This is a case where I treated an experienced marathoner for an injury, and despite the treatment and modifying his training regimen, he did not get better.
The patient, who was training for a marathon, presented with pain in the front of the thigh and groin area. A diagnosis of mild hip flexor muscle strain was made and treatment was initiated along with cessation of running and an appropriate cross training program.
Unfortunately, despite treatment and activity modification, the injury did not improve after two weeks. This is very unusual and led to a re-assessment that confirmed the original diagnosis. The suspicion was that it was something other than running that had caused the injury, and was still aggravating the problem.
Upon further questioning, it turned out that the patient had a significant change in his daily work activities. He was a maintenance worker who had been recently assigned a job, where he had to go to numerous sites every day to check on a pipe system. At the centre of the problem was the fact that he had to wear a very heavy tool belt, and step in and out of a tall service vehicle quite often during the course of the day.
The combination of the added weight of the tool belt and climbing in and out of a vehicle caused the hip flexor strain. Training for the marathon had not in the least contributed to this injury.
Thankfully, this particular job ended in a short period of time, and the hip flexor injury healed without incident.
The point here is that when you present to your health care provider with an injury, always make sure that you provide details on any changes in activity or routines. In this case the patient and I assumed that it was a too quick a ramp up in the training program that caused the injury. We were both wrong, but thankfully some further questioning led us to the real cause of the problem.