Q & A from Injury Clinic on Thursday 3rd October 2013:


Question:  Sometimes when I run I get a sudden very sharp pain on the outside of my knee and this causes me to stop. However, it seems to only happen when I wear lighter trainers (like racers) and not when I wear my more cushioned trainers.  Do you think this is an underlying injury or do I just need to wear more cushioned trainers all the time?

Apex Physio Belfast Clinic:  It’s good news that your pain is not always present when you run. This sounds like it may be a biomechanical issue and your lighter trainers are not giving you enough support. This may be causing a tug on the lateral (outside) ligaments in your knee while you are running which will result in an injury if you continue in these shoes. If you wish to continue running in lighter trainers we suggest you look into getting a thorough podiatric biomechanical assessment.

Question:  I recently started taking my running more seriously and have found that I am having awful problems with my toenails.  They keep falling off!  Any ideas on how to stop this?

Apex Physio Belfast Clinic:  When you are running regularly, this is a very common problem to experience and if not managed properly can be extremely painful. Attending a chiropodist once every 4-8 weeks is essential if you plan on taking your running seriously. Another essential factor is to have your foot biomechanics assessed by a podiatrist who is experienced with runners. At Apex Physio Belfast Clinic our senior podiatrist/ chiropodist deals with these issues regularly… so you’re not alone!

Question:  Hi I am suffering from bursitis in both heels, I have had treatments from dry needling to shock treatment for suspected Achilles tendonitis but nothing has worked. My heels are constantly inflamed and if I run they burn like hell after I have finished. The worst is when I get up in the morning out of bed, my legs are stiff and I have no flexibility in my legs for the first few steps!!!!!

Apex Physio Belfast Clinic:  It sounds like you have exhausted many of the local treatments for this condition. There may be one other element that has not been addressed yet and this is the nerve component. Nerve pain can exhibit as a burning sensation, stiffness and a feeling of being inflexible. Nerve pain can arise from a problem originating in your spine or simply due to a lack of mobility along the nerve. This definitely would need a thorough assessment to get to the bottom of it by a physiotherapist that specializes in nerve pain. Please feel free to contact us via phone or email to get to the root of your problem by speaking with one of our specialist physiotherapists. All the best!

Question:  Good evening! I run regularly 3-4 times per week and have picked up a wee niggle at the top of my right calf, near the knee on the outside, very close to the bone at the knee. Is this a nerve problem or ligament do u think? It seems to persist after an hour of running. I had a deep tissue massage yesterday and she said there was a little knot in the same area. How do I get rid of it? Foam roller doesn’t really help either. Many thanks.

Apex Physio Belfast Clinic:  We agree with you that this sounds like it may be a nerve problem. Usually deep soft tissue massage and foam rolling should reduce the symptoms if it was a local muscle/tendon problem and there are no ligaments in the area you describe. Also usually a local ‘niggle’ will ease once you have stopped running. Nerve pain on the other hand can continue to impose problems long after exercise. It is very important, even though it is a niggle, to get this treated by a physiotherapist that is experienced in treating nerve pain, otherwise you risk the pain spreading . Good luck!

Question:  Hi I strained my glut 5 weeks ago. I was in severe pain but it has now died down to a slight niggle. I haven’t run since but have been doing some cross training which doesn’t seem to affect it. I am doing a marathon in 4 weeks.  What’s best to get me to the start line?

Apex Physio Belfast Clinic:  I understand you are going to be under pressure to safely increase your mileage over the next 4 weeks. The most important element at this point is not to over-do it. The Cross-training will help keep your cardio-vascular fitness stable, however you need to re-introduce gentle running on a FLAT, SOFT (eg- grass/ treadmill) surface and do not forget a good warm up and cool down. At this point aqua jogging could be beneficial for you. All the best with your marathon!

Question:  Hi, 6 weeks ago while on a 16 mile run, I got a severe pain in the side of my right knee. I rested it for 3 weeks and then ran a half marathon. At 12 miles the pain came back ten times worse and it was painful to even walk. I tried 3 miles last night and the pain came back. What is this pain? I have a marathon in less than 4 weeks. Will I be able to compete?

