Q & A from Injury Clinic on Thursday 3rd March 2016:

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Question:  I broke my collarbone after falling off my bike about a year ago. The injury is healed but when I’m running I find that it aches, a dull annoying pain. It’s mainly on longer runs but also on some faster intervals. Any help or advice would be great.

Answer:  From the information provided, it’s likely that your pain should be able to be cleared or helped considerably with the correct physiotherapy treatment. There is a good chance you have one of two things-

1) Scar tissue from the injury which is surrounding the fracture site (where the bone has been broken)

2) Scar tissue on either joint at the end of the collarbone which is causing pain, ie from either the acromioclavicular joint or the sternoclavicular joint.

At this stage, as you are one year on from the initial injury, the fracture site should be well healed so it is unlikely that the pain you are experiencing is from the broken bone. Therefore, if it is scenario 1), strong deep soft tissue massage techniques around the fracture site should clear the surrounding scar tissue and hence the pain.

If it is scenario 2), manual mobilisation of the joint on either end of the collar bone should again, clear the scar tissue in those relevant joints, allowing the pain to clear.

The key is to find the correct diagnosis for the pain.  In the vast majority of cases the pain which you’re describing can be cleared with the correct treatment.  Hope this helps.

Question:  Over the past 2 years I have had a pain in my right hip when running. It is not an impact injury but feels like it is deep. The morning after running it would be very sore when walking, or even getting up off my seat.

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 and nerve pain, we are very familiar with referral patterns from both the hips and from the lower back. 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 in your spine at an area where the nerves run to the hip. There could well be secondary muscle spasm also over the hip itself.  Until the stiff segment in your spine is mobilised or loosened, it is unlikely that your symptoms will clear on their own.  With the correct physiotherapy treatment it is likely that your pain can be resolved.

Question:  I am getting a shooting pain in the area just below my calf, on the back of my leg, specifically the area between the top of my achilles and the bottom of my calf. Any advice?

Answer:  From the information provided, the pain you have described could be due to a number of different things-

1) Nerve pain coming from the nerve running downwards in the area that you have described (tibial nerve). This can occur if you have torn some muscle fibres in that area and scar tissue has formed which has irritated the nerve passing through.

2) Referred pain from the lower back. This could be coming from the joints or discs in the lower back. In this case the pain is often worse when running uphill or running upstairs.

3) Local scar tissue itself in the soleus muscle (which is the lower calf muscle). This can occur following a strain of this muscle.

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

For scenario 1), movement of the nerve tissue needs to be done by a physio who is experienced in treating nerve pain.

For scenario 2), manual mobilisation of the affected segment of the lower back is needed to loosen the stiffened segment and stop the referred pain.

For scenario 3), local deep soft tissue techniques need to be applied to the painful area to break up any excessive scar tissue.

As you described your pain as shooting, it is most likely to be case 1) or 2). All of our physios here at Apex Clinic are experienced in spinal pain, nerve pain and sports injuries, so feel free to give us a shout if needed. Best wishes.

Question:  My neck and shoulders are very tense while running. My neck is also stiff sometimes. Is running causing this, or is it something else I’m doing?

Answer:  It is extremely likely that running isn’t causing the 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.  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 poor postures, such as leaning over a desk or doing computer/paper 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.) If these two changes do not help you, we recommend that you should seek physiotherapy treatment from a physio who has experience in treating spinal problems. 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. Hope this helps.

Question:  I’m just wondering if you have any advice for breathlessness associated with pernicious anaemia and B12 deficiency? I’m struggling to do any running.

Answer:  Unfortunately, we cannot help you as this is out of the realms of our expertise in musculoskeletal problems. We would however strongly recommend you see a Consultant in Sports Medicine who should hopefully be able to help you. There is a Sports Medicine Consultant that we would definitely recommend and we will happily pass their details on to you if you private message us or contact Apex Clinic, Belfast tomorrow. With best wishes.