Webchat with physio Sarah Connors



  • Hi Joanne, I’ve come across back pain prior to a period and if this is happening then it could be causing the calf to get all the p and n’s and numbness, this could be from an increase in hormones and ligament laxity but that’s not really my field. Why don’t you look at trying to cross train that week or do some gentle core work first to make sure the back is working and protected. I wonder if we are more dehydrated this week too, try uping the fluid intake and see if that helps. Sorry no magic answer!



  • Hi Sarah

    Another knee problem! I have pain on the inside of my knee . When I press the bone on the inside the pain increases. After about a week's rest the knee is pain free and there is no discomfort in the knee but the next ady the pain and the stiffness has returned.

  •  Hi John it’s difficult to predict how the body will cope with racing over a marathon. All you can do is make sure you have done all the right training including your long run and some race pace runs. Do you do a long race during your training ie a 20 mile? If so how do they cope then. If you are fitter and better prepared than last year that will help also getting your core as strong as possible so the fatigue sets in later and later preferably at the finish. It’s very difficult to stop and stretch at the end of a race best just to slow slightly let them recover if they will try and keep moving Stopping seems to cease you up even further.



  • Hi Tim can you jog painfree as this will be the most stressfree way back once you are ok with jogging you can bring in tempo so a faster pace for longer rather than short intervals. Can you hop painfree? This is always a good pre running indicator. Is there pain when you stretch the calf? Have you been stretching to ease the tightness. Also try stretching the hamstrings and lower back to ease the pressure on the calf. Try a foam roller to get rid os some more persistent tightness. To strengthen start with 2 leg calf arises on the flat then one then same only on a step.



  • Hi Reef if it’s painful to run then you need to ease back and allow the area to heal and strengthen it up see last post for exercises. If sore after then more stiff if the ankle is stiff then you may need some help to mobilise the joint. Watch it’s not the Achilles at the bottom of the calf as this can take hold and be really stubborn to shift.


  • Hi Michael if painful to run best tack is don’t as it will just make the ITB worse. Get a foam roller to roll the ITB and the tensor facia lata the muscle at the front at the top of the ITB. Also roll the gluts and start a glut strengthening programme with bridging and one leg dips with other leg supported by the wall making sure you have knee over second toe. Pilates is good to try if can’t run as will address all the above.

    Once painfree walking going up stairs you can try 5 mins running to see how it feels. Also check your shoes as incorrect shoes can be the cause.


  • Gary

    Sounds like you have damaged one of the hamstring muscles or the popliteus both sit over the back of the knee. Would be worth getting it checked out to make sure no underlying knee damage and to help you start realeasing the area and that above. If you can’t get help start with easy hamstring stretches and gradually increase the range with ice after.

  • Hi Girafe lady, Calf stretches are good for the Achilles leaning into the wall and progress to dropping your heel down on a step.

    For the hip the Thomas stretch is great if you can get some help, should be on the website, I’ll check. If not then a lunge stretch keeping your back straight will stretch the front of your hip. Try some bridging to help strengthen the gluts as well.

  • Hi john it sounds like you need to spend some time getting the ankle strong again as it’s getting lots of niggles around that area. I would probably put off the marathon until you can handle the training. Start with balance exercises standing on one leg then shut the eyes. Try one leg dips and calf raises so you can assess how strong the ankle is. 

  • Hi Martin did you go straight back into your normal training after your illness? Is then the body probably wasn’t strong enough to cope. When you say it turns to jelly do you mean the tendon or the muscle being weak? Look at the one leg function can you jump can it hop can it hop as far as the other one, back off the running and build back up the functional strength. Add one leg dips calf raises lunges and squats and see what the legs are like in comparison. I don’t like the idea of it turning to jelly! That’s not good so let these symptoms settle.


  • Hi Caf, be really good to see how tight your quads and hip flexors are they could have tightened up gradually with running and caused overload of the knee and tendon. You also need to look at the biomechs of you knee does it turn in on a one leg dip? Is the kneecap being pulled tight by the ITB on the outside causing impingement of the inside of the kneecap. Thomas test is a good way to assess quad and hip tightness and ITB if the leg is pulled out then tight ITB if pulled up then hip and try and bend the knee for quads. I’ll get Annie to ensure this is on the website.

  • Hi Phil have you had anyone assess your mechanics lately? Your spine could have got a lot stiffer and this could be contributing to the extra load. If you’ve tried rest then you really need some help to address the cause and reduce the scar tissue/inflammation around the tendon they can then give you s structured back to running programme.make sure though you see someone who is sued to treating runners so they can assess the cause and treat appropriately.


  • Hi Danny, Sounds like you have a tight quad and hip flexor, try stretching this area and see if that eases the ache. You have to be careful building up for a marathon to make sure you do the TLC stretching and recovery as well as the training  as you build up the mileage.


  • Hi Hollie sounds like you may have bruised the bone at the back of the kneecap. Try ice and stretching the quad and let it settle sometimes these areas just need to heal but get on the foam roller for the quads and try and ease off the pulling on the kneecap. Try moving the kneecap a bit yourself with leg relaxed move it side to side and up and down to prevent any stickiness beyond there and help it heal. If not settling go back to your gp and see if you can have an x rays well as physio. Once feels easier gentle loading 2 legs then one is best prior to running




    Hi Markus, I wonder if you had broken the 5th metatarsal at the time though you should see an old injury on x ray. If so it’s the bone healing you can feel. Is the pain bad to run or and getting worse? Then it could be a stress fracture in the area. Did you strengthen the ankle up properly and have treatment to ensure full range of joint mobility? If not you could have altered mechanics be worth getting it looked at if you can.



