As you probably know, lately I have been dealing with some nagging pain and tightness that has interfered with my running. Did you notice how I didn’t use the word “injury” there? I didn’t even want to use the “I” word in the title of this post but I also didn’t want it to be 15 words long.
When does something cross the line from a tightness/pain to an injury anyway? I have no idea what the answer to that is, and that’s not what will be discussed in this post anyway. However, it seems more helpful to think of this as anything but an injury so let’s just go with that! All I am planning to do today is share what I think I have learned about what is causing some of my trouble and what I’m doing about it.
First off, I’m no sort of medical professional (my degree is in mental health- we could probably argue that it is related to this topic but today will be strictly about physical stuff, although I often wonder if 95% of my aches and pains are in my head!) Please understand that I am summarizing what I think I have learned from doing a lot of my own research and working with my own sports medicine providers over the years.
I’ve been running “seriously” for about 7 years give or take, and I have been dealing with injuries for 7 of those years. Actually, my injury history begins before I even started running seriously. I had plantar fasciitis in 2005 when I was doing some light running combined with aerobic classes like step and kickboxing. So for almost 10 years, I have had some sort of “injury” (ugh I hate that word!) almost every year. Here is a brief summary of my injury history:
2005-2006: Plantar fasciitis (left foot)
2007-2008: Achilles tendonitis (left side)
2010: Hip labrum tear + surgery (left hip)
2012-2013: Piriformis syndrome (right side)
Early 2014: Pain and tightness in upper left quad (left side)
Late 2014-2015: Return of piriformis syndrome (right side) and more pain and tightness in upper left quad (left side)
Yikes. How did I ever run 30+ races with all of that going on? There were so many mistakes I’ve made over the years. Like running through pain, taking ibuprofen for pain and still running, following doctors advice without really understanding what was going on…I remember back when I had PF and achilles problems my podiatrist made me orthotics and said “you can keep running, the orthotics will eventually help the pain, but until then take ibuprofen every day” and wrote me a prescription. He was a medical professional so I listened and never questioned it.
I would like to think that over the years I have gotten smarter about things. I still make plenty of bad decisions when it comes to running, but the difference is my awareness of what’s going in. If something hurts, I question it, I try to address it, and I try to figure out why it’s happening. Are my shoes too old? Did I run extra miles this week or do something different? Have I been neglecting my foam roller?
What I am trying to say is, we need to take responsibility for our own health. Seek advice from those who are more knowledgable, but trust your own instincts, do your own research, and try to understand what’s happening. Be your own injury detective.
Last year I wrote about how my last chiropractor told me I have weak glutes. Well that’s all well and good but I’ve always been one to do core work including glute exercises so what was really going on? He wanted me to do tons of band exercises focusing on the glutes and honestly don’t think it translated into better running or getting stronger. Maybe those specific exercises work for some people but they didn’t seem to work for me, or I wasn’t doing them correctly.
So now that I am in a place where I am willing to back off the running and figure out what is going on, I’ve been doing a lot of thinking and reading about running injuries, form, etc. Here are some thoughts and realizations I’ve come to:
-My initial injuries on my left foot and ankle may have caused some gait changes on my left side. I know that my left achilles is still much tighter than my right.
-My hip surgery likely left me with tighter and weaker hip muscles on that side. Even though I did a lot of PT after, that stopped 6 months after surgery. It was arthroscopic so I only have tiny scars but there still may be scar tissue there causing restrictions.
-I seem to feel the tightness in my left quad the most when I am running all easy miles (which is a vicious cycle because when it starts to hurt I take it easy and stop doing speed work). When you run slower, you use your quads more than your other hip flexors. Your psoas works more when you are running faster and your hip is flexed up higher. Also, if my psoas is weak and not working properly than the quad is going to need to work extra hard as a hip flexor. This article explains this really well.
-The imbalances on my left side are probably causing my SI joint to shift around, which can contribute to piriformis pain.
-Based on the crossed extensor reflex, the glutes of one side get activated with the hip flexion that happens on the opposite side. So that could mean poor hip flexion on my left side= poor glute activation on my right side (which could also cause the piriformis to jump in and try to compensate).
sort of a confusing picture, but you can read the article here which is the source of the picture
-the weak glutes are also probably due to tight hip flexors and sitting too much during the day.
So what am I going to do about all this? Here are the areas I am addressing:
- Release the tight muscles (quads/hip flexors, piriformis, everything really!)
- Mobilize (using dynamic stretching type exercises)
- Strengthen the weak muscles (hip flexors, hip abductors, glute max)
- Stabilize the core
- Then put it all together by improving running form
I won’t go into more detail today because this post is already so long, but leave a comment if you want to know more about what I’m doing. I know a lot of people were curious about the dry needling, which is a way to release trigger points in a tight muscle. I had it done in my piriformis and rectus femoris. For some more info about it you can click here or here.
Have you had consistent running injuries over the years? Do you notice any patterns?
Do you try figure out why you are getting injured or focus on relieving the symptoms?