Glute or Hammy twinge with A-race 6 days away!

David Flint

 Hi Leigh - i've been carrying a muscle niggle on my left leg, think it came on after I wedged my cleat on that side.

Its immediately under my buttock & I can relieve the pressure/numbness (not an acute pain thankfully) by digging my thumb into the groin side of the lower buttock line. 

Doing a normal hamstring stretch irritates it;  self-massage on that seems to relieve the pressure on that point and I'm then more flexible thru the hammy.

Can bike OK - despite it being close to the glute, cycling doesn't seem to cause any problems - can run OK, feel a soreness but certainly doesn't appear to prevent me from doing any pace runs. On the hamstring stretch - if I grab either side of the ham when stretched, the soreness goes away.

During my swim warm-up, doing some back-stroke, the kicking aggravates the condition.

OK, appreciate this injury would benefit from time-out to heal up - but, with my A-race 70.3 on sunday, is there a technique to strap up the offending area? I have KT-tape and have tried the usual hamstring support taping with limited results - the soreness appears too high to be hamstring but not high enough to be piraformis. 

Any tips? I appreciate its tough without an examination but any taping I could do will hopefully stop the injury getting worse - planning on a 2 week break after my race! 

Thanks,

Dave

 

 

Leigh Boyle

with it being that high up at the insertion point, the KT tape can help with the hammie itself but the reality is that you'll need someone to dig out that upper part.

Their video for hamstring pain is the one you'll want to use. here are my modifications- lay on your back + start the tape about 1-2" below the sore spot. just lay down the first 2" of the tape with no tension on it. then straighten your knee and pull your leg up in the air (like you would do if you were trying to stretch it). stretch the tape 1/2 way (meaning not full tension on the tape) and lay that down along the center of your hamstring (be sure to lay down the last inch or so with zero tension. Then cut a second piece. this one will go horizontally on the leg versus vertically like the first piece. you'll want the piece to be about 6" long. the goal is to put tension on the middle and then lay the ends down. You'll want it to go about 1-2" down from the first piece so upper thigh but not right at the top there.

if it were me, I'd get in to see a sports massage ASAP. let them dig it out today and then ice and gently stretch like it's your job until race day and wear compression tights if you've got them. No running this week unless it's pool running to stay loose.

David Flint

Thanks once again Leigh -
I'll get on it straight away - hopefully it will get me through the weekend and then I can rest & heal it properly. Appreciate your input.

David Flint

Hi Leigh - to update, got through my 70.3 race all OK - the hamstring was sore the day before from standing around, even though I had it taped - slightly niggly during the swim but no problems on the bike at all - as an aside, that cleat wedge you suggested seems to have done the trick, thanks! - on the run it only played-up a little when I tried to push the pace (to what I wanted to run at), kinda like a warning sign which went away when I backed off.

Wondered what your thoughts would be on next steps with this? It is sore now - but both legs/all muscles are pretty shot at the moment. If I visited a physio would they just recommend rest and strapping? I have carried this injury for a month now so a 2 week rest break may be just what it needs BUT don't want to rest-up 2 weeks & then have to start rehab from there.
Any thoughts welcome,

Thanks, Dave

Leigh Boyle

Gave you a few more days to rest up and get past the post race muscle soreness. how are things feeling now a few days out??

Did you ever get that sports massage?? does your physio do lots of hands on work or are they more the exercise variety??

David Flint

Hi Leigh - legs coming 'back' now but left hamstring still niggling and restricting stretching - source of 'pain' is high still under the buttock line but is also moving down the ham' when I stretch.
Managed the complete 70.3 without any issues - only when I tried to push things on the run did I get a warning signal.

No, didn't have time to get a sports massage - by the time I researched a local guy (and procrastinated!) he was booked up - did my self-massage which helps but mainly to alleviate the tension/pressure caused by the other muscles, e.g. ITB rolling helps.

My physio appears to be more 'hands-off' providing exercises/stretches etc.

Having another week of transition but it would be nice to try and shake this (doubtful I guess) so I can start IM training (Out Season probably).

Best route to follow now?

Thanks again,

Dave

Leigh Boyle

best route = get it dug out asap. with it being up that high, really hard to get to yourself. strongly strongly recommend you get to the pain free point prior to slipping into OS type workouts. typically not the kind of injury that responds well to intensity. the longer it sits in there and dries out the tendon, the better the chance of you snapping it off the bone. Have you looked into other physio's in your area??? they can't all be hands off over there.

David Flint

Yikes! Thanks Leigh, I'll get onto it immediately - will let you know the outcomes if I may? I guess it will be good info for everyone else in the future.

