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

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Question:  My left hamstring is constantly tight when I run. It’s not strikingly sore, more of a dull ache?

Answer:  There could be a few different reasons for tightness in your hamstring when you run. It may be that the hamstring muscle itself has been injured causing it to tighten, in which case a gentle stretching programme while resting from running (consider cross-training and aqua jogging to maintain fitness) in combination with a sports massage should help ease these symptoms. Alternatively, this tightness could be due to a lack of nerve movement of the sciatic nerve in the back of your thigh. This means that the nerve tissue which should move freely and slide between all the muscles which surround it, has now become restricted. In this case we recommend a specific physiotherapy regime of mobilising/moving the nerve tissue through the back of the thigh. This would be followed by a tailored home exercise program, specifically to maintain the nerve mobility in the long term.  Hamstring tightness is a common complaint in runners and the key thing to beating it, is finding the correct diagnosis for it and treating it at it’s source.   If your symptoms do not seem to be clearing with self management (stretching and massage) then see an experienced physio and make unhappy hammies a thing of the past!

Question:  I have pain in my hips and lower back after long runs.  The hip pain is in the sides of the hips and centre of the buttocks and sometimes I will also have what feels like movement/clicking in the sides of the hips after a long run (10+ miles).  It clears after a few days of rest but returns 1/2 mile into the next run.  Thanks.

Answer:  The pain you describe is unlikely to be originating from your hips. As all of our physiotherapists are spinal and nerve pain specialists at Apex Clinic, this condition is our bread and butter! 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. a stiffening of one or more levels of the spine, repetitive running; especially uphill, on hard surfaces and over long distances will further load these stiff segments. This usually results in a dull ache in the lower back which commonly refers into the buttocks and hips. There are generally no effective self management techniques to clear these symptoms, so we therefore recommend a thorough physiotherapy assessment from a spinal specialist to identify the source of your problem and stop your symptoms progressing.  For now, the best advice is to reduce your mileage and keep to soft, flat surfaces e.g. grass, treadmill, bark or sand. Best of luck.

Question:  How long should sciatic nerve pain in the leg last?  I’ve had this from March and every time it seems to be away, I try running again and it keeps coming back?

Answer:  As all physio’s at Apex Clinic specialise in spinal problems and nerve pain, as well as sports injuries, this is an extremely common problem that we treat.   Although the symptoms seem to ease between runs, it is clear that the source of the problem has not been corrected due to the fact that it keeps recurring.  The key to treating “sciatica” is for a physio who specialises in the spine, to identify the correct origin of the problem and treat it at it’s source. This is a condition which in most cases is easily cleared which the correct physio treatment but cannot be successfully cleared with self-management.

There is no definitive time as to when sciatic pain should clear.  It can last indefinitely if it’s allowed to continue without the correct treatment.  We are confident that your symptoms should resolve on receiving the correct treatment, however, the length of time it will take will depend on; how long you have had the problem, how severe it is and how far down your leg it travels. In the meantime we do not recommend that you continue to run as it will exacerbate your condition. We would love to help. Thanks for your question.

Question:  I do a lot of long distance running and developed severe shin splints 3 months ago. Each time I’ve rested until the pain has disappeared and when I do my first run the pain comes back again, in the same place but more severely.

Answer:  First of all, you need a thorough physio assessment to get to the root of your problem. This will include assessment of your foot biomechanics to see if any insoles are needed, and this physio assessment should establish a correct diagnosis for the shin pain. Virtually all shin pain can be cleared with the correct treatment and in nearly all cases the person can return to running pain free.  There are many causes of shin pain and each is treated differently:

1. A stress fracture – which can be diagnosed with an x-ray or bone scan (organised through your GP)

2. Tenoperiostitis (inflammation of a muscle attaching into the shin bone)

3. Nerve pain of the nerve running through the front of the shin

4. Less likely, compartment syndrome.

Rebecca Nelson (Director of Physiotherapy) wrote an article on shin pain, which you can read on the NiRunning website under the physio section, and it will give you more information on the different causes of shin pain. Shin pain which continues for more than 3 months should definitely be assessed by an experienced physio who treats a lot of running injuries, as if it’s wrongly managed it can continue for months and even years!  If correctly treated it should be able to be cleared and you should be able to return to running painfree (but maybe with a few softer surface runs thrown into your training regime in the future). Feel free to give us a shout!

Question:  I have run 7 marathons in 4 years but last year I noticed my calf getting tight (cramping) when I ran about a mile. I stopped and massaged it and I could feel it release and then I ran on the rest of the race (10k) with no problems. In my last race last summer, again at about 1 mile in, it cramped up badly and I had to walk back to the start as I couldn’t get it to release.  I then rested for a few months and have been to multiple physio’s, sport massage therapists, foot clinics and although the sports massage seemed to help, I still feel my leg getting uncomfortable after about a mile and now it also seems to be painful in the front of the thigh just above my knee. I am trying to get back running again slowly but it is getting disheartening when I feel it tightening.  Please can you give me any advice or things to try? Thanks.

Answer:  Please don’t be disheartened as it does not sound like you have a local calf problem as the primary source of your pain.  You most likely have 1 of 2 things going on and causing your symptoms. The first one, is where the tibial nerve (the nerve running down the back of the calf) is not moving freely as its movement is limited by scar tissue from the calf muscle.  Secondly, you may be getting pain which is referred from your lower back to the calf in response to the high loading involved with running. The nerves which go to the calf area (somatic referred pain) can also refer to the front of the thigh area too. So, it is very likely that the front of the thigh pain you have developed is a result of worsening of the original calf problem.  Despite insoles which may be perfect for you and all the physio in the world to your calf and thigh regions, these pains will not clear with this approach. We recommend you come to Apex Clinic for a second opinion and we will assess your spine and nerve mobility going to these regions.  We hope this has been helpful.

Question:  I have had pain in my right foot since March.  At first I assumed it was a 5th metatarsal stress fracture but two x-rays later they have not shown anything.  I have pain most of the time but more so when weight bearing, along the right hand side of my foot to the base of my toe. My foot swells to a haggis like state, including a pale grey mottled look.  Any ideas?

Answer:  In summary to an unusual question; if you have already had X-rays to rule out stress fractures your next step needs to involve going to your GP and getting blood tests to check for infective and inflammatory markers.  If these come back clear, it may be useful to have a foot biomechanical assessment. Unfortunately we cannot comment any further without seeing you. Hope this is useful.

Question:   After a hard run tonight, up the inside of my right leg, along the length of my shin is sore to walk and touch. Any help would be appreciated?

Answer:  A previous question regarding shin pain was answered just prior to your post please check it out.  Since your condition is more acute (i.e just started this evening) we would recommend you manage your current symptoms with icing, and stretching (see the web for appropriate stretches) and rest.  You may need to consider a biomechanical assessment of your feet to prevent this reoccurring in the future, along with intermittent runs on a softer surface.  Do not allow your symptoms to persist.  Best wishes.