Webchat with physio Matt Todman

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Comments

  • Hi Matt,

    I have a problem with the outside of my ankle starting to hurt after a few miles running. Often it then eases off but when I stop it can be sore for a few days. It started when I was doing a lot of muddy/snowy trail running.

    I assume it is my Peroneal Tendon and I do the usual RICE thing and it gets better in a day or so (at least doesn't hurt in normal life). I then just rest for a couple of weeks but then when I try to run again it starts hurting again.

    My main problem is how long to rest it as it feels fine when not running. Or should I be doing something else fother than just rest?

  • Hi Matt,

    Not strictly a physio Q but as you know about sports medicine....

    I was also having slight knee issues 2 weeks back after 20 mile run but physio gave me same advice you are giving & that seems loads better. However, following that I was off work with a virus for a few days. First comeback run was great but since then my 10k tempo runs feel awful & heart monitor shows BPM 5-7 secs higher for same pace as a few weeks back - so I reduced my effort. Feel like I've lost loads of fitness suddenly & cough cold may be returning! How long is this likely to last? Could I be OK for 21st April? Will I retain fitness despite illness? Any advice welcome. Physiologically what's going on?!

    Thanks, Mike
  • Hi Matt,



    New to running (eight months), completed first half about a month ago, think I upped mileage to quickly, knee now seizes up after only short amount of running, have to stop and head home. Once I apply finger pressure to TFL the pain goes, nbut side of knee still tender.



    Physio said it's weak gluteus medius causing ITBS, have been doing side leg lifts, lunges, squats, planks, to strengthen my core and glutes, but doesn't seem to be getting any better (been doing these for around three weeks) and I use foam roller and stretch the band / TFL as well.



    There's also a clicking noise in my hip area when I flex my left leg (the one with tight IT Band).



    Any advice on how long it may take to strengthen the glutes so they start working proplerly and can ITBS cause long-term damage?



    Thanks Matt.



    Mark
  • Chunky Chops wrote (see)

    Hi Matt, Last 22 miler last Sunday, broken toe on Tuesday, Xray had confirmed break of middle toe, on bone that is actually inside the forr (if that makes sense!). Any chance that I could run VLM? Plenty of RICE but still hard to walk on, Drs have said very unlikey - any thing you can recommend?

     

    Nope! lie in image

  • Richard Abbotts wrote (see)

    Hi Matt,

    I have a problem with the outside of my ankle starting to hurt after a few miles running. Often it then eases off but when I stop it can be sore for a few days. It started when I was doing a lot of muddy/snowy trail running.

    I assume it is my Peroneal Tendon and I do the usual RICE thing and it gets better in a day or so (at least doesn't hurt in normal life). I then just rest for a couple of weeks but then when I try to run again it starts hurting again.

    My main problem is how long to rest it as it feels fine when not running. Or should I be doing something else fother than just rest?

    Hi Rich

    Need to find out why....balance work is really important as is what are your shoes doing as is what's your running sytlee up to.

    No sure rest, in your case does much apart from prolong the waiting

  • Mike Scott 11 wrote (see)
    Hi Matt,
    Not strictly a physio Q but as you know about sports medicine....
    I was also having slight knee issues 2 weeks back after 20 mile run but physio gave me same advice you are giving & that seems loads better. However, following that I was off work with a virus for a few days. First comeback run was great but since then my 10k tempo runs feel awful & heart monitor shows BPM 5-7 secs higher for same pace as a few weeks back - so I reduced my effort. Feel like I've lost loads of fitness suddenly & cough cold may be returning! How long is this likely to last? Could I be OK for 21st April? Will I retain fitness despite illness? Any advice welcome. Physiologically what's going on?!
    Thanks, Mike

    Sounds very viral - and herein lies the problem. Which one, how and why

    Eat well, rest well and don't return too soon. Build up gently but positively

  • Mark Boustead wrote (see)
    Hi Matt,

    New to running (eight months), completed first half about a month ago, think I upped mileage to quickly, knee now seizes up after only short amount of running, have to stop and head home. Once I apply finger pressure to TFL the pain goes, nbut side of knee still tender.

    Physio said it's weak gluteus medius causing ITBS, have been doing side leg lifts, lunges, squats, planks, to strengthen my core and glutes, but doesn't seem to be getting any better (been doing these for around three weeks) and I use foam roller and stretch the band / TFL as well.

    There's also a clicking noise in my hip area when I flex my left leg (the one with tight IT Band).

