Q & A from Injury Clinic on Thursday 7th November 2013:


Question:  Following a hill session on Monday night, my calves were sore on Tuesday, and then even worse on Wednesday. This is not an injury pain, but more soreness from working hard. How long would you recommend leaving it before running again? Is it ok to run even when my muscles are sore?

Apex Physio Belfast Clinic:  This certainly sounds like it is a typical DOMS (Delayed Onset of Muscle Soreness) which is often at its peak 2 days post exercise. Usually on the days of DOMS we recommend that you stretch the affected muscles, twice daily 5 X 20sec holds on each muscle group. In terms of resuming running you could certainly run again gently on Thursday (today) low mileage and on a flat surface only. A gentle run again on Saturday could be done and then resume your normal running routine. Never resume hills until the calf muscles feel fully recovered or you run the risk of a tear.  Sports massage is great for DOMS and for competitive / serious runners it is recommended once monthly. Most runners who receive it usually swear that it significantly reduces any DOMS they feel.  Best Wishes!

Question:  At the moment I am having a bad pain in the arch of my left foot. It has been diagnosed as Plantar fasciitis and treated by both injections and physio but I need some advice on how to prevent this becoming long term as it has happened on both feet and I don’t want it to be a recurring thing

Apex Physio Belfast Clinic:  In most cases a Plantar fasciitis which doesn’t fully clear or keeps recurring suggests that something in the rehab programme has been missed, as in most cases this condition is treatable and clearable if treated correctly. I am assuming the biomechanics of your feet have been fully assessed, and orthoses (insoles) have been provided if needed.  From here we recommend testing the muscle length of all relevant lower limb (leg) muscles and adding any appropriate stretches from any muscle imbalances that are found.  Also, if the arch pain has not fully cleared we recommend assessing if the nerve tissue is involved in the sole of the foot from potential scar tissue that has formed over time from the plantar fascia and finally, we would assess if the lower back is involved in referring pain to the arch of the foot, as well as any local foot involvement.  So, really rehab of PF is multifactorial, and if any of the factors which contribute to it are missed, rehab is often not fully successful.  If you are not fully cleared of it soon please feel free to contact us regarding a reassessment.  Thanks!

Question:  I am training for a marathon and during long runs my right shoulder gets very sore. Any idea what this could be? Is it running related?

Apex Physio Belfast Clinic:  This kind of pain in your shoulder does not sound like a local shoulder problem. If there has been no specific shoulder injury this pain is extremely likely to be referred pain coming from the lower neck/ upper back region of the spine due to stiffness of a few levels of the spine in this area. Running is often a trigger for this pain as it is a high impact sport in terms of the spine as the spine is loaded and jarred throughout running. Often this pain is less severe when running on a softer surface.  There is no real way for you to treat this yourself, you really need a thorough assessment to identify where these symptoms are coming from and treatment will mobilise/ loosen the affected segments. At Apex we treat this problem on a daily basis with great success.  In the meantime stick to softer surfaces (grass, bark or treadmill) for running.  Thanks.

Question:  Is there any treatment for pain in the inside of the left knee when running?  It is a burning pain.  I always wear a cloth support which helps a bit.

Apex Physio Belfast Clinic:  There are many causes of inside of the knee pain such as a torn cartilage, arthritis in the inside compartment of the knee (in older folk), medial ligament overstrain etc. But in your case, the fact that you used the word “burning” may suggest that your pain has a nerve component to it, as irritation of nerve tissue classically causes burning and most of the other causes of inside of the knee pain don’t cause a burning pain.  In order to get to the root of your problem, a detailed assessment would really be needed.  In the meantime, it’s important to have your foot biomechanics assessed to ensure that poor foot function when running isn’t contributing to your pain. If it is, then insoles may be needed.  Sorry that we can’t be of any more help, as an assessment is the only real answer! Thanks!

Question:  I had a bit of tightness in my IT band during Causeway Ultra.  It was no big deal but got very sore in the subsequent weeks.  I ran Dublin last week and it came on very sore after 3 miles.  I ran today for the first time in a week and a half and the pain in my knee was unbearable. I could also feel it tight through the hip flexor. How do I get rid of this quickly? Can I run through it? I need to run!

Apex Physio Belfast Clinic:  Firstly, the fact that you described the pain as unbearable when you ran today, means that yes, you should definitely get a thorough physio assessment ASAP as something could go bang, rip or tear if you don’t!!  It isn’t recommended that you run through unbearable pain as this suggests that you will do damage by continuing.  After a physio assessment has been done to establish the correct diagnosis, such as a possible ITB friction syndrome with maybe some local knee involvement also, there is a good likelihood that you may be able to continue gentle, low mileage running while you receive physio treatment, so you’re not actually stopping running, just backing off slightly while you get it sorted.  The longer that you continue running through unbearable pain, the longer it’s likely to take to get it cleared! Again, having your foot biomechanics assessed is vital to see if insoles are needed or not.  Think about the longevity of your running life and get it sorted quickly, thanks.

Question:  I’ve an ITB problem, mainly sore going down hill. Should I stop running until it’s better or can I run and do ITBF syndrome exercises? Any advice is appreciated. Is there a strap I can wear while running to ease the pain?

Apex Physio Belfast Clinic:  As a starting point, you could try – doing ITB stretches twice daily, 10 times 20 sec holds.  You can find these on the net.  You could continue running but reducing your mileage and avoiding hills completely and seeing if this helps. It’s also vital that the biomechanics of your feet are assessed to see if insoles are needed or not, and to ensure that your running trainers are correct for your foot type.  Try this regime for approximately 3-4 weeks.  If it doesn’t clear you will need a proper physio assessment to get the correct treatment regime started. It is extremely likely that you’ll make a complete recovery and full return to running.  Best wishes!

