Webchat with physio Matt Todman



  • MCS - Yes!

    Start simple. Is it your shoe lacing or fitting? Where is the P&N’s?

  • one leg balance is good as i do a good session of plymetric stuff each week,if that makes sense


  • Hi Matt

    I have a history with achilles problems on my right side following a calf tear and a scm tear in the achilles back in 2005/2006.  I followed a rehab programme under the guidance of a physio and have continued with running/cycling/swimming since then.  I have always been aware of the problem and on occaisions I get the morning tightness and never run on consecutive days and I suppose have managed what I now treat as normal.   I do my exercises (less religiously I admit) heel drops and stability work, stretch and roller and gym work.  I have completed 20+ marathons and 5 out of 7 Ironman events

    Roll forwards to this year and following a fair amount of walking around various Olympic events I seem to have developed a problem on the opposite heel, I believe this is the very bottom of the achilles insertion point rather than anything PF related as there is no pain on the underneath of the foot at all and no tightness, the heel feels bruised and occaisional tightness in the morning, I have done very little running since July/August as it never seems to feel 'right'.   I am unsure as to how to progress with rehab as this one has me a little stumped
    I have continued with cycling/rowing/gym et.c

    I am sorry for chapter and verse but the history may well be relevant !!!
    To pinpoint the location if that helps, if you were to draw round your foot whilst stood on a piece of paper, it would be where the pen touches the heel at the back  image

    Many thank yous !!

  • Gaz - sounds more like a back issue rather than a direct hip problem due to the time it takes to come on when running.

    You don't need to have back pain with a back issue, but I'd go for trying to run tall, not overstride and get some more movement into your thoracic spine. I think I'd stay away from stetching your hip

    Have a try of this stretch: Roll up a towel as if your heading off for a swim. Put it on the floor and put a pillow at the top of the towel, like a "T" shape. The pillow should be bigger than the towel. Now lie on the towel (between your shoulder blades) with your head on the pillow and shoulders off. Bend your knees and hang out here for 10 minutes. It can be painful.....but should feel like you're lying on a towel.

  • Tempo Tom -

    Simple! You need to get your stiff thoracic spine moving more and better. The lower back moves too much, and so is painful.

    You need to change your work and possibly your running posture. Stand, sit and run tall.

    I wouldn’t train with pain – the issue being that the back pain causes the stabilizing muscle to fail and fall asleep. In doing so you’ll temporarily loose the stability that these muscles provide to your lower back. This increase the instability and pain, making your thoracic spine (mid back) stiffen in compensation…..and the process goes around.

    Get more movement in your thoracic spine and learn to stabilize your low back

  • Colin -

    Sounds very PFJ (kneecap!) – the 90 degree is the give away. It’s where you load your kneecap up maximally during a squat.

    The back of the kneecap is covered in cartilage and is thickest on the portion of kneecap that takes the 90 degree load. If you’ve over loaded or poorly loaded the cartilage then it starts to fail, and the bone below (subchondral bone) become irritable and painful.

    It does need a bit of rest and a period of time where you don’t over load your kneecap in this range. Foam roll your ITB, try taping your patella (or get someone to) into better alignment and really concentrate of ramping up the control around your pelvis (glut med), knee cap (VMO) and foot (tib post).

  • Great thanks. Daft as it sounds I now have symptoms of shingles but without any skin rash.  Doctor says it could be some injury related neuralgia but I'm feeling this on my right side.  Any chance of the two being connected?

  • M.....eldy - Wow! You've got heaps of miles and experience under your belt...odd that it's the other heel.

    I take it because you are pretty OK with the rehab aspect then we shoud look at other things that may or may not be so obvious, such as your sciatic nerve, that can very much feel like this. And as with one of the qustions above you need to differentiate the nerve from the achilles - if your stretch your achilles and feel the pain at the boney point can you change it if you moves another part of your body? Head on chest or bending forward from the waist?

