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

0
14

Question:  I have had an on-going issue with my hamstring for over 4 years. The first injury was slight strain while playing football in the upper hamstring near the buttock. I didn’t feel it sore until after I stopped playing that day. I continued to play and carried on training over the next few weeks with a slight bit of discomfort.  However, the niggley pain wouldn’t go away and I eventually rested the leg for one month. After this month of rest I found that even a light jog still caused it to niggle.

This has been on-going for a few years. Currently I feel the pain mostly when running up hills or sprinting. I have tried every stretch possible and have had regular massages in the area but feel it is difficult to get anywhere near it. I personally feel that this is some sort of tendonitis? Any help would be appreciated

Answer:  At Apex Clinic we have successfully treated many runners with re-occurring hamstring pain. From what you describe your symptoms are unlikely to be a tendinopathy (tendinitis) but rather 1 of the 2 following problems:  Nerve tissue dysfunction or referred pain from your lower back.

1) Nerve tissue dysfunction resulting from scar tissue (caused by previous torn muscle fibres of the hamstrings) attaching to neighbouring nerve tissue in the thigh. This then reduces the ability of the nerve (the sciatic nerve which lies in the back of the thigh) to naturally slide and glide with movement. This is best known as altered neural mechanics. This injury is often worse when running down hill (with a longer stride length) or when running faster.

2) Referred pain from the lumbar spine (lower back): The spine is made up of vertebrae (bones) with spongy discs in between, creating a space which allows for shock absorption through the spine when we run. If there is any dysfunction (ie stiffening of 1 or more levels of the spine) the compression and repetitiveness of running, especially up hill, on hard surfaces and over long distances will further load these segments. This usually irritates the nerve leaving the spine and then refers pain into the back of the leg. This sounds more like what you are describing.

There are generally no self management strategies to clear either of these problems and you would require a thorough physiotherapy assessment to distinguish where the source of your pain is definitely coming from in order to stop your symptoms progressing and to fully resolve your condition. Feel free to get in touch with us.  For now, the best advice is to reduce mileage and to keep to soft, flat surfaces.  You will find on the NI Running website an article about this, written by ourselves, under the physio section. Feel free to check it out!

Question:  I ran my first marathon in May. I followed a 16 week training schedule and it went well. During the race I was running well, until about 18 miles, when my leg muscles started to tighten up a lot and really slowed me down. I managed to rally somewhat in the last couple of miles and finished in 4 hours 22 minutes.  At the start of July, I started another 16 week training schedule ahead of the Dublin Marathon. On longer runs, after about an hour or so, I would suffer from a severe pain at the top of the outside of my right thigh. The pain was so severe that, during my longest training runs, after about 13-15 miles, I had to stop running and walk/jog home. I visited a sports masseur and used a foam roller and hoped that the problem would ease before the marathon.

On race-day, I taped the problem area and hoped for the best. Everything was going fine, until about 12-13 miles, when I started feeling a rapidly increasing tightness throughout all of the muscles of both legs (though, strangely, not particularly in the previously problematic right thigh/hip area). I battled on until about mile 18 when I gave up and walked the rest of the course (crossing the line after a disastrous 5 hours 45 minutes).  Can you advise what might be the cause of the deteriorating in my marathon running?

Answer:  Well done on completing your 2 marathons.  From what you are describing your problem sounds very like a nerve irritation originating from your spine. You do NOT need to have accompanying lower back pain for this to occur.  As you have been training for, and have run, 2 marathons this year there has been a lot of mechanical loading through your back. This has likely overloaded a joint or disc in your back which has in turn irritated the neural tissue beside it causing generalised muscle tightness and intermittent episodes of severe pain. The fact that the tightness occurs on both sides further indicates this.

Really you require an appointment with 1 of our specialised physiotherapists who will be able to assess you to diagnose where exactly the source of your problem lies. If you continue to train without treatment you will find that gradually the symptoms (pain and tightness in muscles) will come on quicker and take longer to resolve between training sessions.  In the meantime if you are keen to continue running we recommend shorter, flatter and softer (treadmill, grass, bark etc) runs.  Goodluck!

Question:  I have been told I have mild arthritis in my ankle.  Just wondering about how much I can run on it?  I do a lot of mountain running and indoor cycling, any advice?

Answer:  A diagnosis of arthritis is made from an X-ray which will visually indicate the quality of the joint surfaces of the bones in your ankle joint. You probably know that continued repetitive impact through the ankle joint will gradually worsen your condition as the pressure on the bone surfaces increases leading to further arthritic changes.  Understandably, in order to keep up your mountain running performance you will need to do an element of running training! The best way to do this is by aqua-jogging (running in the swimming pool) and X-training. Neither of these exercises involve high impact but closely resembles the mechanics of running. When you occasionally do choose to go for a run, a softer running surface is best (bark, grass, sand or treadmill).

