Hi Jo, although I said above I am training for my first marathon, it is the second one I have entered. Two years ago I displaced my kneecap playing football 10 weeks before the marathon (in my last game before giving up to concentrate on training) and subsequently lost two months of training.
I had been back in training for one week by marathon date and still had my registration and was SO tempted to run it as I was devastated at the prospect of missing out, but common sense took over in the end. It was tough, but the most important thing is your health and doing yourself justice. If you're not fit, don't run. There will be planty more races.
Sorry if this isn't the answer you were looking for!
I am writing in this forum, for a few reasons. Firstly so no one will make the same mistake as me and develop chronic disabling pain, and secondly to see if anyone can provide any additional advice.
I have (or had) been running for 12 years with no significant injury up until last year. In that time period, I ran 10km on a daily basis, plus several half marathons, and a couple off road 30-40km runs including mountain tracks, in the snow, etc. I mainly ran for personal enjoyment. I absolutely loved it, running was such an important part of my life. .
Approximately, 10 months ago, my sister asked me if I would like to enter a 36km off road race in NZ. I eagerly agreed, and started a training program with gradual increase in running mileage. Near the end of a 20km run, I developed a sudden onset of posterior left hip pain. I really did not think much of it, continued to run without resting the injury. The following weekend, I did another 20km training run. At the 12km mark, my left posterior hip pain returned forcing me to walk. Unfortunately I continued to train. At this stage my hip pain would flare at the start, and end of runs, whilst driving, or sitting for prolonged periods. I ignored the pain, never seeked medical attention (being a medical professional myself), and continued to run. Nothing was going to stop me until one day in october, I was walking and the dull posterior hip pain increased in severity to the extent I I could not continue walking. The pain was sharp and localized to posterior hip/SI region. I could barely make it back to my car. Since that day, I have not been able to walk more than 5 minutes, let alone return to running. My symptoms include a constant dull posterior hip ache, worse on sitting, walking, and can radiate down the posterior aspect of my thigh, to lateral aspect of my calf and dorsum of foot. In the morning, I will often get a sharp posterior hip pain on standing, and taking my first steps, or bending. If I relax, and stop moving it will gradually reside. There have been a couple of occasions the pain has improved, to the extent I can walk for short periods, however often exacerbated by simple activities (travelling in unsupported back seat of car, or carrying 4kg). Then I am back to square one with that terrible dreaded sharp morning pain.
I have been to see sports physician, who queried the possibility of a sacral stress fracture. The MRI was normal (of course). He referred me for a dynamic USS of my hip ? sciatic nerve tethering/nerve entrapment- piriformis syndrome. The radiologist told me my sciatic nerve was extremely tethered, and was the worse case he had seen. He then proceeded to perform a sciatic nerve hydrodilation injection to release the nerve. This was a very painful procedure, and exacerbated my pain. A second injection was done 4 weeks later with further worsening of pain. They then repeated an MRI focusing on the piriformis muscle to see if this was causing sciatic nerve entrapment and tethering and whether surgical treatment was necessary. The MRI was not convincing, however the radiologist thought there was some sciatic nerve entrapment at the piriformis. Thus I was referred to an orthopaedic hip surgeon who felt the diagnosis was still unclear. When he reviewed the MRI he ? labral tear. There was also oedema around ischial tuberosity where hamstring attaches indicating tendinopathy, although I had this on the right hip as well (common finding in runners). I had a hip joint injection to exclude a joint cause, with no improvement in symptoms. The orthopaedic surgeon feels I would benefit from a piriformis muscle release and sciatic nerve release.
I am very hesitant to proceed with this, given the diagnosis still remains unclear. So I did some research on piriformis syndrome diagnosis, and decided to have a LA in to the piriformis muscle. This was done by CT-guided. Unfortunately, my sciatic nerve was hit, and caused ++ pain. Then I asked the radiologist to advance the needle more medially away from the nerve. When it entered my muscle, I felt this tightening/cramping pain, and thus the procedure was aborted. That night again I was in sooooo much pain all I could do was lie on my stomach, and try not to move.
Currently, I have decided to continue with a conservative approach of gentle gentle physio (no manipulation as this gives me sharp pain the next day), massage, and rest. (no stretching- makes it worse) Despite reducing my activities, my symptoms persist. Thus I have decided to take 6 weeks leave from work to see if this helps as my job involves getting up and down constantly. If this fails, I really do not know what to do. I am a 30yr old female doctor, and had planned on having kids in the next year which is obviously not an option now. I am depressed, frustrated, and just want my previous life back. I have started to get counseling on pain management etc. This helps to a small degree.
So my take home message, is rest if you are injured!!!!! Pain is a sign you are causing damage and need time to heal, re-assess your running biomechanics, and ensure you strengthen any muscle weakness etc. Find a good physiotherapist.
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