I had runner's knee this summer and took some time off running (did PT weekly and some strengthening exercises, got fitted for new running shoes - in case that was it). I was also out of the country for 3 weeks during the holidays so I didn't run then (which was probably good) even though I had restarted running slowly this fall. I am feel pretty good now. I have been on the treadmill as it is cold here in NY and go much slower (10 min/mile) and am now doing up to 4.5 miles (which was my average weekday run before). What i focus on is the stretching after (on the foam roller and then hamstrings and calves). I never did this before i had runners knee. I have to admit i dont do the strengthening exercises anymore. My knee feels quite good. I did the trick which pushes on knee cap to test and I dont have that pain - nor the movie theater knee ache when I am sitting. I do pay attention to my knee a lot though so I feel it isn't 100% perfect. I feel some subtle difference still - but not the pain. My aim is to be able to go outside and run up to 6 miles eventually as i used to. Am I cured? What should I watch out for so that it doesn't return? What should I be thinking long-term?
Reply - Janet
It certainly sounds like your symptoms are well controlled.  I think if you'll continue your diligent approach to stretching - and get serious about doing some strength work for your hips and core... you'll be well on your way.  When you make the transition from TM to outdoors running, back things off a little in the distance department.  Instead of doing the same mileage every day you go out - vary it - perhaps 3 one day and 4 another, and keep one day a week for a long run.  It sounds like you caught this relatively quickly and intervened before things got too flared up.  Good job!  Long term - maintain strength with 2-3 workouts a week for functional strength training, maintain flexibility with gentle stretches after every run, keep your shoes "fresh" and always pay attention to your training - build slowly!
Good luck - Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have been running with a purpose for about 1 1/2 years now and I have been experiencing pain for about 1 year. I initially started out training for a marathon, but started with what I thought were shin splints. I changed my shoes, pace, distance, but still had issues. I went to several doctors over time because nothing seemed to help (time off, physical therapy,anti-inflammatories, a boot to immobilize my leg). At first the pain was isolated on the inside of my lower left leg. It would swell only in that area. Then it moved to the right leg. I eventually went to a podiatrist to see if I possibly needed some sort of orthodic, but he said not to bother because I had exercise induced compartment syndrome. He said he had diagnosed it several times before and preformed surgury. He recommended that I wrap my leg when I run and to wear support hose afterwards. Initially it helped, but it has not solved the problem. I ran my first half in February and felt really good, but I have been training for another and I am in severe pain. My pain seems different this time. it is more of a shin splint sort of pain. I am not sure what I should do. I don't want to have surgury if it isn't necessary. I am clueless as to what i should do. How do i find out what is causing my injury?? I know that there are all of these quick fixes, but I want to know what the root is. Please help.
Reply - Janet
Nicky, chronic exertional compartment syndrome has a pretty classic set of symptoms that it presents with. For most, it's a cramping/aching pain that comes on at a consistent point in the exercise bout (say perhaps at mile 2 or maybe 10 minutes into a workout) and it persists until the activity is stopped... at which point the symptoms subside completely. There's usually no pain at rest, no tenderness to the touch, and no swelling at rest.  The diagnositc tool to determine for sure if you have this is to get to an orthopedist who is familiar with this condition and have pressure tests done. They'll test your compartment pressures at rest, then have you exercise to a point where your symptoms have presented... then test your pressures again, and perhaps test them again about 5 minutes later to see how quickly they subside.  This is a necessary step to determine which compartments might respond well to surgery to release them. Unfortunately, if you do have CECS, it doesn't usually respond all that well to conservative treatment, though I have seen some people be successful with a very dedicated flexibility program for the calves, as well as orthotic support to reduce the workload for the muscles that control pronation. This in combination with a dramatic change in your approach to training (a kinder, gentler approach) might work - and it might be worth it to try.  The other issue is to make sure that you've ruled out other diagnoses like periostitis, tenosynovitis, stress fractures, etc.  A good orthopedist will do diagnostic imaging like a bone scan, or MRI to rule these things out.  You can use the American Orthopedic Foot and Ankle Society web page to see if there's an orthopedist in your area who specializes in foot and ankle stuff.  Their website is http://www.aofas.org 
Best of luck to you!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi, I'm a cross country runner and track runner. It's close to spring time and the track season is getting into full gear. I have been training since last summer so i am in fairly good shape, until recently however I have have a sharp pain in my hip (right on top of the illiac crest). I know it seems weird because that part of the hip doesnt even support weight much at all. The weirdest part of this whole situation is that the pain starts and stops at least twice a day. When i wake up and walk around, i usually cant feel the pain at all, but then 2 hours later the pain is in full effect and i can barely walk. Then maybe about the early afternoon it will stop again, but then i'll start getting it later that night. It's reallly strange and i cant make sense of it. I am 16 and i run lots of milage (last week i ran 50) but since spring break has started i have 3 days of rest until practice starts again. I'm not sure if i should just run on it, hoping it will go away or what. ANY advice would be greatly appreciated. Thankyou for your time.
