though.  I work with athletes all over the country so I am quite familiar with the virtual realm.  If you travel on business and go through Atlanta, I can evaluate you in person.  If trying a coach approach appeals to you - go to the services page and down load the coaching questionnaire and we can get started right away.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hello, I had been running about 25miles per week up until about 7wks ago.Also Spinning 2x a week. After running about 8miles I felt a pain in my groin/hip area. I ran abut 5miles the next day and could barely walk when I was done. The pain was pretty intense. I had a hard time walking up stairs or crossing my legs.Getting out of bed or a chair was painful. I layed off running for a week but then tried again and could not even run for a minute. Tried on and off for a week then decided best to lay off all together for a while. I was doing the elliptical with minimal pain. Finally, went to the DR's and was told I have Bursitis. He gave me 800mg Ibuphroine told to take 3x's per day and go to Physical Therapy. Went for a PT consult and was told after being looked over that I had a Dislocated Pelvic. He pulled my leg and put it back in. Walking up stairs was much better. I hardly had any pain for a few days. But it has come back.Went to PT to start Core strengthening and advised that I thought my pelvic was out again. Which it was. I had still been doing the elliptical as they said it was ok the first time but was told to not to this at all. I'm concerned that this is going to be an ongoing issue for me. I'm also concerned that this could actually be a Stress Fracture and I've been walking around and excersing on this. I can move my leg around. The mobilty is good. It just hurts when I try to run or walk. I had an xray done when I saw the Dr but it came back fine. Do you think this could be more or will the core strengthening help? If it is a stress fracture would my pain be more intense? Thanks for any answers you can give me!
Reply - Janet

Sorry to hear you're injured - let me see if I can help. 
It sounds like your PT is on the right track - sort of.  If it IS a pelvic misalignment, then the question remains WHY is it mis-aligned and WHAT can I do to keep it from doing that again?  There are likely several things involved incuding:

 - lack of adequate strength – sounds like the PT is on to this one because they’re giving you core strength exercises, but strength doesn’t balance out overnight so you’ll have to be patient.
 
 - Biomechanical issues – this could include things like a true leg length discrepancy (as opposed to the “functional” one that occurs when your pelvis is tilted), or perhaps excessive pronation or even an asymmetrical amount of pronation when you compare your right and left legs.

 - training errors – how quickly you ramp back into your exercise, what intensity you perform, etc. How you return to your previous level of activity is crucial… go to fast and your symptoms will be back. 
Now… if it’s NOT a pelvic mis-alignment issue and instead it’s a stress fracture – that would likely NOT show up on X-ray. In other words the x-rays will look fine but you’ve still got pain.  Stress fractures require a different type of diagnostic imaging known as a bone scan or perhaps an MRI if your insurance will cover it.  Discuss this with your doctor because taking Ibuprofen 800 mg 3 X day will likely SLOW the bone healing if that’s what you’re dealing with.  If the doctor you went to is NOT an orthopedist, it’s time for a consult with an orthopedist. If the doc was an orthopedist, it’s time to go back – and if they are hesitant to order either a bone scan or MRI then get a second opinion.  You need to know what you’re dealing with in order to treat it appropriately! Best of luck to you.  Hope this helps. Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I'm currently training for a November 10 marathon and have recently begun experiencing groin pain in my right leg that I believe is a hip flexor injury. I believe the injury to be an iliopsoas muscle strain based on the symptoms, i.e., pain at the upper anterior portion of the leg where the crease between the leg and hip is. The pain typically begins to manifest after a few miles running and really becomes bothersome on my longer runs of over 5 miles. The pain is not present during normal walking or climbing stairs, it just comes about after putting in some miles. I attribute the injury to my increased mileage of late and perhaps to my hill running that I have been doing. My total weekly mileage for each of the last 3 weeks was between 31-35 miles with my longest run of 15 miles two weeks ago (I actually ran that 15 miles with no problems, but the week before I had problems with 14 miles and the week after with 11 miles). I have been running consistently for 2.5 years, have run in about 30 races, but this is my first marathon training. I ran a half marathon on July 29 with no problems. I am still running, but I have slowed all my runs down (no more tempo runs or hill work) and I am hoping that I can run thru this and recover. I have also been taking aspirin daily and icing the area. I have also shortened my strides, making sure my legs do not extend beyond my hip and that my feet fall directly below my hip. My question is, is it wise to continure training if the pain does not worsen and if I can continue to increase my weekly mileage according to my training schedule? I am scheduled to see an orthopedist/sports medicine doctor next week, but I would certainly appreciate any advice and knowledge that you can share. Thanks!! Brian
Reply - Janet
