Q & A from Injury Clinic on Thursday 6th October 2016:

Question:   I have been getting a pain, which I think may be shin splints recently. The pain is just to the right hand side of my shin on the right leg. I stopped running completely 2 weeks ago and the pain hasn’t subsided any. I would like to start running again but don’t want to aggravate it.

Answer:  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 several different causes of shin pain and they are mostly treated differently. Rebecca Nelson, who is our Director of Physiotherapy here at Apex Clinic, Belfast, wrote an article on shin pain, which you can find on the physio section of the NI running website. This gives lots of information on the different causes of shin pain.

At the moment if your pain has not gone away, try hopping on the affected leg as a test. If it is not significantly painful on hopping, it is unlikely to be a stress fracture. Other causes of your shin pain could be tenoperiostitis (inflammation of a muscle attaching into the shin bone), a nerve dysfunction of the nerve running through the front of the shin, and less likely again would be compartment syndrome.  In your case it will almost definitely not be compartment syndrome because the pain has not eased with resting.

At this stage, the fact that you have rested for two weeks and the pain remains, means that it should definitely be assessed by a physio who is experienced in running injuries. We would be happy to help. In terms of any self help, it is limited. You are doing the correct thing by not running at this stage. You should get the biomechanics of your feet assessed to see if you need insoles (orthoses) and should also check that your running shoes are currently giving you adequate support and control.  At the moment, we recommend aqua jogging to maintain your running fitness in the water and keep any walking to a maximum of 20 minutes on the flat at one time.  Unfortunately, we can’t offer anymore self-help tips as really, you need a thorough physiotherapy assessment to establish the correct diagnosis for your shin pain and subsequently the correct treatment plan to clear it.

Question:  When I start a training session, I feel a sharp pain in my heel, which generally disappears quite quickly. The next morning, however, the pain is back as soon as I get out of bed, but it disappears after a short time. The pain is sharp and I have tried massaging the area after running, but it doesn’t seem to help.

Answer:  This sounds like the beginning of an early onset of plantar fasciitis. At this stage you should not have to stop running, but try the following self help methods:

1) Check that your running shoes are in good condition with a good arch support

2) Reduce your mileage and always keep your running to the flat – no hills

3) Don’t run on two consecutive days

4) Keep your walking times to a maximum of 20 minutes on the flat only

5) Avoid walking barefoot at all times

6) Try these stretches: a) Calf stretches with the knee bent and the knee straight, five of each stretch holding each one for 20 seconds twice daily; b) Plantar fascia stretches (which you’ll find online). Hold this stretch for 20 seconds and repeat 5 times, twice daily. Try this regime for 2-4 weeks and if the pain does not improve, you will need a proper physiotherapy assessment.  With this pain, you may find it interesting to read an article written by Rebecca Nelson our Director of Physiotherapy here at Apex Clinic. This is called: “Is Heel Pain Ruining Your Stride?” and can be found on the physio section of the NI running website. This will give you a bit more information on the possible causes. Hope this helps.

Question:   A couple of hours after I finish my run, I get an ache on my right hip, just towards the front and outside of it. I’ve been gradually increasing my mileage but nothing drastic and I changed my trainers three months ago. The pain has arisen in the last two weeks.

Answer:   Thanks for your enquiry. The fact that you haven’t mentioned any inner groin pain and that the pain is isolated to the front  and outside of the hip would suggest that this pain is likely to be one of two things; 1) Referred pain from the lower back. With this, the location of your pain is extremely likely to be worse with uphill running as a pose to running on the flat; 2) It could be overuse of the hip flexor muscles, following the change in your running shoes, as this will have an effect on all of your lower limb muscles and may have been a predisposing factor to getting an overuse injury of the hip flexors.

For both of these causes for your hip pain, we suggest you reduce your running mileage, only running on flat ground and avoiding hills; reduce running frequency to twice weekly; reduce walking time to 20 minutes maximum and feel free to aqua jog (or swim) to maintain your running fitness. You can also try performing hip flexor stretches (which can be found online) twice daily, 5 stretches, holding each stretch for 20 seconds. If after 2-4 weeks of this regime, the pain does not improve, you will need a proper physiotherapy assessment by a physio who is experienced in running injuries. Best wishes.

Question:  Any tips for strengthening Achilles tendons?

Answer:  A good strengthening program for the Achilles tendon is an eccentric training program (lowering the body program). We recommend the following two exercises, performing both twice daily:

1) Standing on a step, go up onto your toes of both feet fully, then move your pelvis over to above your affected foot taking your unaffected foot off the step and then lower your heel slowly (with the knee of the affected foot straight) until your heel is fully down, lower than the level of the step. Next, put your unaffected foot back on the step and raise up to the full toe up position, using both feet equally and repeat the same action. Repeat this exercise 2-3 sets of 15 reps on the affected leg or on alternate legs if required.

2) Repeat exactly the same exercise but keep both knees bent at about (an approximate) 35 degrees angle throughout the exercise. Keep to the same reps and sets.  It is essential that you do these exercises with no pain, or with very mild pain. If these exercises cause pain after performing them, the pain must clear within 1-2 hours after finishing the exercises. If it does not settle within this time, reduce the reps accordingly. Hope this helps.