Groin pain and strains

Article by Doug James (intraining physiotherapist and podiatrist)
Article by Doug James (intraining physiotherapist and podiatrist)

Groin injuries – What you need to know

Groin injuries are an increasingly common injury in distance runners. Previously it was predominantly footballers that would develop these injuries due to the forceful nature of the kicking movement, however runners are now reporting more injuries in this region. Despite being a ‘personal’ area of the body, assessment and treatment of these injuries should occur promptly to reduce the likelihood of it developing into a more severe and chronic injury.

There are a large number of injuries that can cause groin pain. While the pain can be due to injuries to tendons, muscles or ligaments in the groin itself, groin pain may be in fact be referred from an injury elsewhere which makes diagnosis more difficult.

Acute groin injuries

Doug_GroinpainAcute groin injuries are those that start suddenly and are usually due to muscle strains in the adductor muscles on the inner thigh. Adductors attach to the central part of the pelvis and pain can be felt anywhere from the knee to the groin. These injuries often feel like a tightness, however attempts to stretch the injury can exacerbate a mild muscle tear into a more serious injury. Continued bouts of stretching an adductor tear may induce adductor tendinitis which can cause long term discomfort that is difficult to settle.

Adjacent to the adductor tendon insertions is the pubic symphysis which is where the two halves of the pelvic girdle are joined together with cartilage. This cartilage can become irritated from adductor tendinitis – an injury known as Pubic Symphysitis – and can also be triggered from running on hard surfaces with poor shock absorption. If poorly treated, a more severe version of this injury, Osteitis Pubis, may emerge where part of the pubic bone is eroded, and a much longer recovery time is needed (including up to a year off running).

Osteitis Pubis is not the only groin injury that involves damage to the pelvic bone. Pelvic stress fractures are a dangerous injury, and shouldn’t be ignored. These often start as a dull, non-specific groin pain that will become sharper with running and exercise. A stress fracture can develop and requires a substantial amount of time to settle.

Imaging can be useful to help accurately diagnose groin injuries.

  • Ultrasound can identify soft tissue injuries such as adductor strains and tendinitis
  • MRI if often more effective to detect any damage to the bone.

When imaging fails to detect a problem in the area where the pain is reported, suspicion of referred pain arises. It is important to have your injury assessed by podiatrist or physiotherapist.

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Referred pain

Referred pain that is felt in the groin can originate from many sources including the hip joint (in the form of cartilage tears or joint inflammation), abdomen (abdominal muscle strain), and lower back (tightness and/or disc injuries). Due to the magnitude of potential areas of concern, a thorough examination is necessary with a podiatrist or physiotherapist.

Most groin injuries respond well to resting from activities that cause pain. Care needs to be taken with cross training as even non-weight bearing exercise such as swimming can exacerbate the injury. There is often a link between weak core and glute muscles and groin injuries. Improving core and lateral glute strength is useful as both a prevention and (at the suitable time) rehabilitation of the injury.

139x89-fromthesoleBe proactive in seeking help. Early diagnosis and management may avoid prolonged time out of training. If you have lingering groin pain, click on the button to make an appointment and start moving towards pain free running again.

For more articles From the Sole, click here.

Achilles injury and footwear

Article by Doug James (intraining physiotherapist and podiatrist)
Article by Doug James (intraining physiotherapist and podiatrist)

Achilles injuries and your footwear choice

Footwear can be a contributing factor to many injuries, and Achilles tendon injuries are often affected by your shoe choice. If you are currently suffering from an Achilles tendon injury (such as tendinitis / tendinosis, or bursitis) there are a number of footwear factors to consider.

Heel pitch

Many running shoes have a 10mm heel pitch (ie the heel cushioning is 10mm thicker than the forefoot cushioning). This tends to help reduce stress on the Achilles tendon by raising the heel higher towards the calf muscle. Running in shoes with very low or no heel drop can increase the discomfort felt in the tendon, particularly if you have tight calves.

