"There's only one hard and fast rule in running: sometimes you have to run one hard and fast."

Saturday, June 22, 2013

The Chronicles of Rehabia

More about my butt than you probably need to know.

What stopped me from running was sciatic pain. Because I'd had it before and because it happened when I tried to run, I was pretty sure it was a common running injury called piriformis syndrome. The piriformis is a small muscle in the buttocks that can press against the sciatic nerve and cause pain; piriformis syndrome is easily identified by two trigger points (places that hurt if you press on them) at the muscle attachments at the femur and sacrum. I had pain there and in the center of the muscle, where the nerve passes - pressing there caused my leg to go numb. I also had trigger points along the iliac crest, which is a problem with the gluteus medius and/or gluteus minimus muscles. There was also a lower trigger point, which was proximal hamstring tendinopathy.

Standard treatment for piriformis pain is stretching and using a foam roller, both of which I'd been doing. Something more sinister was going on. Visits to numerous specialists led to the knowledge that, not only did I have these problems, but also iliotibial band syndrome - yet another common runner's malady - which presented with pain at yet another trigger point near my hip.

The full monty

I also had hip adductor problems. And achilles tendon problems. And peroneal tendon problems. And foot tendon problems (I forget which ones). And psoas problems. And mild problems in the muscles in the mid-back and abdominals.

Tendinosus, not tendinitis

I'd been trying to slap a coat of paint over the problems, rather than treat them. The first step in dealing with severe tendinosus (a chronic problem) is breaking up the calcified scar tissue in the aponeuroses by myofascial release. The method is similar to using foam rollers for tendinitis, but it's like comparing pulling out a tooth to pulling out a hair - it's a big deal. I'll probably discuss it in detail in another post.

I'm told that I can expect significant improvement in 6 weeks and a more-or-less "cure" in 6 months. If 6 weeks doesn't do anything for the heel attachment of my right achilles tendon (the worst problem), I'll have to schedule surgery. I'm already seeing improvement in the lesser problems.


The first goal is to be able to flex muscles without cramping and spasms; that's when I'm done with this first step. Then comes mobility and stretching. Then mild strengthening through isometrics and resistance bands. Then priopoception, balance and stability. Then strengthening and agility. Then sport-specific drills. Then I can return to running. "I'm not dead yet."


Double said...

I've been fortunate lately. I don't stretch, it seems like a waste of time. Running real slow is what I do and at least once a week in the summer I air it out. When Al's run comes in September I add a 2-3 mile tempo at race pace. Like you I have had most injuries. Mostly the hammy. I get my daughter to dig into it with her knee 2-3 times over a week as hard as I can take it and it goes away for a few months. I hate pain in the abdomen or groin area I get every other year. I just work through it. Most of my injuries seem to be turned ankles or from moving/working with stuff around the crib.

Robyn said...

Six months puts you ready to rock in... uhh... late December. Great timing :-) Hmm, Tuscobia?

On the upside, in theory you'd be able to do some great training for spring races. Good luck!

Anonymous said...

I agree with Robyn. Look to get back into it for the long haul. Have a solid base going into the winter; then look at the race schedule. The best training plan is the one that keeps you running. Run with people for awhile. Slow down and put in some time Good luck!.

John K.

Running with MTP said...

Happy to see you have a plan to heal.

I hope you can stay patient and do it right!