Hip and Lateral Thigh Pain in Runners

www.adienthealth.com     Hip and Lateral Thigh Pain in Runners Dennis Gyllenhaal, PT, Adient-Gyllenhaal Physical Therapy Hip and lateral thigh pai...
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Hip and Lateral Thigh Pain in Runners Dennis Gyllenhaal, PT, Adient-Gyllenhaal Physical Therapy

Hip and lateral thigh pain is one of the more common problems plaguing runners (especially long distance runners). It usually comes on gradually (over days or weeks) and can sideline a runner for months. There are several causes of hip and thigh pain. This article will focus on the following: • • • • • •

Piriformis syndrome Iliotibial Band Syndrome (IT Band) Trochanteric bursitis Sacro-iliac dysfunction (SI joint) Proximal hamstring strain Stress fracture

Most of these conditions have one thing in common…they are most often caused by overuse or over-training. I will describe each of the conditions above and review some of the treatments available for these conditions. Piriformis Syndrome Piriformis syndrome is a condition involving the piriformis muscle in the hip. The piriformis muscle is a small muscle deep in the hip that controls rotation in the hip. It is involved in almost all phases of running and can be irritated with anything from increasing your distance or speed to fast, over-striding or changing the terrain you run on.

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Piriformis syndrome often starts a dull pain deep in the hip. The pain is most intense at the start of a run, and often gets better as the run progresses. As the condition progresses, you start having deep hip pain between runs. What makes a piriformis syndrome worse than most muscle strains is the closeness to the sciatic nerve. In many people, the sciatic nerve runs through the piriformis muscle belly. When the piriformis muscle becomes sufficiently irritated, it will irritate the sciatic nerve sending pain radiating down your leg. The treatments for piriformis syndrome include: • Stretching • Deep tissue massage • anti-inflammatories • ultrasound • changing certain aspects of your running Ice will often give some temporary relief, but the piriformis muscle is deep in the hip, and the effects of ice are often minimal, or temporary. I’ve shown some of the stretches you can use below. Remember to stretch slowly. If you want to keep running, shorten your stride and avoid excessive speed or hills until you are past the pain.

Iliotibial Band Syndrome (IT Band)

   

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The iliotibial band syndrome is one of the more poorly understood conditions. To begin with, the iliotibial band is a tendon, and as such does not stretch. The muscle at the near end of the tendon is a smaller muscle in the lateral hip called the tensor fascia lata (or TFL). There are several other muscles that send fibers into the IT band including the gluteus maximus (the large muscle in your buttocks), the outer quads (vastus lateralis in the front of the thigh) and the outer hamstring muscles. The problems arise with the IT band because of imbalances that develop between all of these muscles. These problems can occur because of training mistakes (too much, to fast, to soon), poor footwear or failure to cross train the muscles that balance these muscles out. Treatment of this condition is aimed at stretching out the muscles that attach into the IT band, correcting training mistakes, making sure yo are in the right shoes and strengthening the muscles that balance the muscles that are over-developed. I’ve shown some of the stretches that might be helpful below. One of the most common means of treating the condition is the foam roller. You are instructed to lie on the foam roll with your IT-band directly on top of the roller and roll back and forth. This is often to painful for many people and may contribute to prolonging the condition. For those who can’t tolerate this, a rolling pin or (the stick) can be used to roll up and down the hip with less pressure and less pain. Remember, you want to roll along the edges of the IT-band where the muscles (the lateral quads, hamstrings and gluteals) attach. Trochanteric Bursitis Trochanteric bursitis is an inflammation of the fluid filled sac (bursa) that pads and protects the boney area on the outside of the hip (the trochanter). The trochanter is the

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portion of the hip where most of the hip muscles attach. The trochanteric bursa pads the trochanter from the muscles and tendons that pass over it. Bursitis occurs when there is either excessive or highly repetitive pressure on the bursa. Trochanteric bursitis often begins as tenderness and swelling in the area over the outer hip. If the conditions that caused the bursitis are not changed and the area not treated, the pain can eventually radiate down the outer thigh. Treatment for trochanteric bursitis often includes an injection of steroids into the area. Other treatments include: ice massage, ultrasound, soft tissue mobilization and stretching of the tissues overlying the bursa. If the pain is aggravated by training, you may need to reduce the intensity of your training or in some cases hold on your training until the condition is under control. Sacro-iliac Dysfunction Sacro-iliac dysfunction often comes on suddenly with a fall or a jarring motion that sends an excessive stress through the SI joint. One exception to this is women who develop SI pain after returning to running to soon after childbirth. The sacroiliac (SI) joint is an inherently stable joint. The shape of the joint allows little motion, and the joint is surrounded by a massive amount of ligaments. In a large majority of adults over 30, this joint is fused. In women who have had a child within the past few months and return to impact loading exercise (such as running), there is a high risk of SI joint injury due to the continued laxity of all of the ligaments around the pelvis. SI dysfunction often begins as a dull ache deep in the buttocks on one side. If left untreated and the activities that are aggravating the condition continue, the pain will often begin to radiate down the leg. Treatment for SI dysfunction can include the following: • • • • •

Adjustment of the SI joint Soft tissue mobilization Stabilization exercises stretching and various modalities such as ice and ultrasound

The two key components of treatment are most often the combination of adjusting (or aligning) the SI joint and stabilizing the joint with exercises that balance our the muscle pull around the joint. Activities that aggravate the condition will need to be modified to decrease the level of impact loading or overstretching of the structures around the SI

   

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joint. Proximal Hamstring Strain Proximal hamstring strains are common in middle and long distance runners. This occurs often because of a combination of lack of flexibility and over-striding. Most people who develop this report a feeling like they are sitting on a golf ball. The tenderness and tightness are centered around the ischial tuberosity (that bone in your pelvis that bears most of the weight when you sit). Typically you feel the strain at the beginning and near the end of a run. As the condition worsens, you have difficulty sitting. Treatment involved a combination of ice, ultrasound, soft tissue mobilization and specific stretching (see below). If you choose to continue training, you should shorten your stride and avoid hill training. Often a compressive thigh sleeve will help alleviate the pain while running. Stress Fracture A stress fracture in the hip is almost always a result of over-training. There may be underlying metabolic reasons that cause bone thinning, but too much, too soon (the terrible toos) will often precipitate the condition. Stress fractures are most commonly treated by limited weight bearing on the injured side (the use of crutches) for up to 6 weeks. Returning to running must be gradual. Do not try to return at the level you were training prior to the injury. This article covered a number of causes for hip and thigh pain, but the list is not complete. I will try to add further articles at a later date to offer a more complete list of injuries.

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