  • Gaz......maybe, just maybe!

  • Jennifer Hitch...

    Very much follow you OS advice and the protocol. The tear in essence is not the issue. The why is – and it can be from not so obvious things such as spinal mechanics.

    You’ll start NWB and be advised to get into a pool to increase range and flexibility. You’ll need to work on strength and stability. Take care with too much load and rotation (initially). With a bit of luck you’ll be starting to run within 12 weeks, after some bike, trampet and gym work.

  • Neets..

    Either, or, or a touch of something else! What springs to mind to when symptoms jump from 1 side to the other is that there is often a central (pelvic or spinal) cause. Have the specialists had a good, long hard look north of your symptoms? I’m pretty sure where you feel your symptoms are not where they originate.

    There are however a few things that can mimic Achilles pain such as a wound up or irritated sciatic nerve (which can be assessed by either SLUMP - above this Q or SLR testing) or a dysfunctional tib post muscle (put your foot on the ground with your toes going up the bottom of a wall, lean forwards so that you bend your knee towards the wall. Is it tighter or more painful than the other side?)

    I agree with you, there is little point just crashing on with training without knowing why you’ve got issues. I’m sure (and I know!) there is someone who can help assess you further and give you the correct advice.

  • Louise P

    Parkrun has to be one of the best things you can do on a Saturday morning. This combined with all of your other activites is a great combo. Therefore your symptoms are a total pain!

    I think it all sounds pretty simple….and the blame lies with your shoes! You’re not over training, you’ve got good variance, not massive distance and your symptoms are relatively diffuse.

    Go for the easy option. Make sure your shoes marry up with you foot posture, I'd drop by your local specialist running shop for advice.

  • Mi0805r

    Knee and after running symptoms generally point to a subchondral issue – sounds scary but it’s not. The cartilage that surrounds the joint doesn’t have a nerve supply, but the bone underneath (subchondral) does. It takes repetitive loading of the cartilage surface to irritate the subchondral bone and produce pain.

    The clicking and locking with the above are really indicative of an issue with your kneecap. Either it doesn’t move (track) well enough, or there’s a inflammatory process happening under your kneecap. They either can coexist or be totally independent of each other.

    Quickest way of getting from A to B is try taking a 5 day course of anti inflams (if you can and not on an empty stomach) and try foam rolling on your ITB. If this helps, then you need to improve the control and stability around your kneecap and hip.

    As a Postie do have a good long hard look at the shoes your wear at work. If they don’t give enough control (just like running shoes) then try a week in different shoes to see if there is a difference.

  • Pins and needles are in the foot and up to the knee after running. I wear Asics Gel Kayano 17s and find the right foot where I get them is the one that turns in the left foot doesn't turn in at all. Could do with a neutral shoe on the left foot and a slightly built up one on the right I guess or just go for more neutral shoes.  I dont really overtighten the laces though.

  • Shelby Williams wrote (see)

    I get pins and needles and numbness in my left foot after about 4-5 miles.  I have had Chiropractic treatment, physio, different shoes, different lacing structures and new insoles.  It is better than it was as it doesn't travel up my leg now (it used to go up my leg to my knee and would stop me running) now I can generally run through it, but its frustrating.  Any ideas?




    ah....I knew there was a way

    Hummm, it all depends on where the P&N’s and numbness is. Is it true numbness, as in can’t feel it versus an altered sensation? It’s also interesting that the pain goes up, rather than classically down the leg.

    It sounds very neural (nervous), but functionally related rather than just a structural issue. What happens if you run 3 miles, stop then run 3 miles again?

    I think this is about the way you run and the way that you fatigue, as you run. This may give a functional compromise (as in what you do rather than what you’ve got) to your neural tissue, producing the symptoms. I don’t think you need hands on treatment, but it sounds as if you need a good functional rehab program to improve endurance and form.

