Forums >Health and Nutrition>Breaking the Injury Cycle?
Hey all, just wondering if anyone has had issues with re-occuring injury that they eventually figured out and got back to serious training. I've been to PT with four different PTs and feeling like I'm out of feasible options. I'd welcome your stories /anecdotes just as much as specific suggestions related to my problem.
Injury overview - Right leg posterior chain, primarily calf/hamstring. When running quickly or easy for extended time (>1.5 hours) my hamstring will feel slightly painful and my right calf will feel a dull ache and eventually it will all tighten up such that my heel doesn't impact the ground and I'm running awkwardly on my forefoot and just muscling my way forward painfully. Stopping and doing a calf stretch or simple leg swing will help and I can usually run a bit longer, but those duration decrease as I keep going. When I really push things not only am I running on the ball of my right foot but I'm also running on the outside of my left with no pronation happening.
Timeline and treatments:
- Injury originally occurred in late 2016 (December)
- I have taken multiple breaks from running some as short as 3 days some as long as 3 months.
- My doctor is clueless as to what it is and has referred me to Physical Therapists.
- Physical therapists have tried ART which helps for a day or two
- Physical therapists have tried dry needling (of the lower back, buttocks, hamstring and calf) which tends to help for 2 weeks
- deep tissue massage tends to be similar to dry needling
- Physical therapists have suggested 3 primary treatments supplemental work - mobility work on my back, "neural flossing" of the hamstring, hip strengthening. The final one my current PT has said isn't an issue anymore.
- Physical therapists have been loathe to give a name to my issue but in short they describe it as very similar to sciatica due to something in my lower back pulling on the tendon repeatedly as I run
- doing the suggested work from the PTs tends to help but it just delays the onset of the problem rather than fixing it and things like training for a marathon are simply unavailable to me as a result.
- Wearing high drop shoes tends to make the problem first occur in the hamstring, if I wear 0-drop shoes it first occurs in the calf and moves to the hamstring second.
- Keeping more of my running easy and with only one workout per week tends to be better for my injury. Two workouts per week just aggravates things. Tempo runs are the worst (and also the thing I need the most).
- I had my local running store video tape me running on a treadmill and they saw nothing wrong with my form (obviously my injury wasn't occurring at that point). Mostly they were looking for a quick cadence without overstriding and I met those conditions.
As you can see the timeline for this injury is multiple years and while I've been lucky and had a few really good races and PRs, I've had a lot of ones where I get up to speed and a mile or so into the race my leg tightens up and I'm unable to stride properly. More importantly I just cannot train the way I'd like to and just wondering if you guys have any suggestions that I haven't tried yet. The one thing I've considered is hiring a coach to watch me do a simple track workout and see if they can identify anything in my gait that is unusual or unbalanced.
My doctor wants me to get a XRays and then go see a hip specialist. My main concern right now is money as I suspect an xray will be useless and I'll have to get a MRI and meanwhile my job has told me I'm done at the end of June so I'm loathe to spend big money until I have a new job lined up ; I'm working on now so hopefully this moves forward soon.
1600 - 5:23 (2018), 5k - 19:33 (2018), 10k - 41:20 (2021), half - 1:38:57 (2018), Marathon - 3:37:17 (2018)
What type of doctor are you seeing? Is this your primary care doctor? I would recommend seeing the specialist. With injuries that aren't obvious, I have found my primary care doc is good for referrals, but not really diagnosing. You mentioned you had a gait analysis at your running store--do they have any recommendations for runner friendly doctors? I'm thinking sports medicine, physical medicine or ortho.
I've been to PT twice for the same issue. The first time, I had no idea what the problem was. Primary doc was kinda worthless, no real diagnosis but some costly imaging. Without ever laying eyes on me, the PT practice wanted to schedule me for 3 visits per week for 12 weeks since my insurance approved it. I noped outta there after the first session, many reasons, but one thing was it felt like they wanted to throw everything at me (which each came with it's own procedure code that they billed my insurance) without knowing the problem. Not only did it not help, I was in more pain after the visit than before. Second time the problem was identified, so the PT focused on that. It's possible you may be running into a case where the PT is throwing a bunch of things at the issue to see if anything helps, without really knowing what the issue is in the first place.
If there is an issue related to mobility and or imbalance, it's very possible that there are things you will have to do all the time in order to keep running.
Looking at your log, I see swim, bike and weights as activities. Are you sure this is solely related to running?
You also mentioned going between high drop and 0 drop shoes. By high drop, do you mean 10-12mm? I find going from 12 to 8 is tough. Are you easing into these changes? What type of shoes are you wearing when not exercising?
Hey thanks for the response. Swimming and cycling are not regular activities for me, they're things I do when the injury gets bad specifically because they're don't stress it and I'd like to preserve some of my aerobic conditioning. I've been wearing 0 drop shoes (a lot of Altras, some Merrel) since 2015 and yes I eased into it as I was dealing with shin splints at that time. I rarely run in traditional shoes and the "high drop" shoes I was thinking of were Saucony Kinvara v7s which IIRC were 6mm drop.
