Science Friday: Diagnoses and Discoveries About Hips

Note: This is not a typical Science Friday, but Part 2 in the unexpected series identifying what is wrong with RunnerTeal.  (Let’s hope for no Part 3 anytime soon.) 

Last week I told you about my not-so-hip hip and my upcoming doctor’s appointment.  Everyone’s well wishes and thoughts paid off, as I do not have a surgery-requiring labral tear, but tendonitis in my hip flexor instead. (Yippee!!) Tendonitis means no running for a few more weeks, being forced to confront my hatred for biking, and no fall marathon. (The Philadelphia Marathon has now stolen my money for the last two years. I’ll get you back some day, Philly…) But, it isn’t surgery, and that is a huge relief that indisputably makes a few run-less weeks and hours of boring biking seem like a blessing.

Given the crash course I’ve had the last few weeks, I thought it might be nice to share some of the things I’ve learned about hips, both their tears and tendons.*

The hip is a ball and socket joint, like the shoulder, where the head of the femur (the ball) sits in the pocket (called the acetabulum, the socket) of the pelvic bone. This allows for motion in almost all directions and allows us to walk, jump, and of course, run. It absorbs a lot of forces; when we run, the forces are many times our body weight. The hip is the superstar of joints.

The acetabular labrum is the cartilage that surrounds the socket, helping to keep the femur securely in place. Running repeatedly over years and years (as marathoners are wont to do) can cause the labrum to wear thin and tear. (This can also occur more instantaneously in contact sports or accidents.) The pain occurs on the inside of the hip and it may present as stiffness and tightness or it may feel like it’s clicking or catching. The latter is the symptom that had me (and Dr. #1) convinced I had a tear. If the tear is bad enough, arthroscopic surgery may be required, where the torn portion is cut out. After seeing my x-ray and hearing my description—when the pain was worst, what time of day it hurt, etc.—my doctor was less than convinced that I had a labral tear, and did an ultrasound to check. If I had a tear big enough to need surgery, he’d see it on the ultrasound. Fortunately, he found a healthy looking labrum! He diagnosed me with tendonitis of the hip flexor instead.

The hip flexors are a collection of muscles that mainly function to pull the leg and knee upward, towards the body. Two of these muscles, the iliacus and the psoas major (together referred to as the iliopsoas), are the most susceptible to hip flexor injuries, and tendonitis can occur in the tendons associated with these muscles. (Tendons attach muscles to bones.) When under repeated stress, tendons can degenerate and become inflamed. (The suffix “-itis” means inflammation.) The stress could come from doing too much too soon or from overuse, pushing too hard for too long—again as marathoners are wont to do. If the tendons are inflamed or aggravated, most likely the surrounding muscles are as well. During my appointment, the tightness and stress on these muscles was obvious. The psoas major connects the lumbar part of the spine (the lower back) to the front of the pelvis. When my doctor pressed on my lower back, I could feel pain in the front of my hip—a strange sensation that convinced me he knew what he was talking about. (An interesting side note: only about 50% of people have a psoas minor. It seems not to matter whether you do or do not have this weak muscle.)

Treatment for tendonitis includes anti-inflammatories, physical therapy, massage, and, of course, the most hated treatment: a break from running. The tendon is able to heal itself; the purpose of the initial inflammatory process is to promote healing. As with all injuries, the trick is patience: let your body work its magic (and have a really good PT to help coax it along.)

Here’s a quick run down of other hip issues that affect runners:

Bursitis:

Bursae are lubricating sacs that cushion areas where muscles and tendons slide against bone; bursitis is an inflammation of these sacs. Trochanteric bursitis will cause a dull ache or rubbing on the outside of the hip. Again, the treatment includes rest and ice/anti-inflammatories.

Stress fracture:

In the hip region, the most common place for a stress fracture is the neck of the femur. A stress fracture causes a throbbing pain that gets worse with more running and will probably leave you limping. If you can’t hop on the affected leg, a stress fracture is probably the issue, and you should immediately stop hopping and stop running. Here the treatment is 6-8 weeks of no running.

