Q & A from Injury Clinic on Thursday 6th August 2015:

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Question:  In the last 6-7 months, I have been having cramps in my right calf any time I participate in speed sessions at my local running club. Have you any ideas?

Answer:  It sounds like it could be due to one of two things. Firstly, the cramps could be due to a build up of scar tissue due to micro trauma of the calf muscle fibres (tearing of these fibres), which becomes more apparent when you stress the muscle during speed work.

Secondly, your symptoms could be coming from the tibial nerve (the nerve that runs down the back of the calf muscles) which isn’t moving freely within your calf muscle. This again could be due to scar tissue within the calf muscle following a micro trauma of the muscle itself. During speed sessions the tibial nerve has to move more due to the increased stride length involved, and this then could cause symptoms as the nerve is aggravated by the scar tissue.

In nearly all cases, your symptoms should be able to be cleared completely with the correct physiotherapy treatment. If this has been going on for the past 6-7 months I would advise you seek a specialised physiotherapy assessment sooner rather than later to get you back to pain-free sprint sessions. Good luck.

Question:  Six weeks ago I fell during a run, hitting my knee off the ground. The swelling has now gone and the cut has healed, however now when I run it feels like the knee cap is actually moving. Do I need to rest it more?

Answer:  The most likely cause of the feeling that your knee cap is moving during a run is due to the swelling following the fall which will have caused the muscle in the inner knee area (the VMO muscle) to switch off temporarily. The research has shown that this occurs with only 5mls (a teaspoon) of fluid around the knee. This is likely to have caused patella instability (a feeling of more movement occurring at the knee cap). Physiotherapy treatment is normally very successful and in most cases this can be completely resolved with the correct regime, which includes a strengthening program for the VMO muscle and specific patella (knee cap) stretches in different positions of the knee, performed by the physiotherapist.  Hope this helps.

Question:  I’ve recently had a trapped nerve in my back and am still getting some pain in my upper and lower arm when running. Have you any advice on how to strengthen this to stop the pain? It gets worse the longer I run.

Answer:  Thank-you for your enquiry. From what you have told us it certainly sounds as if you still have a nerve irritation problem in your neck/upper back which is causing the symptoms of pain into your arm. Unfortunately, there are no self-management strategies or strengthening exercises to improve your symptoms at present and in our experience if it is left untreated it may eventually lead to weakness and possibly altered sensation into your arm. This is more serious and can take longer to cure.  At this stage we recommend that you get a specialised physiotherapy assessment of your neck, upper back and arm in order to correctly diagnose and tailor a specific treatment plan to suit your needs.  Here, at Apex Clinic we specialise in the spine, nerve pain and sports injuries, so we would be delighted to see you as we specialise in this area of treatment.  At present, you should rest from longer runs as the repetitive action of your arms is causing further neural irritation and hence increasing the pain you are experiencing.  Best wishes.

Question:  I hurt my back deadlifting 11 weeks ago. The injury is a bulging L5/S1 disc. It has taken this long to get enough flexion to touch my feet. I tried a test run after the pins and needles went 3-4 weeks ago. After 1km it felt like I was running with a wooden peg leg! There was zero push off. I’ve been cycling since about week 2 following the injury. My power feels nearly there on the left leg when cycling. I’ve not had an MRI scan and it has appeared always to be improving, however the last 20% has taken 4 weeks.

I’ve seen a physio and that has helped a bit. I’m also doing my own daily program of foam rolling and resistance band exercises that has helped a really good amount. The question is, how long best-case-scenario, would it take to get back to my 50 mile running weeks? Is there normally a rehabilitation process with running? Thank-you very much for you valued opinion.

Answer:  Thank-you for your enquiry. From the information you have given us, it sounds as though there may be more than one level or segment of your spine which has been affected from the injury. As your injury occurred from deadlifting, this exercise puts the thoracic region under a lot of stress as well as your lumbar region.

L4/L5 and L5/S1 are the most common levels of your spine to be involved in a disc prolapse (bulging disc), however from our experience in Apex Clinic, we see many similar weight lifting injuries which also caused an irritation higher up in the spine in your lower thoracic region.  A common symptom of this can be a heavy, dead or weak feeling in the whole leg or as you described running on a ‘wooden peg leg’. It is great that you are using self management strategies such as the foam rolling and resistance work, however without treatment of all the involved segments of your spine (spinal mobilisation) you may not clear that last 20% of symptoms.  In terms of getting you back to running your 50 mile week, it is very difficult to put a time frame on this without seeing a specialised spinal physiotherapist to assess all possible involved levels in your spine, (and subsequent treatment), and also knowing exactly where you are up to with your training currently. Feel free to get in touch as here at Apex Clinic we specialise in the spine, nerve pain and sports injuries and would love to help.

Question:  Hi Apex Clinic.  I’m a keen runner but have been getting pain right behind my left hip bone.  It is tender to the touch but seems to get worse after I’ve been sitting a while or driving. I’ve had this for months now and I can’t seem to shift it. Have you any ideas?

Answer:  The pain that you’ve described is unlikely to be originating from your hip. As our team of physios here at Apex Clinic are specialised in the spine, we are very familiar with referral patterns coming from the spine i.e. which symptoms sound like they are originating from the lower back or from other areas of the body and from which level of the spine they are originating from. From what you have described it is much more likely that your symptoms are being referred from your lower back, due to a stiff segment in your spine, at an area where the nerves supply the hip region, which would be aggravated by sitting or driving as you described. There could well be secondary muscle spasm which is why you may feel tender to touch.  Until the specific stiff segments in your spine are mobilised, it is unlikely that your symptoms will fully resolve. The fact that your pain has been there for months already, suggests to us that you really should have a full physiotherapy assessment and treatment to clear the pain once and for all.  With the correct regime of treatment, the pain should clear nicely.

Question:  Hi Apex Clinic.  I had to stop running 6 weeks ago due to Achilles pain. I rested it and did my first 10 minute run 3 days ago.  It was fine at the time but sore for the following two mornings. Any advice would be much appreciated.

Answer:  Tendoachilles (TA) problems can be one of the most stubborn injuries for runners if managed incorrectly. The first line of treatment is usually rest as you said, also ensuring your trainers are biomechanically supportive and then progressive stretching of the 2 calf muscles, twice daily. If this has not decreased your pain, then we would strongly advise you see an experienced physio for an assessment to establish the correct cause of the Achilles pain and subsequent treatment plan.  It sounds as though your symptoms may be due to a lack of nerve movement (altered neural dynamics) of the nerve (tibial nerve) that passes through the calf muscles and Achilles tendon.  Your foot biomechanics will also need to be assessed to establish if any insoles are needed or not and a strengthening program will need to be added, which includes heel dip exercises off a step.  The good news is that this problem can usually be cleared completely with the correct physiotherapy treatment.