[mkmanke]

BACKGROUND:
I am 46 year old male who started running three (3) years ago. My training has been consistent the entire time and I would consider myself a “Category 2” athlete. My obsession is Spartan obstacle course races. In the past two (2) years I have successfully finished three (3) Spartan “Ultra” 50Ks and three (3) local trail 50Ks.
My most recent race was December 14th. I have advanced from just wanting to finish a race to actually “competing” within my age group.

I discovered Training for the Uphill Athlete book this fall and have been implementing the progression, gradualness, de-training, modulation, and heart rate zone principles. I do all of my running on trails and fire roads. My mileage ranges from 25-50 miles per week depending on the schedule. I implement one (1) to two (2) strength sessions per week which includes the Muscular Endurance gym workout. My strength and endurance have improved.

ISSUE:
At some point during my weekly long run I would develop a shooting pain in my right hip/groin which usually correlated with a technical trail, rocky downhill terrain, or a pivot of the foot The pain would subside and I would continue on the run. This pain would usually reveal itself somewhere near the 15 mile mark. The pain would be present at the end of the run, but would usually subside later that day or be gone after a night’s sleep. The pain never revealed itself in shorter distance runs. I thought the pain was just part of the process. Most recently the pain worsened, I attributed it to running more miles on technical trails, and would consider it a 6 to 7 on a pain scale. The pain became dull and stayed with me. I realized this pain was not part of the process and stopped running this past week. I suspected it a hip flexor injury. Yesterday, I went to see a sports doctor.

The X-ray and exam revealed I have a hip impingement (cam impingement) condition for both femurs due to the structure of my femur bones. Interestingly enough, I don’t experience any pain in my left leg.

The doctor prescribed me an anti-inflammatory (Meloxicam) and Physical Therapy sessions. I will be scheduling those session as soon as possible.

ADVICE/PERSONAL EXPERIENCE:
1. Has anybody experienced this same condition and what actions did you take with what
results?
2. What exercises should be implemented and what exercises should be avoided?
3. I want to continue my run training. Should I continue running up until the point
where I feel the pain and then stop running. I figure I would mitigate the issue
by sticking to less technical trails. Is this a crazy idea?
4. Has anybody had surgery because of this condition, and if so what were the
results?
5. Any other advice to stay on the path and get back into the fight?

Thank you for taking the time to read and or respond to my inquiry.

Matthew

Topic

[Pete Dickinson MS,PT]

Pete Dickinson MS,PT on January 16, 2020 at 4:51 pm #36393

Internal hip impingement can be treated conservatively with good results early on. You would need to fail conservative care before surgery is considered. Your therapist can guide you in some self ‘gapping’ movements using straps and bands. Relieving the soft tissue tightness around the hip will also aide in improving movement patterns and tolerance of impact (running). We usually use a ball or roller to mobilize the soft tissue ‘densifications’ that conspire to impinge the hip. Activity progressions can span the range from non impact cycling, to progressive impact training with unloading treadmills/elliptical/trail running. The key is progressive training over time to allow for adaptations that don’t feed into your impingement. Strength training is also key, and should be performed after your mobility activities. I would combine both pure strength movements pain free of hip hinges and squats, with some balance control weight bearing training. Progressions from two leg exercise, to single leg exercise will support your running. And lastly, a good core program will support optimal hip function.
Cheers,
Pete

[pedro.lavinas]

pedro.lavinas on January 22, 2020 at 11:10 am #36717

The single most important thing to realize is that the impingment is not due to the vertical forces exerted by the floor on your feet and transmitted through the legs up to the hips.
The impingmente is actually due to too much of a hip flexion (raising your legs to step on a big rock for example). the following video, at 2:30, shows how it happens:

When I was diagnosed with FAI 4 years ago, i stopped running and began cycling in order to maintain some aerobic fitness. Worst thing i could do, because hip flexion, especially on road or TT bikes, is much larger than when running. I also did endless hours of physiotherapy aimed at strengthening hip stabilization muscles, which was good, and stretching the hip and thigh muscles, which was absolutely counterproductive. Let me explain why.

There was, and still is, a small tear in my labrum, with inflammation around it, which was the source of the pain. When cycling, i was applying force with hips flexed, and that contributed to worsen the inflammation and pain. Furthermore, stretching hips and thighs tended to pull the tear sides apart, enlargening it and difficulting cicatrization.

I visited then, like, the fitfth or sixth doctor, which finaly gave me the solution: “stop stretching and cycling; start running slowly on flat courses or swim and come back here within a month”. Strange enough, but i went for it. My pain simply went away. The secret was just stopping to apply forces with flexed hips, wgich compressed the joint, causing inflammation, and quitting stretching the labrum tear, leaving it free of tension to cicatrize and therefore recover. After one month i could already get back to running on steep trails.

Every case is different, but i hope it helps. Remember: the impingement is not due to vertical impact, but to hip flexion. Good luck!

[harry mattison]

harry mattison on January 23, 2020 at 4:04 am #36755

Hi – I’m also a 46 year old male and I had hip impingment and many other right hip problems (torn labrum, arthritis…) For years they were asymptomatic and I was able to do lots of road and trail running. Then on a typical long run it got wonky and I couldn’t run properly any more. PT and strengthening & balance exercise made it much better (I did a lot of stair climbing and walking up and down hills). I still couldn’t run, but I was able to power-hike two 100-mile races that year. In the fall of 2018 I consulted with Dr. Thomas Gross (http://grossortho.com/) and had hip resurfacing surgery in Feb 2019. Six months later I was able to resume running and in Nov 2019 dd the Pinhoti 100. Individual results of course vary, but the surgery has been great for me.
Hopefully your’s will improve sufficiently with PT, but if not, do not give up hope.
Andy Jones Wilkins has written good articles about being a runner with bad hips
https://www.irunfar.com/2018/03/going-under-the-knife-part-2.html