Sunday, December 4, 2011

The Right Leg Rebellion Against Running

What a fun journey this has been. 

Before I discuss the new developments of the past couple of weeks lets back up just a little bit.

I first started having right leg issues back in the beginning of September right after I had an amazing 5k race --- it began as some major tightness in my right quad and groin muscle.

image

“Here is a diagram of where the quad/groin is hurting.  Though its not as centralized since most of my quad was sore.  My range of motion was limited but after some quality time with my Foam Roller and The Stick last night I have a lot of relief today.  I am taking a rest day and plan to spend some time stretching and doing some light Yoga along with more time with the Foam Roller and The Stick.  Usually when my groin muscle is hurting so is my sciatica and piriformis but I’m not having any pain in that area.  But I am using my trusty tennis ball to roll the piriformis just in case though.” –09.07.11

I continued to have issues with my right quad & groin throughout September.  I ran a 10 mile race with little issues but the tightness/pain would come and go.  Sometimes it would hurt from the top of the groin all the way down the inside of my quad to the top of my knee; sometimes it would hurt all over in my quad; sometimes my IT band would tighten up and hurt; sometimes my hamstring was tight; sometimes my piriformis would tighten up.  I kept pushing through it --- having good days … and bad days.  I skipped some cross training, did lots of stretching, skipped a run

“I’m skipping my planned tempo run today.  My right leg is really bothering me.  It manifests differently daily --- some days it hurts in my groin muscles, some days in my IT band, some days in my piriformis, some days in my hamstring.  Its very strange.  Today my hip is feeling super tight and I’ve got a case of dead leg feeling.  And twinges in my groin muscle.  I’ve been doing lots and lots of stretching and yoga moves, using the Foam Roller 3+ times a day, massaging my sciatica/piriformis with my tennis ball.  I get temporarily relief from all of this but not lasting relief.  I’m beginning to get worried that this is going to continue to linger and with my half marathon only 1.5 weeks away I decided it was well past time for me to take a break and see if I can get past this.”  -09.22.11

Towards the end of September I ran a 10k race in my hometown with a 4 mile pre-race run.  I didn’t mention anything about my leg in my race recap but I remember having a lot of tightness in my quad/groin before and after.  Going into half marathon race week at the end of September I was feeling good.  I ran a 7 miler the Tuesday before my half marathon and felt good and “my right quad felt tight but nothing like it has the past few weeks”.  I also ran a 5 miler that week where my right quad was feeling “substantially better but no 100%”

I started October with a 28+ minute PR at my half marathon.  I felt good during the race --- my right leg didn’t bother me at all.  As the afternoon after the race wore on, and the days that followed, I had some major soreness. 

“I felt pretty good after the race on Sunday ... but as Sunday wore on I started to get more sore. I had taken an ice bath when we got home from the race, around 12:30pm, and by the evening my quads and IT bands were super tight so I took an Epsom salt bath too. My legs were very achy and woke me up a couple of times during the night --- especially the dead leg feeling in my right leg. My right quad/groin/IT band didn't bother me during the race but by Sunday night they were especially bothersome. By Monday morning I was so sore in my quads and IT bands --- I felt like I had done 1,000 squats. It must have been from powering up and down the hills at the race. Let me tell you --- I made those hills my b*&%^@#. I powered up each and every one as fast and hard as I could and then coasted down the downhills too. On Monday it hurt to squat down or bend over, and even to get into and out of my car. On Monday evening I took Lucy for a walk while my mom and her neighbor rode their bikes. I was super stiff and very sore but after a few minutes of walking I decided to jog a little bit. After a minute or two the stiffness wore off and although I remained sore I did feel a little better. Lucy and I ended up jogging/walking just over 2 miles total. Lucy had a blast ... and I hoped that by using the muscles that were hurting then maybe the soreness would wear off sooner.” –10.05.11

The soreness from the half marathon wore off by the end of the week.  I ran some 800 repeats when I was still super sore and then a 5 mile tempo run where I felt achy and sore.  I started to increase my mileage for CIM and ran 18 miles --- I remember feeling good and only have some mild tightness in my right quad.  This was our first long training run with our CIM training buddies and we did run/walk intervals of 9:1.   About a week after my half marathon my symptoms changed.