    Any advice on how long it may take to strengthen the glutes so they start working proplerly and can ITBS cause long-term damage?

    Thanks Matt.

    Mark

    Sounds like some sound advise BUT the glut work must be functional - not on your back or not in a dynamic position. Think of training the control and when the muscle switches on and off rather than just getting stronger.

    ITBs can be problematic especially with the timing - stuff to do with a neuroimmune response. Ice, tape, foam roll and make sure your know why you've got it - apart from too much too soon, what about your stylee?

  • Slow_coach wrote (see)

    Hi Matt,

     

    Im in a similar position to MDC. I trained to 14 then 16m without a hitch (a month before the race so plenty of rest) and on race day on a 21m run on March the 24th and my knee went at mile 13.

    I did completed the distance with a combination of walking and running.


    I never had a problem with this knee before, no new trainers or anything odd like that.

    I used Dr Google and as my pain is on the outside boney part on the inner side of my left knee (as if I had knocked it), it sounds like it's patellofemoral pain / Syndrome.

    I can walk ok with no pain but yesterday I tried to run for the first time and it hurted within a few minutes so I stopped.

    I can cycle and swim with no pain.

    I have my first marathon (xc) on June the 8 and I m in desperate need to train!

    HELP!!

     

    Hi Slow coach

    Similar to MDC, and sounds like PFJD – but it’s not as advanced, yet! I think it sounds as if you’re feeling an over stretched medial retinaculum…..half of a bit a cling filmy tissue that keeps your kneecap on the front and in the middle of your thigh.

    Advice is pretty similar, but I’d add get some gluteal stability – lunges, squats, single knee dips, balance work ALL with really good body alignment so you feel your bum working. Taping is great too as long as it feels better when taped, rather than just taped.

    Do have a check of your knee to wall distance on the painful versus the non-painful side – it shouldn’t be tighter.

    Shoes all OK?

    Thank you Matt, much apprecciated. Do you think my marathon is still doable? how should I go about getting back to run training? image

  • Angela Muddle wrote (see)

    Hi Matt

    I'm due to run Paris Marathon this Sunday, but my right calf muscle has been extremely tight and causing me pain when I run.  I've run 2 marathons, and numerous half marathons over the past 18 months and never had any trouble.  My training had been going well, with gradual progression up to 20 miles, until about three weeks ago when my calf muscle gave out about 5 miles into a run on a treadmill (I'm normally an outdoor runner). I think the likely cause was a stupidly-high pair of stilettos I'd worn for a few days (including the night before the run) which probably shortened the muscle slightly, and then didn't cope so well with being stretched out on a flat treadmill.  It hadn't even crossed my mind at the time that heels would impede my training.

    I've spoken to a physio, had a sports massage, taken anti-inflammatories, done strengthening exercises, and tried to rest as much as I can (thankfully, being the taper weeks, i was winding down the mileage anyway).  I managed one 16 mile run just after the injury, but i've not done anything further than 3-4 miles for the past few weeks in case I exacerbate it any further....it has improved, but there is still a niggle of pain - sometimes minor, other times quite sharp.

    The problem is, now I don't know whether I am capable enough to do the 26.2 miles in less than 2 days time.  I know the run is challenging enough at 100% fitness, and I'll be lacking in confidence, for fear of it all going wrong part way through and having to pull out or hobble home.  My head says maybe just forget it and wait for an autumn marathon...my heart (it is the city of love, afterall!) wants to do it, regardless of the time, as I've spent months training through a bitter winter, and I'm heading on the train to Paris tonight anyway, with roam roller tucked in my bag!

    What are your thoughts, and what's your advice for the next 40 hours, if I do want to run? 

     Many thanks

    A

     

    Hi Angela

    It all depends on your shoes….I think they may have lost control and your calf is tight because it’s been over stretched due to the lack of control over a long period. The high heels may have been an accelerant rather than a direct cause.

    I think I’d be on the start line – after all it’s paid for and I’d enjoy a “fun” run. Whether you finish or not (and the not is important) is not the question, it’s how the injury feels. Its better to duck out at mile 10 and have enjoyed Le Paris vibe rather than finish in tears with a big hole in your calf….or you can sip a café au lait and eat an extra croissant because you can!

