I was on my second to last long run before the Big Cottonwood Canyon Marathon, 13 miles. It was early on an August Saturday morning so not too hot and I was doing well with my LSD pace. All of a sudden, on the flat stretch of my local trail with about 2 miles left to go, my left hip seemed to twerk out from under me. I felt a stabbing pain in my hip that seemed to shoot around my glute and hamstring area. I slowed down a little. The pain kept on. I limped and hopped and kicked my legs up behind me to try and shake it out but the pain persisted. I did something I never do and stopped and stretched. Stopping seemed to make it worse and after a brief stretch I powered through the painful final stretch home.As soon as I stopped in front of my driveway the pain seemed to get worse again and I limped inside whining to my husband about this sudden pain. I’ve been pain-free and injury-free for 4 years. My first marathon introduced me to ITBS and that has really been my only other running-related injury / pain. This new pain was nothing like what I felt with ITBS. After about 5-10 minutes of good stretching and walking around it seemed to subside.
The Pain Comes and Goes
Over the last two weeks pre-marathon, the pain would come and go on runs. It seemed that the first three miles of any run were pain-free and then the nag would kick in. Since I was doing the Run Less, Run Faster plan, I was only running three days a week, and not consecutively. I have to believe the cross-training and rest days in between helped prevent this pain from getting worse right away. On my last run before the marathon, only 3 miles, I was pain-free. This left me naively hopeful that the entire downhill marathon would also be pain-free.
Alas, after 8 miles of flying downhill at Big Cottonwood in Utah, the pain in my left hip, glute and hamstring area shot out. I had the same twerking, jerking reaction as the first time I felt it and I know my face cringed in pain. I spent the next 9 miles grimacing through it while trying to maintain the 8:12 goal pace. I tried to stay in the parts of the road which were as flat as possible but in hindsight this meant I was actually swerving constantly and probably doing even more damage. When I slowed down to walk through the water stops, the pain would again increase. I found it odd that it hurt more to stop but it did. For those mid-marathon miles I mostly just cursed and grimaced and found the mental strength (you might say stubbornness) to run through it. When the course started to flatten out around mile 17 the pain shifted from my hip into my calves. I’m still convinced that it literally shifted, but it is more likely that my calves simply started to hurt more than my hip and so I no longer noticed the hip pain.
Hip Pain Diagnosis
Post-marathon I spent 12 days trying to deal with my calf pain (which will be a whole other post!) and all but forgot about the hip pain. I was aware of it for sure when I foam rolled but as my calf pain literally prevented me from running, the hip pain was already gone from my mind. That is, until I was able to run again. I first went out for three miles. I still had hopes of doing my second marathon in four weeks and was attempting to catch up somewhere in the last weeks of a training plan between decent mileage and tapering. I went out for a slightly longer run and the pain in my left hip returned again after the first three miles. Frustrated but not convinced this was an issue, I went out on a Saturday morning for what I intended to be a 10 mile run. At mile 4 I knew that wasn’t happening. The hip pain wasn’t stabbing but it was enough that I knew I had to not only cut the long run short but withdraw from marathon number two. More importantly, I needed to seriously figure out what was wrong and get it fixed.
Runner’s World tends to be my “go to” source for anything and everything hip related. Between the magazine articles, online articles and forums I have always found an answer. And to solve this hip pain I used all those resources plus a few other article results that Google provided. The most helpful was Dr. Jordan Metzl’s RW “Inside the Doctor’s Office” video on the three most common hip pains in runners. With his video I went from panic to hope. It hadn’t crossed my mind that the pain could be a stress fracture but that was on the list of the top three possibilities. After doing his tests to get a quick evaluation I narrowed it down to trochanteric bersitis. Having bersitis seemed to be the best of the worst but I still wasn’t sure how bad mine might be, how best to fix it and what it would mean for my long-term running career.
Physical Therapy to the Rescue: Diagnosis Defined
I emailed a friend of ours who works in a PT office and shared all my woes and self-diagnosis to see if she could confirm and answer my query as to whether or not PT could help. I had an appointment within two days. On the first visit I described exactly what happened, all the actions I’d taken and my PT tried to recreate the pain. We couldn’t do it. I knew exactly where the pain comes from when I run but we couldn’t trigger it in the office. After some additional bending, pulling and stretching, we identified a few key things that are all tied together and are either the cause, or the result, of the pain itself:
- Something in my pelvic area was definitely misaligned causing my left leg to appear slightly longer which meant my whole left hip area was all jacked up and lots of strange compensation was happening on the left side
- Another area in my hip flexors seemed to be out of whack which the PT also straightened out
- Perhaps the most interesting finding, and apparently a very common issue in runners, was the muscle imbalance–my hamstrings fired first when it should’ve been my glutes
- The pain was actually coming from two EXTREMELY tight muscle groups that happen to meet at the hip joint: one in my left glute / piriformis area and one in my lower left back
Treating Hip Pain and Still Running
At the end of my first PT session I’d had some stretching and massage done and I was given two exercises and three stretches to do 1-2 times every day. Perhaps the best news though was that I was “approved” to continue running. We agreed this would be the only way to truly evaluate if the PT work was paying off. My exercises include 1 set of 10 kegels that I hold for 10 seconds and then lying on my stomach, squeezing the glutes, lifting one leg at a 90 degree angle and holding for 10 seconds. Repeat 10 times and switch legs. After the first PT session I did a fast two mile run with no pain. Since then I’ve done 3-4 mile runs with the slightest nag. The pain is not gone but it’s not searing by any means; it is minimal for sure. I have continued to go to PT which is mainly for the insurance-covered massage and to get feedback on whether or not the muscle groups seem to be shifting in strength. The goal is that I will continue to get stronger in the glutes so that those huge muscle groups bear more of the burden and the hip pain will dissipate over time as my muscles re-balance.
Treating this pain is a work in progress to say the least. Of the three most common hip pains runners experience, mine seems to ultimately not have been any of them and really just these two crazy tight muscles. I keep wondering if I had been doing strength training all along would this have happened at all? I have no idea how long it will take to go away and my PT has yet to tell me not to run at all. The logical side of me believes that if I took more time off from running that surely this could heal faster and probably “better.” However, the other, stubborn, naive, “invincible” part of me wants to continue to run through and with the pain to see if I can actually make it go away while continuing to do what I love.
I have a few more PT sessions on the calendar and two half marathons I’m targeting in November. My hope is to be able to run at least the latter one pain-free. I will definitely be diligent with the exercises and stretching and I look forward to a winter of getting stronger all around to keep these mysterious pains at bay.