Reply - Janet
Matt, I think you need to get this checked out.  It might be there's something going on in your low back or sacro-iliac joint.  A few diagnostic tests to rule out something nasty like a sacral stress fracture might be a good thing.  I don't think that's what you're dealing with, but you'd hate to mis-diagnose something like that!.  Get to your orthopedist and have this looked at.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

While on a long run 5 weeks ago I believe I strained my lower hamstring about two inches up from the back of my knee. The pain began at about mile three but it was only more of a discomfort, or just a "slight" tightening of my hamstring. I adjusted my speed and finished my run without any problem...Anyway, I rested for one week, started a deep water training regimen for another week and slowly built my base after 3 weeks. Anyway, after five weeks during a short 4 mile tempo run the area is reaggrevated. I have no pain during resistance, no problem walking and no swelling... is this a "tear" or "strain" of my hamstring or is this possibly a sign of some other abnormality, "muscle imbalance" or other. Thank you.
Reply - Janet
It sure sounds like a strain to me.  The fact that you were sensible in your return to running is a good thing but perhaps you jumped into the intensity stuff too fast (as evidenced by the return of symptoms when you did your tempo run).  If I have my math right, you were just building your base back up (from 3 weeks post injury to 5 weeks post-injury... so two weeks back to running right?) and were already re-introducing higher intensity stuff (a tempo run).  Perhaps your tissue just wasn't ready. The bad news is that you've re-injured it and it likely won't heal as quickly the second time around.  There are several possible factors that are contributing to this... namely:
1. Lack of adequate flexibility (calves as well as hamstrings and maybe even your quads/hip flexors?)
2.  Lack of adequate strength - I'd look into the lateral hips and lower back in your case, but when you get to the hamstrings keep in mind that eccentric exercises will probably be more effective than the hamstring curls at the gym
3.  biomechanical factors - old shoes? wrong shoes? this one is hard to speculate on without doing a gait analysis for you.
While you're in the healing phase, do whatever exercises feel 100% comfortable to you (biking? swimming?) and focus some time on strength work for your core and flexibility work for your legs (but don't be aggressive with the hamstring stretches - that tissue is in healing mode!). When you're ready to resume running be a little more conservative on how quickly you ramp things up.  Get back to your previous base mileage and hang there for a few weeks before you add back in the intensity stuff.  Best of luck to you - let me know if I can help. Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

how can i find out if i have internal bleading and if the injuri has been a week ago can i still have internal bleading
Reply - Janet
Kristina, I'm a running coach and not a doctor. This is a question you need to ask your doctor. If you suspect you've had an injury that has caused internal bleeding by all means get to your doctor TODAY! This can be quite serious.   Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I have been training for my second marathon and running about 40 - 50 miles a week ( over 5 - 6 days a week )including speed training, intervalls etc.I ran 3hous 48 mins last year and was hoping to improve my time. I have developed a groin strain after my long run ( 20 miles ) a couple of days ago. I didn't feel any pain during the run but a few hours afterwards. Now walking and turning is a bit sore.Have been icing the area, taking an anti -inflammatory and stretching. How soon should I be able to return to running? - The marathon is in five weeks - do you think I have a chance of running? Also how quickly will I lose the benefit of all that traning?