Heel and ankle cuff height

DJ Shoe hee cuff height
Heel cup height on left may aggravate your Achilles

The height of the ankle cuff can impact an Achilles tendon by placing undue pressure directly on the tendon . While a higher ankle cuff often feels more stable, it may also exert pressure on the tendon, exacerbating symptoms.

Heel cup shape

While a narrow heel cup may help reduce heel slippage inside the shoe, it may result in pinching of the Achilles tendon. Compare the angled and rounded heel counters in the two shoes shown below. An irritated Achilles may find relief in a more rounded heel cup.

Notice width of heel cup between two shoes
Notice width of heel cup between two shoes


This was a brief snapshot of some footwear considerations to look out for that may impact your Achilles. If you have injury concerns or experiencing Achilles tendon pain, it is worth seeing a podiatrist at intraining Running Injury Clinic to have your injury, footwear and gait assessed.

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Is your gait causing shin pain?

Article by Doug James (intraining physiotherapist and podiatrist)
Article by Doug James (intraining physiotherapist and podiatrist)

Gait related shin pain

Running injuries are common. In a given year, runners have a 70-80% likelihood of developing an injury that will prevent them from running pain free for at least a week. While there are many different types of injuries that can occur, some people may be more prone to a particular injury while seemingly resistant to others. There are a lot of different factors that can account for this including age, sex, training history, biomechanics (and more) however of these, running technique is one of the few factors that can be changed.

It needs to be mentioned that no particular running technique can guarantee that you will be injury free. Different, and sometimes worse injuries can develop when people attempt to change their running style. The aim of this article is understand the types of shin injuries that can develop from running, and the factors influencing them.

Shin injuries are commonly lumped under the umbrella term of ‘shin splints’ by some medical professionals. This rather obtuse term neglects the specific location, onset and severity of the injury – all factors required for correct diagnosis and subsequent treatment.

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Running can cause injuries to muscle and bone in the shin
Running can cause injuries to muscle and bone in the shin

 Antero-lateral shin pain

Pain on the outside part of the front of your shin is usually related to the Tibialis Anterior muscle. This long muscle is responsible for lifting your foot upwards at the ankle joint. The muscle can become overworked if subjected to more exercise than it is used to and tends to become sore after the run, with pain disappearing a few days later. This injury is frequently seen in those that are new to running, or returning after time off from the sport. People that tend to heel strike (i.e. land heel first) are far more likely to be affected by this injury, and athletes are also more at risk if running in incorrect footwear – particularly if the shoe is too stiff (resulting in foot slapping), or lacks adequate pronation support.

Heel striking occurs when the runner’s heel lands on the ground first – usually in front of their centre of mass – and the further in front, the more of a problem this poses. In this position the Tibialis Anterior muscle is working to have the toes lifted higher than the heel to prevent tripping. The forefoot then rapidly lowers putting further strain on the Tibialis Anterior as it is responsible for the controlled descent of the foot. Once the foot is flat on the ground, the Tibialis Anterior may be subject to further strain if the foot heavily and/or rapidly pronates (rolls inwards).

The Tibialis Anterior can be put under even greater levels of strain when running downhill as this tends to amplify the slapping movement of the heel-to-toe progression.

Key points you should know

  • Your running technique can predict the type of injuries you get
  • “Shin Splints” is a commonly used term but utterly innaccurate
  • A running assessment can help identify faults leading to shin injuries

Postero-medial shin pain

Pain felt on the inside part of the shin along the edge of the tibia (shin bone) is often diagnosed as Medial Tibial Stress Syndrome (MTSS), or more recently known as Medial Tibial Traction Perisostitis (MTTP). Irrespective of the nomenclature, the injury usually begins as a broad area of discomfort along the inside part of the shin. This usually starts as a mild discomfort at the start of the run, but resolves after a few minutes. The pain is usually a response to an increase in loading along the edge of the tibia causing swelling around the periosteum (outer lining of the bone) initially, which can progress to bone damage thereafter. The increased loading is usually from higher running volume or intensity (or both) than is usual. Conjecture exists as to whether damage is due to force generated at foot strike, associated muscle tension from the Posterior Tibialis muscle, or some combination of both.

