I talk to a lot of athletes on a daily basis and hear a similar statement consistently, “I took time off and the pain went away, but once I started up again the pain returned.” When I ask what they have done while resting, it typically involves ice, Epsom salt bath, maybe some stretching…maybe.
Rest does clear up some things, but many times our bodies are dealing with issues that will not clear up just with rest. Sometimes the body requires some extra assistance to address the issues. This assistance can be things you can do yourself many times, but it also may require a skilled clinician, such as a PT, chiropractor, or a massage therapist, to address the issues.
This is the first installment in a four-part series that I think you will find helpful with assessing your injuries and issues.
- Tight muscles in runners
- Tight muscles in CrossFit athletes
- Technique and movement pattern dysfunctions in runners
- Technique and movement pattern dysfunctions in CrossFit athletes.
Tight muscles are one thing, but many times muscled develop area called. Trigger points. These are what are commonly referred to as “knots” in your muscles, the lumps or ropy feeling areas that are tender when you push them. When these develop in the body, most times they do not go away just by gently, short stretching. At times they will, but from my experience that is rare. When a trigger point develops, two things happen in the muscle, it cannot elongate fully to allow full range of the muscle or the joint it surrounds, and it cannot contract as forcefully as it would if the trigger point is not there. When these are present, they can cause a number of issues. Let me explain…
Issues Commonly Seen In Runners
Lower Leg And Foot
When dealing with pain in the lower leg and foot, many times runners have developed trigger points in one or more of the many muscles in the lower leg. Most commonly, it has to do with the calf muscle (gastrocnemius and/or soleus), the posterior tibialis, and less frequently the peroneals or anterior tibialis.
To give you an idea of pain location with different muscle groups, this is commonly what is seen:
- If in the calf, the pain is most commonly at the Achilles.
- If in the posterior tibialis, the pain may be deep in the lower leg or around the ankle.
- If in the peroneals, the pain is most likely on the outside of the lower leg.
- If in the anterior tibialis, the pain likely presents as shin splints.
Knee pain can be a frustrating one to deal with because of all the things that can contribute. Knee pain in runners is almost always a symptom of something else not functioning properly. Sticking with the theme of this article, when talking about tightness in muscles, the tightness is often in the quadriceps, a small muscle at the top of the IT band abbreviated as TFL, or in the hip flexors. (Knee pain is commonly blamed on a tight IT band, but due to the properties of the IT band, that is not actually possible.)
Anatomy lesson in the most basic sense, the quadriceps tendon crosses the front of the knee and attaches to the bone in the lower leg. One of the muscles in the quadriceps crosses the hip and is also a hip flexor. Because of this, when the quadriceps or hip flexors get tight, they cause pressure on the knee cap and resultant pain in the knee. This pain typically presents as pain on the front of the knee.
When it is tightness in the TFL, this will create what many people call “IT band syndrome.” Because of where the IT band attaches, the pain will be located on the outside of the knee most often.
Hip pain is another common issue in runners. This can also be caused by trigger points in the TFL and hip flexors, but in the hip we also need to think about the glutes, especially the gluteus minimus and gluteus medius. Because of the role of these muscles in normal function, tightness in these areas can cause many different symptoms.
When the TFL and hip flexors are involved, the pain is typically in the front of the hip, but can also be present in the outside of the hip or in the groin region. When talking about the glutes, that pain can be in the butt itself, but more frequently feels like pain on the outside of the hip or low back.
What To Do About The Trigger Points
So now you know the trigger points are possibly causing your pain, what do you do about it?
You can start with doing self-mobilization work with a foam roller or lacrosse ball. Depending on how deep the trigger points are and how long they have been present, that may or may not work. If it doesn’t work, it is time to get into a massage therapist or physical therapist who can loosen up the tightness. I my opinion, the physical therapist is going to be your better option because the physical therapist can also address the issues that caused the trigger points in the first place, such as weakness in the stabilizer muscles or movement pattern correction.
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