Cycling indoors is not a problem and is of benefit in helping to keep the ankle joint mobile.  If your arthritis is causing a loss of your ankle joint movement or any pain then it is advised to seek physiotherapy treatment in order to stop your symptoms progressing and of course to give you relief. Best Wishes.

Question:  I have been suffering with calf pain for almost 4 months. It started as a slight twinge but has now developed into a pain that feels like someone is cutting my calf muscle at the point where it meets my tendon. I have had treatment, needling, rest and stretching. I thought I was getting rid of it but I pulled it again tonight. I’m so frustrated with it!! I have until March to get ready for European masters indoors! Help!

Answer:  It certainly sounds as if you have a reoccurring calf strain, the question is, “What is causing the calf to keep tearing?” Unless you are returning to sport too quickly, the likelihood is that you have altered neural mechanics (a problem with the mobility of your Tibial nerve travelling down the back of the calf) which is causing the calf to tighten and continue to re-strain.  In order to resolve this condition fully the calf tear needs to be completely healed and prior to returning to training an assessment and treatment of the nerve mobility is required (There are no self management strategies for this, unfortunately.)

You may help healing of the calf muscle yourself by:

1 – Stretching gently 3 x 20 second holds, 3 times daily (Look up specific Soleus and Gastroc stretches as the calf is made up of both of these muscles.)

2 – Icing the calf muscle for 20 mins 2xdaily (only if the calf is bruised)

3 – Having an assessment of your foot biomechanics and footwear to ensure this is not the primary source of your problem.

4 – Continue with your soft tissue massage (we recommend you attend a therapist who is trained in sports massage therapy)

As you have the pressure of the European masters indoors ahead I recommend that one of our specialised physiotherapists assesses and treats you to speed up your recovery.

Question:  Hi.  I really need some advice about my entire left leg, in particular my knee. I have only been running for 2 years now but since training for a half marathon last year (while wearing a knee support) something went in my left hamstring. It felt like a snap and meant I couldn’t continue to run at the time.  Now, 14 months later I’m still having so much pain in my knee/hamstring and the pain is even sometimes now into the pelvis.  I can run about 3 miles (if I’m lucky!) and then can’t run for weeks again afterwards. I now can’t go running without prophylactic ibuprofen and/or paracetamol.  I have tried resting it completely for several months with no training all to no effect. I feel that the left knee definitely tracks in and out of position during the day; however a local physio checked my knee and said there was nothing wrong with it except maybe an internal bursa of the knee that a weeks rest and anti-inflammatories would sort out. This was wrong.

I’m really gutted about this knee and the alternating tight sore hamstring probems I’m experiencing. Supports seem to be making it worse now and send shooting pains up the internal side of my knee upwards (they obviously aren’t ideal anyway and are just compensating for my weak muscles). Please help. Any advice if possible is much appreciated.

Answer:  Your question is not wholly different from another we have received this evening. It sounds as though your symptoms are coming from either 1 of 2 problems: Nerve tissue dysfunction or referred pain from your lower back.  There may also be a lesser maltracking of your knee cap or patellofemoral dysfunction.

1. Nerve tissue dysfunction results from scar tissue (caused by previous torn muscle fibres of the hamstrings) attaching to neighbouring nerve tissue in the thigh. This then reduces the ability of the nerve (the sciatic nerve which lies in the back of the thigh) to naturally slide and glide with movement. This is best known as altered neural mechanics. This injury is often worse when running down hill (with a longer stride length) or when running faster.

2. Referred pain from the lumbar spine (lower back): The spine is made up of vertebrae (bones) with spongy discs in between, creating a space which allows for shock absorption through the spine when we run. If there is any dysfunction (ie- stiffening of 1 or more levels of the spine) the compression and repetitiveness of running, especially up hill, on hard surfaces and over long distances will further load these segments. This usually irritates the nerves leaving the spine referring pain into the back of the leg.

The maltracking of your knee cap is easily corrected but can certainly be exacerbating you problem further.  A biomechanical assessment is important to identify any issues which need to be corrected here.  There are generally no self management strategies to clear these problems and you really require a thorough physiotherapy assessment to distinguish exactly where the source of your pain is coming from and stop your symptoms progressing.  For now, the best advice is not to run (aquajog alone if you like) until you receive a thorough physiotherapy assessment.