Thursday, March 14, 2013

The anatomy of an injury

I've spent a lot of time reading about piriformis problems, watching videos, studying anatomy diagrams and experimenting with different treatment techniques and I think I've finally sleuthed out the problem I've been having with my hips.  It's a long and painful story:

Part 1: Bad Biomechanics

I was watching the Nike Cross Nationals and noticed that the leaders were all bending much deeper into the knees than I was.  Because they were high school students and less experienced their cadence was slower, which made it easier to see than in the videos of elites that I had been watching.  My shallow knee-flexion probably came from when I broke my knee cap: to avoid knee pain I learned to walk with mostly straight legs, and even after the pain went away this habit persisted.  This flaw in my running form led to...

Part 2: Injured Piriformis

The piriformis muscle is a small structure in your butt that rotates your leg from side to side (imagine opening and closing your legs while you are sitting.)  With shallow knee-bend I was inadvertently using this small stabilizing muscle to pull my leg through instead the larger glutes and hamstrings.  Because the piriformis wasn't made for this kind of heavy lifting it became tight from overuse.  I finally learned how to stretch and massage it in late December from a video on (I would link directly to it but their video player doesn't allow it; just scroll through their videos until you find it.)  This did wonders by finally loosening up the muscle.  But unfortunately this caused...

Part 3: Inflamed Tendon

Because this was my first time seriously stretching this muscle it put a terrific strain on the tendon which connects the piriformis to the greater trochanter (hip bone.)  This is where things got sticky: I stopped running and stretched and massaged the piriformis, but tendons are avascular, which means that blood doesn't flow directly to them.  So they take much longer to heal than muscles.  The key at this point was...

Part 4: Ice

I didn't think I was neglecting this part of the recovery because I ice my legs often by sitting in a tub of cold water.  The problem is that because I am completely submerged the water isn't very cold, which is fine for general soreness but not good enough for a real injury.  I needed something more targeted.  So I filled quart-sized ziploc bags with ice cubes, connected them together at the top with an over sized paper-clip, and lie down on my stomach with the ice bags slung over my backside.  Connecting the two bags was the key because the ice really needed to be suspended on the outside edge of my hip, and the easiest way to do that was to counter-balance it with the other bag.  Another important thing about ice is that it needs to be done as often as possibly, every medical website says several times a day.  This means every couple of hours.  Realistically I can get in one in the morning and one at night.  Which finally brings us to...

Part 5: Recovery

My pain isn't completely gone yet, but some days I don't feel anything and the sore days are getting farther and farther apart.  I've also been slowly increasing my running frequency up to every day but keeping it light to avoid aggravating the piriformis.  I've felt like Dr. House trying to put all of this together, and like House I'm confident in my theory because it explains all of the symptoms.  Mostly I'm just relieved to feel like I've figured it out.  The worst part about being injured is not knowing whats going on.  After a couple of weeks of playing it safe and lots of ice I should be all better and ready to start training for the 2013 season!  Just in time because the weather in Provo is getting nice:

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