Expert: Larry - 11/7/2008

Question
QUESTION: I am a female (50)successful masters runner running distances from 5k to the marathon. I am a longtime runner 25 years! Anyway, I started having a pain on my left iliac crest that has precluded me from running. Help!  need to get back to my favorite sport!

ANSWER: Ann,

This is tough.  I'm guessing you mean the pain is on the side...as there are diffirent locations of the iliac crest.  More info would be helpful...what movements make it hurt...raising the leg forward, raising to the side......what does the pain feel like, where exactly do you feel it......this info will help alot.

My first thought here is an irritation of your tensor fascia lata, which connects to your IT band....so I need more info to confirm this.  If the pain is on front, I'm inclined to say iliopsoas.  Plz respond with more info.

Thanks, Larry

---------- FOLLOW-UP ----------

QUESTION: Dear Larry
 My pain is on the left anterior lateral portion of the iliac crest.Loading the leg by putting all my weight on it and crossing my non involved foot in front of it mimics the pain. I have no pain going upstairs. I have pain after sitting or lying down for a time and then go to get up.Once I get moving it feels somewhat better. Because I can't put all the weight on that side it is obviously difficult to run. I do run roads and I wonder if its related to running on the left side of the road all these years? My muscles seem very tight on that left side as well.
Thanks
Ann

ANSWER: Ann,

Please do something for me.  Go to:

http://www.realbodywork.com/learn/hip/psoas.jpg

Based on your description, I suspect an iliacus strain, which I know (unfortunately) a lot about.  Please confirm that the pain is in the region of the iliacus, based on the picture.  According to your description, it seems you are talking about the top, right area of the iliacus in the picture.  Please confirm.

Also, is there any pain if you do a march w high knee lift?  How about standing straight and tall and twisting your torso slowly to each side like you are looking behind you?

Thanks, Larry



---------- FOLLOW-UP ----------

QUESTION: Dear Larry
 Thanks for helping me try to figure this out! It seems the pain would be more on the other side of that pelvic wall as opposed to the inside as the picture describes. When I sit, slouch forward a little and rotate hard to look behind me-that mimics the pain but more when I put all my weight on my left side and lean to the right

Answer
Hi Ann,

My take on this is a strain of the quadratus lumborum muscle.  Most commonly, this injury is the result of a chronic imbalance in weight bearing between the left and right hips.  This can be due to either weak hip abductors (most common), leg length discrepancy, or running on banked surfaces.  I would back off from running (or stop completely depending on pan) for 2 weeks and ice the area at least once a day.  No stretching at all until healed.

I feel pretty confident that this is not a stress fracture.  However, if the pain lingers for more than 2-3 weeks, I would get x-rays to rule it out.

For prevention, strengthening the hip abductors (gluteus medius) and the core stability muscles is key.  The best and easiest way to strengthen the abductors is to buy a strong theraband (grey or black) about 2 feet long.  Stand with your knees together.  Tie the theraband snugly around the top of your kneecaps.  Then, bend your knees into a half squat position, and shuffle to the side.....20 steps to the lft, 20 steps to the right.  Repeat.  Build up to 5 repeats over time.

Other activities like yoga, stability ball exercises, etc. will also help to stabilize your pelvis.

Overall, stronger abductors and core musculature will maintain a neutral alignment.  Your quad lumborum is becoming irritated bc you have inadequate strength in this muscle to maintain pelvic alignment during strenuous exercise.

Hope this helps,
Larry