Q & A from Injury Clinic on Thursday 3rd December 2015:

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Question:  I am getting a dull ache under both my knees when I run. It doesn’t physically stop me from running but I am very aware of it whilst training. After the run, it’s hard to straighten my legs because of the pain. Any ideas or suggestions would be very helpful?

Answer:  From your question, we presume that the dull ache is at the bottom of your knee caps. If this is the case, then it is most likely to be one of two things: Firstly, it could be patella tendinitis, which is an injury of the tendon connecting your knee cap (patella) to your shin bone. It’s an overuse injury and is very common in runners. It is the result of your patella tendon being overstressed. Due to both knees being affected, your foot biomechanics would also need to be assessed along with an assessment of your running shoes. The reason as to why patella tendinitis occurred would need to be established and then addressed, as well as a progressive treatment plan started to clear the pain.

Secondly, due to the fact that both knees are affected this could be coming from a low level of nerve irritation in your lower back, of the nerves that supply the knee. If this is the case, it is identified by finding the appropriate stiff segment of your spine and manually mobilising or loosing it which will reduce and stop the nerve irritation of the nerves supplying the knees.

In both of these cases, you need to reduce your mileage and keep to the flat and softer ground until you have the problem assessed and properly diagnosed. We see both problems on a regular basis at Apex Clinic and the pain can be cleared in nearly all cases with the correct treatment and rehab programme.

Question:  I am currently a beginner and have been increasing my running mileage. I have noticed that my legs are becoming very heavy and achy more after runs especially above the knees, and my runs are feeling harder after a days rest due to this. Is this body / muscle fatigue or should I look into this further?

Answer:  This could be due to a delayed onset of muscle soreness (DOMS) after starting a new activity and continually increasing your mileage, as your body is getting used to the new activity. The best thing to do is to ensure you have a good dynamic warm up prior to running followed by a cool down (for example, 5 minutes of walking) including static stretches (holding for 20 seconds, 3-5 reps of each muscle group) of your main muscles namely your calves, hamstrings and quadriceps. Simple stretches can easily be found on the internet and they provide some great videos of these stretches. We would also suggest a deep soft tissue massage (sports massage) to help to break down any scar tissue caused by microtrauma of muscle tissue during running. A deep tissue massage can also help to reduce muscle fatigue by increasing the circulation and lengthening the muscles, improving flexibility which can prevent potential muscle injury. If this doesn’t help your symptoms to clear, then we would recommend a detailed physiotherapy assessment to diagnose and then clear your symptoms.

Question:  I have a problem with my foot. The bone on the outside of my foot half way between my toes and heel gets very sore in the morning, however as the day goes on it fades away a lot. I am able to train and race on it but it won’t go away. What could be the problem?

Answer:  Was there any trauma to the foot? Does it swell or get worse after exercise? We would firstly suggest an x-ray to rule out a stress fracture of the 5th metatarsal. Most stress fractures are caused by overuse and repetitive activity, and are common in runners. They often occur when people change their activities, such as- by trying a new exercise, suddenly increasing the intensity of their workouts, or changing the workout surface (jogging on a treadmill vs. jogging outdoors). If there is no stress fracture and no trauma, it could be a local soft tissue injury to the foot, most likely caused by over training or poor foot biomechanics. A full biomechanical assessment of your feet and legs will be required. We would suggest with starting with a physiotherapy assessment (who will also assess your biomechanics) as in most cases with the correct treatment this pain can be cleared and we can have you back to pain-free running.

Question:  I have a pain in my right butt cheek. I have taken a week off running and it’s still there. I stretch, strengthen, foam roll, etc. but it just doesn’t go away. It has started to work its way down my hamstring, and into my calf (unless I’m compensating for something). What else can I do?

Answer:  It sounds like you aren’t getting to the root of the problem if it isn’t clearing with stretching and foam rolling. It may be helpful for you to read the article written by our Director of Physiotherapy here at Apex Clinic, Belfast, 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 for you to have a full physio assessment sooner rather than later to get to the root of your 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.

Question:  I seem to be having difficulty lately with tightness /soreness in my calf muscle. Any tips on stretching before and after running?

Answer:  When running or performing any sporting activity, it’s best to ensure that you have a good dynamic warm up prior to exercise followed by a cool down (for example, 5 minutes of walking) including static stretches (holding for 20 seconds, 3-5 reps of each muscle group) of your main muscles namely your calves, hamstrings and quads. Simple stretches can easily be found on the internet. Use of a foam roller after running may reduce the level of tightness and soreness. If this regime doesn’t help then we would suggest a physiotherapy assessment to properly diagnose the cause of your tightness/soreness. It may be that a deep soft tissue massage (sports massage) is needed to break down scar tissue which has accumulated in your calf muscle from repeated microtrauma of the muscle tissue itself during running. This is a very common problem and can be cleared with the correct treatment.

Question:  I have recently developed pain in my inner thighs when I run. I’m worried that I might have torn something. Any ideas?

Answer:  There could be a few reasons for the pain. The fact that the pain is in both inner thighs means that it is not likely that you have pulled a muscle on both legs. It is much more likely that your pain is referred pain from your lower back. If there is any stiffness of 1 or more levels of the joints in your spine, the compression and repetitiveness of running, especially up hill and on hard surfaces will further load these segments. This often causes irritation of the nerves leaving the spine, and in your case it will be the nerves which travel to your inner thighs. You don’t need to have any back pain to experience this. We see many runners with similar symptoms in Apex Clinic, who clear quickly with the correct treatment to the spine. Please feel free to give us a shout.

Question:  I have been running for two years with no injuries and then last week I completed the cross country relays and a duathlon. After the events the arch of my left foot became very tender to walk and touch over the bone and it’s also slightly swollen. I’m not aware of hurting/injuring it at any point. Any ideas?

Answer:  We would firstly suggest an x-ray to rule out a stress fracture. Stress fractures are common in runners and are caused by overuse and repetitive activity. If there is no stress fracture, the pain could be a local injury to the foot for example plantar fasciitis or a local soft tissue injury from poor foot biomechanics. It may be helpful for you to read the article written by Rebecca Nelson, our Director of Physiotherapy here at Apex Clinic called “Is heel pain ruining your stride”. This article can be found on the NI Running website under the physio section and covers plantar fasciitis.

We would suggest a physiotherapy assessment from an experienced physio as soon as possible to correctly diagnose the cause of your pain. The physiotherapist will also need to assess your foot and leg biomechanics (the way your feet and legs move) to see if insoles are needed or not. In most cases, pain in the arch of the foot can be cleared with the correct treatment and you should then be able to return to pain-free running. Unfortunately, there are no self help strategies which we can recommend, as really you need a professional assessment. If you need any further advice, please contact us here at Apex Clinic.