  • Hi Jamie if the foot is numb and gets weaker when running then get it checked by your gp as it could be a disc problem in your lower back Don’t try and run through it as you could do more damage and cause permanent weakness.



  •  Hi Hilary, As long as settling then ok as soon as starts to get more sore back off. As before vary your surface check your shoes and carry on with the stretches. Also try some self massage not into pain around it to ease the tightness along the shin bone but not over the bone.

  • Phil_HPhil_H ✭✭✭

    Thanks sarah, but it is really difficult finding a physio that is interested in people who go out and do proper exercise !

    You say 'address the cause' but the only hint I've had is poor blood supply if it is tendonosis - so how does one improve blood supply around the achilles when training in the winter ?

    I'm coming up to 2 weeks after my last 10k hill ace and I can do one-leg exercise on the bad leg now, so am thinking of restarting training very gently this time (so at least my dogs stop shouting at me )

  • Hi Louise, The ITB can be pretty persistent if you can get a physio session in to asses the cause that would help. Look at your trainers are they right or old, are your gluts weak can you do a one leg dip with knee over toe or does it turn in. try some bridging and foam roller the muscle at the top of the ITB the TFL.

    Running the half at this stage will probably make it a lot worse and damage your chances for Brighton see if you let it settle now to give you chance to train. Try some painfree cross training.


  • Hi Rachel, Yes sounds ok but don’t increase things while still not right make sure you have full range in your quads and hips and you’ve got good strength back in the joint it may just need some gradual loading. Try some kneecap mobs as mentioned earlier.

  • Hi Sarah

    I had to stop running last September when it became clear that an Achilles tendinopathy was gradually getting worse. I've recently been given stair stretch exercises by Physio Direct and am also doing pilates to work on core strength, as well as trying not to do much walking. My question is when do I know it's OK to start back? I went for a gentle 20 min walk/run this week, my Achilles started to be a bit sore after about 7 mins jogging but not very bad and not noticeably worse afterwards. Is it OK to gradually build up from this or should I wait until I don't have any discomfort at all before increasing distance or intensity?


  • Hi Sarah,

    At the end of September last year I sustained a bad stress fracture during an ultra marathon. Next week I have been given the all clear by my consultant to introduce running into my training, and by Easter should be back to full training.

    I'm pretty scared now about getting another fracture, and I'm not really sure how to strike the balance between over doing it and being to cautious, I plan to enter a 35 miler this September. Do you think this is acheivable, and could you give me some guidelines on how quickly I should increase my weekly mileage and intensity?

    Thanks, Jen.



  • Training for LA Marathon 17 March. Training went well until 4 week's ago I suffered from soleus complaint. Then while I rested I caught the obligatory "man-flu", so have run for no more than 7 miles 6 times over the last 3-4 weeks. Not been able to step up to 20-22 miles yet. Max distance so far has been 16 miles. I have now recovered but have only 4 weeks to go. Is the marathon still viable for me? If so, any advice on how I should now schedule my training?

  • Hi Geoff,

    I think what you are able to see is the heel position afftecting the positioning of the achilles. If there is such an obvious curve there then I would debate as to wether you are neutral at all. It may be worth getting a second opinion from someone used to treating and looking at runners mechanics. have you done any strengtheing work for the calf achilles region to rehab them? This should include eccentric calf raises on a step. If they are sore after walking then no running at the moment try some biking. I presume you have done some stretching to the area if you've had calf physio. I would like to see you run or have another opinion but may be worth more stable shoes if you pronate. A good podiatrist may also help with assessing your mechanics.

  • Hi, I am a runner, fitness instructor & personal trainer so it is really important for me to stay injury free. I am currently running 4 x per week in addition to my classes, clients and TRX sessions. I have a couple of quick questions 1) When is the best time to do a full developmental stretch (yoga for instance) and/or foam roll my legs?

    2) I have constantly got really tight calves and although I can manage I wondered if there is anything I can do to help them? I also have noticed that even though my trainers are fairly new I sometimes have mild pain in my feet at the end of a run and wondered if this is connnected?

    Many thanks in advance

  • Hi All, thanks for your questions so far! 

    Just to let you know we are having a minor technical problem but this should be sorted soon and Sarah will continue the webchat.

    Sorry about this!

    Annie image

  • Hi Peter, great that you are going to see a physio they should be able to asses you and give you a full suitable rehab programme, make sure they do. They also need to find out where the current knee pain is coming from is the back tight are the hip felxors quads tight? Are your gluts weak and does the knee turn in on one leg. They should then give you a core programme that includes thinngs like bridging and one leg dips. Good luck 

  • Hi Jen,

      Sarah seems to have gone for a long cup of tea (very deserved after all those answers).  I'm not an expert, other than having run for many years.  My view would be that it is only natural to be nervous about the stress fracture and you can only get over this by slowly building your confidence and fitness.  I wouldn't set myself a goal of a race in Sep at this stage.  Set yourself smaller goals and progress slowly, there's no need to rush.  To help reduce the risk, I would say do all the things that you can read about everywhere, cross-train, strengthen the muscles that support the area where you incurred the fracture, lots of stretching, try to run on soft surfaces, only increase mileage (max 10% per week) and intensity gradually, take a light recovery week every third or 4th week.  As your fitness and confidence returns the biggest risk will be trying to do too much too quickly - you have to really be patient.  When you feel confident to return to races, start with shorter races first and build back up to the ultras gradually.  Good luck !!

  • Hi Alwyn,

    do you have any pain if you cough or sneeze? What's it like if you sit up with your legs straight? This could imply a sports hernia and may need a repair worth getting this checked by your gp. Try some easy core exercises to see if you can build back up your abdominal strength so you are not continually stressing the area while running as you may then cause a hernia. Painfree exercises are the way forward initailly

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