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

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Question:   I’ve been training for the Belfast Half Marathon and training has been going well until now.  I’ve started to taper a little and I’m feeling lots of niggles and my legs feel heavy, especially my hamstrings. Is this normal

Answer:   Sorry to hear you’ve been having these symptoms.  It is likely that the sources of your niggles are due to one of the following –

1. A build up of scar tissue in your hamstring muscles, which will require deep soft tissue massage to clear it.

2. Nerve pain and a feeling of heaviness, from a lack of nerve movement (of the sciatic nerve) in the back of your thigh. This is commonly caused by previous torn muscle fibres of the hamstrings, which attach to neighbouring nerve tissue in the back of the thigh. This then reduces the ability of the nerve (the sciatic nerve) to slide and glide normally with movement. This is known as altered neurodynamics, which can present itself as heaviness in the legs and niggles as you have described.

3. Referred pain from the lumbar spine (lower back). The spine is made up of vertebrae (bones) with spongy discs in between, creating a space which allows for shock absorption through the spine when we run. If there is any dysfunction (ie stiffening of 1 or more of the levels of the spine) the compression and repetitiveness of running, especially up hill, on hard surfaces and over long distances, may overload these segments. This can lead to irritation of the nerves leaving the spine and this in turn refers pain and other symptoms into the legs.

There are really no self management strategies to clear these problems and only a thorough physiotherapy assessment to distinguish where the source of your pain is coming from, is required to clear your condition. Feel free to give us a shout!

Question:   I’ve been getting a sore back for the last few months. The pain is in the lower back and is especially sore after long periods of sitting or lying in the same position. Running tends to loosen it up but I’m scared to continue with it without treatment in case running will eventually make it worse. Would you suggest any exercises to help this?

Answer:   As all Apex Clinic physiotherapists have undertaken extensive post graduate training in the spine and nerve pain we are confident, from the information that you’ve given us, that your symptoms are unlikely to get better fully unless you have the correct diagnosis and are treated accordingly.

The spine is made up of bones with discs in between which act as shock absorbers. If, for whatever reason, the discs/ joints become inflamed, this can irritate the nerve tissue beside it, causing local and/or referred pain. In order to treat this successfully a specialist spinal physiotherapist will diagnose the exact source of your problem and treat it appropriately. It is very likely that your pain can be cleared completely with the correct treatment.

If there is no leg pain, it may be worthwhile trying McKenzie push backs, lying down on your front twice a day, for 20 reps on each occasion (these can be easily found online). Standing bend-backs (arching backwards) with your hands on your waistband may also be helpful, 10 reps a few times per day, as well as breaking up periods of prolonged sitting with standing and walking where possible.

If the above does not fully resolve your symptoms, we would recommend a thorough physiotherapy assessment from a spinal specialist to identify your problem and to stop your symptoms progressing. By keeping on running it may become worse as this is loading the lower back segments, but if you plan to continue running the best advice is to reduce your mileage, keep to soft surfaces such as grass, bark or the treadmill and to stay on the flat.

Question:   I have been having shin pain for about 4 weeks, and attending a physio during this time. It looks like I have injured my anterior tibialis muscle. After a few weeks of resting, ice, compression etc., I went out tonight for a slow run and it was very painful after about 5 miles. Any advice? All swelling had gone down, and my shin was strapped too.

Answer:   Thanks for your enquiry. The good news is that virtually all shin pain can be cleared with the correct treatment regime and in nearly all cases, the person can return to running again pain-free.

There are a few different causes of shin pain and they are mostly treated differently.

1. A stress fracture – which can be diagnosed with an x-ray or a bone scan (organised through your GP).

2. Tenoperiostitis (inflammation of the tibialis posterior muscle attaching into the shin bone).

3. Nerve pain of the nerve running through the front of the lower leg alongside the shin bone.

4. Much less likely, compartment syndrome.

Rebecca Nelson, who is our Director of Physiotherapy here at Apex Clinic, Belfast wrote an article on shin pain, which you can read on the NI running website under the physio section, and under Running Articles, and this article gives you great information on the different causes of shin pain which may be worth reading for you.

If your shin pain continues for more than a couple of weeks it should definitely be reassessed again by an experienced physio, as if it’s poorly managed it could continue for months and even years. We would advise you to run on flat surfaces and try sticking to grass, bark or the treadmill if possible. 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 in the future). We would advise that you do try to avoid using ice or compression clothing at this time.

Feel free to give us a shout if you need further help or advice.

Question:    I’ve been having knee pain and clicking for the past 2 weeks. I’m not doing a significant mileage, approximately 20-25 miles per week. Any suggestions?

Answer:   This is hard to diagnose accurately without assessing your knee fully or knowing where the pain is. However, it sounds like it could be patellofemoral pain. This is caused by a tightness of the structures on the outside of the knee along with weakness of the muscle on the inside of the knee, which doesn’t allow the knee cap to glide up and down properly. This can be caused by an increased running mileage, increased hill work or generally overloading the area.

The good news is that with the correct treatment regime including specific stretches of the patella inwards and strengthening of the muscle on the inside of the knee, usually the pain can be completely cleared. An assessment of your foot biomechanics (the way in which your feet move) would also need to be done, to assess whether insoles need to be added in or not. At this point, we would advise a physiotherapy assessment by a physiotherapist who is experienced in treating runners and currently don’t do any strengthening exercises in the presence of pain.   Also, it’s important to avoid kneeling on your knees.  Any exercises which you undertake need to be done in a pain-free manner, as the muscle on the inside of the knee will not strengthen effectively in the presence of pain.

An exercise which may help you at this stage, if you’re not keen to see a physio yet, is to do step downs, standing on the knee which is clicking.  Stand on 1 leg, on a step, such as your stairs, and slowly bend your knee such that your knee is moving over your 2nd toe.  Only bend about ¼ of the way down and then come up again.  You can find this exercise online for a further explanation of it.  This exercise must be done with no pain occurring, and twice daily, performing 2 or 3 sets of 20 reps each time.  If you try this for 3-4 weeks this may clear the pain.  Otherwise you definitely need professional help!