Ask the Coach: Hip pain treatment

Q. I'm a 41-year-old mother of three who began training a year ago for a sprint triathlon this past March. I was doing the normal workouts for a triathlon, varying my swim/bike/run workouts and resting at least one day per week.

I continued training and completed four triathlons this year, however after about five or six months of training I began noticing pain in my right hip. The pain wasn't significant enough to stop a workout, but noticeable. The pain continues for a day or so after short runs of 2.5 miles or less, and continued to worsen. I eventually went to my doctor and then to an orthopedic specialist, who seemed perplexed at the cause my pain.

An MRI showed no signs of arthritis, so we treated it with a cortisone shot and I was fine. Several weeks later, the same pain is now in my left hip -- and the last time I ran (2.5 miles with an incline max of 1.5) I could hardly walk the next day. I've stopped training now for two weeks (the longest I haven't worked out in a year) yet I can still feel the pain -- now back in both hips.

I've read only one article in Triathlete magazine about an athlete's similar pain, which was treated with cortisone shots as well. My fear is that this is going to be the sole treatment and I'm not sure how I feel about long-term effects of taking steroids of this nature.

Can you suggest any other treatments for this? Are there any other options besides cortisone? If not, are cortisone treatments on an ongoing basis (every three to six months) safe?

A. In your description of the path to injury I have a few areas for you to consider and then a suggestion.

Consistent training: I'm definitely a big fan of consistent training; however I'm also a big fan of rest. I know you're resting one day per week, but I like athletes to reduce weekly training volume every three or four weeks. In the past year, have you had weeks where you intentionally reduced training volume and used that as recovery time or have you kept volume constant each week of the year?

Running shoes: Running in shoes that are worn out can cause problems. Some people can put 500 miles on a pair of shoes and others can get only 200 miles. How often do you replace your running shoes?

Are you running in a pair of shoes that are correct for your running biomechanics? Running in shoes that aren't appropriate for the running surface or your running biomechanics will cause problems over the long haul. Visiting a good running store where the staff watches you run on a treadmill can help with this issue.

Muscle and flexibility imbalances: If you've trained for a long time with minimal breaks, you can develop muscle imbalances or flexibility issues. These issues can be resolved with a strength-training and stretching program. Do you include a strength-training program that works the major muscle groups and one that aims for muscular balance (working opposing muscle groups)?

Bike fit: Although the pain is noticeable when you run, an improper bike fit could be aggravating the problem. Have you had a professional bike fit done?

My recommendation is to visit a group that specializes in sports medicine. An orthopedic specialist who doesn't see many athletes may have trouble diagnosing the cause of your symptoms. The cortisone shots get rid of the pain, don't address the source of the pain. A never-ending cycle of shots without knowing the cause isn't a good path to follow.

I don't know where you live, but visiting a facility like the Boulder Center of Sports Medicine (BCSM) can go a long way to help you maintain an athletic lifestyle. I have no affiliation with BCSM, but I know the work they do has helped countless athletes. If you're unable to visit this particular facility, look for a facility that offers similar services (Visit BCSM at

I hope you get healthy soon.

Do you have a specific training or sport related question? Have world-renowned coach Gale Bernhardt answer it! Send your questions to

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Gale Bernhardt was the 2003 USA Triathlon Pan American Games and 2004 USA Triathlon Olympic Coach for both the men's and women's teams. Her first Olympic experience was as a personal cycling coach at the 2000 Sydney Olympic Games.

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