Webchat with physio Matt Todman

13

Comments

  • That should read I havent had the barbecue out this week.....image

  • J77 wrote (see)

    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).

    It can be 6/12+ if they are really recalcitrant,  but there should be some good porgnostic indicators en route. There is a difference better not progressing fast enough and progressing on time...

  • thank you.

    Done a few marathons this year and never really taken a break. Got a virus that has stopped me running for a week, so hoping that has given the knee a rest as well. Will try and build it up more slowly but hard when you've got a marathon in feb.

  • Six Physio wrote (see)

    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?

    and you should see me trying these out at my desk ....

    In short, there is no pain at the moment, I am sure this has been brough on by excessive walking rather than running although it is now the running that is preventing me from progressing.
    The pain (loosely) is on dorsi flexion, first thing in the morning and usually only if I have done something the day before,  also the same evening
    I had no idea the sciatic nerve could have an effect that far down ... but to me it doesnt feel like a nerve pain but that is not based on anything scientific.
    My gut feeling is an overuse injury due to the walking (ironic as it seems) but it is taking more than ever to heal
    Would you reccommend a period of anti inflams at this late stage or just more patience?  image


  • mcs wrote (see)

    That should read I havent had the barbecue out this week.....image

    thank god, winter's coming!

    If it's whole foot then I'm not sure it's from the ankle or foot itself, but probably higher up. You're wearing great shoes that give stability and it's interesting that the pain goes up...

    Are you ever tight on the outside of your knee?

  • M...eldy wrote (see)
    Six Physio wrote (see)

    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?

    and you should see me trying these out at my desk ....

    In short, there is no pain at the moment, I am sure this has been brough on by excessive walking rather than running although it is now the running that is preventing me from progressing.
    The pain (loosely) is on dorsi flexion, first thing in the morning and usually only if I have done something the day before,  also the same evening
    I had no idea the sciatic nerve could have an effect that far down ... but to me it doesnt feel like a nerve pain but that is not based on anything scientific.
    My gut feeling is an overuse injury due to the walking (ironic as it seems) but it is taking more than ever to heal
    Would you reccommend a period of anti inflams at this late stage or just more patience?  image


    Ha!

    You need a controlled better, same or worse experiment. If it's overuse then do something that'll make it worse BUT then repeat it again wearing a different (more supportive) pair of shoes. Better, same or worse? If it's overuse it'll be worse. If it's more mechanical it may be better. Loathed to say take AI just for the sake....

  • daisydoodoo wrote (see)

    thank you.

    Done a few marathons this year and never really taken a break. Got a virus that has stopped me running for a week, so hoping that has given the knee a rest as well. Will try and build it up more slowly but hard when you've got a marathon in feb.

    Okey dokey - sounds like a plan

  • Hi Matt.

    I seem to be particularly vulnerable to foot problems- I've had a stress fracture in May, have the early stages of Hallux Rigidus and have potentially got another stress fracture brewing. Is there anything I can be doing to strengthen my feet and help stop this happening or am I just doomed to injuries? I'm a mild overpronator and run in Mizuno Wave Nexus shoes, fitted to me after gait analysis.

    Thanks for your help!

  • Matt .. thank you, that makes sense

    I'll try 10k in my stilettos    image

  • M...eldy wrote (see)

    Matt .. thank you, that makes sense

    I'll try 10k in my stilettos    image

    now you're talking!

  • Thanks for all your questions today, and a BIG thank you to Matt for joining us today - loads of great advice there.

    Katie RW

  • sarah marsbar wrote (see)

    Hi Matt.

    I seem to be particularly vulnerable to foot problems- I've had a stress fracture in May, have the early stages of Hallux Rigidus and have potentially got another stress fracture brewing. Is there anything I can be doing to strengthen my feet and help stop this happening or am I just doomed to injuries? I'm a mild overpronator and run in Mizuno Wave Nexus shoes, fitted to me after gait analysis.

    Thanks for your help!

    Yes!

    Have you seena decent podiatrist? You'll need to control the excessive motion and I think an orthotic given by the right person is a good place to start, but not the end of it. You should also think about Pilates and also what's above the foot and how much control you'll need of that...

  • Katie RW wrote (see)

    Thanks for all your questions today, and a BIG thank you to Matt for joining us today - loads of great advice there.

    Katie RW

    Thanks Guys & Gals

    It's been a blast....back off to work

    M

  • Thanks  for the help Matt.

  • He did. Matt responded to your question on Page 3.

  • ....if you can't answer cooking and running questions you're no use to anyone!
  • Ah - I have a cooking Q. Why did my second christmas cake not cook as well as the first?

  • Ah, the latent moisture content of a pre heated oven question....;)
  • image

     

    Hi - if you're still about and responding to Q.s looked at kneecap mobilisation - my knee cap doesn't appear to move at all. It's locked in place. I haven't used super glue. It was also hurting quite a lot yesterday after a day of cleaning - no running or swimming or cycling or playing hockey or any other form of abuse.

    Any ideas.

    hmm - just turned my leg inward from hip knee and ankle and it moves now.

  • Yes and yes!

    Kneecaps have to move. But they have a real tendancy to stick to the outside of where they should be, because of tightness in the structures that run along the outside of the knee and attach to the kneecap.

    This is your lateral rerinaculum, which is the end of your ITB - hence the rolling bit.

    It doesn't matter what activity you do, to stir this up, as long as your knee bends more than 35 degressish, as this is when your kneecap starts to move into a groove on the front of your thigh. There's oodles of this in cleaning....and beding and squatting and holding prolonged positions.

    You need to mobilise (or be mobilsed!) your kneecap, inwards to stretch the tigth tissue on the outsidd that hold your kneecap in the wrong position.

    When  you roll you leg inwards, the thigh bone rolls (inwards) under the kneecap, which in essence stays still (and so "apparently" moves more to the outside) because of the tightness and pull of the tigher tissues that sit on the outside of your knee.....your ITB

  • Thank you.

  • Thanks for the reply Matt, will you be doing a cooking only webchat next week?

  • next week, bread baking and achilles issues!

  • That's perfect. I love bread AND have achilles problems!

  • following my long run on sunday ive a pain in my left heel that has suddenly appeared without any kind of lead-up. Monday morning i could hardly put my foot on the floor and although ice has helped its still to sore to run on. The pain is on the sole towards the 'front' of the heel. It feels like a pin point pain which is quite sharp? 

  • ....if you want a diagnosis, it sounds alot like plantar fasciitis.

    The cause is the key to getting you back running pain free, rather than just feeling better from run to run.

    Have a good look at the support your shoes give (or not!), was this a big increase in speed, distance or terrain? Any knee, hiop or back pain?

     

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