Piriformis syndrome or HHT or Mortons Neuroma?

These are injuries that runners suffer though not as common as some of the other runners' issues such as knee or ITB problems, shin splints,muscle pool or achilles tendon etc. The fact is during a period of a year about 70% of runners are likely to pick up an injury or another. I have had my share of injuries  -  first when I took to long distance running in 2002-2003 and subsequently in 2012-2013. Since December 2013 I have been having varying symptoms : pain in the glutes and hamstring during and after a workout(running and cycling) , pain in the calf while running and numbness in the toes during a workout(running and cycling) which pretty much disappear once the workout is completed. This affected my performances in SCMM in January 2014 and also Boston marathon in April. And this running season looks pretty much washed out unless there is a significant change for the better in the next few weeks.  The  low training volume and intensity is resulting in self-doubt -as to whether one will be able to regain the fitness to  run a FM in the near future, leave alone with any specific time goal.

After multiple consultations and some research on running related injuries  my issue looks like a mix of:

1) Piriformis Syndrome 

A tight piriformis muscle that presses against the sciatic nerve thereby irritating it. This causes numbness and pain in the buttocks which may travel down the leg to hamstring and calf along the nerve. Runners get it due to overuse/high mileage and it gets further accentuated if one spends long periods sitting down. There are a number of stretches and strengthening exercises available on the net to address piriformis syndrome. A few that I found useful  are(though my issue has still not gone away):

Piriformis Syndrome: How to detect it and strengthening and stretching programs to help you heal

Top 3 exercises for piriformis syndrome
Piriformis syndrome - the cause and 2 recommended treatments
Neural flossing

2) High hamstring tendinopathy (HHT)
Hamstring tendinopathy is related with deep buttock pain and pain in the posterior thigh due to inflammation of the hamstring muscles. The pain is often felt in the lower gluteal region, radiating along the hamstrings. The pain increases with repetitive activity such as long-distance running and can also occur while sitting or driving a car. Usually the pain is not acute when it appears- it gradually gets worse.Rest and stretches seem to be the main method of managing HHT. This runnersconnect article has a lot of details on HHT.

3) Morton's Neuroma
This is a swollen/inflamed nerve in the ball of the foot, commonly between the base of the second and third toes causing pain and numbness in the affected area. It can be caused by high-impact sporting activities such as running or karate or tight or narrow shoes. The treatment for this seems to be mainly through changing footwear and use of orthotics pads fitted into shoes and some calf stretching exercises. Some additional information is available here. 

Unsure whether Morton's neuroma really applies to me. I have included it because I do get numbness in the 2nd and 3rd toes which goes away soon after I stop the workout.

There are many running injury related sites. A couple below give a lot of information.
http://www.runninginjuryoracle.com/know-what-you-are-suffering-from/
http://www.marathon-training-program.com/running-injury-piriformis-syndrome/

 

Puma Urban Stampede 2014

Have been running 5Km on and off  in the Puma Urban Stampede in Bangalore. I ran in the 1st edition in 2008(in fact the company I worked for, namely, mformation was the title sponsor) as well as in the 2nd edition in 2009 as part of a team from mformation. Then  in 2012 as part of a team from ALU. And this year soon after taking up my new job at Wadhwani Foundation I triggered participation in the event. We had 3 teams participating. This year the event was held in Bharatiya City  on 3rd August 2014.  I did not train specifically for the event - just did a few easy to moderate pace runs in the previous 10 days after taking a 3 weeks break from running due to injury. 

I left in my car from Domlur at 5:35 am after a colleague from Koramangla came over and parked his bike. After picking up 3 others runners at Domlur flyover, CMH road and Kasturi nagar reached the start point by about 6:20am. There were direction signboards from RFL on Hennur road. As we approached the venue we saw runners on the road who had started their 10K run at 6am. After parking the car we were in the starting area by about 6:45am. In my time Mischelle ran first, followed by Austin with myself being the 3rd runner. My goal was to try and run below 25 minutes and if possible between 23 and 24 with the pace per Km of around 4:45..  I am generally not good at short distance intensive pace runs. My 5K PB is 21:51 at the Puma Urban Stampede in 2012. The only other 5K below 23 minutes that I have run is in the duathlon in 2010.

The weather was quite nice when the first runners from nearly 350 runners started at 7am. By the time I grabbed the baton from Austin and took off around 8:05 am it got a little warmer. Nevertheless started off at a pace closer to 4:30. At about half way mark the left  glutes and calf started to hurt a bit -so eased off a bit. Also I knew was on track to do a comfortable sub 25.  Still I managed to push in the last Km at 4:27 pace to finish in 23:33 - my 3rd best time for a 5K! I was satisfied with my performance. After eating the refreshments and taking some photos left for home around 10am. During the return drive my left glutes started to hurt after a few minutes and I suffered from this for the next couple of days making me realise that my glute/hamstrings needed considerably more strengthening. 

Bill Pierce in India

It was a pleasure to host my running coach Dr. Bill Pierce, who motivated and guided me to BQ in 2012-13, during his visit to Bangalore on 26th August. Bill was brought on his maiden trip to India by Hyderabad Runners as the event ambassador for Airtel Hyderabad marathon on 24rth August 2014.

