Gluteal and hamstring pain 5 weeks out from Ironman

Hi

I am treating a client who is 5 weeks out from competing in the WA Ironman. She was unable to complete that last big run and ride of her training program due to left gluteal and posterior leg pain. 80 minutes into her run the pain was too much and although she could almost finish her ride it also increased her pain.

Her lumbar spine was non symptomatic on testing and treatment to so far has consisted of piriformis and gluteal release, hamstring and quad deep tissue work with home stretches.

It is having some success as she is now able to run 2 hours 45 before stopping (unfortunately that would only get her half way). However she is also displaying symptoms of patella femoral pain syndrome and her pain is shifting away from her gluteals and hamstrings to her adductors. I have assessed her knee and there are no obvious biomechanical issues usually behind PFPS. could it just be tight quads from overtraining??

What else should I be looking to assess/treat to ready my client for the race? She is into her tapering program now and that should help. Everything is bound to be sore after training for Ironman so I wonder to what degree my client is noticing other aches and pains now she is in treatment and what I need to pay serious attention to.

I would love to hear from some of you who have had experience treating someone like this.

Perhaps you need to look at this from a different angle.
Triathlon consists of three very repititious sports, two of which heavily use the lower limbs.
At a cadence of 90 for 6 hours for the 180 km that is 32,400 revolutions of the pedals.
Likewise on the run at a cadence of 90 for 3.5 hours for the 42km its 37 800 steps.

Often it means that these problems stem from a small biomechanical or bicycle set up problem. No amount of physical treatment for the legs is going to stop this problem from continuing to occur if the athlete is flogging themselves for hours on end continuing to perpetuate the problem.
If you are not familiar with bicycle set up then send the person on to someone who is.
Things you would generally consider are saddle height, saddle fore and aft position, handle bar drop, cleat position, crank length and actually biomechanics on the bike as some athletes will have strange assymetries in their actions or unstable pelvis's when pedaling.

gluteal and hamstring issues are likely going to be related to saddle fore aft position, seat height and handle bar/aerobar height and their relationship on the amount of hip flexion occuring at the top of the pedal stroke.
additionally cranks that are too long may be a factor as long cranks though the correct height at the bottom of the stroke with close the hip angle up too acutely at the top of the stroke.

As far as being able to run 2h45- this is more than long enough. There is no real need to be running any longer at all. The majority of athletes who take this long in the race will not be able to run out the entire race as they do not have the specific muscular endurance or metabolic ability to sustain it. 75% of the field walk a significant portion of the run course.
any run over 2 hours takes a significant amount of time to recover from and lots of parts are going to feel sore for a few days, perhaps longer if the athlete has not been training consistently, so do not rule out that this person is simply a bit of a whinger/hypersensitive and sore after doing some crash training to try and catch up on things.

Ruley
Physio/9x Ironman Finisher/Top 10 Ironman NZ/2 x Hawaiian Ironman Finisher