Q & A from Injury Clinic on Thursday 5th November 2015:

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Question:  I tore my calf (gastroc) muscle today, Grade 3. How long am I likely to be out of running for? Can I do anything to speed up my recovery?

Answer:  Unfortunately, a grade 3 tear of the gastrocnemius muscle is the most severe calf strain with a complete tearing or rupture of muscle fibres in the lower leg. Full recovery can take 3-4 months and in some instances, surgery may be needed. It sounds like you have had an assessment so I presume that this diagnosis is correct. As with most soft tissue injuries the initial treatment is RICE – Rest, Ice, Compression and Elevation.  Anti-inflammatory medication is recommended (after checking with your local pharmacist) to help reduce your pain and swelling and can be taken with paracetamol for extra pain relief.  Following this it is important to restore the range of movement of your ankle joint, and then start gentle calf stretching, muscle strength work and then progressing to restoring high speed work, power, proprioception and agility before starting a graded return to running.  We would advise that all the above is done under the guidance of an experienced physiotherapist and is done alongside progressive soft tissue work applied to the calf, to reduce an excessive scar tissue build up in this region.  If you need further advice at any stage, feel free to give us a shout here at Apex Clinic.

Question:  I have been road running all year and have just started back to the track this week. My calves and Achilles tendons feel like they’re going to explode!  Any ideas to help reduce the DOMS (delayed onset of muscle soreness)?

Answer:  The best thing to do is to ensure you have a good dynamic warm up prior to running followed by a cool down (for example, 5 minutes of walking) including static stretches (holding for 20 seconds, 3-5 reps of each muscle group) of your main muscles namely your calves, hamstrings and quads.  Simple stretches can easily be found on the internet and they provide some great videos of these stretches. Use of a foam roller after running may also reduce the level of DOMS.  If your calves and achilles feel like they are going to explode, we would suggest a deep soft tissue massage (sports massage).  This helps to break down any scar tissue caused by microtrauma of muscle tissue during running and lengths the muscle also, which can help to improve flexibility and prevent future muscle injury. Hope this helps.

Question:  Recently, both of my knees have been sore during and after running. The pain is at the bottom of my knee cap and started with the left one, then a few weeks later the right one started to get sore also. The day after running the pain makes them very restless, I can’t keep them still for too long and when I move them they are sore. Any help would be great.

Answer:  Pain at the bottom of your knee cap is most likely to be one of two things: Firstly, it could be patella tendinitis, which is an injury of the tendon connecting your knee cap (patella) to your shin bone.  It’s an overuse injury and is very common in runners.  It is the result of your patella tendon being overstressed.  Due to both knees being affected, your foot biomechanics would also need to be assessed and an assessment of your running shoes performed.  The reason as to why patella tendinitis occurred would need to be established and then addressed as well as a progressive treatment plan to clear the pain.

Secondly, due to the fact that both knees are sore and they feel ‘restless’ the day after running, this could be coming from a low level of nerve irritation in the lower back, of the nerves that supply the knee. If this is the case it is identified by finding the appropriate stiff segment of your spine and manually mobilising or loosing it which will reduce and stop the nerve irritation of the nerves supplying the knees. We see both problems on a regular basis in runners and it can be cleared in nearly all cases with the correct rehab problem.

Question:  I keep getting a recurrent strain in and around my calf which was diagnosed by a physio as posterior tibialis tendinitis. It got to the point where I had to stop running for 2 months as I was limping after each run. I tried road running again recently and the niggle was back almost instantly albeit not to the same extent as it was before. Any tips on how to manage this without having to stop running again for a lengthy period?

Answer:  We see a lot of recurrent calf problems at Apex Clinic. If you’ve had local treatment to the area and have followed a graded approach to return to running and it has still returned, then it sounds as though your symptoms may be due to a lack of nerve movement (altered neurodynamics) of the nerve (tibial nerve) that passes through the calf muscles. This could be due to scar tissue within the calf muscle itself following a microtrauma of the muscle.  Unfortunately, however there are generally no self management strategies to clear this problem and only a thorough physiotherapy assessment to establish exactly where the source of your pain is, and a subsequent treatment plan is essential to clear it.  As you describe the symptoms as recurring, it sounds like a mechanical problem, therefore resting alone is unlikely to clear it, because as soon as you begin running again the problem will recur unless the mechanics of your problem are addressed.  Feel free to contact us for a second opinion.  We’d be happy to help.

Question:  I was out running 10km last night and I managed to hurt my hip.  It’s a shooting pain and ever since then it’s been quite annoying. I went to see my doctor and he said it’s a hip bursitis.  He gave me anti-inflammatory tablets to take.  Are there any other natural things I can try to help? Should I still try to train, or rest and recover?  Is taking supplements beneficial? What would you recommend that I do?

Answer:  Initially, you should rest from any activity or movement that causes the pain.  The rule of thumb is – don’t do anything that reproduces your pain for the first three or four days.  After that, you need to get it moving to prevent other problems from developing.  Ice can be applied for the initial two or three days post-injury if you feel there is any ‘heat’ around the injury.  Apply ice for 20 minutes each time, every 3-4 hours where possible during the day for the first few days.  Ice should also help to reduce your pain and swelling.  If it is a true hip bursitis, this is an inflammation of the bursa (a small sac of fluid), we would advise a physiotherapy assessment to establish why this has happened in the first place. The anti-inflammatories the GP has prescribed should also help the pain, but not the cause of the problem. If the pain doesn’t settle within a week, we would advise a thorough physiotherapy assessment to get to the source of the problem and clear your pain.  There is no medical literature to suggest that taking dietary supplements in this case will help.