Q & A from Injury Clinic on Thursday 2nd April 2015:

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Question:  Carrying an injury. Bursitis of the heel. Have you got any advice on how to get rid of it?

Answer:  Yes, we treat bursitis of the heel (calcaneal bursitis) regularly and in most cases it can be cleared completely. The most important thing is to make sure that the diagnosis is correct. With a true calcaneal bursitis, checking the foot biomechanics is essential.  Ensure that your running trainers are in good condition and are still providing adequate support.  Calf stretches for both the gastroc and soleus 2-3 times daily are important, holding each stretch for 20 seconds and performing 5 stretches of each muscle group at a time.  (these stretches can be found on the internet).  Stretching the plantar fascia is also important (again, these can be found on the internet).  Local soft tissue work is recommended by an experienced physio, over and around the area to increase the circulation and speed up the healing process.

In certain cases it may be helpful to get a felt pad with a circle cut out of it, for the back of the trainer to take the pressure off the bursa. In the vast majority of cases it can be cleared completely with the correct physiotherapy treatment but in rare cases a local steroid injection may be needed into the bursa, if it is resistant to conservative treatment. Hope this helps.

Question:  I started running approximately 6-8 months ago and have gradually increased my mileage. However, recently, whilst working on specific speed sessions I have had problems with my calves. In fast speed work I sometimes get sharp pains in them… then the next day it turns into a dull ache. Is this just because I have started speed work or do you think it is a weakness?

Answer:  It sounds like you could have one of two things going on, causing your symptoms. The first one, is where the tibial nerve (the nerve running down the back of the calf) is not moving freely within the calf muscle… this could be due to scar tissue in the calf muscle itself following micro trauma of the muscle itself.  This scenario often occurs during speed sessions because the stride length increases during speed sessions and the tibial nerve has to move more as a result.

Secondly, the pain may be due to a build up of scar tissue due to micro trauma of the calf muscle fibres, that only becomes apparent when the muscle is stressed more, with speed work.  The first possibility mentioned above requires treatment from a physio who is experienced in treating nerve pain, to mobilise the nerve tissue. In the second case, the physio would apply local deep soft tissue therapy to the calf muscle itself, with the calf muscle positioned in a stretched position, in order to break down any scar tissue.

In nearly all cases, your symptoms can be cleared completely with the correct treatment. Unfortunately, there are no self management strategies which will help to clear your symptoms. Until you have treatment, we advise to avoid speed sessions and running down hill. Good luck.

Question:  I have knee pain that comes on gradually during a hard running effort. It’s actually behind the knee itself in the upper calf region, close to where tendons from the hamstrings meet at the inner part of knee. I am able to squat, jump, twist and turn. But during running, the knee pain gradually gets worse. This pain only started after a recent half marathon race. I’ve been icing and taking anti-inflammatories.  I would like to know if it’s ok to continue running after a few days off?

Answer:  If the pain is in the centre/inside of the back of the knee there could be a number of causes. If it is more the centre of the back of the knee, it may be due to poor movement of the tibial nerve (as detailed in a question above) and if it is more at the inside of the knee then it may be due to a tear of the posterior (back) horn of the medial meniscus (cartilage). If it is cartilage, then you will do further damage by continuing to run therefore we recommend you seek treatment from a specialist physiotherapist with relative rest from running. If it is altered neurodynamics, (poor nerve movement) continuing to run is more a case of hurt rather than harm, but either way it is very likely that you will need treatment to clear the pain. If there is any visible localised swelling, then it will implicate the cartilage more.  Hope this helps.

Question:  I have had a dull ache in my achilles for approximately 4-6 weeks. I have tried resting for a few days, but it hasn’t helped. Is there anything else I can do?

Answer:  At this stage we recommend that you reduce your running distance, speed and stick to running on a flat, soft (grass, bark or treadmill) surface. Stretch the two calf muscles – gastroc and soleus 2-3 times daily (these stretches can easily be found on the internet), holding each stretch for 20 seconds and performing 5 stretches at a time on each muscle.  Consider if simple over the counter insoles are needed if you have high arches or are flat footed to improve your foot biomechanics and/or shock absorption. Ensure your trainers aren’t too tight, and aren’t rubbing at the back of your heel.  We recommend for you to try this regime for a few weeks and if the symptoms don’t ease, then it’s definitely time to seek physiotherapy treatment.  Leaving this problem untreated could invite a possible tendon tear to occur, which is bigger trouble! Hope this helps.