Ultra runner thigh pain

[icarus]

Hi all, my first post and it's a bit of a head scratcher I could really use some help with.

I'm wondering if anybody has encountered any simliar issues with patients. I have a male patient, 50 year old who I was initially treating for achilles tendinoipathy. We successfully treated this in the first couple of months and he now visits just for maintenance every couple of weeks. He is a keen runner and about 2 years ago began increasing his distances from marathon to ultra distances. His first competitive run was a 50 mile one and he now competes at around 50-70 mile distances. His training has been periodised and progressive (he competes 2-3 times per year), his kees are in very good condition and everything is pretty much textbook (i.e. footwear, kit, hydration, SMR, regular sports massage etc). The issue is that in the last couple of months as his training has stepped up for a recent 50 miler, he has noticed a dull pain in his quad, centralised and two-thirds distal. This is quite general and dull pain and just feels restrictive rather than debilitating. It does affect his run and the pain graduallly gets worse until he has to stop for a little while, have a stretch and then gradually build his pace up again.

I obviously assumed this muscular and associated with fatigue but on palpation, his VL and RF were only a little bit tighter than his other leg. This was not massively pronounced and was not causing any sort of patella drift. Some deep tissue work on the affected leg has helped increase the distance he can run before this happens but I seem to have hit a "stopping point". I cant seem to get him through the 30 mile marker without this happening (although he has said its less painful when it does come on). The original achilles issue was with his other leg and we have spent a lot of time rectifying the biomechanical compensations from this (i.e. pelvic tilt, twist and associated assymetric weight shifting through his gait phase), so I'm hopeful this is not playing a part.

Im just wondering if anybody can think of anything that might be causing this? Or has anybody got experience in dealing with these guys. This is my first ultra runner and it seems like most of the normal physical boundaries are shifted...help!
Jay

[Heidi]

So can you feel anything different in the muscles in the area where he feels any pain?
I would expect to feel a knot or something there if it were muscular.
What about it being a referred pain...femoral nerve compression higher up or something?

[icarus]

There are definitely more trigger spots in the affected leg but I think you might be right about a femoral nerve compression. I havent really thought about a neural issue...If he is hitting a point of fatigue and his biomechanics are suffering it's definitely worth looking into; his hip flexors were far more tonic on the affected side. Will investigate further up the chain and see what happens. Thanks