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

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Question:  My achilles has been niggling since the start of the year.  If I use the cross-trainer or run (treadmill or road) it feels like someone is poking the area with small pins.  It is ok when I walk however?

Apex Physio Belfast Clinic:  This sounds like the beginnings of an Achilles Tendinopathy. The best place to start is to look at your footwear and see if your trainers need to be replaced. You may also benefit from seeing a podiatrist who could assess your feet and see if you need insoles, as over pronation is the most common problem to predispose this injury. This problem can be stubborn to clear therefore it is advisable to get it assessed and treated as soon as possible. In the meantime ensure you are gently stretching your calf muscles twice daily 3 x 20 sec holds. I hope this helps.  If you have any further queries do not hesitate to contact us directly, thanks.

Question:  I am training for a 50k in Paris in March but am struggling with a very tight lower calf Achilles problem with also some discomfort on the bottom of the same foot the day after.  It doesn’t bother me running until  my calf tightens up.  Any help is appreciated, thanks.

Apex Physio Belfast Clinic:  As you have probably noticed, we have just replied to a similar type of injury from a question above, so the advice there is also relevant to you. However, your pain in the sole of your foot could also be the onset of plantarfasciitis.  With the training you are doing we would expect that you have had your feet and footwear assessed (if not this is your first port of call). There are special foot stretching and strengthening exercises you will need to do if plantarfasciitis is starting. As your race is coming up in 6 weeks we would strongly recommend that you get a physiotherapy assessment to give you a proper diagnosis and commence the appropriate rehab ASAP.  Good Luck!

Question:  I have recently upped my long run miles for the Larne and Omagh Half Marathons, but I find that when I am nearing the last few miles, my hamstrings are getting very heavy and tight.  Are there any exercises I could do for this?

Apex Physio Belfast Clinic:  It’s very important that you are stretching your hamstring after the warm up and before the run. Current literature recommends that you hold your stretches for at least 20 sec (which most of us don’t do!). It may be beneficial to add in some strength and conditioning for your legs throughout the week on your non running days. This could include mini-lunges, half squats, step ups and bridging. If your symptoms persist, our specialised physiotherapists at Apex Clinic would be delighted to help.

Question:  I am training for the Paris marathon in April.  I am having problems with my IT band , the outside of my right knee and the front inner of my calf . I hadn’t run in 3 weeks and got physio but after a 20 minute run/ walk yesterday,  it just felt the same with the pain starting in my calf and  then my knee.  Any ideas as I am running out of time ? I have been rolling and stretching.

Apex Physio Belfast Clinic:  It sounds like you have been doing everything right if your problem is an ITB dysfunction. The only other recommendation would be to avoid downhill running.  In our experience ITB dysfunction would not cause pain in your inner calf.  Your problem sounds very much like nerve pain. Nerve tissue is the most likely structure that would present with pain in this distribution. We have seen this type of problem many times being misdiagnosed and as we specialise in nerve pain and sports injuries, we would love to see you in Apex Clinic for a second opinion.  You need the correct diagnosis to resolve your symptoms as quickly as possible. Hope to see you soon.

Question:  I have a pain on my forefoot leading into my middle toe and it hurts when I run. It’s slightly swollen on the top of the foot at the base of the toe also. Is this a stress fracture, or something else? And apart from rest is there any way to treat it, like use of kinesiology tape?

Apex Physio Belfast Clinic:  Stress fractures are commonly caused by overtraining and an x ray is the only way that you can diagnose a stress fracture. Another cause of this problem could be Morton’s interdigital neuroma, which is a swelling of nerve and scar tissue arising from compression of the interdigital nerve. Treatment consists of ice for acute tenderness and a podiatry assessment to provide plantar metatarsal padding to help spread the load over the metatarsals. An experienced physio would also give you foot strengthening exercises.

Question:  I experience sharp pain in my knee, behind the knee cap when running, but on the bike I’m fine.  I am a new runner of 9 months and did my first 10 mile run on Sunday (slow and steady). I have got a 10k on Saturday and really want to do it. Any suggestions?

Apex Physio Belfast Clinic:  We treat many knee injuries in the clinic. The symptoms you describe sound like you may have patellofemoral pain.  This is pain coming from under your knee cap from a muscular imbalance of your quadriceps muscles, which places an abnormal load through the knee cap joint. Your inner quads muscle (VMO) is the only muscle used to move the patella or knee cap inwards. If this muscle is not firing correctly it will cause a mal-tracking of your patella which will cause pain. The treatment of this common condition is specific exercises to rebalance the quads muscles especially working on VMO along with an experienced physio performing stretches of your knee cap. The success rate of clearing this pain is extremely high with the correct treatment. Unfortunately, this is not a quick fix problem as with any strengthening of a muscle it will take at least 6 weeks of a progressive exercise program to resolve this problem. If you need any help with clearing this pain, you know where to find us!

Question:  I have been running long distances for a couple of years but over the last few months I’ve been getting very tight hamstrings on longer runs and tightness and discomfort has been focused on the area behind the knees. My usual self treatment of ignoring it isn’t working this time!

Apex Physio Belfast Clinic:  We must highlight that your normal treatment plan of ignoring the problem is not what we would recommend here at Apex Clinic!!!!! On a serious note, we discussed hamstring rehab earlier in tonight’s live chat. So we suggest that you should start a stretching and strengthening rehab program and in 4 – 6 weeks if your symptoms have not resolved or improved within this time frame, that you contact us via phone or email and we can discuss the issues and arrange a thorough assessment.  All the best.

Question:  I broke my big toe just four weeks ago.  The A&E doctor told me that I should wait at least 8-12 weeks before considering a run (as long as it felt ok), but it feels a lot better now.  Do you think it would be ok to try a run on grass?

Apex Physio Belfast Clinic:  Fractures can take weeks to heal. Although you feel much better and painfree we would still recommend that you do not run for another four weeks, to give the minimal recommended healing time for this fracture. During this time you can do some bike training, swimming & cross training as all of these are minimal load on your toes. Grass is certainly a good place to start when you return to running.   Hang in there!

Question:  Is there anything else I should be doing other than stretching and using  a foam roller for hip bursitis?  I have been able to run the past 6 months pain free, but it’s returning.  Is there anyway to help prevent this recurring?

Apex Physio Belfast Clinic:  Has this been diagnosed by a medical professional as hip bursitis? We would certainly not recommend foam rolling for this problem. If this is true bursitis the recommended management would be to rest, gentle stretching of your glut medius, physio applied soft tissue work over the area to increase the circulation and a course of anti-inflammatory medication in the short term.  Prevention of this problem returning would include monitoring/reducing your mileage, checking your lower limb biomechanics and strengthening the hip muscles. If the pain still returns despite this approach, please contact us for help to clear it.

Question:  I am training for the Belfast city marathon but have a problem with my calf getting tight. Have you any ideas?

Apex Physio Belfast Clinic:  General calf tightness can be managed by –

1) stretching 3 x 20 sec holds twice a day

2) assessing your foot biomechanics and footwear

3) adding in a strength and conditioning program on your non running days.

If this doesn’t resolve the problem, a physio assessment should be your next port of call to get it cleared.  Hope this helps.