Physio webchat with Matt Todman

Tired shoulders after that first swim?  

Right here on Friday at 1pm (May 10th) physio Matt Todman from Six Physio will be joining us for a live webchat to discuss all your early season niggles as we head into the Tri season.

Matt qualified as a physio 20 years ago and has spent the past decade at the forefront of sports medicine. He works as a consultant in private practice dealing with everyone from elite level runners to beginners.

Have you got a physio-related question for Matt? Post your questions below.

«1

Comments

  • Hi Matt,

    I’m grateful for the opportunity to raise this question with you as “Dr Google” has thrown up a myriad of possible issues with few obvious solutions…

    I have a ‘clicking hip’.

    My running biomechanics are poor but at 30 years old (I’ve been a hobby runner / triathlete for only three years) and relatively heavy set, it would seem there is little chance of drastically changing these.  The most obvious defect is the rotation in my right foot is greater than my left which results in it turning out (say 35-45 degrees from straight forward) whilst running, to a greater degree in the Marathons I run biannually.

    The clicking hip is on the right hand side and is definitely not the top of my IT band.  Days, weeks and months will often pass without issue and indeed I’ve covered a few 26.2 milers without provoking the problem but when it does present itself, I can feel a physical “clunk” (nothing audible) as the muscle / tendon / ligament passes over the hip area.  If it presents itself during a long run, it will often serve as a catalyst for problems in other elements of my right leg, notably knee and quad.

    I regularly visit a sports masseuse and she recently suggested “the ligament(s) might not be sitting correctly” and that we should try some manipulation of the area.

    I am keen to hear what you think and what you suggest my next course of action is in trying to remedy the issue.

    Thanks in advance.

  • Is there such a thing as a phantom injury?

    I have had 3 big races where I have been in agony the week before (knee, foot, hip) - with no history of trauma - that's left me limping, fretting and visiting physios, only to find absolutely no symptoms on race day at all, before, during or after the race.

    Can pain be in the head sometimes?

  • Good afternoon Matt,

    I am currently struggling with a strained priformis causing sciatica. I am under treatment with a chiro but this does not seem to address the cause.

    What would you suggest as a long term fix as this seems to haunt me on and off.

    Also, is it detrimental to think about low intensity training while in pain or is complete rest best?

     

  • Are there any stretches you can recommend for a triathlete who ends up with massive knots in the top of  her shoulders about half way along each collar bone? They seem to be an issue whatever phase I'm doing.

  • Hi Matt, I've recently upped my cross training, including boot camps, gym classes and know I haven't taken enough rest time, I stupidly tried to throw a 1/2 marathon run in the middle of that ( plus the usual aerobix, body attack ...all high impact ) I started to feel tightening up the back of my left leg that pinched into my bum at mile 9 but as I was out doors I was committed to returning to my car , I walked the last mile. The following day I could barely straighten the leg so I rested for three days and attempted a 10 k this morning managing half of that outdoors n then I came back n stretched n managed a more comfortable 2 mile on the treadmill. I visited the local uni for advice from their osteopath and they felt that my left side was slightly out of alignment. I had massage treatment and see them again in two weeks. They said I would be ok to try to continue exercising from tomorrow but that I should spend more time to warm up 

  • Sorry, I was trying to have your opinion or to grab some extra advice re, stretches or treatment. My whole leg goes tight from the arch of the foot , up the calf and up the leg into my hip and bum. Thank you for your time hope I explained well enough. 

  • I am fairly new to long ish bike routes and at the start of the year acquired a defy 3 composite. My first road bike with drop handle bars.

    When i go out for a longer ride - 40+ miles / 2 hrs ish my left hand especially goes numb / tingly. Its always the little finger and sometimes the next one in as well.

    The bike is set up for me, via the shop - but they did it with me there - checking sizes and fits etc, but am i thinking this is a bike fit issue?

    After a couple of days it goes away again.

    Any advice would be great.

