40-Year-Old Female Marathon Runner with Pelvic Pain

This case study features a 40-year-old woman who relied on the preventative healthcare benefits of MR Neurography imaging – helping to identify and treat pain before it developed into a more complex condition.

Our patient recently began training for a marathon and was experiencing increased pain in her upper thigh and pelvis. Initially, the pain was not much more that a 2 on a pain scale of 10. The patient stated that it was more a muscle soreness and stiffness and was generally felt the day after a run.

Now she states that her pain symptoms are about a 4 out of 10 and that these have gotten progressively worse as she increases her distances. She is concerned that her training regimen may lead to a long-term injury. She would like to identify and proactively treat and protect the muscles, nerves and soft tissue in her pelvis by adapting her running program with additional exercises.

She and her physician selected The Neurography Institute to conduct an MR Neurography scan study to help determine the source(s) of pain, to help lead to a strategy for correction.


MR Neurography Findings: There are no significant lateral marginal osteophytes affecting the descending spinal nerves. The sacroiliac joints are symmetric and do not demonstrate any significant inflammatory or degenerative change. The hip joints do not demonstrate any significant inflammatory or degenerative change. The psoas muscles are symmetric in size and shape.

The scan study did reveal that her piriformis muscles are markedly asymmetric, being significantly larger on the left than on the right. Notably, the sciatic nerve itself demonstrates some marked increase in image intensity just as it exits the sciatic notch. This image intensity increase persists as it descends into the ischial tunnel to the level of the obturator internus tendon and distal to the point the nerve image intensity normalizes.

The general course and caliber of the left sciatic nerve is normal; however, there is a segment of the nerve demonstrating increased image intensity extending from the sciatic notch into the ischial tunnel, linear extent being approximately 5.0 cm. This degree of image intensity alteration over this linear extent typically is clinically significant.

These findings are consistent with the presence of a pelvic sciatic entrapment.

Based upon the findings from the MR Neurography study, our patient has embarked upon a core strengthening program involving Pilates and weights, in addition to her running regimen. She hopes to strengthen her core muscles and take some of the pressure off of her pelvis while running. She is working in concert with a physical therapist recommended by her primary care physician.

Both physicians state that the MR Neurography images have been vital to supporting their treatment plans and that they are pleased with the imaging details and clarity.

If you are feeling nerve pain on a lower level of intensity, do not wait for it to worsen progressively. Be proactive and take charge of your nerve health by asking your physician about an MR Neurography scan study from The Neurography Institute.

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