”Darlene” is a 20-year-old sophomore in a particularly challenging major and she uses running as an important stress reducer in her life. She also had a history of running injuriesthat plagued her through high school. She had been a cheerleader in high school and she felt that had contributed to her running problems. Before this injury she had been running injury-free for over a year, was racing 5Ks, and was starting to beat her dad.

After a harder-than-planned training run, Darlene developed left-sided hip pain. The pain persisted for months but was never disabling. She was in Stage 4 as she was using prescription medication to run. She had gone to another PT for three weeks with no benefit. That PT referred her to a hip specialist who recommended that she have a hip arthrogram. She found this test to be surprising painful. She was told she had a torn labrum in her hip and would need to have surgery. This sent her into a panic; the hip test had been painful enough, and she had watched her cheerleading friends recover from difficult surgeries. A college friend and runner suggested that she get a second opinion from me.

On examination, I found that Darlene had pain on the back and outside of her left hip with stiffness and weakness. I told her these findings were consistent with runner’s butt, which is the adverse effect of dysfunctional running on the buttock region, not a torn labrum. I explained that running rarely tears a hip labrum, although falling does. She said she had not fallen since cheerleading, so I advised her to do PT with me and not to have the surgery unless she fell and suffered disabling pain that does respond to non-surgical care.

After two weeks of Phase 2 physical therapy she no longer had the hip pain. Phases 3 and 4 went uneventfully with just a little right-sided hip and shin pain as we stepped up the mileage and intensity, but no Red Flags. Darlene is now cleared for post-recovery training, and I expect to see big things from her this upcoming race season.

Bruce R. Wilk, P.T., O.C.S. is author of the “The Post Injury Running Recovery Program” and Director of Orthopedic Rehabilitation Specialists.