Wednesday, October 30, 2013

A second opinion

With this problem getting up to nearly 3 years since it first became apparent, I thought it time to seek an 'expert' opinion. Today I visited a specialist in sports medicine. She was just as perplexed as I am. I was surprised that as a specialist she wasn't familiar with the studies from South Africa about acquired training intolerance. However, as has been confusing me, it is hard to rationalise soreness/stiffness occurring only in the glutes/hammies with a generalised muscle problem (the quads at least should also be affected). My iron levels have dropped again, but similarly, it is hard to use that to explain the localised nature of the muscle discomfort. She examined me from a biomechanical perspective and my hip region is very weak (I have had this pointed out before for some running 'niggles'). Weak muscles could be predisposing them to fatigue (although that doesn't really explain all of the symptoms). Also, are they weak and causing fatigue or is an underlying fatigue problem making them weak? Chicken/egg ...... To start with I'm to do an intensive hip rehabilitation program of multiple exercises for the next month (argghhhh, I struggle with sticking to physio exercise plans). She has advised me not to run until the hip region has better strength, although gentle cycling is still okay. I will also have more lab work, this time focusing on muscle parameters. Finally, the glutes and hammies will be the focus of an MRI study to see if there is any detectable abnormality in the muscle tissue. So much for the magic bullet I so hoped for. Maybe we will know more in a month's time.

Where's that magic bullet when you need it?
Recommended exercises to rehabilitate the hip include:
Hamstring stretches
Quadriceps stretches
Scissor leg raise in lateral recumbency tilting forward to work the glutes
'Clam' in lateral recumbency tilting forward to work the glutes
Squeezing a ball between the knees while lying on my back with the knees at 0, 30 and 90 degree angles.
Bending at the knee while standing on one leg and keeping the hips horizontal - no tilting (knee needs to track over second toe).
Using a theraband around the ankle to work the leg sideways (both ways), forwards and backwards.

8 comments:

  1. I was doing all those excercises late last year when I wasn't running due to a heel problem...boring but you do get into a routine...

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    1. Thanks Bron. I've created a 30 day Hip Rehabilitation Challenge to do in attempt to stay motivated! The exercise don't seem like much, but they sure work the right muscles!

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  2. Interesting. It would be good if it was a biomechanical weakness as that's something that can be easily (apart from the boring nature of physio exercises) fixed. Makes sense -- cycling uses the quads (as does downhill running) so there could be an imbalance in strength between the front and back of the legs. Ask her about hamstring strengthening exercises when you see her. I think I need to do those!

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    1. I need to do hammies strengthening as well.

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    2. Thanks ET. Somehow it doesn't really explain all the symptoms and why do I have fatigue issues in the same muscles when cycling (when trying to push the tempo) where biomechanics are completely different? I also would have thought that injuries would be more the issue, not fatigue and sore muscles. But there is no doubt there is an imbalance, so a period of strengthening won't go astray. It's all rather perplexing. So plan is to follow what the Doc has suggested and also up the iron.
      Curls are good for hammies.

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  3. An imbalance between strong quads from years of cycling & hammie weakness may have caused the strong to overtake the weak & the poor cells haven't had a chance to recover & stayed weak. If the glutes are also affected, then lower back muscles might also be a problem as these also hold or help hold the hip area in place. Go with the glute/hammie strengthening & hope they improve without the quads taking over. Chicken & egg is right, solve one & the rest may fix itself. Good luck, keep at it, you will win one day.
    Nice to see you again last Sunday, take care.

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    1. Thanks TF. Yes, no doubt there is a big imbalance. But I would have expected there to be more in the way of injury issues rather than this weird training/exercise intolerance. Also, why did it take a few years of running before I developed the problem? I did plenty of glute/hammie exercises in the gym. Clearly they don't work in the appropriate manner! Anyway, 'tis best to follow the suggested plan and see how it goes.

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  4. Yep, follow the experts & see if there is an improvement. You are not injured as such, but an ongoing fatigue. Those little cells must be tired or worn out. Need more time, take care & stay upright on the bike.

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