Healing hip pain

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Healing hip pain John Kemp 11/13/12 5:01 AM
At 10 miles into the marathon I did a month ago, my left hip became very stiff. I didn't think a whole lot about it, and carried on to complete the marathon without anything painful going on.

I ran two miles easy the next day, and then took the next two weeks off.

I'd intended to take off two months, which is normal for me sometime at the end of the year. But this year, I've felt so good, that I didn't want to stop running. So I started back up and my left hip started complaining loudly. Pain. I had to walk after a mile.

I think there are three things going on:

* I was told a long time ago that my left leg is shorter than the right, giving my hip muscles more work to do, generally, than the right leg. This is why they gave me orthotics 17 years ago.
* I expect my hip muscles are weaker than I would like, and my IT band is much tighter - this seems to have been made worse by my time in marshmallow shoes and orthotics which is when I used to have much worse hip pain than today.
* I run exclusively on steeply-cambered country roads without sidewalks, facing into traffic, which extends my left leg a bit further than the right.

I think I have hip bursitis - ie. inflammation where my tight/weak tendons and muscles are rubbing over each other at the hip. The standard way to diagnose and fix this is a shot of anaesthetic and cortisone into the bursa itself. If that relieves the pain, that's what they tell you - "hip bursitis".

I'm trying to avoid the doctor. And I'm also trying to avoid taking *any* anti-inflammatories (not even ibuprofen, which has bad effects elsewhere for me). And I'm trying to avoid the need to stop running altogether.

I started doing some exercises to strength the flexors and extensors. I started stretching out the hip.

I've continued to run every day, but until the last two days, with a maximum of about 3 miles, which is when the stiffness typically starts to become a dull pain. There seem to be no specific ill-effects to this, other than I am clearly not resting my hip, so perhaps it will not get better. But as soon as I stop running, there is no pain.

I have been working out my hips - "side planks", the Foundation core workout (thanks Gordo) and yoga stretches for the hips. I've recently added foam roller workouts on the hips. My hips certainly feel freer, and I am able to run further without pain than I could 3 weeks ago - I'm doing 3-5 miles a day without pain, and things seem to be improving.

But, am I crazy to try it like this? Is there really no cure but RICE? Is my body really telling me to rest (it doesn't feel like that - I feel wonderful otherwise from running, and I stop before this gets painful)? Does anyone have any good hip exercises or other advice? I'm really missing my long runs, and I think I'm still some way off from being able to run as far as I'd like. It's been almost a month, and the rest of me is itching to run far again.

JohnK


Re: Healing hip pain gordo 11/13/12 5:59 AM
Thanks, but that wasn't me. I do core exercises from "Core Performance", "Anatomy for Runners", from a PT, and from T-Nation. I read Core Foundation" after I had put my routine together and it didn't offer anything new.

Gordo
Re: [Minimalist Runner:126439] Re: Healing hip pain John Kemp 11/13/12 6:06 AM
You're right, it was Rich. Thanks Rich :)

JohnK
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Re: [Minimalist Runner:126440] Re: Healing hip pain Tuck 11/13/12 6:57 AM
I'm going with the rest prescription, myself.  When I've gotten my IT band annoyed at me a vacation was the only thing that worked.  I'd run a bit, but stay under the point at which it became irritated.
 
Avoid the cortisone like the plague.  It kills the tissue it's injected into.  Dead tissue doesn't hurt... But (obviously) leads to worse things down the road...
--
_________________________________
Tucker
 

Re: [Minimalist Runner:126451] Re: Healing hip pain John Kemp 11/13/12 7:04 AM
"I'm going with the rest prescription, myself.  When I've gotten my IT band annoyed at me a vacation was the only thing that worked.  I'd run a bit, but stay under the point at which it became irritated."

Running a bit is not the kind of rest I'm worried about :) I'm trying to avoid needing to stop running completely. I'm only running up to the irritation point now - the question I have is whether it will only heal if I stop completely for some (longer than two weeks apparently) period of time.

I'm trying to fix the underlying weaknesses while I carry on running enough to stay sane. That is, if I am still actually sane at all :)
Re: [Minimalist Runner:126453] Re: Healing hip pain Tuck 11/13/12 7:07 AM
"...the question I have is whether it will only heal if I stop completely for some (longer than two weeks apparently) period of time."
 
Mine did.  More like 5/6 weeks, though. 
Re: [Minimalist Runner:126454] Re: Healing hip pain Denise Skidmore 11/13/12 10:54 AM
I started out this journey with really messed up hips.  Rest alone didn't do much, I got worse and worse.  Keep it limber and keep up the PT.  Check your posture with a pendulum while your eyes are closed.