Training load plays a large role in the development of this injury, however there are certain gait factors that may increase the likelihood of developing it. Over-pronating can play a part in increasing the tension in the Posterior Tibialis muscle, which in turn exerts a traction force on the tibia. Overstriding (landing too far in front of the centre of mass) increases the initial impact forces transferred through the lower limb and shin that can also damage the tibia. Additionally, running in shoes that offer insufficient cushioning (i.e. are worn out, or offer less support than the athlete is accustomed to), and under-pronating can increase shock that also affects the tibia and lower limb.

Worse still…

Overstriding and heel striking are two common factors in shin pain
Overstriding and heel striking are two common factors in shin pain

With both of the injury areas mentioned above, after a sufficient reduction in training (and in some cases complete rest) for a suitable period, the injury will recover and heal. There are two notable exceptions to this however – shin injuries where pain becomes worse with running need to be investigated immediately. Sharp localised pain (on the front or side of the tibia or fibula) can be the sign of a stress fracture and should never be run on as this will steeply increase the injury severity and healing time required. Management usually involves rest (the amount of which can be calculated somewhat more precisely with the aid of an MRI scan), a fracture boot (in some cases), and a considered return to exercise plan.

The other critical shin injury not to miss is compartment syndrome. This is a dangerous injury where pressure builds up in the muscle sheath persisting for hours after exercise and can lead to permanent damage to the muscle and nerves in the leg and foot. This often requires surgery. If you suspect you have a stress fracture or compartment syndrome this should be investigated immediately.

For the injuries mentioned earlier, specific changes in running gait, footwear, and training can help to reduce the severity and reoccurrence of these injuries and possibly lead to better performance as well. If you’ve been dealing with running related shin problems, contact the intraining Running Injury Clinic for an appointment.

600x600-workshops-logoIf you are training more without realising the benefits of increased performance, it may be a simple modification to your running form that will result in the benefits you are looking to achieve. The intraining Running Injury Clinic conduct running form workshops on a regular basis.

If you are interested in improving your running form or reducing your risk of injury, sign up for the Running Form Workshop on 8 October or 3 December 2017.

For more From the Sole injury articles click here.

RunTalk Ep07 – What is Prehab?

runtalk-intraining-logoWelcome to RunTalk episode 7 with Steve, Margot and special guest this week – intraining Running Injury Clinic podiatrist and physiotherapist, Doug James.

This week together with our guest Doug James, we discuss how prehab should form an important part of your training regime. Prehab incorporates sports specific strengthening to assist with injury prevention as well as improving function and form whilst running.

Click here to listen to episode 7 of RunTalk

Episode 7: Strength and conditioning – with Prehab.

Featuring Guest: Podiatrist, physiotherapist and marathoner, Doug James

Doug_JamesPrehab is a proactive approach to avoiding pain and injury. A common afterthought with runners, often when it is too late and you are already injured. Prehab encourages strength work – including Pilates, running drills as well as stretching which assist in providing you with the foundation to running and staying injury free. Listen up and learn with our guest podiatrist and physiotherapist, Doug James on running specific prehab exercises that will help you get the most out of your running.

Click here to find out more about Pilates and strength and conditioning classes offered in Park Road, Milton.

About Doug James

  • Completed New York Marathon and Las Vegas Rock ‘n Roll Marathon
  • Qualified podiatrist
  • Qualified physiotherapist
  • New parent

Click here to check out the February edition of ‘From the Sole’ newsletter with some fantastic articles by intraining clinicians where you can learn about everything running.