Ask the Experts: Avoiding Injury Q+A with Sarah Connors

Morning all,

ASICS Super Six physio and ASICS PRO Team member Sarah Connors will be online 1-2pm today to answer your marathon - and half-marathon - injury questions.

Sarah is a chartered physiotherapist who has specialised in treating track and field athletes for the past 20 years. She has worked for the British Athletics Team and was lead physio for the English Institute of Sport in London before setting up a successful sports injuries clinic.

If you've got any aches or niggles from your training, or queries about the best ways to prevent injury during race training, then pipe up - Sarah's expert advice will keep you running strong.

We're opening the discussion now so Sarah will be able to get stuck in straight away at 1pm (rather than having to deal with too many questions all at once). That's enough from me - time to get posting!

Alice

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Comments

  • I strained my hip (apparently the right adductor) over a month ago and it is very, very slow in healing (as in, 5 weeks later i still can't run on it) - anything specific i can do (other than rest) to speed things up? and once it is healed, what can i do to strengthen it for the future? not running for a month has been one of the most frustrating things i've ever endured!
  • Hi Sarah,

    I've got a question myself actually! I strained my left knee medial ligament in a botched ski jump last February (I think you had a look at it on a training day in Birmingham, in fact!)

    It's ok now - I get no pain walking or running (I've only run up to half-marathon distance since then) but I definitely notice something still odd when I kneel down or squat. It's like there's something moving that shouldn't be?!

    Should I worry about this - is it connected? Could it affect my running over longer distances? And if so, are there any exercises I can do to continue sorting out my wonky knee?

    Thanks!

    Alice

  • Hi Sarah,

     I regularly run 4-5 times a week with my long run (10-11 miles) being on a Saturday and mid-week runs being around 5-8 miles. My mid-week runs are fine but when I do my long run, I get to around mile 7/8 and I begin to get some discomfort in my left knee and right hip. My hip hasn't been causing me as much trouble as what it has done, but my left knee still causes me issues and feels like it is going to give way at times.

    I had some physio last year on my right knee following a football injury and I was told that my hips are not fully straight and that my legs lean/bend inwards whenI bend down.

     Is there anything that I can do to help eliminate this discomfort and help with knees and hips?

    Thanks,

    Jamie

  • Hi Sarah

    I've laid off running for a couple of months as I was getting a lot of little injuries followed by a torn hamstring in the latter half of last year.

    I've just started back doing a few 5 milers and found that my knees start hurting straight away when I start but starts to ease off after a couple of miles, but still with some discomfort. I do stretches before I start and after I finish.

    I've found the worse one is the leg I damaged the hamstring in.

    Is there anything I can do to help combat this?

    Thanks
  • After doing my longest run so far (14 miles) I've got blisters under nearly all of my toenails or the very ends of my toes. I wear 1000 mile socks, and my shoes were properly fitted after I had a gait analysis. (I am a neutral-gait forefoot-striker). Any tips to avoid this in the future?
  • Hi Sarah

    I had a inguinal hernia op on my left side two weeks ago today. Should I do any rehab before i start back running orjust start of with gentle jogs and see how it feels. And when would you start those?

     Thanks

     Adrian

  • Hello, question for you. While out running last weekend I started to get a lot of pain along the top of my foot / tendon which goes to my big toe.

    If I lift the front of my foot up it's extremely sore, I stopped exercising for a few days but went running last night (6 miles) and its back again.

    My shoes are asics gel nimbus 11's which I've had for over a year. Done about 500 miles in them with no issues. Does this sort of injury sound like its down to the age of the trainers?

    What suggestions do you have to releive the pain as I've got the LVM this yearz

    My budget to purchase new shoes is very limited.

    Cheers 

  • Hi Sarah

    I have had 2 sports massges so far on this campaign with 1 more due at the end of March to help ease the muscles, particuarly my calves as I have had a couple of issues with cramp in a marathon. Are there any exercises/stretches I can do to compliment the massages and if so how often should these be done? I have also noticed my calves are a bit tighter generally. Thanks.

  • Hi,

     i did a short 4 mile run 2 weeks ago and notice slight pain in my left knee the day after, went out to do 13 miles last saturday, it started to niggle at 5ish and by 10.5 I couldn't run on it all, by the time I walked back I couldn't put any real pressure on it. Had 2 sports massages this week and the pain has allievated did a a test run of 3 miles last night, it went through a range of different pain levels and today I can definetly feel it! The lasy who did my massages said it was too much pressure??? I'm not sure. The pain is all round the knee cap with more pain to the left side of it today - any advice greatly appreciated have mk half next sunday!! Thanks Sian

  • Hi Sarah,

    How important is stretching and regular sports massages in injury prevention? I know runners who do both and still get injured and I know runners who do neither and don't get injured. What would you advise?