  • mcs wrote (see)

    Pins and needles are in the foot and up to the knee after running. I wear Asics Gel Kayano 17s and find the right foot where I get them is the one that turns in the left foot doesn't turn in at all. Could do with a neutral shoe on the left foot and a slightly built up one on the right I guess or just go for more neutral shoes.  I dont really overtighten the laces though.

    The whole foot? Top or bottom?

  • Lapaz wrote (see)

    I only run very moderately. I wish I could run more as I find it very enjoyable.

    When I first started running I suffered from calf cramp. I now take sports salt tablets to overcome this issue. I generally suffer from shin splints. I manage my running around the problem.

    I've been to a recommended running shop to get advice and new shoes. I started as a heel runner but I've adjusted my techique so that I now land on my forefoot with my foot landing under my body. I was previously overstriding.

    I've found that when I run out doors (generally on grass) that the shin splints return if I have more than two 5K sessions a week. Due to the approach of winter weather I currently do my running on a treadmil. I've found that the shin splints no longer appear but the calf cramps do!

    Does this situation give you any insight in to what I may be doing wrong, or am I just a peculiarity on nature?!!



    Hi Graeme

    Anybody who changes technique from heel strike to fore foot running needs to be coached, especially if there is a whiff of injury in the air.

    It’s controversial at best and can sometimes mask more issues than solve them, but if you can, can and if you can’t, can’t!

    I’m sure you’re not a peculiarity, but do need some thought hence the running action. The main difference between out/indoor running is that outside you need to propel yourself up and forwards as the land stays still and you move over it. The forwards bit means that you can land heavier onto your forefoot – often the cause of shin splints. However on the TM just going up (and not forward) leans to an imbalance between your muscles at the front and back of your shin – namely tib ant and tib post, which could be interpreted as your calf.

    It sounds as if you’ve got an imbalance issue between these 2 muscles and foot position, which I’m sure is not unrelated to your running style….

  • J77 wrote (see)

    I was diagnosed with insertional achilles tendinpathy 6+ months ago. Haven't run in almost 8 weeks however, I bike for 20-25 minutes 3 times per week and started weight training. I've been following my physio's advice of light stretching, clams, one leg squats, planks and bridges for the last 3 months. Light stiffness is still present along with minor pain at the point of insertion. Should I be 100% pain free 100% of the time before slowly getting back into running? Or can I start again while still experiencing stiffness and minor discomfort/pain? I don't experience any pain during physical activity, only after periods of inactivity (sleeping, extended time sitting down, etc).


    Hoorah for light stretching! Tendon issues, wherever they are, are over stretch issues. They do not need to be overstretched. They need to be restored to optimal length and not stretched to within an inch of their lives. Stretching will make them feel better, as receptors are “knocked out”, but it will never, ever get you better. As you're not dealing with the cause of the problem.

    Light stretching is therefore on the money! Restoration of length please, no more.

    Stiffness can be an indication of an ongoing inflammatory process. Your rehab appears to only have 1 functional (one leg squat) exercise – and you need more, but the one thing you are not doing and have to be doing is eccentrically loading your tendon. You’re allowed mild pain, and do it on the flat.

    You don’t need to wait to be 100% pain free for 100% of the time, as your Achilles needs progressive loading to restore itself to normal function. A good graded and paced running program is a must. Try something as simple as walk for 1 minute run for 1 minute to complete a total run time of 5 minutes. Repeat 3 days later and again in another 3 days. Then run for 2 minutes and walk for 1 minute for a total run time of 10 minutes. Repeat as above then run for 5 minutes and walk for 2 minutes for 15 minutes. You’re allowed mild pain, but no more.

