Tuesday, August 19, 2014

SRM WEEK 14: Poked In the Psoas + What's Up With SRM

The Bad News:

I can sum up Week 14 for you pretty succinctly. After my awesome 20 miler on Sunday, I rested on Monday. I was a tiny bit sore, but not much, and not particularly in my right hip/leg.

I'd begun to suspect that the hip problems (which if you'll recall have plagued me on & off since early 2013) were related to cumulative fatigue & tended to appear when some muscles somewhere on that side had been working hard for an extended period of time (ie, days or weeks of high mileage and/or tougher speed/tempo workouts), so on Tuesday I thought I would maybe not tempt fate with a track workout two days after a twenty miler. Instead, I tried to run 8 easy miles, got about 3 miles out, and became convinced I was feeling weird stiffness-maybe-kinda-sorta-pain. Again, not wanting to tempt fate, I turned around to make it 6 very strange, "off"-feeling miles for the day.

On Wednesday everything felt fine with my leg, but I went home from work mid-day with stomach cramps & went straight to bed.

On Thursday I was feeling better & my leg still felt good, so I decided to attempt Tuesday's skipped track workout (2 wu, 1200m @ 10K pace, 800m @ 5K pace, 1200m @ 10K pace, w/ 1:00-2:00 recoveries, 2 cd), see how it felt, & stop if I had any pain/weirdness. It did start to feel a little stiff at a couple of points, but there was never any pain, and I was able to run all the intervals at the right effort level & faster than prescribed pace. In fact, that evening my right leg felt better than it had in a long time--no pain, discomfort, or stiffness of any kind.

AND THEN, I woke up Friday, & the pain was back. It wasn't awful--certainly not as bad as it was after SF2HM--and I could walk fine, but it was enough to make it completely clear to me that I would not be running that day. Which continued into Saturday, and then Sunday. Each day it's been slightly better, but when I jog down the hallway at home there is still a little niggle of pain on impact that tells me I wouldn't get farther than a quarter mile or so if I tried to do a run.

The Good News:

I saw the massage therapist Monday, and he has a working hypothesis about the underlying problem.

If you've been a distance runner for any length of time, you've probably heard about a muscle called the psoas.

On each side, the psoas originates at the lumbar spine, stretches down your torso through your hip, joins with the iliacus, and inserts at the lesser trochanter of the femur. You can see that it's a great big beast of a muscle, and the only muscle in your body that connects your spine to your legs.

The psoas does a whole ton of important stuff, which you can read about by googling the internet. Most relevant to this discussion, though, is its function as a hip flexor. It is the main muscle involved in lifting your leg forward toward your trunk, and in lifting your trunk towards your legs if your legs are stationary.

We have lots of other muscles that participate in hip flexion (quads, TFL, adductors), but they're a lot smaller and less powerful than the psoas and serve more of a stability function than a prime mover function.

"When you're running and the psoas stops firing," my MT told me, "your body will use anything and everything it can to keep moving your leg forward. Quads, adductors, TFL, whatever it can get. And suddenly you've got an overuse injury or three."

Of course he was careful to remind me that he isn't a doctor and isn't the person to give me an official diagnosis about all this, but if you assume that's what's happening, suddenly a lot of things fall into place: pain that's diffuse and kind of everywhere, with the worst of it moving around from incident to incident, that fits the profile of an overuse injury while the muscles themselves seem to be looser & more supple every time I see him, & still retaining excellent range of motion with no signs or symptoms of structural damage (labral tears, stress fracture, etc.).

What really won me over was when he dug his fingers deep into both sides of my hips under my ab muscles. While it wasn't exactly super comfortable on the left side, when he moved to the right side I was immediately howling in pain.

"Yep," he nodded. "That feels awful in there."

He also showed me how to lay on my back and externally rotate my leg so that the only way to raise it is by engaging the psoas. Again, it wasn't super easy on the left side, but I could get my leg a few inches off the table, which is apparently respectable enough. On the right side, though, it was like I didn't even have that muscle. For a few seconds I just laid there, trying to figure out exactly how I was even going to do this. I finally managed to engage something a little, but barely enough to get my skin out of contact with the table, my leg shaking all the while as I tried not to cheat by pushing down on the table with my opposite leg.

This is called "not being able to use your psoas." Sooooo....

  • Good news: Strengthening the psoas & getting it to fire correctly is an easier fix than, say, surgery for a labral tear or taking 8-10 weeks off for a pelvic stress fracture.
  • Bad news: It's not something you fix in six days.
  • Good news: The whole thing seems to be fatigue-related, ie, multiple weeks of 40-50 miles culminating in an 18 miler was enough to render it useless, but seven days of rest got me another 47 miles, including a 20 miler, with no pain & no soreness.
  • Bad news: This has been the most anemic taper in the history of ever, & I still have no idea what's going to happen Sunday.
  • Good news: Better under-trained than over-trained, eh?? Eh??

By some magical voodoo I don't understand, I managed to get an appointment with my sports doc for Friday morning, so I'll be interested to run the psoas theory by him & see what he thinks.

Santa Rosa:

I am not so under-trained that I think I couldn't run a fair-to-middling marathon Sunday if my leg is pain-free & cooperates, particularly if I can do some of the exercises the MT showed me to get the psoas firing a little more reliably. I was in worse shape after SF2HM, and after a week of rest I did run a pretty darn decent 20 miles at a completely respectable pace, so there's some hope.

If my leg is feeling good by Saturday, then I'll likely go to Santa Rosa, pick up my stuff, check into the hotel, & see how the two easy shakeout miles feel. If all goes well and it's still feeling good Sunday, I'll likely start the race and see how things feel and what kind of pace I'm able to hold. If I'm in any way struggling to hold a BQ / PR pace (~8:10 or better) and I can tell that early-on, I have no problem quitting. I don't care about finishing this race just to finish, especially when my leg has been in such dicey shape. Likewise, if I ever have anything more than the least little bit of discomfort in my hip/adductor, I will totally walk off the course & not think twice about it. It's just not worth the rehab. (Been there, done that.)

If I'm able to hold the pace fine and still not having any pain (the metric I have for this in my head right now is hitting the half in the ~1:47 range), then I don't see any issue with bopping right along & seeing if maybe < 3:35 is in the cards. If I get to 20ish & can tell I'm going to lose the BQ/PR but still not having any pain, I *might* be willing to just finish comfortably for the heck of it, but only if I'm in a good place mentally & don't feel like there's any risk with my leg.

Honestly, even if I do run, because of the number of workouts I've missed lately due to the hip thing & being sick, a lot of things will probably depend on circumstances beyond my control--the weather, the course, & the luck of the draw in terms of how I'm feeling. I had a chat with Coach Tom about my goals (again, assuming I can even run) & admitted to him that since my long runs had been perfectly comfortable in the 8:15-8:25 range, I was hoping to be able to race around 8:00-8:10. Given everything, though, he thought 8:10-8:20 was maybe more realistic.

And hey, if that's how the cards fall, okay. I certainly won't be going out at an 8:00 pace. But since all my long runs have been on rolling hills & often into massive headwinds at least half the time, there's a little part of me that is curious to see if maybe I'll get some help from the flat course and (fingers crossed) nice weather. (Right now, the forecast calls for partly cloudy & 55F at 6am & 57F by 9am with basically no wind, which, hey, could be a lot worse.)

Also, I'm pretty thrilled about the lack of black top.


  1. Argh!! This is all so frustrating! But at least you've got something to work on that may actually FIX the problem, and at least you have a fantastic mindset about Santa Rosa. You see the bigger picture so much better than most of us. (You're also making me think I should find a massage therapist, especially since I'm recently realized that my non-injured leg is actually weaker than my injured one...)

  2. I've been having some issues that sound like they could be similar, in particular how the pains/soreness seems to move around. Could you maybe share what exercises you're doing to help the psoas?

    1. There's not really time for me to do much in the way of strength, but what he wanted me to do to try to activate it & get it firing was this:


      If my Dr agrees that that's what it is (or at least could be) I'm hoping he'll let me go back to PT for just a couple of weeks & learn what you do to actually make it stronger (if that's what I need). Hope that helps!

  3. Yeah, the psoas is a nasty little thing, and now (post-surgery) mine is all torn up from being cut through AND in traction for 4 hours. Right after I had my hip surgery I actually could not lift my leg. I'd stare at it and will it to move, then I'd give up and lift it up with my hands! Hope you heal up and be careful at your race.

  4. Good luck with the marathon! Hope the conditions and your leg hold up. I am impressed with how aware you are of your body, and it sounds like you'll be able to maintain that awareness - and then actually listen to what your body is telling you, which is not the easiest thing to do! - out there. I'm pretty daft during a marathon, it's like my higher order thinking skills just go out the window during strenuous exercise.

  5. Ah yes, I spent the summer of 2012 in therapy for a hip flexor strain and with my PT digging her fingers into my psoas. Painful, not fun. Hope you've caught it early and can still finish on Sunday!

  6. Love your attitude, lady. I'll keep my fingers crossed for you.

  7. I will really be pulling for you this weekend. Good luck!

  8. Sounds like a solid plan! Here's hoping for cloudy, cool weather and strong legs, mind, and heart!

  9. I've had a nonfunctional psoas too! What you described about trying to lift one leg and then the other...I vividly remember that! Here's to healing and activating!