Hamstring muscle strain from running

I have a patient who complains of acute pain right under the right butt cheek, and inner part of the thigh.  It is a persistent pain that has been bothering him for weeks and also feels stiff.  He is in his mid 50s, professional, and in good health other than “high” cholesterol, for which he takes Lipitor.

The pertinent history for this patient is that he is an avid runner, and has been running regularly since his 20s.  He is one of those folks who enjoys the feeling of running, during and after.  It is a form of stress relief for him.  He also does Pilates using the reformer, and enjoys 3-4 glasses of wine on most nights.

The area in question is the biceps femoris tendon, which is part of the “hamstrings” of the leg.  It functions as the major knee flexor of the leg (its agonist, opposing muscle is the quadriceps group).  The biceps femoris muscle inserts into the ischial tuberosity, which is the bony part of the ischium (half of the pelvis) that we use to sit.

Without the benefit of an MRI or CT scan, and based mostly on the history and lack of other findings that would cause me to think otherwise, I diagnosed myofascial strain of the biceps femoris tendon, with possible tendinopathy (degradation of the tendon from overuse).  Basically, something has happened to the muscle and tendon that is resulting in unrelenting pain.

Running is the repetitive, alternating contraction and relaxation of opposing muscles.  The most stress occurs at the tendinous attachments to the anchor points on the bone.  However, the spot where the tendon attaches to bone is stronger than the breaking point of the tendon itself, so when it is stressed, the  body of the tendon will experience tearing (strain) first.  It is rare for a tendon to separate from bone at the attachment site.  This is the case for this patient, as his pain is described as about 2-3 inches from the attachment point on the ischial tuberosity.

I am treating his injury with a LiteCure deep tissue laser and have given him a nutritional prescription consisting of whey protein to provide the building blocks for repair; high potency fish oil and capsaicin to help reduce the inflammation, and bromelain supplements to serve as an enzyme to soften scar tissue formation.   Today, I advised him to drink distilled water for 2-3 weeks.  Distilled water may have a chelating-type of effect (binding) on dissolved, inorganic toxins or debris in tissues, which could help with the situation; it is often used for detox programs because of this quality.  He was advised to rest, ice and compress the area for 3 days to help suppress the inflammatory reaction.

The case is a very interesting one that will hopefully have a good outcome.  We should realize that a muscle is very much like an organ of the body, although it is rarely referred to as one.  It has its own unique type of cells, blood supply, and plays an important function.  As in all cases of disease of the body, a good strategy is to give it an edge in repairing itself.  Diet modification, concentrated, high potency supplements, and non-pharmacological, manual therapy, when used in the right manner can oftentimes hasten recovery.

 

To Run Barefoot or Not?

If you suffer from foot pain, knee pain, or lower back pain of unknown origin, then it might be related to your shoes:  Scientists recently held a conference in England to debate shoe running vs. barefoot running.   Over the last five years, the barefoot movement has gained a lot of recognition among runners and experts in human biomechanics.    I wrote about the merits of going barefoot last year.   The movement was apparently started by the book “Born to Run” by Christopher McDougall.  In it, he tells of time spent with members of Mexico’s indigent Tarahumara tribe, who routinely run long distances barefoot, often very fast, apparently without suffering the injuries that plague many avid runners in the developed world.

The issue is whether or not putting on a pair of running shoes implicitly causes the person to run in an unnatural way; a way that goes against nature’s design, due to a “false sense of security” offered by the thick cushioning of the shoes, especially in the heel and arch.

In a study published in the scientific journal Nature last year, Daniel Lieberman, an evolutionary biology professor at Harvard University, sought to find out how our ancestors, who ran and hunted for millions of years in bare feet or simple moccasins, coped with the impact of the foot hitting the ground.

Lieberman and colleagues from Britain and Kenya studied runners who had always run barefoot, those who had always worn shoes, and runners who had abandoned shoes.

They found that barefoot endurance runners often land on the fore-foot (the ball of the foot) before bringing down the heel, while shoe runners mostly rear-foot (heel) strike, prompted by the raised and cushioned heels of modern running shoes.

The study further discovered that barefoot runners incur less collision forces on their feet compared to shoe runners, despite the heel cushioning of the shoe, and that they use their calf muscles more efficiently.

As of this date, there isn’t a large scale study that gives definitive data on what is better for the human body, going barefoot or wearing shoes.  People are taking sides based on their beliefs, biases and experiences.  Major athletic shoe companies generally are against the barefoot running idea, for obvious reasons; but some are experimenting with “minimalist” shoes to capture this growing market.  These are shoes that offer protection to the feet but with the least amount of restriction.

My take on this:  it makes a lot of sense to walk and run barefoot.  It is a natural act, and it’s tough to argue against nature because it has its ways of cancelling out bad traits.  Our human ancestors walked and ran barefoot for millions of years, and were fine.   I believe that walking barefoot exercises the muscles and small joints of the foot and takes more of the load off the knees, hips and pelvis in doing so.  On the contrary, wearing shoes binds the feet, prevents the foot joints from doing their job of distributing the body weight and cushioning the shock, and makes the leg and back muscles work in a less efficient manner.    It is easy to see how this can result in lower back problems.  So, walk barefoot more than you currently do– not just in the house, but on pavement, hilly terrain, and the nearest park.  Then, when you feel that your feet have acclimated to the new sensations, give barefoot running a try!

 

 

 

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