Left Hip Pain in the 38 year-old-marathoner
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Susan, a 38 year old marathoner from Iowa came in for an initial consultation and possible treatment to left hip. The patient was referred to Caring Medical and Dr. Hauser by a local physical therapist in Iowa, and also from another runner patient from University of Iowa track team. Susan is training for a marathon in April (Nashville Rock and Roll Marathon). She started noticing discomfort in her hip when running around 10 miles. She did a 13 mile run 3 weeks ago and stated her hip was extremely tight the next day. The few times she has tried to run, she has not been able to run more than 3 miles due to pain. Susan reported that she could not even run a mile yesterday when she tried. Susans pain radiates into left quadriceps and down the lateral aspect of thigh and knee on physical examination by Dr. Hauser. She also reports pain when she pushes her left foot off the ground but says there is no crunching.
After a thorough physical examination, Dr. Hauser recommended that Susan have her left hip and left sacroiliac joint treated because there is instability in both areas. She said she did not have pain in her low back area, but reports stiffness in her low back in the mornings.
Dr. Hauser told the patient that she has some hip and sacroiliac instability, as well as benign congenital hypermobility syndrome, which means that her ligaments and joints are looser than most peoples. This is a great mechanical advantage for athletics and good for aging, but this means that she is more likely to get an injury (because her ligaments are already stretched out). Ligaments have a very poor blood supply, so when they are injured, its difficult for your body to adequately heal the injured ligaments. Because her hip and sacroiliac joint are unstable, her piriformis muscle is trying to stabilize her hip and when the piriformis muscle tightens up, it can compress the sciatic nerve, which can cause the flat footed feeling she is experiencing when she tries to run.
Dr. Hauser felt Susan was a good candidate for Prolotherapy. He felt that she needed her hip and sacroiliac joint treated. He recommended that she do the elliptical for 3-4 days post Prolotherapy. He reminded the patient to remember to keep her chest up when on the elliptical and when running to protect her pelvis. If she can do the elliptical hard (with intervals), then she can start running. Dr. Hauser recommended she start a 3 mile run in zone 1. Then jog for 2-3 minutes and walk for 1-2 minutes during the run. He also instructed her to not do any speed work until she can run 10 miles in zone 1 (heart rate 125). If her hip is bothering hurting, she can try shortening her gait. Dr. Hauser thinks there is a good chance that she will still be able to do the Nashville Marathon, but she might not be able to do the speed work she wanted to do. After the marathon, she should do strength training 3 days per week for an hour at a time. This will help you to tighten up your joints/ligaments and will help to prevent future injury.
To strengthen your hip, Dr. Hauser recommended she do the one legged balance exercises on the Bosu ball. He also recommended that she learn to swim, because swimming will strengthen muscles that she doesnt normally strengthen with running. Running does not cause arthritis. Non-healed injuries cause arthritis.
Dr. Hauser felt that her treatment today should cause her hip/back to improve right away. But if it does not, then he recommended that Susan come back again in two weeks. If you see some improvement, then come back in 4 weeks for a second treatment.
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