Hamstring Injury Help Needed In A Big Way
I'll try to keep it shortish, as I can ramble (update, I didn't). IRONMAN Maryland coming up 9/28.
After a year of the best running in my life, big PRs from mile to marathon, a run streak of 329 days, and using Stryd to exclusively run by power without a care for pace, it all came crashing down in an instant on Sunday August 11th.
Sunday the 11th was the last split long run on plan before going to the single long run leading into IM. 9 miles done in the AM, smooth as glass, no problems, couldn't have been happier. Had no issues. Came home, went though my normal post run routine of pretty much doing nothing, having a meal, and relaxing before moving on to the days pretty mundane and unexciting and not physically demanding in any way activities. Get ready to go out for 2nd half of run, just steady Z1 to TRP power. Go to a loop I have run hundreds of times, so wasn't anything new or unusual. Things are going good. Its super hot (as is always the case in NC in the summer). I'm a bit fatigued, as one would expect having done a 100 mile ride with 5 miles off the bike (7:45/mi pace, which is a relatively moderate effort) the day before and then 9 that morning. But I feel no pain or even soreness anywhere. Just tired but moving well and keeping my power steady in the range it should be. Then at 3.6 miles, in the blink of an eye I have a searing pain in my right hamstring. I take 3 hop steps to come to a stop and know this isn't good. So I walk about half a mile back to my car. While my hammy/leg is 'sore' but not in pain, my walking stride is not affected. No limping, favoring the leg, no gingerly stepping. Its pretty much normal. The remainder of the night is uneventful and the leg doesn't impact activities.
I go to the pool the next morning and swimming is 100% AOK. No issues with kicking, flip turns, pushing off the wall. All is normal. I decided to end the run streak at 329 days and take the night off. Tues is "Max Effort" intervals on the bike. 10, 20, and 60 second all out efforts. NO issues at all. None. Its like my leg is in perfect working condition. I crush the workout. I take another day off running. Wednesday, back to the pool in the AM. Again, its a normal day with zero issues. I do not run (and don't run again until Sunday, we will get to that).
Thursday is SST Intervals on the bike. Over/unders basically. Perfect. No problems. Friday is Big Gear work (high power, low cadence). Another perfect workout. Saturday do 102 on the bike, went great, feeling good, leg is giving no indication anything was ever wrong. I brought sneakers incase I wanted to try a run of the bike. While everything is feeling awesome, I decide its probably best, or at least not harmful to take another day off of running.
Sunday is 2 hour long run on plan. I do not plan on doing this. I just want to try a run for a few miles and see how it feels. If feeling good, maybe go as far as a 10K. Plan is to keep it Z1/TRP power. Starts off fine. No issue. Leg not even sore. Half mile, no problems. 1 mile, no problems. Alright, we might be good. 1.5 miles, feeling great. 1.8 miles, BOOM! The same pain locks me up in an instant. Done. Walk home.
During the previous week I had made an appointment with my PT to get dry needled and evaluated on Monday. I'm thinking its a cramp/tightness/irritation issue. I knock out the morning swim, again with zero issues, I go in to PT and as she is rubbing my hamstring and feeling around she says its totally cramped up, and feels like there is a log in there the muscle is so tight. Get needled and go about my day of sitting at my desk being sedentary but walk around a lot and have a heating pad under it for 20 minute intervals several times. Ride an easy <Z1 10 miles on Zwift when I get home as she suggested an easy ride to keep things moving. No running. Tuesday is Max Intervals on the bike, crush it. Weds AM swim, perfect. So I'm feeling good. Weds PM try to run. There is some soreness. But I attribute that to the needling. Its a soreness, not a tightness. Made it 2 miles, feeling good. Then at 2.1 miles the exact same thing happens. Blink of an eye, pain and I'm done. Thursday swim perfect. Did 116 miles on Zwift yesterday in 5:16 and it was probably least fatigued I have ever been after such a long ride and my legs honestly felt like they hadn't really done much work. No soreness, no fatigue, nothing. So whatever is going on only affects the run and has zero impact on swimming and biking.
I'm going in for another round of needling Monday morning and hoping it gets this thing to release and loosen up. If infant that is what the issue is. Coach P had suggested to explore it possibly being the sciatic nerve. Nothing thus far indicates that it is from my past experience with sciatic problems and a quick conversation with my PT to get her thoughts on it being a factor/reason.
So who else has encountered a similar thing were swimming and biking are 100% perfect, and even better than perfect, but a hammy just will not under any circumstances allow running of any level of effort and how does one go about getting something like this fixed and fast? I've resigned myself to knowing I will not be at peak running condition or ability come race day and I'm fine with that as I have to be. But I am not fine with and not looking forward to a the likelihood of a 7 hour walk for the marathon.