Iliotibial (IT) band syndrome:

This can present as a jabbing pain on the outside of the knee, but it starts up in the hips. IT band syndrome is from irritation of the ligament that runs along the outside of the thigh from the hip to the shin. You can get it from doing too much too soon (always trouble!) or even from running the same direction on the track (too many left turns!) IT band syndrome can be helped with rest, ice/anti-inflammatories, and massage before starting a program that strengthens the surrounding muscles.

Piriformis syndrome:

This is literally a pain in the butt, as pain shoots from the butt down the back of the leg. It can be treated with massage and physical therapy.

Staring at images of skeletons, muscles, and joints and learning all the things that can go wrong makes me appreciate how amazing it is that, most of the time, things work smoothly to allow us to move around. And, someday soon, to run again.

*Note: I am not a doctor, just a scientist who likes to teach herself things. You should see an actual doctor if you’re having hip trouble.

Dream big, 

Teal 

Broken

I have never been injured. 

When I admit this to someone, it is not to brag. Rather, I confess it sheepishly, full of guilt, fully aware that I don't deserve to be an injury-free runner, fully aware of all those runners who have been frustrated by injury for years. (My sister, who will always be a far superior runner to myself in my eyes, has been hit with one too many injuries. Why can I run and she can't? It isn’t fair.) 

In high school I had a problem in my foot that flared up a few years later while training for my first marathon. Before my first Boston, my Achilles started acting up. In these cases, the remedy was a few days off and then carefully resuming running. I've never been to the doctor for these minor glitches. 

When asked how I remain injury free, I list the usual reasons: I watch my mileage and have built it up slowly over years. I take careful inventory of what hurts and stretch/ice/rest when anything feels off. I know what works for me and what my body can handle. But honestly, I'm just lucky. I've broken the ten percent rule. I've gone weeks without a day off and felt a sense of pride about it. Busy mornings mean skipped stretching and icing. The injured runners reading this now hate me. Don't worry. Karma will get me soon. Maybe it already has. 

While training for this spring's Boston, my hip acted up a bit. Some days it would feel tight and go away, some days it would be a quick pang of pain, and then disappear. Looking over my log, there is one day it bothered me enough to cut a workout short. Instead of logging 15, I cut it to 9. Still, I ran 9 miles; I wasn’t debilitated. I worried about it a bit, but it wasn't serious enough to slow me too much. 

After Boston, I took off more time than usual. I did a short test run; the hip was still tight, so I took some more days off, and repeated this process a few times. By June, I was aching to run and getting out of shape. I started slowly and built back my mileage. My hip made its presence known a few times, but nothing to sideline me. I religiously did hip exercises and iced it. It seemed to be going away. Three weeks ago, I did a tempo run that wasn't a complete disaster. I was coming back. 

The next day, while visiting Brother in Philly, he took me on a run along the river, following the same course the marathon would. It was a gorgeous day, the kind of beautiful morning that makes you glad to be a runner. My hip was tight in the beginning, but loosened up. I hit a pretty decent pace, and felt happy with it. Afterwards, I did my stretches, grabbed some ice and hopped in the car for a wedding in the Hamptons. 

On the drive the hip stiffened and throbbed. But after we got out of the car, it felt fine. We danced and celebrated, all fine. The next day, Husband and I tried to go for an easy run. It tightened immediately. “Maybe it will loosen up like it usually does,” Husband said. But I couldn't even make it two steps to try and see. I was hurt.

I took a few days off before testing it again with an easy jog. After five minutes of pain-free running, it tightened. I could have pushed it to see if it would stretch out like I have in the past. But remembering not being able to take two strides a few days before made me realize it wasn't worth it. At that moment I switched from someone who defied injury to someone who was injured, and accepted it. Time to see the doctor.

I called the best hip doctor around, as recommended by a teammate. I couldn’t get an appointment for three weeks. Three weeks? That seemed like an eternity. I am supposed to be training, what the heck do I do with myself?

