30 Weekly Miles is Not Likely to Affect Fertility

I am a 37-year-old male runner with fertility problems. 85% of my sperm are abnormal and their mobility is poor. Last fall I was running between 50 and 70 miles per week; I am presently down to 30. Could my distance running be a contributing factor?

Hershel Augious
Stockton, CA

It's clear that excessive running may affect the hormone status and menstrual cycle in women, and men are not that different from women. So it is possible that excessive running may be preventing your testicles from performing the job they were meant to do, though at 30 miles a week, this does not seem to be the problem. Be sure to visit a urologist who specializes in male infertility. The national organization Resolve can help you find one in your area.

Jon Pryor, MD
Minneapolis, MN

Studies have shown that overtraining lowers testosterone levels and sperm counts. With decreased training, counts return to normal, though this takes several months. I reviewed the literature, and did not find any reports on exercise affecting sperm morphology and mobility, however. This, combined with the fact that you have decreased your training, leads me to believe that running is not the source of the problem.

Cathy Fieseler, MD
Tyler, TX

Evaluate Blood Pressure if Cramping Persists

I am a 44-year-old brain stem stroke survivor, very fit before my illness. Most of my deficits are involuntary (such as balance problems), and not muscle-control related. I am running again but at about 45 minutes into the run, I experience cramping in my left foot and lose control of my left ankle and foot. Is this what is known as spasticity? Is there anything I can do to reduce this? I’d like to be able to run longer, and I certainly can’t see myself giving up running.

Cory Scofield
Annapolis, MD

Muscle spasticity during exercise is not uncommon in your situation, and may represent blood flow problems triggered by the running. Most neurologists would probably caution you about running, which is vigorous exercise, but as a runner I appreciate your addiction. Before asking you to abandon the exercise, I advise you to take a treadmill stress test—not to evaluate your heart, but your blood pressure, during running. If it is aberrant, taking an appropriate medication might spare you complications and be helpful to alleviate your symptoms.

Ron Lawrence, MD
Malibu, CA

Hamstring Rehab

I am a 37-year-old male who runs four to five days per week, totaling about 25 miles per week. I recently injured my right hamstring playing football. I made a sudden, quick dash and felt it pull right in the middle. I fell to the ground immediately. I iced it on and off for four hours. I now wear an ace bandage, and follow the RICE treatment. What else can I do to help this heal quicker? What shouldn't I be doing? Should I stretch it? Is weightlifting OK? How long before I should run again? How can I prevent this from occurring again, especially since it has already happened once?

Stephen Grimlich
Washington, NC

The hamstring consists of three muscles in the back of the knee that cross both the knee and the hip joint. It functions both to flex the knee and extend the hip. When the muscles in the quadriceps are much stronger than the hamstrings, they can be injured, as well as when they are tight with limited range of motion and flexibility. Rest, Ice, Compression and Elevation are good first steps toward healing. Massage therapy often expedites recovery.

When the pain subsides (and it may take some time), you should add a stretching and strengthening exercise program for full range of motion in the hip and knee joints. Start with gentle isometrics such as tightening the quads to straighten the knee. Proceed to wall slides in which you straighten your leg against a wall while lying down and moving forward until a gentle stretch is felt. Finally, stand with your leg extended and supported on a table (or similar object at a comfortable height) and lean forward from your hips

All stretches should be performed slowly and held 15 to 30 seconds for three to five repetitions. Strengthening is also essential for full recovery and can be accomplished with hamstring curls. Start with 60% of normal maximum weight (for one repetition) and work up to three sets of 10. Add weight when this becomes too easy.

Carol Hamilton Zehnacker, PT
Frederick, MD

My experience has been that people rupture a hamstring muscle on the functionally shorter leg (and quads on the longer leg). If there is no history of fracture in the leg to cause the leg length difference, you might check for a lumbo-pelvic dysfunction as well.

Mitchell Goldflies, MD
Chicago, IL

Post-Marathon Pain One Month Out

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 did not get much worse, but it didn't go away. It continued to hurt a month or two afterwards (most noticeably while running) and sometimes seemed to travel to the hip joint on my right side. What can I do to stop this pain from returning when I train for my next marathon?

Andrea O’Donnell
Cincinnati, OH

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, PT
Rockledge, FL

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