Q & A from Injury Clinic on Thursday 5th June 2014:

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Question:  I have only recently started running (very slowly), but I am experiencing soreness around my knee’s. It’s not a sharp pain, more like a dull pain.

Answer:  If the knee pain that you’re experiencing is very generalised, all around the knee, then it is most likely soreness as a result of force or impact coming up from the ground to your knee joints. If this is the case, then running more frequently on softer surfaces is important, such as grass, bark tracks or the treadmill to reduce the impact passing through your knees. Alternatively, a generalised knee pain all around the knees may be due to poor foot biomechanics which in turn will lead to overloading of the knees and resultant soreness. A podiatrist or good physio would be able to tell you if this is the case, and over the counter, or less likely custom made insoles may be needed to resolve this problem. Which ever the case, ensure you have good trainers with a good arch support and good shock absorption as this is vital. Hope this helps!

Question:  Can you advise as to the best way to deal with a groin strain?

Answer:  If you have had a recent groin strain, then it’s important to gently stretch the adductor muscles (inner thigh muscles) twice daily, approximately 3 reps of 20 second holds with the knee straight, standing up for example and then 3 reps of 20 second holds with the knee bent, for example sitting down with the soles of your feet together and pushing gently downwards with your elbows towards the floor and holding. Just perform each stretch to the point of the beginning of discomfort.

Relative rest also is important if running is painful, ie reduce the mileage and pace if the pain is mild, but if it’s severe then stop running for a few weeks. Gradually, when back into running building up the speed and mileage slowly. If the groin pain has been longstanding, then a physio assessment is definitely needed to get a proper diagnosis and resultant tailor made treatment plan started, as not all pain in the groin is from a muscular groin strain, there are many other causes for this, which we see daily in the clinic and until the correct diagnosis is found, the pain will usually continue! Good luck!

Question:  I’m doing my first 10k in two weeks and training was going well. But I’ve aggravated my plantar fasciitis. I’ve bought sole inserts and I am taping/stretching but it still hurts. Please advise. Thanks

Answer:  Well with 2 weeks to go, we understand that you don’t want to waste all your valuable training up till now, by not doing it! So, using soft over the counter FULL length insoles can certainly be helpful, just ensure they aren’t hard and digging into the plantarfascia to annoy it further. If you’re not sure if they are the correct ones to have for your condition, feel free to phone us at the clinic tomorrow and we’ll tell you the ones that we recommend. Taping is OK as a symptom relieving help, but it isn’t going to help you in the long term, so only use taping if it’s giving effective pain relief and not otherwise.

As for stretching, ensure you’re stretching your 2 calf muscles, with your knee straight and knee bend, 3 of each for 20 secs twice daily and do plantarfascia stretches, as seen on the internet twice daily, the same quantity also. Then the decision remains whether to run through it and complete the 10k or whether to stop and get it treated and not continue training. It all depends on the severity of the pain. If you continue through moderate pain just to complete the marathon then that is fine if you are dead set on completing it, then after you’ve done it, you definitely need a proper physio assessment to get it cleared fully with the correct treatment. Best wishes!

Question:  I was wondering could you give me some advice. I was at A&E and they told me I’ve pulled a stomach muscle. They didn’t tell me too much else except rest for up to 10 days. I don’t know what strain it is, my symptoms are if I stand up, sit, bend, sneeze etc.  I’ve a sharp burning stabbing pain in my stomach. Is there any way I can speed the healing process up and is there any exercise I can do that wouldn’t hurt my stomach muscles once the severe pain settles?

Answer:  The advice we give, really depends on whether you actually have an abdominal muscular strain or not, as from the information that you’ve given us, we’re not so sure that you do!  Without assessing you, we can’t say for sure but from what you’ve said, the sharp pain in your abdominal region on the actions you described, may in fact be referred pain from the spine at the bra strap level in a woman, or equivalent area in a man and this referred pain certainly feels commonly sharp and stabbing and is often worse on coughing/ sneezing etc. I think if the pain is still sharp and stabbing after 2 weeks, you really need a proper assessment to diagnosis what’s causing it. If it is your spine, then it is usually straight forward to clear with the correct treatment and resting it often doesn’t help. If it is muscular, then it should progressively improve fairly rapidly with rest and would only need treatment in rare cases. Don’t let the pain drag on unnecessarily, best wishes

Question:  I have a shin injury, I think either I’ve torn a muscle or it’s shin splints. Fine for cycling but too sore to run on. Rested it for 10 days & only marginally better. After a short trial run, it’s much worse. I’m taping, bandaging, stretching, iceing etc. I’m a regular runner, 3-4 times a week, anything from 5k-1/2 marathon. Feeling very frustrated!