After the aborted test run, I cross-trained to maintain sanity. On Friday (day 7 of no running), I saw my doctor to get a referral to Dr. Hip Specialist. She thinks it may be a labral tear, to be confirmed by the specialist with an MRI. She warned me a tear could require surgery, although it may be possible to rehab it with physical therapy. She also said I can run in the meantime, provided I decrease mileage and avoid hills. I can run? This happy news clouded the rest of the appointment. But as I walked away, the reality of what else she said dawned on me. Possible surgery!?

I was able to run for five pain-free, glorious days before the tightness was back and I was sidelined again. Tomorrow I have my appointment; the three weeks of waiting are over. I’m eager to get a real diagnosis: will I need surgery? Is cross-training aggravating it? When and how can I get back to running? I’ve come to accept my immediate goals may need to change, but I want to get started fixing this as soon as possible, so my long term ones don’t need to.

Dream big,

Teal

Science... Wednesday(?)/Shameless Plug

Much to the chagrin of my Science Friday fans, most of my science writing this summer has been concentrated on my internship at NOVA, where I contribute to the NOVA Next website. This week I wrote a feature about focus in sports and devoted half of it to discussing focus in running. (Interview people about running marathons for my day job? Yes please!) Get a dose of Science Friday Wednesday and check it out here.

But first, a warning! There is a spoiler; if you haven't read my Charlottesville Race Reports, I suggest (in a completely non-biased way) you read Part 1 and Part 2 before the NOVA piece. 

Hopefully I'll have some real Science Fridays finished soon!

Dream big,
Teal

Hey Stranger, Good Workout!

Friday’s run was an out-and-back route. I hit halfway in a decent-for-these days time, nothing impressive. Shortly after the turn around, a few paths merge into one and I found myself between two runners: one who I had just passed as the roads came together, and one thirty meters ahead. Well, I couldn’t let the guy I passed pass me back, because I’m too prideful/competitive/stubborn. Once I pass someone, I have to stick to it. It’s embarrassing to get passed right back, admitting you couldn’t handle it. If you make your move, you better commit to it. Except I had kind of fallen into my move; rather than one of us gradually overtaking the other, we had just emerged on the same path at the same time and I had gone in front. Oh well, better commit.

So I picked up the pace a bit and put some comfortable distance between us. The acceleration shook me out of the shuffling trance I’d been in lately.  I felt surprisingly good at this new pace, just pushing it slightly, opening up the legs and getting in the rhythm. I realized the guy ahead wasn’t getting any further away, but I wasn’t catching him either. He was keeping up a decent clip, so I decided to make a game of it, to stick with the pace to maintain the constant gap between us. Mr. Blue Shirt and I ran that way for close to three miles, him setting the pace, me trailing behind by about thirty meters. At one point, I thought he might turn a different way, but was glad when he didn’t. This was fun!

I have no idea if he knew I was there. He very well may have hated me—I know I despise when people do this to me. They force me to go fast, just because of my stupid pride of not getting passed. (See above for example.) In the end, though, it amounts to a better workout. Everyone ends up being pulled or pushed a bit faster, and so everyone wins. (Although if it’s a scheduled easy day, better to just let them go.)

Finally, Mr. Blue Shirt turned around and passed me going the other direction. He didn’t acknowledge me at all, not even in an ‘I hate you for following me’ kind of way. He may very well have not known I was there. Meanwhile, I had to refrain myself from giving him a high five, “Good workout, stranger!”

I tried to keep up our good pace the rest of the way, but it wasn’t as fun without my (oblivious) workout buddy. Thanks to his rabbiting, our second half was three minutes faster than my first. More importantly, it snapped me out of a running funk. Thanks, Mr. Blue Shirt. Same time next week?

Dream Big, 
Teal 

[Image courtesy of Roland Tanglao]

The Return of the Watch

Last week, I finally dusted off the old Garmin. The stats on the screen were still there from Brother’s marathon—which he ran two months ago. The last time I used it was a month before that. It probably would have been better for my self-esteem if I left it collecting dust, but it was time to know the truth.

I wore the watch for my “long run,” but I didn’t let it dictate the pace. I just wanted to see: how out of shape am I really? Give me a number.

