Nagging marathon pain. (The Clinic).

Last year I ran my first marathon and about halfway through the race I began to feel pain in the groin at the point where my thigh meets my torso. The pain didn't get much worse, but it didn't go away. It continued to hurt for a month or two afterwards (most noticeable while running) and sometimes seemed to travel to the hip joint on my right side. What can I do to prevent this pain from returning when I train for my next marathon?

Lyn Petty, Bethesda, MD

Many different conditions can contribute to pain in this region, including stress fracture, iliopsoas irritation and sacroiliac joint dysfunction. Therefore, an accurate diagnosis by a sports medicine doctor is very important. One likely possibility is that you have irritated either the rectus femoris tendon or one of the surrounding bursae (protective fluid sac). If so, I would suggest icing to help control the pain and swelling; 20 minutes on followed by 30 minutes off, repeating as often as needed. A non-steroidal anti-inflammatory medication such as ibuprofen can also help to control any related inflammation and pain.

Next, you may need to modify how you are training. Your body needs variety to continue to improve fitness levels and to prevent overuse injuries. Vary your distances, speed, terrain and time on a regular basis. It's far too easy to get into the rut of simply piling on the miles as you train for a marathon.

Don't neglect stretching. Even though research hasn't confirmed its benefits, most experts believe stretching is vitally important to prevent injury or recover from one. Because the rectus femoris (one of the quadricep muscles) flexes the hip and extends the knee, in order to stretch it effectively, you must oppose its actions at both of the joints-that is, flex the knee while extending the hip. This stretch can be performed while standing, lying on your stomach, or lying on your side. Avoid common mistakes with this stretch by keeping the pelvis tucked under, knees close together and a "neutral" back (no arching). Grasp the lower leg and pull your heel towards the buttock until a strong pull is felt along the front of the thigh. Be sure to keep your knees side by side. Hold for 20 to 30 seconds and repeat three to five times daily.

If this preventive stretching program fails, see a sports professional at the earliest sign of a return of the pain to get an accurate diagnosis.

Maribeth Salge, P.T., C.S.C.S., Cocoa, FL

Stress fractures, iliopsoas irritation and sacroiliac joint dysfunction each have the possibility of becoming chronic if not treated properly. Be sure to follow up with a thorough exam and biomechanical evaluation by a sports medicine professional.

Mitch Gold flies, M.D., Chicago, IL