Thigh Pain When Running: Strains, Stress Injuries and Nerve Pain

You're listening to the Restoring Human Movement podcast. Thanks for joining the movement, movement. I'm Sebastian Gonzales, show curator and head clinician at Performance Play Sports Care in Southern California. This show's for active people, those who refuse to let pain and injury get in the way of their life and how they want to live it. Trails and trips, fields and courts, whatever moves you. Each episode features rotating host, expert guest, and real clinical conversations that help you move better and trust your body again. Here we go. This is your co-host, Dawne Costantino, and today we are going to be covering common musculoskeletal diagnoses of the thigh.

So we're just covering the not-so-small-but-small area between the knee and the front of the hip. Most of these diagnoses are going to go over bone, muscle, tendon injuries from overuse and trauma. If we get a little closer to the knee or a little closer to the groin, we're going to link some YouTube videos in the show notes for you to check out that we go over the injuries in those areas. So we're really just sticking to like the mid-thigh here. If this is your first time, welcome. Just so you know, we do have a YouTube channel where a lot of these podcasts are accompanied by videos, not specifically recorded the podcasts, but we go over things like exercises, stretches, education with videos, showing you how to do movements and stretches if you want to check those out.

And we also have just an entire vault of other podcasts where we cover many other topics. So go ahead and check those out. And if you guys are returning, welcome back. So let's hop right into it. So the front of the thigh is what we're going to be talking about first. In the front of the thigh is the quadriceps muscle. It is made up of a few different muscles, the rectus femoris, the vastus intermedius, vastus lateralis, and vastus medialis, which all of these muscles run down the thigh and attach to the quad tendon at the top of the kneecap. Injuries to these muscles typically include strains.

Strains are tears to the muscle fibers themselves and they can range from mild to severe, depending on how much of those fibers have actually torn. This can be minimal to full tears, which in full tears, there is no longer a connection. So what do these strains typically feel like? They usually feel like a tearing or a popping sensation in the moment, which can be followed by pain and swelling. Bruising sometimes occurs as well, depending on how bad the strain is. And even this bruising can come a day to a few days later. A noticeable indentation can also occur where the tear is at in the area of the thigh, but not always, depending on, again, how bad this tear is.

An inability to straighten your knee so some decreases in range of motion can occur afterwards. Feelings of cramping, tenderness, trouble with walking, usually all of these due to just pain or it could be due to weakness as well. This is usually seen in people who are, excuse me, who are typically active. So especially those who increase demands on the muscle too quickly or don't allow for enough recovery. So we usually see this in our office with people who are runners and they just increase the running distance or intensity too quickly, not allowing their body to adapt to that demand. And usually injuries like this occur because of it.

So the next thing that can occur to those muscles that we covered are things that we call contusions, which are usually direct blows, typically resulting in a bruise where you got hit. You see this a lot in sport. This feels typically like tenderness, pain with walking or standing up can also decrease range of motion due to swelling and pain. So just something to cover, unless fully torn, most strains can be treated conservatively, this can look like rest, modified activity, working surrounding muscles, working the movement patterns via rehab exercises. Manual therapy can also be involved, which is fantastic in these cases to help with swelling, range of motion.

In some offices or places, they use passive modalities like cryotherapy, sauna, norma tech, which all can be utilized as well with the recommendation of the person that you're working with. I also want to cover, too, the topic of a radiculopathy. So if you are familiar with a radiculopathy or if you're not familiar, really this is a nerve irritation or a nerve compression that can mimic the feeling of a muscle strain. This will not cause bruising, typically doesn't cause significant swelling. Irritation to the nerve roots in your low back, L2 through L4. Those nerve roots make up the femoral nerve, which runs down the front of the thigh and supplies those muscles.

It can often feel similar to a tight muscle. It can decrease range of motion of the hip and knee. It can cause weakness. It can even be the cause with the absence of numbness and tingling and the absence of low back pain. So people typically think of nerve irritation from the low back, sciatica being the common thing that people are familiar with, where they think it is just this kind of, you know, continuous pain down the leg, numbness and tingling. And it doesn't always look like that. So I just wanted to make sure that we cover, like it can truly just feel like a tight muscle. And you might think it's that muscle being strained and it can't be the nerve because there's no numbness or tingling involved.

