I've had quad tightness since early January from crouching down to clean and polish my floors. It's something I've done before, but of course since it was the week before a marathon something had to flare up. My legs were very tight the next day so I thought a slow jog would loosen things up. About 1.5 miles into it I felt a pulling sensation above my knee (slightly to the outside of the knee) so I walked home. I rested the next 2 days and then ran - it was fine until around 5 miles. Afterwards I noticed a huge knot above my kneecap and that the entire muscle (vastus lateralis) was very tight with another knot toward the top. I tried working it out before the marathon but couldn't. I ran anyway (of course) and it got worse as the race progressed but never to the point of "I should stop." The pain really set in after I finished running. I got a massage afterwards which really helped the knot but I could barely walk for a week afterwards. I took a full week completely off from all activity except core work. After 9 days I began pool running...sometimes I still experience some knee pain though. I went to PT and they cannot break up the two knots either. I have been on 2 rounds of steroids, had some type of anti-inflammatory injection, and I've gone to 9 PT appts. I've also tried ultrasound, cold laser, deep tissue massage, needling treatments, accupuncture, foam roller, the stick, topricin, horse linament, tennis balls, etc. NOTHING will break up these knots. I'm running out of money and I still can't run. As soon as I load the leg, I get that pulling sensation above my knee and then it settles down alongside the kneecap (on the outside but tucked right next to the cap on the joint line). Do you have ANY recommendations???? My IT bands are pretty good, my hip flexors are not tight. I had no problems until I spent that afternoon crouching. I'm at a loss and am looking for help anywhere I can find it... :(
Reply - Janet
Wow... you've been through it with this injury!  Have you seen an orthopedist for an MRI? I kind of wonder about myositis ossificans.  It's not the usual way of getting it (usually it's related to a huge hematoma) but your description of the location and type of knot is consistent. I think it's time to let the orthopedist have a good look at you! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hello and Thanks in Advance, In August 2007 I was taking Army Physical Fitness Test; during the two mile run I started to have serious muscle spams in my lower back and hips. I can best describe the pain as if someone was squeezing my lower back and hips with a vise grip. I repeated the same test 5 times in 7 days only exasperating the injury. Not to smart on my part.... My doctor prescribed muscle relaxers and Anti-inflammatories. I also went to physical therapy for the next 5 months. While it provided relief I am still not at 100%, and have not really been able to get my run time to where it should be. The only time have serious pain is when I run. The pain usually starts about 1 mile into a run. The pain usually starts in the middle of my lower back right above my buttocks and radiates outwards to the hip pointer region. If I continue to run my right calve and shin began to spasm, and also feel both thighs begin to hit muscle failure. The pain is most noticeable on my right side. After I stop running it feel as though I my lower back is trying to push through my stomach. ( I'm sorry if that doesn't make sense.) The pain usually goes away within about 30 minutes. I am required to run on MWF weeks. We usually run anywhere from 3-6 miles. On Tues and Thurs day I usually do low impact cardio and strength training. I am trying to see a spine specialist soon and want some advice on what I should tell the doctor to look for. I really don't want them to give me some ibuprofen and say go back to Physical Therapy. Also not running is really not a feasible option right now. Thanks Again
Reply - Janet
If you've had Physical Therapy for this, did they check your flexibility in your hamstrings and calves and if so -- did they teach you some stretches?  Tight hamstrings, calves and hip flexors are often a factor in people who have back pain when running.  Next - did they do a gait analysis to figure out if the shoes you're wearing are correct for your gait pattern?  If not - that could be a big factor.  Also - when you are "required" to run on MWF - do you go out and run easy pace (to build your tissue strength and aerobic capacity) or are you trying to run close to your target pace for your test?  if you're going out the door at or close to target test pace, that could be one piece of the puzzle... you're racing every time out the door. As for what to tell the spine specialist - the key issue in my mind is that the only time you have pain is with running.  Most people with back pathology have pain with sitting and prolonged standing but you mention your only symptoms occur with running. To me that points to either muscle flexibility issues (tight calves and hamstrings and hip flexors) or strength issues (weak "core" muscles in your lower back, abdominals and hips), biomechanical issues (like shoes that don't control your pronation well) or training errors (running at too fast a pace for your current capability).  Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi Janet, I got some advice from you a couple months ago regarding possible runner's knee. I did what you recommended, including rest and strength training, and the pain went away! However, the past week or so, the pain has returned and is present when I am sitting and climbing stairs. On a really bad day, it also twinges with normal walking. Is this normal? Should I just continue on with my workout plan? Thanks again for you help!