“The right quad is no longer giving me any issues but the issue has now moved more inside on the groin {where I’ve been having some twitching issue occasionally} and to behind the knee which is very troublesome.  Also, when I am using the foam roller on my hamstrings I get a painful sensation at the top of the right hamstring where the hamstring meets the buttocks.  I have no idea what this is or how to relieve it.  Using the foam roller makes it hurt too much and does not give relief.  I am assuming its related to the groin issue.  I noticed after doing some regular squats and door knob assisted deep squats yesterday that I have additional relief in my right leg.” –10.11.11

So the tightness in my quad went away but the tightness in my groin increased and I started getting some tightness directly behind my knee from my hamstring to my calf.  It didn’t hurt but it affected my range of motion.   Then a few days later I did a tempo run and felt fine “not 100% but its feeling better each day”.  I did another 18 mile long run and felt ok – I remember I had the tightness behind my knee but after a mile or two it went away.  I also remember that I was more sore than usual for a day or two after my second 18 miler.  The tightness behind my knee from the hamstring to the calf started to extend down into my lower calf at the top of my Achilles tendon. 

“The tightness in my right calf and pain behind my knee started almost immediately and gradually got worse as the workout progressed.  Thankfully the groin/quad issue I was dealing with for the past few weeks is now gone.  Unfortunately it seems it has been replaced with this new issue in my calf and behind the knee.  I have a feeling its all related in some way or another.” –10.18.11

achillies The circled area shows where the tightness was centralized

On October 19th I talked about my leg issues in detail:  When life gives you lemons.  I talked about how the issues had changed during the previous few weeks and that I had made an appointment with a local sports doctor for a consultation.  I remained optimistic and hopeful that the doc would be able to help me figure out what was going on.  During our 20 mile long run I experienced some issues but “Overall I felt pretty good during the whole run.  I had some tightness in my right leg {the leg that has been giving me issues} but nothing too troublesome or severe.  Occasionally my calf would get tense and shot pains up and down my leg up but only if I had been stopped for longer than a minute or two”

On Monday October 24th I had my first appointment with the sports doctor.  We talked about my issues; he watched me run and gave me some pointers about my form; he had me do some “tests” to gauge when and where pain began; and he did some soft tissue work {using Active Release Techniques (ART)} on my right leg.  He encouraged me to run as long as I didn’t have any pain and I made a follow up appointment for the next week.  I did an easy 3 mile run the next day where my right left felt tight but I didn’t have any the of pain/tightness I had been having.  Then I did an easy 5 mile run:

“Once I got started on my run I focused on my leg and how it was feeling and on my running form.  With focusing on my form I have not been obsessing about my pace as much lately.  I was feeling sooo good going into this run.  I had two days off from running and the only activity I did in those two days was one long leisure walk with the puppy.  My legs felt fresh and after my treatment on Monday I was feeling 99% better.” –10.29.11

However, as that run progressed things started to go down hill:

“As my run progressed so did the pressure like feeling  and tightness in my lower calf and whole right leg overall.  I continued to walk after each mile and even had to stretch a few times.  Towards the end of the last mile I started to get some shooting pains down the middle of my calf and up my groin muscle too.” –10.29.11

After that run the pain in my calf and upper Achilles got worse and it remained tight and sore the next day too.  It felt like a ton of pressure was being applied to the back of the calf and the shin bone.  That was two days {10.28.11}  before the last time I ran {10.30.11}. 

On Sunday October 30th I ran the Lake Natoma Four Bridges Half Marathon.   I declared that it was the worst race ever.  I felt ok when the race started with some tightness in my right leg mostly in my calf and behind my knee.  By mile 4 I needed to walk and by mile 5 I switched to a run/walk of 4:1 {often with more walking than that} because I was having pain in the lower part of my calf and around the outside of my ankle and the inside of my shin just under the knee.  By mile 10 I had started to limp due to the pain in my shin.  I really struggled physically and mentally and was so grateful for my running buddy Kat.  I finished, but it was not easy and it was painful. 

The next day I went to see my sports doc.  We talked about my week, the race, and how I was feeling.  Then I got another ART treatment on my leg.  The doc gave me some exercises to start doing daily and told me to return to activity as soon as I could without pain.  At this point I was limping, badly, due to the pain I was having on the outside of my right ankle.  I was also sore from the race and the ART treatment and the new exercises I was doing.  I tried walking a few times that week but I had a lot of pain.