I know you don't want to hear this, but I'm never a fan of trying to train through pain that's intense enough to cause you to alter your gait pattern or take medication.  There's a saying in medicine, "When you hear hoofbeats think horses, not zebras."  That basically means that when someone describes symptoms you should look for the most obvious problems first.  The hip flexor strain follows that path. However if it were a hip flexor strain, I would expect the act of lifting your leg to place it on a step to cause some level of discomfort.  The other things that could be going on are much more significant - things like a stress fracture of the pelvis or femoral neck or perhaps a labral tear.  These are much more troublesome injuries.  Bottom line is you've got to get a diagnosis so that you know what you're dealing with.  An x-ray will be of little value in diagnosing a stress fracture, so hopefully your doc won't waste your time and money on that and will go straight to a bone scan or MRI.  For now - I'd think the prudent approach is to back WAY off training and focus on gentle flexibility exercises, walking (if you can do it without pain) and perhaps consider biking or swimming as an alternative for maintaining cardio fitness.  Best wishes for good news from the doc -- Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I was diagnosed in late May/early June with a stress fracture of the right inferior pubic ramus. I started feeling better,was doing PT exercises etc. Eliminated all exercises except upper body weights, some core exercises and swimming with a leg buoy (ie no kicking). Felt better in late July/early August and so the Dr cleared me to start doing no more than 20 min on the elliptical a day and some light weights on my legs including inner/outer thigh presses. A week later I started having pain and also had an mri done and found I still had the stress fracture but it is healing (has the calcium deposit?). 2 questions: I have pain that is in my lower back around the sacrum area which radiates into my neck as well as the groin, hip, butt pain still. I have also been told my pelvis is shifted up on the right side which is also the side where the PR Stress fracture is....Is the pain in the lower back/neck part of the referred pain felt with a PR Stress fracture or due to the pelvis being out of line or something else? How long does this type of fracture take to heal? Very frustrated and want to get back to exercising and running. I am 39 year old female runner who got this stress fracture from running intervals on the treadmill about 6 to 8 miles a day ..I also have osteoperosis in my spine but my dr said this SF is NOT a result of my osteoperosis. Also originally had a bone scan in the area including the sacrum and only showed activity in the Pubic Ramus. Any help or advice you can provide on recovery from this would be really appreciated.
Reply - Janet
Susan, it's kind of not typical for pain to radiate UP from the lower back to the upper back but it could be that your pelvic mis-alignment is being compensated for in your upper back and neck. In other words, the rest of your back is trying to make up for the fact that your pelvis isn't lined up just right.  Perhaps a visit with a good massage therapist or even a few visits with a good orthopedic physical therapist who specializes in back and neck issues would help sort that stuff out.  I'm kind of surprised at the doc allowing you to not only go back to the elliptical so fast, but also to clear you for the inner-outer thigh machine... that directly places load on the muscles that attach to the area you have your stress fracture in! When the time comes, you'd be better served to avoid that silly machine altogether since your leg muscles need to be worked in a fashion that more closely will translate to running and walking and that move/machine does not do that!  also, you need to be careful with "core" training right now since your front abdominal muscles attach to your pubic bone and your lateral abdominal muscle attach to your iliac crest (pelvic bone).  Not that you can't work them, but you need to be very cautious in light of the stress fracture AND the pelvic mis-alignment issue!  It's hard to say how long this will take to heal but it's common for pelvic stress fractures to take 6-9 months to heal to a point where running can be resumed.  I also find it odd that your Dr. felt that the stress fracture was unrelated to osteoporosis.  Surely the overtraining errors (6-8 miles of treadmill intervals daily) were the direct cause, but if you have known osteoporosis... this is most certainly a factor! I would encourage you to get a second opinion from another orthopedist as to what stage of healing you're in and what activities are considered "legal" at this point.  It is important to be patient with this one - you can easily prolong your healing time by jumping the gun and trying to get back to training too soon.  When you're cleared to resume walking get in touch - I would be happy to help you navigate that path back to running.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi Janet, I had asked you about a week ago for some info on a bulging disc, and my appointment to get the epidural steroid shot is in a couple of days. I know you had said this would be a last resort you would suggest, so I was wandering if you could tell me of some stretches and strengthing exercises I could do to feel better. My bulging disc is on the right side of my lower back, but it is my left side that is in a lot of pain. I have been stretching and icing my back, but nothing is seeming to make it feel better. I have been dealing with my left side hurting for over six weeks now. Any information would be very helpful. I just am hoping to feel better soon, and I don't know if I should go through with the shot, but I have to make my decision soon, because they get booked up very quickly and I don't know if there is anything else that will help. Thank you for all of your help!
