INJURY: Iliopsoas Tendinitis

My last check-up with John brought more reasons for optimism, he was very happy with my progress and described me as being “five and a half weeks into a twelve week healing cycle”. I have to further increase my running now and can contemplate competing if I want. He expects the symptoms to fluctuate as we apply stress to the area and then peter out again as we take the load back off.

The “migratory pain” that I’ve experienced is not directly related to the osteitis pubis as it proves: rather it’s a mild form of iliopsoas tendinitis caused by the general area still being somewhat overloaded. Strength in my right hip flexor is back in the normal range but my pelvis still tilts too much forwards and I still have a tendency to use a “pull” rather than a “push” action during the lengthening phase of my abdominal muscles. Both are functional deficiencies I have to keep correcting through the program provided by John.

He wants to see me again in three weeks to track my continued progress and from there on hopefully bring me onto a more functional rehabilitation program which my current state still does not allow. Even five easy core exercises still cause a significant discomfort, so there’s reason to be buoyed  by today’s news but restraint is still in order. It’s remarkable that you can let something as invasive into your biomechanics develop this far without noticing that a real injury is developing.

Earlier in the year part of my success in staying injury-free was an acute awareness of any niggling sensations in old problem areas allowing me to pull back just enough to make any injuries that occurred brief in duration. The issues appear when a new injury appears where you don’t know what you are dealing with and don’t take the appropriate action. With this in mind, its advisable for runners to be slightly hypochondriac and immediately go to a chartered physiotherapist when any worrying symptoms occur rather than procrastinate and hope the symptoms will fade.

The words “only he who dares venture too far, can know how far he can go” are worth keeping in mind.

Comments

Colm O'Cnoic said…
then again one could be running to the physio every morning.

If you bounce out of bed every morning, you clearly haven't trained hard enough the previous day.
Renny said…
Well, that's why injuries are so hard to deal with, what’s a niggle and what’s a sign of a serious injury? You have to learn through experience but until you understand it’s better to be safe than sorry.

I agree you should always be sore when doing high mileage. John Murphy tells me this every time I knock on his door: “With your mileage you’ll always have pains somewhere.” But this is not the same as saying every pain should be ignored.

When I was in my late teens and early twenties, I could get away with a lot more. He'll even four years ago, I could get away with a lot more. Now I heal a lot slower, and once I fall over the age it takes longer to heal.

My own experience has been that I always overtrain rather than undertrain and always wait too long rather than go too early. With that in mind, and if you're similar (as I think many runners are), caution is worth. The time lost from training can never be regained and it’s amazing just how much more acutely I am aware of this fact at 31 than I was at 27. The margin for error grows thinner as the year progress.

If you can learn to fix yourself early on, rather than have the physio do it for you, that's even better, but when you get a new injury you need to learn from scratch.
Runners like me, the “late-starters” with no sporting background, are undoubtedly the group at risk the most. Any serious 16-year old junior athlete has probably run more miles and has a better physical conditioning than our group and when you add to that the fact that physical skills are learned more slowly and muscle-mass lost more rapidly past thirty, older runners must follow different advice from their younger brethren.

As for bouncing out of bed, I wouldn't have had that feeling for a good six months or more. I don't consider that a good thing. Periods of tiredness must be followed by periods of absorption.

As Lydiard said: "Suffered? My athletes never suffered, we enjoyed ourselves."
Colm O'Cnoic said…
The classic good pain - bad pain divide.
In general terms, good pain will slowly vanish after 10mins of running/biking. Bad pain will make you stop.

If bad pain is still there the next day, have a cold shower.
Every endurance athlete that wants to do well will have a tenancy to over train at some point. The more is better mind frame is hard to get out of.

The only day you want to bounce out of bed is the day your going to smash a course to pieces.

Pain is inevitable, suffering is optional.
Obsessed is what lazy people call committed.
It always seems impossible until its done.

Or as a great man once said, "Youthful enthusiasm, down with that sort of thing."
Renny said…
Nothing wrong with youthful enthusiasm Colm, it hasn't done you no harm, for me enthusiasm has only ever led to lost running time.

So different folks, different strokes.

I can't agree with the good pain definition, I'm afraid, several of the most serious injuries I have had followed exactly that description: plantar fasciitis, osteitis pubis the most noteworthy. Both got better as the run progressed only to return with a vengeance (indeed this is normal for this type of injury).

I also can't agree that bad pain will make you stop. I ran 26km in Three-Peaks with a lump of fat hanging out a gash in me knee, cramps in two legs, an ever worsening plantar and my old sprains going to shod.

Some runners aren't born with a pain threshold that allows them to pull out when they should. That's why I recommend getting a professional opinion.

There is a very important distinction between obsessed and committed:

Obsessed - compulsion: an irrational motive for performing trivial or repetitive actions, even against your will; "her compulsion to wash her hands repeatedly"

Committedness - the trait of sincere and steadfast fixity of purpose; "a man of energy and commitment"

No one illustrates this point better than the late Buddy Edelen, the first man to break 2:15 for the marathon, as it reads in his biography "A Cold Clear Day":

"Fred knew what he was up against and he tried regularly to get Buddy to understand himself well enough to change: "the compulsion to run and restlessness comes from mental inferiority complex"; "here comes the old insecurity again"; "you are just now to the point where you could go too far"; "I cannot kill your spirit but you are your own worst enemy. Why not be kind to Buddy Edelen? Why kill him now?" Fred's protests illustrate the sharp edge in Buddy Edelen. The same motivations that made Buddy a good runner could also destroy him."

It did destroy him. Perhaps it stems fromthis insight from one of the great Kenyan coaches:

“So, when a Kenyan is tired, his training is to sleep (may be also one day). When a European, or an American, is tired, the first thing is to go running, because training is not considered something in order to improve, but something like a drug, irremissible also in very bad general conditions.”