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

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Question:  What’s the best recovery for shin splints? Thanks!

Answer:  First of all, you need a thorough physiotherapy 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 should also 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 at Apex Clinic) 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 behind 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 pain free. In the future we would advice a few softer surface runs in your training regime.  Feel free to give us a shout!

Question:  I have had a pain up the inside of my left leg for some weeks now.  It is approximately 10-15cms up from my ankle. It hurts when I run, but not enough to make me stop. Any ideas on what this could be? Thanks.

Answer:  Often vague calf symptoms can be attributed to slightly poor biomechanics. We would recommend a physiotherapy biomechanical assessment of your lower limbs and feet as there might be asymmetry on 1 side which may be gradually overworking the muscles on the affected side and eventually causing pain in the calf complex.  At present conservative management should consist of:

– Stretching your calves regularly both the Gastroc and Soleus muscle. Stretches must be held for 20secs repeated X 3, 2 X daily- correct techniques can be accessed online.

– Icing the sore area after runs for 15-20mins.

– Deep soft tissue therapy to the calf muscle (Sports massage).

We would also suggest you keep your runs shorter and on the flat in order to reduce any progression of your pain (i.e.- a tear!) until your pain has settled.  It is also important that all runners establish a good warm-up and cool-down regime to include post-run stretches in order to help prevent these niggles occurring.  If the above management does not improve your condition within the next 2 weeks feel free to give us a shout!

Question:  On my longer runs (over 60 minutes) I sometimes get a sharp pain in my right hip. This would make my leg feel weak and wobbly, but once I stop and stretch it goes away. It might happen 2-3 times during a 2 hour run. Is this something that I should get looked at?

Answer:  By the nature of the pain you describe it sounds unlikely to be originating from your hips.  As all of our physiotherapists are spinal and nerve pain specialists at Apex Clinic, this condition is commonly treated successfully by ourselves!  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- i.e. a stiffening up 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 pain either in the lower back, buttocks or hips and can cause general muscle weakness and pain in these areas.  There are generally no effective self management techniques to clear these symptoms, so we therefore recommend a thorough physiotherapy assessment from a spinal physio specialist to identify the source of your problem and clear your symptoms.  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:  Hi, any good advice for recurring achilles pain. Thanks.

Answer:  Tendoachilles (TA) problems can be one of the most stubborn injuries with runners if managed incorrectly. The first line of treatment is usually rest, ensuring your trainers are biomechanically supportive, progressive stretching of the calf complex and soft tissue therapy on the lower legs. If this does not decrease your pain, then you need to see an experienced physio.  The symptoms then may be due to a lack of nerve movement (altered neural dynamics) of the nerves that pass through the calf muscles into the Achilles tendon or referred pain into the Achilles and often heel area from the lower back.   Altered neural dynamics is often the answer to a lot of recurring Achilles problems that have not resolved with local Achilles treatment.

As this problem can usually be cleared completely, our advice to you at this stage is to seek an experienced physio who is familiar with this problem. We are experienced in this treatment if you wish to have it assessed.  In order for you to get back on the road we recommend that you are pain free running on a softer surface ie- treadmill, bark or grass first before progressing to road running. Thanks!

Question:  Hi.  I’ve just been diagnosed with a degenerative knee.  I am an endurance triathlete.  How do I keep some race run pace with limited training on the road?

Answer:  We are glad you are already aware that you are limited in how much road running you may do with a degenerative knee joint. As you already probably know, continued repetitive impact through the knee joint will only worsen your condition possibly leading to a knee replacement in the future.  The positive to this situation however, is that as a triathlete the 2 other sports you do are actually very good for your knee condition as they involve lots of movement without the impact.  Understandably, in order to keep up your performance you will need to do an element of running training. The best way to do this is by aqua-jogging (running in the swimming pool) and x-training. Neither of these exercises involves high impact but imitates the mechanics of running. When you occasionally do chose to go for a run, a softer running surface is best (bark, grass, sand or treadmill.)

Here are a few exercises to help build up the muscles surrounding your knee: Squats, lunges, step Up/ down, one legged balance and calf/heel raises.  We recommend that you incorporate these exercises as part of your pre-exercise warm-up.  Glucosamine is a popular supplement amongst people with knee osteoarthritis but there is no firm research to support its use.  If you have any further queries about the management of your condition please feel free to contact us. Thanks.