Q & A from Injury Clinic on Thursday 6th March 2014:

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Q.  Private Message (AS1) – I have only started running about 6 weeks. I run 5k every Saturday at parkrun and have built up to a 10k run during the week as well as spinning Pilates and gym. Last Saturday after I had stretched and cooled down I took this dull pain and a stiffness on the outside of one of my knees. I applied a cold patch which eased it a bit but I still felt a dull ache for a few days. Is this likely to be a normal occurrence or as a result of running at my fastest pace ever. Please note I had no pain whilst running. Any advice on this would be appreciated. Thanks.

A.  Apex Physio Belfast Clinic – Hi AS1, This pain you described is unlikely to be originating from the knee joint, namely cartilage/ ligament/ joint surfaces, because you had no pain at the time of running. It may be due to the ITB rubbing at the side of your knee (ITB Friction Syndrome) and if so there is usually tenderness to touch the ITB at the side of the knee. If this is the case, ITB stretches should be tried for 1 week or 2 and if it clears GREAT! If not, you need a proper assessment and treatment. Alternatively the pain may be due to poor nerve movement at the side of the knee (altered neural mechanics) which is very common in new runners who are building up their mileage. If this is the case it is easily cleared with the correct physio treatment, but can’t be cleared with self management. Hope this helps!

Q.  John Apperley – Hello, I broke the base of 5th metatarsal at Dublin marathon 18 weeks past on Monday. I was put in plaster for 4 weeks. I then went privately and was put in a fracture boot for approx 3 weeks. Got xrayed early Jan and the bone hadn’t healed, doc advised no running but to come back in 8 weeks and should be ok to run by then, got X-ray last week and no real change in 8 weeks, bone hasn’t fused and doc now saying 50/50 chance I’ll be able to complete another marathon. Is this normal? Should I have had a screw inserted at beginning? Any advice appreciated. I have tried running on treadmill but getting some discomfort.

A.  Apex Physio Belfast Clinic – Hi John Apperley, It is unwise to run on this injury until it is either healed or stabilised as it is more likely to lead to malunion, and annoy healing. If you are not happy with the orthopaedic opinion you have received (and certainly the fact that giving up running was suggested!) we would advise a second opinion from a different orthopaedic consultant. Also, although not entirely supported by literature we have seen many patients in Apex who have taken calcium supplements, we don’t sell them, but can recommend them, and these folk have sworn that it speeded up their slow to heal fractures or malunion recovery. We will gladly recommend an orthopaedic consultant who specialises in feet if you ring the clinic or private message our facebook tomorrow.  Don’t resign to hanging up your trainers yet!

Q.  Private Message (DJ1) – I am training for the Omagh Half Marathon and I’m finding that as I reach the peak of my training plan I am getting very tired or sore (not injury sore), so much so that it is affecting my sessions the next day… Do you have any advice? A friend told me to get a massage but would this not leave me sore the next day as well?

A.  Apex Physio Belfast Clinic – Hi DJ1,  Certainly from the information you’ve given us a sports massage should significantly help. Also remember to have at least 1 rest day per week on the build up to the half marathon. Intersperse running on the road with bark, sand, aquajogging and/ or treadmill.  A sports massage will help to get rid of a build up of lactic acid from your fatigued lower limb muscles, which is very likely to be the reason why you are feeling so weary and achey.  On the day after a good sports massage you may feel a bit worked on but not significantly sore. It is recommended to have a sports massage 3 days before a big event, and obviously more frequently leading up the race.  Our sports massage therapists treat many competitive runners who swear that it is that that keeps them going in terms of injury prevention. Thanks.

Q.  Private Message (DS1) – Hi, I have a pain in my left calf, it is in the upper outer calf. When seated, if I place my foot flat on the floor and turn my leg out there is no pain but if I turn it in there is. When running it can come on at anytime either long or short runs, sometimes it clears but on a few occasions I’ve had to stop due to almost limping.  I have entered the Larne Half on the 22nd of this month.  Many thanks

A.  Apex Physio Belfast Clinic – Hi DS1,  From what you’ve told us there may be a build up of scar tissue (muscle fibrosis) in the lateral/ outside gastroc muscle and the only way to remove it and clear the pain is by deep soft tissue massage combined with home stretching of the affected muscle. If it is fibrosis an experienced physio will definitely be able to feel it and consequently break it up with soft tissue work. This pain can’t be cleared with self management alone.  If on examination scar tissue can’t be felt within the calf muscle then it is very likely that the nerve which travels through the outside of the calf is being restricted in it’s movement by local scar tissue. With the correct treatment this can be cleared easily. In both of the above cases getting treatment ASAP is very likely to clear it/significantly reduce it in time for your half marathon. Thanks!

Q.  Private Message (PMcA1) – Since last week, I have had a sharp pain on my right foot, just above my toes. This seems to only come on during longer runs?

A.  Apex Physio Belfast Clinic – Hi PMcA1, the first thing to ensure is that your foot biomechanics are good and that your trainers are suitable for your foot type and aren’t past their best! If you already have an insole or orthoses ensure you have a neutral trainer.  We recommend a physio assessment to diagnose what exactly is causing this pain. The least likely is a stress fracture and the most likely is that it is pain resulting from poor foot biomechanics. An experienced physio will be able to diagnose it properly and will know whether you need to see a podiatrist or whether over the counter insoles will be enough to make a difference.  There is no self management we can suggest as you need a proper diagnosis to clear this pain. Thanks.

Q.  Kate Pell – Hi, I was diagnosed by a physio as having shin splints. It’s only on my left inner shin and it’s like a sting. I went for a sports massage and was told it was a pocket of inflammation that had to be iced and massaged. It eased for a short time but always niggled… It’s back again sorer than ever now.. What do you think it is and how do I get rid of it?

