Q & A from Injury Clinic on Thursday 1st December 2016:

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Question:  I’ve been doing a lot of pavement pounding recently and have managed to run 5 miles without stopping, but I’ve started to get a pain on the right side of my right foot, which then moves up towards my ankle.  The pain doesn’t start at the beginning of the run, but I have noticed that it happens when I go down a steep hill, which is at the end of my usual runs.  I haven’t run on grass for a while and I don`t know if that would make a difference. I’ve got the correct trainers for my feet and have been running for about 7 months now. Is this something which I should worry about or is it one of the little things which comes on with running?

Answer:  Sorry to hear that you’ve developed this pain, and many runners do think that foot pain is a normal thing to experience when running, but it certainly isn’t and should be cleared before it stops you running!  From the information that you’ve given us, your pain could be due to a number of different things. The most likely cause however would be due to overloading of the joints on the outside of your foot, as there are a lot of joints in our feet. With high load and pavement pounding, especially with uphill and downhill running the joints in your foot can be overloaded and get inflamed which then in turn causes pain. This is an overuse injury of the foot. The best thing to do at this stage is to reduce your running mileage, slow your pace and run on softer surfaces only ( ie grass, bark or treadmill) and keep to the flat alone (ie no hills). The fact that your shoes are great biomechanically is one less thing to be concerned about. If with this regime in 3-4 weeks time, the pain has not gone completely then you would really need to seek help from a physio who’s experienced in running injuries to get a proper diagnosis and hence a tailored treatment plan to clear your pain.  Hope this helps.

Question:  I have a question regarding my knee. I have been having trouble with it swelling for the past couple of years.  I have been to physio and have done a lot of rehab work on my hip and quads etc. to increase my knee stability but my knee still swells up. What could be causing this?

Answer:  If it is generalised swelling of your knee you are experiencing, the most likely cause of this would be wear and tear or osteoarthritis in the knee joint.  This is very common in runners in middle age and older but it doesn’t necessarily mean that it’s the end of the road for your running.   At this stage we recommend that an x-ray of your knee joint should be taken through your GP as this will show the health of the joint surfaces of the knee. If osteoarthritis is confirmed on x-ray, then it would be best to seek professional help from a physio along with your x-ray results for him/her to read.  A physio who is experienced in running injuries should know how to manage osteoarthritis in knees of runners, and with the correct management regime you are likely to be able to continue running.

If you have a knee x-ray and the joint surfaces are healthy, then it is more than likely that you may have a cartilage tear. Here, we would recommend a knee MRI scan to see if there are any cartilage tears and to look at all the other structures of the knee joint.  Your treatment/management would then be decided from here.   If you need any help organising an MRI scan, we would certainly do this for you at no charge.

Question:  I’ve recently been getting mild pain in my groin/inner thigh area which feels quite deep. I also have a very pronounced click in the same area when I raise my knee up while standing. I’ve stopped running altogether for the last 4 days.

Could you please give me any advice or help?

Answer:  From the information you have given us, there could be a number of reasons for the pain and clicking that you are experiencing. The most likely cause of your pain is due to one of the following reasons-

 

1) Depending on your age, this could be the beginning of the onset of osteoarthritis  (ie OA) in the hip joint.  OA of the hip joint normally begins with discomfort in the inner groin area and can cause pain to radiate down into the inner thigh. We would recommend an x-ray of your hip joint through your GP as this will show the health of the joint surfaces of your hip joint.  If osteoarthritis is confirmed on x-ray, it would be best to seek professional help from a physio experienced in running injuries along with your x-ray results to hand,  With the correct management regime, you may still be able to continue running.

2) If the pain is not caused by the above, then it could be referred pain coming from your lower back. If you haven’t had a trauma and the pain appeared suddenly for no reason, then this is the more likely cause of the pain, and is a very common complaint in runners. The clicking you are experiencing in this case, is due to maltracking of the hip joint, due to muscle spasm which is associated with the pain.   If the pain you are experiencing is referred pain from your lower back, then the best advice at this stage would be to reduce your running mileage and stick to flat surfaces only (ie no hills).   If with this regime in 3-4 weeks time  the pain hasn’t cleared then we would advise that you seek help from a physiotherapist trained in spinal problems and nerve pain.   If treated correctly, then you should certainly be able to return to full pain free running.

Question:  I was hoping that you would be able to give me an idea of what’s going on with my knee pain. It started just over a week ago, and came on so gradually that I didn’t even notice it. It’s kind of a dull ache above the knee joint.  It’s not hugely painful, but there’s enough discomfort to be constantly reminded of it. It seems to be the same whether I’m sitting or standing.   A 5km run at the weekend didn’t seem to make it any better or worse and I didn’t notice it at all when running.  I’ve occasionally had a painful hip during colder months, so I’m wondering if it’s something new along the same lines.  Any thoughts? I don’t want to be accidentally doing anything that’s making it worse.

Answer:  From the information you’ve given us, the most likely cause of your pain is referred pain from your lower back region. The fact that the pain started for no apparent reason, with no injury and no trauma and also the fact that it is easier when running and doesn’t change on sitting or standing, all suggest together that it’s extremely likely for this to be referred pain. The fact that running was pain free would certainly suggest that the pain is not coming from your knee. The hip pain which you are describing is likely to be coming from the same source in your lower back, where the pain is referring to both your hip and your knee along the line of a nerve. Usually the onset of the pain that you have described follows some sort of heavy loading/lifting or bent over postures which has stressed your lower back, a few days or weeks earlier.  Alternatively, a lot of uphill running is very stressful for the lower back.

 

In terms of self help there is very little unfortunately that you can do yourself. The fact that the pain is there all of the time means that it is really time to seek help from a physio who’s experienced in spinal treatment and nerve pain, as it will most likely need treatment to clear it. The physio will identify the segment in your spine from which the pain is originating from and then mobilise or loosen it, followed by strengthening exercises to help prevent recurrence in the future.   In most cases this pain can be totally cleared with a full return to running. In the mean time try to avoid bending, lifting or twisting where possible and avoid walking uphill. To carry on running without seeking treatment will very likely end up in disaster! Feel free to give us a shout if needed as our physios here at Apex Clinic all specialise in spinal problem, nerve pain and sports injuries.