Yes the doctor is my regular practitioner. I've already been to the physical therapist that all the local runner recommend. The PTs as a group have often felt like they don't give me a clear diagnosis, they just find something that makes me temporarily better which is really the root of my frustration. If I have to shell out for a visit every two weeks for the rest of my running life... well that's not really acceptable. My current PT is the only one whose tried to describe what he thinks is going on and he had me a lot better for awhile but then I tried to race and it really really aggravated things so I took about 2 weeks off and mostly swam. The one thing that gives me a little bit of confidence is that 3 of the 4 PTs have basically prescribed similar work for me (1 leg deadlifts, back openers, snake pose and some hamstring stretching). You're probably right that it's time to see a specialist.
so i have been dealing with issues with my hamstring for the past three years. I gave up on the PT and dr's and instead I work with a personal trainer and a massage therapist. Instead of stretching (which never helped me) I foam roll ALOT, every single day. and i do strengthening exercises for my hamstring several times a week, easy stuff like glute bridges and single leg lunges/squats, and harder stuff like hamstring curls and all kinds of other nutty things. Every hamstring move i can do, I do. I only started stretching my hamstring when it started feeling completely better. One thing I learned through all of it was that running didn't really hurt things, I tried resting, even up to several months, but it didn't make that much of a difference. So i run easy. harder faster work i have to be much more careful, lots of slow build up before i try anything fast, and i don't ever sprint. I have been racing recently and that's been going okay. i also get a massage as often as i can, even just a ten minute rub down if that's all i can afford, the lady that i found works out of my gym and she specifically works on athletes, she frequently brings me to tears, this is no relaxing massage, but she is amazing. she always makes me feel better.
the only odd thing from your post is how you mention zero drop shoes but also wanting to land on your heel. i thought the purpose of the zero drop shoes was to encourage you landing on your forefoot. you might be fighting your shoes if you are trying to land on your heel in shoes designed to help you land on your forefoot
i know its frustrating, good luck!
MoBramExam
Timeline and treatments: - Injury originally occurred in late 2016 (December) - I have taken multiple breaks from running some as short as 3 days some as long as 3 months. - My doctor is clueless as to what it is and has referred me to Physical Therapists.
Actually, since late December 2016 you have ran between 50 and 200+ miles every month. And not just ran, you have also done tempos, interval workouts, and races in almost every one of those months. Even just looking back a few weeks, see:
4/7 - Long Run...hurt.
4/8 - Interval Workout...hurt.
4/13 - Race...hurt.
4/15 - Interval Workout...hurt.
IMO, you're in denial of the extent of your injury and by continuing to train and race through it, you've never given yourself a legit chance to heal, taken the time to truly address the source, or to effectively get on a proper strength program for a runner. After all this time, by regularly compensating for pain and discomfort, you have probably programmed too many poor movement patterns into your running to count.
Easy to say, hard to do, but may be best to take a seat (from running and other forms of impact exercises) for 6-8 weeks. Study folks who know movement patterns and how to properly develop strength for runners (Jay Dicharry and Trent Nessler). Use their expertise to help you find a local sports doctor and PT who will legit "fix" you and not "guess". Start back with a clean slate. Start back slow, build back slow, and build back better and stronger.
Long process to basically burn it down and start all over, but if running is important to you, well worth it for the long term to do it right.
MoBramExam thank you for looking. You're right I had no idea I'd been that dishonest about it. I've been telling myself it was just a few miles here and there but the summer months last year where I told myself I was just doing C25k with my son I was clearly throwing in lots of extra runs that I had no business doing. The middle two weeks of Dec. are the closest thing I've done to true rest and that included 20 miles over 2 weeks. =(
Christirei thanks for your experience. I've gotten away from the hamstring specific exercises I should try that again. I was doing single leg bridges on an exercise ball for awhile I think it helped. I've been assuming glute-ham raises, squats and deadlifts (and the 1 leg version of each as well) are doing enough. To explain the 0-drop thing, I don't want to land on my heel, but it should still touch down after the forefoot. Basically my calf is so tight it keeps my foot plantarflexed through the entire gait cycle.
Intl. correspondent
Zebano - have you been doing any kind of strength training?
I've had a chain on injuries which plagued me for a very long time, especially my left calf and foot.
However back in December 2017 I've started going to Functional training twice a week.
What they do is basically diagnose how you move and start addressing some of the weak links in the chain one by one.
Over that period they've had me work a lot on strengthening my oblique abs so I don't rotate as much when I run, then a lot of work on the muscles in the back (under the scapula) so I'm not so arched forward when running, quite a bit of leg strength work, most of it single legged.
Since I started with them I've never had any injuries anymore. I was just watching a video of myself running last week and my posture has improved a lot and the best part is I'm not thinking about it.
A lot of the issues I had was probably due to my forward leaning posture and my lack of dorsiflexion on the left side, and probably a lot more stuff that got fixed over time with the work there.
And it's not the regular gym work with isolated exercises either.
So if there's something like that in your area I'd highly recommend you give it a try.
PRs: 1500 4:54.1 2019 - 5K 17:53 2023 - 10K 37:55 2023 - HM 1:21:59 2021
Up next: some 800m race (or time trials) / Also place in the top 20% in a trail race
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