Ischiogluteal Bursitis – Quite Literally A Pain In The Ass

The D33 Route

The D33 ultramarathon is tomorrow and training has not gone to plan.

Not that this is much different to any other year. However, thanks to ischiogluteal bursitis 2017’s training has, quite literally, been a pain in the ass.

Despite my best efforts to cope with the bursitis, and with the best will in the world, I am approaching this weekend’s D33 with a high degree of trepidation.

2017 started so well, and with the best of intentions.

I signed up for the D33, the Highland Fling, and the Salomon Ben Nevis Ultra (gulp!).

Spurred on by significant weight loss towards the tail end of 2016, and buoyed by some decent technical trail runs in the Cairngorms over the New Year period, I approached 2017 with a firm belief that it was going to be the year of the PB.

Ironic then that, as things stand, it may become the year of the DNF, or perhaps even worse, of the DNS.

  • DNF: Did Not Finish
  • DNS: Did Not Start

Three letter acronyms that strike fear into the heart of all runners, regardless of the distance involved.

Now, if I was to put the sensible hat on, I wouldn’t even contemplate starting tomorrow’s D33. However, I’ve yet to ever come across that hat and, if truth be told, I’m still reeling from the impact on training that accompanies children. D33 is a ‘training run’ for the Fling, which in turn is a ‘training run’ for the Ben Nevis Ultra. The opportunity to get a 33 mile training run in rarely/never presents itself and, as such, it’s very much a case of carpe diem for me.

D33 was my first ultramarathon, back in 2010 and, save for the single year ‘parental leave’ absence that cost me my ever present status I have, well… been ‘ever present’.

As such, I know that I can go the distance and, indeed, it is the shortest ultra that I run. I therefore have ‘previous’, and the knowledge that I can finish it. I am also, after 7 years of ultramarathons (aside from the aforementioned 2013/14 parental leave) well versed in dealing with the pain that often accompanies ultramarathons and the need to ‘dig deep’, ‘tough it out’ etc.

So, what’s so different this year?

For starters, my last/only long run of 2017 was 20 miles back on the 21st January, which even by my fairly unregimented training standards counts as way not enough training specificity and as being a good bit too far back in the past to even count as ‘race preparation’.

The only upside is that I did the distance in 2:54:21, a time I was delighted with in comparison to previous years and, further, off the back of no longer than 12-13 mile runs preceding the 20 mile run.

But enough positivity, lets get back to reality.

First, some background.

A couple of years back I had a bad fall, slipping on wet wooden steps and landing smack on my ass with a jolt. At the time, the pain from a suspected arm fracture diverted my attention to any other pain and, whilst the arm improved, I found myself left with the kind of daily back pain that I wouldn’t wish on my worst enemy. Just for the record, I can’t actually think of anyone who fits that description so it’s a vacant position if anyone’s interested.

Joking aside, there’s not much that I wouldn’t do for even a single pain free day.

The good news is running is one of the few things that offers any relief from the pain. Whether this is down to serotonin from running or some similar side benefit is anyone’s guess. Regardless, its all the excuse that I need to lace up and hit the trail.

Unfortunately, my right shoulder appears to have felt somewhat left out and has, over the past 6 months or so, decided to join the lumbar area of my back in causing me grief. I’ve cut back my expectations in terms of the weight that I can lift at the gym and, as for monkey bars, well that was just too embarassing and will likely never be repeated, at least not until I have a fully functioning shoulder again (I can only live in hope). My range of motion isn’t impaired too badly but, depending on the range that I utilise, and the task in hand, I can generally ‘count the clicks’, which is surely never a good sign!

I’ve tried both physio and Pilates to try and remedy the back. The first physio was fairly ineffectual unfortunately. The physio led Pilates class, on the other hand, really helped to strengthen my core and served a secondary purpose of providing an hours worth of focussed, fairly chilled time. Unfortunately, the continued decline of the oil industry in the North East of Scotland, which hit that little bit too close to home in January of this year, and the, by now, increasing pain in my shoulder, meant that I stopped after 3 blocks of Pilates. Benefits aside, the Pilates did little to remedy the back pain.

After a couple of shots of Cortisone for the shoulder, and an X-ray on the back that revealed ‘only’ minimal damage to the spine and, according to the GP, certainly not enough to be the cause of the ongoing pain, I was again referred to a physio, this time closer to home in Ellon.