The following week I went for another appointment with my sports doc.  He said that both my aching knee and ankle were 100% stable and cleared me to run.  I had taken the entire week off other than a couple of easy walks and my daily exercises the doc gave me.  However, I attempted two test runs that week and both were big fat epic failures.  I reported back to my doc via email about my attempted runs and he made the suggestion for me to go see my primary care physician to rule out a more serious injury.  By this point, I had been “resting” for two weeks.  The following Monday {November 14th} I went to see the sports doc again and he again advised me to go see my primary care physician.  Instead of working on my lower leg he focused on my back, hip, and glute and sent me on my way.  When I got home from his office I made an appointment at Kaiser and was able to see my primary care doctor that same afternoon.  After my initial visit, she sent me downstairs for x-ray’s of my ankle and knee.  A few days later I got an email from my Kaiser doc {I love that they use email to correspond} where she informed me that my x-ray’s came back clear and that she was referring me to a Kaiser sports specialist whom I saw the following Monday {November 21st}.  My appointment with the sports specialist went well.  She went over all my x-ray’s with me, we discussed all my issues from way back in September, and she had me do a series of “tests” as I call them --- balance tests, squat tests, flexibility tests, etc.  She said that even though my x-ray was clear that she felt confident that I might in fact have a stress facture on the outside of my right ankle and that the lump and pain in my right upper shin was a nerve issue.  She said I had very weak hips and glutes that cause my right knee to turn in.  She also said my IT bands were very tight on both legs and that I had Gluteus Medius Syndrome. 

From my handout regarding Gluteus Medius Syndrome: 

“Gluteus medius syndrome is characterized by inflammation and pain at the outer hip caused by strain of the gluteus medius muscle and its tendon attachment to the femur.  The gluteus medius muscle attaches the pelvis to the outer hip.  This muscle stabilizes the hip when walking, running and jumping, and moving the leg and thigh away from the other leg and thigh.”

“Common signs and symptoms:  pain and often a limp when walking or running; tenderness over the outer hip; pain, tenderness, swelling, warmth, or redness over the outer thigh, often worsened by moving the hip; weakness of the hip {especially when spreading the legs and hips with resistance}.”

“Expected outcome:  Healing time varies but usually averages 2 to 6 weeks.”

The Kaiser sports specialist gave me a referral to the Kaiser sports physical therapist and gave me some stretches to do until my first visit with the PT.  She also advised me to stop using the elliptical as it was causing me some discomfort the past couple of times I used it and therefore it might be too much impact at this time and to not run or do any activity that caused any pain. 

The following Monday {November 28th} I went for my first appointment with the Kaiser PT.  We met for about 45 minutes where we discussed my symptoms and history and he put me through the same balance, stability and mobility tests.  He prescribed me a series of exercises to do, daily, as well as a few stretches.

~exercises daily
~stretches daily, 3-4 times
~ice shin and ankle daily
~no running for another 4-6 weeks
~use the stationary bike for cardio
~stop doing all other strength exercises, for now
~follow up in 2 weeks
~walk but only if no pain during or after
~avoid shifting weight when standing

The Kaiser PT had me do some balance/stability moves and as I would slowly lower into a one legged squat on my right leg my right knee turned so far inward.  Its amazing the things you realize/see/feel when someone else points them out to you. 

Throughout all this time I have also been having lower back pain and severe tightness in my right buttock/hip as well a dead leg/tingling feeling in my right leg.  I discussed this, in great detail, with both the Kaiser sports specialist and the Kaiser PT.  The PT said it was likely that I was also suffering from piriformis syndrome and that my piriformis muscle {in the butt} is likely pinching or crushing my sciatic nerve and that the exercises he gave me for my weak hip/glutes will help to alleviate the issue. 

sciatica&piriformis 
  Sciatica_Full_Figure1  TP_min3 copy

The sciatic nerve issue could be the route issue for all my right leg problems! 

So, that’s where I’m at.  Its been 35 days {5 weeks} since I last ran.  I go back for a follow up appointment with the PT on December 12th and a follow up appointment with the sports specialist on December 22nd.  I have not been back to see the other sports doc, for now. 

I am feeling better each day.  My ankle pain is almost gone but I still have some pain/tenderness/soreness in my shin area.  The two areas of “pain” in my ankle and shin are in the circled areas in the figure below, both of which can be attributed to or related to the nerve issue:

Sciatica_L5_Dermatome 
I’ve been doing the exercises/stretches the PT gave me DAILY as well as some stretches for my piriformis and my back.  I’ve also gone on a couple of walks and been mostly pain free.  My ankle hasn’t bothered me at all on or after the walks but the shin area has.  I haven’t yet attempted to ride the stationary bike for cross training but I hope to give that a shot next week.  My back pain has significantly decreased as well has the tingling in my right leg and the tightness in my right buttock but they are not gone completely.  I feel like I’m making progress. 

Today I was suppose to run the California International Marathon but I’m going to sit it out instead and go out and cheer on my friends and the husband as they run instead and I hope to get back to running by the end of the year or the first of the new year.  I’ll update again after my next PT appointment on December 12th.

1 comment:

ajh said...

I hope the cheering went okay for you. That must have been hard.