There’s a new man on the scene. A new character taking, if not centre stage then a fully supporting role. I’m collecting physios like an obsessive Pannini completist. This Italian is brutal on my technique. Don’t go inside! is his mantra as my knee buckles. My body cheats to complete set tasks, finding a way to deliver the result while avoiding the designated route. I was blind but nothing escapes his eye, and with his pointers mine are now on the case too. So the exercises move on. They’re all from the same extended families but have been tweaked, enhanced and adapted to herd my cheating body’s compensations into a mould from which it can’t escape. My single leg lunge looks like an air hula hooping workout, with my hips swinging violently out of line until, after much struggling, he gets me back in the perpendicular groove. The side plank has become a man killer in its new form. But despite that I’m still here and the glutes are feeling the pain and responding as designed. The bridge has been rebuilt. There are no scandanavian killers and no troubled water, just a cramping hamstring as the seconds tick by. But each time they tick by a little longer. So we might be growing some hope here at rehab central but we’ve been here before so we’ll tread cautiously this time. I think the r word was mentioned at our last appointment but let’s not get ahead of ourselves I’ve got to complete my v50 before I’ll allow myself to think about that.
But this isn’t a stile. It’s a gait. It’s a broken gait but they gave it a name anyway. Trendelenberg. And guess what causes that then? Our regular readers are jumping ahead. Yes, once again it’s dysfunctional glutes. Those pesky kids just can’t stay away from the action. Or more correctly, when the glutes stay away all sorts of weird actions start to take place.
Whatchu talking ’bout Huggins? Right, here goes. When you walk you end up doing a lot of balancing on one leg. Mid gait, you’re standing on one leg, just as the other swings through. At this point your centre of gravity is unsupported on one side, so your hips would naturally drop down on the unsupported side. But if that happened your swinging leg wouldn’t clear the ground and the lurch down would destabilise you. This doesn’t happen because your glutes on the unsupported side go into action and keep the hips level. This gives a nice balanced, smooth walking gait. Except when you’ve got weak glutes. They can’t hack it. So the body, in trying to be clever tries to find some other way to stabilize and get the swinging leg through without scraping the ground. The tfl in your thigh, and the ql in your back jump into action. They get the job done as best they can. But they’re not specialists. The hips rock up and down from side to side. The lift of the swinging leg is uncontrolled and jerky. The ql in the back is overworked and starts to complain. It’s all bit of a mess. The foot lands awkwardly and feels odd. The stresses spread like tremors from an earthquake weakening the body as they spread further and further from the hip epicentre. Not Shoreditch. Definitely not.
Solve hip drop. Solve the issue. Possibly. Hopefully. But the damn bugger of an injury makes all the pain, discomfort and tightness exhibit on the opposite side to where the weakness lies. Cunning. Deceitful injury that it is. Luckily there are a lot of generous experts on the net and with the help of one of them we’ve cornered the problem now. My left hip is getting a lot of attention. The glute on that side is gonna be busy doing all sorts for the next few weeks until it’s back to the form expected of it. So clams, leg raises and hip hitches are the order of the day. Again. In the kitchen, on the train and anytime they pop into my head. I’ve got an urge to buy new trainers but I need my glutes to be ready for some action first. So they’d better shape up.
So I’m a bit stubborn. Stopping running was not an option. Although my body had been screaming at me for weeks and making strong hints for months I still wouldn’t stop. Why was that? A few reasons I suppose. Among them was that I didn’t want to give up on what I’d found. I didn’t want to give in to a bit of discomfort, pain or difficulty. Runners must have to push themselves and if I gave up so easily how could I expect to get where I wanted to go. Running was routine. Without it I would feel less fulfilled. I wanted to be better. I didn’t want to stagnate or worse regress after so much hard work. But mostly it was a lack of peace with being idle. I needed to do something. To be connected. Connected to something I loved, and the only thing I loved that was so available was running. And like the best paradoxical irony you can think of, the more I chased the further away I ended up. So I was pushing too hard for too long when I should have been listening and paying more attention… Or rather acting on what I was indeed hearing. I’m not stupid (ok the evidence says otherwise) but somehow I ignored the obvious.
It’s a funny old time to start writing a blog about running seeing as just over a week ago I ‘celebrated’ a full year since my last run. In that time I’ve actually run two naughty parkruns, both in pain, very slowly and both times setting back my recovery a few weeks. Both came at difficult times for me and the lure of the warm atmosphere and the sense of belonging to the running community overcame any semblance of common sense that I still retained. I say that but each time it was something of a calculated risk. A grasp for the glow of running and the people who do it weighed up against a couple more weeks of running isolation. I think I can see a recovery on the horizon but it says something that just writing that sends shivers through to my very soft skinned feet.
To add frustration on a big heap of frustration that looks a bit like depression in a wig is that running is the place you go to make yourself feel better. A good run lifts the mood. Even a bad run. What’s a bad run? Not sure. Anyway running is a place to run to when you’re running from and when you’re running to. So now where do you go? (Couldn’t cycle or swim either). Well walking but that is a poor substitute.
So what’s the deal? It’s a bugger of an annoying injury, or collection of injuries that we’re calling osteitis pubis. I’ve read lots of books about running and I’ve had enough injuries to make far more seasoned runners jealous… or not. But I’d never heard mention of this one. One year in to reading everything there is to read on the internet I’ve decided that I’d like to add to the information out there. The osteitis pubis for me is really a symptom of the real injury. The osteitis pubis bit just means that there’s inflammation around my pubic symphasis. That’s not good. It’s where just about all the bigger muscles in your lower abdomen and upper thighs connect. All the muscles you use for running. Then on top of that the strain on these muscles and the associated tendons and ligaments becomes so much that your pubic bone starts becoming weak and begins to degrade.
So why did this happen? Simple. My glutes were in a horrible state. To be honest there wasn’t much of them left and what was there was dysfunctional and inhibited. That’s what working in an office does for you. Sure I ran 5 times a week. I’d run 180 odd parkruns (I FMBC a few times) a couple of marathons and plenty of 10ks and halfs. But it turns out when your glutes aren’t up for it after years of neglect they just switch off and refuse to come out to play. Yeah all the books on running talk about core exercises, strengthening and so on but really come on, how boring is that? Well not as boring as doing half an hour minimum of rehab for over a year and still not being able to run. Yes you can take that as a shot across the bows. Yes even you. I’m serious. And no this piece doesn’t end with “reader I married him”. Anyway, do your prehab before you do your rehab.
In 2013 I had a brilliant weekend doing a 24 hour relay race. Except I didn’t end up running much. We had to take turns running a 5 mile trail loop in the beautiful countryside somewhere near Reading. I managed 3 loops before I found I could no longer run forwards due to terrible pain on the outside of my knee. Ok so you stopped and looked after yourself. Er, I decided to run the next two laps backwards. Then I came to a stop. But it was only 11pm with over 12 hours to go. So I set off again, walking, hobbling in the dark with a torch on my head. I came to a stop again. I was a bit stubborn so next I gritted my teeth and went for an all out sprint… and amazingly enough I found I could run pain free. But you can’t sprint 5 miles… so I did 200m bursts stopping every 30 seconds or so to catch my breath. I completed that lap. And then a few hours later another one. Anyway the point is despite worrying about the health of my fellow runners to the point of thoroughly pissing them off I wasn’t being that smart. That night I couldn’t move. It felt like I had a tooth infection in my legs. And the tooth was the size of a football. It took a month or so before I could run again. This was a nasty brush with IT band syndrome. Cause: weak or inhibited glutes.
My marathon came next. Actually I only had a minor hiccup here. A few pains over my achilles bursar and a two week lay off for suspected plantar fasciitis. Only it wasn’t. It was another early warning sign that my glutes weren’t all they could be. Little did I know. I got away with it that time. And more mysteriously I had a month where I couldn’t run anything but pbs. I’d go and say I feel like running a pb today. And I did it. Time after time. Obviously the glutes had come to stay. But they were gone again soon. My running gait began to feel awkward and lumpy. I wasn’t floating anymore as I had when I knocked 6 minutes of my half pb. I trained harder but the times got slower. I thought I was over training. I was but not in the usual sense. I should have looked more closely at my gait. Done what all the books say. Do some clams. Do some hip thrusts. Do something to engage the big muscles that should have been propelling me along but which instead were taking it easy while the rest of my muscles struggled to compensate.
So I got slower. No big deal. I was still quicker than I had been a year earlier. I was counting the miles in the bank thinking I’d reap the reward soon enough. But as yet I haven’t. I carried on running but it became harder and harder. After runs my shins would scream for days. My thighs were endlessly full of painful knots. I’d hobble around in the morning while the stiffness in my ankles eased. My back became stiffer and stiffer. I’d have to unhinge myself from my chair. My stride became shorter and jerkier. My warm up mile became a hobble, I forgot what smooth floaty running felt like. The kind of running that inspires you was slipping from my grasp.
Finally I started doing some core work. Sit-ups, bridges etc. Not really what was needed but better that nothing and what did I know. I did that for a couple of weeks. Then I stated feeling the pain. In the lower abs. Maybe two inches below the navel at 45 degrees. So I’d overdone the core work? No. Finally the lurker that was osteitis pubis was making itself visible. I ran a few more times. The pain seemed to move over my pubic bone and settle there. This didn’t seem good. I did a final few parkruns and decided to have a break until the pain had gone. That was over a year ago. It still hurts. My walking gait completely fell apart. Walking to and from the station was excruciating and very slow. Throw in a broken toe and running seemed a long way away. Everything became painful. Your abs connect into your pubic symphasis.. at least indirectly. My abs became permanently tight, prickly lumpy and painful. My hips felt like they were falling apart. I thought I was heading for a hip replacement.
So I got an MRI scan. And a very clever consultant told me that my walking gait was extremely peculiar. Not just a bit. Extremely. Get me. She said this was due to my glutes having gone awol. She said go away. Do lots of hard work. The way she said lots stayed with me ever since. I took notice but more than anything its been a reminder when I’ve been at my lowest that this was never going to be easy. She didn’t overly emphasise it but she had that gravitas that I pay attention to. And I thank her because I’ve occasionally felt like giving up – however briefly but that cool way she said it has snapped me back into the room. The room with my muli-coloured resistance bands in varying weights and spikey massage balls and lots of non sweaty running kit.
…. in progres
Lots of clams. I mean lots. Seriously lots. Hip thrusts. Glute isolation. Work with resistance bands. Standing on one leg. Standing on one leg on a train to train my hips to do the stabilizing. TBC