CLINIC: Pelvis, Thighs, Groin, Spine—Treating One Means Looking at All

Tue, 6 Dec. 2011 - 1:31 a.m. MT
Credit: ARA Staff - American Running Association

I’ve had thigh issues in the past on my left side—pain when it moves and pain extending it in what my doctor diagnosed as piriformis syndrome. The pain is tolerable and I’ve managed to complete five marathons in the seven years I’ve been running.
The trouble now is groin pain on the right side. When I move my right leg in the motion of adduction, I experience pain in the inner thigh. It particularly hurts to adduct the right leg behind the left. At slow speeds I can run through the pain, but it is too painful if I try to run fast. My x-ray came out negative, and I plan to get an MRI. I am currently training for a marathon and hope to have this resolved soon. Do you have any diagnostic and/or treatment advice? I am a 5’3”, 120-lb female, age 43.
Connie Brooke
Sacramento, CA

“Piriformis syndrome” means different things to different people, but often means tightness or tenderness in the gluteal/buttock region. In any event, this left-sided pain may well affect your running mechanics, with a magnified effect the farther you run. The pain on the right side may be related to the pain on the left side. Treating your piriformis syndrome on the left is part of the means to resolving the pain on the right side.
An examination by a sports medicine physician (if not already done) will help reveal any imbalances in strength and flexibility involving (but not limited to) your hip girdle/pelvic region, as well as any structural (actual) or functional (e.g., due to overpronation) leg length discrepancy.
A stress fracture is surely on the list of possible causes for your right-sided symptoms. You are right to undergo an MRI scan of the pelvis (looking at both the right and left sides), and also a bone scan, as these will more definitely evaluate for this possible diagnosis. Additionally, the possibility that your symptoms on both sides may emanate from a lumbar spine problem should be explored; your physician may therefore wish to perform an MRI scan of your lower back.  
As opposed to a stress fracture, spinal disc protrusion or arthritis, a “soft tissue” basis for these symptoms may include a pelvic girdle strain or abdominal muscle on the right side. Relevant strength and flexibility exercises, soft tissue mobilization by a massage therapist, correction of any underlying biomechanical issues (e.g., overpronation, running posture, etc.), and even consideration of running surface and shoes may all be elements of an effective treatment program for both your right- and left-sided symptoms.
In the meantime, until you are running at the level you desire, crosstraining is certainly appropriate to help you maintain your cardiovascular fitness.
Brian L. Bowyer, MD
Columbus, OH
(RUNNING & FITNEWS®  May / June 2011 • Volume 29, Number 3)
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