One of our recent patients named Rachel, or “Rae” for short, tried for six months to recover from a marathon. Taking so much time off was foreign to Rae as she was a lifelong runner and had completed the Boston Marathon several times.
“After my last marathon I had some pretty significant pain in both hips and my lower back. The pain was bad enough that I had to stop training, and it hurt just to sit down.”
She was referred to a hospital-based PT Clinic which was the standard protocol for doctors in that hospital system, regardless of a patient’s injury or the experience of the clinic staff. Rae was diagnosed with a bulging disc and hip bursitis. For 6 months she performed exercises and stretches meant to improve her hip mobility and lower back strength.
The exercises she did at home were the same ones she did when she came for her appointments. Rae felt like her in-clinic visits were a waste of time. She wasn’t seeing the results she expected, and she was even taking a steroid regularly to decrease inflammation and pain.
“I was only about 60% better after 6 months of exercises that seemed redundant, plus I was worried about being on prednisone for so long. I decided to look elsewhere for solutions.”
The 30,000 Foot View
During Rae’s initial consultation with Mobility-Doc, we wanted to take a step back and look at the bigger picture. We didn’t want to treat a bulging disc if we weren’t sure that was the root of her pain. Rae had progressed back to running, but not nearly as much as before, and she still couldn’t sit without pain. We would have expected her to be much better 6 months after her initial injury.
We took a deep dive. Our initial physical assessment included:
- Hip muscle strength testing
- Special orthopedic tests for the hip
- Hip muscle length assessment
- Low back muscle testing
- Special testing for the lower back to rule nerve issues in or out
“I had full strength and range of motion in my hips and spine, and was very surprised to find out that none of the tests revealed a nerve problem at all. I 100% expected nerve issues due to the bulging disc.”
We didn’t reproduce any nerve symptoms at all. What we did find was that her hamstrings were extremely reactive to any stress placed on them during the evaluation. It became clear very quickly that the source of Rae’s pain was not a bulging disc after all.
A Surprising Diagnosis
Rae’s limited Improvement up to that point was in part due to the fact that her previous Physical Therapy Clinic was treating the wrong tissue. Through our consultation and detailed evaluation, we discovered that her hamstrings were strained during her last marathon, and this was the root of all her pain.
“Since my hamstrings had been strained during my last marathon, they weren’t working as well as they should have. The Mobility-Doc team explained how the brain and hamstrings weren’t communicating well. Since my hamstrings were kind of on a strike, my low back had to pick up the slack. It made so much sense when they took the time to explain everything.”
When we dug deeper, and asked more targeted questions, we learned that Rae’s last race was on a particularly hilly course and she did recall some discomfort in her hamstrings right after the race.
“I never put two and two together. I remembered being sore, but I never connected that soreness from 6 months ago to my current situation. When the first doctors told me I had a lumbar herniation, I just went with it and didn’t question it. After several months I felt like I should have been better than I was which is why I reached out to Mobility-Doc.”
Although Rae’s symptoms were very similar to those you might expect with a bulging disc, you have to take the entire person, their history, and your full physical exam into account. With the right information from her interview and all the data we gathered from her personalized and specific physical exam, we now had a correct diagnosis and executed our plan.
Putting A New Plan in Action
We immediately shifted the rehab focus and targeted the missed hamstring strains. We didn’t even need to treat her low back. Rae’s plan included hands-on treatment in our office as well as exercises for Rae to do at home.
In the clinic, we spent our time doing manual techniques like myofascial release, Graston soft tissue release, and we used other technology such as our normatec and H-wave. At home, Rae worked on strengthening and lengthening her hamstrings with the ultimate goal of improving how the hamstrings functioned.
Over time, Rae’s hamstrings were able to improve their work capacity and not get tired so quickly. Rae’s low back pain and hip pain during sitting resolved completely once we restored the health of her hamstrings. And it only took two months!
“I had to relearn how to use my hamstrings since they were relying on the lower back to do all the work. I was finally able to return to racing and even hit new PR paces after graduating to MD-Fit.”
MD-Fit is our PT-based home exercise program that focuses on improving mobility, stability, and strength throughout the entire body. It can be done from anywhere and takes just about 35 minutes, three times a week.
It was an honor to work with Rae, and we love to hear her new run times when she sends us updates.
Would you like to be our next success story?
Whether running is your passion, or you enjoy staying active in some other way, our deepest wish here at Mobility-Doc is that you know you don’t have to live in pain. We’ve dedicated our lives to helping active people stay active. Health is the most important investment you can make! Schedule an appointment with us today to get to the root of your muscle or joint pains and get back to truly living.