Hip pain… who hasn’t had hip pain? The real question is what is it and how do you get rid of it? There are a plethora of hip injuries, but the most common that I see clinically is the infamous Gluteus Medius Tendinopathy. Let’s call it “Glute Med Tendinopathy” for short.
Tendon-what, you ask? Tendinopathy translates as “pathology of the tendon”. Once a tendon is injured, inflammation and fluid starts to accumulate around the strained tendon. This initial injury is called “tendonitis” or inflammation of the tendon. If you are lucky and your musculoskeletal system is in tiptop shape, the tendonitis will heal and you will continue with your activity pai- free in one to two weeks.
If the tendonitis does not heal properly, then you are left with a tendinopathy. Glute Med Tendinopathy consists of chronic nagging posterior hip pain worsened by activity. This is commonly linked to bursitis of the hip. A bursa is a fluid filled sack that helps the tendons glide smoothly over the joints. This is the type of injury that you don’t want to “wait it out.” The best time to take care of a tendinopathy is to address it right away.
Now that we know what it is, how do you get rid of it? Contrary to belief, a tendinopathy is easily treatable. Seeking early treatment and a proper diagnosis is the biggest hurdle with this injury. Deep tissue sports massage, active release technique, PRP injections, Prolo therapy injections, or, the beloved, foam roller will help heal this chronic injury by causing micro trauma to the injured tendon. The controlled (key word here) injury sustained from this type of treatment will cause swelling and inflammation to occur at the targeted damaged site. This is a key factor in the natural healing process of the body. Surprise! Inflammation is not all bad.
The second, and equally important, treatment for Glute Med Tendinopathy is to strengthen it. Strengthening the gluteus medius muscle correctly and all the other hip muscles, as well as the core, will give the injured tissue a break and allow it to heal without complications.
If you suspect that you are suffering from Gluteus Medius Tendinopathy and two weeks of “at home treatment” doesn’t seem to be working, it is time to seek treatment from a sports provider.
Dr. Crystal Neal
Spine and Sports institute
Although it doesn’t seem like it, warm weather will be here before we know it! Several years ago, I explained how to stay safe and train well running in the winter. Today’s topic is safe summer running.
First, the physiology! The human body has an amazing ability to maintain a relatively stable internal temperature. This is accomplished by auto-regulation, balancing heat production with dissipation. Most of the heat in the body is produced by contraction of the muscles. So, during exercise like running, heat generation rises. If the body cannot step up heat elimination and internal temperature rises too high, heat- related illness can occur. Symptoms of these illnesses range from mild heat exhaustion with fatigue and muscle cramps, to severe heat stroke with loss of consciousness and multi-system organ failure. Other factors contributing to heat related illnesses are inadequate conditioning and dehydration. Lack of acclimatization can also contribute. This may affect all of us if we transition rapidly from our long cool spring to heat and humidity this summer without about 2 weeks of moderate temperatures in between.
The body cools itself by several mechanisms. Radiation is loss of heat from the warm skin to the cooler environment. The body can also be cooled by convection – air is blowing over the skin. Evaporation occurs when we sweat and the water in the sweat converts to water vapor. All of these cooling mechanisms are hampered if the weather is very hot and humid.
Here are some simple strategies recommended by the American College of Sports Medicine to prevent heat-related illness while running:
Hydration: You can lose between 6-12 ounces of fluid each hour during a long run on a hot day. Adequate hydration is probably the most important factor preventing heat-related illness. You should drink adequately throughout the day and at least 16-32 ounces of water about 2 hours before a run in the heat. Weigh yourself before you run so you know how much fluid you need to replace after the run. Drink 5-10 ounces of water every 15 – 20 minutes during exercise. If you run for longer than an hour, you may want to switch to a sport drink with 4-8% carbohydrates. Weigh yourself after the run and replace 16 ounces of fluid for every pound lost. If you are a newer runner, be sure to practice drinking on the run before trying it in a race.