Answer:  First of all, you need a thorough physio assessment! As virtually all shin pain can be cleared and in nearly all cases the person can return to running painfree with the correct treatment! Where to start. Taping, stretching willy-nilly is really going in blind and firing anything at it!  Which shows that you’re keen to clear it, but usually won’t result in success! A proper physio assessment involves assessing your foot biomechanics to see if any insoles are needed ONLY if you have poor foot biomechanics and also establishing a correct diagnosis for the shin pain.

There are many causes of shin pain and they are mostly treated differently, most unlikley a stress fracture, or tenoperiostitis (inflammation of a muscle attaching into a bone), nerve pain of the nerve running through the front of the shin, and less likely compartment syndrome. We wrote an article on shin pain, which you can read on the NI running website under the physio section, articles which will give you more information on the different causes of shin pain. Honestly, shin pain which continues for more than a few weeks 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, in 95-98% of cases it should be able to be fully resolved and back to running (maybe with a few softer surface runs thrown into your training regime!) Feel free to give us a shout!

Question:  For the past year and half I have been suffering from pain which is best described as being on the inside of the leg between the shin bone and calf, I have been told that this is untreatable only rest for several months will help, as we are now in mid season, resting is a big no, so any help would be graciously accepted. Darren

Answer:  Unfortunately, we don’t agree with the advice that you’ve been given elsewhere..that you’ve had this pain for 18 months and that only further rest will resolve it…The only time that this would be the case would be if you had malunion (not healing) of a confirmed stress fracture in the painful area!! When you’ve had a problem for 18 months which isn’t clearing or hasn’t cleared with a treatment regime, then it’s time for a second opinion as to the cause of the pain and the correct treatment plan! Resting at this stage is certainly NOT recommended as you will have a mechanical problem which needs to be treated and cleared. Resting just reinforces the problem and just delays getting back to running painfree! Please refer to Bryony May’s response from us as to likely causes, and if you’d like a second opinion, feel free to give us a shout! It is very likely that your pain should be able to be resolved from the information that you’ve given…. Best wishes

Question:  My achilles has been causing me pain. When I rub it there’s a crunching/creaking sound/feeling! I don’t run much or very fast but I’m doing Lisburn 10km on 18th June.

Answer:  Hi Fiona, The creaking, crunching feel that you describe, means that you have a tendonopathy (which is a new, updated word for tendinitis) in your achilles tendon!! Unlike some injuries which cause hurt and not harm, running through an achilles tendonopathy can increase the risk of tearing it, which can be a long, slow process to recover from! So, beware with running through it. It is your call whether to run through it, but there is a risk involved here! In the meantime, try stretching the calf muscles with the knee straight and knee bent, twice daily , 3 x 20 sec holds and avoid hill running, and reduce the mileage if you do plan to complete the 10K…if you REALLY want to complete it , the best regime would be to aquajog all the running sessions in a pool that’s deep enough, right up until you do the 10K, as this will be the kindest possible on the tendon until the big day! If sense prevails and you don’t do the 10K then get it treated now so you’ll be fighting fit in 8- 12 weeks for further races! Best wishes

Question:  I am having problems with my periformis muscle, very tight which is causing problems down my leg into my foot. What are good stretches for this?

Answer:  From the information you’ve given us, this is not in fact a piriformis problem as the piriformis muscle can cause muscular pain up to cm’s away from the actual muscle and not down the whole leg into the foot. Also the current literature is actually debating whether piriformis syndrome actually exists or not! It sounds that you have referred pain (or nerve pain) referred or coming from your lower back, and in fact by stretching the piriformis muscle this more often than not, worsens the referred pain or nerve pain because the nerve is tugged or tensed when the piriformis muscle is stretched.

The piriformis muscle often will become tight secondary to the referred pain or nerve pain and it is a secondary protective response and not the primary problem. Once your pain has cleared then it is the time to stretch the piriform muscle if it’s tight. Really, you need a good physio assessment to establish where your leg and foot symptoms are coming from and then the appropriate treatment regime can be implemented. It’s a very common symptom that you’re describing which is usually straight forward to clear with the correct manual treatment. Best wishes