Runner Therapy: Remembering the Pain

Question:  So last year when I started running, literally from my first step I experienced a sharp pain in my right hip, kind of at the very top of my thigh, about 2 inches under my hipbone.  I had to stop running that first time, and every time I attempted another run, that pain would come back. I spoke to my friend’s personal trainer who is also a yoga instructor, and she gave me hip stretches to do. Once I started doing these stretches before my runs, the pain completely stopped. I trained for and ran two half marathons and started really improving my speed on 10Ks and never felt the pain again for an entire year. Even if I forgot to stretch before a shorter run, the pain never came back. Then in the race on Saturday, I wasn’t even running as fast as I had been or as long, but the pain was back again. I stretched before the race. No idea why it is suddenly back or what to do.
Runner Therapy Says: Any chronic muscle pain can be exactly that, a pain. You have no idea when it will rear its ugly head again. In this case, it sounds like a chronic hip flexor inflexibility which is well-documented in your history, and you know how to take care of it with a few stretches. This is great news.

So is something missing that it keeps coming back? Or is it not the right treatment? It seems you did everything ‘right’ by stretching before your run, and that usually works, so why did it not work THIS time?

Your muscles do this every day in response to an old trauma or injury. Just like the new relationship, it just takes the perfect set of circumstances to bring it all back. When this happens, and it senses a threat or old fear, it goes into a protective mode and spasms a bit to stop you from using it, to stay in a safer zone. It thinks it is trying to protect you from injury. But if when you start to feel it tightening you don’t stop your run and thus ignore the ‘warning signals’, it will go right back into that painful scene it remembers from the last.

So the question is, what did you do differently that ‘scared’ the hip flexor into tightening up? Generally it can be several different factors, not limited to the following: a change in terrain (for instance more hills than usual, running on a beach, or running on a slanted road), new sneakers or orthotics, adding too much mileage too son, running with or after a cold or weakened immune system, a more humid/hot run, dehydration, low blood salt, an injury somewhere else with compensation at the area, etc. What to all of these factors have in common? They are all anything that differs from the norm. So, really, almost impossible to always avoid…there will always be something a bit different with your runs!

The take home message? Keep an eye out for warning signs and stop promptly to stretch, get a massage or just take the day off. The earlier you catch signs of the muscle having a bad memory, the less severe the reaction will be. Rest. And avoid putting it in harms way until it calms down. For preventative measures, the stretching is the best bet. But also, you may want to incorporate yoga, which will stretch muscles but also strengthen and stabilize them in a lengthened position.

Unfortunately, that pint of Ben & Jerry’s that helps you cope will do nothing for the injury, but plain ice will! Throw it on for 15.

Run smart. Use your brain, too.

- Marisa

(Marisa, MS PT SCS ATC, is a physical therapist in private practice in midtown NYC.  She one of a dozen or so therapists  in the state of NY to be board certified in sports.)