Left thigh pain

Kori Martini

Need some help from the medical community, as I'm baffled. My left thigh is seriously hurting me. It "seems" fine when biking...maybe a little twinge in my hamstring area, but not pain. A couple of weeks ago, I went out for an easy/short run and my left thigh felt painful and not right. I was borderline limping by the end. Didn't run for about 4 days to let it rest (still did long rides, etc). Saw my sports med doc who said it's not a stress fracture and diagnosed IT band. i've had IT band and this is not that. The whole like quad/hamstring/inner thigh hurts. LIKE THE WHOLE THIGH. What the hell is that??? After resting it for awhile, I was able to run 8 miles on back-to-back days the following week. It was still ouchy but not as bad. Ran a 15-miler and it didn't hurt at all during the run, but the next day, I was almost limping again. WTF????? I can't find a pressure point on my leg that triggers pain. I can't stretch anything that makes me think "yep, that's it!" I'm just clueless. As is my doctor. No history of any stress fracture stuff, and I seriously doubt I could run on it for 15 miles if it was that.

It hurts more to lower myself down a step (like going downstairs), and it hurts more in the morning. After I "warm up" it feels significantly better, but still painful. I'm seriously lost on this one. Going BACK to my PT tomorrow to try to figure it out, but I need help on this one. What the heck?? Anybody have any thoughts? I'm beyond irritated with this one. I know I can get the runs in, I just have to space them apart and manage the discomfort the day after, but this obviously concerns me as I don't know what it is or if it's going to get worse??

Satish Punna

Hi Kori.  Sorry to hear of your troubles.  Pain coming on after activity and first thing in the morning suggests to me tendonitis or enthesitis (think plantar fasciitis). The gracilis is a muscle that lives in the inner thigh and can be injured by overuse, but any or all of the other muscles and tendons here could also be involved.  Does abduction with hip flexion or extension hurt or hurdler's stretch?  See if you can find a thickened muscle band on the inner thigh.

new2703

Hard to say. Could be anterior hip impingement due to tightness of the posterior joint capsule. Try this. Lying on your back pull the right knee towards your chest and see how it feels and what you feel. Repeat with the left. Things to feel and look for. Does the left go back as far as the right? are there any deviations in the direction of the thigh? Do you get pinching in the groin? Test 2: lying on your back with hip and knee bent to 90 degrees rotate your lower leg out to see how much internal rotation you have. Compare both sides.

new2703

Additional test: Put your hands on your greater trochanter and do a SLR does your hand/ greater trochanter appear to travel in a anterior/superior direction or does it stay stationary and provide a nice looking fulcrum

Kori Martini

John - I would love to do that second test, but I haven't had enough time to Google all the instructions. In my career, SLR means either Square Loop Resonator or Scalable Linear Recording. :-)
I did see my PT after an 8 mile run yesterday that ended with me feeling a great deal of discomfort. He thinks I have an irriated (inflamed?) hip joint. I'm icing the crap out of it and planning to scale back to 2-3 runs per week. Not exactly where I wanted to be in my season right now, but I don't have a choice. My friend (ER attending at UofM) is writing me a script for x-rays and potentially an MRI, since my athletic med doc seems to think it's ITB (which it's clearly not).

Kori Martini

Satish - Hurlders stretch does NOT hurt (the back of my thigh DOES hurt when I'm getting into and out of the stretch but not during it). Abduction and Adduction does not hurt either.

Satish Punna

Hey kori. Glad to see you are getting your hip looked at. Morning pain can be a sign of an inflamed joint so that is a good thought. It's unusual to inflame a whole hip joint with activity so some sort of bursitis should also be considered, but I assume your PT tested for the usual suspects. Does your hip pop or snap, can you sit with your affected leg ankle crossed on top of the other leg, is range of motion restricted in extension? if it were me i would stop any activity for a few days though, especially anything weight bearing or that exacerbates symptoms, until you know exactly whats going on (I don't know when your race is). X-rays are a good first step and overview but will yield limited information. MRI is the best test, bone scan could also be useful, but I would go with the MRI if you have the means as it would exclude anything serious. How long does it take to get one of those for you?

new2703

Sorry. SLR equals straight leg raise

cgres123

Kori, man your gonna hate me, but since you asked, I suggest you stop running. I'm not a Doc but around here it's said that, the injury/pain, is your new coach. If you want to keep running do it in the pool until you heal up and or find the cause of this. You are not suppose to have pain, end of story, exhausted, sore and some mental fatigue perhaps but pain not so much.

