Q & A from Injury Clinic on Thursday 7th August 2014:

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Question:  I’m having problems with my foot when I run. The problem is happening when I run 3-4miles, I get pains in the arch of my foot and if I don’t stop running it gets worse and it will remain sore for 3-4 days after.  I’m stretching my calves and have tried arch supports with little improvement.  Any help would be great thanks.

Answer:  It sounds as if you are irritating the soft tissue that makes up the arch of the foot while you are running. We understand you have already trialled an arch support but we recommend you receive a proper Podiatric Biomechanical assessment to ensure you are wearing the correct type of insoles (orthoses) as poor biomechanics may be a major contributing factor to this problem.  In the meantime in order to self treat your symptoms try: deep soft tissue massage in the arch of the foot (by rolling a golf ball or frozen drink can along the foot) for a few minutes twice daily, icing the foot and regularly stretching the plantarfascia (these exercises can be accessed online).  Our podiatrist has a special interest in gait analysis in runners so feel free to get in touch! Best Wishes!

Question:  My left calf has been troubling me for the last 2-3 weeks, particularly when doing speed sessions. I have had it rubbed out a few times which has helped, but it still seems to be lingering. Should I rest?

Answer:  General Calf pains may be helped by:

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

2- Having an assessment of your foot biomechanics and footwear to ensure this is not the source of your issue.

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

While doing the above regime, reduce the frequency and distance of your runs and only run on flat and softer surfaces (ie- sand, grass, bark etc).

If your problem persists, one of our specialised physios would be delighted to assess you, to get to the root cause of your calf pain.

Question:  I am just returning after a stress fracture on the top of my foot (metatarsal). How long should I take it easy before picking training back up? The injury was diagnosed exactly eight weeks ago and I’m not feeling any pain while running. It is still a little tender when I touch it after a run.

Answer:  Metatarsal stress fractures take around 8-10 weeks to heal.  Even though you are not experiencing pain at present (8 weeks post fracture) we do not recommend you run at all for a further 2 weeks to give the recommended healing time for your fracture. During this time to maintain your fitness you may partake in aqua jogging, X-Training, cycling or swimming as all these activities are low impact through the foot.  When it is time to return to running, grass, bark or treadmill is a safe place to start for the softer surface. Hang in there! If you continue to run too soon this will become an on going issue and possibly shorten your running career! Thanks for your question.

Question:  My hips are giving me problems. It used to be the bones that ached down into my pelvis, but now it seems more muscular. I feel like they are so tight I can’t move my leg forwards and my buttocks are sore when I run. Also, I have a sore shin for the first 2 miles of running. How to prevent that?

Answer:  The pain you describe is unlikely to be originating from your hips. As all of our physiotherapists are spinal and nerve pain specialists at Apex Clinic, this condition is commonly treated successfully by ourselves! The spine is made up of vertebrae (bones) with spongy discs inbetween, creating a space which allows for shock absorption through the spine when we run.  If there is any dysfunction ie. a stiffening up of one or more levels of the spine, repetitive running; especially uphill, on hard surfaces and over long distances will further load these stiff segments. This usually results in a dull ache in the lower back which commonly refers into the buttocks, hips and pelvis causing general muscle aching and tightness in these areas. There are generally no effective self management techniques to clear these symptoms, so we therefore recommend a thorough physiotherapy assessment from a spinal specialist to identify the source of your problem and clear your symptoms. For now, the best advice is to reduce your mileage and keep to soft, flat surfaces e.g. grass, treadmill, bark or sand. Best of luck!

Question:  I hurt my left ankle 20 years ago.  It was fine for 18 years and then bang, it got sore during a cool down after a 10k run up a slope.  It was really sore for weeks but once I warmed up, it was ok for me to run on. Now it’s fine to run on but when I get up in the morning I have to walk around on the outside of my foot for the first hour and then the pain goes. I do loads of stretches using steps etc but it’s an ongoing problem! Any magical advice?

Answer:  Sorry to hear your ankle has been giving you so much bother.  Are we correct in thinking it has now been ongoing for 2 years? If this is the case, self management is unfortunately not working and physiotherapy intervention may be required now. If you continue to run with this problem you will certainly be making things worse and risk damaging surrounding structures in the ankle.  Please feel free to get in touch with us for a thorough physiotherapy assessment so we can identify the source of your problem and clear it appropriately.

Question:  I have run 2 half marathons in the last 12 weeks. When I run approximately 4/5 miles I get increased pins and needles and numbness in my right foot and my right calf is very tight and has lots of trigger points. I don’t have any back pain. Any ideas?  One person mentioned chronic compartment syndrome or just a nerve irritation. It has been going on since March 2014 .

Answer:  Here at Apex Clinic the 2 main areas that we specialise in are sports injuries and spinal problems (which includes nerve pain and headaches).

From our experience this sounds like a nerve irritation originating from your spine. Compartment syndrome does not fit the features of your symptoms.  You do not need to have accompanying lower back pain for this to occur. As you have recently run two 1/2 marathons (very impressive!) there has been a lot of mechanical loading through your back. In order to treat this problem you require a physiotherapy assessment to establish where the origin of this is coming from in your spine and treat it at its source (as well as a thorough assessment of your foot and calf also). It is very unlikely to clear with self management or rest alone. In the meantime if you are keen to continue running we recommend shorter, flatter and softer runs! Good luck!

Question:  I’ve been having a twinge at the top of both legs during and after running. It goes over the top of my thighs into my groins. I’ve only been running for a few months.  Any advice?

Answer:  The origin of your problem sounds very similar to our previous answer.  The fact that your pain is on both sides and refers from the top of your thighs into your groins implicates referred pain from the lower back.  Again, continuing to run with this problem will certainly cause it to worsen.  It is best treated by a spinal physiotherapy specialist who will assess your back to find the origin of the pain.  Best of luck!

Question:  I’ve been struggling with a sore heel for ages.  I’ve tried cushioned shoes and gait analysis.  Any ideas?

Answer:  There are a number of sources from which your heel pain may be coming from, but the most likely (especially for runners) is plantarfasciitis, which is irritation of the connective tissues on the sole of the foot causing pain.  Pain is felt at the bottom of the heel and sometimes in the arch and is usually worse for the first few steps of walking in the morning.  It may only occur in milder cases after running or after another activity.   Plantarfasciitis may start as a result of running or walking in a worn-out pair of shoes, training on a new surface or adding hills into a running or walking routine.  It may also start for no apparent reason.

At this stage, we recommend for you to try the following, only for a 3-4 week period:

1. Rest- No running or prolonged walking.

2. Stretch. Stretch your calf and sole of your foot 3 times, twice daily, holding each stretch for 20secs.

3. Wear Shoes. Make sure you are in supportive shoes all the time and never barefoot.

If there is no significant improvement in the heel pain after 3-4 weeks of performing the above, then you really need to see an experienced physio to get a proper diagnosis for the pain and a proper treatment plan started.  In our experience in Apex Clinic, nearly all heel pain, even if it’s longstanding can be cleared with the correct treatment regime and the person should be able to return fully back to running.  The fact that you’ve had your heel pain for “ages”, really tells us that it is most likely that you’ll need proper physio treatment on it to get it cleared completely.  Feel free to give us a shout.  Best wishes.