Reply - Janet
Valerie, before you go for the shot -- have you seen a physical therapist?  If not, that's a sure place to start.  I could help you with some exercises, but if you can actually SEE someone it would be so much more effective!  At the top of this page there's a link to a search engine for specialist Physical Therapists.  Click on that link and follow the instructions there to get to the search.  You're going to put in your state and you're searching for an Orthopedic Certified Specialist.  You'll get several hits, you can then narrow it either by looking only for those in your city or (better) look for those that state their practice focuses on lower back injuries.  Hopefully this will result in finding someone nearby who can see you pretty promptly.  Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I'm 28 years old, and run about 4 times a week, between 3 and 4 miles, at about a 9 minute pace. I weigh 198lbs, and am 5'11.5" and have lost 30+ pounds this year. Within the last 3 to 4 weeks I've increased my mileage up to 4 miles a run on a fairly regular basis. The problem I am experiencing is in my right foot on my right big toe it starts tingling now after I run. It feels somewhat number. It is mainly on the left side of the right big toe, but then sometimes also goes to the back left part of the heel. I have good shoes in good running shape (Saucony and wear very good socks) and have had these shoes for 6 weeks, so I do not believe they are the cause, but am not sure. I have ran up to 4-6 peoples before in years past without any of these problems. Thank you, Matt
Reply - Janet
My first thought was "shoes" but you mention they're not old.  Perhaps they're new enough but not the correct shoe for your foot type? Second thought was "pacing".  When you increased your mileage did you also try to speed up?  You mention the toe tingles AFTER you run... does it tingle during?  Perhaps what we're dealing with is more related to lack of adequate flexibility and this is contributing to the issue at hand?  If you don't stretch regularly you might try starting on some calf and hamstring stretches.  The final thing that you should keep in mind is that the pattern of numbness you describe could be related to issues in your lower back... even in the absence of any low back symptoms! If the regular stretching doesn't do anything - check in with your local running shoe store and see if they'll do a gait analysis to see if the shoes you're wearing are correct for you.  If that is the case and all is fine in the shoe arena, then it might be time to see a good PT for a back evaluation.  Best wishes! Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

I am a 43 year old male. I used to lift some but now just mainly run. I use running to keep my weight down. I am about 5ft8in tall and weigh about 155. I ususally run 3 to 5 times a week at about 1 hour at a time at a pretty fast pace increasing from about 6.5 to 8.0 miles per hour over the time on the treadmill. A few days ago I ran for an hour and felt good. BUT, I noticed that from that time on I have not been about to run more than 40 minutes without totally running out of gas in my arms and legs, I am having numbness in my hands, and also I have pretty bad veins in my legs. Any thoughts on this?
Reply - Janet
Several things come to mind - why a treadmill and why are you bludgeoning yourself with an excessive focus on speedwork if your main mission is to use running for your health and weight control?  Perhaps you ramped up duration and intensity simultaneously and you're now overtraining?  One of the symptoms of overtraining is a degradation of your performance on workouts - and your description of "running out of gas" at 40 minutes is pretty classic.  HOWEVER - the numbness in your hands and "bad veins" in your legs isn't usually a symptom of overtraining.  Perhaps a trip to your doc to have a stress test done would be a good thing.  You're young - but not too young for heart issues! If there's something going on - it's better to catch it early.  If you pass the stress test and there's no circulatory issues - then simply backing off to a more reasonable pace might help a lot.  Also, give some serious consideration to running on real terrain - it's much more effective in the long run! Best wishes - Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi, i am 15 years old and i am a freshman in my highschool, i have been running cross country but lately it seems everytime at practice i either overtrain or undertrain because whenever race time comes i seem to not be able to go fast at all even though i train harder than most of the people on my team. My main concern is that when i start a 5k race and i start going at about my 6:30 mile pace around 3k my lower back starts to shoot out pain which makes it harder to run and my chest feels like it's caving in. Also my left shoulderblade tends to hurt also and same with my calfs, they always seem sore everytime even though i take an ice bathe after every practice and i wear a brace for my knee to also reduce the pain there. I had a concussion on my dirtbike about 1 year ago and ever since than i have been needing to sleep more and I feel that something happened to where no matter how hard i try i cannot improve, I can currently do a 21:00 5k but i just don't know what's wrong. Some advice on my injuries and what's wrong with me would be a great help. I have yet to see a phsyical therapist or anything, but i just want to get your output on this and all, Maybe i should go in for an MRI? I just don't know, well let me know. Thanks :0)
Reply - Janet
There are many unknowns here - but one thing pops into my mind when I read your race plan... you say you start out at 6:30 pace but you also mention you do a 21 min 5K -- perhaps you're running your first split TOO fast, and getting too anaerobic.  Perhaps you could try doing your first mile at a pace more like 6:45?  See how your body feels, then crank it up to a faster pace for the second or third miles? Talk to your cross country coach about race strategy.  As for your history of concussion and feeling the need to sleep -- this needs to be discussed with your physician!  The best 5K racers have good endurance (built by lots of easy paced running), and good running economy (built through speedwork, hill work, etc).  If every workout is a speedworkout or hill workout or otherwise "hard" workout then there's a high liklihood you're bludgeoning your body and your race performance will suffer.  Most distance coaches encourage only 10-20% of weekly mileage in the high intensity format, the rest should be aerobic pace.  Hope you get to the doc soon about the sleep issues - Janet Hamilton, MA, RCEP, CSCS, RRCA-certified coach

Hi Janet, I wrote you the other day asking about a bulging disc, and it is on the right side of my lower back. I originally went to the doctor because the lower left side of my back was bothering me, but the MRI results only showed the bulging disc on the right side. Is it normal that the left side would be bothering me, even if nothing showed in the MRI? Also, the doctor recommends me getting the epidural steroid shot. Is this something that would definitely help, and if so, will it take the tighteness away on the left side of my back as well? Or should I maybe just think about going to a chiropractor instead? I am just getting very frustrated because I have been stretching so much and just been walking for exercise, and doing lots of core work, but I feel like my back is just not getting any better. It seems like everytime I do crunches or any other ab work, my lower back feels super tight. What am I doing wrong, and is this normal?
Reply - Janet
There are several things that could be going on with the left lower back pain -- one that comes to mind is muscle guarding (you may be more familiar with the term spasming) on the left as a result of the right sided bulge.  I'm not a huge fan of jumping straight to the epidural shot until I'm convinced it's the only avenue left.  Have you ever seen a good orthopedic PT? If not - go to the link at the top of this page (APTA search directory) and look for an OCS (Orthopedic Certified Specialist) in your state.  When you get the results, narrow your search by looking only for those who focus their practice on lower back and lower quarter issues.  A good PT will be able to do segmental mobilizations (more gentle than chiropractic) and will also be focused on teaching you specific exercises to address muscle imbalances.  You mention doing "crunches" and "other ab work" make things feel worse -- that's no surprise considering the spinal forces involved in those exercises. I'd recommend you NOT do those anymore and instead focus on lateral abs and lower back extensor strength as those are the muscle groups most likely to be able to help support your lower back and most likely to be weak.  You mention you've been stretching -- again, depending on what you've been stretching you may be on track or way off course.  Walking is good - but if you have been pushing pace or walking a lot of hills that may not be a good thing.  If there's no good OCS Physical Therapist near you, I'd be happy to try to help from a virtual realm. Sometimes it just helps to have someone guide you through a proper progression of focused strength and flexibility exercises and look over your shoulder at the training you're doing.  Let me know if I can help. Janet Hamilton, MA, RCEP, CSCS, RRCA-certfied coach