Q & A from Injury Clinic on Thursday 7th December 2017:

Question:    For a while now I have been struggling with tight hamstrings. I’ve done some core work as suggested by a physio but it doesn’t seem to be loosening them up. I find it hard to push on during speedwork because of this. Any advice would be appreciated. Thank you.

Answer:   There could be a few different reasons for tightness in your hamstring when you run.  From the information that you’ve given us, the most likely cause of your hamstring tightness is due to a lack of normal movement of the nerve in the back of the thigh, the sciatic nerve.  The is called altered neurodynamics (or poor nerve movement).  Nerve tissue which passes through muscles, should normally move freely with unrestricted sliding and gliding.  If you have previously torn some muscle fibres of the hamstrings in the past, and scar tissue has formed in the area where the sciatic nerve is passing by, then this scar tissue can irritate the nerve as it passes through causing a feeling of tightness.

The second less likely reason for your hamstring tightness is due to a build up of scar tissue in the hamstring muscles themselves, from previously torn muscles fibres in the past.  This trauma or injury may have gradually occurred over time, such that it went unnoticed by yourself (microtrauma).  The resultant scar tissue which formed may have left the hamstring muscles feeling tight, because scar tissue itself is inflexible, giving the person a feeling of tightness and restriction.

Hamstring tightness is a very common complaint in runners and the key thing to beating it, is ensuring that the correct cause of it is found, because both of these 2 options mentioned above are treated entirely differently.

To treat hamstring tightness which is due to poor nerve movement, specific movements of the nerve tissue are needed to be done by a physio who’s experienced in treating nerve pain, in order to restore free movement of the nerve tissue again. This treatment approach is then followed by a tailored home exercise program, aimed to maintain the mobility of the nerve in the longer term.

Hamstring tightness which is due to a build up of scar tissue in the muscles is treated by progressive deep soft tissue massage techniques to break up the scar tissue followed by a home exercise stretching program for the hamstring muscles.

In the vast majority of cases, hamstring tightness in runners can be cleared completely if the correct cause of it is identified and then it’s treated accordingly.

As all the physios in Apex Clinic, Belfast specialise in spinal problems, nerve pain and sports injuries feel free to give us a shout if you need any help.

Question:   Each time I start running recently, I get a sharp pain in my left knee. It comes on almost instantly and feels like it is right underneath the knee cap. Sometimes I stop my run and walk back but I have also tried running through it and after one mile (approximately) it clears. Any help is much appreciated.

Answer:   From the information that you’ve given us, the most likely cause of your knee pain is due to Patellofemoral dysfunction.

This occurs when the knee cap isn’t quite moving up and down in the correct alignment, and therefore it moves up and down out of alignment (maltracking) which causes pain. One in four of the sporting population will experience this in their lifetime.

The good news is that this problem responds extremely well to a specific regime of physio treatment and specific exercises. It normally only takes a short course of treatment to clear it and it’s managed mostly with a combination of strong stretches of the knee cap inwards and home exercises to strengthen the muscle which pulls your knee cap inwards. You should also have your footwear (trainers) assessed as well as your foot biomechanics, as this could be contributing to the problem if you need better trainers for your foot type or insoles to improve your foot biomechanics.  In most cases, patellofemoral pain can be clearly completely and the person can return to painfree running.

At the moment, before you see a physio who’s experience in running injuries, you should reduce your running mileage, reduce your running frequency and keep to flat ground when running to avoid aggravating your knee pain.  You should also strictly avoid kneeling on this knee and avoid any form of compression on the knee cap, such as wearing a knee brace, a tubigrip or tight running  leggings, as compression on the knee cap will aggravate the pain.

To ignore your symptoms at this stage, is very likely to result in the pain slowly worsening with time, so take action now!  It may also be useful for you to have a read of an article on this, entitled Treat and Beat Runner’s Knee, written by our Director of Physiotherapy, Rebecca Nelson on the NI Running Website, under the physio section, Running Articles for more information. Hope this helps.