Hello janet, my name is jarrett and i am a 15 year old runner about 6'0 or 6'1 and still growing. I have a question about my legs, i have been training all summer pretty much because we are getting ready for the xc season and we started doing time trials, but what i noticed is that my legs ALWAYS feel fatigued. They might feel fine before a run but about 4 minutes into the run whether its an easy run or a hard run they feel like crap and like all the energy is gone. I drink lots of water about the daily amount i should drink for my age and i do not drink pop anymore, i do drink lifewater at times , which im not sure if it is good or not for me, but besides all that i just always feel fatigued. i had a time trial today and i ran around a 22:10 for a 5k but i just felt horrible like i couldn't run anymore about 4 minutes into it. Could there be any possible causes for why i feel so fatigued all the time? If you have any suggestions let me know ! :) thanks.
Reply - Janet
Well it could be as simple as over training or it could be more complex like a medical condition or disorder. Have you talked to your family physician to rule out things in the medical arena?  If not, then that's probably your first step.  If your blood tests are clear and there's no immediate cause apparent for the fatigue, then perhaps it is a simple issue of too many hard workouts back to back.  When designing your weekly training plan, think about doing a "hard/easy" schedule.  "Hard" can be defined as a long run (even at easy pace) or as a fast run (even if short in distance).  "Easy" can be defined as a short easy paced run, or even a rest day. If you're not taking rest days, or worse yet... trying to squeeze in two workouts a day, then perhaps just taking a bit more rest or an additional recovery day will refresh your legs. If all you're doing is hammering it hard day after day - your muscle glycogen is chronically depleted and you're basically tearing your muscles (and other tissues) down without allowing them the gift of time to recover!  Talk to your physician, and then get together with your XC coach to figure out if you might need a schedule tweak!  Best of luck in your upcoming season,  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Approx 10 years ago I was hiking in and out of the Grand Canyon on a one day trip when I experienced profound pain in the outside of both of my knees directly between my upper and lower legs. I made it out on my own but both knees audibly squeaked and I could feel by touching the outside of knees the tension in the band as if a rubber band was being stretched between my upper and lower legs. I recently began to exoerience this pain in both legs while running and it usually starts at about 3 miles. i stretch, Ice, and take ibufrofren but it wont go away. What the heck is going on and why is it in both of my knees?
Reply - Janet
First off let me apologize for taking a week to answer your question - I've been traveling.
The location of your pain is consistent with iliotibial band friction syndrome, but of course it could be other things as well.  If we go on the premise that it's an iliotibial band friction syndrome then the things that need to be stretched include the calves, hamstrings and quads.  If you've been focusing your stretch on the lateral knee/hip then you may have been missing the perpetrator.  In addition, it might be worth it to see someone for a gait analysis - perhaps the shoes you're using aren't supporting your feet in their best alignment. This translates to a torsional stress on the ITB area. Finally -if your lateral hips are a little weak, or your core muscles (abs and lower back) aren't as strong as they should be - that could play into things.  Hope this helps.  Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor

Hi, I am 27 and have been a yr round runner since the age of 9. I ran and rowed in college. I am currently a personal trainer and coach, so the injury I have been experiencing is more than frustrating. While in highschool, I had some hip flexor pain. So I was given orthodics and stability shoes. About a yr later during the last 100m of an 800m final, I felt my hamstring pop. I took off for about 4 days and raced in Districts the following weekend. Up until March of 2006, I had no injuries. I competed in college, ran a marathon, taught spinning classes etc...Then in March of 06' my left hamstring started hurting. I kept pushing through, icing etc...June, I stared going to a Physical Therapist. We did ultrasound, massage, stim, etc...it alleviated the pain until I ran again. I got an MRI in Nov. of 06'. The Dr told me I had tendinopathy. So since then I was in physical therapy with 2 different people. I have been working on strengthening my hamsrings, I have cross-trained, but NOTHING is working. I recently went back to the podiatrist who originally made my orthodics, who is a distance runner. He checked my 3 yr old orthodics out and told me I didn't need new ones b/c I was not able to run high mileage over the last 3 yrs. I asked him to also check out the length of my legs/ hips, because I read that could be a source of injury. He said my left left WAS shorter than my rt and gave me a cushion for my left shoe. He also said I should probably see a chiropractor to see about the alignment in my hips. I haven't yet b/c I would like another opinion before I spend anymore $. I am so fed up. It has been almost 3 yrs and no answers that help. Iam so frustrated. I am 5'2", ranging between 110-115 lbs. I have very strong quads and not as strong hamstrings. I am pretty much at a loss...It is hard to be a trainer and not know how to help yourself. CAN YOU HELP???????

