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Pose Method runner w/ Hip pain, post meniscus rehab.
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Pose Method runner w/ Hip pain, post meniscus rehab. - February 8, 2007 9:48:00 AM
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rru2s
Posts: 17
Joined: February 7, 2007
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I am a Pose Method (ball-of-foot) runner. After months of conservative rehab from a serious knee meniscus injury (volleyball), I had to learn a new way of running over 01/2006 to 12/2006, but then recently I injured my hip in Dec. 2006.
SIDETRACK: Pose Method of running is different biomechanically, but easier on the knees. You land on the forefoot/ball of foot, land with slightly bent knee, no foot pushoff just a pull of the rear foot, short compact strides, and landing directly under (NEVER FOOT IN FRONT) of center of mass.
CURRENT HIP INJURY:
In December, I had been running 6 miles X 3 days per week, plus elliptical 80 minutes X 2 sets per week. Over the fall/winter 2006, running distances were held constant for each three to four week period, then I would increase each run by 0.5 miles.
Hip injury occurred new years eve 2006. I have stopped running for 3 weeks after having anterior pain in RIGHT HIP with each weight bearing step with delayed onset beginning 1 hr. after (but not during) running. Event No.1 occurred on Dec. 31 after a 6.7 mi.run. One hour later strong hip pain approximately near the iliopsoas bursa whenever I tried to initially stand up and put a foot down, or with each step of walking, etc. This lasted for 3 days, gradually subsiding. No pain on any type of non-weight bearing leg or hip motion/rotation. After the pain was gone, then tried to run again 2 more times that week; each time strong hip pain returned immediately after running and gradually diminished over following 2 days. So then I rested 10 days, NO impact sports, then I tried to run an easy 3 miles on Jan.17, but afterwards had severe pain once again. Since Jan. 17 I have completely avoided running, distance walking (other than day-to-day getting around), even avoiding elliptical. All achiness in right hip has been gone since 1 week after my last run Jan. 17.
This could possibly be an injury to either iliopsoas muscle, it's attachment area, the iliopsoas bursa over the hip joint, or even a stress fracture of the femoral neck.
So far I have only been examined by my GP, who recommended 4 weeks rest. No MRI, bone scan, or Xray were recommended yet. Since femoral neck stress fractures can be misdiagnosed as hip flexor in runners (found many cases of this on running web forums), therefore I am being cautious and am restricting myself to 4 weeks of only upper body workout - swimming and upper body weights. After 4 weeks have elapsed since my last attempt to run, I will do core strengthening workouts (non-impact) for two weeks, then at the 6 week point I will resume elliptical (3X per week), and then at 8 weeks begin walking 1.5 to 2.5 miles (3X per week). After 11 weeks, will beging easy sets of pre-running drills, then if no pain, after 12 weeks, begin actual running with 1/3 mi. intervals X 3 sets X 3 per week, then over next 3 weeks I will gradually increase running volume until I try continuous runs of a total distance of 3 mi. each X 3 per week (by week 16 after the last injury event).
WHAT IS THE SOURCE OF THIS INJURY SO IT DOES NOT RECUR IN THE FUTURE?
BACKGROUND - PREVIOUS KNEE INJURY:
LEFT KNEE, MRI confirmed torn lateral mensicus after injured in volleyball, July 2005. Could not straighten knee past 30 degrees for a week (catching). Did long workouts sitting and flexing knee ("air bicycles"), and after 10 days made tear go back into place. Several other catching incidents, gradually diminishing over next 6 weeks. 14 days post injury, started elliptical 3X week. Knee ROM restricted to 3 degrees less than full extension for over 6 months, with sharp anterior joint line pain and feeling of hyperextension if I suddenly applied a straightening force to front of knee or otherwise accidentally forced knee to extend more fully while standing.
I immediately felt harsh pains from the planar contact area of tibial plateau and femoral condyle when I first tried to jog 100 feet about 8 weeks post injury. My walking gait was quite abnormal for months, but very gradually improved. I started limited treadmill jogging (heel striking) from 2.5 to 3.5 months, but stopped jogging when pain suddenly returned after I increased duration to intervals of 0.8 mi. X 4 sets. Harsh and achy interior joint pain occuring during 2 runs and lasted 3 to 7 days afterwards. So I stopped running from month 3.5 to month 7 and only did elliptical (which I have kept doing since knee injury through Jan. 17 2007).
NEW RUNNING METHOD AFTER KNEE INJURY:
7 months Post-injury of knee I started Pose Method of running...NO KNEE PAIN. Over 12 months worked up from 1/3 mile intervals (1/06) to 3 miles continuous runs (4/06) to 5 mi. in fall '06 and 6 to 7 mi. in December 06. ALL RUNNING 3 days per week ONLY.
Before each run, I do drills as follows: Stand with 75 percent body weight on front foot, 25 percent on rear trailing foot. Pull front leg up with hamstring rapidly and let it drop, 45 reps. Also, 2 sets of stand on 1 leg on ball of foot, pull other leg up like flamingo, then let it drop rapidly, barely touch ball of foot, and pull rapidly again. Meanwhile support leg's heel taps with each drop of other leg. These drills have more impact stress and are harder than actual running.
BIOMECHANICAL ASPECTS:
Suspect biomechanical imbalance may have contributed to RIGHT HIP overuse given 18 month earlier I injured my LEFT KNEE MENISCUS. Had abnormal gait for about 6 or 7 months, lack of full extension. My lower back would always be "tired feeling" on RIGHT hip flexor attachment area. But the recent hip injury is felt only in the FRONT of HIP, right over the femoral head, but also diffuse pain radiating over iliac crest and somewhat down over the upper thigh. Not likely labral tear because no pinching feeling, or pain DURING run, or pain with non-weight bearing rotations.
QUESTIONS TO ANSWER:
What should I do to come back to running so this does not recur? Is the Pose Method flawed? No one on the [URL=http://www.Posetech.com]www.Posetech.com[/URL] website has had hip flexor injury or femoral neck fracture so I doubt it. I posted a running video to their website and nobody noticed any imbalance or left-versus right running gait discrepancy. They did note that I had been crossing over my legs -- knees would almost touch and both feet touchdown are in center of body, not directly under hip.
This post serves 3 purposes: (1) Testimonial to conservative rehab (air bicycles initially and then 300 minutes per week elliptical) for long term rehab of torn meniscus, even given locking catching for first 6 weeks off and on; (2) Testimonial for Pose Method of running for reduced knee shock (actually there is a research paper on their website which measured impact forces); and (3) intriguing questions on the influence of my past LEFT KNEE INJURY on my current RIGHT HIP injury and how to come back to running safely.
Note -- I was a heel strike runner for 27 years before tearing meniscus during volleyball in 2005, never any serious long term injuries. Previous mileage averaged 30 mi/wk, 3 runs per week for all those years. Since beginning Pose in Jan. 06 worked up to 18 mi./wk, 3 runs per week. Currently 49 years old.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 8, 2007 2:13:00 PM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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A little knowledge is dangerous. Go to a PT or orthopedist and get your hip/back/pelvis checked out. It has gone on too long. You are in absoulutely NO position and obviously lack the qualification to rule in/out anything based on the symptoms you describe.
BTW - You have, in this post alone, provided me, a clinician, some insight into your self-centered and ultimately self-destructive way of thinking about yourself and your ability to manage potentially serious health issues. You do not have the capacity to self-diagnose and treat - even if you were an MD,PT,DC,etc.
I am absolutely not bashing you, I am genuinely concerned. PT's are extremely accessible and qualified to help you figure things out and there is no reason you should NOT consult someone who can thoroughly examine you and get OBJECTIVE info from your situation. There are so many other things you could be dealing with here, and it appears you are hanging your hat on a lot of pop info you have read.
Your meniscal injury certainly may be responsible for some other sort of overuse situation - however, to exemplify my points above, you let an extremely common injury and subsequently routine surgical intervention go on for a long time while causing you impairment and disability. A course of PT with/without surgery with a running-oriented clinician would have expedited your return to function - undoubtedly.
Get worked up by a qualified health care professional. You are an older athlete, these things are going to start happening to you more and more, and you need to get a handle on them early, not only after you have failed yourself with inappropriate pop management.
_____________________________
Ed, PT, MTB-XC
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 8, 2007 5:10:00 PM
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rru2s
Posts: 17
Joined: February 7, 2007
Status: offline
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[QUOTE]Go to a PT or orthopedist and get your hip/back/pelvis checked out. It has gone on too long[/QUOTE]It would seem prudent to see an Orthopedist first to perform/order the proper tests for a diagnosis, since my primary Dr. hasn't made a definitive diagnosis.
On Jan. 19, my primary Dr. examined me and prescribed one month of no running or impact exercises, after which he said I could try drills then a test run (less than 1 mile).
Should I ask for a referral BEFORE or AFTER the one month is up, without trying to run again?
I am concerned on what basis the insurance will justify referral, yet don't want to set myself back again by running too soon.
[QUOTE]...self-centered and ultimately self-destructive way of thinking about yourself...[/QUOTE]I am confused as to why you regard this as "self centered" when I am asking for input in how to best approach a hip problem when I have already seen one Dr. and am awaiting a one month rest before trying to run. It is hard for the consumer to decide when to push for a referral when the primary Dr. is HMO and is encouraged to NOT make excessive referrals, meanwhile the orthopedists love to recommend surgery for anything they have a convenient surgical procedure to attempt to fix a particular malady. That is why I approached a PT forum -- for advice from a community of PT prefessionals who may have a different idea of what to do next. A PT should be aware of patients coming in with hip problems that have not yet been diagnosed with MRI/bone scan/Xrays, and should know when to push for more definitive diagnostic information before starting a treatment plan based on assumptions regarding the source of the problem.
[QUOTE]you let an extremely common injury and subsequently routine surgical intervention go on for a long time while causing you impairment and disability. A course of PT with/without surgery with a running-oriented clinician would have expedited your return to function - undoubtedly.[/QUOTE]Regarding the meniscus tear injury, I got a prompt referral for an orthopedic surgeon within several days of the injury...I made sure the OS was one of the best in my area, but the earliest appointment date wasn't for 8 weeks. I called back several times to check for cancellations and push up the date to 6 weeks. He did Xrays and MRI, and the radiologist read them and confirmed the tear. At the followup OS visit he stated the following recommendations: The tear was not in danger of being an urgent problem, so I could wait a while and see if it got better; or I could schedule a menisectomy with him. He said I could live with it, but it was a "heck of a nuisance".
So I opted to see if it got better over time, which it did. I was more patient that most people, since it took 6 months to get back ROM.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 9, 2007 4:13:00 AM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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You need to be a strong advocate for YOURSELF - screw the HMO and your primary MD if he/she is having clinical decisions being strongly driven by an insurance company.
Perhaps use of the term "self centered" is inappropriate - I apologize and certainly did not mean to offend. Your first post gives the impression that you take it upon yourself to take care of your medical issues, and there was no indication that you may have been limited by bad medical advice/insurance coverage. And make no mistake, you are recieving bad medical treatment- for the "best" ortho in your area to have you wait 6-8 weeks before seeing your locked knee is ludicrous. Your approach to your meniscus tear and your plan for return to running are very obviously not being medically directed, and they should be.
Like I said, you are an older athlete, and obviously a passionate one. Your doc obviously has no appreciation for that. You need to assemble a team of healthcare players that are going to be responsive to your needs, as it is likely that you will continue to be athletic for years to come and will face issues unique to older athletes. The sooner you take proactive steps to find the right people, the better off you will be in the long term.
I have no confidence in a primary MD's ability to perform a clinical musculoskeletal exam on an athlete's hip. I have further concerns that your MD did not do any sort radiological study.
You will be hard pressed to find anyone on this forum to give you specific clinical or self treatment advice - we just don't know enough about you. This is why I urge you to get yourself checked by the appropriate clinician(s).
If you live in a PT direct access state, consider going to a good sports PT clinic and paying cash for a thorough evaluation - it will be tremendously worth it. I'm sure there are plenty of people on this board who can help direct you to a clinic.
THIS IS WHAT YOU SHOULD DO NEXT!!! DO NOT WAIT.
If you reply/PM me with your state/zip code I can PM you with some PT's in your area.
_____________________________
Ed, PT, MTB-XC
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 12, 2007 5:15:00 AM
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rru2s
Posts: 17
Joined: February 7, 2007
Status: offline
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I called the PT you recommended, and they told me my HMO does not cover their company. Insurance requires a doctor's order for PT and requires that a person utilize only their list of specific PTs based on each county.
So I am back to getting a referral for an OS, who will do a better diagnosis, and go from there if PT is recommended by the OS.
Since I am paying over $500 a month for my HMO policy for full coverage, it is ridiculous for me to have to pay cash for PT when it could be prescribed by a Dr.
It is putting the cart before the horse to have a "thorough evaluation" by a PT or to actually start PT therapy when an OS has not even done the proper diagnostic imaging tests for accurate diagnosis.
The reading I have done is not "pop" medicine. I have researched numerous journal articles written by MDs regarding hip problems, and they all agree hip problems are one of the most common misdiagnoses, and certain imaging tests are the ONLY way to do an accurate differential diagnosis:
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O'KANE, JOHN W. Anterior Hip Pain. Cover Article. American Family Physician. October 15, 1999.
http://www.aafp.org/afp/991015ap/1687.html
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Browning, Kara H. Hip and Pelvis Injuries in Runners - Careful Evaluation and Tailored Management. THE PHYSICIAN AND SPORTSMEDICINE - VOL 29 - NO. 1 - JANUARY 2001
http://www.physsportsmed.com/issues/2001/01_01/browning.htm
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Iliopsoas Tendinitis
http://emedicine.com/sports/topic52.htm#Multimediamedia9
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Femoral Neck Stress Fracture
http://emedicine.com/sports/topic37.htm
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Hip Overuse Syndrome
http://emedicine.com/sports/topic49.htm
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Hip Fracture.
http://emedicine.com/SPORTS/topic48.htm.
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Avers, Dale, et.al. Taking Care Of Your Hip. American Physical Therapy Association.
http://www.apta.org/AM/Template.cfm?Section=Home&CONTENTID=20885&TEMPLATE=/CM/HTMLDisplay.cfm
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St. Barabaras Medical Center. The Five Most Common, Undetected Sports Injuries.
http://www.sbhcs.com/hospitals/saint_barnabas/newsletter/family_health/fallwinter2000/injuries.htm
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Harmon, Kimberly G. MD. Lower Extremity Stress Fractures - Practical Management Clinical Journal of Sport Medicine: Volume 13(6) November 2003 pp 358-364.
[URL=http://209.85.165.104/search?q=cache:jhDYUe37mkkJ:www.cjsportmed.com/pt/re/cjsm/fulltext.00042752-200311000-00004.htm%3Bjsessionid%3DF18BK4hvKSyX12XKRvRwpXr40nfvyjyYVw3vYWhPx95GgCvD82Cx!406032005!-949856144!8091!-1+total+rest+stress+fracture+femoral+neck&hl=en&gl=us&ct=clnk&cd=12]http://209.85.165.104/search?q=cache:jhDYUe37mkkJ:www.cjsportmed.com/pt/re/cjsm/fulltext.00042752-200311000-00004.htm%3Bjsessionid%3DF18BK4hvKSyX12XKRvRwpXr40nfvyjyYVw3vYWhPx95GgCv D82Cx!406032005!-949856144!8091!-1+total+rest+stress+fracture+femoral+neck&hl=en&gl=us&ct=clnk&cd=12[/URL]
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Long term outcome of undisplaced fatigue fractures of the femoral neck in young male adults. Journal of Bone and Joint Surgery - British Volume, Vol 88-B, Issue 12, 1574-1579.
doi: 10.1302/0301-620X.88B12.17996
http://www.jbjs.org.uk/cgi/content/abstract/88-B/12/1574
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Mishra, Allan. Hip Flexor Injury
http://www.emedx.com/emedx/diagnosis_information/hip_pelvis_disorders/hip_flexor_outline.htm
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Johnston, CA. Treatment of iliopsoas syndrome with a hip rotation strengthening program: a retrospective case series. J Orthop Sports Phys Ther. 1999 Apr;29(4):218-24.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10322594&dopt=Citation
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Perron, Andrew. Principles of stress fracture management. VOL 110 / NO 3 / SEPTEMBER 2001 / POSTGRADUATE MEDICINE
http://www.postgradmed.com/issues/2001/09_01/perron.htm
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Shultz, Sandra. 2005. Examination of Musculoskeletal Injuires. Human Kinetics. Champaign, IL. ISBN 0736051384
http://books.google.com/books?vid=ISBN0736051384&id=-2RL0p3wClkC&pg=RA5-PA482&lpg=RA5-PA482&ots=F_JpzDb7xv&dq=iliopsoas+bursitis&sig=opSXs95aYcJL8f9fYgUSAp7lRh8
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Each branch of medical treatment has it's own self-serving bias -- general practitioners would like people to keep coming back without going to specialists, while orthopedic surgeons would like to do surgery even if a wait-and-see approach is medically justifiable and less risky in the short-term, to chiropractors who would have you ignore the MDs altogether, and PTs who think they can diagnose better than MD specialists despite their inability to perform or order diagnostic imaging tests.
Insurance companies are supposed to make sure diagnosis and treatment are performed in an objective manner. However, often they appear more focused on cost savings than on a commitment to the best quality of patient care.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 12, 2007 2:54:00 PM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
Status: offline
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I'm glad you were able to make contact with them. It is unfortunate that they are not CIGNA providers and I agree that it IS ridiculous for you to spend additional $ out of pocket - but it is an unfortunate reality that many people face in order to get the best and most appropriate care.
Your point about putting the cart before the corse in regards to getting a thorough PT evaluation is highly debatable. PT's are highly qualified to perform detailed clinical examinations of the neuro-musculo-skeletal system and recognize signs of serious pathology. There is no necessity for prior MD consult in many cases. The goal of a PT eval is NOT to diagnose medical pathology, but to identify impairments that are amenable to PT treatment. If serious pathology is suspected, referral to a qualified practitioner will be made. A good, sports/ortho oriented PT will do an extremely thorough clinical examination that compares to one performed by an orthopedist. Your second article citation by Browning describes a portion of what a typical PT will do for someone with your complaint - did your PCP do anything resembling what was contained in the article?
I initially recommended that you seek a PT or orthopod, you enlightened me to your HMO situation, I then suggested an out of pocket PT evaluation (assuming you are in a direct access state), ONLY because it became obvious to me what you are up against with your gatekeeper. It is a sensible, low risk, cost-effective, and expeditious way for you to get some insight and answers, not a difinitive diagnosis. I never intended to suggest you see a PT INSTEAD of an MD, only while you were waiting for them to get their acts together regarding your care.
I will not argue with you regarding the biases that exist in health care. You are right. However, insurance companies are more interested in cost containment rather than objectivity.
If, in fact, the articles you posted were studied by you prior to your initial post (and not collected over the weekend), you should be quite angry. There is some very good info in those articles,(I have not read all of them) and as you've acknowledged, there are gold standard methods for diagnosing hip pathology - they are imaging studies, not 4 weeks of rest.
Please continue to advocate for yourself. And keep us posted on your progress.
_____________________________
Ed, PT, MTB-XC
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 12, 2007 3:03:00 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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[QUOTE]If, in fact, the articles you posted were studied by you prior to your initial post (and not collected over the weekend), you should be quite angry. There is some very good info in those articles,(I have not read all of them) and as you've acknowledged, there are gold standard methods for diagnosing hip pathology - they are imaging studies, not 4 weeks of rest.[/QUOTE]Yes, I had the articles a month ago BEFORE I visited my Primary. I even photocopied some of them for the visit. I was afraid to show them to him because in general most doctors act very arrogant whenever a patient tries to relate technical knowledge. All I showed him was a written record of my chronological injury history. Then when I suggested that MRI would be the way to tell apart femoral neck stress fracture from soft tissue injury, he just said, "he didn't think" it was stress fracture. My response was, "well here is a copy of my injury history, because time will tell, so I want you to have this on file so that if I need a referral later you have the documentation."
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 13, 2007 2:06:00 AM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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You should never fear discussing anything with your MD, especially well researched info. Although an MRI would probably not be a first-line diagnostic imaging choice in your case, He should have had some discussion with you regarding his decision NOT to investigate your pain further (via XRAY or orthopod referral).
It is difficult for untrained people to fully comprehend the complexities of diagnosis and treatment of musculoskeletal disorders. However a patient like yourself - one who is obviuously intelligent, diligent, and inquisitive and who strives to be an educated consumer of health care, deserves better consideration.
Again, keep us posted.
_____________________________
Ed, PT, MTB-XC
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 13, 2007 4:38:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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It is like watching 24, I am waiting fo rthe next episode!
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 14, 2007 4:47:00 AM
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USAPT
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Joined: January 14, 2004
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My vote is a consult from House, MD
rru2s,
Don’t be afraid to speak to your GP (you're paying for the visit). Be demanding but couth as they do lose $$ should they refer you out. But that is their job when the s/s are out of their expertise/ knowledge base (which most of all would agree that musculo-skeletal assessment is).
you pay $500/mo for coverage??..thru work?
_____________________________
Jason, PT
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 14, 2007 1:35:00 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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Biweekly my employer deducts $292 for HMO coverage of self plus 2 or more dependents ($632 per month). In addition, because we are living together but not married, they consider her daughter and my gf as not pre-tax deductions, so my W2 reports income I never see as the portion of the pre-tax medical that does not qualify as pre-tax by Federal rules, equal to $82 portion of the employee contribution plus an additional $232 that is a fraction of the employer's contribution that would have been invisible to me otherwise.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 21, 2007 9:51:00 AM
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rru2s
Posts: 17
Joined: February 7, 2007
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Update: I went to my primary physician (5 weeks post-injury) to get a referral.
I told him I was still having discomfort and I needed to get a firm diagnosis. I will not begin weight bearing exercise or impact exercise until the ortho does an MRI and makes a firm diagnosis.
My ortho appointment is Feb. 28.
The general practicioner fully agreed that he could not make a firm diagnosis without a specialist for my symptoms. He was also interested in the information I had that femoral neck stress fractures are not that uncommon in runners and are frequently misdiagnosed unless a definitive imaging scan is ordered.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - February 24, 2007 3:34:00 AM
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Rwantz
Posts: 84
Joined: December 10, 2004
From: Middletown, PA
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This is definitely an interesting post. I absolutely agree that, while worthwhile to educate yourself, it is not wise to diagnose yourself based on what you are able to Google about "Hip pain in runners." The resources are definitely available to help you understand your diagnosis.
I think that what you have learned so far is very important. Your GP is responsible for guiding you through the medical hierarchy, but many times you are responsible for guiding them.
It is prudent that during those 4 weeks of rest that you are doing something to improve the problem (which could very well be used to get an accurate diagnosis). Rehabilitation, including physical therapy or athletic training, to help you return to function is appropriate during that time whether you have a clear diagnosis or not. PTs and ATs are able to evaluate and treat you based on your hip/knee pain. It is unfortunate that some insurances restrict who you may see.
Best of luck with your appointments and getting through this.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - March 5, 2007 8:41:00 AM
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rru2s
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Joined: February 7, 2007
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Ortho agreed to order an MRI. The desk clerks said my particular insurance company would argue about it and take an hour on the phone to convince them to approve the MRI. I just told them that "I pay 632 dollars per month for my insurance, and if the ortho has justification why an MRI is needed then insurance will have to approve it." Five days later the ortho's office called me and told me it was approved.
Meanwhile, the ortho said elliptical was OK as long as it didn't hurt. So I did 30 min. easy paced elliptical on Thursday. No hip pain that evening, but the next day I had a diffuse and dull ache in the front area of hip, very mild.
Saturday I did some foot tap drills and 3 sets of 200 to 500 feet jogging intervals. Felt just fine on Saturday and Sunday, but Monday morning I awoke with a slight stiff feeling and dull ache in hip, a very mild pain not focused, and which totally went away after being up and around for a half hour.
Until MRI results are available, I don't want to do any significant volume of weight bearing exercises.
Meanwhile, for the past 2 1/2 weeks, it appears that core strengthening does not irritate my hip, so I am doing the following 2 or 3 times a week:
Pilates 100
jacknife situps
lying down hip rotations
1-leg-lowering (other leg vertical laying on back)
classic hip flexor stretch
hip pushups (2-hand/2-foot, 1-hand/2-foot, 1-hand/1-foot)
the plank
side plank (with/without side leg raises)
gluteal bridges
Once I the MRI is read, the ortho can tell me what is safe to do, and good rehab plan can be developed with the advice of professionals.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - March 11, 2007 5:16:00 PM
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PhysioThis
Posts: 84
Joined: October 23, 2006
From: New York
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Keep us posted.
_____________________________
Ed, PT, MTB-XC
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - March 16, 2007 12:06:00 PM
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rru2s
Posts: 17
Joined: February 7, 2007
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I received the diagnosis from my orthopedist today: The MRI indicated a STRESS REACTION on the compression side of femoral neck near the lesser trochanter.
I believe this injury was related to the Pose Method -- a more direct shock to hips from leg being near vertical at the point of foot impact, as opposed to leg being out in front when I used to run heel striking. Also, I believe the foot taps and static front lunge shown in Dr. Romanov's training video are also high impact.
Is it possible the lesser trochanter was stressed by the iliopsoas tendon insertion point, or is this likely a stress traveling up the bone from the foot impact?
It is very strange that I never had a stress fracture or any hip problem in 27 years of heel strike running, 10 miles to 15 miles each run, 3 times a week, yet within 12 months of starting to learn Pose, after getting up to 18 miles per week and 6 miles per run, I get a femoral stress fracture.
The strategy for my return to running would be diffferent depending on the answer. I am looking for advice on how to gradually get back into running safely after this injury.
I was fortunate enough to run into a qualified person on the Posetech.com website who understands Pose Method biomechanics and training technique and is also qualified to treat rehabilitation of orthopedic injuries. He is a certified Pose Method Running Coach, Board Certified clinical specialist in orthpaedics (American Physical Therapy Association)
B.S. in physical therapy, M.S. in orthopaedics, and recreational triathlete. However, he is not local, so I will have to communicate long distance for advice, as I am also doing here.
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To help see if my form was a major contributor to the stress fracture, please open the link to my last fall running video:
OCTOBER 22,2006 (2 months before injury:
http://video.google.com/videoplay?docid=664464492769312043
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HIP PAIN FIRST STARTED ONE-HALF HOUR AFTER A RUN DECEMBER 31, 2006...
Strong pain in the front of RIGHT HIP during walking at the exact moment of right foot touchdown and also medium-strong RIGHT HIP pain when standing on one leg...Pain would last 2 or 3 days, then diminish.
Tried running 2 more times, same repeat performance. Rested 10 days, then tried an easy 3 mile run Jan.17 2007, but one-half hour afterwards strong pain again in right hip, again lasting 3 days.
4 days after each run, my hip pain would GO AWAY COMPLETELY.
NO RUNNING SINCE JANUARY 17, 2007. Doctor adviced 4 weeks rest and during this time I avoided ALL WEIGHT BEARING EXERCISE.
Started swimming once a week or twice a week for cardio during first 4 weeks.
After week 4 I got a referral for an Orthopedic Surgeon (OS) so I could get an MRI to know when it was safe to start up again.
STARTING 4 WEEKS SINCE LAST RUN, I started core strengthening workouts, not really diligent, only 1 set 3 times a week of PILATES 100, JACKNIFE SITUPS, PLANKS, SIDE PLANKS, GLUTEAL BRIDGES, HIP PUSHUPS, LYING ON BACK HIP ROTATIONS, LYING ON BACK LEG LOWERING, CLASSIC HIP FLEXOR STRETCH. NO pain with any of these exercises.
STARTING 6 WEEKS SINCE LAST RUN, restarted elliptical -- front wheel drive CYBEX ARC TRAINER, high resistance. Initially 30 min. 1 X week.
7 WEEKS SINCE LAST RUN, now doing ELLIPTICAL 60 min. 2 X week.
TRIED SHORT JOGGING LAST WEEKEND BEFORE DIAGNOSIS AVAILABLE: 5 mile walk, intermixed with 0.85 mile run and 0.7 mile run. SLIGHT PAIN IN FRONT OF HIP DURING RUN and for a very short time (2 hours) afterwards.
AFTER HEARING THE DIAGNOSIS TODAY from the Orthopedic Surgeon, he says NO RUNNING, NO IMPACT SPORTS, DRILLS, OR DISTANCE WALKING until next followup visit in 6 WEEKS.
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Re: Pose Method runner w/ Hip pain, post meniscus rehab. - March 18, 2007 6:18:00 AM
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rru2s
Posts: 17
Joined: February 7, 2007
Status: offline
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I have corresponded a couple times with the PT/Pose Coach. Here is a summary of my latest questions and his answers:
(1) Do you see any running form biomechanics issues affecting hip fracture susceptibility from my video?
(2) Do you think the hip flexor rather than landing impact shock caused a stress reaction near the iliopsoas insertion point on the lesser trochanter?
(3) Do you advise a bone-uptake enhancer during healing or should I just go with my current regimen?
(4) Do you advise long-term changing the Pose Drills that I do before runs?
(5) Did my left knee meniscus tear in 2005 permanently affect leg length or gait subtly yet enough to cause hip overuse on the opposite leg?
(6) What steps should I undertake with my doctor or a clinician to determine the answer to question number (5)?
(1) Discussion: He thought my running video was "reasonably good technique" but caveated with "landing slightly in front of overall GCM" and "upper torso and head were well behind the vertical line that we attempt to maintain (with the idea of "falling" forward)". He also noted "a great deal of noise from your foot landing" and stated there should be "no noise with landing" if my landing is properly done "beneath the GCM as well as relaxation of the knee (release of the knee, or bending of the knee at the time of contact with the ground)".
(2) Discussion: I had noted the MRI did not look like a hairline crack on the compression side of femoral neck, which would have been consistent with impact stress. On the other hand, it showed a diffuse white area centering on the lesser trochanter, which suggests the stress comes from forces applied there.
My theory is the hip flexor was interacting with impact shock, and the result was constant sharp tugs on the lesser trochanter leading to a stress reaction centering around the lesser trochanter rather than femoral neck stress fracture.
In answer to this question, the orthopedic PT and coach stated that, "it is not uncommon to have vigorous muscle contractions lead to avulsion type fractures of the bone."
The hypothesis which seems to be supported, or at least not refuted, is that the stress reaction was caused by vigorous contractions of the hip flexor affecting the insertion site at the lesser trochanter as opposed to the footstrike landing impact transmitting up the leg through the bone.
(3) Discussion: Bone stimulators are often utilized to accelerate bone injuries and that would be indicated in my case (however, insurance companies usually do not reimburse for something like this in typical cases).
(4) Discussion: He thought the drills are entirely safe, provided they are done appropriately and in a context of gradual progession.
(5) Discussion: Leg length discrepancy is identified by the use of a standing x-ray in which the level of the pelvis is measured with a straight edge and level....the two sides are then compared.
ANY THOUGHTS, ADVICE, OR COMMENTS ARE WELCOME...
Thanks,
Russ
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 21, 2008 1:50:18 PM
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rru2s
Posts: 17
Joined: February 7, 2007
Status: offline
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UPDATE ONE YEAR LATER:
DECEMBER 2006 HIP STRESS FRACTURE -- Stress reaction in the lesser trochanter confirmed by MRI 2 1/2 months after hip injury (IN MARCH 2007). After diagnosis, for 4 weeks I did nothing but swim , then progressed to biking for about 3 months, then walking, walk/run, and finally running.
AUGUST 2007 WALK-RUN RESUMPTION -- After clearance from my ORTHOPEDIST in AUGUST 2007, I started out with walking 5 miles x 3 times per week for about 3 weeks, then gradually intermixing 1/2 mile jogging for another 3 weeks. Over another 6 to 8 weeks, I eased back up to running about 14 or 15 miiles per week on 50% trails / 50% blacktop.
CONTINUING STRIDE MECHANICS PROBLEMS WITH FOREFOOT-STYLE RUNNING -- After resuming running after the stress fracture, I was still running forefoot style (Pose Method), but with imperfect biomechanics: I made a running video that suggested excessive vertical bounce (3 or 4 inches up-and-down movement of head/shoulders) during each stride cycle. Several Pose Method coaches and runners told me this may have contributed to impact shock in the hip. Many people don't experience this problem.
NOVEMBER 2007 RETURN OF HIP PAIN -- Given the poor stride mechanics, it wasn't suprising the hip pain came back again in late NOVEMBER 2007, after 3.5 months of running. The pain was milder than before, so I rested a week then I did an experiment, watching myself run on a treadmill 2 feet in front of a mirror. With heel striking I had only 1-2 inches vertical bounce of my head/shoulders, in contrast to 3-4 inches with forefoot style running. So that convinced me to give up on the 16 month experiment with forefoot strike running.
The question remained as to whether my left knee lateral meniscus would ever heal up enough to handle heel strike running since for the first 8 months following the original knee cartilage tear in JULY 2005 I had sharp pain whenever I attempted to run the usual way (heel striking). As noted in earlier posts, upon starting forefoot style running in JANUARY 2006 I noticed a complete disappearance of knee pain during or after running.
2008 RETURN TO RUNNING AFTER HIP PAIN RELAPSE -- After symptoms of hip pain came back in LATE NOVEMBER 2007, I was afraid of getting a full-blown hip stress fracture relapse. So I took a week off, then I decided to cautiously attempt to revert back to heel strike running only on the treadmill, at a slow pace, for about an hour per session. The progression was: RUN ONCE/WK for 2 weeks; TWICE/WK for 7 weeks; 1 DAY RUNNING/2 REST DAYS for 10 weeks; and finally back to 3 RUNS/WK starting APRIL 2008. Also, I transitioned from treadmill to outdoors in mid-April 2008.
CURRENT STATUS -- Now I have been heel strike running for 6 months (12/01/07 through 04/08/08 on treadmill, 04/09/08 through 05/21/08 outdoors about 50 % trails 50 % blacktop). For the last 6 weeks I have run 3 times per week, 7.5 miles, 7.1 miles, and 7.1 miles, mixture of blacktop and trails. Generally, I haven't had hip pain during or after any runs until May 21.
Onset of hip pain May 21, 2008 -- My hip just started to hurt again on MAY 21, 2008 (without warning and with ONSET AFTER 2 REST DAYS after an 8 mile run -- But it is notable this was the week after doing 2 speedwork sessions at fast paces. The hip pain was intermittent but of medium intensity -- equally while sitting, standing, or walking. The hip pain was of reduced intensity on May 22, 2008, and barely noticable intermittently on May 23, 2008.
CURRENT PLAN FOR MODIFYING RUNNING PROGRAM -- I still think I have an underlying problem, but after 3 episodes of hip problems I have been learning the pattern of triggering events and so I think I can be more successful at modifying my activities at an early warning stage before it gets too severe. Right now I am resting until I have a couple days with no pain, then when I resume running I will avoid speedwork, hills, and pavement running.
Implementing permanent training changes based on activity patterns preceding the last two hip pain episodes:
(1) RUN a maximum of ONLY 1 day/wk on pavement, other days on trails
(2) AVOID or LIMIT SPEEDWORK <= 1 day/wk; even then ONLY DO SPEEDWORK ON A TREADMILL
(3) AVOID HILLS, especially hills on pavement
(4) MAXIMUM FREQUENCY OF 3 RUNS/WK for each 3 week period, then follow in sequence with one easy week of only 2 runs
Compared to my long history of 27 injury-free running years before the start of my knee and hip injuries, the last year and a half of repetitive hip problems suggests some underlying problem predisposing me to develop hip problems. However, I have learned quite a bit about my new limits of althletic running performance so as to generally stay in a safe zone and prevent further permanent injuries.
HOWEVER, WHAT IS THE UNDERLYING PROBLEM? -- My ortho claimed I have no leg length difference that might affect my opposite hip to the knee that was injured 2 1/2 years ago, but he only had me lay on my back for a quick visual qualitative comparison of leg length and did not perform a measurement by x-ray to rule out this condition. Since the hip injury keeps coming back I'm not so sure. At this point, I'm not sure if the early hip pain symptoms are necessarily an early sign of a stress fracture -- rather it seems more like the right hip works harder and creates diffuse pain around the back of the hip above the glutes and also from the area near the greater trochanter on the lateral side, which might be referred pain or other type of musculotendon sheath, and occasionally front of quad. Historically, I have never had ITB issues or anything like this in all my previous years of running. I think I have an acquired susceptibility to hip overuse, which if I don't back off and rest, could then lead to complications such as stress fracture of the hip. But as a runner, how can I eliminate the reccurring effects from this acquired susceptibility to hip overuse?
< Message edited by rru2s -- May 23, 2008 10:32:51 AM >
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 8:49:52 AM
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rru2s
Posts: 17
Joined: February 7, 2007
Status: offline
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UPDATE MAY 29 2008 -- The hip stress reaction is coming back. I RAN ON 5/26 on TREADMILL with no hip pain, and I did 1 hour easy mixed with 5 one-third mile intervals at 6:15 pace. No pain the next day. Then I had a mild stiffness on MAY 28, but instead of resting I made the mistake of running on it. In the middle of my MAY 28 2008 run, my hip pain started up around at mile 5, but it was getting dark in the woods and I had 2 miles to run back to the car.
This time the pain was more focused in the inner side of the hip, near the lesser trochanter as with the original stress reaction. The pain was like a dull ache but constant - pain level 2 out of 10. It is defintely the stress reaction in the SAME HIP.
So it looks like I'll be cross training most of the summer. I don't know if I caught this early enough to just cut back to once per week running. My gut tells me total curtailment of running and avoidance of longer walks. However, since I can walk pretty much pain-free no crutches unless things get worse.
Now I have been through 3 stress fractures in the SAME HIP --- JANUARY 2007 (8 months off - most severe); NOVEMBER 2007 (caught it early - reduced frequency of running for 4 months), and now MAY 2008 (don't know severity yet).
One fhing for sure - something is amiss compared to my pre-2005 running stride mechanics. I may have to have some type of analysis done. I'm also going back to 13 ounce ASICS Kayanos next time instead of 8.5 ounce Brooks ST3s. Also, it looks like the final trigger was speedwork, so I may have to permanently give up speedwork and races... But I may still be able to run again, based on past recoveries.
ANY ADVICE FROM THE ORTHOPEDIC REHAB SPECIALISTS out there?
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RE: Re: Pose Method runner w/ Hip pain, post meniscus r... - May 29, 2008 10:15:01 AM
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Tom Reeves DPT ATC
Posts: 415
Joined: March 14, 2006
Status: offline
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Wow, what a story.
There is no true gold standard for measuring leg length discrepancies. A standing AP pelvis Xray is considered the gold standard but really it has to be done perfectly. i.e. everything that is not in the film MUST be exactly the same (knee flexion, foot pronation) and even then, it is only a 2 dimensional measurement. When I do an assessment for LLD, I look at 10-11 items and if a large majority says one side is longer, i give the patient a lift. (the reason is that no single clinical indicator is very reliable. they are simply indicators.
There is a reason that you have the stress reaction on one side and not the other. i would suspect an LLD or asymmetrical foot structure. I didn't see in any of the above posts where you commented on your foot type and if R was the same as L.
Look at the wear pattern on an older pair of shoes. Does it look the same R vs L? if not, it could be an indicator of asymmetrical pronation which could be either from bad foot posture/structure, or a LLD.
Good luck.
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