Q & A from Injury Clinic on Thursday 4th June 2015:

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Question:  I was diagnosed with ITB (iliotibial band) syndrome five weeks ago. I’ve had anti-inflammatories and been resting since. I’m also using a foam roller, stretching, strengthening and had a massage. I really need to get back running but I don’t know how long to rest or if I should run or what to do now! I’m struggling to get past 4 miles which is very frustrating as a marathon runner. Help!

Answer:  At this stage, to get the problem cleared you really should not resume running until you are pain-free walking, fast walking and using the cross trainer.  It may be helpful for you to read the article on ITB problems by our Director of Physiotherapy, Rebecca Nelson which is on the NI running website under the physio section and this will give you more detail on the best exercises to do to gain hip stability and therefore less pain as part of the rehab program. Your foot biomechanics will also need to be checked, to assess if you need either over the counter insoles or custom made insoles to improve your foot biomechanics.

Since your symptoms have been persistent for 5 weeks, really at the moment you should seek an assessment by a physiotherapist experienced in running injuries, as you may need some hands on deep soft tissue release techniques to the appropriate hip muscle groups as detailed in the article above. The longer you have this problem the harder it will be to clear so please take action now. Thank you.

Question:  Recently I have developed soreness on the inside of my right ankle, just above the actual ankle. It gets worse the longer I run and when I do speed work the pain becomes sharper. Last week I made the decision to rest and I am also seeking treatment, although I haven’t had any answers as yet. Have you any ideas?

Answer:  If you haven’t had any trauma to your ankle ie. no known accidents or sprains, then from the information that you’ve given us this pain may be due to poor nerve movement of the nerve which runs down that area of your ankle (the tibial nerve) and this would fit in with your symptoms being worse with speed work (and it also is often worsened by down hill running).

If this is the case, you need to see a physio who is experienced in treating nerve pain and will therefore know how to treat it. They would also need to assess your foot biomechanics to see if any insoles are required. There are no self-help strategies for this problem unfortunately, but the good news is, that if the pain is due to poor nerve movement, then in nearly all cases this pain can be cleared completely. As all of our physios here at Apex Clinic are experienced in treating running injuries, nerve pain and spinal problems we would be delighted to help you to get you back to pain free running. If you need any more advice, feel free to give us a call. Thanks.

Question:  I think I have a stress fracture of my little toe. It is sore when I put pressure on the outside of my foot, close to the base of the toe and is especially sore when running. I have a doctor’s appointment booked for next week. I have run through it for a month, but realistically how long can I wait before I start training again? Is there anything that can be done to speed up the process?

Answer:  It is great that you are seeing your GP next week, as really you definitely need an x-ray of the toe to confirm if it’s actually broken (fractured) or not. As, if it’s painful, but not broken, then the time frames for returning to running will be different than if it’s broken.  If it is fractured, then you must not run for approximately 8 weeks, but can maintain your running fitness by aqua jogging, and you could use the cross trainer to maintain your general fitness after 4 weeks. To speed up the bone healing, all you can do is- eat a healthy diet, plenty of diary products and fruit and vegetables; don’t smoke; take calcium supplements from a local chemist or health food shop (this isn’t proven, but many folk swear that it speeds up bone healing); and don’t overload the toe too early ie. don’t run on it too early or else you will delay healing by causing micro motion at the fracture site. Hope this helps and good luck!

Question:  I’m getting pain in my calf (soleus) after running in both legs. I’ve recently got orthotics but it still seems to be occurring. I am only running about 25-30 miles a week. There is a dull type of pain in the morning when I get up.

Answer:  That’s great that you have had your foot biomechanics checked however the dull pain you reported in the morning is unlikely to be coming from the muscles as they have been at rest overnight and is more likely to be referred pain from your lower back. This is a very common problem we treat at Apex Clinic.  Our spine is made up of vertebrae (bones) with a spongy disc in between them creating a space which allows for shock absorption through the spine while we run or walk. If there is any dysfunction ie. a tightening in a segment of the spine, it can cause referred pain into the calf muscle. There is a common misconception that you need to have lower back pain to have pain referred from the lower back, but this is definitely not the case. The reason the pain is present in the morning is because overnight, the discs absorb fluid and are slightly bigger, which makes the discs more likely to leak and irritate surrounding nerve tissue causing pain in the legs.  We recommend a thorough assessment from a physio who specialises in spinal problems to identify and treat the source of your problem, by gently loosening the tight segments and enabling you to return to pain-free running under their guidance.