  • Angela Muddle wrote (see)

    Hi Matt

    I'm due to run Paris Marathon this Sunday, but my right calf muscle has been extremely tight and causing me pain when I run.  I've run 2 marathons, and numerous half marathons over the past 18 months and never had any trouble.  My training had been going well, with gradual progression up to 20 miles, until about three weeks ago when my calf muscle gave out about 5 miles into a run on a treadmill (I'm normally an outdoor runner). I think the likely cause was a stupidly-high pair of stilettos I'd worn for a few days (including the night before the run) which probably shortened the muscle slightly, and then didn't cope so well with being stretched out on a flat treadmill.  It hadn't even crossed my mind at the time that heels would impede my training.

    I've spoken to a physio, had a sports massage, taken anti-inflammatories, done strengthening exercises, and tried to rest as much as I can (thankfully, being the taper weeks, i was winding down the mileage anyway).  I managed one 16 mile run just after the injury, but i've not done anything further than 3-4 miles for the past few weeks in case I exacerbate it any further....it has improved, but there is still a niggle of pain - sometimes minor, other times quite sharp.

    The problem is, now I don't know whether I am capable enough to do the 26.2 miles in less than 2 days time.  I know the run is challenging enough at 100% fitness, and I'll be lacking in confidence, for fear of it all going wrong part way through and having to pull out or hobble home.  My head says maybe just forget it and wait for an autumn marathon...my heart (it is the city of love, afterall!) wants to do it, regardless of the time, as I've spent months training through a bitter winter, and I'm heading on the train to Paris tonight anyway, with roam roller tucked in my bag!

    What are your thoughts, and what's your advice for the next 40 hours, if I do want to run? 

     Many thanks

    A

     

    Ahhh Annie

    Sounds like an issue with your musculotendinous junction, rather than just the belly itself. The crunchiness is an inflammatory reaction due to the over stress.

    Here’s the plan. Do lots of single leg balance work for 40 seconds often during the day. Get on your (emotional) foam roller(coaster!) and roll your calf BUT not over the sore bottom bit. Make sure your shoes have enough support –it’s not the end of the world and there are options rather than attempting to change at this late stage.

    After 3 days of doing this (so Mondayish) start also walking around on tip toe for periods of 2 minutes  (which you can build if pain allows) – little and often and do this for the week until Friday. Now go for a paced run after rolling all normal things.

    Think of this as a pre taper, taper!

  • Slow_coach wrote (see)
    Slow_coach wrote (see)

    Hi Matt,

     

    Im in a similar position to MDC. I trained to 14 then 16m without a hitch (a month before the race so plenty of rest) and on race day on a 21m run on March the 24th and my knee went at mile 13.

    I did completed the distance with a combination of walking and running.


    I never had a problem with this knee before, no new trainers or anything odd like that.

    I used Dr Google and as my pain is on the outside boney part on the inner side of my left knee (as if I had knocked it), it sounds like it's patellofemoral pain / Syndrome.

    I can walk ok with no pain but yesterday I tried to run for the first time and it hurted within a few minutes so I stopped.

    I can cycle and swim with no pain.

    I have my first marathon (xc) on June the 8 and I m in desperate need to train!

    HELP!!

     

    Hi Slow coach

    Similar to MDC, and sounds like PFJD – but it’s not as advanced, yet! I think it sounds as if you’re feeling an over stretched medial retinaculum…..half of a bit a cling filmy tissue that keeps your kneecap on the front and in the middle of your thigh.

    Advice is pretty similar, but I’d add get some gluteal stability – lunges, squats, single knee dips, balance work ALL with really good body alignment so you feel your bum working. Taping is great too as long as it feels better when taped, rather than just taped.

    Do have a check of your knee to wall distance on the painful versus the non-painful side – it shouldn’t be tighter.

    Shoes all OK?

    Thank you Matt, much apprecciated. Do you think my marathon is still doable? how should I go about getting back to run training? image

    Yes, absolutely - with the right and sensible input.

    Get the things I mention above looked at and sorted, then slowly reintroduce by running paced pyramids. Your pain needs to be well controlled - too much and you'll take a step backwards not enough and you'll flounder...not the fishy type!

  • That's me done - laces undone.

    I'll answer any stragglers later.....

  • thank youuuuuu image

  • Not what I wanted to hear but thanks Matt

  • Thank you very much for your help Matt!

  • Thanks Matt.
  • Thank you, Matt! 

  • who can tell me where i can catch a cable car
  • is it good to bodybuild with light weight and plenty of reps 4 a marathon
  • what kind of training can you do when suffering from central sensitization? I am getting nerve pain up and down the left hand side of my body and its stopping me from being able to run

  • excited
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