Also, I am not prone to cramps ever in any part of my body. Never have been. The only issue I have ever had with cramping my entire life has been in my calf during really long swims and every once in a blue moon when standing up to exit the water during an OWS. Other than that, cramps don't really exist in my life.
Nutrition, sodium, hydration, etc... are all on point and consistent with what they have always been. Nothing new has been added to the diet or subtracted from it. No life changes. No additional activities piled on. All of life is consistent and the same as its always been.
I need some help over here. Thanks!
Comments
@Brian Terwilliger Not sure I have an answer but I did not hear you mention any stretching, rolling to otherwise loosen up the hamstring, assuming you have the green light to do so from your PT. Your description of a feeling like a log seems to go beyond muscle tightness/cramps.
A few other questions/thoughts?
Have you changes your shoes, new ones?
Other things that maybe contributing I find that chair that are too high can add to the tightness in my hamstrings but this seems well beyond that.
How is your cadence as you increase intensity running? If you are increasing your stride instead of cadence you could be over utilizing the hamstring muscle.
Finally I know that you note no other issues with swim or bike but cycling does utilize the hamstring muscles and maybe contributing to the muscle fatigue which overwhelms you while running.
Have you tried one of the magic potions for cramps, like pickle juice or HotShot?
@Brian Terwilliger: so sorry to hear this. Have you ever heard of the Neubie? It is basically electrical stim on steroids.
https://www.neu.fit/
Perhaps your PT know of someone in your area that can provide treatment.
I use a DCT Proflex to help 'elongate' the hamstrings:
Sounds like the 'log' in your leg is one huge knot, and the DCT Proflex device can help heal the knot.
Good luck with this.
So to hear about your hamstring. I've had a few hamstring issues to include minor pulls to being very tight. My sports certified Chiropractor worked magic applying ART to my hamstring. Two to three sessions over 2 weeks, then once a week. It was very painful but effective. It's also important to find out what's causing your hamstring to be tight. Weak or non-firing glutes or hip flexors could be making your hamstrings work harder than designed.
@Brian Terwilliger Does your PT have a electric stim and ultrasound? I've had several similar situations and both these techniques worked to get in there and loosen the muscle. What's interesting is that it happens at almost the same place in your run. Just enough to fire up the muscle then get locked up.
Acupuncture is another route. Or is that what you mean with needling? I've tried it. It can work if you multiple sessions.
@Sheila Leard
Dry needling.
https://www.apta.org/PTinMotion/2015/5/DryNeedling/
A couple years ago I had a calf cramp that also halted my running and with 1 session it was like brand new. So hopefully session #2 on the hammy tomorrow will do the trick.
I think at this point I've resigned myself to not running again for an extended period hoping that laying off completely for a period will provide enough relief, healing, etc... that come race day in 5 weeks it will have 'repaired' itself enough to get through 26.2.
But will see what the PT tells me to do in the days following to help get it to loosen up and hopefully completely let go. I think I've built up enough of an engine and have enough running in the tank this year that I can get through the IM run pretty well IF I am able to run. If not, gonna be a long walk.
My current harebrained scheme is to give it a test run a couple days before race day. If I can get through several miles feeling good, then I'm going to race as if everything is normal. Stick to standard swim and bike protocol and then pray for the best on the run. If however I still can't run, then its all going out the window and I'm treating it like an aqua-bike and going to attack the bike like the run doesn't exist. Because it doesn't.
Sports medicine physician is best to rule out other causes, but ART by a chiro to work on hammy but also something else may be tight or have limited ROM which is putting more strain on your hamstring which they can work on as well.
@Brian Terwilliger I feel your pain. I damaged a Hammy in January and still haven't recovered. a ton of ART work 3x per week got me through IMLP. The IM didn't go as planned, which is a mystery to me as I did a camp 2 weeks before where I had an awesome 17 mile run the day after doing 2 full days of 112 mile rides with Bricks. So hopefully you will do better.
My ART guy and I discussed dry needling (which is not legal in NY state) and he also has a practice in CT and felt it would't do anything more for me than the ART.
If I were telling you what to do, I would say to start doing ALL of your runs at a slower pace. do NO speedwork. run every day, but lower mileage per day to nail your weekly mileage goals. Start with a shorter "long run" and see how it goes.
FWIW I gave the recommendation to Andy Lustigman in January when he had a Achilles problem and he followed and ran the Half Mary of his dreams in March.
My situation was similar to yours, zero issues on the bike & swim, big issues on the run. If you go back and read my race plan for IMLP it was to nail the swim & the bike, Run as I normally would and hope I stayed together (I didn't)...
that's the best advice I have for someone going through something similar. THE biggest issue is going to be how your body starts to compensate for the injury and all of your form starts to change and damage other items. I had an MRI today and am likely getting PRP injection once we see the results. I do have a pretty clear high hamstring tendinitis/tendinosis on the left and possibly right sides..