Question:  Hi. I’m getting pain on the outside of my knee. It initially started on a hilly 10k run, about 4 miles in the pain started but I kept going. It was worse going up hill. I rested for a week but then I only managed 1 mile of running before I had to stop with the same pain. I rested it for another week and then I did 5 miles last night but I had the same pain after 2.5 miles. Any ideas?

Answer:  From the description of your pain, there are 2 likely causes. It may be due to the ITB (iliotibial band) rubbing at the outside of your knee (ITB Friction Syndrome) and if so, there is usually tenderness to touch the ITB at the outside of the knee. It may be helpful for you to read the article on ITB problems by our Director of Physiotherapy, Rebecca Nelson which is on the NI running website under the physio section, which will give you more detail on the best exercises to do to gain hip stability and therefore less pain as part of the rehab program. If this is the case, try the exercises for a few weeks and hopefully the pain will clear.

Alternatively, the pain may be referred pain from your lower back due to the increased impact on your spine during running and especially up hill running. If this is the case, it is usually easily cleared with the correct physiotherapy treatment. Unfortunately, there are no self-management strategies to clear this alone. Hope this helps!

Question:  When I put pressure on my foot, I have a pain which shoots into my middle toes. What would this be, and am I doing damage by running on it?

Answer:  Firstly, we would advise resting from running at present. The pain is there for a reason and running through it could cause more damage/injury. It sounds like it could be either a strain on the capsule of the metatarsals (toe joints) or a Morton’s Neuroma.

In either of the above cases, we would advise a biomechanical assessment by a podiatrist who’s experienced in running injuries, to see if you need either over the counter insoles or custom made insoles to improve your foot biomechanics. You also need a thorough assessment by an experienced physiotherapist to confirm the possible diagnosis mentioned above and to treat it accordingly. Hope this helps.

Question:  Recently, I completed my first marathon in London. However, at 16 miles I had a horrific pain on the outside of my knee. From this, I haven’t been able to surpass 6 miles without it flaring up again. I have been reading up on this and it seems to be the ITB (iliotibial band). I have been resting and stretching. Is there a fixed time for recovery or how do you know when it becomes injury free?

Answer:  For this injury to become pain-free on running, you should only resume running once you are pain-free walking, fast walking and using the cross trainer. If this is the case, then a graded approach to returning to running is advised. The graded approach that we recommend is to reduce your mileage by 50% prior to injury, allow a rest day between each run and avoid hills and speed work until you are back running at 75-80% of your mileage prior to your injury. Always increase one thing at a time, either your distance or your speed.

It may be helpful for you to read the article on ITB problems by our Director of Physiotherapy, Rebecca Nelson which is on the NI running website under the physio section, which will give you more detail on the best exercises to do to gain hip stability and therefore less pain as part of the rehab program. Your foot biomechanics will also need to be assessed to see if either over the counter insoles or custom made insoles to improve your foot biomechanics are required. Due to the level of running you have been doing, you may need some hands on deep soft tissue release techniques to the appropriate hip muscle groups as detailed in the article above. Hope this helps.

Question:  I have a pain deep in the crease of my groin. Initially (about 6 weeks ago) it hurt when I coughed/sneezed and after I ran. I checked with my doctor to rule out appendix issues. His opinion was that it may develop into a hernia if it continues to get worse, but didn’t offer any advice.

I have rested and after doing a training run, there is always a pain there. It doesn’t seem to get worse but doesn’t improve with time. Because of where it is I don’t really know how to address it, by stretching or massage?

Answer:  It’s good that you have had the pain checked by your GP to rule out a current hernia. The pain in your groin sounds like it could be coming from your lower back (discogenic- ie. the disc of origin). This groin pain, is a common problem from the discs in the upper part of your lower back region and is caused by nerve irritation in that area. Sneezing and coughing increases the groin pain because it increases the pressure within the discs, causing pain.

At present, we would advise you to take a short break from running in order to reduce your symptoms and the load on your lower back. During this break, physiotherapy treatment is also required to mobilise or loosen the area of the spine from which the pain may be coming from, to completely clear your symptoms. We recommend a thorough assessment from a physio who specialises in the spine to identify and treat the correct source of your problem, and get you back on the road running painfree.