Q & A from Injury Clinic on Thursday 3rd April 2014:


Q.  Private Message (PH1):  Hi, I have recently got back into running after 6-8 months of very little training. I find that I am constantly aggravating my right calf when I run. On Tuesday night I was doing a tempo run and it just went. I was able to finish, but when I woke on Wednesday morning it was very tight. I am warming up. Do you know why this would be happening? Thank you.

A. Apex Physio Belfast Clinic:  Hi PH1, 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 problem.  Ensure you are gently stretching the calf muscles (hold stretches for minimum 20 seconds x 3 each leg) regularly.  There may also be a build up of scar tissue contributing to your symptoms.  The only way to remove scar tissue and clear the pain is by deep soft tissue massage combined with the above recommended stretching of the affected muscle. This pain can’t be cleared with self management alone.

If on examination scar tissue can not be felt inside the calf muscle, then it is likely that the nerve which travels down the back of the calf is being restricted in its movement.  With the correct treatment by a physiotherapist, this can be identified and easily cleared.  In both of the above cases getting diagnosis and treatment ASAP is very likely to clear it.  Many thanks.

Q.  Prviate Message (TMcK 1):  I am having trouble with what I think is a groin strain on longer runs. It doesn’t seem to flare up on shorter runs, but I have found that when doing long Sunday runs, it starts to cause me problems later on in the run?

A.  Apex Physio Belfast Clinic:  Hi TMcK1,  a local muscular groin strain is a common injury in sports that involves sudden changes of direction and pain will always be present during the entire run.  In our experience, pain that presents during longer runs (when otherwise pain free) may be due to the lengthy impact on your spine causing referred pain into the groin area.  This needs to be identified and treated.  In the meantime, keep to shorter, flatter distances and softer surfaces (eg grass, sand, trail).  If these symptoms are not treated soon, you may find that the groin pain starts developing sooner.  I hope this helps!

Q.  Quigs:  What is the best way to remove scar tissue from the vastus lateralis muscle?

A.  Apex Physio Belfast Clinic:  Hi Quigs, the best way to remove scar tissue in any muscle is deep soft tissue massage (we recommend one deep soft tissue massage per month for regular or competitive runners).  Stretching regularly especially quads, hamstrings, calves and gluts after running (3x 20secs each leg) should help reduce and prevent build-up of scar tissue. Thanks.

Q.  Quigs:  Would dynamic or static stretching make a difference?

A.  Apex Physio Belfast Clinic:  It is generally recommended to do dynamic stretching prior to your run as part of a warm-up and static stretching following your run after a sufficient cool-down.

Q.  Prvate Message (MMcE 1):  Hi, any ideas? I have recurring knee pain mainly going down stairs. I’ve been out of running for 8 months and every time I try a wee light jog the pain comes straight back. MRI clear. I tried rest, ice and ibuprofen on and off for nearly a year. No joy.  Constant clicking/crunching in my knee. it has been suggested that it may be radiating from my lower back.  So far nothing has helped and I have been resting now 3 months.

A.  Apex Physio Belfast Clinic:  Hi MMcE, we will try to answer your question with the information you’ve given.  The most common cause of constant clicking and crunching when bending the knee is patellofemoral dysfunction (maltracking of the knee cap.) 1 in 4 sports people will experience this in their life time.  This problem responds extremely well to a specific regime of treatment. It normally only takes a few treatment sessions and is managed mostly with a combination of intense mobilisations of the patella and 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.  Clearly rest has not been effective and therefore an active approach is necessary now!  We hope this helps.

Q.  Derek Goodfellow:  I was out running two weeks past Monday on an 8 mile run and at mile 7 I had excruciating pain in the side of my left foot.  I went to A&E and there was no break; they said it was the ligaments.  However, the pain is not around my ankle, it is mid way towards my wee toe (metatarsals?).  I rested and iced for two weeks, went out training on Tuesday and it started to hurt again after 20 mins light jogging and a short sprint or two, any suggestions?

A.  Apex Physio Belfast Clinic:  Hi Derek, if the pain is focused around the base of the small toe, and a fracture has been ruled out by an x-ray, it could be either a local tendinosis, joint impingement or nerve pain.

1. The treatment for a local tendinosis is rest for 2-3 weeks and to wear supportive footwear.  As you are still experiencing pain after 2 weeks rest, we can rule this out at present.

2. If a joint impingement is the diagnosis, treatment involves specialised and specific joint mobilisation techniques carried out by a specialist physio, in combination with a biomechanical assessment of your feet.

3. The other possibility is that you are suffering from referred pain from the spine. When you increase the running distance, the load throughout the spine is increased significantly, which is also the case when you increase running speed. Specialist treatment to your spine would most likely clear these symptoms (which we very commonly treat at Apex Clinic).

In summary, the origin or root of the problem really needs to be established through a physio assessment. Feel free to give one of our specialist physio’s a shout!