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Mayo Clinic Q&A: pain when running; varicose veins


I am 42 and training for my first marathon. During my longer runs I have pretty significant hip and knee pain. Some runner friends advise that I just stretch more, and others say I need to do exercises to strengthen my ITB. What can I do to alleviate the pain? Is it safe to run with these issues?

It may be okay to keep running, but to avoid injury, it's important that you address the problems you're having on your long runs. It's likely that stretching and strengthening will help to relieve the pain. It would also be valuable to have your footwear and running cadence assessed to see if they could be contributing to your discomfort.

Proper stretching is an important part of any exercise program. It can increase flexibility, improve your joints' range of motion and reduce the risk of injury. For runners, stretching the quadriceps, hamstrings and iliotibial, or ITB, is particularly important to help avoid the type of hip and knee pain you're experiencing.

Your quadriceps muscle runs along the front of your thigh. The hamstring muscle is on the back of your thigh. Your ITB is a band of tissue that runs along the outside of your hip, thigh and knee. To learn specific techniques that effectively stretch each of these muscles, talk with a physical therapist. Suggestions for basic stretches are available at

Don't stretch a cold muscle. Before you stretch, warm up with at least five to 10 minutes of light activity, or wait to stretch until after you've completed your workout. Hold your stretches steady, without bouncing. You shouldn't feel pain as you stretch — only light pulling. Hold each stretch for about 30 seconds.

Along with stretching, you may also be able to help ease the pain you're feeling by working to strengthen your hip abductor and extensor muscles — the gluteus medius and the gluteus maximus. Increased strength in these muscles can help provide an extra measure of stability and support to your body when you are running. Again, working with a physical therapist you can learn strengthening techniques that target these muscle groups.

The way you run and what you put on your feet while you're running can make a big difference when it comes to avoiding injury and staying comfortable throughout a run, especially when you're going a long distance. When choosing a running shoe, comfort is the most important consideration. Correct fit and support also are key. Replace your running shoes when they lose their ability to provide proper support and become uncomfortable.

Running cadence is how often your feet touch the ground when you run. The right cadence varies somewhat for each runner. If your cadence is too fast or too slow, you may be increasing your risk for injury or pain when you run.

A sports medicine specialist can evaluate your cadence, as well as your overall running form. He or she may be able to help pinpoint other areas of concern that could be contributing to your hip and knee pain, too. Such a specialist also will be able to provide you with the right rehabilitation program to decrease your risk of injury, as well as increase your performance.

Jeffrey Strauss, D.P.T, Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minn.


I have several varicose veins in my legs that aren't bothering me other than how they look. My doctor said they are not harmful, but I'm concerned that they are going to get worse. Does having them mean I am at risk for other health problems? What's the best way to have them treated?

Most of the time, varicose veins are a cosmetic issue. They typically don't raise your risk for other medical problems. If you'd like to get rid of varicose veins, treatments are available to close or remove them.

A vein's job is to return blood that has delivered oxygen to the tissues in your body back to your heart, so it can be resupplied with more oxygen and recirculated. Lack of oxygen in the blood within your veins gives veins the noticeable bluish tint that you see through your skin.

Varicose veins are veins that have become enlarged. Rather than being pumped smoothly through the veins, blood tends to pool in varicose veins, making them bulge out and appear gnarled. Sometimes varicose veins look like cords within your skin. Any vein can become varicose. But varicose veins are most common in the legs and feet because those veins have to work against gravity to return blood to your heart.

Although it sounds like you aren't experiencing any problems due to varicose veins other than their appearance, they can sometimes become uncomfortable. Some people with varicose veins have an achy or heavy feeling in the legs. Pain associated with varicose veins may flare after sitting or standing for a long time. Burning, throbbing, muscle cramping and swelling in the legs may also happen as a result of varicose veins. If you notice any of these symptoms, talk to your doctor. Also, if you develop sores near your ankle, seek medical attention right away, as that may be a symptom of a more serious vascular disease.

Even when they don't cause symptoms, many people want to get rid of varicose veins. You have several options for that. A procedure called sclerotherapy involves injecting a solution into the vein that scars and closes it. After sclerotherapy, varicose veins usually fade within a few weeks. This procedure is most effective on small to medium varicose veins. In some cases, the treatment may need to be repeated for it to be most effective.

For larger varicose veins, your doctor can insert a thin tube, called a catheter, into the vein and heat its tip with a laser. As the catheter is pulled out, the heat destroys the vein by causing it to collapse and seal shut. Lasers can also be used to close off small varicose veins from outside the skin, so no incision is necessary.

Vein stripping is another option. It's generally used for a long vein that has become varicose. The vein is removed through a series of small incisions. Removing the vein isn't a problem because other veins deeper in your leg can take on the blood supply that previously ran through that vein.

Before you go ahead with one of these procedures, you may want to try a few self-care steps that can help shrink varicose veins. Exercising regularly, losing weight, avoiding long periods of sitting and standing, and not wearing tight clothes can all help. In some cases, wearing compression stockings can be useful. These stockings steadily squeeze your legs. That helps the blood move more effectively through the veins.

Talk to your doctor about the treatment options that best fit your situation. In many cases, varicose veins can be successfully treated.

Thom Rooke, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Mayo Clinic Q & A is an educational resource and doesn't replace regular medical care. Email a question to MayoClinicQ& For more information, visit © 2015 Mayo Foundation for Medical Education and Research. All rights reserved distributed by Tribune Content Agency, LLC.

Mayo Clinic Q&A: pain when running; varicose veins 10/29/15 [Last modified: Thursday, October 29, 2015 4:08pm]
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