Q & A from Injury Clinic on Thursday 4th December 2014:


Question:   I train regularly, 30-50km per week.  I did my first half marathon and it was pretty painful in the top of my hamstrings and lower glutes and this is quite normal for me with longer runs. I get no doms and stretching isn’t overly uncomfortable.  Any ideas to help this?

Answer:  From what you describe your symptoms are unlikely to be a tendinopathy (tendinitis) of the hamstrings or a muscle problem; but rather one of the two following problems: Nerve pain from a lack of nerve movement or referred pain from your lower back.

1) Nerve pain from a lack of nerve movement.  This is commonly caused by previous torn muscle fibres of the hamstrings attaching to neighbouring nerve tissue in the back of the thigh. This then reduces the ability of the nerve (the sciatic nerve which lies in the back of the thigh) to normally slide and glide with movement. This is best known as altered neurodynamics. This injury is often worse when running down hill with a longer stride length or when running faster.

2) Referred pain from the lumbar spine (lower back): The spine is made up of vertebrae (bones) with spongy discs in between, creating a space which allows for shock absorption through the spine when we run. If there is any dysfunction (ie stiffening of 1 or more levels of the spine) the compression and repetitiveness of running, especially up hill, on hard surfaces and over long distances will further load these segments. This can lead to irritation of the nerves leaving the spine and this refers pain into the back of the leg. This sounds more like what you are describing as your pain tends to be present during longer runs.

There are generally no self management strategies to clear either of these problems and only a thorough physiotherapy assessment to distinguish where the source of your pain is definitely coming from, is required to resolve your condition. In our experience pain in the lower buttock/ high hamstring area which is left untreated will gradually develop into pain radiating down the back of the leg as you continue to run high mileage.  Once this occurs, it takes longer to clear with treatment so feel free to get in touch with us.

For now, the best advice is to reduce mileage and to keep to soft, flat surfaces. You will find on the NIRunning website an article about this under the physio section. Feel free to check it out!

Question:  Over the last 2 weeks I have felt a pain on the top of my left foot.  It’s not really sore to touch but it’s painful when I run and tends to get worse the longer I run.  If it was sore to touch I would understand, but I’m confused as it isn’t.  What do you think?

Answer:  Due to the fact that you are unable to reproduce your pain by touching your foot, it is unlikely to be bony (a stress fracture) or soft tissue (a ligament strain or tendinopathy) injury.  It is likely to be another underlying structure, such as nerve tissue which is causing your pain.  The nerve may be causing pain due to a problem with poor nerve movement around the top of the foot (known as altered neurodynamics) and this problem needs to be treated otherwise it will remain persistent or get worse.  This problem can be nearly always fully resolved with the correct physio treatment by a physio who is experienced in treating nerve pain.  In the meantime we recommend you run for shorter periods and on the flat only (running down hill is likely to make this worse). I hope this helps.

Question:  I’ve been running for a couple of years but have been unable to for the last 3 months due to.pain in my glutes, lower back and into my leg. I’ve been attending a physio who.fitted me with orthoses but I’m still getting pain even when I’m standing or sitting.  Any suggestions?

Answer:  As all Apex Clinic physiotherapists have undertaken extensive post graduate training in the spine and nerve pain we are confident, from the information that you’ve given us that your symptoms are likely to be referred from your lower back and you will not get better unless you have the correct diagnosis and are treated accordingly.  We see many people in Apex Clinic who come wanting a second opinion when treatment elsewhere has not cleared their pain.

The spine is made up bones with discs in between which act as shock absorbers.  If, for whatever reason, the discs/ joints are irritated this can annoy the nerve tissue beside it causing referred pain down your leg.  In order to treat this successfully a specialist spinal physiotherapist will diagnose the exact source of your problem and treat it appropriately. It is very likely that your pain can be cleared completely with the correct treatment.  In the mean time we do not advise you to do any running due to the fact that you have pain even when you’re sitting or standing.  Please get in touch.