    Thanks,

    mitiog
  • Hi Sarah

    Do you have any view on whether yoga or pilates is best to help maintain flexibility and work on my core strength.  Would one be better than the other in terms of running benefit?  Realistically I only have time to do one or the other and enjoy both. Or should I do maybe one session of each per week? Would I still improve my proficiency if I mix and match?

    Thank you

    Sleepy

  • Hi Ash Mann,

    If you've hurt you're hip you need to look at the cuase, was it a sudden injury ie pulled muscle if so then could take 4-6 weeks to settle with a stretch and strengthening programme. Or more likely a gradual onset where the wrong forces are on the muscle causing it to overwork ie because the pelvis and lower back are tight and out of line and the gluts aren't working properly.

    have you had an physio assessment? If not i would think about it. also try some core work activating the gluts with bridging and plank to take the pressure of the adductor.

    Hope that helps

    Sarah

  • Hi Alice,

    it sounds like you may have a very samll tear in the meniscus inside the knee and it catches when you kneel or squat. i prob wouldn't do anything with it at this stage as not causing any pain.

    good to do genereal knee circuits to keep the knee strong ie small sqauts and lunges.

    Sarah

  • Hi Jamie,

    it sounds like you have issues with your core and your biomechanics, you are prob ok on shorter runs but when you wind up on the long ones the core gets more tired the pelvis drops and this causes the knees to turn in more.

    you need to check your trainers and make sure you have the correct ones for your gait and they are giving you enough support a good running shop will do this for you. you also need to start some strength work and core to give you the inner strength to hold your form when you run further.

    A general circuit is a good starting point squats lunges calf raises plank bridging try twice a week 3 sets of 20.

    Good luck

    sarah

  • What are your thoughts on the minimalist running revolution?

    i've been struggling with medial knee pain for approx 12 months, following an impact injury whilst playing football, that is severely effect my ability to do a decent amount of mileage.

    I've had physio and a biomechanical assessment which resulted in being prescribed orthotics, but still have an annoying niggle.

     i'm now considering going down the minimalist route (admittedly after reading the barefoot 'bible' "Born to Run") to see if evolution can cure me!

    thanks, 

  • Hi lfc runner

    have you done any rehab to strengthen the torn hamstring? You need to specifically strengthen a muscle if torn and stretch it as it heals with scar tissue which is inelastic.

    Try some prone (on front) hamstring kicks to start with lying on stamach kicking heel to bum slowly then increasing speed.

    This can also be done in standing. try some bridging to see if the gluts rae working or are the hamstrings doing all the work shouldn't feel them doing a bridge. If this is the case your hamstrings have been overworking which is the cause of the tear and you need to also work on your core.

    You also need to strtech the quads and hip flexors and if these are tight then the knees can be sore.

    try the Thomas stretch and see if legs hang to a straight line or are hips tight and knee lifted.

    thses exercises should all be on the website if not Alice can you put them up again!

    Thanks

    Sarah

  • Hi Lady 1

    sorry no great tips for this other than vaseline over the toes or try and see if a shoe slightly bigger helps

    Sarah

  • HI Sarah

    For a couple of months now i've been getting lower back pain and stiffness around there and down the back of my legs beginning about 10 mins into a run, it eases off around 50mins in and dissappears completely after about an hours running.

    Obviously those first 50mins are not much fun - any tips/advice?

    Thanks

  • Hi Sarah,

     Thanks for the advice and info. I have been doing some core exercises for a few weeks now, which I'm hoping has contributed to my hip not giving me as much trouble.

    As for trainers, my current pair are 'off the shelf' trainers, so I will definitely be investing in some gait analysis to get the correct pair next time. I'm running the Milton Keynes Half a week on Sunday, so it's probably a bit too late to be getting new trainers for that race.

     Thanks again,

     Jamie

  • Hi Adrian,

    have you been given a rehab programme and guidance from your surgeon? they normally tell you when to start with running and exercising dependant on the repair.

    If you have the all clear then to def need to strengthen the area as well as very light jogging. Any area that's had surgery will be weak. Start with abdominal contarction just holding the muscle tight then add some pelvic tilts and small inner range curls ie knees bent up, then try and slowly start to straighten one leg bring it back then the other.

    You must keep your back flat the whole time to prevent any damage from weak muscles stop if any pain and progress slowly if you feel your back lifting/ arching then the exercise is too hard and go back to an easier point. Also start adding bridging and plank on your knees to start with.

    make sure though you've had the all clear from the surgeon.

    Sarah

  • Hi Sarah,
    It was a sudden thing caused by over-ambitious intervals on a treadmill.
    Physio assessment seems like the logical next step.
    Cheers!
  • Hi Oracleboy,

    it sounds like tendonitis of the msucles that lift the foot and toe, did you have your shoes too tight?

