Hi, I went to an Orthopedic doc after a nagging ache in my right hip/groin area. It started hurting while training for a 1/2 marathon. I rested for a week and resumed my training. I ran the 1/2 marathon and my right groin area would grab and then I would feel a shocking sensation down the inside of my right leg. I had to stop several times to rest then continue but i finished. The doctor did X-rays and an MRI. He's saying AVN in the right fermoral head, stage 3! I don't have pain in that area so I'm getting a 2nd & 3rd opinion. I haven't been on steriods, nor had any breaks or accidents in the area affected! What are your thoughts? Thanks.
Reply - Janet
I think a second opinion is definitely in order.  Although long term steroid use and trauma are the two most common causes of AVN - there are cases when it occurs without those predisposing conditions.  The location of your pain (hip groin) is consistent with that diagnosis... as is your description of the symptoms.  However it could also be other things.  The second opinion will help rule out stress fracture, tumor or labral injury.  Second opnions are always a good thing! Hoping for the best... Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi Janet I just trained and finished my first 1/2 marathon. 3 weeks prior to the marathon I thought I pulled a muscle due to limping and rested two 1/2 weeks. I finished the 1/2 slowly and had increased pain. I just saw a Sports MD and he said that I have a hairline stress fracture, looks like it's healing, and put me non weight bearing for 4 weeks! What can I do to help my healing and will I ever run again? I really enjoyed running and would like to do it again. Thanks!
Reply - Janet
Congratulations on finishing your first half marathon! Depending on which bone is the stress fractured one, 4 weeks non weight bearing may do it... or it may take a little longer.  It is a little bit unusual to be put on a non-weight bearing restriction for a stress fracture, unless it is certain bones or certain areas of particular bones that are known for slow healing.  Since you've seen a sports med doc - I'm assuming he knows what he's doing.  As for your question of how to speed healing... the best thing you can do is create a favorable environment for healing. That means adequate nutrition, good hydration, plenty of recouperative sleep, and avoiding activities that stress the area too much.  In addition, talk to your doc about whether or not a calcium supplement might be a good idea.  Other than that, your body will do it's best to heal as quickly as possible.  If the healing isn't progressing as expected, your doc may put you on a bone stimulator (electrical stim device) to try to speed things along.  I see no reason why this should side track your running long-term -- once it's healed and you've dealt with the underlying factors that may have contributed to it (flexibility and strength issues, biomechanical issues, training errors) then you should be able to gradually work your way back through a transitional program and back to running.  When you're ready - I'd be delighted to be your guide on that journey! Best of luck and wishing you speedy healing.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I'm 19 and a avid Distance. I've been coming off on some overuse injuries, and I'm getting better. I first had a case of runners knee, then IT Band syndrome, and some hip flexor problems, all in my right leg. This was a pre and post race marathon training over do. But as everything else is getting better and my running is slowly building up again, a tightness in my right quad more towards the side of the quad will start to build up after about 7-10 minutes in a run. Then will seem like it gets tighter as I go on. I have been stretching before and after runs. What should I do to get rid of this problem in my quad
Reply - Janet
As you've discovered, you can't stretch away an injury. You'll need to address the underlying muscle imbalances which probably include tightness not only in the quads but probably more likely in the calves and hamstrings and also the muscle weaknesses in your lateral hips.  In addition - check back through your training log to determine if you're running the proper paces. If you're running at too fast a pace on most of your runs, this could be a relatively simple overuse issue.  If you'd like specific guidance on exact exercises to do - that would require I get to know a lot more about you, your injury and trainining history etc.  If this appeals to you - go to the services page of this website and read about the virtual and in-person coaching options.  Send me an e-mail if you have questions.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