Reply - Janet
Krista, it seems odd that the pain would go away, and then return out of the blue. Did you stop your exercises when your pain went away? If so - you'll probably want to continue them on a maintenance level (sort of the way you keep brushing your teeth even after your dentist gives you a clean bill of health!).  If you were doing some strength work 3-5 times a week before, perhaps you can maintain your improvement with 1-2 workouts a week.  Did you make any changes to your traiing program like increasing your mileage or pace or changing to a more challenging terrain? Are your shoes old?  There are lots of things to consider.  I could perhaps be of more help if I had more info.  If you're interested - I have room on my calendar to take on a new athlete at the moment.  If this appeals to you - check out the "services page" of this website and download the coaching questionnaire and send it to me.   Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I am seeking advice about lower mileage marathon training programs/options. I am recovering from an IT Band injury from LAST spring and was unable to run the Boston Marathon because of it (so very sad!). I am training again this year but notice some weakness in the same IT Band. I am wondering if I should decrease my long runs and opt for an overall lower mileage program (sort of "under training" as opposed to "over training" and risking re-injury). Any experience with this approach or words of wisdom? Is there a safe way to do this? This will be my second marathon and my longest run in this training cycle is 15 miles so far - for 60 days to go until race. For my previous marathon I completed two 18 milers, one 22, one 21, and one 20 prior to the marathon. This year I am not trying to set a PR - just successfully complete the marathon. Thanks!!
Reply - Janet
Hi Christine - congrats on qualifying for Boston! If you're not trying to PR, you can certainly survive a marathon on weekly mileage as low as 40 per week. The real concern though is have you adequately dealt with the cause for your ITB injury last fall or did you just "rest and recover"?  Sometimes you can do an alternating program of training with the long run being UP one week and DOWN the next -- allowing a little more time for recovery. For example, one weekend you might go for a 16 miler and the next weekend only do 12.  No matter what, I'd like to see you get to a minimum of 1 20 miler before your marathon... but even so - it's better to go into a marathon slightly undertrained rather than overtrained and injured.  The other things to consider when you're designing your training program (besides total weekly mileage) are
1.  PACE -- make sure you're running the proper pace -- not trying to do every run at marathon target pace or faster.  You should be running easy, aerobic paces so that you not only develop your cardio capacity but more importantly you develop your musculo-skeletal strength and tissue stamina. 
2.  Overload/recovery - don't run the same distance every day, or the same terrain! Make some days a little longer and some a little shorter. Perhaps doing 4 on your "easy" (recovery) days and 8 on your "moderate" (overload) days, and then also using the alternating weeks for recovery for your long run (as mentioned above). 
I'd be happy to help with guidance on proper exercises and design a customized program for you.  I find that the "generic" or canned programs are fine for those without injury or problem, but are often inadequate for folks coming back from or fighting off an injury.  In these cases, fine tuning may hold the key to success!  Check out the "Services" page of this website or feel free to e-mail me if you have questions.  Janet Hamilton, MA, RCEP,CSCS, RRCA coaching instructor

I had a stress fracture diagnosed in November in my right shin. I believe the stress fracture was a combination of increasing my mileage too quickly along with inadequate orthodics. I had custom orthodics created since then but haven't broken them in yet. I'm just now getting back into running and would like it if you could recommend provide a training program for me to get back into running.
