Hamstring injury, RICE… Sciatica!

Everything was going so nicely this year.  I had hit 20 miles in my slow run 6 weeks before the marathon, I had the pleasure of writing in my running log “no notable pains or injuries” almost every run, and my overall running fitness is far better than it’s ever been.

And then – bang.  A pain in the hamstring area.

As I say, I had run 20 miles last Sunday without incident, followed by a 1-mile recovery run on the Monday, and headed to the gym on Tuesday for my usual cross-training session.  Towards the end of my 20km on the bike, a pain was creeping in behind my right knee.  I didn’t think much of it, and went swimming afterwards.

Wednesday was a rest day, and then on Thursday I had my scheduled tempo run which I was going to take up to 7 miles, consisting of 2 easy miles and 5 at tempo pace.  Despite the pain being more obvious when running, I pushed through the pain, which never eased, and now regret it.  It’s the typical story of a stubborn runner.

Hamstring injury?

There was general pain right up the back of my right leg, from the bottom of the calf, right up to the glute.  But there were one or two areas of more concentrated pain, which seemed to be in the hamstring area – one right in the middle of the posterior leg, about half way between the knee and the top of the leg; and the other in the inside posterior leg closer to the knee, which from diagrams looks like the semi-tendinosus; basically a tendon connecting the hamstrings to the knee joint itself.

Hamstring diagram
Diagram showing the hamstrings. ©MMG.

I was pretty worried by this pain, which didn’t subside much over Friday and Saturday.  The pain did become more localised to the specific regions I’ve pointed out, and having reluctantly skipped the 21-mile run I had scheduled for yesterday, I went out for a 20 minute walk in the evening just to give my legs at least a little bit of movement.  All was fine until I was walking home – slowly and carefully – when it felt like something moved and gave way a bit in that mid-section of the posterior leg.  Bearing in mind I was aiming for a PB in the Glasgow Half Marathon this Sunday coming, and with everything else having gone so well, this seemed depressing to say the least.

RICE

After much searching online, I discovered that one thing I should at least do is what’s called RICE – short for Rest, Ice, Compression and Elevation.

Rest – The simple idea being to give the affected area a break.  Stop putting strain on it.  An area like the hamstrings, consisting mostly of soft tissue, can be easily aggravated and any hamstring injury can deteriorate if further strain is put on it.  So, instead of going out for a 21 mile run, sit down.

Ice – The application of ice can ease inflammation and take some of the heat and pain out of the affected area.  I applied it about 3 or 4 times a day, for a 20 minute period each time.  I have a little material bag that the ice bag itself is in, to reduce the chances of burning the skin (i.e. actually freezing the skin itself).

Compression – I didn’t do this, simply through a lack of any compression bandage.  The idea is that the right kind of compression on the affected area can reduce swelling and control blood flow through the region.  An over-tight or firm bandage doesn’t seem advisable as this might be likely to restrict blood flow in a potentially harmful way.

Elevation – Lift that leg up, and put it on a chair.  Elevation is, like compression, aimed at reducing swelling in the affected region.  It can also assist in the removal of waste products from the injured area.  Because of the location of the hamstrings in the body, however – and the same applies to any kind of thigh or upper leg injury – it’s not always that easy to elevate this area.

A trip to the physio

For those living in the vicinity of Edinburgh, I strongly recommend the FASIC Clinic, attached to Edinburgh University, for the treatment of sports injuries.  They have a team of physiotherapists, podiatrists, sports doctors and sports massage therapists who are often chosen to work with the Commonwealth and Olympic athletes.  In fact, the physiotherapist that treated my patellar tendonitis last year was apparently in London the whole summer, as an official Team GB physio.  If it’s good enough for Olympic athletes, it’s most certainly good enough for me.  FASIC have sorted out in full previous running injuries I’ve had, most notably stress fractures and patellar tendonitis, and FASIC is again where I decided to go today.

I wish I was getting commission for plugging like this, but alas, I’m not.

Sciatica

After a thorough examination, it turns out that my hamstrings are fine.  I could certainly never have discovered that myself, as I have no idea what to look for.  This is at least one piece of relatively good news, as hamstring injuries can of course take ages to heal up properly – and certainly if you have the heavy demands of marathon training pounding through your legs.

Instead, it seems that my problem is the sciatic nerve, more commonly called sciatica.  I think I’ve only ever heard old people complain about having this, but it seems that sciatica is a not overly-rare running injury, too.  Who said running was good for your health?

