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March 12, 2015

Marathon Training and Overuse Injury

When I started training for a half marathon, I expected pain. And I've been proud of myself that I've been able to accomplish as much of the training as I have without too much difficulty. However, now I've been temporarily side-lined from training due to an inflamed adductor syndrome called Gilmore's Groin. I've never heard of Gilmore's Groin but I am familiar with overuse injuries which did no abate with continued activity. Luckily, there seems to be no rupture, so with rest, ice, stretching, and massage, I can rehab this injury myself.

While I'm disappointed to not be able to continue training, the silver lining on this event is the opportunity to research and review the biomechanics of lower extremity function and rehabilitation. I've always used this blog, not only as a resource to my massage therapy clients, but also a way to educated myself about a variety of conditions that massage therapy and now physical therapy can address. You might be thinking, "but you're a physical therapist, you should know all of this already." The bulk of my physical therapy experience is hospital-based, where I assist patients out of bed following a surgery or stroke. Out-patient physical therapists work more with ambulatory patients and those who are injured due to sports.

So, this is a good review of some education that is already 5 years old!! Not only that, it is one thing to know information didactically, and completely another to know it when applied. Experiencing a sport, and having pain inside your own body, is a different kind of learning yet again. Movement, and how it aggravates pain, and how you must compensate to avoid that pain, is information I can use to make me a better therapist.

One thing I will admit that I should have known, and I didn't listen, is to start slow. By pushing myself too quickly in order to adhere to a truncated training schedule, I could have predicted this. However, there were other things at play here. Remember, in a prior post on this topic, I gave a run-down of muscle soreness? It turns out that long-standing SI joint instability set me up for this kind of strain. And this is where the real learning about lower body biomechanics is useful for me as a therapist.

If the SI joint acts as a shock absorber for the forces that are transmitted between the upper and lower body, than it is crucial that joint be healthy. Having an adhesion where the psoas is stuck down on the iliacus, means that the pelvic stabilization needed in order to have optimal biomechanics for running, is compromised. The body has to compensate somewhere and that area of compensation occurred for me in the antagonist muscles to the gluteus medius and gluteus minimus. Those two muscles are responsible for balance in standing and hip extension that occurs in the lengthened position of running when the foot is out behind. Remember, too that gluteus maximus is a big strong muscle driving the body forward. The adductors work against all of those muscles, especially the adductor magnus, to act as stabilizers against hip extension and external rotation. Instability in that system logically indicates weakness somewhere, meaning muscles within that dynamic complex will be asked to work overtime or engage in activity they were not primarily intended to do, and an overuse injury occurs.

PT peers, please feel free to chime in here and enhance my education if there is a piece of the biomechanical puzzle I've missed. Knowing how muscles are supposed to act in one or two planes is a different than when we begin to examine how they work dynamically within a complex during weight-bearing and movement.

Posted by linda at March 12, 2015 11:35 AM

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