Q & A from Injury Clinic on Thursday 7th May 2015:

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Question:  What’s the best exercise to strengthen your IT band?

Answer:  The iliotibial (IT) band is a tendon-like length of connective tissue that runs along the outside of the leg from the hip to the knee. Whilst you can’t strengthen the actual IT band you can strengthen the hip abductors and hip external rotators (the muscles on the outside of the leg) which help to stabilise the IT band. Two great exercises for this are- the clam exercise lying on your side and another exercise involving lifting your leg out to the side with a straight knee when lying on your side or when standing.  These exercises can be progressed by using therabands to add resistance to the exercise.  On each exercise complete 3 sets of 20 reps twice daily.  For more information on ITB problems and the rehab of them, you may like to read an article on this, written by Rebecca Nelson, Director of Physio here at Apex Clinic on the NI Running website, under the physio section.

If you are experiencing pain during the exercises or during activity we would strongly advise that you have a physiotherapy assessment to get to the route of the problem, and to ensure that you can complete the exercises pain-free and can progress them as appropriate.

Hope this helps.

Question:  My right calf has been giving me problems over the past 4-6 weeks. It feels tight and when I do speed work it just feels like it is going to ‘pop’. I have tried sports massage.  Do you have any other advice? Thank you.

Answer:  It sounds like it could be one of two things. The tightness could be due to a build up of scar tissue due to micro trauma of the calf muscle fibres, that becomes more apparent when you stress the muscle during speed work giving you the feeling it could ‘pop’ as you don’t have the flexibility in the muscle. You said that you have had a sports massage, if this didn’t work it could be that it wasn’t deep enough into the muscle or did not move through the full range of movement of the muscle, lengthening the muscle during the massage.

Secondly, your symptoms could be coming from the tibial nerve (the nerve that runs down the back of the calf) which isn’t moving freely within your calf muscle.  This again could be due to scar tissue in the calf muscle following a micro trauma of the muscle itself.  During speed sessions the tibial nerve has to move more due to the increased stride length involved, and this then could cause symptoms as the nerve is aggravated by scar tissue.

In nearly all cases, your symptoms should be able to be cleared completely with the correct physiotherapy treatment. I would advise that if you have tried a sports massage and this didn’t help, to have a physiotherapy assessment to have your problem correctly diagnosed and get you back to pain-free sprint sessions as soon as possible. Good luck!

Question:  Hi there, I just wanted to enquire about a pain in my back and neck.  It was fine prior to taking up running but since then, I have found that the muscles on the left side of my neck at the base and shoulder are so sore and stiffen up when running. It is only on the left hand side and not the right. On occasions I can’t even look down as the pain in my neck and shoulder is so sore.  I’ve been for sports massages and this has been of limited help. Would you have any suggestions to help me? It makes long distance running incredibly painful.

Answer:  The pain on the left side of your back and neck sounds as though it could be caused from stiffness in a segment of your neck or upper back region. This can be aggravated by running alone, or by poor running posture, increased running distance or hill running.  You said that you have been for a sport massage which hasn’t significantly helped.  Usually, the muscles on either side of the spine will be stiff and painful around the area where there is joint stiffness, therefore a massage may reduce the symptoms however, without mobilizing or loosening the joints, sports massage will only offer short term relief.  The fact that your movement is restricted also, would suggest that a physiotherapy assessment rather than a sports massage at present, is what is needed.  We would also advise you to either stop running at the moment or to reduce your running distance until you get this problem resolved.  Hope this helps.

Question:  I have a dull, sometimes sharp pain high on the outside of my right calf. This seems to occur if I’ve been sitting at my desk at work for any extended period.  I have tried strengthening and foam rolling to help, but with no luck yet!

Answer:  The pain you describe in the outside of your right calf is most likely to be referred from your lower back and this is a very common problem which we treat here in Apex Clinic (as we specialise in spinal problems and sports injuries, this is our bread and butter!). Our spine is made up of vertebrae (bones) with a spongy disc in between them, creating a space which allows for shock absorption through the spine while we run or walk. If there is any dysfunction ie a tightening up in a segment of the spine, poor posture or long periods of sitting at a desk can load the stiff segment of the spine even more, and can cause disc related symptoms. The most common misconception that people often have, is that you have to have back pain to have pain referred from the back into the legs.  This is definitely not the case. When you are sitting, you are not moving the calf muscle so it is very unlikely that stretching or strengthening the calf will work. There generally are no effective self management techniques to clear these symptoms so we would recommend a thorough assessment from a physio who specialises in the spine to identify and treat the source of your problem.  We understand that this is a debilitating problem, but it should be able to be cleared fairly quickly with the correct treatment. For now, the best advice is to take regular standing and walking breaks from sitting at your desk and ensure you are sitting with good posture.

Question:  Hi.  I have a burning pain in the centre of my back and my lower back is very stiff. Also, I’ve been getting pain in my left hip.  I have stopped running altogether. Any ideas?

Answer:  The burning pain you describe in the centre of your back referring into the left hip is most likely all coming from your lower back and is a very common problem we treat. Our spine is made up of vertebrae (bones) with a spongy disc in between them creating a space which allows for shock absorption through the spine while we run or walk. If there is any dysfunction ie a tightening in a segment of the spine, repetitive running especially uphill, on hard surfaces and over long distances will further aggravate these segments. Although we agree that currently you should take a break from running in order to reduce your symptoms, this alone unfortunately won’t be enough to clear your symptoms once you return to running, because the segment in your lower back from which your symptoms are coming from, hasn’t been mobilised or loosened by specialised physiotherapy treatment, so when you return to running the mechanics of your spine won’t have changed and the pain is very likely to be present exactly as before.   Therefore we recommend a thorough assessment from a physio who specialises in the spine to identify and treat the source of your problem and enable you to return to running under the guidance of your physiotherapist.

