Q & A from Injury Clinic on Thursday 2nd June 2016:


Question:   I suffer from really bad shin splints. I have only been running for the past two years and during this time I have been injured with a stress fracture, as well as shin splints. I would love to be able to run without feeling the effects of these injuries. Any advice you can offer me would be greatly appreciated.

Answer:   Thanks for your enquiry. First of all, you need a thorough assessment to get to the root of your problem. This will include assessment of your foot biomechanics to see if any insoles are needed and should also establish a correct diagnosis for the shin pain. Virtually all shin pain can be cleared with the correct treatment and in nearly all cases the person can return to running pain free. There are many causes of shin pain and each is treated differently:

1. A stress fracture (which from your question we see you have also experienced)

2. Tenoperiostitis (inflammation of a muscle attaching into the shin bone)

3. Nerve pain from the nerve running through the front of the shin

4. Less likely, compartment syndrome

Rebecca Nelson (our Director of Physiotherapy at Apex Clinic) wrote an article on shin pain, which you can read on the Physio section of the NI Running website, and this will give you more information behind the different causes of shin pain. Shin pain which continues for more than 3 months should definitely be assessed by an experienced physiotherapist who treats a lot of running injuries, as if it’s poorly managed it can continue for months and even years! If correctly treated the pain should be able to be cleared and you should be able to return to running pain free. In the meantime we advise you to run only on softer surfaces, such as grass, bark or treadmill.

Question:   I’m not sure if this is running related, but it is certainly affecting my recovery. I have a sore neck, which restricts how far I can tilt my head to the left. My left shoulder is also achy. In particular, I find it hard to put my head on the pillow when lying on my left side.

Answer:   It is extremely likely that running isn’t causing your neck problem. However, running 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, specifically in one or two of the joints. 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 high loaded postures, such as leaning over a desk or doing computer/desk work. We would 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 NI Running website under the Physio section, “Is running a pain in your neck?’

If these two changes do not help you, we recommend that you seek physiotherapy treatment from a physio who has experience in treating spinal problems. We see this problem on a daily basis within the clinic, which can cause restriction of neck movements. This problem should be relatively straight forward 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. Sleeping posture is also very important, so make sure your pillow is providing the right amount of support for your neck, ensuring that it’s not too flat or too soft, allowing your neck to have sufficient support during the night. Feel free to give us a shout.

Question:   Recently, my hamstrings have been getting very tight. I am currently training for a marathon and upping my miles (sensibly). They aren’t sore, just tight. I have tried sports massage before and it seemed to work initially but then I seemed to become reliant on it to resolve the problem, which comes back quickly. Do you have any idea what is causing this or is it something that just comes with big mileage?

Answer:   There could be a few different reasons causing this feeling of tightness, however, the most likely by far would be due to a lack of nerve movement of the sciatic nerve in the hamstring area, also called altered neurodynamics. This means that the nerve tissue in the back of the thigh, which should move freely and slide between all the muscles that surround it, is not moving freely. In this case, unfortunately there is no self help or amount of stretching of the hamstrings that will help, but we recommend a specific physiotherapy regime of mobilisation or movement of the nerve tissue as it passes through the back of the thigh. This will be followed by tailored home exercises to maintain the improved nerve mobility.

The key to beating hamstring tightness lies in finding the correct diagnosis of the origin of the problem and then treating it at its source. Rebecca Nelson (Director of Physiotherapy at Apex Clinic) wrote an article on hamstring problems, which you can read on the physio section of the NI Running website, and it will give you more information.  All our physiotherapists here at Apex Clinic are very experienced in treating nerve pain and we treat this complaint on a daily basis. We’d be delighted to help if needed.