Hello Dr. Allen,

I just read about Ischial bursitis on your website.  I have been dealing with this condition for almost 8 months now.  I continue to run and stretch and began a more focused gluteus and core strength training program which has not been going great.  I am still having a lot of pain, especially if I run hills, do any type of speed work or run over 6 miles. I feel it on shorter runs also but I manage to deal with it.  Do you have any recommendations?  I don’t want to stop running– it is the only thing that manages the stress in my life.

Your feed back would be appreciated

Thanks, Janet

Hi Janet,

Please read all of the below very carefully and consider your options.  It is unfortunate that so many runners, especially those that live in smaller communities do not have access to excellent sports injury care.  Running injuries are different than traditional sports injuries in that they are caused by long term repetitive trauma to the tissue and bones.  This is very different than a moment in time injury like tearing your ACL while playing a sport.  Most doctors and therapists are  well trained and adept at dealing with that type of injury.  Unfortunately, in the case of running injuries they are not.  Pain in the Gluteal and Hamstring region can be caused by many different variables.  Based on your limited description I am including the 6 most likely diagnosis based on what you said.  I do have more questions for you regarding your condition.

1. Stress fracture (not likely….at all…but possible) Does it ever hurt AFTER you run?

2.  Ishiogluteal bursitis (this condition does hurt when running and running uphill could hurt even more) Does it ever hurt SITTING?

3.  Gluteus Medius Syndrome (this would hurt running, running uphill and possibly sitting) Does it radiate down your glute?

4.  Lumbar Disc Bulge (would be called sciatica and should radiate past the knee all the way to your foot.  Would probably hurt more often and not just after 5 miles) Does it ever shoot down your leg or travel anywhere else?

5.  Piriformis Syndrome (might hurt sitting, running, and driving–also might radiate pain down the hamstring to the back of the knee and would affect only one side) is there any stretch that alleviates it?  Does it radiate down your glute.?  Past your knee?

6.  High Hamstring Tendonopathy… Does it get worse when you run faster?

There are simple solutions to all of these problems early on but the longer the condition worsens the longer it will take to recover from it.  Judging from your email the injury is pretty bad–8 months is a long time and although you did not say it –I am reasoning that the problem is getting worse since you are reaching out for help.  Does it hurt to sit after running?  Where exactly would you say the pain is?  Does it radiate down your hamstring?  Does it get worse if you run faster? Even though you do not live in San Diego I should be able to help you in many ways.  I am an expert in the diagnosis and treatment of these conditions and can provide you with a solid management plan to overcome this condition before it prevents you from running at all because currently you are doing something that is actually aggravating the condition and we both know where that is going to lead!

Since you do not live in the San Diego area, you can schedule a Zoom consultation with me. The consultation is $227 and by calling my office at 858-268-8525 or email me back at drallen@sdri.net, to schedule a 1/2  hour  appointment. These are very successful because prior to the exam you email Janet,

1. Provide me with a detailed history regarding when and how the pain started.

2. Any and all doctors, therapist etc that you have seen and what exactly they tried to do to help you

3. Anything you did on your own that may have helped or hurt

4. A list of any special tests including X-rays, MRI’s, blood tests etc

5. Any information you have that you feel I may need to know.

After reviewing you information we will have a online Zoom conversation.  I will walk you through some simple provocative tests and will be able to narrow down the diagnosis.  I will then be able to provide you with your best treatment options based on the most current available scientific research.  I look forward to helping you Janet.