Nagging pain serves as warning when it comes to fitness injury

The word “nagging” brings to mind my mother’s voice when I was kid (I love you, mom).  I distinctly recall her constantly telling me to stay on the sidewalk when riding my bike or reminding me not to sit too close to the TV.  As much as I wanted to rebel, in the end I knew it was for my own good.

An ache or pain that “nags” you during exercise is like your mom’s voice coming from within your body … and the eventual problems are just not worth ignoring.  A nagging pain may be the sign of an injury to come.

I’m a bit embarrassed to say that I am a repeat offender of ignoring nagging pain during my marathon and triathlon training over the years.  It started with a sharp pain in my left hip that I wrote off as a sore muscle after running a marathon in 2006.  I kept running after the race and incorporated more stretching but the pain got worse until I could barely walk up stairs.

After seeing an orthopedic doctor, I was diagnosed with piriformis syndrome, an overuse injury that affects the muscle behind the hip joint, common in runners.  Five months of physical therapy later, I was up and running again.  Within a year, however, I experienced a sharp pain in my left heel that gradually got worse over time, to the point that I could barely apply pressure on my left foot.  This injury turned out to be plantar fasciitis, a condition in which the thick tissue on the bottom of my foot became irritated and swollen.  After two more months in physical therapy, I’m now finally able to run again without pain.  Needless to say I’ve learned my lesson-twice over.

Mary Haney’s story is a bit more serious.  Haney is a San Diego triathlete who learned the hard way that the recurring pain in her right hip wasn’t as innocent as she had originally thought.  As an Ironman competitor and former All Conference swimmer at the University of San Diego, Haney is now facing arthroscopic hip surgery next month at the age of 30 because she ignored a nagging hip pain over the years.

“As a swimmer in college I had some pain in my right leg and hip,” said Haney, who added that cortisone shots-an injection of a natural steroid that helps relieve pain and inflammation-allowed her to compete without pain for big swim meets in her college swimming career.

“When I started doing triathlon after college, I’d feel a minor ache and pain in my hip after a long bike ride or run so I’d rest for a day, ice the area or pop an Advil to mask the pain. I just wrote it off as having bad hips.”

After seeing many doctors and orthopedists who had differing opinions regarding her injury, it wasn’t until this summer that Haney was diagnosed with a labral tear and femoroacetabular impingement injuries in her hip-due in part, unfortunately, to her intense exercise regimen.  These injuries cause the ball and socket in the hip to rub abnormally, creating damage to the hip joint and impeding her ability to walk without pain.  Doctors say her injury, if left untreated, could have lead to arthritis or a hip replacement in the near future.

A consistent, often subtle pain is usually the start of an “overuse” injury.  Overuse injuries can affect anyone from the occasional fitness enthusiast to the veteran athlete, women and men, the young and the old-no one is impervious to overuse injuries.

Just as the name states, overuse injuries are the result of recurring use, physical stress or trauma to muscles, tendons, bones and joints when there isn’t enough rest allowed to let them heal.  Common overuse injuries include tennis elbow or swimmer’s shoulder, often the result of inflammation or irritation of a tendon, as well as runner’s knee, stress fractures and shin splints.  Symptoms usually include muscle aches and soreness, swelling and reduced speed or strength during or after activity.

For those new to exercise, the pain of an overuse injury is often felt at the start of an exercise regime as many go too hard, too soon when their body isn’t in proper shape.  Those at risk include “weekend warriors” who try to squeeze in a week’s worth of exercise in just two days.

But overuse injuries don’t just happen to weekend warriors.  In seasoned athletes, it’s often the result of not letting the body rest long enough to recover after a hard workout or race.

In Haney’s case, she went from running to swimming to biking, often spending hours at a time in each sport, while training for her first Ironman competition.  She kept up this rigorous training routine every week for six months until the race, putting an abnormal amount of stress on her already ailing hip with little down time.

According to the American Orthopaedic Society for Sports Medicine, overuse injuries are the result of poor training practices, such as neglecting to warm up or stretch before a workout and wearing improper shoes or equipment.  Some people are physically prone to overuse injuries simply by their natural imbalances and body alignment like bow legs or flat or high arched feet.

Since overuse injuries are often the most challenging to treat and diagnose, exercise enthusiasts and athletes need to learn to listen to their bodies-paying particular attention to where the pain is coming from.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases website, here are some tips to avoid overuse injuries:

• Build up your exercise level gradually and respect your body’s limitations.
• Use correct form when exercising to reduce your risk of overuse injuries.
• Incorporate a five minute warm-up and cool-down before and after exercise.
• Make sure your shoes and equipment are in good condition.  For runners, shoes should offer good stability and shock absorption and should be changed every 300 to 500 miles.
• Cut back on the intensity, duration and frequency of any exercise that produces pain.  The motto “no pain, no gain” is misleading.
• Cross-train.  Make sure your workout routine includes cardiovascular exercise, strength training and stretching.

If you are concerned about a nagging pain that won’t go away after exercise, consult your doctor or a sports medicine professional.  For those new to exercise, you might want to work with a certified personal trainer as you begin a workout regime.

Here are warning signs that it’s time to consult a medical professional immediately:

• If you experience severe pain, numbness or swelling.
• If you can’t put weight on the affected area.
• If an old injury aches or swells.
• If the injured area feels abnormal.

As an extreme athlete, Haney realizes that hindsight is 20/20 when she looks back on the times when she should have stopped training to rest her hip.

“You only have one body.  Treat it right otherwise you could cause irreversible damage,” said Haney.  ”If the pain becomes constant it’s a signal to slow down or stop and seek medical attention.”

Cassie Piercey is an SDNN contributor.

Tags: American Orthopedic Society for Sports Medicine, exercise, fitness, injury, Mary Haney, nagging pain, National Institute of Arthritis and Musculoskeletal and Skin Diseases, physical therapy, SDNN

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