Reply - Janet

Tendinopathy is a tough diagnosis -- it's a degeneration of the tendon, not an inflammation and therefore it needs to be dealt with differently.  Most studies I'm familiar with promote eccentric functional-based exercises in a progressive manner as the eccentric load has been shown to stimulate collagen formation and muscle hypertrophy better than the concentric phase.  Did your PT evaluate your leg length difference?  If not, shame on them... you need to call that PT back and ask a few questions.  They may have evaluated it and not found one (likely).  If indeed you do have a leg length difference it needs to be determined if it's a TRUE difference in leg length (not so common) or a FUNCTIONAL difference due to pelvic or low back alignment issues (more common).  If you put a lift under a functional difference you'll make matters worse in some cases so this is an important detail to figure out.  

Keep in mind that all the "Cross training" you're doing may or may not be helpful as far as the hamstring tendinosis is concerned. It may be that the exercises given to you by the PT are fine and great but you're side-tracking yourself with all the other stuff you're doing in your spin classes, and other gym activities. I think it would be good for someone to take a good hard, overall look at your TOTAL training load and figure out what direction you need to go. Going after this piecemeal isn't working too well.  Let me know if I can help - you can feel free to e-mail me. Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor 

I am in search of some help, as you will see from the story below, my skier has tried everything we can think of to cure this problem but with no success. He has the ability to be world champion in our sport of water ski racing, if only we could beat the problem. All your comments and ideas would be greatly welcome. many many thanks. Robs (my skier) story and a brief description of our sport below: I started skiing when i was 6 and have always been passionate about it, i got into race at the age of 14, and won the national series for under 16 in my second year. i then went on to win two European champions ships and represent GB in my first world championship come 6th. I carried on skiing in the men’s events at the age of 19 i was also at the top of my game and looking forward to the European championships as part of the GB team. that was 4 yrs ago midway through the season I started to noticed a pins and needles sensation in both my feet. At first it was just pins and needles and I was able to complete a full race. Every race the problem got worse and the pins and needles turned into numbness in both feet and gradually worked up my legs to my knees. Every time I skied this sensation came on quicker and for the past 4 yrs I have not been able to ski for more than 20 mins. I have been to see various physio’s and chiropractors as initially we thought it was coming from my back. When nothing worked I went to see a sports doctor who suggested possible compartment syndrome. I had the operation on both legs on the compartment to the front of the legs outside of the shins. That was 2 yrs ago and the problem is still as bad. Having tried changing every piece of equipment i you whilst skiing to see if it is circulation and nothing has worked. I have the ability to excel in my sport but this problem and the drive to do train my heart out, but i can't beat this. can anyone help? Many thanks Rob.
Reply - Janet
Not sure I can add a whole lot of wisdom to this... but I'll pose a few questions.  Did the orthopedist who did the compartment surgery TEST the various compartment pressures before exercise AND within 5 minutes of an exercise bout that brought on symptoms?  If not -- perhaps they released the wrong compartment?  Has your athlete had nerve conduction tests done to rule out something bizarre like Multiple sclerosis or other nerve dysfunction?  Have they had doppler studies done to look at vascular health?  I'm not sure what practitioner to point you to.  Usually pins/needles sensations in an otherwise healthy athlete is related to nerve issues stemming from the low back and this would certainly be plausible in a sport like water skiing... but you've already checked that out.  Perhaps a vascular specialist or a neurologist is the next practitioner to see?  Best of luck to you - sorry I couldn't come up with anything more helpful than that!
Janet Hamilton, MA, RCEP, CSCS, RRCA coaching instructor