My 11 year old daughter plays basketball. Her coach has them do a lot of running in the gym and for the last two weeks my daughter is complaining that when she runs both ankles pop, crack, and burn. I watched her last night and I noticed that it has slowed her running way down. She says that when she sprints her ankles and feet start to tingle and she feels like she is going to collapse? History on my daughter she is 4 ft 9 in and weighs 80 lbs. She is solid muscle, no fat. She is very active, plays all sports and is a top swimmer on our swimteam. She also says that she has had no injuries to her ankles in practice at school or otherwise?
Reply - Janet
I think this is worth talking to an orthopedist about.  The primary reason is your comment about the ankles and feet starting to tingle.  A couple of things to check into prior to that appointment though -- if she's running in basketball shoes, they may not be giving her feet adequate support, or perhaps they're not fit well to her feet (too tight or too loose?).  Secondly - if her calf muscles are tight (high probability of that) then perhaps that's interfereing with good smooth running biomechanics.  Perhaps some focused time on flexibility exercises ( stretching a couple of times a day) would help?  Finally - if shes launching into some fairly fast running without adequate warm up with slow jogging and some general warm up calisthenics... then perhaps her muscles aren't limber and ready for it.  Just some ideas to think on... hope it helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I hearda popwhen I wasdancing Ballet and i now have a very painful hamstring! i cant aford to go to physio, what shall ido I have an audition in a week!, it happened a week ago
Reply - Janet
there's not much you can do if you've strained/torn a muscle.  With only a week to go to your audition, your major training is done. Focus on avoiding strain to the area (no focused intense stretching) and you may want to check into getting a massage to see if that will help with blood flow.  You really should see a doctor about this - not treating the injury properly now may affect your long-term outcome.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Can I get runner's knee from an elliptical? My symptoms seem to match, but I was under the impression that an elliptical allowed for nonimpact workout. During and after workouts I have pain behind the kneecap (on the medial side) and that pain continues when I am climbing up and down stairs. Thoughts?
Reply - Janet
You bet you can get it from the elliptical! "Runner's knee" is simply a tendinopathy of the patellar tendon and though it's most often seen in runners you certainly can get it from other activities! The issues most often related to it's onset are pretty straightforward and are not really related to impact so much as muscle action:
1.  Lack of adequate flexibilty - look especially at calves, hamstrings, hip flexors and quads.
2.  Lack of adequate strength - especially lateral hips and low back and abs.
3.  Biomechanical issues - usually it's excessive or poorly timed pronation that's not being adequately supported by your shoe or shoe/orthotic combination.
4.  Training errors - even if you're doing all your trainining non-impact - you still have to adhere to the principles of smart training (adding duration and intensity gradually and varying both duration and intensity during your week). 
Hope this helps - get started on the cause for the symptoms and back off your training to allow your body to work the miracle of healing!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have recently purchased an elliptical machine as running caused knee pain. However, I have found that my knee pain has worsened - particularly pain on the medial aspect of my patella. Walking up and down stairs is quite painful and walking on flat surfaces for a long distance or at a quick pace also causes pain. Any ideas?
Reply - Janet
Perhaps flexibility and strength issues are playing a role here? Are you diligent about flexibility exercises on a daily basis? If not - work on calves, hamstrings and quads and be gentle with it... nothing hard, just consistent gentle stretches. Are you pretty good about your core strength work? If not - that may be playing a role - work lateral hips, lower back and abs especially.  Finally - if your shoes are old - make sure that you replace them with something supportive (cushioning isn't the big issue here).  Although the elliptical machine dramatically reduces impact forces, it's the muscle imbalances that are likely contributing to your continued symptoms.  Hopefully with the right mix of flexibility, strength exercises and footwear you can be back to running soon!  Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor.

I saw the physical therapist because I was having pinching in my right hip anywhere between running six and eight miles. She said my hip needed to be realigned. I had no knee pain or hip pain other than the pinching until the PT aligned my hip. I had no popping or cracking before the PT aligned my hip. Now, I have pain in both hips and knees and popping and cracking in both. Thank you so much for your response. The three doctors I have seen have told me to keep doing everything I was doing before but vary it up with biking and swimming. I was an avid runner/marathoner prior to the PT manipulation and I have had to completely stop running and it is really taking a toll on my mindset.
Reply - Janet
Perhaps the biomechanical issues which were previously being compensated for in your hip are now being compensated for in your knee? I'm starting to think the gait analysis I recommended in the previous post is even more important.  Perhaps there are biomechanical issues going on that you're not able to tolerate? If you're not working on the flexibility and strength stuff already - that would be a good place to start. Most of your exercises should be functional in nature, not the leg machines at the gym.  As for the prognosis -- if it is runner's knee, it can take a long time to heal because it is not an inflammatory process (not an "itis") but is instead a degenerative process (an "osis") and this takes time to heal.  Emphasis should be on eccentric exercise as much as possible.  If you need help with the exercises or gait analysis - please check out the services page of this website and get in touch with me via e-mail ifyou have questions.  It's pretty unusual for a manipulation to have this dramatic of a long-lasting effect --- so hopefully we can get to the bottom of the biomechanical issues that are likely contributing.  Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