Apex Physio Belfast Clinic:  This is hard to diagnose accurately from the information given. Pain in the outside of the knee could be due to a number of different causes.

1) it could be due to a cartilage tear in the side compartment of the knee due to wear and tear or the repetitive impact through your knee or

2) Nerve pain- If you have never had this pain before and it came on that sudden and sharp, not healing with rest and worsening, it is most likely to be nerve pain.

I strongly recommend you get a thorough physiotherapy assessment ASAP to assess, diagnose and treat this problem. The physiotherapist will be able to give you advice regarding your upcoming marathon. Looking forward to hearing from you.

Question:  I hurt my foot over 3 weeks ago (soft tissue damage) and have not been able to run ever since. I get pain when I walk or when I stand on my tip toes. Running is totally out of the question at the minute. No pain while resting. It has gotten slightly better but isn’t healing as fast as what I would like. I’ve tried physio and compression.  Any advice for a speedier recovery?

Apex Physio Belfast Clinic:  Have you had a recent physiotherapy assessment? Could you please clarify where in your foot/ankle you are experiencing pain? Many thanks.

Question/Response to above Apex Clinic reply:  In response to your reply Apex Clinic… I had a private physio assessment two weeks ago. I was recommended not to run on it and try some ankle strengthening exercises. I’ve had an x ray to eliminate a stress fracture and also had acupuncture which seemed to give me the most pain relief. The pain is on my left foot just under my ankle bone on the outer side just where it connects to my foot.  It started as a niggle which I ignored and kept running on, until on a longer run I pretty much had to stop as the pain was bad. I’ve been exercising in the pool and some light biking in the gym which has not been aggravating it. Thanks.

Apex Physio Belfast Clinic:  Thanks for getting back to us.  If you’ve had a physiotherapy assessment and received treatment to the local soft tissue in the lateral ankle and it is not responding as expected there may be another underlying structure contributing to your pain. This structure may be the superficial peroneal nerve which lies in the area you are describing. The nerve maybe causing pain due to a problem in the spine or due to poor nerve mobility around the ankle. Either way, a nerve problem needs to be treated otherwise it will remain persistent or get worse. Please contact us for a thorough assessment of your ankle. I hope this helps.

Question:  Hello, I am having great intermittent severe periods of pain from the back of the ball of my foot. I have been treated for plantar fasciitis and a few other things. I have had new orthotics made which have greatly helped and I have had a steroid injection for Morton’s neuroma on 3 occasions. Up until 20months ago, when these problems started, I was running every day and loving it.  Any advise would be appreciated.

Apex Physio Belfast Clinic:  Morton’s Neuroma is a condition that affects one of the nerves between the toes as the nerve becomes irritated and compressed. A steroid injection can certainly help the symptoms in the short term, but we would be more interested in diagnosing where the origin of nerve irritation is coming from. Finding the source of nerve pain is one of our specialities at Apex Physio Belfast Clinic! We have treated many runners who have complained of similar symptoms and have successfully returned to the road- when they didn’t think it was possible.  It is worth exploring this avenue as it sounds like you have exhausted local foot treatments. Best of luck!

Question:  Why do I get pain in my knees just after 8 miles or so

Apex Physio Belfast Clinic:  Many runners suffer from knee pain. There are 2 likely causes of your symptoms.

1 – Depending on your age, and past running road regimes, the symptoms may be the beginning of wear and tear (arthritis) of the joint surfaces of the knees, but if you’re young this is unlikely. An X-ray of your knees (via your GP) is an easy way of assessing any wear and tear. If there is wear and tear of the joint surfaces your running mileage will need to be reduced with consideration given to the surface you are running on.

2 – It May be due to poor lower limb biomechanics causing increased load and therefore discomfort through your knee joints.  Either way an assessment is needed to correctly diagnose your knee pain to manage appropriately. Good luck!