My latest progress:
Re: Healing hip pain JJ 11/13/12 11:17 AM
in the for what it is worth category, i find sitting cross legged for 5 mins a day (meditation style) helps tremendously in stretching out my hips.  the good news it it doesn't require much thought either. 
Re: [Minimalist Runner:126483] Re: Healing hip pain John Kemp 11/13/12 11:19 AM
Thanks Denise - how do I check my posture with a pendulum? I tried Googling that and failed ;)

I am known to have bad posture though since I spend all day in front of a laptop with the screen mostly well-below my gaze...
Re: [Minimalist Runner:126436] Healing hip pain JZ 11/13/12 1:13 PM
* I run exclusively on steeply-cambered country roads without sidewalks, facing into traffic, which extends my left leg a bit further than the right.
 
That would be the first thing I changed.  I have read a number of accounts about this alone causing significant hip issues. 
 
Also, keep up the foam rolling.  My understanding is that this is one of the best things for the ITB (which is, of course, connected to the hip).
 
I have a hip that gets upset once in a while, but, luckily, running is not one of the activities that irritates it (so far, anyway). I've never seen a doctor about it.


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Re: [Minimalist Runner:126485] Re: Healing hip pain Denise Skidmore 11/13/12 1:48 PM
This is just right-to left posture.  Stand in front of a mirror or another person who can judge.  Close your eyes, stand straight, hang a weighted string or a straight stick at the tip of your nose.  Open your eyes and see if the line goes straight down your middle.  Sometimes you're leaning more than you realize.
Re: [Minimalist Runner:126436] Healing hip pain JZ 11/13/12 3:33 PM
Also, when my hip gets irritated, I often find massage is helpful.
Re: [Minimalist Runner:126508] Healing hip pain John Kemp 11/13/12 4:28 PM
On Nov 13, 2012, at 6:32 PM, JZ wrote:

> Also, when my hip gets irritated, I often find massage is helpful.

I've heard that "myofascial release" is the thing for IT band... any experience with that?

JohnK
 
>
> On Tue, Nov 13, 2012 at 8:01 AM, John Kemp <jo...@jkemp.net> wrote:
> At 10 miles into the marathon I did a month ago, my left hip became very stiff. I didn't think a whole lot about it, and carried on to complete the marathon without anything painful going on.
>
>
Re: [Minimalist Runner:126510] Healing hip pain ebank 11/13/12 4:39 PM
YES!  DO IT!!  ART or a foam roller or a PVC pipe or a lacrosse ball.
 Great stuff.

Sent from my iPhone
Re: [Minimalist Runner:126436] Healing hip pain Tuck 11/13/12 4:44 PM
Isn't that to help release scar tissue?

Harry convinced me of the value of that with his ankle... Could be
worth a shot...
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_________________________________
Tucker
Re: [Minimalist Runner:126510] Healing hip pain JZ 11/13/12 4:54 PM
I've heard that "myofascial release" is the thing for IT band... any experience with that?

No, other than using the foam roller (which is considered a form of myofascial release) I haven't done that for my hip or IT band.  I've generally relied on self massage and my wife for massage.  However, I think that having someone who does myofascial release to work on you would probably be a good way to go.
--
Joe
Re: [Minimalist Runner:126508] Healing hip pain gordo 11/13/12 5:06 PM
On Tuesday, November 13, 2012 5:28:39 PM UTC-7, JohnK wrote:

I've heard that "myofascial release" is the thing for IT band... any experience with that?

Another name for "myofascial release" is "massage". ;)

Gordo
Re: [Minimalist Runner:126515] Healing hip pain JZ 11/13/12 5:15 PM
Yeah, any type of "deep tissue" massage would probably be beneficial.


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Re: [Minimalist Runner:126515] Healing hip pain John Kemp 11/13/12 6:32 PM
Hmm, I thought "massage" is directed at the muscles, where as myofascial release works on connective tissue: http://en.wikipedia.org/wiki/Myofascial_release and involves both pushing on the fascia and moving muscles around - seems a bit more involved?

JohnK
Re: [Minimalist Runner:126515] Healing hip pain gordo 11/13/12 6:40 PM
I don't think it's that nuanced. My LMT does whatever it takes. Trigger point massage, cross-fiber friction, deep tissue, etc. I suspect that she's typical that way. I think the only time you get the differentiation is when someone is trying to sell something ...

Gordo
Healing hip pain KatieK 11/13/12 9:13 PM
See a Feldenkrais practitioner.  A good one will be able to rebalance you and help you find what is causing it and what to do differently.  I'm working on a very similar issue and that's been the best thing.  Also some deep tissue work with a physical therapist in addition to this to release the tightness that has built up.

