CLINIC: Leg Pain on Days off from Running

Wed, 22 Aug. 2012 - 8:59 p.m. MT
Credit: ARA Staff - American Running Association

QUESTION:
The pain in my left hamstring has become chronic. This is new for me; I’ve been running for years and have never had problems before. I am very careful to only increase mileage gradually. Right now, in fact, I’m running just three times a week, for a total of 20 to 30 miles.
 
The pain started when I was training for a marathon, even though I was following a very conservative run-walk program. It has been ongoing for several months. I was originally diagnosed with hamstring tendonitis. I quit running for about three weeks and went through several weeks of physical therapy, but the pain would resume almost immediately. Nothing showed up on an MRI of my left leg.
 
I have difficulty believing I have tendonitis. The pain is often most noticeable on days when I’m not running. Now I’ve begun to have tailbone pain, particularly after running. My regular physician gave me a basic exam and some anti-inflammatories for this. I’m a bit at a loss as to who to see next—another orthopedist, or perhaps a chiropractor? I really would like to get to the bottom of this problem, and not suffer through more trial and error.
 
George Evanoski
Fairfax, VA
 
ANSWER:
It sounds like you may need an MRI of your lower back, not your left leg. Often a lower back or sciatic issue will yield symptoms like this, including the hamstring pain manifesting after inactivity, and of course the recent tailbone pain. Anti-inflammatories address the symptom, not the problem.
 
I would strongly consider a lower back flexibility program, over about three months before you look for results. It may take six months to work. Once you feel better, continue treating your back or the condition will return in as little as six weeks. The simplest program is to sit on the edge of a chair and bend your head down between your legs. Do this for 10 seconds, five to six times a day. Another option is to purchase a lumbar elastic belt with dual Velcro adjustments for about $24. Try running in it and see if the pain is slightly less. Just be wary of overtightening or you won’t be able to breathe properly. A sports therapist can give you a comprehensive lower back stretching program, during a session in which the doctor coaches you on exercise form and gives you things you can do at home. 
 
Robert C. Erickson, MD
Canton, OH
 
ANSWER:
I see the type of injury you have frequently and treatment can be elusive if you just focus on the symptoms. The cause is probably not your hamstring, but how you run and the cumulative effects of that gait pattern. This is ultimately the source of the overload, and the ensuing symptoms. You may, for example, have pelvic dysfunction. I also can’t rule out lumbar pathology as a source for your thigh pain. You may have tendonitis but the treatment must be directed at treating the reason the tendonitis arose, and not just the symptoms that declare themselves. If the muscles of your pelvis and trunk are not working well enough to stabilize your pelvis during running, your hamstring or adductors may become overloaded as they try to keep you upright and moving somewhat efficiently. 
 
You should probably see a physical medicine specialist with a mind toward function. I think you could benefit from a gait analysis and a musculoskeletal exam. In the meantime, work on hip abductor (gluteus medius) strength. Using a cable column, stand on one leg and pull the cable away from your side with the other leg from the ankle. Repeat on the other side. Do side-lying leg lifts, as well as squats with your buttocks back and loaded as if you were going to sit down. Also, reduce your running to an amount you can tolerate.
 
John Cianca, MD
Houston, TX

(RUNNING & FITNEWS®May / June 2010 • Volume 28, Number 3)

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