Q: I am a 46 year old male runner who's been running ~20 years. I've developed an unusual hip pain which is not described in your previous article (Ask the Coaches: Hip Pain). The pain comes only after running. It is located in my side along the top of my left iliac crest. I feel it only when walking...a dull throb every time my left foot hits the floor. It lasts a day or longer, depending on how long the run was, then fades away until I try running again. Now I am taking most of my exercise on an elliptical trainer, which does not aggravate the pain at all.
I googled around a bit and found rare mention of Iliac Crest Syndrome, which is the closest I could come to describing this. Have you any experience with this, and is there anything I can do?
A: A number of trunk and hip muscles attach to the iliac crest (ridge of the pelvic bone). The iliotibial band originates on the ilium and travels along the outside of the hip, to the knee. You may have an inflammation of this hip abductor (it is called the tensor fascia lata at the pelvic level).
If you run on the side of the road against traffic, the IT band has a constant strain on it each time your left foot strikes the ground due to the camber of the road. If there is any hip weakness and your pelvis is not well supported at foot strike, there is excessive strain on the band. Poor flexibility, bowed legs, leg length differences and pelvis/sacroiliac dysfunction are other factors that increase the likelihood of IT band problems.
Start working on core (trunk) and hip strength. Use an ankle weight or sports cord and perform leg lifts in all 4 directions (front, back, inside and outside). Work on the flexibility of your IT band, hamstrings, quadriceps, hip flexors and hip adductors. (Check out our article on IT band syndrome). A physical therapist can guide you through these exercises.
Assess your running surface. Is it flat or cambered? This can have a major effect on your running form. Apply ice to the painful area for 15 minutes following all workouts. Another, though less likely source of your pain is a stress fracture of the pelvis or sacrum. If your symptoms persist despite these recommendations, seek evaluation by a sports medicine specialist.
–Dr. Cathy Fieseler