Reply - Janet
Bill, I would be delighted to help.  First you'll need to get yourself used to your new orthotics. Hopefully the practitioner who made them will give you their break-in protocol.  If they didn't I usually recommend increasing "regular wear" time by an hour a day, up to an 8-hour day... then transition to using them for more vigorous activities.  Next you'll need to work your way through a progression of a walking program.  It would be good to get to about 10-12 miles a week of walking before you begin your walk/run transition.  I usualy recommend starting with very short bouts of easy pace running, interspersed with longer segments of walking. For example, starting with 30-60 seconds easy run, with 3-4 minutes walking in between.  Gradually you'll lengthen your run segments and shorten your walk segments until you're able to run continuously.  That's "generic" advice, but each person will vary. For example I've brought people back from femoral stress fractures at a slower rate than I'd bring them back from a metatarsal or tibial stress fracture. In addition to the proper training program, make sure you've addressed the strength and flexibility issues that may have contributed to the stress fracture.  It probably wasn't just due to orthotic and training error issues.  I'd be happy to help with details - check out the "Services" page of this website or e-mail me if you have questions. Good luck on your return to running! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have been dealing with trigger points in my quads and IT bands for the last 18 months since my marathon. I am an athlete and finished it no problem. The last few miles hurt and the recovery was pretty painful using ice and massage to help. I took the proper 2 weeks off and eased my way back but since then I haven't been able to run or move the same since the race. I believe it is an overuse injury and neglect of myofascial release and not enough stretching during the marathon training. Its mostly on my left leg as it is weaker, occasional left knee pain. The soreness is my main issue and it comes and goes.My legs get very sore after an aerobic run or knee flexion exercises. I get the soreness the day of and then two to three days later, unbearably sore. I have spent thousands of dollars on stim units, massages, trigger point therapy massages... I haven't ran in 4 weeks in fear of the pain I get afterwards, mostly in my vastus lateralis, rectus femoris, and IT bands. My legs have atrophied quite a bit since then as well. Do you know anyone with this? Any help would be greatly appreciated. I will do anything at this point.
Reply - Janet
It sounds like your theory of an overuse injury is pretty plausible, but it sounds like you might not have addressed the muscle strength issues as successfully as you focused on stretching and Myofascial Release instead.  Nothing wrong with stretching and MFR, but without adequate hip strength, your quads and other muscles aren't getting the support they need from above.  The strength work you mentioned (knee flexion exercises) won't get to the root of the weakness which is in your hips. Massage is well and good, but it too doesn't deal with the underlying issue of hip and core weakness. The other issue to consider as a possibility is that you may have some things going on in your lower back - these can often refer symptoms to the areas you described. Just some food for thought... if you'd like more detailed assistance, I'd be happy to try to help you.  You can e-mail me directly or check out the "Services" page of this website.  Don't give up -- you've not gotten to the root of the problem yet!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

At 29 years old, I have been active in running, biking, swimming, high school sports, and so on for as long as I can remember. A year ago I began running in 5 and 10K events. About the time I decided to begin training for a half marathon I was diagnosed with post tib tendonits. It has "sidelined" me for three months now. I went to PT, had custom orthotics made and still can't get relief. I'm in stability shoes now. Should I be in motion control shoes? Any help you can give me would be great.
