ASK THE EXPERTS - excelsior orthopaedics

Excelsior Orthopaedics Expert Doctors Answer Your training Questions

+ What’s the best way to take care of a grade 1 hamstring strain ahead of the race day? -Harvey B

Hi Harvey and thank you for your question. This is a second line of the answer. When we treat hamstring strains, we ensure that our runners have flexibility through the majors movers of the lower extremities including the hip flexors, hamstrings, gastroc/soleus complex, and quadriceps muscles. Balance of strength between the hamstrings/quadriceps is another factor to consider as you move forward.

You may supplement you running with simple home exercises focused on increasing strength in the hamstring. This is a simple as performing a hip bridge or an RDL movement. As you begin running again, listen to your body.

If the hamstring starts to bother you, stop running, apply ice, and rest for the day. Gradually build back into your program. If your symptoms persist or worsen please reach out to us!

+ Why is my hip sore especially after I run long distances? I feel it right on my left hip bone especially when I press on it. - Nicole P

Hi Nicole and thank you for your question. There are multiple issues that can cause pain on the outside of this hip. IT Band Syndrome is one. The IT Band is a wide band of connective tissue that passes over the lateral (outside) hip bone.

This is often seen in runners who have had a significant increase in their mileage over a short period of time. Another issue that can cause pain is greater trochanteric bursitis.

This is an irritation of the muscles and tendons that connect to the lateral hip bone. This often occurs over time and typically presents as that soreness, especially when touched, that you describe.

+ I’ve been training for the half and during my long run last week I pulled something in my left calf. I’ve iced, rolled, and rested but the pain remains. What advice do you have for quick recovery? but - Amy T

Hi Amy! Thank you for your question. What you describe sounds like a muscle strain. Strains can take weeks to heal completely. You should continue to ice as symptoms persist. You many gently stretch the gastroc/soleus complex.

Avoid aggressive rolling or deep massage to the area as this may prolong irritation of the muscle. I understand that time is of the essence we are now 8 weeks out. In order to continue building your cardiovascular endurance, consider alternatives to running like aqua jogging, swimming, or biking.

As your symptoms improve, begin to gradually re-introduce running. Stop when you feel like symptoms are returning. As time goes on, your symptoms should improve as long as you listen to your body. If symptoms persist or worsen, please reach out to us!

+ I'm training for the half marathon and 4 miles into my 6 mile run two weeks ago, I started having pain at the top of my inner thigh at the intersection of my groin. How should I ramp up to get back on schedule? - David

A gradual return to your volume is indicated in your situation, starting back with low mileage, low intensity runs. Returning back to where you were 2 weeks prior to the injury and progressing no greater than 10% each week would be the general answer.

Without having a formal evaluation, be mindful of your symptoms. Identify the location, pain quality, duration, and situation in which your symptoms occur. This will help shed more light on potential causes. Make sure you are diligent with flexibility exercises during your training.

If you continue to have issues, we would be happy to see you and encourage you to reach out to our STRIDES (Striving To Reduce Injuries During Endurance Sports) team at run@excelsiorortho.com to arrange an evaluation for recommendations for further treatment.

+ Should you stop running if you are diagnosed with trochanteric bursitis? If so, for how long? - Heather

Hi Heather and thank you for the question.

As you have likely been told, trochanteric bursitis is an inflammation of the small, fluid filled sac around the greater trochanter of the femur. There are multiple factors that can cause this diagnosis including (but not limited to) repetitive activity, leg length discrepancy, muscle weakness or imbalance.

Rest can be helpful, though each individual responds over different time frames. Your first goal should be to reduce your symptoms. This can be achieved with use of oral non-steroidal anti-inflammatories (like ibuprofen or naproxen), cryotherapy, stretching, and modification of activities, including taking a break from running.

Following a reduction in your symptoms, a structured program incorporating flexibility, mobility, and strength can help reduce the likelihood of recurrence of symptoms.

