Glute injury

First, I want to thank you all for reading my post. This is the first time I've ever been to your site, and I'm grateful in advance for any insight you may offer.

The short story on me is this: I've been a competitive athlete my whole life. I am 47, and have been participating in triathlons seriously for the last five years. After my last big race of this past season (Sept. 08), I experienced significant pain in my hip that didn't go away even after I all but stopped working out for several weeks. I went to a terrific physical therapist who diagnosed a gluteus medius strain and gave me exercises to address the weakness that had developed in the muscle. He didn't believe I was dealing with a tear.

It's an odd thing. It seemed to get better and worse but without a corresponding change in activity. Meaning, I couldn't figure out what was hurting it. And full rest seemed to make it worse. I went back to my PT (second visit for this injury), and in addition to the deep massage and electrical stimulation pads (not sure what that's called exactly) he did some dry needling to relax the aggrieved muscle. I thought I was "fixed" as it was much better for weeks. Now, it's seemingly much worse.

I'm having a lot of trouble sleeping (either side, with pillows between my knees, without, on my back, on my stomach). After I get up, it takes an hour for my back to loosen up. I'm also getting numbness/slight pain on the side of the injured hip, but down the outside of my leg. In my amateur sleuthing, I'm wondering if the glute minimus is involved, perhaps with trigger points as I compensate. I think that because when I dig into the minimus with a massage ball, the numbness/pain goes away. I also have a little pain near the SI joint, which the PT said was compensatory for the glute injury.

Also, I should tell you that I had a quadratus lumborum injury this summer -- on the opposite side from the glute problem. I believe the QL problem (for which I also saw the physio) was due to a combination of a killer 15 percent cycling climb after I had damaged that muscle from a bout of coughing weeks earlier when I had a nasty cold. It seemed to resolve quickly.

So that's a long description, but my question is, basically, what should I do? At the moment, I have an appointment set up with an orthopod, who I hope will order up an MRI. I want to rule out a tear. Mostly, I want to nip this thing in the bud before I have all sorts of issues develop as the rest of the muscles and tendons in the neighborhood try to compensate for this injury. I have had minor injuries over the years, but never anything debilitating. I have made it a point to catch issues early so I can continue to compete.

Any ideas would be very much appreciated.

Can think of how one would tear their gluteus medius on training for triathlon unless getting charged by a run-away bull or landing on a post :)

That said it sounds like perhaps this is a lumbar spine issue (previous QL issue) and mayabe the pelvic in relation to that. Of course a long 15% climb, in the saddle?, could have irritated the hip joint/bursae in the area. You need to go training, including hills and work out functionally what is the major aggravation. This might not be know until the day or so after training. Then work backwards to eliminate things.

The pain resolution from your last treatment is impt to analyse with your therapist, especially in relation to any MRI findings. On that not make sure they look closely across the hip joint and if you can have a functional MRI then have it in the position of most discomfort.

As for a QL problem: well that might have been tight or in spasm but likely due to something it did to the underlying joints of the spine and ribs and that the treatment to those areas resolved that issue. QL is a pretty darn strong muscle that wouldn't itself be injured with coughing. Again this points to some underlying spinal issues with muscle imbalance and perhaps weakness.

Regardless of what they find on MRI, the cause needs to be assessed and your mechanics and training regimen and even bike setup should be modified slightly as required. Also think about adjusting the bike setup for courses with more hills vs those on the flats.

Let us know the results of the MRI. Best of luck :)