Bill  is professor and chair of the Health Sciences Department, at Furman University, in Greenville, South Carolina, USA. He is co-founder of the Furman Institute of Running and Scientific Training (FIRST). FIRST promotes running as a healthy physical activity by providing training based on scientific principles and research. Bill, now 64 years of age, ran his first marathon in 1977 and to date, he has completed 40 marathons. He also has the distinction of having run the Boston Marathon in five different decades – 1970s, 1980s, 1990s, 2000s and 2010s – the last time being when he was in his sixties.

With over 250 road races under his belt, 1st place finisher in 10 road races of distances from 3k to HM between 1978 and 1991 and Top 3 age group finishes in 114 races, Bill’s running history is very impressive. Bill is co-author of the best selling book “Run Less, Run Faster”, which completely revolutionized marathon training. Backed by scientific research and experiences of real runners, the book describes how to achieve faster speed by limiting to just three running workouts a week.

Bill did well in his first race in India completing the HM in the challenging Hyderabad course under tough weather conditions in 1:50:46 and finishing 4rth in the senior mens veteran category. This despite sight seeing in Delh and Agra and also addressing several meetings in Hyderabad prior to race day.

Over 40 runners ( a lot of them were pacemakers trainees) assembled at Kanteerva stadium on 26th morning by 615am and had a nice easy 10Km run in Cubbon Park. Followed by some yummy food from fellow runner Aseema and  breakfast at 1st floor of Konark restaurant in the stadium. About 20 runners were around for breakfast and interacted with Bill.

On 26th evening Bill gave a talk titled 'Smart training for the long run' at the auditorium at the Puma store on CMH Road, Indiranagar. There were over 75 participants many of whom got their copy of Bill's book autographed. The talk was well received and Bill left for Chennai very satisfied with the interactions with the Bangalore runners.

Revisiting plans for running season 2014-15...

Like the past several years, I  had mapped out my events events in the running season 2014-15: TCS 10K in May, HM at Hyderabad in August, FM in Bangalore in October, 75Km at the Ultra in November, SCMM 2015 in January and finally Comrades marathon on 31st May 2015.  After running Boston marathon on 21st April 2014 I had a decent run at the TCS World 10K on 18th May. I then took a few weeks break with plans to start training for the Bangalore marathon(on 19th October)  from the end of June. However, despite taking 4 weeks break from running I was unable to run comfortably when going beyond 15Km or so or when running at a pace below 5:30/Km. The glutes,hamstring,calf and toes of the left leg felt uncomfortable and hurt slightly while running. Moreover I was unable to sit in the same position for more than 30-45 minutes after a workout without shifting the left butt due to discomfort. Therefore I shelved my plan to start training for a FM from June end and took a break again from running after an easy paced 27Km (longest since Boston 2014) with the BHUKMP gang on 28th June .  I have been having an issue with my left  glutes and calf for a while - my races in 2013-14 were all below par due to the issue; however it has never been this bad specially the numbness in the toes. I have been consulting Dr. Johnson Gladson of Attitude Prime for a while and following the stretching and strengthening regime suggested by him. I sought a second opinion from Dr. Kannan Puzhandi of Sparrc - which now has a center in Indiranagar. Despite the meeting with Dr. Kannan being unimpressive I went ahead with 3 consecutive days of deep tissue massage at Sparrc and a gait assessment session -  being on a short break as I switched jobs and career from ALU India to Wadhwani Foundation enabled me to do this.  Also went through a MRI after consulting a neurologist -  a horrifying experience that I will try my best never to repeat again. Fortunately no pinching of nerve or undue damage of lower back was detected .  With guidance from running coach D I started focusing on exercises to strengthen my glutes,hips and core. I resumed running after 3 weeks break at the end of July. While running at an easy pace seemed ok even a 5K at a fastish pace at Puma Urban Stampede 2014(see next post) exacerbated the pain. So I had no choice but to reduce both my training mileage and pace intensity- with no more than 25Kms of running at average pace between 5:45 and 6:15 and about 30Kms of cycling in the Gym at 30Kms/hour speed . Am having to make efforts to keep the running pace slower than 6 minutes/Km. I do not plan to run beyond 15Km  till at least September end. And am restarting  strengthening at Manipal hospital department of sports and exercise medicine from September. At the slower pace the glutes do not seem to be stressed as much and do not hurt post the run. This will at least help me keep my fitness at a certain level.

As a result my plans for  the running season 2014-15 has gone haywire. I had to miss the pleasure of running a HM with my coach Bill Pierce at Hyderabad on 24rth August and the fun of staying and travelling with the BHUKMP gang. I have not registered for any event this season except SCMM 2015.  As of now that is the only I will surely participate in this season. Registration for Comrades 2015 open in a couple of days on September 1- my participation  is out unless things improve dramatically in the next 60 days and registrations are still open. 75Km at Bangalore Ultra is also ruled out - still hoping that I can do a slow 50Km there to keep my streak at the Ultra going - despite the advice to the contrary from D and Bill. Will make that call towards the end of October. And FM at Bangalore is surely out. Hope to do a slow HM - considering being a 2:15 or 2:30 pacer which is better than skipping it altogether. The only event that I would like to really like to race  this year  is SCMM 2015 - my goal was to try and BQ again with a sub 3:40 - however depending on how it goes over the next 60-90 days it is now likely that I may  end up doing a 5 hour FM there just to keep my streak going!!