I have had knee pain on and off for 7 months now ever since a physical therapist realigned my hip. I have also had clicking and popping in both knees. I have been to three different orthopedic surgeons which have provided no help. I have had MRI's and Xrays done on both knee and both hips and both were negative. The pain in both knees is in the middle of my kneecaps. I have another appointment in three weeks to see a different orthopedic surgeon/sports med. doctor. I have stopped all running for the past 5 months. I just stopped teaching step last week. I am icing my knees twice a day and after any activity. I am doing a stationary bike for 40 minutes 3 to 4 times a week. I have a pamphlet on knee rehab exercies that I have been doing twice a day with 5lb. ankle weights. I am really concerned and would like any advise on what I should be doing and should not be doing to heal what I have. My knee pain is usually worse at night. I have knee pain when sitting and after climbing stairs. I have no knee pain when exercising. It always shows up at night. I also have knee pain when standing. One doctor told me I had runner's knee and that it could take a year to heal. I just want to do the right thing so I will get better and not cause any further damage to my knee. Thank you for your help.
Reply - Janet
A couple of questions come to mind... first of all - what were you seeing the PT for when they "realigned" your hips? Was it a hip problem or knee problem or back problem? Were you having knee pain before? The fact that you have no pain with exercise is a little odd for "runners knee", but the location of your pain is consistent with that diagnosis.  The clear MRI kind of clears you of the diagnosis of arthritis, though the night pain is consistent with that as well. You mention you do biking and used to do step aerobics - its good you quit the step class, and you should make certain that the biking you're doing is moderate in intensity - not vigorous. Also make sure that the seat is adjusted properly (your knee should almost get straight at the bottom of the pedal stroke).  If you've never had a gait analysis done, that might be something to consider as biomechanical issues often play into knee problems. Finally - stretching and strength training will be important.  Work diligently to make sure you have adequate flexibility in your calves, hamstrings, quads and hip flexors.  Make sure you're working to get your core region as strong as possible (abs, lower back, lateral hips).  The pamphlet of exercises you're using may or may not be the most ideal exercises at this point.  Hopefully your third opinion coming up will be able to shed a little more light on this! Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

Hi Janet. I'm glad I found this blog. I'm 37 years old, and after years of saying "I hate running" I started running in the last year and now I love it! I had to take several months off to recover from shoulder surgery, so I would say that I have been consistently running 2-3 times per week for 4 months. I have some issues with arthritis in one knee and I over-pronate (have been fitted for running shoes and use insoles), so I have been building up my mileage very gradually. I am now up to about 12 miles per week and hope to keep gradually building to run a 10K and then a half-marathon. Yesterday after a standard 4 mile run, I noticed serious pain in my big toe, especially when going up stairs. It seems focused in the middle joint of my toe, not the metatarsal. Any idea what's going on? I really don't want to lose the level of fitness I've reached if I can avoid it!
Reply - Janet
Don't fret too much about losing fitness with just a few days off running.  You won't be set back too far. The fact that you have arthritis in a knee and you overpronate kind of indicates some biomechanical challenges.  Are you pretty confident your shoes and orthotics are working well as a team? Second question - have you ever had issues with gout?  If it's gout - the toe will generally be red, swollen and perhaps hot - though not immediately... these symptoms may take a day or so to come on.  The pain is usually pretty significant.  If the possibility of gout doesn't seem plausible, then perhaps you just pushed pace a bit on that last run?  You've been building mileage gradually - are you keeping the pace nice and easy? Do you vary your distance from day to day to avoid overuse issues? What about your everyday shoes - have you recently transitioned into a shoe with an elevated heel? I'll be happy to try to troubleshoot further - send me an e-mail if you like. Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