Reply - Janet
Depending on your base before you did the marathon build up - it may be several weeks before you "lose" the benefits of all the mileage you've been doing. The more important issue though is your injury.  I always cringe when people describe a "groin strain" that lingers the way you describe yours.  I think a visit to an orthopedist is in order, to rule out the big issues like pelvic or femoral stress fracture. These won't show up on x-ray - so that diagnostic tool won't be of much help to you... but a bone scan or MRI will light up like  flare in the dark if there's a stress fracture.  The other issue is that some over the counter anti-inflammatory medication may unfavorably affect the rate of healing of bone... so just masking your symptoms with an anti=inflammatory medication may not be such a good plan.  How soon you'll be able to return to running depends on the underlying diagnosis, but if it's a stress fracture it's a pretty good bet your marathon plans will be changed.  Best of luck to you -- get to a good orthopedist and get a real diagnosis!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hey janet. I know this isnt a runnign problem but i know you know a lot about injuries. So this weekand i was snowboard and i tried to do a 540 off a jump. thats about 1 and a half spins, I failed and hit my head and slammed my hand on the ground. Now my left hand seems fine but my right seems to hurt. When i put it in a fist and open it up to a full hand spread i get a low dull pain right below my thumb. Or when i have it standing straight up and i let it fall forward down slowly my wrist starts to hurt a little bit. any advice?
Reply - Janet
You may have injured your neck in that fall and the pain in your hand is a referred pain? Perhaps you injured the hand more than you realized at first.  I think the best advice here is to get it checked out by your orthopedist -- better to know what you're dealing with than to speculate and miss something important! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

After much online research and 2 weeks rest I believe I have ITBS. This week I started walking and later in the week light jogging for a short amount of time. The Issue is there, but it does not hurt to the point I have to stop. My big question is am I further injuring my leg or am I on the right track to getting back to running? I have been resting every other day. Thanks, Michael
Reply - Janet
Rest is a necessary first step to getting ITBS resolved, but don't stop there... make sure you're doing some strength work for your lower back, lateral hips and abs and make sure you're doing flexibility exercises as well (particularly calves and hamstrings and hip flexors).  Returning to training is a tricky business with ITBS.  Some studies show that if you run too slow a pace you'll actually have more stress on the ITB than if you run a little quicker.  I think you're on the right track to resume with walking first, then transitioning into a walk/jog routine, then finally into just running.  Have you had anyone look at your gait to see if your shoes are good for you?  If not, that might be something else to pursue.  For now - keep with the routine you've been doing for a bit and make your changes very gradually.  Good luck, let me know if I can be of help!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Scary indeed! He just looked at my leg. Never looked at me walking (well-limping really), my back etc. He came highly recommended so I accepted it. And kept apologising when he kept telling me I should be better! I thought I must have a very low pain threshold. He mainly deals with field sports so maybe he wasn't that interested in a running injury. It definitely taught me to be less dismissive of my own symptoms. Won't be running through pain like that again! Suppose I haven't done too badly. I was weight bearing all along (when I shouldn't have been really) and still managed to run pain free at 5 months which is around the recovery time I heard. You have helped so much. I really really appreciate it. If I'm in Atlanta, I'll be in touch. Otherwise might end up doing the virtual thing if things don't go to plan! (Fingers crossed....) Gráinne
Reply - Janet
Just let me know if I can be of help to you -- virtual or face to face both work well.  I've had athletes from Australia, Canada, and all over the US.  We can work in the virtual realm just fine! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Thanks so much. And thank you for getting back to me so quickly. Yes, walking is completely pain free since Christmas, regardless of speed. At diagnosis in early December it was still a little sore if I picked up the pace...but I'd been trying occasional gentle jogs as recommended by the physio for me presumed adductor strain...as well as lots and lots of active therapy/adductor strengthening! Since January I've also been doing a circuit programme for strength which included 2 min intervals of step jogs and bench step up...with no pain at fracture site whatsoever. Even though my ankles suffered from that impact initially! Will take your advice and take it slowly. Started with walk-jog around 3 weeks ago. Tried 20 mins easy jogging this morning and had no pain whatsoever but will take it very slowly as you recommended. Might do pool running as well so that I don't do too much too soon (again!) Thanks again. Wish I wasn't so far away (Ireland..)-would be great to have formal assessment from you. Will be in DC and visiting San Fran in April/May but that doesn't help much! Hopefully can find somebody here to take a proper look at me. Had to actually ask initial physio if my core strength was alright etc...