David Flint

Hello Leigh - still trying to heal my hamstring issue - 4 weeks ago I visited the physio who provided a series of active stretching exercises to isolate & I guess stimulate the area (to re-cap, at the attachment point, close to my groin) - no real change, slight improvement and able to do Z1 easy runs for 3-4 miles or so - tested it last week with some HIM/IM type pace stuff and soreness started again - this time with the soreness transferring down the rest of the ham'.

Back to Physio - we're trying a different attack - this time more plyometric style exercises and a thermaband one.

One of the exercises is a dynamic jump onto high box - thing is I can't find one! Physio suggested a bed (no good, bed too low) & stairs are too shallow - can you recommend an alternative?
The other exercise is the 'Frankenstein walk' which does pull at the upper hamstring, a good one. Need more to make up a mini-circuit.

We are reviewing in 2 weeks time - not running at all, just extra bike (no pain) and swimming (only when kicking hard doing back/S).

Any observations / advice would be much appreciated.

Thanks!
Dave

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Leigh Boyle

you need a manual therapist, someone to massage and stretch it all out. exercises are all well and good, but not if the initial injury is still adhered in there.

David Flint

Thanks once again for your response - I value it!

Ok, tried to reach Physio, on vacation but did get a call back from his colleague who ran through the notes & my thoughts on some massage therapy - he doesn't see why not and saw it as complimentary - suggested some local therapists, one of which I know from the local cycling scene.

Typically, had my head up my ass as per usual and didn't realise that the therapist is ex-triathlete with a 8:58 finish at Roth, Kona twice, a 2:38 fresh mara' PB and was the '08 UK 24-hr TT National champ! Doh!

Hope he's as good at massage! I'll let ya know...........

David Flint

Hi Leigh - had the massage with 'my man' - kinda cool, his treatment room with cycling & Kona poster from 1988 I think it was! :-) He qualified at Roth, didnt set out to but after qualifying, thought 'why not, Kona sounds fun!' - did it twice and suffered each time and couldn't crack 10hrs which was his goal!

Anyways, good massage, spent an hour & going back on Monday for 30min session - continuing the plyometrics + stretching and no running. Hopefully, this process will improve the condition - physio appointment in 1.5 weeks time.

Question is, although cycling doesn't cause any discomfort, would you consider stopping cycling,as well as running, while going through this process? My rationale is my suspicion that sat in the aero position hammering the glutes/hams may be limiting the recovery.

OK, the plyometrics are deliberately targeting the offending area, i.e. to prevent the body neuro-muscularly 'protecting' the injury - this also may be happening on the bike, however the shortening of the ham in the pedal stroke may be stressing the injury - for all I know Leigh, the bike (and wedging my left cleat 3mm, the same side as this injury) may be cause of all this - running just brings on the soreness due to the action/impacts involved.

What ya reckon? What's 2 weeks off in the scheme of things? I can swim OK so can keep the aerobic side going. Am I actually getting wise in my old age & standing-down! No! Cant be! :-)

Thanks again,
Dave

Leigh Boyle

if it were me, I'd stand down completely and make healing this thing once and for all your priority. There's too many variables between swimming, biking running to truly pinpoint the actual cause and if you guess wrong you can definitely prolong recovery time. I also say stay the current course- it's gotta be that tag team of massage + stretching/strengthening. Two months = tendon/muscle changes due to the initial injury. You need the soft tissue work to reverse that as exercise alone won't cut it.

Time to be the patient. Use the free time to maintain everything else. Foam roll your calves, quads, ITB so that massage guy can work on the problem area instead of digging out other stuff. Stretch. Ice. repeat often.

David Flint

Thanks Leigh, I'll keep at it - real frustrating as its not as though I'm getting acute pain but know that could happen if I pushed it; if not the same hamstring then perhaps the opposite knee or something - calves extra tight since the injury...............



Another piece of the jigsaw! :-(



Best,

Dave

PS. Leigh - can I ask your opinion on the rehab exercises my Physio has set me? Although I see the logic, the rehab session do make me sore.

His rationale is that we need to 'get at' the offending area and break down the adhesions and scar tissue at the injury site - it does feel as though there's a minor separation of the tendon at the attachment point.

So, the 1st protocol / idea was to stretch at the area - this didn't seem to work - next step, try plyometric & active stretching exercises to stress the area and allow healing.

Again, the exercises seem to inflame the area - massage takes the pressure off  the area as you'd expect. I see the neuro-muscular logic to all this, i.e. if we don't stress the area the body will just by-pass the area and not heal. However, I wonder if the soreness felt after the sessions  are setting me back some more - if 'active' rehab to stress the area works, why don't I just run on it?