Now this is the point when I can be positive.

Looking initially at the shoulder, then the lumbar region of the back and, finally, at the gluteus maximus and the hamstrings, this physio may well have found the cause if not yet the remedy to my problem.

Under assessment, the physio identified an over-reliance on the hamstrings in favour of utilising the gluteal muscles. This is something that has been identified previously a number of years ago and, in trying to address the imbalance, I found myself getting injured (a common theme it would appear).

The assessment this time around suggests that there’s actually more to it than a poor running form, with the suggestion that this imbalance is actually responsible for the general tightness in my back and the pain in the lumbar area.

I’m not going to even pretend to understand the diagnosis but the gist of it was that there was a lack of curvature in an area where generally curvature would be expected and that the muscular imbalance may well be responsible for that, pulling things out of shape. Or something like that!

As far as a diagnosis goes, it works for me, especially when it has the potential to be remedied. I’d rather not live each and every day in pain if that’s ok thank you very much!

And so, armed with a diagnosis, we set about sorting me out, around about the same time that Facebook, as it does, reminded me that, around this time of year I was typically running anything from 20 to 30 miles. Fantastic! Now don’t get me wrong. When it comes to photos of a 1 to 2 week old Harris, as has been the case this past couple of weeks, I absolutely love Facebook’s ‘On This Day’ feature. When it comes to guilting me into running long distances however, that’s generally something I could do without.

Returning to approx. 1 month ago, inspired (and I do use that term loosely) by Facebook’s ‘On This Day’ feature, I set off up the Formartine & Buchan Way with the intention of running 20 miles. My glutes were slightly tender, after a week of gluteal exercises prescribed by the physio, but I thought nothing more of it, expecting things to ‘loosen off’ as the run progressed.

Well that was wishful thinking!

Instead, I found the gluteal tightness worsening and, thankfully (in retrospect), I turned early and headed back towards Ellon. I was some way short of my intended distance but I knew that things were far from right.

And then, without any further warning, something spasmed in my right leg, all but preventing the mechanics of running. With a running ‘form’ more typically seen in the final stages of a 96 mile run (WHW Race), I somehow nursed the leg home, hobbling, skipping and hopping along. Oh the irony, physiotherapy strikes again! It really does make me wonder about the merit in trying to fix things sometimes.

After a few days, I found myself able to run again. However, it continues to be painful and, from experimentation, I know that it doesn’t take much before the glutes start to grumble, offering once again to fire. Recent weight loss may have facilitated faster mile times, for example, but the glutes don’t appear to be on board with that, at least not yet!

My next physio session saw a diagnosis of ischiogluteal bursitis and a discussion of the merits of continuing with trying to fix my back Vs the impact of this on my running form and ability to run long distances.

Regardless of my desire to continue running long, and of the desire to bag some PBs along the way, there was no question of deviating from the physiotherapy that will hopefully remedy my back issues. In the short time between starting physio and the arrival of the bursitis, I have noticed an improvement in my running form, with a much higher degree of utilisation of the glutes, resulting not just in faster mile times but, also, in a feeling of far greater ease when running.

As such, I can appreciate the light at the end of the tunnel, but can only hope that the tunnel is not so long as to impact negatively on my planned ultramarathon events for 2017.

Last Friday, I set out for ‘the decisive run’, the run that would determine whether I opted for a DNS at D33 or whether I would delay that decision until closer to race day. It wasn’t until the latter stages of the run, once everything had loosened off, that I picked up the pace and, at this point, the spasms started to return. So, the ‘tactics’ for tomorrow’s D33 are to try my best to achieve ultramarathon finish #25, recognising that I may need to curb my desire to push on for a PB, but equally recognising that I may well need to pull out at some point in the race if the worst case scenario presents itself. I’m all too aware that the legs may once again take matters into their own hands, with a repetition of the muscle spasms that would leave me unable ro run.

Concerns aside, I intend to try and enjoy the day as much as possible, and to try and use the day as a ‘training run’ for the 53 mile Highland Fling which follows on 29th April.

Once tomorrow is out of the way, I can resume working on the glutes and hopefully start to build up the necessary mileage required to facilitate finishes in the other events that I have committed to, hopefully with an improved running form.

That’s the plan at least! Time to go pack the drop bags.

Best of luck to everyone running the D33, and especially to all those ultra newbies.