Marathon Runner Hip Pain: Normal X-Rays, Still Hurting

Welcome to the Performance Place Sports Care Podcast, where you can learn about sports injury theory, rehab, diagnosis, and how to understand the doctor lingo you didn't understand at your appointment. And now, your host, Dr. Sebastian Gonzales. Hey, thanks for joining the show again. This is Dr. Sebastian Gonzales with Performance Place Sports Care Podcast. And today, we are actually going to go over one of the voicemails we got off of SpeakPipe here. If you want to have your question answered on air, please go to p2sportscare.com. There is a voicemail button right there, which basically sends you straight to a voicemail, which you don't have to use your phone or anything for.

You just go and use your computer, and send it directly to us, and we pick out a handful of them and just answer it the best we can. So, right now, we have Mohamed, and he sent in a question, and I'll just let you hear it. Hello, Dr. My name is Mohamed Rifan, and actually, I'm sending you the voice message from Jaira, Saudi Arabia. Actually, I'm a marathon runner, long-distance runner, so I had a little bit of a problem on my right side of the hip, the place where my leg is joined, like my leg is beginning. There is, I had a pain, and I make x-ray to check with many orthopedic doctors, and they check it.

So, they say that I'm okay, but I'm not okay, actually. Whenever I'm running, during the running time, I had a pain. I can't be run. So, if I'm going to be stopped running, everything is going to be okay. Meanwhile, Dr. Vaz recommends some medicine, like diclofen sodium, diclofen potassium, and some ointment. But it doesn't happen anything. I really don't know to whom I have to contact. So, just, I was actually looking at some videos on YouTube, and then this website opened. So, the good thing is that I found the option for the voice message. So, I would like to just ask your advice. What should I have to do, to whom I have to be exactly contact regarding these are all issues.

So, kindly be advised. Thank you. Okay, so, I'll just take this bit by bit here. And, I guess, first, just a disclaimer. I can't really give 100% medical advice on this podcast since I haven't examined anybody. And, I'm just mainly go off of what I'm thinking from a sports injury standpoint. So, first thing I'm kind of noticing about what he's talking about is that it sounds like he's not getting the care that he needs. And, he mentioned that he's had x-rays done, and they said there's nothing wrong with him, and just mainly to rest. And, if you're a marathon runner, like he is, this is not an acceptable answer.

And, I've had a lot of people actually come in the office before saying that, you know, this is what someone told me. They told me to rest. They told me to not run anymore, whatever it is. And, I'm not saying this is wrong information, because sometimes it could be right. But, I think rest is overused, honestly. I think it's overused a lot. And, it really, coming from an athletic standpoint myself, I feel like rest is, you're waiting on something to heal. And, then, at the end of time, say you've taken like a month off, and you try it again, your body's become deconditioned. And, you go out and try to do the same thing again.

And, it's painful again, and it's super frustrating. And, from a personal experience, at least for me, like when I had my back injury first in high school, I had, I did rehab for probably about three months or so. And, it was really easy rehab. It was stretching, foam rolling. We did do some great stuff on some machines in regards to strength training of the back. But, when I went back to play again, actually the very first at bat, and I'm not making this up, I went in and swung. And, first swing of the bat, I felt it again. And, I just walked straight back to the dugout. So, it's really, really frustrating, just from a mental standpoint.

Not even saying that, are we rehabbing the right stuff? But, just, it makes me feel like I want to give up. And, I'm sure that a lot of people feel the same way. So, first off, let's establish some control, I think. We need to figure out what hurts it, what doesn't hurt it, and what maybe hurts it. And, I've done this exercise quite a few times with patients in my office. Is, if we have a hip injury, and it sounds like in this case, we need to figure out, well, does squatting bother it? If it does, then that's maybe something you take off for this period of time. Let's just say we're talking about a month here.

So, we take off squatting. Let's just say push-ups don't bother it. Dead bugs don't bother it. Core work doesn't bother it. Dead lifting doesn't bother it. But, the only thing it does is squatting. So, that's all the stuff that's on the second part of your list. And, maybe other things you haven't tried yet, like flutter kicks, or skipping. Let's just say these things are things you haven't tried yet. You put on the I don't know side. So, it's more of no man's land. So, you have to establish some control. And, from an athletic perspective, this control is really, really helpful in regards to feeling that you will repair, and that you are healing, that you have some progress.

Because, just rest, sometimes it really messes with the mind. So, going into the next part of what he said is that he's had x-rays and they say they're normal. I know I've talked about this on a few podcasts before, but x-rays really just evaluate a few things. And, they evaluate bony structure or alignment. So, are the bones attaching where they're supposed to be attaching? Or, are they kind of lined up? Also, too, they do note cortical irregularities. Which, cortical irregularities are, think of skin on the bone, or actually, let's just think of drywall. So, the wall at your house. If you took, like, a hammer to it and you punctured a hole in the wall, that is what an x-ray would see.

But, it doesn't see anything really, really detailed inside the bone. But, it will see some on the outside of the bone. So, stress fractures might be, or sorry, stress reactions might be missed. It might pick up a stress fracture. It'll pick up a large displaced fracture. Such as, if you fell off of a building and you broke your leg in half. All these things would show up on x-rays. But, they actually doesn't, it doesn't really show in great detail the inside of the bone. And, it doesn't really show some of the soft tissue problems, which will go hand in hand with marathon running. Now, how do we find the soft tissue problems via image from marathon running or overuse?

So, MRIs are good. Ultrasounds or musculoskeletal ultrasounds are good. Both of them are very, very good at looking at soft tissues. And, ultrasound is not really good at looking at bone. It'll see the surface of the bone, but it won't see inside. So, it does have some limitations. MRI is really good. But, it's really expensive to get. And, that's why, actually, a lot of people will opt for ultrasounds. Now, I have a couple friends in the sports injury community who will argue, why are we imaging this person? If we, if we see that everything's fairly okay. Oops, that's my coffee. If we see everything's fairly okay, it just really just labels this condition for this person.

An example of this would be when you tell someone in their 50s that they have arthritis in, say, a knee. A lot of times, that's just a death sentence to them, and they just end up kind of not being active anymore. And, using that same example, arthritis does not mean you stop doing things. It means you do things smarter, and you spend a lot of time stretching and strength training. So, in this case, my colleagues might argue, why label the person with a condition because it'll disable them? And, I think if we take this from more of a control standpoint, I would want to see, as an athlete, okay, so the bone looks good, the cartilage looks good, do the muscles look good, do the tendons look good?

Is it torn off of the bone? And, or is it a small tear? Is it a large tear? Is it a partial tear? And, if it's a small tear, we can estimate rough healing times. And, I think that's a huge bonus in regards to figuring out when you can run your next marathon again. Okay, so going down the list here, again, I think next we need to establish when you eat, we need to figure out placement. Now, I do have a course online that I allow my new patients to interact with, and there is one podcast in there. Actually, we did this podcast. I think I put it public. It was on Common Terms. And, it didn't cover everything that you're going to find in a sports injury setting or with a condition like this, But, it does cover a lot of them.

And, placement or position on the body is really, really important if we haven't actually seen you. And, I can only imagine where it is on his body. I might be wrong. It might be on the front side of his hip, the outside, the back side. For terms, we use anterior for front. Lateral is side. Backside is posterior. Okay, I'm going to say that again. Anterior is the front side. Lateral is the side. Backside is posterior. So, then we can use anatomical landmarks. So, he said where the leg becomes, where the hip becomes the leg. So, we can, I guess generally speaking, we can say the crease. If we're talking about the front side, perhaps a very specific area is the groin crease.

Okay, the backside might be just under the butt cheek, which would be the gluteal fold. On the outer side, there's some bones you can feel there. On the top, right around the side of your, almost, it feels much higher than your hip, but it's almost in your torso area. There's the iliac crest, which is that ridge you're kind of rolling over. And, you slide down and there's a bony area again, which is the trochanter of the hip. So, using these guidelines, you can say, oh, it's one inch above the trochanter of the hip and on the backside or posterior side. I mean, there's only a handful of things there, which now I can really get a nice visual of where it's at.

And then we can say, in that case, it might be a gluteus medius tendonitis or a trochanter bursitis or a, what else could it be? There is the sciatic nerve in that region. Let's just say if it's on the front side. On the front side or in the groin region, this is a more exotic area, I think. So, if it's in the crease right where, if you flex the hip up, where the thigh meets the hip, then we chance have a rectus femoris strain, which is one of the quad muscles. Perhaps it's a hip flexor tendonitis. Perhaps we have a cartilage injury, a hip impingement. There's quite a few things around the front side.

We're also running the risk of having sports hernias, adductor tendonitis, and there's actually real hernias. Direct and indirect hernias are there as well. So, I guess, Mohamed, what the last question you ask is where you should go for this. I would go to someone who is experiencing sports injuries. And it sounds like you're taking some over-the-counter stuff, which might make you feel better. But have we established what the actual condition is? And have we established what the missing link is, what caused it? I typically take people through a series of, maybe, I call it the rough algorithm.

And I just ask them straight out, do you stretch? And I'm not saying any of these things are more important than another, but it's more of just addressing the elephant in the room. Do you stretch? And they say, yeah, I stretch every day. Okay, great. Do you do core work? No, I don't at all. What is core work? You know, then obviously that's one of the elephants in the room. Hey, do you squat? Do you deadlift? Do you lift weights or resistance training? And they usually say no. And I'll say, do you do any foam rolling? Or generally speaking, or slang term they call this mash work, where they're rolling the area out or creating some of their own soft tissue work.

And if they say yes, we've already established that they're doing stretching, they're doing myofascial release or soft tissue work. But it sounds like there's no stabilization in the area. There's not, there's not any core strength, probably. If they haven't done any, then it's only logical to think that they can probably be a lot better. And I know a lot of people say, well, I'm thin, but core strength is more about functionality. It's not about aesthetics or look. Okay. So I hope this was helpful. Again, if you want to have your question featured on air, just put it through the P2 Sports Care website.

Remember, we do have some courses available online too. So I really have tried to make a good effort over the course of this year to put everything that I know down in audio form, on video form, on paper. And I see that there's a lot of disconnect between my side, which would be the clinical side or the doctor's side and the patient side. And I don't expect them to know all about their condition before they come in, but I do expect them to know about it as their care is progressing. Again, it's that sense of control. And if a patient came in and said, look, you know, I have this anterior hip pain, it's in the, it's in the crease right where I bend my hip at and it clicks and pinches.

And I've tried stretching and myofascial release, but I haven't done any core work, but I have tried to do, I can do front planks, side planks, bird dogs, supermans, and so on. There's already so many things that I can, I can take to the second level on these patients. So anyways, the point of the courses are, and a lot of these courses are free, are to give you the bare bones education with each condition. We do have one on rotator cuffs right now. There is one on hip impingement, and a lot of these will carry over for different types of hip conditions as well. They're targeted for baseball players, but it doesn't mean it won't help for other types of conditions too, or other types of athletes too.

There will be some paid courses on there, and I can guarantee you the paid courses will be better than any course you've ever taken, and it'll be well worth your money, there's money back guaranteed. So I don't want to say this is a pitch that I'm doing right now, but for the most part, my goal is to educate the public. I'm giving a lot of it away for free, but for the best stuff, I'm going to reserve just for pay because I do need to make a living too. So I hope this is helpful, p2sportscare.com. The courses are on Performance Plays HB. Again, that's Performance Plays HB. That's the site where I'm hosting all the courses at, and I'll talk to you guys soon.