Outside knee/hip pain after distance running

[topsltennis]

Ok, so here's the deal.I almost never run. A sports med doc. told me a couple of years ago when visiting him about a sports hernia that given my flat feet and general wear and tear of many years of tennis that I should probably never run long distances.

Well I have basically followed that advice as I don't like to run anyway. However, a couple of times just trying to shake up my workout routine ( I play tennis everyday, but nothing else) I decided to take a 30 minute run or so and came back in severe pain. I ran today, literally for only 30 minutes. Not long after the outside of my knee to my hip started hurting really bad. I tried to hit tonight and literally could not move. The pain is horrible trying to go down stairs in our house. I have to go down them like an 80 yr old man. The weird thing is the pain is somewhat intermittent. At one point tonight while hitting tennis, took a 3 minute side break or so, came back on court and was pain free for a few minutes, and then all of a sudden, boom, it was back.

The strange thing to me is tennis everyday, no pain. As soon as I try to run, this happens. The last time it happened, it just went away after a few days.

Any thoughts would be appreciated.

 

[charliefedererer]

It's hard to know exactly what is going on. For that you should go back to your sports medicine specialist for an exam.

But it is possible the problem could be related to your flat feet.

Do you have corrective orthotics in your running shoes?



Most flat feet are largely correctable with orthotics. The "flat" part of the sole of the foot is simply pushed up by the orthotic.

So how does this help prevent knee and hip pain?

Right now as you stand there, is a tendency for your flat feet to pull your ankles in and knees out:

As you walk, that propensity of people with flat feet to have their feet turn inward results in a twisting motion at your feet and ankles, a process known as over pronation.

But that twisting motion down at the feet and ankles also causes a twisting motion at the hips and knees:

You probably would find the following video helpful to better conceptualize what is going on:
Overpronation - what is it? http://a.blip.tv/runners-world/overpronation-what-is-it-1173419

This twisting motion at your knee and hip puts undue stress on the joints, and can result in pain.




Many people with flat feet find they get good support/correction with the Superfeet Orange or Green insole. Others get better relief with the Dr. Scholl's custom fit orthotics available at kiosks in many pharmacies and even Walma*t. But some only get relief from custom orthotics from a podiatrist.



And running shoe makers have shoes specifically made as "motion control shoes" to help you further. [It is possible your tennis shoes have much better support than your running shoes.]



Vendors like Running Warehouse have helpful "shoe finder" features to help best match your feet to the type of [motion control] shoe that would help you.


Now tennis does a lot of running, but it is a different sort. The split step ends with you on the balls of your feet, and there is a fair amount of hopping and skipping on the balls of your feet. Thus there often is no landing on the heel and then the "heel to toe" motion of the foot like you do with each step in long distance running.



I hope this helps. Good luck!

 

[topsltennis]

Thanks for the informative post. I was in terrible pain yesterday and didn't feel a thing today. Didn't run, did my usual evening hit with no pain at all. My question is what exactly is the source of the pain? My guess was fluid or something that goes away the next day or so after no running.

 

[Hondasteve]

Do some soft tissue work on the IT band. It's connective tissue that runs from your hip to the outside of your knee. Foam rolling is the easiest way to decrease the density of the iliotibial band and 'loosen' up the fascia in that area. I do this with a lot of my clients and see good results when they consistently work on the area week in and week out.

http://www.google.com/url?sa=t&rct=...nY9W_uHKg&sig2=Aa0pmbCcx07deK6wd_N-3Q&cad=rja

 

[charliefedererer]

Thanks for the informative post. I was in terrible pain yesterday and didn't feel a thing today. Didn't run, did my usual evening hit with no pain at all. My question is what exactly is the source of the pain? My guess was fluid or something that goes away the next day or so after no running.

Fluid is an effect - not a cause - of inflammation.


Basically I think that there is just too much excess rotational movement at the knee and hip level.

Normally when we run, in the normal heel to toe stride, we land on the outside of our heel, and the foot turns in [pronates] as our foot flattens out, then we have a balanced push off from the ball of the foot. The pronation that occurs
at our our foot and ankle keep the legs fairly straight at the knee and hip.

But if you have flat feet, and are therefore likely an over pronator, as your
foot flattens, it pronates beyond flat to a position where your ankles are turned in, and your ankles are turned in. But since your lower leg connects your ankle to your knee, your knee is turned in, and above, your upper leg is turned in, even at the hip.
Then as you push off, ankle turns out to a more normal position, dragging the lower leg/knee/upper leg/hip out as well.
There is a lot more medial to lateral movement, and hence stress, at the knee and hip.

The non elastic tendons and ligaments at the knee and hip are drawn through a medial to lateral movement with your full weight on them as you push off from the ball of your feet. (In the air, the leg/ankle/knee/hip straighten out.)
The cartilage in your knee and hip is grinded through more medial to lateral movement.


All that extra stress on tendons, ligaments and cartilage will result in microscopic tears in the tissues. The microscopic tears immediately attract white blood cells to the site. These white blood cells release chemicals (cytokines) to attract fibroblasts to repair the small tears with fibrous protein strands.
This inflammatory state occurs after any kind of injury, large or small.
This inflammatory state is necessary for healing to occur.
But those chemicals (cytokines) also stimulate nerve cells, resulting in pain.
The pain part is probably a warning that an injury has occurred, and the area should be rested.
If there is only a small amount of injury, the cytokine phase is brief, and the pain can resolve fairly quickly.

Again, I can't be sure this is what is happening in you, but I suspect that this is what is going on. An actual medical exam would be your best way of knowing for sure what is happening.

 

[charliefedererer]

Do some soft tissue work on the IT band. It's connective tissue that runs from your hip to the outside of your knee. Foam rolling is the easiest way to decrease the density of the iliotibial band and 'loosen' up the fascia in that area. I do this with a lot of my clients and see good results when they consistently work on the area week in and week out.

http://www.google.com/url?sa=t&rct=...nY9W_uHKg&sig2=Aa0pmbCcx07deK6wd_N-3Q&cad=rja

The ileotibial band syndrome is more common in over pronators, likely due to the increased stretch on this tissue from the excessive motion and tension at the foot being transferred up the leg with excessive medial to lateral movement.

The following site has a pretty good discussion of it: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/irunnersknee.html

One of the ways of improving this condition in overpronators is with proper arch support and a motion control shoe.

 

[topsltennis]

Thanks again. Have played some good hard tennis the last 2 days and felt nothing at all.