Q & A from Injury Clinic on Thursday 4th August 2016:

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Question:   Lately, I have been getting some twinges in my back on the lower right side after longer runs. I’ll be stiff that night, but then it’ll be fine the next day, until I run again. Is there anything I can do to prevent this? I was considering some core work.

Answer:   Thanks for your enquiry. As a first step we recommend that you avoid any hill running (or incline running) as this will minimise the pressure on the lower back discs. If the pain is no better with this, then really there is no alternative other than seeking help from an experienced physiotherapist, who will mobilise the tight segment of your lumbar spine which is causing the lower back pain. Once this pain has cleared (and this should only take a few sessions of manual mobilisation techniques), it is then that core exercises will be of great benefit to help strengthen the lumbar spine and therefore help prevent reoccurrences in the future. Strengthening the lumbar spine and core as a first step however, is not appropriate as if there is a tight segment in the lower back from which the pain is originating from, then strengthening the muscles may certainly strengthen, but the pain itself is unlikely to improve.  The timing of core work is key here.  Hope this helps.

Question:   My left hamstring has been achy recently.  I don’t think I have pulled it and I can run on it, but I feel the ache after a run and sometimes during long runs. I’ve upped my miles for Dublin Marathon over the last month.

Answer:   From the information that you’ve given us, the most likely cause of your hamstring ache may be altered neurodynamics (i.e. poor movement of the sciatic nerve up and down the back of the thigh). There is an article on the NI Running website written by our Director of Physiotherapy, Rebecca Nelson on hamstring pain, “Don’t let recurrent hamstring trouble stop you in your tracks” which will give you more information on this subject.

As a starter, try to avoid hills and keep your stride length shorter.  Also, reduce your running speed slightly.  This should lessen the intensity of the hamstring ache.  Treatment for this should be fairly straightforward for a physiotherapist who’s experienced in treating nerve pain.   It involves moving the nerve tissue in a controlled fashion so that it moves more freely in the back of the thigh when running.  Unfortunately, there are no self-help techniques to clear this ache, however there is a very specific home exercise that you can do once the pain has cleared to help to prevent a recurrence of the problem. Feel free to give us a shout for help if needed, as the physios here at Apex Clinic all specialise in spinal problems, nerve pain and sports injuries.

Question:   I have a set of twinges which I think are to do with tightness in my hip. Regular stretching seems to be somewhat helpful. The location of the twinges are in my hamstring, inner knee and ball of my big toe, all on the same side.  I feel them after running rather than during running, except occasionally the hamstring twinge.

Answer:  From the information that you’ve provided, it sounds like you have a nerve irritation in your lower back which is causing the three areas of your twinges. There is also the possibility that you have tightness (scar tissue) in your hamstring muscle too. Stretching could be helpful in the short term, however there is likely to be no long term improvement with stretching. Other than stretching your hamstrings, there are no other self-help exercises to clear the twinges in your knee or toe.   You really need to get help from an experienced physiotherapist who specialises in the spine, as your symptoms should clear nicely with the correct manual mobilisation techniques to your spine, once the stiff segments of your spine from which the pain is originating from, have been identified. You may also benefit from deep soft tissue massage to the hamstring area, if scar tissue here has been identified.  In the meantime, we advise you to avoid running uphill and reduce your mileage.  You should also avoid any exercises that may irritate your back such as using a rowing machine, sit-ups and planks. Hope this helps.

Question:   I have torn ankle ligaments and broken (fractured) the tip of my fibula nine days ago. I am currently on crutches and unable to put my foot down to weight bear. I was just wondering what are the best ways to recover/rehab this injury please? Also, this is the third time I have torn the lateral (outside) ligaments of my ankle. What can I do to prevent this injury in the future?

Answer:  The number one cause of recurrent ankle sprains is the lack of ankle proprioception (i.e. your brain’s perception of where your foot and ankle are in space) following the first lateral ligament ankle sprain that you suffered.

This is the key factor in rehab here ie that your ankle proprioception is fully restored in your rehab program (these exercises can be found online).  As for rehab for the rest of your condition, usually you will be on crutches for up to 6-12 weeks depending on the severity of the fracture. After the fracture is healed (8-12 weeks), intensive rehabilitation is really important to focus on the following-

1. Regaining full ankle and foot range of movement, to break up and clear any excessive scar tissue which may have formed in the joints of the ankle and foot.

2. Soft tissue work on the lateral ligament of the ankle to get rid of any excessive scar tissue here.

3. As already stated above, a progressive program of ankle and foot exercises to make the proprioception of your injured ankle EXCELLENT for the future, to help prevent further ankle sprains.

4. A progressive strengthening program for your ankle, knee and hip muscles

5. An experienced physiotherapist should also assess your foot biomechanics to see whether insoles (orthoses) are required or not.

Please feel free to phone us for advice if needed.

Question:   I have had plantar fasciitis in my left foot for nearly 2 years. I run on trails and mountains. I wear orthoses, which have been modified and I also stretch.  I use foam rollers also. I have been able to run through it since last autumn until now, but recently it’s been getting the better of me. Any advice?

Answer:   Plantar fasciitis can be extremely stubborn to clear unless the predisposing factors for it have been identified. You may find it helpful to read an article written on the NI Running website by our Director of Physiotherapy, Rebecca Nelson on this subject for a bit more information.  The article is called, “Is heel pain ruining your stride?”

From the information you’ve provided, it sounds like you have tried every self-help regime that is recommended. It’s very likely at this stage of your injury that you have one of two factors contributing to your symptoms:

1. Poor nerve movement (altered neurodynamics) of the nerve passing through the heel (the tibial nerve)

2. An element of nerve irritation in your lower back contributing to your symptoms

At this point we recommend that you see a physiotherapist who is experienced in the treatment of nerve pain to assess if either of these two pathologies are involved in your condition. Our team of physiotherapists here at Apex Clinic treat long standing plantar fasciitis on a regular basis and we certainly find that in most cases it can be cleared if the correct treatment is given to address ALL of the factors that are causing the pain.

As our physio team here at Apex Clinic specialises in spinal problems, nerve pain and sports injuries, one of our team would be delighted to asses you, even as a one off to give you a treatment plan to clear it. Hope this helps.

Question:   I’m a very amateur runner and I always have problems with my calves. I concentrate on them before runs, which are usually 10ks, but they always give me bother afterwards. Any advice?

Answer:   From the information you’ve given us, it’s most probable that you have a build up of scar tissue in both calf muscles which has accumulated over the recent number of months.  You are particularly prone to this happening if you are new to running. Scar tissue may be the cause of your symptoms and the way to clear this, is to go to a physiotherapist for deep soft tissue massage and soft tissue techniques to work on the scar tissue once it’s been identified, and then clear it.

Once the scar tissue in your calves is cleared using soft tissue techniques, then this should be followed by a home exercise program of calf stretching and strengthening. It’s good to get this problem sorted out quickly as it may lead to muscle strain in one or both calf muscles if you don’t.  Best wishes.