    One thing to check is too feel the shaft of the bone and check there is no underlying boney tenderness causing the inflammation.

    Does the toe/ tendon creak if so this is def inflanntion of the tendon and you need to give it a bit longer to rest ice is good for inflammation. It does sound like your shoes are at their tale end but not nec caused this i would thinka bout a new pair if poss if you are running the marathon as you will be doing high mileage.

    Give it a week and reasses if you can get some treatment that would help. try and release the muscle belly to the tendon follow the tendon olong the front of the shin and it will feel tender in the muscle use your fingers to do some soft tissue release hold the msucle and stretch the foot away.

    Good luck

     Sarah

  • Thanks for the advice Sarah.

    I do the plank if that's what you mean with the bridge, and I normally hold it for a minute and and side plank as well.

    I will do the exersises you have shown me here.

    Thanks again.
  • Hi Sarah

    I'm not sure if you can give an answer just on a few facts but I thought it was worth a go.

    I'm training for VLM.  Training has been going well, I'm following the RW sub 3.30 plan.  Hit 50miles in a week, completed the first 20miler.  After a Sunday 20 miler I was fine.  Rested on Monday and Tuesday did a 5 mile tempo session.  Again, no problems.  Then by weds afternoon i had a strange sensation in my knee which was moving around a lot - up my quad to my glutes.  A little pain, something not quite right.  I did the sensible thing and rested for a week.  After that I did a slow 4miler and the next day had a bad case of DOMS.  The problem hadn't gone away..

    I had a sports massage last night at Birm Uni, they didn't see any particular issues, just recommended I do foam rolling.

    It's probably a biomechanics issue as I know one leg is slightly shorter than the other - (neutral in one foot and pronate in the other!) I have been doing pilates for a while now which is excellent.   But I can't afford to keep resting!! 

     I'm wondering whether it could the trainers. I'm on 375 miles in my asics 1160s.  The supersix team last year at the selection day recommended them for me and I've never had problems before.  In your experience can a simple thing as replacing shoes really help?  I thought 375 miles was still ok.  Perhaps they do need changing.  At the moment I'll try anything!

    Any guidance would be appreciated. Thank you.

  • Hi Knight Rider,

    you should really be doing a regular stretching campaign now as you are deep into training, I would include some lower back stretches rotations knee hugs and push up on arms as well as core work. You will be getting into fatgue in training now and so need to unwind all these effects as much as possible.

    A good one to link the lower back and calfes is to lye on back leg in air pull foot down 3x10 with a towel not holding the foot on stretch this is a nerve stretch which will help release the calfs. the key thing though is to keep that core stroing and be able to hold your form during long runs. I'll be able to help next sat with some extra work.

    Sarah

  • Thanks Sarah, I've found myself doing more stretching than previously - will try that towel foot stretch this weekend.
  • Hi Sian,

    pain around the knee cap is normally caused by tight quads, these prob got tighter and tighter through your training until on the long run the kneecap starting rubbing as it's being pulled into the wrong place and yes as the muscles rae tight they add extra pressure on the kneecap against the bone.

    you really need to release these muscles by stretching the quads and hip flexors, the best way is the Thomas stretch see website and get someone to help you v gently push the knee down so you feel a comfortable strtch not pain.

    if you can do this then try and stretch the quad in a lunge position keeping the back and stomach tight not letting the pelvis tilt.

    Ask your sports masssur to help you stretch the quads.

    Good luck

     Sarah

  • Hi Sarah

     I have only just taken up running as a way to increase my fitness for Tae Kwon Do. However I have found that my shins really hurt while I'm running and the following day I have painful ankles. My trainers were fitted professionally by a well know store as I am quite flat footed.

    Any advice?

    Thanks

     Wendy

  • Hi Sarah,

     Saw a physio on Tuesday because I've developed posterior shin splints in my right leg. She showed me some stretches to do, but I've forgotten how often I should be doing them image I've been doing them twice a day - is this enough or should I be doing them more often?

     Thank you!

  • Hi Mitiog,

    yes some do some don't very frustrating. On the whole a stretching programme to unwind tight muscles is a very good thing once or twice a week.

    Sports massage is a great recovery tool and helps release tight muscles if you access this monthly esp in hard training great.

    The stretching is very easy to add to your weekly programme and is a really good way or having active recovery on an easy day. If a muscle it tight it will stay tight unless you adress the issue.

    Some peolpe are more injury prone than others and you will find because of this they tend to do more to combat it those who aren't injury prone only start when they get a problem.

    A good habit is to have a stretch ahome 2x per week.

    sarah

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