It can't be coming from my low back because my back doesn't hurt at all. There's nothing going on there. This is what we see most commonly in our office, to be honest, and is typically treated with things like manual therapy and rehab. Rehab usually looks like stretches that will offload where the nerve is being compressed can be paired with things like core exercises, hip strength for long-term benefit. Many conditions can feel similar, which can make it difficult to diagnose. So we can consult with you virtually or in person if you'd like to open up a discussion with us, just reach out. I really highly recommend not doing things like this on your own, waiting a little while to see if your body will just naturally take care of these things.

There's nothing wrong with that. But if it's feeling like it's not getting better, it's taking too long, you've tried some things for a muscle strain, you've tried some things for a radiculopathy, and just not feeling the progress that you're looking for, this is where I would start to consult with somebody. Now for a quick pause before we keep going. Hey everybody, it's Sebastian. If what we've been describing in the show so far sounds very familiar and you've been dealing with some ache, pain, or stiffness that keeps coming back no matter what you do and no matter what you try, we're offering a free discovery call today where we brainstorm with you what has been working for you, what hasn't been working, and we also try to unravel what is a critical part of the puzzle that you've actually been missing that's keeping you from full recovery and getting back to full activity.

The link's in the description. It only takes a few minutes to fill out the form. Okay, back to the show. So the next topic, well, we're not really going to cover it, but something I want to mention is tendonitis. Tendinitis is inflammation typically in the acute stages to the quad tendon, which is down by the kneecap, or to the iliopsoas tendon, which is up at the groin. These are the ones I was talking about are mentioned in the knee and the hip diagnoses videos on YouTube. And see the, just check out the podcast description for the links and for more information on that. Next injury we'll cover is a femoral stress response or a fracture.

This injury is located in the thigh bone from repetitive mechanical loading that exceeds the bone's repair. Excuse me, let's try that again. This injury is located in the thigh bone from repetitive mechanical loading that exceeds the bone's capacity to repair. You can clearly tell I'm reading from notes here because this is a lot to cover. So as I'm trying to read some of these notes, I'm getting a little tongue-tied. Excuse me. Anyways, so what is a stress response? It's basically a weakening of the bone seen as bone marrow edema usually on imaging. If mechanical loading, meaning the activity that you're doing, continues with this stress response being present, it can usually lead to a fracture.

This is common in activities like runners, jumping sports, military personnel and their training. Femoral fractures can occur with trauma like in car accidents or impact sports as well. Bone stress responses or fractures can be seen in the neck of the femur, so closer to the pelvis or the hip, or in the shaft along the thigh, which is the area that we are talking about. This can present as a feeling of like a deep ache, usually two to three weeks after you increase that activity that you're doing and can persist even when we're not doing the activity. Causes to this are just too much activity too quickly, not enough rest, malnourishment plays a massive role in things like this, so just not giving the body the nutrients that it needs to repair after we do activity, underlying hormonal imbalances, decreased bone mineral density in the older population, but again, even in the younger population, this can occur due to malnourishment as well or some underlying conditions and can lead to injuries.

So really, this can happen in people who aren't just active and increasing activity too much, so if we have malnourishment, hormonal changes, underlying diseases that are undiagnosed or even diagnosed, these are all things that can just lead to the bone stress response as well. Again, most of these things can be managed conservatively by significantly changing activity levels for about six to eight weeks for the stress response to heal. From there, we want to talk about how to properly increase activity at a rate that is safer and is slower moving, just a little bit slower moving forward. Progression is not bad.

We all have goals we want to reach, but it's about trying to go too quickly is the problem here with these injuries. Fracture healing time can also vary just depending on the type and the location, so I gave that six to eight week range but it's very individual. I mean, that's like a good timeline and that's usually where it's going to fall, but that's not meaning you're going to go right back to where you started. This is now we can start to bring activities back in and slowly build that bone again. There are things I want to mention, other conditions that can mimic these pains such as osteomyelitis, compartment syndrome, CRPS, or tumors, which we won't be going over in this podcast.

These are reasons why, though, it is important to go see somebody to help you properly diagnose and manage these conditions. The ones that I just mentioned here are not ones that are going to respond to conservative care. If you're noticing things like you have a fever, you have a significant swelling, you're not getting better, it's waking you up in the middle of the night, these are reasons to go see your doctor and make sure that you're getting properly managed and diagnosed. So we're going to move locations of the thigh. We're going to move to the back of the thigh now, which most people will know is their hamstring.

We're going to cover muscle strains first. So the hamstring is typically made up of, not typically, it is made up of the biceps femoris, the semitendinosis, and the semimembranosis. This is a common sports injury where the hamstring muscles are torn or overstretched. This is seen in sports requiring sprinting, like baseball, soccer, because of the longer stride and that stretching of the hamstring or the hamstring needing to take on force, trying to decelerate you, all different things to consider. Depending on the severity of the tear, the symptoms can range from feeling like a tight muscle to maybe you felt a pop, to seeing bruising or swelling, noticing weakness, having difficulty flexing or extending your knee.

You might even, again, see an indent somewhere on the back of the thigh where the tear actually occurred. Sciatica is very, very important to mention when we're talking about the back of the thigh, which is commonly known to people, again, as pain, numbness, or tingling from the low back down the back of the leg or into the foot, but that is not always how it presents. It can present anywhere along that path. So more often than not, when people come in and they feel a tight hamstring, they don't have any bruising, they didn't feel a pop, they're usually dealing with more of a sciatic nerve issue than a muscle issue.

Caused by compression or irritation of the sciatic nerve at the piriformis muscle or at the hip or at the nerve root levels L4 through S1 in the low back. So this is the common reasons why somebody will be dealing with sciatic issues. It can result in shooting pain, numbness, or tingling down the back of the leg, but again, it doesn't have to have those symptoms for this to be a sciatic nerve issue. Oftentimes, it presents differently in everyone. Again, so it can feel like a tight hamstring, it can feel like a numb pinky toe in the mornings, might get better with movement, or better in the mornings with mild low back pain.

Maybe the back pain gets better throughout the day, but the hamstring in the back of the knee or the calf gets tighter throughout the day, especially when sitting long periods of time. If you notice stretching your hamstrings might make things worse or just doesn't stick, never makes things any better. These are just some of the many ways that this can present in each person. So a detailed history and an examination can really help with diagnosing whether this is a true hamstring strain or a sciatic nerve issue. Keep in mind if you've healed from a hamstring tear with bruising and a pop in the past, sometimes that last bit of symptoms that you might be feeling are coming from the sciatic nerve as well.

Outer thigh pain typically thought to be the IT band. Sorry, we're kind of moving locations here and this is the last little bit I want to leave you guys with is outer thigh pain which usually if there's some discomfort on the outer thigh people will think it's IT band syndrome. This is covered in our hip video on YouTube. So again, check out the description in the show notes and if you'd like to know more about pain in the areas that we discussed and the ones that I've said are on YouTube, you are confused, hopefully this was helpful for you to just things to consider, things to look into if you're somebody who likes to do a little self-research.

Maybe you've been dealing with this thing for a really long time and it's just not responding to care that you thought just a muscle strain would respond to. Check out our YouTube channel. I think it's really, really helpful to see some things that you can try on your own but also don't prolong this especially if this might be a nerve issue. Not to say you're going to get worse but it needs very specific things sometimes to just get better and so reaching out to somebody near you a conservative care provider starting with your doctor or again we can help you virtually or in person I think that that's always the best step just ask for some help there's nothing wrong with that.

If anything in today's episode resonated with you visit the link in your podcast player there you'll find any free resource that we mentioned in the show any guest links and a link for a free discovery call with us we're licensed to work with our outdoor active people via telehealth across many states in the U.S. at this point in fact we cover almost half of the population in the U.S. and we add more states every year. Thanks for listening subscribe to the show and we'll see you in the next one.