Question:  I’ve been suffering an Achilles injury over the last few weeks.. I’ve been having physio sessions for this along with no training.  I’ve been off training now for 4 full weeks!  The physio has also said that the soleus muscle is a bit tight.  I’ve been doing exercises throughout the day to try to help. What would be the best training recommendations for starting back? Maybe grass work? etc.  I’m currently using my bike, trying to keep my fitness up.

Apex Physio Belfast Clinic:  You should only resume running when your TA (tendoachilles) pain has gone completely ie no pain first thing in the morning, on walking after prolonged sitting, on any prolonged walking for more than half an hour to 1 hour.  Once you are pain free eccentric strengthening exercises should be started ie toe ups on a step with both feet then lower slowly with the affected foot only, doing approx 15-20 reps twice daily. This is then progressed to include the same exercises with a bent knee on both sides for soleus.  Dynamic exercises should then be added.  In terms of running, once you are fully pain free you can start a very gentle walk- jog- walk etc routine, such as 5mins of each walk and each jog, starting from 10mins in total and gradually building it up from there. Gently… as a remodelling or repairing tendon likes a bit of stress while healing.   Always start the jogging and then running on a soft surface (grass, bark, treadmill).  Do not add hills until you can run 45mins on the flat symptom free.  Best Wishes!

Question:  I’ve had a tibialis anterior tightness for a few weeks.  It’s an annoying pain that I can’t seem to shake.  I’ve seen a physio and had a number of massages.  I’ve even rested for a week.  The numbing pain still exists if I run the next morning after running the day before, which can hinder running 2 days in a row.  I always ice and use compression guards for support.  I ran the Dublin marathon recently with it.  Any advice would be great.  Thanks in advance.

Apex Physio Belfast Clinic:  This most likely sounds like it is something which is called, ‘altered nerve dynamics’. which means that the nerve which runs down the front of your shin (the deep peroneal nerve) is not moving freely. This certainly will cause a numbing feeling, which is often indicative of nerve problems, tightness and even pain. In most cases, compression socks will actually make it worse as it squashes the nerve and reduces its movement further. Also ice usually worsens the problem too, as the nerve tissue will get more irritated by ice.  We specialise in nerve problems at Apex and advise you to book in for an assessment as this problem clears in nearly all cases. Sports massage will not help this problem in the long term and is not recommended as it may even worsen the symptoms by annoying the nerve tissue even more!  Many thanks.

Question:  Can I ask how long a stress fracture (metatarsal) takes to heal? I was told not to run for 8 weeks but that seems to be the standard overcautious medical advice – could I start again gradually once the pain has gone? Thanks for your help.

Apex Physio Belfast Clinic:  The answer is definitely NO! Even with mother nature working at her fastest your stress fracture can’t heal in less time than 8-12 weeks!! You should definitely not start running before 8-12 weeks.  If you do, you will delay bone healing and could end up with malunion problems.  We promise!  We would recommend that in order to prevent this happening again you should have a thorough biomechanical assessment of your feet with the prescription of orthoses if required as really the key thing here is to identify WHY this stress fracture happened in the first place.. and prevent it from ever recurring in the future.  Many thanks.

Question:  I have had a pain in my left foot running from my heel down to the ball of my foot. If I try running, I can’t strike the ground properly and afterwards it’s hard to put my foot on the floor.

Apex Physio Belfast Clinic:  This sounds like it could be due to, again, from a previous question tonight, a lack of nerve movement of the nerve in the sole of the foot, called altered neural dynamics of the tibial nerve.  It means that this nerve is not moving freely and doesn’t like being tugged, i.e. it doesn’t like being tugged as you heel strike when running, therefore flat foot running is often less painful. With this problem you may find that running down hill is more painful and running faster is also more painful.  You will need to have your foot biomechanics checked to see if insoles are required or not and otherwise you really need a thorough assessment and the correct treatment regime started to clear the pain and restore the mobility of the nerve.  The beauty about this treatment regime is that it includes a few specific home exercises for the person to do themselves to help to clear the problem, and in private practice this will reduce the number of sessions needed to clear it, in most cases!  Best wishes!

Question:  What is the quickest way to get a soleus strain back on track?

Apex Physio Belfast Clinic:  To start with, you should do twice daily stretches of the soleus muscle (knee bent)-you’ll find these easily on the net if needed, and do 5 times 20 second holds on each session.  It’s also advisable to stretch the gastroc (knee straight) too, so that you don’t get any scar tissue between the two muscles. Don’t run in the early stages, but you could keep up your running fitness by aqua jogging or just keep up your cardiovascular training by using the x trainer for example.  Depending on the severity of the strain, once you are mostly pain free when walking then start eccentric strengthening of the soleus, which is done on a step, by doing toe ups on both feet, knees bent but then lowering on the affected leg only , slowly and do 2-3 sets of 15-20 reps twice daily.  The only thing about doing all this yourself, is that if you have a significant amount of scar tissue in the soleus muscle then when you return to running, it may tear again. So, if it’s a bad strain, you should see a good physio for soft tissue work to supplement your stretching and strengthening program.  Best wishes with your rehab!

Question:  I keep getting blue toenails and they are very painful but eventually they fall off after a few weeks. I have tried everything, bigger trainers, trainers with larger toe box and specially made insoles. I seem to claw my toes when running.  Do you have any advice?

Apex Physio Belfast Clinic:  We recommend that you see our chiropodist/podiatrist who specialises in running related foot, nail and skin conditions. You certainly sound like you’ve tried most things but I wonder if a soft, custom-made toe splint may be appropriate here. I think that it would definitely be worth a reassessment as there is likely to be a solution.  Best wishes!