  • just realised that I'm not being ignored.just that he is working backwards on the list image

  • Oscarsmum wrote (see)

    At 43 I have recently returned to running (with my surgeons approval) after 6 hip surgeries, including 2 to reconstruct my hip sockets due to dysplasia. Hips are fine and I regulary stretch etc and keep trying to work on strengthening glutes and quads with squats,clams, bridges side leg raises etc...but Achilles seem to flare up easily, could this be related to weaknesses further up and what exercises are best to help, apart from heel raises and stretches on stairs? I am trying to increase my mileage slowly, presently averaging only around 17 a week with the longest an 8 miler. I am hoping it will be possible to complete some half marathons next year.


    Well done for getting back out there – it may be well worth your while getting your running assessed by someone who can. Having corrected your dysplasia you’ll need to move and run very differently.

     Strength is good, but if you can’t control that strength you'll loose stability and replace it with rigidity. If the top bit of your kinetic chain too “stiff” when under load, then the bottom bit (Achilles) has compensate and move more because the top bit won’t.

    Stay away from over stretching your Achilles – you’ve already got an over stretch issue. Try releasing your calf’s instead by using a foam roller or a massage dude. You also need to improve the strength of your Achilles by working on an eccentric loading program. It’s the lowering down bit that’s critical, rather than the lifting up bit when doing a heel raise/drop. Increase mileage slowly is really important, as you’ll need to progressively load up.

  • daisydoodoo wrote (see)

    Can I follow on from that ITBS question.

    During a race a few weeks a go, I suddenly got a pain on the outside of my knee.

    I've self diagnosed it as ITBS...that might not be what it is. 

    I got rid of it after two weeks only for it to come back worse when I did the next race. 

    I've googled stretches, and will try those. But what else will help, marathon training at the moment and have had to step it right back. Should I still be doing things like spinning, body pump? Never had problems with my knee before, so this has come a bit out of the blue.

    Thanks, will tune in next week image


    Think you might be right!

    Friction syndromes are just that. Something (your ITB) rubs over something else (the outer bit of your knee). Alot.

    This can be due to poor mechanics at your foot, knee, hip and pelvis. It can be due to poor technique – either how you run or how much you run and in what time.

    I’m going for too much too soon in view that it improved within 2 weeks, but returned. Think of it like a scab – it needs a bit of time to heal and if you start picking it too soon it’ll break down again…

    Keep spinning, keep body pumping keep running BUT smaller, shorter and smarter distances. Bung some ice on after exercise and roll your ITB using a roller. Keep it simple….if this doesn’t progress then we’ll need to have a look a biomechanical causes.

  • Also-ran wrote (see)

    ITBS - this is back to revisit me after a recent injury, but on my other leg. Last time I had this I strength trained my why out of the problem - the focus was on glutes, TFL, and hamstrings, and trying to loosen up the quads. Do you have any tips on dealing with ITBS, or are there too many causes to give specific advise.

    Do you advise complete rest or to continue with running?

    ITBS – can either rear its ugly head as a trochanteric bursa (pain on the outside of your hip) or a friction syndrome (on the outer part of your knee) either way I’m not sure you’ve dealt with the cause of why you had ITBS, more like you’ve dealt with the symptoms.

    You’re working all the right muscles BUT if you are only getting them stronger, without improving the control, stability or timing (when it switches on and off) of the muscles then you are where you are.

    Do think about using a foam roller on your ITB, practice single leg squats with great form, control and balance. If it makes your symptoms worse then stop, don’t train through pain. But if you do this correctly (and have good foot posture and shoe control) and keep your rehab “run functional” you’ll find that you can get on top of your symptoms, because you’re dealing with the cause.

  • kittenkat wrote (see)

    Burning question: Is BBQ food really more likely to give you food poisoning?

    Another question, I run on cambered roads and so, apart from running in the middle of the road (which I can do mostly as they are country lanes), is there anything I can do to overcome the camber in terms of potential injury? My gait is very neutral and I'm a light runner.

    (That actually is a serious question for those of you doubting me, I think that all my injuries in the last few years have been due to the road camber changing my gait)

    BBQ food? Maybe, if your meat is burnt on the outside and raw in the middle or drops on the floor before it lands on your plate….but then again you don’t need a barbie for it to do that!