Question:  When running, about 3 miles into the run I get weakness in my left knee as if it’s going to give way. I am not running very fast, 7.30 to 8 minute miles. After 10k I am sore but not in severe pain. It is not my cruciate as I had the same problem in my other knee as well. Any ideas? Are there any remedies or type of strapping you would recommend?

Answer:  If you have had the anterior and posterior cruciate ligaments ruled out as causing the symptoms (because of the excessive gliding of the lower leg which would occur and this in turn would lead to weakness of the knee) then, a feeling of weakness in the leg can result from a low level of nerve irritation in the lower back, of the nerve that supplies the thigh muscles. If this is the case it is identified by finding the appropriate stiff segment of your spine and manually mobilising or loosing it which will reduce and stop the nerve irritation of the nerves which supply the thigh muscles. We see this scenario on many occasions in runners and it can be cleared in the vast majority of cases. Strapping is not recommended here as it is not getting to the route of problem and is unlikely to help. Please feel free to get in touch with us, to get this problem cleared.

Question:  I have been having trouble on my right shin for the last 6-8 weeks.  It started with pain on the shin bone but I was still able to run.  Later, with speed work and training for a 10k run, my shin bone and the muscle around it, and even my calf muscle became sore and the soreness was such that I was only able to run once a week. I have stopped running over the last two weeks to see if this helps but I am wanting to get back to running to prepare for the Dublin marathon.  Any help is greatly appreciated.

Answer:  First of all, you need a thorough physio assessment from a physio who is experienced in treating running injuries, especially if you want to prepare for the marathon! Virtually all shin pain can be cleared with the correct treatment and in nearly all cases, the person can return to running painfree again.  A proper physio assessment involves assessing your foot biomechanics to see if any insoles are needed ONLY if you have poor foot biomechanics and also establishing a correct diagnosis for the shin pain.

There are many causes of shin pain and they are mostly treated differently.  The most unlikely is a stress fracture and other causes include tenoperiostitis (inflammation of a muscle attaching into the shin bone), nerve pain of the nerve running through the front of the shin, and less likely compartment syndrome.  Rebecca Nelson, Director of Physiotherapy here at Apex Clinic wrote an article on shin pain, which you can read on the NI running website under the physio section, and this article will give you more information on the different causes of shin pain.  Honestly, shin pain which continues for more than a few weeks should definitely be assessed by an experienced physio, as if it’s poorly managed it can continue for months and even years.  If correctly treated, in 95-98% of cases it should be able to be fully resolved and the person should return to painfree running (maybe with a few softer surfaces thrown into your running training regime!) Feel free to give us a shout.

Question:  Hi.  When doing a long run, over 6 miles I get a pain/stiffness in my right shoulder, going from my shoulder to my ear and down to my elbow.  It will remain for a day after the long run but fades away over the next few days.

Answer:  It is very likely that the pain from your ear to your shoulder and into your elbow is all related and coming from your neck or your upper back.  This can be caused by having a stiff segment of your spine, in the neck region and when you increase your running distance this loads your spine and can stress the stiff segment of your spine, such that the nerves in the area are irritated.  This in turn causes your symptoms.  I would advice that you have a thorough physiotherapy assessment by a physio who specializes in the spine as your symptoms should be straight forward to clear, once the stiff segment or segments of your spine have been correctly identified.  Hope this helps.

Question:  My right hip is constantly painful.  The pain runs down my hamstring and around the knee.  I can find the trigger point deep in the hip. I’m wondering what is causing this and what techniques I could use to help recovery.  I’ve had this injury for a few months now.

Answer:  Sorry to hear that your injury has continued for a few months now. This pain that you’ve described is unlikely to be originating from your hip. As all of our physios here at Apex Clinic have undertaken extensive post-graduate training in spinal and nerve pain we are very familiar with referral patterns ie which symptoms sound like they are originating from the lower back or from other areas of the body.  From what you have described it is much more likely that your symptoms are being referred from your lower back, due to a stiff segment in your spine, at an area where the nerves supply the hip and knee. There could well be secondary muscle spasm which is why you can feel the trigger points, however unless the stiff segment in your spine is mobilised, it is unlikely that your symptoms will fully resolve.  The fact that your pain has been there for months, suggests to us that you should have a full physiotherapy assessment.   Feel free to get in touch.

Question:  Hi.  I injured my left hip during a 10k run about 3months ago and now I can’t seem to get past 5k without pain.  I’m usually ok for the first 3-4 k then the pain kicks in.  Any ideas? Any hip strengthening exercises you can recommend?

Answer:  Without knowing the exact location of your pain it is difficult to diagnose where your pain is coming from.  But from the information you have given us, without examining you, it is likely that your hip joint has been over loaded from longer runs and as a result, muscle weakness around the hip can occur.  If that is the case, a progressive program of hip stability exercises would be recommended which may help to unload the hip joint to some degree and should in turn lessen or clear the pain.  The latest article on the NiRunning website on IT band friction syndrome (written by Rebecca Nelson, the Director of Physio here at Apex Clinic) provides three exercises that should be appropriate for you and are likely to help.  If these exercises don’t help your pain however, then a thorough physiotherapy assessment would be advised.  Good luck.