Reply - Janet
Wow... that's really scary that you had to prompt the physio about the core strength question!  Makes you wonder doesn't it?  If you've progressed over the past 3 weeks to be able to tolerate a 20 min easy run... you're well on your way! Don't get too aggressive with it - keep in mind that the bone remodeling cell cycle is about 6 weeks long so take your progressions slowly and give yourself rest days.  If you ever travel through Atlanta, get in touch and perhaps I can see you in person then! Warm regards - Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Sorry to jump on the stress fracture thread...but am 5 months out from inferior pubic ramus stress fracture. I'm now running pain free and want to get back to it but am absolutely terrified of reinjury. How many times a week could I attempt some very easy runs? I was a novice runner when I did this, the week after a half marathon. I was running 20-30miles/week. I've been walking approx 30 or so miles per week since the injury (it was 10 weeks before I was diagnosed!). I used elliptical, stair climber, pool running and strength training to maintain fitness while injured. I think the plan I've seen was similar to the one previously mentioned...from Pfitzinger site. And a schedule I was given aimed to get me back in 8 weeks. Is this too ambitious? I've no ambition to do a race soon (well, I've accepted that I won't be...) and will obey any rules I'm given. Help!
Reply - Janet
Unless I've misunderstood something, you're walking painfree about 30 miles a week? -- so you should be safe in beginning a transitional program to running.  I wouldn't recommend switching from walking to straight out running but rather follow a more gradual progression that has you walking some and running some.  A nice conservative plan is to do 3-4 minutes walking and 1 min running.  If you tolerate a couple of workouts like that, you can transition to shorter walking segments and longer running segments and then gradually progress to straight running.  If you're tolerating walking 5-6 days a week now, you might start with 3 days a week of the transitional program and do some short easy walks on another couple of days when you're sure you're tolerating the transition.  8 weeks is possibly fast for coming back from a pelvic stress fracture, but it all depends on the person.  Canned programs are just that -- they work for some, and not for others... I prefer to take a more individual approach based on the injury, the person's base prior to the injury, their own unique physical and medical issues etc.  Make sure you've dealt with the underlying factors that lead to the initial stress fracture -- hip strength, calf flexibility, gait issues, training errors, etc.  Good luck on the transition, it sounds like you're well on your way with that walking program!  Feel free to get in touch if I can help with more questions or to customize your approach!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Thank you Janet. I really appreciate your advise. I think I realized that about right after I posted.In reality I saids "conservative", because sometimes the milage or time allowed seems too much,too soon and I'm afraid of re-injury.BTW, It was my tibia, I've only been running for about a year and my weeky milage was about 25. Do you think it would be okay to run some and walks ome of that H/M ? I know there are other races but I was just going for fun anyway w/a group just for the experience. Thanks again. I really appreciate yor honesty.
Reply - Janet
I'll say again that I don't think it's a great idea. Have you had someone help you figure out what the causative factors were related to the original injury? Was it related to strength or flexiblity issues or perhaps gait issues? Have you addressed those underlying factors? Certainly doing a run/walk combination is less stressful than running the entire half marathon but 13.1 miles is still 13.1 miles whether you run it, walk it or crawl it!  It's still a long distance event.  Take it slow, listen to your body and make your judgement call on how you're progressing in a couple of weeks.  Hope this helps!  Good luck on your rehab process.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor.

In early December I was diagnosed with a S/F.I'm certain that I created this situation for myself by trying to run hills while being a bit ambious for speed. Although I continued to stay arobic by using the eliptical, I did absolutly no running until I was given the"okay" by my othopedic. That was early February. I found what I think looks like a reasonable "return to running" plan and have been conservatly following that.It does get me to returning to about 1 hour running by the end of this month,(which by the way was nearly my long run prior to injury.) My question is this, does it seem realistic to you that I will be able to train for the Indy H/M in May ? My ortho thought it should be fine if I'm not experiencing pain. What do you believe ?
