The task of determining the cause of a runner’s injury is sometimes difficult, while other times quite simple. The easiest ones by far are the ones that are revealed in the patient’s history, when the runner himself tells you exactly what has led to his problem.
More often than not, the answer may be found in a change in the runner’s training schedule (a significant increase in mileage or speed work) or footwear. These two factors are the most common culprits in cases where the athlete has sustained a rather sudden onset of symptoms, especially if she is a long-time runner who has never had this particular problem before.
Sometimes the cause is not quite so obvious, but can still be determined easily if the right questions are asked and the answers are listened to carefully. Here’s one example.
A forty-something year old runner, in the midst of training for a marathon, develops pain in the front of the right hip. His running schedule has not varied greatly prior to onset and there is no apparent problem related to his footwear in terms of worn-out shoes or a drastic change in model/style. There is one thing, however, that he has added to his routine – leg lifts.
About a week before, this gentleman had taken a West Coast business trip, during which he sat a great deal of the time, both on the plane and in meetings. He began to experience some mild low back pain on the left side. On his return, he followed the advice of a running partner (“most low back problems are due to weak abdominals”) and began to perform double-leg lifts while lying on his back. Within two days, his aforementioned hip pain appears, signaling the onset of a tendonitis/bursitis condition. Of course, he not only continues to run – albeit at a gentler pace and reduced mileage – but he also continues the leg lifts, not recognizing immediately that they are the cause of his problem.
This particular exercise has been around a long time, so it is really not a surprise that this runner, like many, thought nothing of doing it. But, just because something has been handed down from one generation of runners (or doctors or therapists) to another does not necessarily make it right. And in my opinion, this is one exercise that should not be performed by most people if they are just starting to work on abdominal muscle strength.
The problem with double-leg lifts is that they are the most advanced stage of abdominal exercises. One part of the hip flexor muscle involved – the psoas – attaches to the lumbar spine. When it contracts, it pulls the spine into an extended position, unless the abdominal muscles counteract that movement sufficiently. If those abs are weak, however, there is that spinal movement plus added strain on the hip flexors. This can subsequently lead to an overuse injury to that flexor tendon if the movement is performed too much, which is what I believe happened to this runner. Beginning his abdominal strengthening program at an easier level may have prevented this even if he eventually progressed to this exercise.
There are several lessons to be learned from this runner’s experience:
- Be careful when adding any new exercise to your routine. Don’t assume that they are safe and risk-free just because “everyone does them.”
- If you do add a new exercise, whether it is strengthening or stretching, start gradually, just like you did when you started running. Make sure you have no problems with just one set of 10 per day for a few days before adding more.
- Anytime you experience new symptoms of any type and you are able to trace the onset back to your having added something new to your program, stop doing it for a few days and see if things settle down. If they do, you’ll have made a good self-diagnosis and will likely be able to take care of the problem yourself.