Everything is connected and you'd be surprised what affects what.   For me, my tight SOAS and hip muscles on the right side travel down my hip and leg to the knee, causing some pain there, while pulling my L5 out of alignment in the spine as well, causing the disk to herniate, while simultaneously pulling the right hip forward and upward (right is higher and more forward than left), transferring the weight burden to the left side.  Apparently, this is why I get Plantar Faciitis on my left foot lately, because of the weight burden there.  I've just started with the PT and Feldenkrais Practitioner (a friend of mine), but both are fabulous.  I feel completely different after a Feldenkrais session and she saved me from really having a bad problem while working a strenuous job recently that normally would have ruined my back.

Katie

Re: Healing hip pain runs_with_kona 11/13/12 10:00 PM
Where is your left hip when you stand on your left leg ?  Compare that to standing on the right leg.  In my case my left hip was sliding out and my right hip was exactly on top of the leg. Like you, my hip tightened somewhere around 10 miles into a 50K race and I had to quit at 37.5k. I figured out the form problem after the cross over gait discussion.  The fix however took months.  The first few weeks my hip would tightened in 1/2 mile no matter how fast or slow I ran.  I kept deconstructing and analyzing my form.  I went through many of the exercises in Ed Yu's book.  And slowly I changed my form.  I no longer let my left hip slide out. I still consciously step through with my left leg to insure that I get full extension on the left side.  Foam rollers, ART etc all treat the symptom.  You can strengthen your hip area, yet if you have a problem in your form it will come and bite you when you hit your limit next time.  My left knee is a mess, my hip problem came out a compensation for the knee.  You are going to have to find a form and run with your slightly shorter left.

On Tuesday, November 13, 2012 6:01:56 AM UTC-7, JohnK wrote:
Re: [Minimalist Runner:126532] Re: Healing hip pain John Kemp 11/14/12 3:33 AM
RWK,

"Where is your left hip when you stand on your left leg ? Compare that to standing on the right leg.  In my case my left hip was sliding out and my right hip was exactly on top of the leg."

Very good point. I have tried to look at my form in this way, but I haven't found a language to understand how to correct this issue. My form is definitely different on the left compared to the right. I have tried barefooting very slowly to see what was going on but I haven't yet found something that works.

Thanks for the recommendation on 'The Art of Slowing Down' - I haven't read that one, but it is now on my pile. I will also go back to the crossover gait thread and see what I can find...

JohnK
Re: [Minimalist Runner:126530] Healing hip pain John Kemp 11/14/12 5:54 AM
Thanks Katie - I live in the middle of nowhere so I'm not sure if anyone does Feldenkrais near here, but will check it out!
 
"For me, my tight SOAS and hip muscles on the right side travel down my hip and leg to the knee, causing some pain there, while pulling my L5 out of alignment in the spine as well, causing the disk to herniate, while simultaneously pulling the right hip forward and upward (right is higher and more forward than left), transferring the weight burden to the left side."

Ouch! I'm glad to hear you're on the mend.

JohnK
Re: [Minimalist Runner:126515] Healing hip pain Wilt Alston 11/14/12 7:01 AM
+ 35,007

...my LMT "does it all" as well, and I mean that in a strictly therapeutic way.
Re: [Minimalist Runner:126553] Healing hip pain John Kemp 11/14/12 7:13 AM
Trouble is, where I live there aren't many to choose from, and the ones that are here are mostly of the "spa" or "alternative" massage types. I'm trying to find someone, anyone who could even manage a "simple" sports massage...

"+ 35,007" - reminds me of the altitude, in feet, of my last flight in an airplane ;)

JohnK

On Nov 14, 2012, at 10:01 AM, Wilt Alston wrote:

> + 35,007
>
> ...my LMT "does it all" as well, and I mean that in a strictly therapeutic way.
>
>
> On Tuesday, November 13, 2012 9:40:40 PM UTC-5, gordo wrote:
> I don't think it's that nuanced. My LMT does whatever it takes. Trigger point massage, cross-fiber friction, deep tissue, etc. I suspect that she's typical that way. I think the only time you get the differentiation is when someone is trying to sell something ...
>
> Gordo
>
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Re: [Minimalist Runner:126553] Healing hip pain Doug Sims 11/14/12 7:28 AM
The "spa" that I go to for massages is just a small place run by a few ladies. They are very good about focusing a standard massage on a specific area (shoulder, back, hamstring, etc.). 
If you can find a chiropractor close by, they will usually provide a sports massage type service as well. Especially if you tell them your IT band (or whatever hurts) is making your back out of alignment.

