Q & A from Injury Clinic on Thursday 2nd October 2014:


Question:  I am in the final weeks of training for the Dublin Marathon. After my longer runs my calf is cramping really badly. Although it feels as if it is going to cramp whilst running, I can hold it off, but when I stop, it gets really bad, almost like a spasm. Any advice?

Answer:  Muscle cramps are extremely uncomfortable and involve intense contraction of the calf muscle; this usually needs to be held in a stretch in order to resolve the spasm.  There are a number of factors that can lead to muscle cramps. Most common are:

1. Exercise-related cramps, usually caused by muscle fatigue. This is when the muscle fibres fatigue and the nerve input to the muscle is overstimulated causing the muscles to cramp (a basic explanation!).  You may not be giving your calf muscles enough time to recover between runs (i.e. your long runs are too close together and any sustained micro trauma has not been given enough time to settle). The first 2-3 days following a long distance run are the most crucial to a good recovery. These are the days to take relatively easy and consider replacing running with x-training or swimming (which will still allow you to build and maintain fitness). Gentle stretching of the major muscle groups (hammies, calves and quads) holding 20 seconds 3 reps, 3 x daily should be done.


2. The other proposed culprit is a potassium/ sodium imbalance and/or dehydration following prolonged exercise with lots of sweating. This can be reduced by good hydration and considering drinks with added electrolytes.

3. Alternatively, another cause of cramping which is commonly overlooked is poor nerve movement in the calf (altered neural dynamics of the Tibial nerve which runs through the calf complex). This is very common in runners building up their mileage. If this is the case no self management strategies are appropriate and  physiotherapy assessment and treatment is required to get to the root of this problem and in nearly every case, it can be cleared completely with the correct treatment.  We see this in Apex frequently.

Many runners we treat at Apex Clinic use regular soft tissue massage as a preventative to maintain their muscles in optimum condition during running season and also as a post-race recovery method. We would be happy to iron out your calves in preparation for the big day!!

Question:  I broke my arm 6 weeks ago and am waiting to go see the consultant for a check up. There is currently no pain in it. The cast covers my elbow but I can move my arm back and forward at the shoulder, do you think it would be ok to run?

Answer:  We do not recommend you run in a cast at all as it is likely to jeopardise the healing process. This is due to the transmission of vibrations coming from the impact of running. This type of vibration if introduced too earlier can contribute to malunion of the bone and lead to further problems down the line. Your consultant will remove the cast when he/she is happy that the bones have properly healed. Generally fractures in the upper limb take between 6-8 weeks to heal.  Be patient- it’s not much longer!

Question:  Occasionally while walking up-stairs if I lead off with my left foot I hear a clicking noise in the Achilles. Having recovered from Achilles trouble in my right leg I’d like to know why is now the left giving that noise? Again it’s not a lot, just now and again.

Answer:  Clicking is usually a warning sign of an early onset of tendinosis (previously called tendinitis). At this point we highly recommend you undergo a specialist physiotherapy assessment as it is vital to determine why the problem is now starting on the opposite foot.  Reasons for this may be muscle imbalance in the lower legs or poor biomechanics. Physiotherapy at this point will almost definitely stop this progressing into a true tendinosis.  In the meantime self management should consist of regular stretching of the Gastroc and Soleus muscles with a reduction in running. Appropriate stretches for these calf muscles may be accessed online, remember that stretches need to be held for at least 20 seconds and repeated 3 times.  Feel free to get in touch with one of our specialist physiotherapists to arrange an appointment. Best of luck!

Questions:  7 weeks ago I injured my left knee, probably from overuse as I’ve run a lot of marathons (26 this year) so there was no sudden trauma it just gradually became a problem over the space of 2 weeks. I ran 4 marathons in 4 days in August and after day 4 I couldn’t even walk. After 6 week’s rest I’ve tried running but the pain remains.  It feels like there is pain and weakness in behind the back of my knee joint. When I’ve tried to run those few times I get extreme pain at the back of the knee and afterwards I get some pain and swelling under the knee cap about an inch and to the side a bit towards the inside of the leg. I’ve no trouble walking or cycling. Could this be a meniscus injury?

Answer:  This does not sound like a classic meniscus injury as there was no specific trauma and the symptoms you describe are generally too wide-spread to be so. We would seriously question the integrity of the joint surfaces in your knee i.e- there may be wear & tear/ arthritic changes within the knee which have been majorly overloaded with all the recent (and very impressive!) running. These overloads on poor joint surfaces have likely caused a capsular swelling of the knee which is exacerbated now every time you run.

A proper physiotherapy assessment is certainly required to give a more definite diagnosis and if any doubt remains an MRI scan will be considered before treatment and rehab of this condition is commenced.   After being such an accomplished runner I feel we need to get to the bottom of this one to secure the future of your running career. Feel free to get in touch with us.

Question:  After I’m out for a long run I get a pain in my buttock. Just wondering what the cause could be and the best way of preventing it?

Answer:  The pain in your buttock is most likely to be referred from your lower back and is a common problem we treat in the clinic (as we specialise in the spine and sports injuries, this is our bread and butter at Apex Clinic!).  Our spine is made up of vertebrae (bones) with a spongy disc in between creating a space which allows for shock absorption through the spine while we run. If there is any dysfunction ie.- a tightening in a segment of the spine, repetitive running; especially uphill, on hard surfaces and over long distances will further aggravate these segments. This usually results in a dull ache in the lower back which commonly refers into the buttocks. There generally are no effective self management techniques to clear these symptoms so we would therefore recommend a thorough assessment from a physio who specialises in the spine to identify and treat the source of your problem.  It is an extremely common problem and should be cleared fairly quickly.  For now the best advice is to reduce your mileage and keep to soft/ flat surfaces for example: grass, treadmill, bark or sand.  Best of Luck!!