Welcome to the next edition of Ask Coach Parry, and the question today comes from Catherine. Catherine says her question relates to injuries and cross training in preparation for the Comrades Marathon. She’s been hampered by injuries.

It started as a hamstring glute niggle and she went to a physio and it’s progressed to painful hamstring, glute and shins. She’s now had about three months of physio, she’s rested the legs for 3 weeks and then missed Comrades Marathon training runs as it would bother and then be fine and then bother.

Brad Brown: Welcome to the next edition of Ask Coach Parry, and the question today comes from Catherine. Catherine says her question relates to injuries and cross training in preparation for the Comrades Marathon. She’s been hampered by injuries.

It started as a hamstring glute niggle and she went to a physio and it’s progressed to painful hamstring, glute and shins. She’s now had about three months of physio, she’s rested the legs for 3 weeks and then missed Comrades Marathon training runs as it would bother and then be fine and then bother.

She’s had a chiro work on her, which seems to be the most effective, she’s had ultrasound and found an inflamed tibial posterior muscle and Piriformis.

They ultrasounded the entire leg and found no sign of injury or scarring. She’s had her feet checked and is in orthotics for pronating and medial arch issue. This has also helped the leg slightly, though it is still niggling. She’s doing strengthening exercises as well.

She’s also dusted off her bike and wants to start cycling to see if this will help, however, any advice regarding injury and how much cycling would she need to do to maintain a suitable level of fitness to run the Comrades Marathon, she’s aiming for a sub 12.

She’s not keen on medication but would it be advisable to take anti-inflammatories to try and get the issue under control or should - in general - these be avoided. She’s worried that if she takes antiinflammatories she won’t be able to judge if her exercise is too intense and thereby causing further injury.

Physio has also said they don’t think they can help, as everything they do either makes the leg worse or has no effect, so she’s at a bit of a loss.

What is first priority?

Lindsey Parry: Okay, so the first thing you need to address is the Piriformis syndrome and if a physio can’t help you with Piriformis syndrome, it’s time to find a new physio.

I don’t know where you live, but it is a slightly complicated condition and it is a little bit difficult to treat, I suppose because the Piriformis is quite deep into your glutes, but an experienced physio should be able to get in there, should be able to work on that Piriformis and should be able to break that spasm that’s in the Piriformis.

They should be able to pick this up on the MRI, so it is something that’s worth checking. A lot of people when they do get an irritated Piriformis, get a full blown Piriformis syndrome which is because the nerve, your sciatic nerve runs through the Piriformis.

If that’s the case, that’ll explain the pain in both the buttock and the hamstring, but the other side of it is, if you have Piriformis or a sore Piriformis, it’s going to affect your run mechanics, which is probably why you’re getting a much bigger torsion or rotation or stress in a circular motion around your shin and why your tib post and your tib ant are taking a beating and why they are sore.

So you do really need to sort the issue out and between a good physio and a good biokineticist, you should be able to sort that out. The fact that it’s a little bit sore today, not so bad after a little bit of rest, get a bit sore, that’s a good sign because it means that if you can just get on top of those issues, that even while training slowly, that should improve and get better quite quickly.

In terms of the cycling, yes, that’s a very good option in the immediate short term, to keep you fit and to ease the pressure that you’re putting through the lower leg. My rule of thumb is for every minute of running, for a fairly equivalent physiological workout, is about 4 minutes of cycling, so 4:1 ratio.

That has some practical issues and also at some point that relationship is going to become skewed. So for example, a 2 hour run, you’re not going to do 8 hours of cycling to compensate for it, but certainly for your standard mid-week one hour run, you probably need to cycle in the region of 2.5 – 4 hours to get a similar physiological adaptation, particularly in your legs because cycling is low impact and it’s much less abusive on your muscles.

But from a cardio respiratory point of view, if you cycle quite hard, then you can substitute fairly closely to a one and a half to one ratio, in other words an hour run, an hour and a half cycle. If you cycle really hard, it’ll give you very similar cardio respiratory or cardio vascular adaptation.

In terms of the Comrades Marathon, you really do need to get on top of that, otherwise you’re going to start with sore shins, if you start with sore shins, it’s going to be very difficult to finish the Comrades Marathon. Then my final comment is on the anti-inflammatories.

Some short term anti-inflammatory use, while you’re resting, is perhaps not a bad idea but I would, again, do that in conjunction with a medical person, but if you can just get control of that inflammatory process and then start training again, but what I would not recommend is doing anti-inflammatories while you’re training.

It does have a masking effect, it also has potential kidney and liver complications that may come if you do it long term.