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

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Question:  During my recent longer runs over the last two weeks I have been getting aching shoulders, right across the top of my back just below my neck. I haven’t increased my mileage too much but I’m currently training for the Omagh Half Marathon in March. Any help or advice would be appreciated.

Answer:  The pain in your shoulders sounds as though it could be caused from stiffness in a segment or segments of your neck/upper back region. This then refers the pain to your shoulders. This is often aggravated by running alone, or by poor running posture, increased running distance or by hill running. Usually, the muscles on either side of the spine will be stiff and painful around the area where there is joint stiffness. Initially, we would suggest a deep soft tissue massage. If this does not relieve your shoulder pain then you should have a thorough physiotherapy assessment by a physio who specialises in the spine, as your symptoms should be straight forward to clear with the correct manual mobilisation techniques once the stiff segments of your spine have been identified. Hope this helps. Good luck for your half marathon.

Question:  I would like to know what is wrong with my hip. I have a pain which is right on the bone. When I push it, it’s sore. After speed work it gets a bit sore then after 2 days of rest, it dies off again. Any ideas?

Answer:  From the information you have given us, the pain that you’ve described is unlikely to be originating from your hip. As our team of physios here at Apex Clinic, Belfast specialise in the spine and sports injuries, we are very familiar with referral patterns of pain which originate from the spine. It is much more likely that your symptoms are being referred from your lower back due to a stiff segment or segments in your spine, at an area where the nerves travel out to the hip region. These symptoms are likely to be aggravated by running, particularly speed work as you have described. There could well be secondary muscle spasm which is why you feel tender to touch. Until the specific stiff segments in your spine are identified and then mobilised, it is unlikely that your symptoms will fully resolve by themselves. With the correct treatment regime, the pain should clear nicely and you should be able to return to running painfree. In the meantime, you should reduce your speed work and keep to flat ground when running. Hope this helps.

Question:  What do you recommend is the best method to clear plantar fasciitis? My pain eases after a few days of rest but comes back with any exertion. I have not run for 6 weeks and am currently aqua jogging and icing the sole regularly. The pain flares up with very little movement.

Answer:  As you may know, plantar fasciitis, is an overuse condition of the connective tissue on the sole of the foot which causes pain. Typically, symptoms are felt in the middle of the heel and/or along the arch of the foot. The pain is usually worse for the first few steps of walking in the morning. In the case of a true plantar fasciitis, we recommend the following treatment- 1. Relative rest – no running or prolonged walking for a few weeks. Aqua jogging is perfect to maintain running fitness; 2. Stretching – Stretch your two calf muscles and the plantar fascia 3 times each stretch, holding each stretch for 20 seconds, twice daily; 3. A strengthening program- to improve the proprioception (awareness of where your ankle is in space) and stability of the foot and ankle; 4. Get a biomechanical assessment of your feet and legs by an experienced physio to find the cause of the plantar fasciitis, and to decide whether insoles (orthoses) are needed or not. In some cases, if the runner has recently been wearing hard orthoses, these in fact may be aggravating the plantar fascia and contributing to the pain; 5. Wear supportive footwear- make sure you are in supportive shoes all the time and never barefoot or in flip flops; 6. Massage – attend an experienced physio for deep soft tissue massage applied to the plantar fascia and calf muscles.

From the information you have given us, it sounds as though you have already tried some of the above recommendations. The fact that you are unable to completely clear your pain and that it continues to flare up, indicates that you really need to get a thorough assessment in order to get a tailored treatment plan for you, and to establish the reason as to why you developed plantar fasciitis in the first place. With our experience in Apex Clinic, nearly all sole of the foot pain, even if it’s longstanding can be cleared with the correct treatment regime and the person should be able to fully return to running. It may be helpful for you to read an article which our Director of Physiotherapy, Rebecca Nelson wrote on plantar fasciitis, called, Is Heel Pain Ruining your Stride? You can find this article on the NI running website, under the physio section. I hope this helps and feel free to contact us if your pain persists.

Question:  Some mornings when I get up, I have an excruciating pain on the bone of my left big toe. I can hardly put any weight on the ball of my foot without it being painful. It then goes away after about 10 minutes. Do you know what would be causing this?

Answer:  We presume from the information that you’ve given, that there was no specific trauma (or injury) to your big toe. If this is the case, the pain you are describing is most likely to be referred pain (nerve pain) coming from your lower back. As the discs in the lower back are fattest and fullest first thing in the morning, this type of pain which occurs first thing in the morning on walking is extremely common and usually does disappear, as you say, with gentle movement within 30 mins to one hour. If this pain is left untreated however, then it will usually occur more frequently throughout the day also. To clear your pain the best thing to do is to attend a physio who is experienced in treating spinal problems and nerve pain, and once the segment of your back is identified from which the nerve pain is coming from, this segment can be loosened or mobilised effectively and the pain should clear completely. There are no self management strategies to suggest unfortunately. Feel free to get in contact as we’re very experienced in treating nerve pain.