Clothing: Don’t over-dress. Wear loose-fitting running clothes made of tech fibers that wick sweat to aid evaporation. Light colors reflect the sun’s rays, dark colors absorb them. Don’t wear cotton. It wicks inefficiently soaking up sweat. Avoid hats. If you must wear one, make sure it’s well ventilated and light in color.
Time & Place: Run early in the day or later in the evening when it is cooler. Stay off the asphalt and run on the trails. Run in the shade or better yet, in the woods.
Be Sensible! The hotter it is the easier you should take it. If it is extremely hot, forget it! Be aware of the symptoms of heat-related illness. If you develop a headache, lightheadedness, weakness or muscles cramps, stop immediately! Get in a cooler environment and drink fluids.
I recommend avoiding NSAIDs like ibuprofen before you run, especially on a hot day. These meds make the renal arteries constrict and if you are not adequately hydrated, your kidneys can suffer. Last but not least, don’t forget the sunscreen!
Dr. Marie-Christine Leisz is a Physical Medicine and Rehabilitation and Sports Medicine Physician at Courage Kenny Running and Endurance Sports Injury Clinic. She collaborates with the Courage Kenny RunSmart Physical Therapy program. Learn more at our websites: http://www.allinahealth.org/ahs/ski.nsf/page/running_endurance http://www.allinahealth.org/ahs/ski.nsf/page/Run_smart
Now that the worst of winter is over, are you looking forward to running outside again? Maybe you would like to try something different this year. If so, go off road and try trail running.
To get the lowdown on trail running in the Twin Cities, I talked to Maria Barton, PT. She is a Physical Therapist at Sister Kenny Sports and Physical Therapy and a seasoned ultra-marathoner and trail runner. She began trail running while participating in high school and college cross country as part of her overall training. Maria says “I was getting burned out with trying to run faster and dealing with numerous injuries running on the roads, so I decided to switch to mostly trails for a change of pace. I shifted to the point where I was doing a lot more training on trails and started to do mostly trail races instead of road races”.
Maria found the trails worked different lower extremity muscle groups, especially in the hips. She found she felt much less physically spent after doing a long run on trails versus roads and recovered faster afterward. She loves the extra challenges of running over hills, mud, ice, roots and rocks. She says, “It’s so much fun! There are so many great trails to explore and races to run at all distances around our area”. It’s even more fun if you don’t mind getting dirty!
Maria notes that she does not advance her mileage any differently than she would on roads but cautions you may be tempted initially to run too many miles or advance too quickly on trails due to the forgiving nature of the trail surfaces and the novelty of discovering new trails. You may find you adopt a shorter stride when running on more technical trails and a quicker cadence – or number of steps you take per minute .She says because of the variable terrain, expect to run slower on trails compared to roads.
The only special gear she recommends is a good hydration pack/belt or handheld bottle and a good pair of trail shoes. The extra traction the lugged sole provides can be a big plus. Bug spray in the summer and a head lamp in the early morning or at dusk are helpful too.
Maria is a member and former officer of Upper Midwest Trail Runners (UMTR). This is a member-supported organization for anyone of any ability who likes to run off road. This organization sponsors numerous trail series including the UMTR Trail Series, 15 trail races throughout the year of varying distances around the state of Minnesota. This group also “gives back” by participating in trail maintenance, volunteering at races and promotion of trail resources, races and running throughout the upper Midwest.
For more information about trail running in Minnesota, go to the Upper Midwest Trail Runners website, http://www.umtr.net.
Marie-Christine Leisz, DO is board-certified in Physical Medicine and Rehabilitation and Sports Medicine, with advanced training in the diagnosis and management of running and endurance sports injuries. She is medical director of the Running and Endurance Sports Injury Clinic at Sister Kenny Institute and collaborates with the Sister Kenny RunSmart Physical Therapy Program. Learn more at www.allina.com/ahs/ski.nsf/page/running_endurance and http://www.allina.com/ahs/ski.nsf/page/Run_smart