I prefer the small spa service though since they are just in there to work on your muscles for a set amount of time and then leave. They don't pester you to come back next week like a chiro does. I usually don't even make an appointment either, I can just pop in on my way home from work if that day was particularly bad.

For those wondering, it IS run by Chinese ladies, but it's not THAT kind of Chinese massage parlor.
Re: [Minimalist Runner:126553] Healing hip pain gordo 11/14/12 7:34 AM
On Wednesday, November 14, 2012 8:28:43 AM UTC-7, Doug Sims wrote:
... not THAT kind of Chinese massage parlor.

I figured that was what John meant by "alternative". ;)

Gordo
Re: [Minimalist Runner:126530] Healing hip pain KatieK 11/14/12 8:02 AM
Ah, I see.  My friend recommended a website to one of my friends in Norway, that you can use to try to perform Feldenkrais on yourself.  I will get the URL for you.
Re: [Minimalist Runner:126532] Re: Healing hip pain KatieK 11/14/12 8:06 AM
I see that Ed Yu draws from Feldenkrais, too.  Probably very helpful.  Looks like a good book.
Re: [Minimalist Runner:126564] Healing hip pain John Kemp 11/14/12 8:34 AM
LOL. Laughing made my hip feel much better.

Thanks,

JohnK
Re: [Minimalist Runner:126575] Healing hip pain JZ 11/14/12 9:55 AM
If you can't find an LMT, you can do quite a bit with a foam roller, a lacrosse ball, and your own hands.  You can get some good ideas from mobilitywod.com on how to "attack" (or "mobilize") that hip by yourself.  I've also got one of these, http://www.thumpermassager.com/minipro.html, which works quite well. 


--
Joe
Re: [Minimalist Runner:126530] Healing hip pain gordo 11/14/12 10:58 AM
On Wednesday, November 14, 2012 9:02:46 AM UTC-7, KatieK wrote:
Ah, I see.  My friend recommended a website to one of my friends in Norway, that you can use to try to perform Feldenkrais on yourself.  I will get the URL for you.
Re: Healing hip pain John (NoVa) 11/14/12 1:46 PM
Yeah, I have the same short leg/hip issue.  For me, increasing the knee bend was the main fix.

Re cambered surfaces:  that certainly makes a difference and will exacerbate the problem if your left leg is short and you run on the left hand side.  As long as you are injured, I think you absolutely have to change this.  I mean, I don't know your options but running on the left hand side is not one of them IMO.

In terms of rest, that never helped me at all, it was just a matter of more knee bend and switching sides of the road/sidewalk every half mile or so.  In fact, my experience was that my hip would be stiffer if I took more time off -- steady, moderate running is better than alternating hard and rest days while dealing with this prob.

FWIW, the foam rolling didn't help me at all, although I didn't stick with it for very long.  Certainly can't hurt though.


On Tuesday, November 13, 2012 8:01:56 AM UTC-5, JohnK wrote:
At 10 miles into the marathon I did a month ago, my left hip became very stiff. I didn't think a whole lot about it, and carried on to complete the marathon without anything painful going on.

I ran two miles easy the next day, and then took the next two weeks off.

I'd intended to take off two months, which is normal for me sometime at the end of the year. But this year, I've felt so good, that I didn't want to stop running. So I started back up and my left hip started complaining loudly. Pain. I had to walk after a mile.

I think there are three things going on:

* I was told a long time ago that my left leg is shorter than the right, giving my hip muscles more work to do, generally, than the right leg. This is why they gave me orthotics 17 years ago.
* I expect my hip muscles are weaker than I would like, and my IT band is much tighter - this seems to have been made worse by my time in marshmallow shoes and orthotics which is when I used to have much worse hip pain than today.
* I run exclusively on steeply-cambered country roads without sidewalks, facing into traffic, which extends my left leg a bit further than the right.

I think I have hip bursitis - ie. inflammation where my tight/weak tendons and muscles are rubbing over each other at the hip. The standard way to diagnose and fix this is a shot of anaesthetic and cortisone into the bursa itself. If that relieves the pain, that's what they tell you - "hip bursitis".

I'm trying to avoid the doctor. And I'm also trying to avoid taking *any* anti-inflammatories (not even ibuprofen, which has bad effects elsewhere for me). And I'm trying to avoid the need to stop running altogether.

I started doing some exercises to strength the flexors and extensors. I started stretching out the hip.

I've continued to run every day, but until the last two days, with a maximum of about 3 miles, which is when the stiffness typically starts to become a dull pain. There seem to be no specific ill-effects to this, other than I am clearly not resting my hip, so perhaps it will not get better. But as soon as I stop running, there is no pain.