  • When I ran a marathon the last 2/3 miles were agony - not because of my legs but my lower back! Every step caused me pain in my back, and when I finished I realised it was grossly swollen - I had totally lost the curvature in my back. It was tender and I couldn't have anything touch it. It resolved itself after about 24 hours. 

    I never had anything like it in training, although only ran about 21 miles in training. 

    I do intermittently get very mild lower back pain - I think due to poor posture and occasional poor liftinag at work. Never had any swelling since but I'm worried it will be a problem when I do an ironman. 

    I thought it might be poor posture/weak core. I now work on my core twice a week at the gym. 

  • I have had knee problems for a couple of years, the symptoms being mainly the symptoms of ITB and possibly piriformus syndrome.

    I have been to 2 osteopaths, a chiropractor, a podiatrist, a CHEK exercise person, pilates classes and a physio so far, tried different shoes, tried barefoot shoes, rested for ages and also tried to run through. So far, nothing has helped (and yes, I did do all my exercises I was told to do!)

    The last person I saw said that, because the symptoms haven't shifted even though I have been told my body responds well and adjusts itself after treatments, there is something 'not firing properly' somewhere in my back, or trunk.

    I've not been able to run for more than 30 mins for over 2 years because of this, and it is very rarely pain free even at that short time (I was previously running half marathons and training for a marathon) - do you have any advice or suggestions please?

     

  • A quick Q in advance 

    Having seen a physio I am managing a likely retro calcaneal bursar, have built up from no miles following a months rest, this has been ongoing for best part of a year!

    I am using ice massage, heel drops, calf strengthening and am part way through a transition to a more mid foot gait, I rarely have any pain now when running, varying degrees of a feeling of bruising afterwards and minimal effects the next morning, I have really good dorsi flexion and hopeless plantar flexion!

    what exactly is a bursar, do they 'go' completely or is it a case of reducing the inflammation? Anything else I can try to get back to 'normal'?

  • Hello Matt,

    I seem to suffer from tight calves, which in recent months has caused my left achilles to become inflammed and sore to touch/pinch after running & racing.

    I've taken it easy over the past month in training to allow me to race hard on two occasions. Each race has required a long warmup to get achilles to work. The day after each race I have been stiff but not sore, even on the achilles.

    My last run was a 10km race on the 6th May. Today my achilles is not sore to touch when extended, though there is feeling if I pinch it when slack.

    I'm now on a proper rest from running though still cycling to maintain fitness.What can/should I do to resolve the calf/achilles issue, and yet allow me to smash a 5km run at the end of a GBR qualifying triathlon on the 26th of May?

    Many thanks.

  • Six PhysioSix Physio ✭✭✭

    1pm....The starting gun

  • Six PhysioSix Physio ✭✭✭
    Proven Robbie W wrote (see)

    Hi Matt,

    I’m grateful for the opportunity to raise this question with you as “Dr Google” has thrown up a myriad of possible issues with few obvious solutions…

    I have a ‘clicking hip’.

    My running biomechanics are poor but at 30 years old (I’ve been a hobby runner / triathlete for only three years) and relatively heavy set, it would seem there is little chance of drastically changing these.  The most obvious defect is the rotation in my right foot is greater than my left which results in it turning out (say 35-45 degrees from straight forward) whilst running, to a greater degree in the Marathons I run biannually.

    The clicking hip is on the right hand side and is definitely not the top of my IT band.  Days, weeks and months will often pass without issue and indeed I’ve covered a few 26.2 milers without provoking the problem but when it does present itself, I can feel a physical “clunk” (nothing audible) as the muscle / tendon / ligament passes over the hip area.  If it presents itself during a long run, it will often serve as a catalyst for problems in other elements of my right leg, notably knee and quad.

    I regularly visit a sports masseuse and she recently suggested “the ligament(s) might not be sitting correctly” and that we should try some manipulation of the area.