Reply - Janet
That seems like a fairly aggressive return to running program-- getting you back to your previous level in only a month after an 8 week layoff for a stress fracture.  Even if you're able to do that, your body's may not be able to get adapted to the higher mileage needed for a half marathon in only a couple of months.  Part of the return to running after a stress fracture depends on what bone was fractured and what was the person's foundation prior to injury.  If the person had a very good foundation with lots of base mileage for many years and the stress fracture was in a smaller bone.. then the outlook is more favorable than if they didn't have as much base mileage and the stress fracture was in a bigger bone (tibia, femur, pelvis).  It's hard to make a "cookie cutter" program work for everyone.  Listen to your body and don't push - there will be other race opportunities...  Good luck, let me know if I can help.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor 

I was recently diagnosed with Chronic Exertional Compartment Syndrome. I had been experiencing pain and burning in my left leg and a hard cramping feeling in my right leg every time I ran, usally at the 1/2 mile mark. I am scheduled for surgery on April 11. My question is what is a realistic expectation in your experience on my ability to get back to the 10mi or half marathon mark by the end of summer. I used to be a 40mi a week runner, but I have not been able to run any distance for 6 months and have lost a ton. I can not find much info on rehab from this condition post surgery. I even started a blog on my surgery experiences for people who are considering this. http://pporonto.blogspot.com/. Thanks
Reply - Janet
I'm sorry to say that I wouldn't hold out a ton of hope for being up to the half marathon race distance by the end of summer.  This is a really difficult condition to treat as you've already found out and the outlook for conservative measures is pretty poor... surgery is usually the only thing that resolves it.  I can tell you that you should really push to have your doc refer you to a good biomechanically minded therapist for your rehab.  You would do well to have a slow motion video gait analysis performed so that any biomechanical issues can be identified. Perhaps orthotic support after your surgery will help to supplement the beneficial effects of the compartment release.  Also make sure your PT works with you on flexibility exercises for the hip and strength exercises for the hips and core.  Good luck!  Hopefully you'll be recovered faster than most!  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I've had a "pain in my butt," right where the leg connects to my hip on the left side for about 5 months. Recently, I took a run without warming up (I know, I know) and the pain has been prohibitive ever since. I can't bend over fully (as it feels like this "muscle in my butt" will tear if I bend more)and no kind of stretch helps it. In fact, the stretching just exacerbates the pain. I know something's wrong, but I'm not sure where to begin to get it diagnosed and treated. Do I go to an orthopod? A sports medicine doctor? Could the performis muscle be involved as well? I haven't done any activity in the last week and I'm on the verge of tears. Any guidance you can provide would be much appreciated!!
Reply - Janet
There's several things to consider... could be a high-hamstring strain or perhaps it's piriformis syndrome or perhaps it's a referred pain from low back issues.  If it's a high hamstring strain, then the stretching will definitely seem to make things worse.  The issue with that is the need for some eccentric strength exercises to stimulate the tissue to regenerate.  If it's a low back issue, then all the hamstring stretching in the world won't fix it until we figure out what alignment issues you might have.  Where to go for help... you can seek out a good orthopedic manual physical therapist by using the NAIOMT search engine (see the link at the top of this page) or perhaps ask around your running club to see what experience others have had with various orthopedists or physical therapists.  If you don't want to go that route - we can certainly try you on some exercises to work on core strength and stability and some eccentric focused strength work on that hamstring.  If a month of that doesn't make any difference, you can still go the medical route...  For now, it's important to avoid activities that seem to exacerbate it - forward bending, aggressive stretching and running... you have to let the tissue start to heal!  If I can be of help feel free to e-mail me directly.  I'd be happy to get you started on some exercises.  See the services page for the coahing questionnaire, fill that out and we can start right away.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

I'm 48 and have been running 12 to 15 miles a week for about 3 years. Last November I was just about to the end of a 5 mile run when I got a sharp pain in the back of my right knee. It hurts when my knee is fully extended and I then flex my ankle so that my toes are closer to my shin, like when doing a runners stretch. It's 3 months later and I just can't get shake this problem. I can only run about a mile and a half before it starts to flare up. It typically doesn't bother me very much while walking, but it is limiting my running. It's now been 5 weeks since I've run last and there doesn't seem to be any improvement. Any thoughts on what might be the problem? Thanks, Greg
Reply - Janet
Pain in the back of the knee always makes me concerned about meniscus damage.  Have you seen an orthopedist to rule that out? Was there any change in your routine prior to the initial symptoms? If the doc rules out meniscal injury, then the things to work on might be to focus on hamstring flexibility, and also make sure that the shoes you're wearing are correct for your gait pattern.  Have you ever had a gait analysis done to insure you're in the correct type of shoe? Another thing might be to look into your stride rate/length.  If you're loping along with really long strides (overstriding) it might help to think about having your feet hit the ground at a slightly faster cadence - this would make you slightly shorten your stride.  Its hard to say what's going on, but if 5 weeks of rest hasn't helped I'd be inclined to think it's time to see the doc.  Best of luck to you! Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor