Monday, March 8, 2010

Oops!

In the process of getting my butt kicked it kicked me back. Piriformis pain hurts! I have never really had any piriformis issues but my lower head got so pissed off last week I was seriously worried. What started as mild tightness led to right down pain after a leg workout. Not only my piriformis but the outer head of my hamstring attachment also got flared up. Have you have had a swollen butt cheek? Well not only is it ugly it's painful. I didn't get any sciatic stuff probably because it was more in the lower portion of the piriformis. Last Thursday's 10 mile run was darn painful and I found myself dragging my left leg along to the finish. All the downhill running was awful. It hurt so bad with every step. The flat stuff was not good either but manageable. When I got done and home I got busy. I needed information and I needed it fast. Here is what I found and it hits the nail on the head for me.

The obvious cause of piriformis syndrome is overuse. Ultra runners are a walking overuse injury. I know there has to be more to it. Since I haven't suffered from this kind of pain before and I have run a lot miles and at times overuse would be an understatement I knew there was another reason this hit my like a brick.

First ah ha: The movement pattern. The piriformis can get pissed when you do 3 things:
1. When the thigh bone swings too far back (hip joint in hyper-extension). Check! I do this and have blogged about it before.
2. The knee pointing too far outward (hip joint lateral rotation). No! I think I tend to do the opposite more.
3. Thigh bone swung too far out to the side (hip joint abduction). Not sure, so I would say this is not an issue for me.

Part 2 of the movement pattern theory is:
1. Glute Maximus is slow to activate leaving the piriformis as the sole workhorse for rotational movements of the hip.
2. The pirifomis muscle is being asked to do its solo effort working over a shorter range.

This movement theory is really interesting and part 1 causes part 2. So far I think I only do one of the bad movement habits. But, there is another part of the movement pattern and that is postural issues. The postural issues that most likely aid in a poor movement pattern are:

1. The shoulders are behind the line through the back of the butt hence "sway back". BINGO! That is me. With my natural anterior tilt to my pelvis and my years in the weight room I can have a sway back position while running. In my attempt to stand proud with my shoulders back which is a requirement for proper lifting form I have taken that a bit to far. Finding that neutral pelvis is always hard for me but now I have added a very proud chest resulting in the exact issue described here. I knew I was doing this especially on my downhill running. Well now I need to STOP doing it.

2. The gluteal development is poor, "flat butt syndrome". NO! I may have a bit of weakness in some of glutes but overall they are strong. I don't think this applies to me.

My action plan started on Thursday because I knew if I didn't get a handle on it was going to be a full blown injury. Not simply the piriformis but the compensation due to the pain was setting in my outer hamstring head. That was causing some serious pain as well. I started with some mild stretching but not over stretching the already limp muscle. I did not stretch my hamstring but instead rolled it out with a roller and sat on a massage ball which was positioned right in the sweet spot of my hamstring attachment. I cut short my track workout when I realized the lack length in my hip and hamstring along with the pain was not worth the workout. I trigger pointed the lower head of the piriformis with roller and my thumper (electric thumping device). I sat on ice 3 times a day for 20 minutes with 1.5 hours off. The inflammation and pain got better and last night I did some hip and gluteal exercises to help re-connect those muscles with their action and my brain. I also took Advil on my long run Friday. It's been at least 2 years since I have resorted to anti inflammatory stuff but I felt it better to dull the pain and not compensate. I still felt quite a bit of pain on the downhills but it was doable. With last Thursday's run being a 7-8 on the pain meter meaning my mouth would occasionally water it hurt so bad to today being a 2-3 I think I have made progress.

Watching my sway back positioning is key along with the hyper striding especially on the downhills. I sure hope I have dodged a bullet here but thought I would share the info. I found. The article on www.easyvigour.net which outlines all of this.

Despite the pain in the butt, which I deserved, training has been good. Absent the un-productive track workout I am getting stronger on the trails. I am ready for Chuckanut and excited to race. I have run this race 2 times and need to go back and dig up my best but I think it's somewhere around 5:40ish. I am hoping to better this but I remember being in pretty good shape when I ran it last. Plus I had Kris to chase but this year I will have Cheri to chase.

I have been eating non-stop! All great food an my body is digging the higher calories and the abundance of carbs. I have moved to almost all fish for protein. I used to eat tons of chicken but felt so bogged down in the digestion. Since I like to keep my lean muscle I need the protein. Fish is quick to digest so I can get more food in. I have grown a love for salmon and cod. If you have asked me a year ago about fish I would have scrunched up my face big time. The benefits are too good to pass up. The bonus is Alex loves fish, Bill not so much but he's coming around :). For me the issue while training hard is to feed myself enough food to sustain my training and fat loss. Pizza and hamburgers are not part of the plan. :) I made some other changes I am finding beneficial with food timing. Adding fruit at just the right times, recovery drinks directly followed up by a well rounded meal is helping. I am drinking a fair amount of BCAA's because along with running I am doing at least 4 weight workouts. Cheri gave me the book, "Racing Weight" and I have just started it. I am curious to see how the theory differs from the one I follow now.

9 comments:

  1. Stop sandbagging. I ran Chuck in 5:22 once. Long time ago, but you are in far better shape now than I was then. Get out there and give it your all, skinny butt!

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  2. Ouch. I hope you have this nipped in the bud. I was sort of worried when you were talking about the crazy increased intensity of your workouts -- that's always when I get hurt. Overuse can be intensity + miles not just miles. But it sounds like you've got the biomechanical reasons down more or less. Get better!

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  3. Sorry about the piriformis. I know that feeling. I have always had issue from the middle of my hamgstrings up. One thing you didn't mention was tightness (low flexibility) which is my issue. As soon as you mentioned "sway back" I thought - "yep, that sounds like Ronda." But I didn't know that caused piriformis issues. Good to know since I have a bit of that myself.

    Anyway, sounds like you have gotten a handle on it. Hopefully it will be gone by Chuckanut.

    - Tony C.

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  4. Really interesting! From your description, what I've been thinking of as pseudosciatica (from muscle swelling pressing on the nerve - also an overuse problem), may have been piriformis pain. I'll have to look into it!

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  5. Way to be proactive! Sounds like you may have nipped it in the bud. I had a problem with piriformis a couple of years ago, and had to slow down on the downhills- you're right that the longer stride stresses it more. I learned several stretches (which you probably already know) and used them alot, and that helped.

    I'm curious how you cook your fish. We had cod poached in salsa the other day and that was quite good (and very easy).

    Have fun at Chuckanut!

    Cynthia

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  6. A bit of an update. I saw Dr. Tollenaar yesterday. He is amazing and is an ultra runner so I knew he would give me the once over and tell me what to do. He said my medial hamstring is most likely the cause of the pirifomis issue. He said it is/was balled up from head to head. He dug and released and dug and released some more. It hurt darn bad. The issue: when the medial hamstring is tight or non-functional the piriformis bears the brunt of hip rotation. I got my medial hamstring fired up good weight training, not running....story of my life, will I ever learn! However, my straight leg run and sway back make this issue worse. Gotta get better at proper movement. Things are looking up and with the taper for Chucky I know I can run the race.

    Olga, sandbagger??? You need to remember you are faster than I. I know you want to claim out of shape and slow but sorry you can't! 5:22 on that course if fast.

    Cynthia, please pass on your stretches. I used your glute medius stuff and still do. Thanks to that I have one thick medius now.

    Ronda

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  7. Glad that was helpful. See http://smiweb.org/omt/guides.html and click on the "injury prevention for runners" link. There's a piriformis stretch depicted. I do it with the knee flat (bending head toward the ankle) as well as knee pulled toward the opposite shoulder. I also just stretched it constantly- when lying in bed on my side, I'd let the upper knee lay on the bed too. After a while, the stretching sensation felt natural rather than painful. The plantar fasciitis guide on that page is one of the best I've seen (been researching that too since it is hanging around). Pray tell us what you're doing for hamstrings too!

    Cynthia

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  8. Ronda, I meant to email you, actually, now that you're heading into Chuck taper and planning to follow through with one of your goals - crank a 50k all out. Somehow, we managed not to become running buddies while lived close, but we surely followed each other's runs and races. And I believe, we always encouraged each other to do best - even if it meant we kind of were a bit scared to face each other:) In a good way. I read Annette's B. blog post how she used a friendly rivary with Anne Lundblad and now with Jill Perry to be a better runner. I always knew you could kick my buty any day, while you thought I pose a "threat" of a competition to you. Ha, I laughed at it:) but - but - it did give me incentive to work just a bit harder, knowing that you said - Olga, stop sandbagging.
    So, that said, I hope your piriformis issue gets resolved in time, and you do kick my (former) butt at Chuckanut! I was doing intervals on TM today and remembered how you always sing while running races (I hear it when around), and I was always amazed how you have enough breath for it. So, in memory, I did this today. I hope the ears of those around didn't turn green:)
    And I hope you take it all as a compliment. I am not very good at those:)

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  9. @Drs. C&D: I checked the smiweb site and was surprised to find I do ALL the exercises depicted in all the links, except one - that kneeling quad stretch causes tremendous cramps; I'm actually afraid to try it again.

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