    Road cambers do contribute to nagging injuries, just as continual running in one direction around a 400m track can do.

    There’s not too much you can do with regards to orthotics, shoes or running style. How about running there and back rather than a circuit?

  • seren nos wrote (see)

    whats the best exercises for  strengthening weak glute muscles


    You’ve got 3 gluts, all of which slightly differ in function. Strength in no substitute for stability and control….and if you’re coming back from injury or rehabbing an injury these will not help, but they will get the muscle(s) stronger.

    Glut Med: Clams, side lying leg out to the side, pelvic drops, single leg squat, planks with leg out to the side

    Glut Max: Single leg bridge, lunge, single leg dead lift, ballistic hop.

    Don’t worry about Glut Min, feel the burn, keep a very close eye on form…..

  •  seren nos wrote (see)

    just realised that I'm not being ignored.just that he is working backwards on the list image

    ...never ignored image

  • thank you


    no injury at the moment..i believe that they are the cause of most of my nigglesimage

  • Thanks Matt! In your experience what's the average recovery time for chronic insertional AT? I know everyone is different but I'm wondering if 6+ months is a bit extreme (I'm 35).

  • T.mouse wrote (see)

    I fell over in the summer, in the process bashing my left knee on tree stump / root? I don't actually remember. I hurt myself enough that I wasn't able to get up immediately. I had to walk 3 miles to pushy then cycle 8.5 miles home.

    My knee appears to be fine when running except when running downhill and that isn't consistant. I had a week out in the summer and forgot that I had hurt my knee afterward. Had no pain or discomfort for several weeks. However, I cycle commute and a couple of weeks of high mileage running and cycling and my knee started to hurt again in the same way. Swimming breaststroke will also aggravate it.

    I can't really quantify or identify the pain. If I kneel or knock my knee it will hurt. If I straighten my leg after sitting for a while it will hurt but then not. It doesn't hurt day to day, running doesn't hurt it, doing too much cycling can but yesterday I did a 10 mile sprint and didn't notice it.

    It seems to be related to getting a little stiff or tired and mostly moving in a sideways motion. ( I can't side step for example). Bit difficult to identify and work out what hurts as I can't induce pain, it'll hurt once then not again even if I do the same thing.

    For the most part it doesn't hurt unless I knock my knee or do too much. I can be no more specific about the pain than that, it's not behind the knee and not above the knee but anywhere in a u shape around the knee.

    Any ideas or anything I can do?


    Bashing anything that is boney is going to be painful – bone bruises, bleeds and hurts! So you learn to adapt the way you move but taking load off of the painful bit and putting it elsewhere.

    Turning your foot out slightly helps. This also lets your knee & thigh roll in and tissue at the front of your hip becomes tighter….but not enough for you to notice.

    The knee feels better, but how the kneecap sits on the front of the knee is in an “apparently” different place, because the thigh (& knee) has rolled in. Cycling, with the foot fixed exaggerates this, causing irritation behind the kneecap – as does swimming. Running downhill is also key, as the lack of control and the pull of gravity exaggerates the poor mechanics.

    Funnily enough the lack of easily identifiable and unrepeatable aggravating factors does make this look like a patella (kneecap) tracking issue, so does “not sure where it hurts” bit.

    I’d go for rolling on your ITB, a short blast of anti inflammatories (if you can) and see if you can stretch the tissue on the outside of your kneecap, by mobilising your patella…YouTube it! If you feel better with this, you know you’re on the right track.

  • seren nos wrote (see)

    thank you


    no injury at the moment..i believe that they are the cause of most of my nigglesimage

    Great! Stay that way....

  • The whole foot? Top or bottom.
    Its the whole foot and up into the lower leg but only on the right hand foot and leg.  I do about 30 miles or less most weeks.  I have had the barbecue out this week thoughimage

Sign In or Register to comment.