Friday, August 29, 2014

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):
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.


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