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

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Question:   The top of my right foot is concerning me. When I run I get pain in it and if I continue, the pain becomes more severe. I have had to abandon my last two runs because of this. Due to work, I am finding it hard to get to see someone about this so any advice would be appreciated.

Answer:   From the information that you’ve given us, the most likely cause of your pain is poor movement of the nerve in the top of the foot. This is often triggered by a tight shoe or shoe laces which are tied too tightly, or alternatively, faster or longer runs can also trigger the pain. At this stage, we recommend that you reduce your running mileage and keep the laces of your shoes loose, to reduce compression of the nerve in the top of your foot.

There is more information on this particular type of pain in one of the articles written by our Director of Physiotherapy, Rebecca Nelson, which you can find on the NI running website, under the Physio section, called: ‘Laces too tight? Or, is there another reason for pain on the top of your foot? This problem can nearly always be fully cleared with the correct physiotherapy treatment by a physiotherapist who is experienced in treating nerve pain. In the meantime, we recommend you run for shorter periods and on the flat only. Hope this helps.

Question:   My back, just below the middle of my neck, has been giving me problems recently. My neck is also a bit stiff and it is sore on turning to the right and left.  This tends to worsen during heavy training periods. Is it related to running?

Answer:   It is extremely likely that running isn’t causing the problem, however it may be bringing out or exacerbating the problem.  If you have stiffness in your neck joints, the most common place to have this is in the lower part of the neck. Running is a high impact exercise so when pounding the pavements there will be a lot of force coming up from your feet through your whole spine and into your neck and shoulders. Any stiff areas of your spine will tend to be overloaded by this force and this can result in pain. It is likely that you have stiffness in the lower neck area as a result of a previous injury or prolonged poor posture, such as from leaning over a desk or doing computer work or paperwork. We suggest, as a start, to run only on softer surfaces such as grass, bark or the treadmill and be mindful of your running posture. There is more information on running posture in one of the articles written by our Director of Physiotherapy, Rebecca Nelson, which you can find on the Physio section of the NI Running website. If these two changes do not help you, we recommend that you seek physiotherapy treatment from a physio who is experienced in treating spinal problems. Your problem should be relatively straightforward to clear with the correct manual mobilisation techniques applied to the affected areas of your spine, along with a few home exercises to maintain the mobility.

Question:   I’m training for a marathon at present and after 10 to 12 miles the bone below my knee cap starts to ache on both legs and it feels like I need to straighten my leg out to get a bit of relief from the ache. Is this just to be expected or is it something of concern?

Answer:  From your question, if you are an adult as a pose to a teenager, the most likely diagnosis for your knee pain is patellar tendinitis, which is an injury of the tendon connecting your knee cap (patella) to your shin bone. It’s an overuse injury and is very common in runners. It is the result of your patella tendon being overstressed or overloaded. Due to both knees being affected, it is important that the biomechanics of your feet are assessed, along with an assessment of your running shoes to see if insoles/orthoses are needed. To improve the biomechanics of your knee, and therefore help recovery, it is helpful to do a simple exercise called step downs on each leg (you can find this exercise detailed on one of our most recent top tips for runners on the Physio section of the NI running website).

You should do this exercise twice daily, 2-3 sets of 20 reps on each leg, short of your knee pain if possible. We also recommend for you to stretch your quads and hamstrings on both legs, twice daily, performing 3-5 of each stretch and holding each stretch for 20 seconds.  At this stage, you also need to reduce your running mileage and run on softer surfaces such as grass, bark or treadmill.  If there is no improvement within 4 to 6 weeks with the advice given, then we recommend that you seek professional help from a physiotherapist who is experienced in treating running injuries.  Best wishes.