I have been working out my hips - "side planks", the Foundation core workout (thanks Gordo) and yoga stretches for the hips. I've recently added foam roller workouts on the hips. My hips certainly feel freer, and I am able to run further without pain than I could 3 weeks ago - I'm doing 3-5 miles a day without pain, and things seem to be improving.

But, am I crazy to try it like this? Is there really no cure but RICE? Is my body really telling me to rest (it doesn't feel like that - I feel wonderful otherwise from running, and I stop before this gets painful)? Does anyone have any good hip exercises or other advice? I'm really missing my long runs, and I think I'm still some way off from being able to run as far as I'd like. It's been almost a month, and the rest of me is itching to run far again.

JohnK


Re: [Minimalist Runner:126593] Re: Healing hip pain Hermine Stover 11/14/12 1:57 PM


On Wed, Nov 14, 2012 at 1:46 PM, John (NoVa) <eil...@gmail.com> wrote:
Yeah, I have the same short leg/hip issue.  For me, increasing the knee bend was the main fix.


having legs and arms of different lengths is not rare. it is the reason custom tailors measure each leg separately and each arm. human beings are quite asymmetrical. it is how one compensates which can become a problem.
herm 
Re: [Minimalist Runner:126593] Re: Healing hip pain John Kemp 11/14/12 2:01 PM
"For me, increasing the knee bend was the main fix."

What exactly do you mean by increasing the knee bend?

JohnK

P.S. I've tried running on the other side of the road and even in the middle of the road. That doesn't help right now... nor does the dreadmill.
Re: [Minimalist Runner:126593] Re: Healing hip pain John Kemp 11/14/12 2:10 PM
" it is how one compensates which can become a problem."

Yes. Especially if you make the same movement and hit the ground with that compensation hundreds of times a day.

JohnK
Re: [Minimalist Runner:126593] Re: Healing hip pain John (NoVa) 11/14/12 2:40 PM
Just bend your knees more than whatever you are doing now.  ;-)  So if your knee angle is 160 when your foot is below your hips (with 180 being straight leg), try 155.  Or maybe think about "running shorter".

I don't have any scientific explanation of how this would help, I just know that it helped me.  All I can say is that by doing this I felt like I was running more gently and probably was moving shock absorption off of my hips and onto my quads (or in any event, that's how it felt).  Another way I think of it is that the straighter your legs, the more the leg length discrepancy matters, and vice versa as you bend your knees more (as you are free to bend your longer leg more to compensate for the difference).

Good luck!
Re: [Minimalist Runner:126593] Re: Healing hip pain gordo 11/14/12 2:57 PM
On Wednesday, November 14, 2012 2:57:40 PM UTC-7, hermine stover wrote:
having legs and arms of different lengths is not rare.

Having them appear different lengths due to muscle imbalance is not rare at all. Much more rare is actual skeletal asymmetry. And the asymmetry is caused by compensation, so you could say that compensation issues are key. And you'd be right. ;)

Gordo
Re: Healing hip pain runs_with_kona 11/14/12 5:41 PM
You were able to run 10 miles w/o pain and another 16 miles to finish the race.  This means any imbalance or defect in your form is going to be very subtle. Look at this as a blessing.  It's not easy to address a flaw that only shows up after running a marathon.
Re: [Minimalist Runner:126602] Re: Healing hip pain John Kemp 11/14/12 6:14 PM
"You were able to run 10 miles w/o pain and another 16 miles to finish the race.  This means any imbalance or defect in your form is going to be very subtle. Look at this as a blessing.  It's not easy to address a flaw that only shows up after running a marathon."

Funny you should say that. As I was driving home today I had the same thought. I am blessed to have got so far in my running as to be able to work on such a subtle flaw ;)

Trouble is that I feel so good from the aerobic fitness that it is difficult to keep myself from simply running as fast as I can for as long as possible, pain be damned! But, again, it's a good problem to have... and I'm taking up rowing (a new sport for me) for the remainder of my exercise needs while I scale back the running ;)
Re: [Minimalist Runner:126602] Re: Healing hip pain runs_with_kona 11/14/12 6:44 PM
6 months later, I'm running 9 miles (4.5 up and 4.5 down) 5 days out of 7, and the other 2 'rest/recovery' days are variable (3~5 miles with lots of walking mixed in).  If I run fast down hills several days in a row, I can feel my left knee whispering but so far no complaints from the hip. I added a second dog named Guz to my run 4 weeks ago.  She has not been a regular runner like Kona, so my fast down hill is defined/limited by how far back Guz is trailing. I'm glad I fixed that hip issue.
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