Reply - Janet
if the only intervention you've done is orthotics and switch shoes, you may be missing some pieces of the puzzle.  Often lower leg injuries (PTT included) are related at least in part to weakness up above in the core and hips.  If you've not been doing any good lateral hip work or abdominal and lower back strength work that could be a significant piece of the puzzle. Also it's important to address flexibility issues like tight hamstrings, calves or hip flexors. The issue with whether or not to use a motion control shoe is difficult to speculate on without having done a gait analysis for you.  Hopefully the PT who made your orthotics did a slow motion video based analysis of your gait pattern?  You're on the right track - Posterior tibial tendons get loaded very heavily in people who over pronate or pronate late... the orthotic should help with that. But don't stop there - address the strength deficits above in the core and hips and when you resume running, do so very gradually so that you can monitor your tissue's endurance level and not overstep the bounds.  Let me know if I can help with this. Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I wrote earlier about my hamstring. It started one week ago. I was running along just fine then at about 1 mile point, I got a sharp stabbing pain in the back of my thigh about 1/3 way up from knee. I tried to walk a minute and then started back up running and it was so painful that I could not run. So I walked back. Two days later, I thought I'd try again, this time I made it about 20 yards before it stabbed again and I had to walk back. It throbbed all morning. I walked my dog Sat and Sun and could feel it but it was not what I would consider pain. Today, I did the elliptical which again, I could feel but not a pain per se. However, tonight it is really throbbing again. What could I have done? I have not increased mileage and/or speed in any significant way. Should I curtain all activitie that use my hamstring? I just want it to go away as quickly as possible and I am willing to do whatever it takes. Thanks for your help!
Reply - Janet
Only two days off running is a short period of time.  Perhaps a full 4 days off would be a better plan. During the 4 days, avoid any activity in which you  "feel" the hamstring (elliptical, stair climber, etc).  If you can walk comfortably at a "social" (not brisk) pace, then that activity may provide a little stimulus to the  muscle without overstepping the bounds.  I can't really propose a reason for  your injury based on your description of the onset of symptoms (sounds like just an ordinary run) but sometimes it helps to look back at the activities in the days before. For example - I strained a hamstring on an easy run two days after doing yardwork that had me bent over for several hours. Didn't feel it during the yardwork but things showed up the next day on the run.  In order to speed the recovery on this, I think you'd be wise to really step back for longer than 2 days -- the body is telling you something.  Feel free to e-mail me if you wish.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

I'm reply about your May 25th answer to Stephanie about the knee. I have been to a Orthopedist and have no torn meniscuis and very little arthritis (I'm 52). Can you suggest some exerices to strenghten the knee.
Reply - Janet
Most knee injuries and issues will do well with a functional approach to strength training in my opinion. This includes things like squats (depth dependant upon remaining symptom free) and balance and reach exercises.  I also favor the use of a theraband for standing hip-strengthening exercises.  I've been really successful with this approach not only with athletes that I train but also with pre-surgical clients who are in training for their upcoming joint replacement surgeries.  You'd be surprised at how dependant the knee is on a strong set of hips and core muscles. The other thing to work on is calf flexibility -- it can really place strain on the knee if it's tight.  If you'd like more specific guidance, I'd be delighted to help.  Please see the services page of this website or e-mail me for more information!  Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor

I have a pain in the back of my leg about 1/3 way up from knee to buttock in my hamstring. It is very localized and only hurts when I try to run. I am a triathlete in training and want to know if I am damaging it further by running. If I need to lay off running, how long? Thanks
Reply - Janet
Without knowing more about the onset of the injury it's hard to say but it sounds like it's a hamstring strain.  My general feeling about continuing to run on an injury is that even if you can endure the pain... you probably aren't doing yourself any favors. There's a good liklihood that you're altering your gait pattern somewhat and this may create the environment for other areas to be placed under strain. In other words you may take one injury and turn it into a whole cascade of injuries as you try to bludgeon your body into continuing.  You'd be better off to first identify what exactly is injured and how, and then address the underlying factors that contributed to that original injury whether that's strength and flexibility imbalances, training errors, or biomechanical issues.  Finally -- keep in mind that the body will try to heal if you give it time and the right environment.  I'd be happy to help further but i don't have enough info to go on here.  If you're interested in more detailed guidance - check out the services page of this website.  Short answer - I'd think it's wise to lay off running and spend that time working on the underlying issues that contributed to this injury... then gradually work your way back into running when you're able to do brisk walking painfree.  let me know if I can be of further assistance.  Janet Hamilton, MA, RCEP, CSCS, RRCA-coaching instructor