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Slowtwitch Forums: Triathlon Forum:
iliac crest pain and TFL

 

   


runagain

Jul 8, 09 19:27

Post #1 of 6 (9239 views)
iliac crest pain and TFL Quote | Reply

 
What strength and stretching exercises have people found useful for the iliac crest pain? Has anyone figured out the biomechanics that are causal or related?? I want to get to the root of it. Mine was diagnosed by a sports doc as being caused by inflammation of the tendons where the glute medius and TFL attach to the crest. It's been a bugger to heal-- haven't really run since March and no end in site at this point. Have to pull out of IM Canada. Have used ice, ice, and more ice; PT, acupuncture, anti-inflammatories, wishful thinking, etc... I am able to swim, bike, and pool run. Hopefully, these things are not slowing the process. Any input is appreciated.


Endurancegeek

Jul 8, 09 20:00

Post #2 of 6 (9226 views)
Re: iliac crest pain and TFL [runagain] [In reply to] Quote | Reply

If this is a true tendonitis then it would probably respond favorably to an eccentric strengthening program which will overload the tendon triggering a repair response. If you saw a good physio, they may have already employed this treatment strategy and should have evaluated you for muscle imbalance throughout the lumbo-pelvic-hip complex and the entire lower kinetic chain. Also, your running gait, pedal strokes/bike fit and swim stroke should be evaluated.




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"When you like suffering, when you like the pain in your legs and all your body; it means you are good."
-Ignatus Konovalovas
winner stage 21 TT 2009 Giro D'Italia

(This post was edited by Endurancegeek on Jul 8, 09 20:02)


runagain

Jul 9, 09 7:13

Post #3 of 6 (9191 views)
Re: iliac crest pain and TFL [Endurancegeek] [In reply to] Quote | Reply

Appreciate the reply. What do you mean by 'good physio"? A PT or physiatrist? How would I find out more about an eccentric strengthening program? My PT gave me some exercises to get my glutes firing, and they are now firing well, but still no injury relief. Next week I see my rolfer/osteopath in the hopes of figuring out some of the imbalances but it's hard to find someone who sees the whole enchilada. I really believe my running gait needs analysis but not sure how to evaluate whether such analysis is "good". I have been thinking of contacting the guy who puts out the Evolution Running DVD because he does analysis but not sure if he does so from perspective of specific biomechanical imbalances vs. just whether someone is using the running form he advises. I recently had a very good bike fit-- from someone who specializes, has lots of experience, is a biker, and is a PT. What would I look for in the swim stroke that could be causal?


toothpuller

Jul 9, 09 7:36

Post #4 of 6 (9183 views)
Re: iliac crest pain and TFL [runagain] [In reply to] Quote | Reply

I used to have what I called my bad "bum" leg (Left) . I had itb then hamstring pull then pain at the illiac crest. And it always felt "different" like it had vague sciatica symptoms.
I tried pretty much everything, I self diagnosed myself with leg length discrepancy. Go to the cool runnings website and go the injury treatment section. I put a very thin insole from an old pair of racing flats that i no longer used in my stability sneaker ( left foot only). Two weeks ago I did a 21 mile run to build for imlp. Felt great. I probably should have orthotics , but this seems to be working. I sometimes think strechting when you are in pain does more harm than good.

I could run thru the pain when I had it. Sounds like yours is more severe. Your problem could be something entirely different but I would start googling leg length discrepancy. Good luck.


Endurancegeek

Jul 10, 09 19:41

Post #5 of 6 (9138 views)
Re: iliac crest pain and TFL [runagain] [In reply to] Quote | Reply

What do you mean by 'good physio"?
PT

How would I find out more about an eccentric strengthening program?
Eccentric strengthening is nothing more than working the muscles involved slowly on "the negative" or returning back to the starting position of the exercise. This type of muscle contraction where the muscle works while going into an elongated state places more strain on the muscle and tendon fibers. There is evidence that this strain when applied appropriately will assist with remodeling of the tendon tissue and help with resolution of tendonitis. The best evidence of this in the literature is with achilles tendonitis. I know of no studies that apply to the specific diagnosis you have(or other tendons for that matter), however I take liberties and apply this treatment application when treating tendonitis (I am a PT) with apparent success. To strengthen your involved muscles eccentrically you could do leg raises lying on your side, raising the leg, holding briefly and lowering slowly. Use weight to add resistance. I use 10 repetitions, 3 sets with resistance that is moderately difficult by the last repetition without sacrificing form (base this on ACSM recommendations). You can also do the same exercise while externally rotating your leg (turning your foot toward the ceiling). I would also choose to work those muscles in the closed kinetic chain (standing) to allow for strengthening of the muscles in the way they function. To do this, stand with the involved side on the edge of a step and the other leg off the edge of the step. Keep the knee of the involved side straight and slowly lower your other leg. To do this you will need to pivot at your hip. Work the lowering phase of the exercise slowly.


I really believe my running gait needs analysis but not sure how to evaluate whether such analysis is "good".
I am not advocating changing your running gait, however your running gait may provide clues to problems that may contribute to your existing problem. I just finished working with a runner two hours ago (discharged her) who was overrotating on one side and contributing to her low back problems. The excess rotation (or lack of rotation to the other side) was accompanied with a tight rectus femoris muscle(one of the quads) and hip extensor weakness on the oppsite side. Whether these findings are causative or correlative we'll only be able to speculate. However, the imbalances were there and when corrected resolved her low back issues. Get the osteopath's eyes on your running gait and he/she may see something that they wouldn't see otherwise. Running is highly repetitive, especially in hightly repetitive runners! I'm thinking the same thing regarding your pedal strokes and swim strokes.

Hope this helps and good luck.



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"When you like suffering, when you like the pain in your legs and all your body; it means you are good."
-Ignatus Konovalovas
winner stage 21 TT 2009 Giro D'Italia


TriTrainingMama

Sep 11, 09 18:07

Post #6 of 6 (8937 views)
Re: iliac crest pain and TFL [runagain] [In reply to] Quote | Reply

I had this issue while training for the Oliver Half Iron. I saw an excellent physio who recommended ice and heat 3x daily, advil, in addition to weekly treatments of the glutes, QL's, and psoas. I finished the race without pain. She did say the glutes weren't firing properly, I was recruiting the quads and hip flexors instead. One legged squats in front of a mirror to ensure the pelvis remains level throughout, along with side-lying leg lifts, really making sure glutes and not hip flexors are contracting. Good luck.