The sciatic nerve is one of the larger nerves in the human body, running from the lower back region to the lower limbs.  Pain in the hamstring area turns out to be pain in the sciatic nerve itself, which is interwound with the hamstrings.  This also explains why I initially felt pain all the way up the full length of the posterior leg.

Sciatic Nerve Diagram
Diagram showing the sciatic nerve. © Sciatic Nerve Treatment.

Sciatica is caused by something else; in other words, its an effect.  What is causing sciatica in my case is not 100% clear, but my physio has pointed to a number of factors which may be affecting this.  First, I may have a problem in the lower back area.  I don’t have any pain here, but such a problem can manifest elsewhere.  My physio was in fact surprised when I said I didn’t experience any back pain, as she pointed out that the left side of my back is more muscular than the right side.  There’s an imbalance right there.

Second, my left thigh muscle is more pronounced on my left than my right leg.  That’s another imbalance, and suggests some kind of weakness in the right leg or right side of the body generally, which can contribute to sciatica.

Third – and this might be partly responsible for some of that weakness – the iliotibial band (or ITB) in my right leg is weaker than in the left leg.  The iliotibial band is a fibrous area running down the outside of the upper leg, and plays a key role in the flexing of the knee and hip, as well as the rotation of the hip.  The iliotibial band is a common site of injury in runners, resulting in what’s known as Iliotibial Band Syndrome (ITBS).  Again, this can drive sciatica.

So I have to work on these.  I’ve been given a number of physio exercises including the bridge (to work hamstrings and strengthen lower back), half squats with tensed glutes (to strengthen upper right leg), nerve mobilisation (to gently stretch and strengthen the sciatic nerve), and the foam roller (to treat the weakness in my right iliotibial band).  It was also recommended that I get hold of a tennis ball to massage into my glutes.

By the way, ever had someone massage an over-sensitive sciatic nerve?  It’s sore.

Sciatica 1 – 0 Glasgow

Running next week’s half marathon is a bad idea, for two reasons.

First, if I run in Glasgow in this condition, I seriously risk setting myself back too far so that I can’t recover in time for Berlin, which is now just under 5 weeks away.

Second, if I run in Glasgow, I might have to abandon the race before the finish anyway.  That is surely more frustrating and demoralising than not turning up at all.  There seems little point in running Glasgow now anyway, as I was running for a PB – which I am sure my fitness would have allowed this year – but which is unlikely to be possible with this problem.

Iliotibial band exercises with foam roller
Foam roller exercise for the iliotibial band. © Bycycling.

It pains me to miss the Glasgow Half Marathon – again.  I had to miss it in 2007 due to stress fractures, and it sent me into a pretty foul mood.  Anyone who has put in months of hard, dedicated training, with hours and hours of pain, gritted teeth, stamina and endurance, and who then gets injured and has to pull out, knows what this feels like.

But maybe I have to stop running just the one half marathon each year.  It’s a long time between races.  I know I can beat my PB of 1:52 and I’m sure I could have got down into 1:49 this year too.  I’m not going to wait until the Great Scottish Run 2013 to achieve that.  There’s no reason why I can’t do a few half marathons a year.  The training is, after all, significantly lighter than for the full marathon.

At the end of the day, though, my ‘A’ race, if you like, is Berlin this year.  Apart from the fact I’ve already paid for the flights, hotel and all the rest of it, I would never have gone out for 20-mile training runs in the pouring rain for a half marathon.  I’ve done all this for Berlin, and a PB at Glasgow would have been a bonus in what was, to be honest, a season of training that was going almost too well for me anyway.  I dare say I will be up and down about this over the coming week, and next Sunday – the day of the half marathon – it’s probably better not to speak to me, but sometimes you have to get your priorities in order, and I’d much rather a PB in my second marathon in a brand new city, than to sacrifice that for running Glasgow, which I’ve done 4 times already.  Glasgow will still be here next time round, and I’m just going to have to wait till then to run across that Kingston Bridge again.

It’s Sciatica 1 – 0 Glasgow, but I’m putting in the effort now to make it Berlin 1 – 0 Sciatica.

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2 Responses to Hamstring injury, RICE… Sciatica!

  1. Pingback: Nice to feel that pain again... and not 'that' pain » My Running LifeMy Running Life

  2. Pingback: Sciatica exercises for runners » My Running LifeMy Running Life

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