Q & A from Injury Clinic on Thursday 1st October 2015:

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Question:  I have been suffering from pain in the buttock (gluteal) area. The pain seems deep and appears to be connected to the upper hamstring. I would describe the pain as an achy feeling both in the buttock area and hamstring area. It affects the length of my stride. The symptoms sound similar to a high hamstring tendinopathy.  I am considering having an MRI scan to identify the exact cause of this pain, because the injury has lasted so long (12-18 months) and treatment, although it has loosened the area, has not cured the problem.  From a physio perspective, would this help in the treatment of this type of problem? Would a consultant need to report on the scan, or can a physiotherapist read them just as well? Thank you.

Answer:  From what you have described it sounds like the pain in your buttock could be referred from your lower back, due to a stiff segment in your spine, at an area where the nerves supply the hip/gluteal region, which is often aggravated when running. There could well be secondary muscle spasm over the hamstring area, but if local treatment hasn’t resolved the problem and it has been on-going for 12-18 months, it is more likely that the pain is referred from your lower back. Until the specific stiff segments in your spine are manually mobilised, it is unlikely that your symptoms will fully resolve.  An MRI scan of your gluteal region may certainly be helpful. These are usually read by a consultant radiologist and a report is then sent to the physiotherapist who is treating you. However, we treat a lot of runners with similar symptoms whose symptoms clear completely with the correct treatment without a scan being needed.  At this stage, we would advise a full assessment of your condition including your lower back prior to having an MRI scan. If you would like any more advice please feel free to get in touch with us here at Apex clinic.

Question:  After long marathon training runs of 2.5hrs and more, can you recommend any simple exercises to release a tension build up in my shoulders? I try to run relaxed but tension can still gather in my shoulders.  This is not such a problem when the runs are off road.

Answer:  This is a common problem with runners. Concentrate only on running in a relaxed manner. Don’t hunch up your shoulders while running. Deliberately let your shoulders drop if they rise upwards. Concentrate on holding your arms more loosely, keeping your elbows at 90 degrees bent or slightly less bent than this.  Since you are running for longer periods, let your arms swing a little from your abdomen periodically.  Keep your wrists limp.  There are some simple shoulder exercises on the Runner’s World Website (HERE) that you may find useful on the link below.  Also, a hot shower allowing it to run over the shoulders or a deep soft tissue massage every 4-6 weeks can also be of benefit . Hope this helps.

Question:  I’ve had a pain in my right knee for a few months, below the patella. It happened after the Ards half marathon. I have rested it and triedstrengthening but it can still be a bit sore. There is also a nip when straightening the knee.

Answer:  This is hard to diagnose accurately without assessing your knee fully, however it sounds like it could be patellofemoral pain.   This is caused by a tightness of the structures on the outside of the knee along with weakness of the muscle on the inside of the knee, which doesn’t allow the knee cap to glide properly. This can be caused by an increased running mileage, increased hill work or generally overloading the area.  The good news is that with the correct treatment regime including specific stretches of the patella inwards and strengthening of the muscle on the inside of the knee, usually the pain can be completely cleared.  An assessment of your foot biomechanics (the way in which your feet move) would also need to be done, to assess whether insoles need to be added in or not.  At this point, we would advise a physiotherapy assessment by a physiotherapist who is experienced in treating runners and currently don’t do any strengthening exercises in the presence of pain.  All exercises which are done need to be done in a painfree manner, as the muscle on the inside of the knee will not strengthen effectively in the presence of pain.  Hope this helps.

Question:  I’ve been running for nearly 2 years now. During training for a half marathon earlier this year I developed a lump on the top of my foot, about where my laces would tie. The lump is always there but it’s not always sore. Sometime it is sore after a hard training session or after more than 10 miles of running, when it gets agitated, more swollen and has a dull pain in it. I thought the issue may have came about from tying my laces too tightly but I have adjusted them and changed trainers several times and now my other foot is starting to have the same issue. Is this a common thing to have as a runner?

Answer:  Yes, this is quite a common problem we see and treat here at Apex Clinic. Rebecca Nelson our Director of Physiotherapy here at Apex, wrote an informative article called “Laces too tight? Or is there another reason for pain on the top of your foot.”  This article can be found on the NI running website under the physio section and covers the most common causes of this pain.  The treatment for this pain purely depends on the diagnosis for it.  From what you have described, your pain on the top of your foot/feet may be due to altered neurodynamics, but really a thorough assessment would need to be done to be certain of the correct diagnosis and subsequent treatment.  Unfortunately there are no self management strategies to suggest to help you.  Feel free to give us a shout.

Question:  I have anterior knee pain and I’m attending a physio.  It is so painful on walking and up and down stairs. I’m just worried that I’ll never be able to run again!?

Answer:  It is hard to diagnose what is causing your pain with the limited information we have, but the most likely cause of this pain is due to patellofemoral pain. We’ve seen many severe cases of this which can be cleared completely and the patient is put on a pathway to a graded return to running. In some cases, the person may have to adapt the surfaces they run on or cut out hill running or add more rest days into their training regime. But in the vast majority of cases, this pain can be cleared with a full return to running.  It is hard to comment on your specific case without knowing your history and treatment progress. I would advise you to discuss your concerns with your physiotherapist and if you don’t make a full recovery or would like a second opinion please feel free to give us a shout here at Apex Clinic.

Question:  I have had a bit of pain in the left buttock area this week. What’s the best way to help to get rid of it.  Are there any stretches? Foam rolling? I have been running but the pain isn’t during running, it just comes and goes from time to time. I’ve been doing a lot of bridging to help to strengthen my hamstrings, would that be why?

Answer:  Stretching can sometimes help to relieve buttock pain.  A simple stretch for your gluteal (buttock) muscles is:

1. Begin seated on the ground with your legs straight out in front of you.

2. Bend your left knee and place your left heel as close to your right sit-bone as you can.

3. Reach your left arm behind you, and plant your palm or fingertips on the floor. Place your right hand or elbow on your left knee or thigh, and gently pull your knee to the right until you feel the stretch in your buttock.

4. Hold for 30 seconds, then release and straighten your legs again.  Repeat 3-5 times twice daily.

We do not advise foam rolling for buttock pain as really this is not addressing the root cause of the problem.  It may be helpful for you to read the article written by Rebecca Nelson, our Director of Physiotherapy here at Apex Clinic called “Is running giving you a pain in the butt”.  This article can be found on the NI running website under the physio section and covers the most common causes of buttock pain.

We also advise you to reduce the bridging exercises in case that this exercise did trigger the pain, as this is a possibility.  If the pain persists for longer than 2-3 weeks despite stretching, we would advise a physiotherapy assessment to accurately diagnose the cause of your pain and subsequent design a treatment plan to clear it.  Hope this helps to get you back to pain-free running.