Login required to started new threads

Login required to post replies

Another 'be an Armchair remote physio' diagnosis and treatment plan thread
Quote | Reply
First off, I am seeing a physio, actually two in parallel working together, have been going to them for last 3 years regularly, with the senior of them the official physio of several of the National sports teams. I have full faith in their work. I also have a coach that is very well qualified and he is working with them in terms of balancing load and recovery with treatment plans.

But, we're at a loss with a bit of a bizarre 'thing'. Brief history, M47, been doing tri since 2000 from a cycling background. Have always had very dodgy ankles with achilles operations aged 12 and several significant injuries and surgeries in 2008, 2015 and 2017 to repair ligaments/ tendons torn through inversion injuries when running. Over the last year I've been trying to get rid of some lingering achilles and plantar fascitis issues and so have been doing limited training since March 2020. It's all been recovery mode stuff. By limited then I mean short and light sessions about 10 hours a week, not the 20-25 I'd typically do. Ultrasound and xrays a few months showed some cam wear (think this was the term) on my hips, but very slight and not impinging anything soft.

The specific mystery is hamstring pain that comes on almost instantly, or like today absolutely instantly part way through a run that feels like a bullet (well I've no idea, but it's a 9/10 pain, very localised) and is about 3 inches up from the back of the knee, mid hamstring. Running another step impossible, and yet walking is almost totally fine (handy to get home) and no stretching or self massage will even allow a slow jog back. Over the course of the rest of the day after the area will get tighter and a bit sore, with a local 'knot' present the next day that needling / massage helps but doesn't instantly heal. About 5 days later it's 'fine'. Now this has happened, (and again today) on both sides, seemingly randomly. Over the last 2 months I've gradually built up to be running 16km for my long runs, adding 2km a week, with the 2 midweek runs capped about 6km each to manage the load. Today, at 11km 'ping'. So way below what's been fine for the last few weeks. No other indicators as I had a shorter than normal ride yesterday too.

I am having some issues with the lower right back, and so sciatic nerve involvement is clearly likely/ possible. Although why it effects both sides (only one at a time) is odd. The back issue is superficial though and does get sorted with a few needles each week. In terms of prevention I do 2 Pilates sessions a week and spend more time each week doing self massage on my back with a wide array of rollers, spikey balls and other implements of torture than I have spent racing over the last 2 years combined.

Other factors, I've a 'desk' job, but alternate between standing and sitting desk and have an OT prescribed chair / workspace. I wear orthotics at all times - running and just in general, and have since 2002. Last update was a couple of years ago but was not materially different. Same running shoe model too, Saucony Omni's, and definitely not wornout - twice the 'issue' occurred second run in new shoes and I tend to get about 500km out of a pair before swapping. I get massage fortnightly, see the physio basically weekly at the moment. I do mobilisation exercises before each run, and whilst I wouldn't claim to be perfect, then do stretch well after, although the nature of the issue doesn't suggest muscular to me.

EDIT to add: Instead of going up, what about the issue being below, and related to tightness in the gastroc and soleus- both of which have been tight as for the last year and in the end the cause of the achilles issues. Could these be going 'up' as well? Seems odd as the pain is nervy and just above the branch of the tibial nerve and common femoral nerve.

So thoughts for discussion with my physio?
Last edited by: Duncan74: May 8, 21 16:24
Quote Reply
Re: Another 'be an Armchair remote physio' diagnosis and treatment plan thread [Duncan74] [ In reply to ]
Quote | Reply
What investigations have you had done?
You really need some imaging, either an ultrasound or MRI of the area.
Physio's can only go so far and at this point you definitely need it imaged.
Quote Reply
Re: Another 'be an Armchair remote physio' diagnosis and treatment plan thread [Amnesia] [ In reply to ]
Quote | Reply
But what would I get imaged? Hamstring? Back? Calves? I've had x-ray and ultrasound of hips recently but no other imaging.

In terms of treatments and 'following the chain, then we've been up and down the body from the foot (plantar fascitis) to the shoulder blades and everything inbetween. As I say, I've had over a year off to work through essentially a whole bag of niggly persistent issues I'd trained and raced through for the year before.
Quote Reply
Re: Another 'be an Armchair remote physio' diagnosis and treatment plan thread [Duncan74] [ In reply to ]
Quote | Reply
OK, so it's a nerve thing 100% Strength tests fine, and nerve (slump) tests positive.

The mystery is why it's coming on when it does. At the moment the only thing we can come up with is that as I fatigue then I start dropping my head or slouching a bit that is adding tension to the nerve.

Really frustrating as I am doing, and have for a long time, all the things I should be to sort this.
Quote Reply