Physio said he was confident that other damage wouldn't occur by training on it - how he can say that I don't know, perhaps 'cos I've no apparent loss of range of movement.

On the verge of deciding to take a day off work next week and travel to see another physio - more time/money etc, etc (the other physio isn't local, 2.5hrs drive away and also charges twice the price!). Could be worth it though........

Know all this is tough when you can't examine me but you thoughts are always valuable in my process - appreciate it!  

thanks!

 

 

Leigh Boyle

Hang in there. it's superfrustrating and honestly, if it was just the muscle that was cranky, you would have been done and healed by now. When it's the actual tendon/insertion point, it's a whole other ball game and the fact that it's an area you literally sit on all day, doesn't help speed up the process.

Typically when I'm working with someone. I expect them to be sore following the first few sessions. That being said, it shouldn't be sore past the week mark. So if you're still sore after weeks in PT, then the exercises may be too agressive. Plyometrics are helpful, but there are a million different ways to achieve the same kind of stress to the area (ball bridges with hamstring curls, single leg up and over lunges, single leg dead lifts and squats). Might be time to back those down in intensity and get some changes first before jumping straight to the difficult stuff. 

Is there anyone in your neck of the woods whose Graston certified (grastontechnique.com)?? Works specifically on tendons and can be performed while actively moving the hamstring to break up all the adhesions in there.

A second opinion is a good thing. What credentials does this guy have before you drive hours away and drop the $$??

David Flint

G'day Leigh!

Thanks for your support and encouragement - yeah, injuries are always a real pi**er - especially when I could train on it but there's always the concern of making the original injury worse or picking up some compensatory injury - already have asymmetry issues, although this may even me up a tad! :-)

Re; 2nd opinion - the PT I have in mind is a guy called Kent Fryth who's married to (and works with) Joanne Elphinston - Jo is one of the leading exponents of movement analysis & stability, particularly using the pilates ball - her book has sold loads of copies in Europe - worth a read Leigh. http://www.getontheball.co.uk/get_on_the_ball_tutors.html

and http://www.amazon.co.uk/Stability-Sport-Performance-Movement-Technique/dp/1905367090/ref=sr_1_1?s=books&ie=UTF8&qid=1281453957&sr=1-1

Hopefully having a phone consult with one of them first of all before making the trip. Massage going well - last session (#2) he really got into the injury.

Graston technique seems kinda new in UK although my local chiropractic college (AECC) has it listed on their syllabus - not sure if there clinic practises it however, need to check - good grief, another massage therapy out there!!

Keep ya posted - at this rate it'll be cheaper to fly out to the US and see you! (that'd look good on your website huh?!)

Dave

David Flint

Leigh - does my condition sound as though it could be either hamstring tedinopathy or Ischiogluteal bursitis?? This is from my own research I might add - if its IS, then I understand that massage would do very little?

Spoke with other physio, conversation was too quick, however did recommend more eccentric exercises - it seems that the 1st physio's sessions includes eccentric but also concentric.
If you have any links to good exercises, lunges etc that eccentrically load the ham' & drive thru' the glutes, then I'd appreciate it.

Thanks!
ps. at least I'm learning some stuff! :-)

Leigh Boyle

I think it's a hamstring tendinopathy- that's why I was recommending graston actually. think of it like a tendinitis that stalled during the healing process. the result is a dried out tendon that no longer has the flexibility and elastic abilities that it used to. When you stretch/contract the hamstring it then just pulls on a tendon and keeps it aggravated.

what kind of core stuff are you doing as far as glute/low back? anything or is the focus strictly on hamstring. lunges and squats work more on quads and glutes than hammies.

David Flint

Nothing at the moment for core or back - kinda took a back seat due to this - have a back stretching program that I do daily however. Since I posted today, i was thinking that tendinitis made sense as it would also explain why during stretching etc the numbness/pain transfers down my ham' - would that happen with bursitis?

Back to the core etc - I do have a good series of ball exercises that have helped in the past plus using the elastic for 'monster walks' etc for the hips.

Leigh Boyle

I would stop the lunges/squats/monster squat stuff for a bit and work on bridging the gap between glute/hamstring/low back. that means stability ball exercises like bridging, hamstring curls and back extensions etc (http://www.ehow.com/video_4938608_stability-ball-bridge-exercise.html). all of plyometric squat stuff just reinforces your quad dominance.

how often are you getting the numbness/pain?? ever had your back looked at x-ray/mri wise?