Member Case Study: Leg Pain After Brick Workout

author : AMSSM

comments : 0

I rode 20 miles on the bike and I was 0.1 miles into my run when I experienced a hot shooting pain deep in my left glute that radiated down the back of my leg.

Member question from laurier

I am now 12 days away from my first HIM, which is my first triathlon ever. I was scheduled to do a short and easy BRICK last Wednesday.  I rode 20 miles on the bike.  I was 0.1 miles into my run, and experienced a hot shooting pain deep in my left glute that radiated down the back of my leg.  The pain was somewhat debilitating...it felt nerve-related.  I stopped running, and walked 20 paces or so, and tried running again.  Same hot pain.  I tried stretching my IT band and hamstrings, and then I walked 1/4 mile.  Tried running again...same hot pain.  I walked home and immediately started icing. That was six days ago.  

I have been stretching 3x/day, icing 4x/day, taking ibuprofen, doing yoga, and focusing on my swim.  I have a massage scheduled tomorrow and another scheduled next week.  Now, my hip/glute/lower back area is quite sore when I walk...dull, achy soreness - not the hot pain I experienced last week.  It now also feels like there is some "play" in the joint, which I think means that some of the deep swelling is going down. I haven't tried running again, and probably won't until the event.  I cycled for one hour on a spinning bike at the gym over the weekend without incident.  I will likely do my remaining cycle workouts in the gym with low to moderate resistance because riding in the aero position seems to exacerbate the pain and discomfort.¨  How can I heal the problem?  What exactly is the problem (i.e. pirformis syndrome, IT band tendonitis, some other overuse injury)?  Will participating in the HIM make it worse?  Should I plan on doing my remaining run workouts on the elliptical, or would it make more sense to skip them altogether?  All of PTs in the area are booked, and scheduling new patients out four weeks, which is after the HIM.  I need some advice.

Answer from Dawn Mattern MD
Member AMSSM

First off, congratulations if you did finish your triathlon...if not, let's fix this problem and find another one!  Your problem is most consistent with piriformis syndrome which manifests as nerve-like lower back and buttocks pain that radiates down the back of the thigh. However, if the pain radiates all the way down into the calf or foot, I would be concerned for a disc problem or something from your back as the cause of your symptoms.  An exam by an experienced clinician can be helpful in distinguishing between the two.

The piriformis muscle is a flat muscle deep to your gluteus muscles that acts to externally rotate the hip and stabilize the pelvis when running.  The sciatic nerve runs close by the piriformis and can be irritated if the muscle is tight (which results in posterior leg pain).  The piriformis can become overloaded and tight if the gluteus medius muscle which lies on top of the piriformis is weak --extremely common in runners.  My favorite strengthening exercise is a side leg lift: lie on the "good" side, bend the knees, and lift the top leg ("bad" leg) up and away from your body. Lift in a nice controlled manner and try to progress to sets of 20-30 repetitions.  Strengthening the gluteus medius will take the pressure off of the piriformis and hopefully get rid of your pain.  It can also be helpful to stretch the piriformis by lying on your back and bringing your knee to your opposite shoulder.

In respect to your specific questions, running with an irritated piriformis muscle can make it worse.  It can increase the total time for the problem to heal as well as compounding the problem even further.  Entering a race healthy, but with less training than initially planned usually, is usually better than getting injured while finishing the plan.  Remember your goal is the race not the training!

If you have time between now and your next race commitment, I would highly recommend working with a physical therapist or seeing a sports medicine physician to advance your strengthening program and help you work on your core so that you can bike and run pain-free.

Dawn Mattern MD

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date: June 25, 2010