Q & A from Injury Clinic on Thursday 4th July 2013:


Question:  After about 2/3 miles I get very sore calf pain, then after the run the day after feels as if gonna cramp badly wots up?

Apex Physio Belfast Clinic:  This doesn’t like a local calf problem in our experience.  As you are aware a local calf problem would occur immediately with running and would most likely ease once you have stopped.  A characteristic of nerve pain is that it has a latency (delayed) effect which means the pain gets worse after activity, which sounds like what your experiencing.  We can assume you are warming up and cooling down (stretching etc) appropriately therefore it would be worth while coming to Apex Clinic for a proper diagnosis as this is an area that we specialise in. Hope this helps.

Question:  On the front/inner aspect of my left knee, I have what feels like a clicking motion.  This normally happens when I am walking but causes no real problems when running.  Does it sound like something to worry about? Ps… I have been aware of it for a 15/18 months.

Apex Physio Belfast Clinic:  This sounds like it could be a slight mal-tracking of your patella (knee cap) which can arise from a muscle imbalance in the quadriceps muscles.  Although is it not painful at present it would be advisable to have this problem addressed with specific exercises as prolonged mal-tracking of the patella could lead to further problems in the future.

Question:  I went running on Sunday and pulled up with my calf muscle about 3 miles in. I thought it was torn but it feels more comfortable to walk on now with no pain.  When do you think I should start running again (Ps… I’m doing 10k regularly so it isn’t an injury from just beginning)?

Apex Physio Belfast Clinic:  At this stage it would be advisable to regularly stretch your calf muscles throughout the day holding for 20secs each time.  If you can walk on your tip toes pain free then on Sunday you could start a gentle interval running program on a bark/grass surface ensuring you have correctly warmed up and don’t forget the cool down.  If you are not pain free with this gentle running it would be advisable to get you calf muscle treated with soft tissue massage.

Question:  I have just been diagnosed with my second stress fracture on metatarsals in a year, is it over training? or should new orthotics prevent loading?

Apex Physio Belfast Clinic:  The most common cause of stress fractures is over training! Although orthotics can reduce loading in the foot during running, if you continue to over train you are still putting too much force through these small bones.  Aquajogging is an ideal way to maintain your running fitness while your injury heals as there is no loading/pressure going through any joints.  Patience is a virtue!

Question:  I have been struggling with tight right hamstring and pain at back of knee when i stretch,seems to hve spread to inner leg between groin and knee also ?

Apex Physio Belfast Clinic:  There could be a few different reasons causing this pain.  It could be the hamstring muscle itself that has been damaged.  It could also be arising from a neurogenic origin as the pain is spreading.  If it was a muscle tear it should be healed by now therefore we would advise that you have this problem thoroughly assessed so it can be managed correctly.  Sorry we cannot give you a more definitive diagnosis at this time.

Question:  Limping with sore left foot, felt like coming from below the ankle towards the bottom of the small toe however it’s not sore to touch, it’s sore when I touch the top of the foot towards the bottom of the toes, feeling a bit weird at the side of my calf now, I do get tight calfs I think because I don’t drink enough water , the pain started the day after a 9 mile easy run 2 days after a PB in ards half marathon, too sore to run now.

Apex Physio Belfast Clinic:  Congratulations on your PB! If the pain is focused around the base of the small toe it could be either be a local tendonosis or joint impingement. The pain at the side of your calf could be due to a biomechanical problem or overcompensation from the foot pain. I’m sure you are wanting to get back to running as soon as possible therefore we would advise you to see a physiotherapist to help you get there as quickly as possible.

Question:  Another calf question if you don’t mind.  After an hour or so training, which involves running, circuit type activity, etc, my calves cramp up and feel as if sometimes they are going to literally detach from my legs. Is it weak calves and if so, what can be done to prevent this?

Apex Physio Belfast Clinic:  This does not sound like a case of weak calfs.  This may be coming from incorrect footwear (poor support or poor shock absorption), or as discussed earlier the latency effect of pain is most likely due to a neurogenic component.  Nerve pain can present in many ways, not just pain eg feelings of cramping, tightness etc.  Again this would be quickly diagnosed with a thorough physiotherapy assessment.

Question:   How should I treat my recurring calf injury?

Apex Physio Belfast Clinic:  If this is a reoccurring injury the correct diagnosis and treatment has not been identified.  There are two main causes of recurrent pain in the calf area these are nerve tissue dysfunction and referred pain from the spine.  At Apex Clinic we specialise in the assessment and treatment of nerve pain or nerve symptoms so please feel free to give us a shout.

Question:  Pain in glutes and hamstrings for past few months, cannot maintain speed over long distances but long and slow is manageable.  I am doing constant stretching and strengthening.  Have most pain when sitting… any suggestions? Have reduced mileage but should I take a complete break?

Apex Physio Belfast Clinic:  This could be either a problem with the insertion of the hamstring muscles however you would have most likely felt an improvement with regular stretching.  The other reason behind this problem could be a referring pain from the spine.  When you sit, the load throughout the spine increases significantly and when you increase the running speed this also happens.  This is a very commonly misdiagnosed problem we see in the clinic and believe a correct assessment and diagnosis is key to solving your problem.