Dr. Atul Prakash
Orthopedician and Traumatology
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I am a regular runner and have recently been trying out a new program running five days per week, with lots of gentle short runs. I have had a few running-related injuries in the past year. I got shin splints and peroneal tendonitis on the outside of my left foot for several months last year. I had physiotherapy for tendonitis. The physiotherapist discovered that my left hip flexor was weak and the hamstring was too tight on that side, which was causing the foot issues. Last weekend, I seemed to have pulled a muscle in my left hip. I did a steep trail run and felt like it was on the downhill that I triggered the injury. It was hurting when I tilted my pelvis forwards. I tried swimming, but the side-to-side tilt of the pelvis caused little sharp pains that felt like inside my pelvis. The sharp pain has now gone, but all of the muscles in my lower back, mainly on the left but also on the right, are now tensing up, causing me discomfort. Any ideas about this? I have done a bit of self-diagnosis, and it sounds like one of the muscles that do balancing on the hip. Please help.
Hello,
Welcome to icliniq.com.
It is very difficult to be precise without examining you. Your recent injury could be an iliopsoas strain or a rectus femoris strain from the hill run. Is the pain deep within the groin? Is the movement of getting up from a sitting position uncomfortable? Is there any clicking on the hip? Then you need to take a course of anti-inflammatories as your body is trying to protect something by tensing up the muscles. Your best bet is to see a sports physiotherapist, who should be able to guide you further on this. If you have questions after seeing the physiotherapist, then please let me know, as I can rely on the physiotherapist's examination findings to guide me.
Patient's Query
Hi doctor,
Thank you very much for your response. The pain was originally in the pelvic area to the left-hand side. It was above the hip, so it did not hurt when I lifted my leg at all. It hurts on the extension of my leg backward, if I do a leg swing, and if I tilt my pelvis forward. It feels a bit like it is linked to the lower abs rather than to the leg muscles. I have been taking anti-inflammatories, and the sharp pain seems to have gone now, but the tension in the rest of my lower back is now causing more problems. Is it important to fully rest, or whether I should try to move it? I cycled to work this morning, which just made my back tense, but not sore. And when is it safe to continue running?
Hello,
Welcome back to icliniq.com.
As your symptoms persist, though not at the same place or intensity when they started, you still need to be on NSAIDs (nonsteroidal anti-inflammatory drugs). Two to three weeks is a safe duration.
You should do gentle stretches of the back and limit yourself to the point of pain and no further.
The process of tilting your pelvis forward can stretch your Iliopsoas. I am going back to it because Iliopsoas originates from the lumbar spine and inserts on the lesser trochanter and helps me explain both the acute and delayed phase of pain and the spam you are feeling in the back.
I will still rest the limb, no running. You can cycle if you can tolerate it. How much do you cycle for work, and any uphill climb?
I suggest you see a physiotherapist for myofascial release and ice massages.
Thank you.
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Orthopedician and Traumatology
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