With the 36th London Marathon taking place on Sunday 24 April, this week’s blog post takes a look at the help our osteopath Josh McCollum recently gave to one of his marathon running patients.

Mrs G is a 44 year old, long distance runner and Pilates instructor. She first started running around 10 years ago and has taken part in marathons consistently since. On average Mrs G reports running at least 65 miles per week during her off-peak season, and can run over 20 miles per day as her race approaches (six to eight weeks before).

When the patient first visited Good Health Centre, she reported experiencing low back pain centrally and on her left. This pain was also felt in her left buttock, hip and groin. As soon as Mrs G bent forward she felt a pinching and clicking within the front of her hip.

During examination, Mrs G was unable to bring her left knee towards her chest as closely as on the right side. However when the movement was done passively by the osteopath (patient did not have to activate her muscles), it was even. This suggested a muscular limitation to the movement. Josh then examined the muscles that flexed the patient’s hip (Picture 1) (the Iliopsoas, Rectus Femoris and sartorius are the major ones) which proved to be very tight. Due to this tightness, the left side of the pelvis was rotated forward.

As the muscles within the low back were tighter on the left, it led to the facet joints (picture 2) within Mrs G’s spine being approximated (forced closer together). There was an ache when Mrs G arched backwards within the same area as her pain, and the symptoms in the central spine were eased as she bent forward. This approximation of the facet joints is called a facet irritation.

Josh also noted that the movement of the patient’s sacroiliac joint (Picture 3 – the joint between your tailbone and pelvis) was more on the left than the right. When Mrs G laid on her back and raised her leg whilst keeping it straight, it led to pain, however this pain was eased when compression was placed through the pelvis and the movement repeated.

Diagnosis

The diagnosis for Mrs G was a hypermobile sacroiliac joint (the joint was too mobile) leading to a rotated pelvis and facet irritation, maintained by extensive tightness of her hip flexors which lead to the pinching sensation and restriction in movement.

Treatment

Stage 1 of Mrs G’s treatment was aimed at reducing the tightness within the hip flexor muscles and her low back muscles using a combination of massage, articulation and stretching. This also reduced the compression in her facet joints (picture 2). After the muscles were looser, Stage 2 was based around strengthening the muscles around her Sacroiliac Joint with a combination of exercises and resistance techniques during treatment.

How did the patient respond?

The patient continued with her training programme of running up to 20 miles per day, and despite this reported gaining 60-70% improvement after the first treatment.

Exercises

Josh gave his patient an exercise routine to help maintain the improvements between treatments. These exercises were aimed to correlate specifically with the different stages of her treatment plan. This ensured that she could continue with her marathon training as best as possible.

Stage 1:

Initially the exercises given were designed to stretch the tight hip flexors, and stretch her lower back muscles (examples as follow)

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Knee Hugs

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Knee Hugs – to help stretch the muscles in her low back, alongside decrease the compression of her facet joints.

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Gluteal stretch

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Gluteal stretch – to help reduce the spasm associated with the facet irritation, and reduce the stress in her buttocks.

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Hip Flexor Stretches

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Hip Flexor Stretches – given to help decrease the tone of the hip flexor muscles and decrease the rotation with the patients sacroiliac joint.

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Stage 2

The second stage of rehabilitation was designed to strengthen the muscles around the sacroiliac joint. This included increasing core stability to help reduce the strain on the spine (such as plank, superman plank, adductor bridge, and pelvic floor exercises).

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Clam exercise

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Clam exercise – Given to help increase the strength within the patient’s buttock muscles and stabilise her Sacroiliac Joint.

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Body weight squat

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Body weight squat – Given to help increase the strength within the patient’s buttock muscles and stabilise her Sacroiliac Joint.

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Adductors squeeze and bridge

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Adductors squeeze and bridge – given to help strengthen the core stability through the pelvic floor muscles, abdominal muscles and stabilise the Sacroiliac joint.

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At Good Health Centre our practitioners regularly treat patients with minor sporting injuries that are causing them pain and affecting their performance. If you’d like to find out how we could help you, give us a call on 0113 237 1173 or click to request a callback.