I'm really sorry to hear about your injury, @Brian Terwilliger. It sounds like you have a PT that you like and trust. Sending good thoughts your way.
@Brian Terwilliger I'm actually dealing with something similar to this now. It started out as a hamstring injury I thought as my pain was at the origin of the semimembranosus (1 of the hamstring muscles). I had to stop running as well. I tried dry needling as well at the glute med (which is where the origin of that hamstring muscle is and the ischial bursa as well.) and it helped relieve the pain and numbness. I did some more research and discovered that my psoas muscle was tight. This became a hip-spine syndrome. I worked on some area specific exercises to target the glute/hamstring origin area and its much better after about 3 weeks. I tried to run over the weekend and just did a mile with little to no pain after an hour and 15 min on Zwift. You might try using the elliptical and keep the ramp flat. I've found that working forward and backwards on the elliptical has helped strengthen my glute med also. I'm am athletic trainer and I take care of athletes with sports medicine injuries. It's funny that I'm the one injured now. Haha! My season is over but I'm just working to get better before the Outseason starts up.
I am not sure if it would apply here, but during @Gabe Peterson Leadville 100, he used CBD Balm. Maybe something to look into for race day at least.
If it's inflamation, CBD might be a good option. What kind of balm (what brand, if you don't mind sharing) did you use, @Gabe Peterson ?
@Brian Terwilliger, how did the PT go yesterday?
@Brian Terwilliger I struggle a lot with a similar hamstring issue. Biking is no problem, walking is no problem, but running hurts. I've had "the other kind" of hamstring issue where there is bruising etc.; that is clear to diagnose. The one that I struggle with is never 100% clear if it is a hamstring, referred sciatica (if so is it caused by psoas?)... those three things have a lot of the same symptoms and are, ultimately, over training issues. I hate that term - over training - because I get the issue no matter how "smart" I try to build.
I've tried most of the things mentioned above with varying levels of success. This year, I started using a TheraGun. I called a Orthopedic Dr friend and asked him if he could inject my hamstring 😂and he told me "no flipping way... but I will loan you my TheraGun."
I took him up on his offer, because I planned to leverage its failure into some kind of injection 😁
But - the TheraGun was magic for me. It relaxes the area in less than a minute. I use it before / after working out, when I wake up etc. I still have a little discomfort and get flare ups, but so far, the TheraGun makes them go away and I am able to run and do hard run workouts.
They are expensive - I ended up buying a refurbished one. If you know someone that has one, I'd give it a try.
Last thought - I'm a big proponent of stretching, but the general advise is not to stretch an injured hamstring until you have taken a couple weeks off and given the injury time to heal. I would check with Dr / PT before doing any stretching. On the other hand, if it is one of the other causes (psoas, referred sciatica, etc), stretching will probably help. Get medical advise and be careful!
@Janyne Kizer and @Brian Terwilliger the CBD balm is Muscle MX. It looks like you can buy it online now. Before I could only get in from my sports PT in Salt Lake City. I don't have any stake in this company. It helped me when I was injured after the Bear 100, to manage tendonitis in my knee leading up to Wasatch 100, and this year I discovered it reduced soreness in my legs at the Leadville 100 during the run.
Thanks, @Gabe Peterson !
Now that we are a little more than 2 weeks removed from IMMD, thus greatly reduced training load and intensity, the leg is healing up nicely. This confirms my thoughts that it was an overuse injury as I was putting in some very high training loads, particularly on the run.
Loaded up the post IM 4 week plan and have stuck to it pretty well. But all that Z1 running was getting to me so decided to take the legs out for some strong efforts and have been able to get back to running sub 7 minute miles without pain or the leg sending any little reminder twinges to back off or its gonna bite. So hopefully another couple weeks of this then getting into a little of the durability plan before training for Boston starts. That will be the real test on if things are healed or not.
My favorite website on the science of pain! Lots of good information on muscle issues.
https://www.painscience.com/
update on this since my post above - a week and a half ago I had 2 PRP injections to my hamstrings (Ouch!) but now on the mend. No biking for 3 weeks, no running for 6.. trying to avoid food!
how are your hammy's doing post IMMD @Brian Terwilliger
@scott dinhofer
The leg seems to be coming around nicely. I believe that I just pushed my body to the limit on the volume and intensity it could handle between the bike and run, then went over the edge and my body told me to knock it off. Post IM it seemed to quickly start to improve and runs on the Post IM recovery plan have been going very well. Non stop Z1 running drives me little nuts so I've mixed in some faster intervals and have been able to start running sub 7 miles again without any real issue. But keeping that to a minimum. Will be moving into the balanced durability program in a few weeks, so hopefully will be mostly recovered and ready for action by then. Thanks for asking.