Q & A from Injury Clinic on Thursday 3rd August 2017:

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Question:   I’ve been suffering from hip pain since late May this year. There’s no pain as such while running but I’m definitely aware of something (It’s hard to describe). The real pain comes the next day. I have been resting and tried anti-inflammatories with neither having made any difference! Any advice will be greatly appreciated.

Answer:   From what you have described, it’s unlikely that the pain is coming from your hip. As all of our physios here at Apex Clinic have undertaken extensive post-graduate training in spinal dysfunction and nerve pain, we are very familiar with referral patterns from the lower back to the hips. The symptoms that you are describing sound as though they are originating from, and being referred from your lower back, due to a stiff segment/s in your spine at an area where the nerves travel to the hip. There could well be secondary muscle spasm also over the hip itself. Until the stiff segment/s in your spine is mobilised or loosened, it is extremely likely that your symptoms should clear.  If your symptoms were due to a hip problem, it is much more likely that your pain or symptoms would be worse at the time of running as a pose to afterwards.

There are really no effective self management techniques to clear your symptoms, so we therefore recommend a thorough physiotherapy assessment from a spinal specialist to identify the source of your problem and clear your symptoms. For now, the best advice is to reduce your mileage and keep to soft, flat surfaces e.g. grass, treadmill or bark and we would advise using heat on the lower back or hip, for short term relief. Best wishes.

Question:   I was out running on Tuesday night. I was doing hills and on my last rep when going back down I got a pain in the side of my knee, which felt like it was travelling round into my calf. When walking downstairs I can still feel the pain. What could be causing this?

Answer:   From the information provided, the most likely cause of this pain is due to poor nerve movement (called altered neurodynamics) of the nerves which pass through this area. It is very unlikely to be a local knee problem as any local knee pathology is unlikely to refer round into your calf as you have described.

This type of pain most commonly occurs when walking or running downhill or when running at a faster pace.  It is usually very successfully treated with techniques used to restore the normal slide and glide of the nerve tissue.  The fact that this is such a recent injury means that the pain may well clear itself if you do the following:

1. Reduce your running mileage and frequency for a few weeks, and only keep to flat ground
2. Avoid stretching your hamstring or calf for a few weeks
3. Avoid any tight clothing such as compression socks or tight leggings
4. Avoid sitting or any positions where both legs are straight – for example sitting in an L-shape with both legs straight

This pain could clear over the next 2-3 weeks, however if it doesn’t you should seek help from a physiotherapist experienced in treating nerve injuries in runners. Feel free to call us if the problem persists.

Question:   This week I’ve developed a pain in my right calf. It is very low in the muscle, close to the Achilles tendon. It is sore when I run, then stiff after the run and the next morning. Any help would be great.

Answer:   From the information provided, the pain you have described could be due to one of two things:

1) This could well be due to micro-trauma of the calf muscle fibres themselves, that only becomes apparent when the muscle is loaded more.  Here, there is an accumulation of scar tissue which builds up within the calf muscle and causes pain
2) Nerve pain coming from the nerve running downwards in the area that you have described (the tibial nerve). This can occur if you have torn some muscle fibres in that area, and scar tissue then has formed which has irritated the nerve passing by.

Both of these problems are treated differently as described below:

1) 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.
2) Techniques used to restore the normal slide and glide of the nerve tissue in the calf.

It is extremely important to find the correct diagnosis for your pain. In each of the above cases, the physiotherapy treatment is completely different depending on the diagnosis.

In terms of self-management, we suggest that you reduce your running mileage, keeping to the level you are comfortable with at the moment, which is not giving you as much discomfort. It is also important that you run only on the flat, and at a slowish pace, so as not to irritate the nerve further. It is also important that you warm-up and cool-down effectively.

Finally, at this stage you should stretch your calves regularly – both the Gastroc and Soleus muscles (see online for these stretches). Stretches must be held for 20 seconds and repeated three times, twice daily.

All of our physios here at Apex Clinic are experienced in treating spinal pain, nerve pain and sports injuries, so if the above self-management doesn’t improve your condition within the next 2 weeks, feel free to give us a shout.