I am desperately seeking answers to a numbness I have developed in my foot while running. I have been running for 15 years. I had a labrum tear to the right hip which was undiagnosed for approx. 1 year. During this time I continued running. I began to experience gradual numbness. I had surgery to repair the tear in May of 07. I then developed acute pain in the hip flexor region and/or glut region. I have been working with the physical therapist to eleviate the pain and weakness. The strength is back to the hip but I am left with numbness in my foot while running, elipticle, and driving in traffic. It seems to be occuring when repetitively raising my leg. I have seen a spine Doctor and have no spinal injury or abnormalities. Any ideas?
Reply - Janet
Gayle, though you've seen a spine doc -- perhaps the tests he's running are overlooking something? I would encourage you and your physical therapist to really look hard at the low back region as a source for this symptom.  The fact that it's intermittent kind of supports the spine doc's conclusion that there's no "abnormalities" -- but there may well be significant muscle imbalances and weaknesses?  If your PT is not really experienced in spine issues - you may want to seek out the assistance of a certified orthopedic manual therapist (COMT).  You can do a search for one in your area on the North American Institute of Orthopedic Manual Therapy website at http://www.naiomt.org.  In addition, if you've not had a gait analysis done, that might be another avenue to consider.  If you've got some biomechanical issues going on (which may have contributed to the initial labral tear) then perhaps they're contributing to the symptom.  Hope this helps. Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

I have been a moderate excerciser for most of my life. I consider myself to be "fit". I practice yoga and am getting certified at be a vinyasa teacher in the spring. Here's the prob: I have been asked to participate in a 1/2 marathon in June after a friend's wedding. Both the wedding and marathon are in AK (mayor's run). I have started training so that i can build endurance and strength. I just bought new shoes (NB 767, got fitted for them) and thought i was on my way. I have run over the past 3 weeks, about 3 miles each run. VERY easy runs. I stretch before, drink lots of water throughout the day and (here;s the kicker), my knee is hurting after about mile 2. The outside of my knee is screaming. On rest days, the knee is fine. What gives? More strength? More weight training? Would love a pro opinion! I really want to be strong enough to finish the race, would be thrilled for a 10 min mile throughout the race. Lady D
Reply - Janet
Running is very different than the Yoga you're used to.  Your "fitness" only carries you so far - and primarily in the cardiorespiratory region... not so much in the specific strength needed to run well.  We'll assume the NB 767 are appropriate in their control, and we can assume that your flexibility is probably OK.  The missing pieces may be simple training errors (running the same distance daily rather than following a hard-easy schedule with varying mileage) or specific strength issues.  If you jumped into your training with 3-mile runs then that could also be an issue. 
You might try backing off on the pace, and varying your mileage from day to day.  You might also work a bit more on lateral hip strength (not on the machines at the gym but rather with functional exercises).  If you are unsure if the shoes are correct for your gait pattern, you might consider a video gait analysis.  I'd be happy to help you through this - it sounds like you've got a fun trip to Alaska in your future!  Hope this helps - Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

I’m 25 year old and been a long distance runner all my life. Once I graduated college I figured the natural progression for my running career was to start coaching at the high school where I’m a teacher. I became the assistant coach of my high school track and field team with my primary focus on distance. Recently the head coach was fired and I find myself leading the entire team with little knowledge or experience on anything other then distance. Although I have a lot of work and reading ahead of me to answer the thousands of question that come with coaching an entire track team. The main problem I’m having is creating a workable running program for runners specializing in 800 meters and below. Do you have any suggestion for basic workout programs? Maybe, ideas of where I could find some good resource around the internet. Thanks.
Reply - Janet
congratulations on the "promotion"!  Perhaps a good place to start is on the USATF website. They can be found at usatf.org  I don't have a broad background in the short distance coaching realm - being more of a distance coach myself... but you can look for books by Jack Daniels and perhaps get some good ideas there.  Best of luck to you!  I recommend getting USATF certified - it's a rigorous process but the info would be really helpful for you.  Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

In 1994 I broke my femoral neck in a bicyling accident. Since that time I have been fairly active despite 2 more surgeries and being told I would never run again. My question is this: Is it ridiculous to even attempt to train for a marathon? It was always a goal of mine and I am willing to put in the work, however at most I run 5Ks now. Do you think this will do major damage to what's left of my hip? I had the pins removed and a scope several years ago.
Reply - Janet
without knowing the condition of your hip joint it's hard to say.  Perhaps it would be better to train for shorter stuff (10K and half marathon) and see how your body tolerates it? Remember that in order to function optimally, you'll need good strength and flexibility.  Can your orthopedist give you a sense of the condition of your joint?  I'm a big fan of the long-term view... in other words it's not worth it to damage tissue for a short-term, one-time event like a marathon.  It's better to strive for long-term life-long running rather than compromise it for one event.  Truin for the shorter stuff and see how you do. Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor