Sunday, March 21, 2010

Getting to the bottom of this pain in my bottom, and more Leiahdorus

This was a good week for running. I nailed a faster time on the reverse course of Mount Doug, and shaved anther 3 minutes off my best time (54:20). You have to love the spring, where drastic changes in your fitness and times are observable almost every run.

I have had a pain in my butt for over a year now. I have self diagnosed it as Piriformis Syndrome, which is basically when the piriformis muscle is inflamed and clamps down on the sciatic nerve causing all sorts of drama in the butt cheek and down the leg. The usual cause as you read about it, is overuse in challenging terrain. Well since I only run about 50 miles or so a week and only run up and down gnarly-rooty-rocky trails I was able to conclude that my injury is not a result of overuse or strain from running too much in rough terrain. So I turned to the scientific method to actually get to the bottom of this pain in my bottom. Basically I gathered all the observations as to why or when or how my butt hurts to identify the real culprit. Plenty of people run 200 miles a week in much worse terrain than me so clearly it has more to do with my form or biomechanics than the act of trail running alone.






Observations

  • It doesn't matter how long I take off from running it always comes back when I start packing on some volume.
  • It hurts when I sit for too long on a crappy chair.
  • My gluteus isn't very maximus (I mean no padding)
  • Speed work on flats makes it worse than hills and distance.
  • Often feels better during running sore after.
  • Only on my right leg.

Conclusions

The observation I really focussed on was it is only in my right leg. That tells me that there is something going on in my right side that isn't happening on my left. Possible explanations are:
  • I am missing a lower right ab muscle due to surgery
  • there might be some asymmetry in leg length
  • I always carry a fat wallet in my back right pocket
So to me any one of these three observations would explain why my right side is more prone to injury than my left.

I tend to notice in science, if there is multiple explanations for a problem, it usually isn't one or the other but a combination of all the possibilities in different proportions. So to summarize I have a pain in my butt (right side only) because I sit in hard chairs at school and in my office (terrible office chair) all day long with a fat wallet in my right pocket, which crushes my muscle and pinches my sciatic nerve. I also use the toilet with a hard seat more than the average person (a gory side effect of not having a large intestine - T.M.I. - I know!). Lastly I have a missing ab muscle in my right side which makes a generally weaker core on the right side and may be manifested in asymmetry in running particularly on long runs when fatigue sets in. All of these problems place stresses on the piriformis and sciatic nerve, which are then exacerbated by running high volume in challenging terrain but even more so by flat speed work.

Solution

If I was really taking a scientific approach I would try to resolve one issue at a time such as removing the wallet for a month to see the effect this would have and in this way I could pinpoint the exact problem. I don't have the luxury to experiment on my butt pain for the next six months so I am running a preemptive strike against my pain in my butt.
I am first removing my wallet. Next I am trying to walk around more when sitting for long periods of time (I may even start sitting on an exercise ball). I think I need a padded toilet seat, and a new office chair. Lastly I really need to do core work to strengthen my weak core and particularly ab muscle and back. There are some stretches I need to start doing to fix the existing problem. The final step is using as efficient biomechanics as possible focusing on a neutral pelvis and straight back with no hunching or slumping. This should solve the problem.

I dislike that anytime there is any sort of injury on an endurance runner, the go to answer is too much running on too rough of terrain. I can see if I increase mileage in rough terrain by 40-50% in one week, but when I am doing the same mileage that I have been for a while there is usually a different explanation. I find if I try real hard to think and analyze all of my actions and movements throughout the day, not only when running, that often times the cause is more subtle and usually not related to running per se but aggravated by running. I have already put most of these anti-butt pain measures into effect and have noticed a marked difference in my butt pain already, with my wallet being perhaps the biggest factor (nothing to do with running). I think this stresses how important it is that we are able to analyze and listen to our own bodies. Doctors don't know each individuals daily routine and frankly have no choice but to blame running but we can dive deeper and come up with additional explanations.

Yesterday was a long 11 mile easy run (when I say easy I mean effort not necessarily the course or distance since the course I chose was brutal). I wanted to run 13-14 but it got dark on me and I had to bail because I didn't have a light. I made an effort to run easy and go up and down the hills as smoothly as possible. After my usual 7 mile mark I found I had tons of reserves and ran very well the last four miles including my fifth summit of Mount Doug for the night. I really love the 1.5-2 hour runs. I should be logging 3 hour runs right now for my long runs but I am a bit behind due to school. I can't wait to start injecting much longer runs into my week.

Spring is in full bloom on the mountain and I find it super refreshing and motivating to run through cherry blossoms and delicate neon green foliage. I really love the spring. I think that running anywhere in the spring is just about as good as it gets ( I especially love running the deserts in the spring, a green lush desert is just such an oxymoron). It seems that my fitness usually finally starts to come back around about this time of year, as I am ramping up for epic Summer runs.

For this post I decided to throw in a song by Leiahdorus called "Wake". I describe a bit more about this group in a earlier post here. It is just a chill song I really like.



5 comments:

Anonymous said...

As a "kindred spirit" medically and sportswise - can I ask what you eat on you runs? I am about to attempt my first Ultra- The Highland Fling (I'm Scottish!)-check it out.The running doesnt phase me but the eating with only my ileum to help me out does! The hill runs are ok its just the distance stuff.

Having been ill and fed-up being ill for so long trail/hill running is a sort of exorcism for us. Cant remember who it was that said "We run because we can" but thought that nailed it pretty well! Ann

Tim said...

I think the reason for your sore buttocks is because you are not listening to Vye, so she has to keep spanking you to get your attention. Just kidding, that is really weird about the pain in your tush, however, I think you have probably nailed it on the head, and its not any one particular thing that is causing it, rather its a combination of all of them. Sounds quite painful if you ask me. Hopefully it doesn't start to affect your running.

Steve said...

Hey Ann - the Highland Fling looks awesome! I would love to run the highlands of Scotland!

As far as eating, I am still working on strategy for long distance and I have discussed some of these concerns via e-mail with Dr. Noakes the renown running Dr. from South Africa who wrote "Lore of Running".

First it is nice to know that I am not the only intestinally challenged ultra runner out there but we are definitely a very small group.

I don't do well on eating things with too much sugar or chocolate and have even strayed from Gu and Gel. I find that I do best with bananas, cooked potatoes with seasoning and a little butter, and corn tortillas filled with beans. I know this is not the easiest food to carry along for long runs. If there is aid stations with a crew this is easily remedied. I do most of my long runs solo so I am playing around with different ideas for carrying bananas, potatoes, and burritos. I have thought about wrapping them in plastic wrap or bags and placing them in an empty water bottle that I can carry. The problem is you can't access this food easily, which is a problem for races. Truly I am still in the experimental phase but I hope to continue to make headway on this front.

Most important is I eat food that doesn't cause me to jump in the bushes every 20 minutes. Second I drink about a liter an hour on all runs over two hours, and lastly I want food that gives me energy and the banana, potato, and corn/bean mix seem to do the trick.

Good luck with your Ultra endeavors and let me know what works for you any feedback from fellow runner's with the same challenges would be greatly appreciated.

Steve said...

Tim - I forgot to add the explanation that I am just naughty and have to get my bum beat now and again to knock some sense into me. On second thought that may be a better explanation, heaven knows I cause everyone who knows me enough grief with all my shananagans. Good stuff!
Honestly the butt pain is bearable and I have ran through it for a year now but it would be nice to sort it out so I can continue to improve. Hows the poor old knee?

ann said...

Thanks Steve.Your blog really cheered me up. It was so motivating to find someone in a similar predicament achieving such great goals.

I find I eat the same stuff as you and I try to keep it as high calorie(+ some protein for longer runs) and low residue as poss and not wind-producing - hellish complicated aren't we?!! One thing I am finding is that when I am at about 5 hours or so tipping a sachet of Complan into my water bottle works well as I get nutrition and hydration but it is gentle on my stomach. I am also toying with odd spoonfuls of peanut butter and honey. Probably one of the most foods here is creamed rice pudding. I've heard folk swearing by it but haven't tried it yet. The Highland Fling has a drop bag set up so you can pretty much put in what you want(and the ever patient husband is adding support). Really looking forward to it - its a race with a lot of character.The hill/trail racing community over here is very close. Expect it is the same for you.