Q & A from Injury Clinic on Thursday 6th April 2017:

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Question:   I’m unsure if the following is related, but I’m hoping for some advice. I recently had my running style analysed and was told that I needed neutral shoes, but then offered me and sold me some specialist supporting insoles. Looking back, I think I was stupid buying these.

I’ve picked up a few niggles recently and was wondering if this could be related. Should I stop using the insoles?

Answer:   From the information you have given us, we would certainly recommend that you should have a neutral shoe type with your orthoses, whether you have either a flat foot type or a high arched foot type, to avoid overcorrection of either one.

The likelihood is, that with your neutral shoe type and orthoses, the niggles that you are experiencing are due to your body getting used to the new biomechanical position that you are now in while running.

It could really take up to 3 months for your body to get used to this new position but if this is what the situation is, then the niggles you’re experiencing should clear within 3 months.

After a 3 month period if the new symptoms you are experiencing are still persistent and not diminishing, it would be advisable to see a physiotherapist who is experienced in treating running injuries who would reassess your foot biomechanics while you’re running and walking in your new trainers and orthoses, and would also assess your niggles to see what need to be done to clear them.

Question:   I have been suffering with what I think is shin splints. I did Jimmy’s 10k run a few weeks ago and since then I have had awful pain in the front of my shin. It was throbbing and felt bruised. It took a few days for this to ease. I have rested for a week and then tried a short run and the pain returned just as badly, so that I had to stop running. I haven’t run for the last two weeks and I’ve been using ice and heat pads on my leg and taking anti inflammatory tablets. I have been for a sports massage every week and I’m wearing compression socks. I’m also stretching and doing foam roller but still unable to run. I simply ran across the road yesterday for all of 5 seconds and the pain came back again. What else can I do to help the pain subside and be able to run again?

Answer:   Thank-you for your enquiry. First of all, you need a thorough physiotherapy assessment to get a proper diagnosis or cause of your shin pain.  Shin Splints, is a dustbin diagnosis, as it doesn’t tell us the actual cause of the shin pain. A physiotherapy assessment will include assessment of your foot biomechanics to see if any insoles are needed, and it will also establish a correct diagnosis for your shin pain. The good news is that virtually all shin pain can be cleared with the correct treatment and in nearly all cases, the person can return to running again pain-free.

There are a few different causes of shin pain and they are mostly treated and managed differently. Rebecca Nelson, who is the Director of Physiotherapy here at Apex Clinic, Belfast wrote an article on shin pain, which you can read on the NI Running website under the physio section, under Running Articles, called “Apex Clinic’s secret ingredient for tackling shin splints” and this article gives you great information on the different causes of shin pain.

The causes of shin pain are detailed below and each is treated differently. Your pain could be due to a number of things:

  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. Altered neurodynamics – see our running article on this, mentioned above. This pain is commonly misdiagnosed and with the correct treatment is nearly always cleared. This type of pain is usually worse with faster running versus slower and running with longer strides, such as running downhill. It will never clear with massage. We treat this injury on a daily basis at Apex Clinic. 4. Much less likely, compartment syndrome.

If your shin pain continues on for more than a couple of weeks it should definitely be assessed by an experienced physiotherapist, as if it’s poorly managed it could continue for months and even years. At the moment, we would advise you to stop running and perhaps aquajog instead, to maintain your running fitness, until you get your pain properly assessed and treated. If correctly treated, shin pain like what you are suffering, can be cleared in 95-98% of cases and you should be able to return to painfree running.
Question:   I have a sore right shin which has stopped me training completely for 2 months now. It was swollen at first and then sore to touch and finally I experienced shooting/stinging pain along it. I’ve iced it and rested it for weeks. I tried easy running on grass to see if it was better but it flared back up. Any ideas?

Answer:   Having just answered a very similar question on shin pain, please see the above answer as your case sounds very similar.

At this stage you really need to seek professional help from a physiotherapist experienced in running injuries, as they will be able to tell you whether a stress fracture is suspected or not, and whether you would need to get an x-ray to confirm or disprove this.  From the information that you’ve given us, a stress fracture really needs to be ruled out, as if you have a stress fracture, it’s really important that it’s managed correctly.   At the moment, you may wish to consider trying aqua jogging in a local pool, which is deep enough as this is a fantastic way to maintain your running fitness while you are unable to run on dry land.

I’m so sorry that we can’t give you any more self-help tips, as really you need to get your injury assessed as soon as possible.  Please feel free to give us a call if you need any help.

Question:   I have recently started to do a lot of long distance running but lately while out running, I have had a niggling pain in my groin, and have had pain from my hip radiating into my bum. Would you know what this is and what causes it?

Answer:   From the information you have given us, the pain that you’ve described is unlikely to be originating from your groin or hip. The pain which you are experiencing is most likely to be originating from your lower back.  Referred pain from your lower back is commonly referred to the groin, buttock (bum check) and hip and one segment in the lower back and can refer pain to all of these common areas.

As our team of physios here at Apex Clinic, Belfast specialise in the spine and sports injuries, we are very familiar with referral patterns of pain which originates from the spine. It is very likely that the pain you’re experiencing is due to a stiff segment or segments in your spine, at an area where the nerves travel out to the hip, groin and buttock areas. These symptoms would certainly be aggravated by running, particularly over long distances as you have described.

To treat this problem, unfortunately there are no self-help tips which we could advise.  If you see a physiotherapist who is experienced in both running injuries and spinal problems, they will identify the specific stiff segment/s in your spine from where the pain is coming from, and will then mobilise this segment/s so that pain will then clear.  It’s very unlikely, unfortunately that your symptoms will fully clear by themselves.  The physiotherapist will also need to assess the biomechanics of your feet.  With the correct treatment regime, the pain should clear and you should be able to return to running pain-free. In the meantime, you should reduce your running speed and distance and also keep to flat ground when running. It’s important to only run on soft surfaces at the moment, such as grass, bark or the treadmill if possible. Hope this helps!