Sorry I asked. The number was embarrassingly slow. I could blame the heat—which is a valid excuse these days—but the truth is I’m still just out of shape. I take comfort that even though my “long runs” are still shorter than what would qualify as a long run to an in-shape Teal, they are twice as long as a month ago. Progress.

A few days later it was time for an actual workout. Use the watch to time things. Set goals and splits. Compare actual times to predicted ones. Celebrate hard work paying off or get a well-deserved kick in the pants.

The plan was a tempo run of four miles. I had a modest goal pace in mind, but no real idea how I’d feel. Considering how slow I had gone a few days before, this could be trouble.

The first mile didn’t feel so terrible, and I hit my pace dead on. Hey, maybe I’m not so out of shape after all! Mile two I slowed slightly, and reality set in. Nope, you can't keep this up. There’s no salvaging this. You are only going to slow more. The debate began at mile 3: to cut the workout short or to push through, even if that meant a slow time?

The devil on one shoulder listed the pros of calling it at three miles: Sometimes, it is better to call it—it’s just an off day, you may not be fully recovered from a previous effort, it may be better to save it for another day. It’s silly to dig yourself deeper into a hole if you just don’t have it.

The angel on the other shoulder fired back with the cons of slacking off: This was my first workout in months. I wasn’t overtired; I was out of shape. I didn’t need to save it for another day. I needed to suffer through for the hope that I’d be able to handle this workout another day. If I start making excuses now, where will that get me? A month from now I’ll be in the same spot. Four slower-than-expected miles is a tougher workout than three miles. And what I needed was a tough workout.

In the end, I ran the fourth mile. And yes, it was slower than I liked.

But, you know what? It was faster than my third.

That's why you wear the watch. To give yourself a kick in the pants when you need it, and then to do something about it.

And that’s why you keep going. To witness progress, even the tiniest bit.

Dream big,

Teal

[Photo credit: purplemattfish]

Welcome Back

Dear Readers,

I’ve missed you. Sorry it has been a while. Life got a little crazy for a minute there; I got married (that’s Mrs. RunnerTeal to you!), honeymooned, and moved to Boston for an incredible internship. Running has been minimal to say the least.

After Boston, I took my usual post-marathon time off. Then, thinking I should be recovered, I went for a few short runs but I still wasn’t feeling quite right. It was as good a time as ever to give my body a break, and it was telling me it needed one. Unfortunately, I had to maintain my pre-marathon wedding dress shape, so I was forced to cross-train (which served its purpose in reminding me that I love running, not cross-training). After I got married, I let myself go. (Sorry, Husband, I’ve got you now!) I enjoyed the honeymoon like a normal person would (with an abundance of tropical drinks, great food, no running, and not a hint of guilt). But it's back to business (and blogging) now.

Mr. & Mrs. RunnerTeal.

Dear Running,

I've missed you. I wanted to start up again as soon as I got back from the honeymoon, but I had promised my body a longer break. Finally, this last week, it was time. In the few moments we’ve spent together this week, I can tell you’re punishing me for ignoring you. Sunday’s excursion was the most time we’ve spent together in a long while, but two months ago (gosh, has it really been two months??) that would have barely qualified as a date. I can tell this upsets you; I can feel it with my whole body.

I’ll have to work hard to earn your forgiveness. It seems like an impossible task at the moment, like we’ll never get back to how we used to be. But we’ve come out of worse before; I know we can pull through this, and be stronger than ever.

Dear Boston,

I’ve missed you, especially your running routes. When we parted a few years ago, I didn’t know if I’d see you again. But you kept your paths and trails just the same, waiting for my return. It was here, on these roads, that I fell in love with running and marathon training. It was here, right along this river, that I chased alongside the Trials competitors to see if I could keep up. (I’m still chasing the dream that started here.) I’m going to have to get in better shape quickly, because I can’t wait to spend more time with you.

I’ve missed you all. It’s good to be back.

Dream big,

Teal

[Photo credit: Liz Reese Photography.]

Boston 2013

Yesterday I ran the Boston Marathon. It was not the day I, or anyone else, had hoped for.