A.  Apex Physio Belfast Clinic – Hi Kate Pell, shin splints is only a dust bin diagnosis and really just means pain in the shin area!  Your pain could be due to a number of things:

1) A stress fracture, which can only be diagnosed by an isotopic bone scan. However, the quality of your pain ie- stingy is less likely to be due to stress fracture.

2) Compartment syndrome, again less likely due to the quality of your pain.

3) Tenoperiostitis, this is what the physio you saw probably thought that it was. If it is this it usually responds to local soft tissue work, stretches and ensuring that your foot biomechanics are good with the correct trainers +/- insoles if they are needed.

4) Altered Neural mechanics, see our running article on this on the NIRunning website. 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, longer stride running and down hill running. It will never clear with massage.  We would recommend you come to us for a second opinion as it should be able to be cleared. Thanks!

Q.  Wayne Morrow – Hi, just a quick query. In Dec last year I started getting a pain on the bottom of my left foot, just behind my 3rd/4th toes on the padded part of the sole of my foot. I have been nursing it ever since with limited training but it has neither gotten worse or better? Any idea??? I have done the usual Google diagnosis and came up with ‘Morton’s Neuroma’!!!? Can you recommend any self treatment or a good sports podiatrist? Thanks.

A.  Apex Physio Belfast Clinic – Hi Wayne Morrow, your Google searching has actually come up with a likely diagnosis for your pain!  It may indeed be a Morton’s neuroma which is relatively common. And yes, insoles either custom-made or over the counter in this case would be recommended.  Here at Apex Clinic our podiatrist treats many many sports folk and a high percentage of runners. We would recommend that you see her and she will tell you if insoles are appropriate and which type, custom made or over the counter.  However… Not every pain in the location you’ve described is a Morton’s Neuroma! I think to see a podiatrist as the first port of call is recommended as if it isn’t a Morton’s Neuroma the podiatrist will certainly know and will recommend a physio assessment to clear it. Thanks!

Q.  Eóin J. Lennon –  I tend to feel pain in both feet (stronger in the right) for a minute or two when I get up out of bed and walking around in the morning. Tends to be midfoot, sometimes feels like it’s ‘pulling’ the heel. It generally ceases within a few minutes although it may crop up throughout the day, and is strangely never an issue when running. I had tried massaging with a golf ball for a day or two but it seemed to make it worse. It’s manageable certainly, as are all the other niggles, but would you reckon there is something underlying that maybe needs attention? Thanks

A.  Apex Physio Belfast Clinic – Hi Eoin, The pain you have described does Not sound like a local foot problem, such as plantar fasciitis, as it is not painful during or after running.  It is most likely, from what you have described, to be somatic referred pain from your lower back, even though you may have no back or leg pain whatsoever. If this is the cause the pain is usually worse 1st thing in the morning (when the pressure within the discs is high) and is also worse after prolonged sitting or prolonged driving on the first few steps of walking. If you run uphill you may find that your foot pain is present during or afterwards as this also loads the lower back discs.  The way to treat this pain is to see a physio who is experienced in treating nerve pain and referred pain (such as 1 of our team!) and they will assess your back and feet to confirm or disprove this likely diagnosis. It also goes without saying that your foot biomechanics need to be good as poor foot biomechanics can predispose to this problem. Best wishes!

Q.  Tom Purves – I dislocated my left kneecap 5 years ago. If I squat, on the way back up it crunches / grinds, stops when my thighs are parallel to the ground, it doesn’t cause me any pain at all, even when jogging, but can feel warm after a run, more concerned of lasting damage I may do when pounding the tarmac. I only used to jog 3-4 miles, 3 times a week, and still could but I’am reluctant due to my concern. Thanks in advance for any advice you can offer !!!!

A.  Apex Physio Belfast Clinic – Hi Tom, in view of your dislocation history it is likely from what you have described of the warmth feeling following a run combined with the knee cap crunching, that you have a little bit of patella maltracking (where the knee cap isn’t quite moving up and down in the correct alignment) which is very commonly leftover as a remnant of your knee cap dislocation.  This is easily corrected with the correct treatment regime (see an article on this written by ourselves on the NiRunning website). A physio assessment to confirm this is needed but the likelihood is extremely high that the above diagnosis is correct and also that you will get back to your full desired running regime. To ignore your symptoms may speed up the onset of arthritis on the under surface of your knee-cap.  Hope this helps!

Q.  Private Message (SA1) – On some runs I get a real shooting pain in my right knee. This usually happens just as I start my run and is very sore, so much so that it makes me stop, it doesn’t happen all the time but I would like to know why it happens?

A.  Apex Physio Belfast Clinic – Hi SA1, we will try to answer your question as best we can as we don’t know the location of your knee pain.  Your sharp knee pain may be due to a floating body (a fragment of broken off cartilage) within the knee joint which is causing sharp pain sporadically, but not all the time as it can float out of the way of the joint surfaces. This really needs a physio assessment to diagnose.  If the sharp pain is at the front of the knee it may be due to maltracking of the knee cap, as mentioned in a previous answer tonight. This can easily be cleared with the correct treatment.

If there has been no knee injury another likelihood of sharp knee pain which is very intermittent and can sometimes be severe and other times be not present, is referred pain from the lower back. If it is this, this pain will almost certainly be worse with uphill running, but the good news is that in most cases can be cleared with back mobilisation techniques.  In summary a physio assessment is needed to ensure the sharp pain does not become more frequent and stop you running completely. Best wishes!