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


Question:  I ran the Dublin Marathon last Sunday (in just under 3 hours). My legs are not as sore as they have been after previous marathons. I’d like to get back to running but I know my body needs rest. Any advice on how long I should rest for? I don’t want to get injured.

Answer:  Congratulations! What a fantastic achievement. The answer to your question is that there is no exact timeline with regards to post-marathon training.  The good news is that ‘rest’ in your case does not mean no running at all, but rather a decrease in training intensity, so there’s no need to become a couch potato. We recommend you take around 3-7 days completely off from running, but return to active recovery following this. This involves running at a slower pace and lower aerobic capacity with a reduced time of your training session. Light activity will actually help you recover faster than inactivity because it promotes circulation. Good circulation delivers fresh oxygen and nutrients to muscles and carries away metabolic waste and therefore aids healing and recovery.

A deep soft tissue massage would also help aid recovery as this can increase the circulation following any micro tears of the muscle fibres.  Minimal soreness is normal after such a high intensity event and this is due to the onset of DOMS (delayed onset of muscle soreness). However, the more pain you have, the longer the recovery will be.  The recovery period is a good time to let your body heal, so enjoy this time off and plan your next running goals. All the best.

Question:  I’m doing a bit of running (maximum 5 miles) but I have a sore knee the day after the run, with pain around the back of it. It isn’t sore to run on, just afterwards. I’m not sure if I should take some rest or keep training. Any advice?

Answer: The pain you are experiencing could be one of two things. The first, and most likely cause of the pain, could be due to poor nerve movement of the tibial nerve (ie. altered neurodynamics) which is the nerve at the back of the knee. Poor nerve movement can result from scar tissue (caused by previous torn muscle fibres) attaching to neighbouring nerve tissue in the local area. This then reduces the ability of the nerve to naturally slide and glide with movement. This injury is often worse when running downhill (with a longer stride length) or when running faster. The fact that the pain comes on the next day is a classic sign of nerve pain as it often displays a delayed onset of pain.

The second cause could be due to a Baker’s cyst at the back of the knee. This is very common in runners and is associated with wear and tear in the knee joint (osteoarthritis). It occurs where the joint is overloaded on arthritic joint surfaces causing pain and usually slight swelling at the back of the knee.  The good news is, that if your pain is from the first cause, then it can be cleared easily by a physiotherapist who specialises in nerve pain and running injuries. If it’s from the second cause, we would recommend a knee x-ray through your GP to look at the health of the joint surfaces to see if there is in fact any arthritis, and if there is, to check what stage it is at. After having an x-ray, if it is a Baker’s cyst, then physio should help to some degree. Make sure to shorten your runs and try to run on softer surfaces like grass, treadmill or bark. You should check your foot biomechanics to see if insoles are needed or not. If you need any further help, please feel free to give us a call.
Question:  Whilst trail running approximately 6 weeks ago, I placed the outside of my foot on a sharp rock. It was sore at the time but I was able to continue. However, it has ached since. There is no restriction in the movement of the foot, no swelling and no noticeable bruising. Will this just go away with time?

Answer:  From the information you have given us it sounds most likely that the sharp object your foot has hit against, may have injured nerve tissue inside your foot. Unlike muscle tendons, when nerve tissue is injured, it often causes cyclic pain (ie. pain which goes round and round, continuing on, despite the passage of time). We would expect if it was a tendon or muscular injury, it would have well improved since the injury 6 weeks ago but the fact that it hasn’t improved with time sounds very likely that you have injured a nerve trunk in your foot. Unfortunately, there are no self management tips to help this other than relative rest and adding insoles if needed. A physiotherapist who is experienced in treating nerve pain should be able to clear this for you with similar treatments used to treat altered nerve movement (i.e. altered neurodynamics). This will usually completely clear ongoing cyclic nerve pain.  Avoid wearing anything tight, such as tubigrip around your foot and ankle as this will aggravate the nerve pain further. Please feel free to get in touch if any further help or advice is needed.