Q & A from Injury Clinic on Thursday 20th June 2013:


Question:  I’ve never had trouble with my achilles, but recently in the morning when I get out of bed the area around my achilles and ankle is tender. After hobbling around for around five minutes it returns to normal, then when out running again after five minutes all pain and tightness that may remains has disappeared….. any ideas of the best way forward?

Apex Physio Belfast Clinic:  This sounds very much like the beginings of an Achillies Tendonopathy (What used to be called Achillies tendinitis).  The best place to start is to look at your footwear and see if your trainers need to be replaced as being flat footed can very commonly predispose to this injury.  If this is the case, advice from a specialist running shop on whether you need an anti pronation shoe or not could be helpful.  If your trainers are in good shape and there is no need for a change, I would recommend a thorough assessment with ourselves to find out the origin of this problem.  As an achillies problem (like a tennis elbow pain) can be one of the most stubborn problems in the body to clear.  Therefore early action is advised. In the meantime, ensure you are gently stretching your calf muscles twice daily.  3x 20sec holds with the knee straight and your knee bent, also reduce your running millage until the morning pain clears.  Hope this helps!.

Question:  This months Irish Runner magazine totally debunks the idea of ice treatment saying that markers have show that it is actually bad for the user.  I swore by them during my marathon training, was this just a placebo?

Apex Physio Belfast Clinic:  If you are talking about ice baths, we would tend not to favor these, in our experience deep tissue massage has most effectiveness pre and post event.  Ice treatment performed as part of PRICE (protection, rest, ice, compression and elevation) is evidenced based first aid treatment to and injured soft tissue, here icing is recommended.  As for your ice treatments possibly being a placebo while marathon training…we can only say, what works for one, doesn’t work for another.  As long as it got you through your marathon, you cant argue with that!!

Question:  Any advice for on going calve problems, severe stiffness after longer runs.  I am wearing compression socks and using the foam roller before and after, is there anything else i could be doing? Could it be a hydration issue?

Apex Physio Belfast Clinic:  From what you’ve told us, it certainly doesn’t sound like its a hydration issue, this is unlikely.  Compression socks wouldn’t usually help with this problem either, but we understand that it was good to try.  The fact that foam rolling hasn’t helped with the calf stiffness, it is unwise to continue, as the origin or root of the problem really needs to be established.  In our experience, the most likely reason for your symptoms, from what you’ve described is either – a build up of scar tissue (fibrosis) in the calf muscles which can be reduced and the symptoms cleared usually by deep soft tissue massage (which we offer).  Secondly, the symptoms could be due to a lack of nerve movement (altered neural dynamics) of the nerves that pass through the calf muscles, by scar tissue which has occured in the past in the neighbouring calf muscles.  This can also be usually cleared completely by a specialist physio who is familar with this problem, but it needs properly diagnosed.  We would be experienced in this treatment if you wish to have it assessed.

Question:  Recently every time I get above five miles both my knees become incredibly stiff round the sides resulting in me not being able to bend them and its really painful to run. I was just wondering what could be causing this?

Apex Physio Belfast Clinic:  It sounds from what you’ve said that there are two likely causes of your pain and stiffness; firstly, depending on your age, and past running road regimes, the symptoms may be the beginnings of wear and tear (arthritis) of the joint surfaces of the knees, but if you’re young (watch out,some of us here feel young!) this is unlikely, an x-ray of your knees (via your GP) is an easy way of assessing any potential wear and tear.  The second reason, is that your symptoms may be referred pain coming from your lower back, especially if your symptoms are worse when or after running UP hill.  For treatment, in the first instance, if there is wear and tear of the joint surfaces your running mileage will need to be reduced, and your footwear assessed to consider more shock absorption in them.  In the second case, specialist treatment to your lower back would be very likely to clear these symptoms (which we see very commonly at Apex) in conjuction with over the counter shock absorption insoles for your shoes.  Either way, an assessment is needed.

Question:  I’m suffering from numb toes after about 5 miles into my run or when I’m running hard.  Have you any advice or heard of this before? My trainors are not too small or tight.

Apex Physio Belfast Clinic:  It’s great that you’ve considered your trainers, as this could have been a causative factor, so you’ve eliminated that.  We have seen many, many runners and other sports folks with similar symptoms and nearly all of them have recovered fully from treatment.  The most common cause of this, is irritation of nerve tissue (as numbness is a common symptom of nerve irritation) originating in the back (this does not mean that you need to have back pain to be experiencing this).  A full assessment is required to identify where exactly the nerve tissue is being irritated and then that area can be treated by mobilisation of the affected area, and then a few exercises to keep that area loose.  At the risk of sounding like we’re blowing our own trumpet, one of our specialist areas in Apex is the assessment and treatment of nerve pain or nerve symptoms, so feel free to give us a shout.

Question:  When your legs feel stiff/heavy and sore after a tough long distance race, how long would you leave it before getting a good ‘deep’ tissue massage?

Apex Physio Belfast Clinic:  We recommend that a good, deep soft tissue massage should be given the day after a long distance run, largely to prevent/ reduce the onset of DOMS and also to optimise the muscle recovery (and increase the circulation following any micro tears of the muscle fibers).  For regular runners, a deep soft tissue massage is recommended once monthly to reduce the risk of a build up of scar tissue in the leg muscles.

Question:  If you were restricted to only doing the one same simple stretch each and every day.  Which one would you recommend and why?

Apex Physio Belfast Clinic:  To answer your question, the best option if you’re restricted for time, which we understand, is to do one stretch for 30secs to 1 minute (and no less) once daily on each leg – alternating between the quadriceps muscles on one day, the hamstring muscles the next day, and calf muscles (with your knees bent) the next day, and your calf muscles with your knees straight the next day, hip flexors and adductor muscles etc these are the most important muscle groups for runners to stretch…. why not stretch each muscle group twice, instead of once, that’d be even better!

Question:  How long would it be best to wait to complete a quality/high intensity session following a vigorous deep tissue massage?

Apex Physio Belfast Clinic:  We would recommend that you wait until two days after a deep tissue massage before commencing a high intensity session.  This will ensure you get the full benefit of the effectiveness of the massage, and will be in optimal condition for your next session.

Quesion:  I hurt my knee while traing for Belfast, inner part of knee cap, I’ve reduced my running to about 3/4miles 2 or 3 times a week with some cycling. While the pain is reduced, should I stop running totally to help it clear?

Apex Physio Belfast Clinic:  The most common cause of knee pain on the inner part of the knee cap is Patellofemoral dysfunction (maltracking of the knee cap).  One in four sports people will experience this in their lifetime. T his problem responds extremely well to a specific regime of treatment.  It normally only takes a few treatment sessions and is managed mostly with specific exercises.  You should also have your footwear (trainers) assessed as this could be contributing to the problem.  Again a thorough assessment should be carried out to identify the true cause of the problem.

Question:  Whilst performing hill sprints, my calves tend to cramp up badly.  I keep hydrated and stretch adequately but after an hour or so, I struggle to even jog with the calf cramps.  Is it a lack of sodium?

Apex Physio Belfast Clinic:  It is unlikely that the problem would be caused by low sodium levels, as your symptoms would not be worse when running up hill, you would most likely feel your symptoms at other times.  It is most likely to be coming form a build up of scar tissue or the neural tissue not moving well in the calf muscle.