Q & A from Injury Clinic on Thursday 1st May 2014:

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Question:  Thank you for doing this before the Marathon. I have had a slight hamstring strain for the past two weeks, I am due to run in a relay team on Monday. I was thinking about still running, but taking it easy. Is there anything you would recommend I do or try in order to reduce the risk of worsening the strain?

Answer:  As physiotherapists we do not encourage running with a muscle strain as in most cases it will worsen the problem.  However, to reduce the impact on the hamstring during the marathon we recommend you run the shortest and flattest leg.  Gentle stretching of all major leg muscle groups and good water intake are recommended between now and Monday.  Following the marathon we would highly recommend a sports massage or if the problem persists a physiotherapy assessment to diagnose the problem and return you to the running field ASAP.  Good Luck for Monday!

Question:  Hi – I have recurring Achilles issues – the last flare-up in my right Achilles was over 2 weeks ago, and since then I have been cross-training, doing lots of heel drops and strength exercises for my legs BUT no running! I overpronate slightly, wear orthotics, have newish shoes and have been trying to run with a higher cadence. Any advice on how to minimise achilles niggles would be great, as well as advice of when I can get back on the road. Many thanks.

Answer:  Tendoachilles problems are one of the most stubborn injuries with runners. The first line of treatment is usually rest, having your feet biomechanically assessed, progressive stretching and strengthening (eccentric) and soft tissue therapy on the lower legs. If this does not decrease your pain, the symptoms may be due to a lack of nerve movement (altered neural dynamics) of the nerves that pass through the calf muscles into the achilles tendon.

This requires specialist diagnosis and is usually the answer to a lot of recurring achilles problems that have not resolved with local achilles treatment. As this can be usually cleared completely our advise to you at this stage is to seek a specialist physio who is familiar with this problem. We are experienced in this treatment if you wish to have it assessed. In order for you to get back on the road we recommend that you are pain free running on a softer surface ie- treadmill, bark or grass first before progressing to road running.  Thanks!

Question:  I have an issue with damage on the arch of my right foot.  Could you tell me what would fix this issue please?

Answer:  We recommend you initially can try to self manage your condition by deep soft tissue massage on the arch of the foot (by rolling a golf ball or frozen water bottle along your foot), icing the foot and stretching the plantarfascia (check the web for specific stretches). If your condition persists or has not been the result of an injury we would recommend a physiotherapy assessment to get to the root of the problem and a podiatric biomechanical assessment may also be needed.

Best of luck!!

Question:  During longer runs (approx 6+ miles) my left hamstring seems to tighten a lot. I can still run, but it feels uncomfortable. What could cause this?

Answer:   There could be a few different reasons causing this feeling of tightness. It may be the hamstring muscle itself has been injured causing it to tighten. If it was a local hamstring problem you would usually feel the tightness earlier than 6 miles and gentle stretching would ease the symptoms. Alternatively this feeling of tightness may be due to a lack of nerve movement of the sciatic nerve in the hamstring area. This means that the nerve tissue in the back of the thigh, which should move freely and slide between all the muscles that surround it, is now restricted in its movement.  In this case we recommend a specific physiotherapy regime of mobilisation or movement of the nerve tissue as it passes through the back of the thigh. This will be followed by tailored home exercise to maintain nerve mobility.  The key to beating hamstring tightness lies in finding the correct diagnosis of the origin of the problem and then treating it at its source.  If your symptoms don’t seem to be clearing, seek a second opinion, and make unhappy hammies a thing of the past!

Question:  I wonder could you help me?  I’m currently being treated for severe pains in my right hip.  I’ve had lots of physio elsewhere but it didn’t help me. I just got my MRI results back and they came back normal (I haven’t had a follow up appointment yet) so I started back to running, entering races and upping my mileage slowly. I still have severe pain and it is now affecting my left hip and my back, the pain is worse when I’m not running, any ideas?…

Answer:  Sorry to hear of your ordeal. This pain you describe is unlikely to be originating from your hips. As all Apex Clinic physiotherapists have undertaken extensive post-graduate training in spinal and nerve pain (alongside sports medicine) we are confident that your symptoms are being referred from the spine and you will not get better unless you have the correct diagnosis and are treated appropriately. Your MRI clearly indicates there is no local hip problem. The fact that your pain is beginning to spread indicates the problem is worsening. In the meantime we do not recommend you continue to run, you are making the condition worse. We would love to help you as this is our bread and butter!

Question:  Hi, after doing a long run (marathon distance) the inside of my right foot is very sore. I think it’s my arch? It is very painful to walk with no shoes or in flat shoes. The only relief is wearing heels.  Any advice? Thanks

Answer:  We recommend a podiatric biomechanical assessment of your feet as the preference to wearing heels following a run indicates an issue with the arch of your foot. We would encourage you to do lots of lower leg stretching, especially of the plantarfascia (look up online for specific stretches for this area) and to ice the area following long runs. If this regime does not help please feel free to contact us directly.

Many thanks

Question:  Around my knee got stiff following a more energetic run, any suggestions?  It has been a week or so and it’s still stiff.

Answer:  Stiffness around your knee could be due to a number of different problems.

1) Muscle imbalance causing mal-tracking of the knee cap/patella.

2) Poor biomechanics

3) Cartilage wear and tear due to repetitive impact.

If rest and gentle stretching does not resolve your symptoms or you find in the future your symptoms become reoccurring then you should have a thorough physiotherapy assessment to diagnose the origin of the problem.  At present on returning to running, keep your distances short, hills to a minimum and keep to soft surfaces.  Best of luck!!