If you are still limited by your symptoms, you may benefit from the guidance of a skilled medical professional. We would be happy to see you and encourage you to reach out to our STRIDES (Striving To Reduce Injuries During Endurance Sports) team at run@excelsiorortho.com to arrange an evaluation for recommendations for further treatment.

+ I am experiencing what I think is plantar fascitis-serious right heel pain all the time. What can I do and is there a specific type of running shoe for this problem? - Janet

Hi Janet and thank you for your question.

This does sound like plantar fasciitis and there are multiple treatment options available for you. Having already tried stretching, icing, and resting would leave you options like ASTYM (https://www.astym.com/Main) , orthotics, or a more aggressive treatment like an injection. ASTYM is a treatment method using hand tools that helps regenerate healthy soft tissues and reduces scar tissue that may affecting proper movement in the foot and lower extremity.

The injection introduces anti-inflammatory medication directly to the area and can help reduce and eliminate inflammation. If looking for new shoes, you should ensure that the store performs a gait analysis to lead you in the right direction. It's not always the shoe that is the issue, rather, it could be related to muscular imbalance or lack of flexibility. As mentioned prior, they may also discuss the use of orthotics in your shoes.

If this issue continues to limit your training, we would be happy to see you for further evaluation encourage you to reach out to our STRIDES (Striving To Reduce Injuries During Endurance Sports) team at run@excelsiorortho.com to arrange an evaluation for recommendations for further treatment. This includes referral to one of our sports medicine physicians if indicated!

+ I've been a consistent trainer, took 8 weeks off for a medial tibial tendonitis.Returning at a slower pace/schedule, I now have a snapping on the lateral side of the same ankle, no pain. Any advise on what i could be and any stretches or strengthening I might be able to add? - Kristine

Hi Kristine and thank you for your question.

There are multiple structures on the lateral portion of the ankle, but the most likely culprit for a "snapping" sensation would be the peroneal tendons. The peroneus longus and brevis tendons pass behind the lateral malleolous and act to evert the ankle. If you are experiencing snapping, the tendon retinaculum (or structure holding the tendons in the proper place) may be compromised.

If this issue is not painful, balance and strength training could be of benefit. Single leg standing on the floor progressing to an unstable surface will challenge your balance. Using an elastic band and pulling the foot outward against resistance will help build strength.

If you're able to train the way you would like are not having further issues, keep on training! If this issue begins to limit your training, we would be happy to see you for further evaluation encourage you to reach out to our STRIDES (Striving To Reduce Injuries During Endurance Sports) team at run@excelsiorortho.com to arrange an evaluation for recommendations for further treatment. This includes referral to one of our sports medicine physicians if indicated!

+ I am having pain in my tibia/muscle group thats on the anterior/lateral side of lower right leg, the pain only presents when I run and it's to the point where I feel I may injure it if I continue to run. Once I stop, the pain stops. How can I help subside the pain and heal so that I can get back to training and running again? - Kaylee

Hi Kaylee and thank you for the question.

There are multiple potential causes for your symptoms. Issues that can occur in this area include stress fractures, compartment syndrome, and anterior tibial tendonitis.

If your symptoms are related to the first two, it is important to get checked out by a physician as soon as possible. If it is related to anterior tibial tendonitis, there are a few ways to improve symptoms. The first is to improve strength of the muscle to support your foot during heelstrike.

Heel walks are one exercise you can use to strengthen this muscle. Try to heel walk without shoes for 4-5 sets of 25'. Another exercise you can try is ankle raises. Sit or stand with both feet on the ground and raise your forefoot toward the ceiling while keeping your heel on he ground. 2 sets of 15 reps is a good place to start.

Finally, you may want to look at your footwear. Tight laces can sometimes cause irritation of the anterior tibial tendon. You can also try a shoe with lower heel to toe drop which may reduce stress on the anterior shin. If this issue begins to limit your training, we would be happy to see you for further evaluation encourage you to reach out to our STRIDES (Striving To Reduce Injuries During Endurance Sports) team at run@excelsiorortho.com to arrange an evaluation for recommendations for further treatment. This includes referral to one of our sports medicine physicians if indicated!

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