Q & A from Injury Clinic on Thursday 2nd February 2017:

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Question: I have had a deep pain in my left glute for the last 7/8 months. I have been running and racing through it. I’ve been to physio three times but I’m still getting the exact same pain. It never went away – in fact I’d say it’s worse.

Answer: We’re sorry to hear that you didn’t get relief from physiotherapy treatment elsewhere. Buttock pain can be caused by a number of different reasons.

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

  • Begin seated on the ground with your legs straight out in front of you.
  • Bend your left knee and place your left heel as close to your right sit-bone as you can.
  • 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.
  • Hold for 30 seconds, then release and straighten your legs again. Repeat 3-5 times twice daily.

If the pain persists for longer than 2-3 weeks despite stretching, we would advise a physiotherapy re-assessment to accurately diagnose the cause of your pain and subsequently design a treatment plan to clear it. It may be helpful for you to read the article written by our Director of Physiotherapy, Rebecca Nelson, 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. If it is starting to travel down into the hamstring, we would recommend that you have a full physio assessment sooner rather than later to get to the root of the problem. It is most likely that the pain you are describing is referred pain coming from your lower back. This is very common and can be treated successfully by a physio who’s experienced in spinal problems and nerve pain. Feel free to give us a shout.

Question: I have been running now for about 1 year and after my long weekend runs (about 6-7 miles), I have been getting pain down the outside of my left hip. This is worse when I get up after a long time of sitting or stretching. Do you know what could be causing this or if there’s anything I could do, for example stretches to help ease the pain?

Answer: From the pain that you’ve described, it is much less likely to be coming from your hip joint itself. The most likely cause for this type of pain is referred pain from your lower back.

Due to the location and nature of your pain, it’s very likely to be worse with uphill running as opposed to running on the flat. The fact that your hip pain is worse after prolonged sitting suggests again that it’s more likely to be referred from your lower back.

There are a number of self-help strategies which we would advise, to help to reduce your symptoms. We recommend that you reduce your running mileage, only run on flat ground and a soft surface, avoid running on hills, and reduce your running frequency to twice weekly. If after 3-4 weeks of this regime, the pain hasn’t improved, you’ll really need a proper physiotherapy assessment by a physio who is experienced in spinal problems and running injuries. Good luck and don’t hesitate to give us a shout if the pain doesn’t clear.
Question: I took a few weeks off over Christmas and I am now back and upping my miles to around 30 mpw. For the last 3 weeks I’ve been struggling with a pain in my left achilles, about 4cm up from the heel. It’s much worse when on hills or doing speed work. I’ve since stopped both of these and I’m just running easy and icing it, but the pain is there all day. Is it possible to keep running while recovering from what I assume is achilles tendinitis? Is there a recommended way to treat this injury?

Answer: We’re very sorry to hear that you’re suffering from this pain which is affecting your running. Your achilles pain could be due to a number of reasons:

  • Tendoachilles (TA) problems can be one of the most stubborn injuries in runners, if it’s not managed correctly. The first line of treatment/self-help is usually rest for a few weeks, avoiding running and avoiding walking up/down hills. When walking, you should walk for no longer than 20 minutes at a time, and avoid repetitive stair climbing. Also, ensure your trainers are biomechanically supportive and correct for your foot type and get insoles (orthoses) if needed to support your arches. Stretching, is also important of the two main muscles of the calf, namely the gastroc and soleus (you’ll find these stretches easily online). We would advise you to stretch these muscles twice daily, with 5 stretches of each muscle, holding each stretch for 20 seconds. If you try this regime for 3-4 weeks and there is no significant relief in your pain, then your pain could also be caused by poor nerve movement, also known as altered neurodynamics.
  • Altered neurodynamics, or poor nerve movement is when the tibial nerve (the nerve running down the back of the calf and achilles) is not moving freely as it passes by the achilles tendon. This could be due to scar tissue from the muscle or tendon, following micro trauma when running. 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. Altered neurodynamics can be effectively treated by a physio who’s experienced in treating nerve pain, and the pain should be able to be cleared completely. Feel free to ask us for advise if you need any further help.

Question: I have been gradually increasing my running mileage for the last few months and I’m now up to 15 miles. Ever since my mileage increased over the last few weeks, I’ve had issues with my right foot but I’m not sure what is causing it. The pain is on the outer edge of my heel, just beneath the ankle. I’ve tried icing it and resting as much as possible during the week when I’m not at training. The pain is worst in the mornings when I wake up and first stand on it. Any help is much appreciated.

Answer: From the information you have given us this sounds like a classic overuse injury. It may have developed whilst you have been gradually building up your running distance, which may have been too much for the structures in your ankle.

From the location of the pain this may be specifically an overuse injury of the peronei tendons, which are tendons on the outside aspect of your ankle as you described.

At this stage, the best things that you should do are:

  • Reduce the frequency of your running
  • Reduce your mileage
  • Make sure your shoes are appropriate for your foot type (a specialist running shop will give you advice on this)
  • Avoid running on pavements for 4 weeks. Run on soft surfaces such as grass, bark or treadmill and also when you’re not running, make sure you’re not walking any more that 20 minutes at a time.

Follow this regime for 4-5 weeks, then gradually try to build up again. If your pain is still present you will need to seek help from a physiotherapist who is experienced in running injuries to get a specific diagnosis for your pain and a tailored treatment plan to treat it. Feel free to phone us for further advice if required.

Question: I completed a 4 mile hilly run on Sunday and it has left me with pain beneath my right knee cap. My knee felt a bit sore on the run but that soon wore off after about 10 minutes or so. When I got home, I fell asleep and when I stood up again I got really bad pain underneath my knee cap. It especially hurts when walking up stairs, or starting walking from standing still (although once I’m walking it’s generally okay). Any idea what it is and how to treat it?

Answer: From the information you’ve given us, it sounds like you may be suffering from patellofemoral pain. This occurs when the kneecap is maltracking in its movements (ie it is not moving in the correct position when you bend and straighten your knee).

This injury is extremely common in runners and approximately 1 in 4 suffer from it, but the good news is that in nearly all cases, it can be cleared completely with the correct physiotherapy treatment regime. For more information on this condition, there is an article written on the NI Running website by our Director of Physiotherapy, Rebecca Nelson, called: “Treat and Beat Runner’s Knee”.

In terms of self-help, make sure your footwear is adequately supportive (ensure your trainers don’t need renewed or changed to provide more support), avoid kneeling on your knees completely if possible, try performing step down exercises (standing on one leg and stepping down off a step –you can find this exercise on the internet). Perform 2 x 20 reps of this exercise twice a day, avoiding pain during the exercise. Reduce your running mileage and try to minimise going up and down stairs where possible. Also, avoid wearing tight leggings as this will worsen the pain. Hope this helps.