It started with a disappointing race. The details are meaningless now; I had hoped for a five minute PR, but struggled with cramps and a cranky hip just after halfway, and I barely managed a PR at all. I crossed the line in tears, and fell into my Fiancé’s arms, heartbroken.

But then it got much, much worse. A few short hours later those tears seemed like the silliest thing ever. And my heart would break many more times over before the day would end.

When we left lunch, my family and I tried to board the T near the finish line. It was closed; no one knew why. There were rumors of some threat on the T, and we saw police car after police car drive by. Firetrucks came too, but no ambulances, so I was comforted that perhaps no one was hurt. As we walked up the street to another T station, my sister sent a desperate text: “Please let me know you are alright, heard there was an explosion.” Then the ambulances started coming. I got an email news alert simultaneously, and when I read the headline, I crumbled to the sidewalk in a fresh set of tears. Explosions at the finish line—no one knew why/how many hurt/what to do. Fortunately I was able to get a few texts through to my sister and brother who got the news out to family and friends that we were okay. My teammates started an email chain, and quickly almost everyone responded. One teammate, unable to get through as the cell phone towers went out, wouldn’t be heard from for a few anxious hours. We were comforted knowing she had finished long before, and had no reason to be near the finish anymore. We kept walking, trying to figure out a way out of the city, and the news kept getting worse. As we tried to hail cabs, we found out people had died. More tears were flowing, real tears for people’s lives and limbs lost, lives forever changed. 

We couldn’t make it to my parent’s car to get our bags, so we left them behind and headed to the airport. At the airport, we saw the footage for the first time. I struggled to watch it. I could not, and still cannot, believe what happened. I feel ridiculous for having cried over some silly time in a silly race. The events of yesterday quickly put that in perspective. Life, family, and friends are so much more important. Who cares about a running race?

But that’s what makes me so angry. This race, this event, is not offensive to anyone. It is a celebration of hard work, of hope through adversity, of triumph over diseases and tragedies just like this one. Spectators line the entire 26.2 mile course, standing for hours, cheering for strangers. There is no ill will; from the starting corral to the finish line, everyone is bonded together as they run, as if they have been friends forever. I don’t think there is a friendier environment anywhere. Why would someone ruin that? The runners yesterday are people who have spent years trying to qualify, who have worked hard to become better athletes for a chance to compete at Boston. Other runners raise millions for charities—supporting cancer research, veterans, and victims of Newtown. The spectators yesterday are those people that stand by their sides, giving these runners the encouragement to keep going, to keep up the training, and to keep fighting through the whole grueling race to the finish line.  The fact that an event like this, a celebration like this, would be targeted is unreal. The fact that the spectators—our constant support team—took the brunt of it is not right. A day later and safe at home, I am in shock this happened.

In the airport, we met others who shared the story of where they had been and how fate had saved them. Two parents talked about their daughter, how she was set to run but an injury prevented her from being on the starting line. Instead they watched from near the finish line. They left before the explosions, but the daughter said she would never run a marathon again, not after this.

I’ll admit, I was thinking the same thing—even before the day changed forever. I was selfishly moping, thinking I had spent a year working hard to improve my marathon time and had only come away with only 30 seconds. I was thinking how hard the race was, and how I didn’t know how I’d be able to do another one, faster. I was thinking the same thing many marathoners think at the end of the race, how that will be the last one. Time, healed legs, and encouraging supporters will eventually change our minds, but that’s the important thing: we will get to make that decision ourselves, in our own time. No terrorist should be able to take that away from us. We cannot live in fear. We will band together, as runners always do on our way to a far off finish line, and we will pick ourselves up and get through this together. We can’t let these terrorists get what they want—to ruin our celebrations or crush our spirits.

I am moved by the generosity already exhibited. The influx of donations crashed the Red Cross’s websites, their blood banks are full, donations are being offered from around the country in the form of food, coffee, places to stay. The running community has always been a supportive one, and it will continue to support us all, even when a tragedy crumbles us.

Dream big and pray for Boston,

Teal