Kori Martini

John - SLR actually causes the discomfort. Very weird, but I feel the irritation/sensation down the front AND back of my thigh when I do a SLR. It feels better with rest, so I'm going to attempt my run tomorrow as planned. I'm guessing I'll be regretting that afterwards, but I won't run THROUGH pain anymore.

Dave - I wish I could just bail on running, but I'm too close to race to completely give it up. I'm spacing runs apart and not running through pain anymore. It usually only hurts the day after (or later that day).

Satish - I'm planning to request an MRI. I feel like my doc is kinda blowing this off as IT band, which I'm having serious doubts about.

cgres123

@ Kori, MRI good idea let us know the results.

new2703

If I remember correctly you had an injury last season? What was it and what side? Still suspect anterior hip impingement. Typically present with anterior translating greater trochanter with SLR, tightness in IT band/ lateral quad, weakness with tenderness in gluteals and piriformis. Another possibility is SI joint dysfunction.

Kori Martini

Hey John - I had PF on my left foot...same side. Here's the thing...there's two things that I have going against me. One being that I had ACL sx on my right knee about 12 years ago, which seems to make me want to favor my left leg since my right is weaker. I'm working on strengthening it again. It never hurts per se while training but I also only ever get running injuries on my left side. Coincidence? I think not.
Also, I had twins in June of '11 (two years ago now and close to one year before IMLP last year) and my PT things I have some sciatic nerve compression from a weakened core and also from doing the hunch-you-back thing that I do about a thousand times a day with diapers and cribs and highchairs and carseats galore. He thinks that the twinges I get in my left hammy are somewhat from this (as well as what we "though" was PF). Long story short, I feel like a mess all of a sudden. This bugs me since I've done 20+ marathons and been running distance since '98 and just NOW I'm all injury prone???

new2703

Do straight leg raise while tightening core and see what that does to your pain. If it eliminates or makes it better you know the core is involved. Have your PT look at L5/s1, SI joint and pubic symphysis esp with your history

Kori Martini

John, thanks for the info. I see my PT again on Wednesday and will mention all of what you said above.
I ran 16 miles this morning. I do my long runs on either Monday or Tuesday, just due to scheduling. It wasn't super fast and was on a pancake-flat rail trail (less impact since it's a softer surface), but I'm hoping it means I can work my way through this leg injury. I definitely felt it but it wasn't super duper painful. I wonder if it will be tomorrow. All I keep thinking is that this can't be a bone-related issue (like a stress fx) if I can run 15 or 16 miles on it without the pain getting worse as the run progresses. It all seems to live in the back and outside of my thigh while I run. The only time it's downright painful is when I stop running and then start up again. Takes a few steps to settle in. It never was completely normal and pain-free, but it wasn't bad enough to stop. I know I'll have to wait 2-3 days to run again though. I'm dunking myself in ice baths for 20 minutes after ever hard workout. Not sure if that is recommended, but it seems to be helping.
So frustrating to not know what this is.

Kori Martini

John - the L5/S1 thing is pretty much right on. Turns out I lack (greatly) pelvic rotational control, so I have a whole slew of exercises I'm supposed to do. I guess I'm glad its not more severe of an injury, but at the same time, when it's bad, I CAN'T run through it. I'm going to keep working on it. I can't believe that a back issue can cause pain this severe in my LEG!?!? That doesn't make a ton of sense to me, but as long as it gets better....
Any additional thoughts?

new2703

Kori Glad to hear things seem to be heading in the correct direction. The biggest thing to think about is L5/S1 is probably a symptom of something else going on. When looking at "rotation issues" causing stress to the lumbar region it is usually in response to lack of movement else where. Its simple physics really. If an area doesn't move the way that its suppose to other areas will pick up the slack and as a result things start to break down. Start by looking at hips. Want to check hip extension, flexion, internal and external rotation , and hip abduction and adduction. Want to assess range of motion and how they impact the back. For example, when rotation your leg out to the side does it cause your back to rotate. If you extend the hip does it cause the low back to arch excessively. Once normal movement is established you'll get a better idea about strength.