Right ham/glute always tight=knee pain
So I will get my question out right away and then tell my story. My right glute/hamstring is almost always tight after running or biking and I get occasional right knee pain. Does this mean that my right side is dominant and accomodating for the weak left side or vice versa? I have been stretching and strengthening the right side more than the left but it occured to me that perhaps it already is the dominant side!
Here is the quick story. Knee pain began as I prepared for my first HIM in summer 2008. I gutted it out for the season and then did PT, saw the best knee doc in Cincinnati, got an MRI, etc. Neither the PT nor the doc thought I had a leg length imbalance issue. I did not have any knee damage on the MRI. We all just chalked it up to triathlon repetitive stress issues. I was told my the doc and the PT to strengthen "all the muscles that connect to my knee." They wanted me to focus particularly on the quads. They gave me exercises which I did faithfully; I cut way back on running, and all was well for 2009 though I took it easy with only Olympic distance races. With that behind me, I am gearing up via EN for Ironman Lousville 2010. While this is not new really new, now more than ever my right side hamstring and glute are very tight and this translates into the knee pain/soreness reoccuring in the right knee. Before I redouble my efforts to gain strength and flexibility on the right side, it occured to me that perhaps the real solution is to strengthen the other side. By the way, Spin Scan indicates the left side is slightly weaker than the right on the bike which got me pondering this.
I also know that getting a professional opinion on my biomechanics for the run and fit for the bike will help. Any other counsel based on experience is appreciated!
Comments
1) I wouldn't put too much value on the direct comparison using SpinScan. It interpolates the relative power input of each half of the pedal rotation, but each half is a combo of downpush on one side and lift on the other. Just like with your running, it would be hard to know if SpinScan shows your right half is slightly stronger whether it is because you are pushing down harder on the right or pulling up harder on the left relatively. FWIW, I usually show about 48:52 on the SpinScan ratio myself.
2) I suffer from similar problems, although I do seem to alternate between left and right legs as to which is more of a problem at any given time. I agree that flexibility seems to be a big limiter and whenever I am tight, I seem to pick up more knee pain issues. I am trying to increase my stretching substantially right now, with morning, noon, and evening sessions. This does seem to be helping. I am doing 3x10 minutes, mostly focusing on hammies, calves, IT band, quads, plantar fascia.
3) I am very skeptical of the whole muscle imbalance theory as a source of problems, at least in the sense that doing isolated lifts to try to strengthen a particular muscle doesn't seem to help me, nor if I judge other athletes who embark on that strategy does it ever really seem to help them either. [If anyone disagrees feel free to chime in. I'm not being dogmatic, its just that many friends who have been told they have "muscle imbalance" and should do x,y,z pretty faithfully do x,y,z and see no benefit at the end].
4) I do think running form may be implicated. Personally, barefoot running seems to really help my knee issues, but does increase stress on calf so proceed carefully. I still mix the barefoot in with regular running shoes.
5) Biking may be a culprit too. We spend a lot of time aero with backs bent forward. Switching to run then forces everything to stretch out which increases stress on the ITB, which is a very common cause of my own knee pain.
Just random thoughts of mine. If anyone has a bulletproof answer, forward it to me too!
I hadn't thought about the push-pull on the Spin scan. Great point.
I can be more diligent about stretching as you are doing.
I also would love to hear from anyone else who has cured an imbalance issue. I do think it may be bike biomechanics so I will get that checked out.
I got vibram five fingers in October, so I also am mixing in some low cushioning work to improve running biomechanics.
Thanks for your thoughtful response!
Scott
Scott-
When you say glute and hamstring pain- where? Deep in belly of hamstring? Whole length? Worse just above knee and below butt? Where is knee pain? Inside? Lateral- (closer to hand on same side) or medial (closer to opposite side)?
Are you using a foam roller on quads, ITB?
How do you stretch? Which exercises, how often, before or after exercising?
I think more info would help.
As an example N=1: What seemed out of the blue, I developed severe R hamstring/ glute pain with a continuous ache that got worse with driving. (Knock wood- I have never had knee pain except when bumping into furniture). No stretch or rolling seemed to help. After trial and error, turned out I had spasm in very lateral aspect of hip rotator. Firm pressure significantly increased the pain EXACTLY. I am now a faithful foam roller of the ITB and trigger point ball to hip. I can still replicate that discomfort, but it is very mild these days. There are so many ways to cause pain....
Michele
For clarity, the glute and hamstring are tight not necessarily in pain. It is the knee where the pain shows up plus the glute ache described next. I would say the entire hamstring is tight, more lateral than medial. When the hammie is really tight is when I get also get an ache in the glute, kinda lower/middle of the butt. The knee pain is right above the patella - dead on center to slightly lateral.
I do lots of stretching of the hamstring including lying on my back, extending the leg up in the air and stretching via a cloth strap. I then rotate the hip first to the outside and then across my body to the inside. Finally I do hip flexor stretches very much like the first two in this clip from livestrong:
www.livestrong.com/video/2787-do-hip-flexor-stretch/
I have a trigger point set and do feel it when I use the roller on the quads and the ITB. I am much more faithful with the stretching than with the TP roller so probably need to make sure I am using that every day, even twice a day. It sounds like I need to include the ITB, hip flexors and even quads as possible culprits here. If it is upper leg, stretch it and massage it!
It sounds like you had something similar and resolved it. Good to know. Perhaps soon we'll have N=2.
Thanks for any additional advice for me on the journey.
Scott
Scott- Just got a chance to watch the video. Yup- good stretches.
Look at this one.
www.youtube.com/watch
Ah yes. She didn't realize it was truly a compliment. My husband has been working on an animated video about cults- oops I mean triathlon.