    I am keen to hear what you think and what you suggest my next course of action is in trying to remedy the issue.

    Thanks in advance.

     

     

    Hi Robbie

    Hips can make a myriad of different noise from clicks, clunks and deep seated thunks.

    The foot rolling out is the clue. Our role in life (well, apart from a few other major ones!) is to get our knee caps facing forward. You’ve got an internally rotated femur – your thigh rolls in, and so does your kneecap. To get this pointing forward you point your foot out, which compensates for your rolled in thigh.

    Your thigh rolls in for a major and a not so major reason. The former is poor gluteal control and the latter is a boney issue, which can’t be altered.

    The clunk is the rotation of your hip in your socket and the deep muscles at the front rubbing across it. I’m not sure I’d worry about stretching the hip, which will make it feel (temporarily) looser but instead really work on improving your hip and pelvic control and not necessarily strength.

    Have a

  • Six PhysioSix Physio ✭✭✭
    Britrisky wrote (see)

    Is there such a thing as a phantom injury?

    I have had 3 big races where I have been in agony the week before (knee, foot, hip) - with no history of trauma - that's left me limping, fretting and visiting physios, only to find absolutely no symptoms on race day at all, before, during or after the race.

    Can pain be in the head sometimes?

     

     

    Yup, absolutely. It’s far more common than imagined. Just recognise that it can happen, understand it and crack on. If it doesn’t get better within a few days – seek advice

  • Six PhysioSix Physio ✭✭✭
    Iron Muffin wrote (see)

    Good afternoon Matt,

    I am currently struggling with a strained priformis causing sciatica. I am under treatment with a chiro but this does not seem to address the cause.

    What would you suggest as a long term fix as this seems to haunt me on and off.

    Also, is it detrimental to think about low intensity training while in pain or is complete rest best?

     

     Absolutely agree with you. Piriformis strain, syndrome or tightness is a description of symptoms and very, very rarely a cause. There needs to be a really distinct clarification between a tight muscle and stiff muscle – but they’ll feel the same.

    A tight muscle generally implies that the equal and opposite muscle is not be used and is (possibly) posturally controlled. This can be stretched to feel better, but until the opposite muscle is rehabbed then the symptoms will reoccur.

    A stiff muscle is due to an increase in muscle tone, which is most likely to be a protective mechanism, and shouldn’t be stretched. Ever.

    I think your piriformis is stiff to protect your sciatic nerve, not causing it. Why is it stiff is the question. The most common cause is a really stiff thoracic spine making your low lumbar spine relatively unstable (to the thoracic spine). The unstable lumbar spine causes your sciatic nerve to become irritated and your muscles (not just piriformis) contract to protect it and attempt to stabilise your lumbar spine. It fails woefully and just increases lumbar spine shear and joint compression.

    Get your thoracic spine treated, don’t go near your lumbar spine or piriformis. This is the worlds greatest thoracic spine stretch on RWIC http://www.runnersworld.co.uk/health/video-stretch-on-holiday/9575.html

  • Six PhysioSix Physio ✭✭✭
    AliBear30 wrote (see)

    Are there any stretches you can recommend for a triathlete who ends up with massive knots in the top of  her shoulders about half way along each collar bone? They seem to be an issue whatever phase I'm doing.

     

     

    Hi Ali

    Any stretching around this area will make you feel better, but it’ll never get you better. The 2 are very different things.

    Here’s why.

    It’s most likely because you poke your chin out when swimming, biking or running. And you do this because you’ve got a super tight thoracic spine, which is great at bending forward, but can’t reverse and bend backward. You’ll cheat spectacularly by either bending your back backwards or poking your chin out to see where you’re going.

    The muscle tightness is a product of what you’re doing to your neck and the opposite muscles (lower traps, serratus anterior) not doing very much.

    Get more movement in your thoracic spine and improve the control of the muscles that look after your neck. This RWIC stretch still rocks http://www.runnersworld.co.uk/health/video-stretch-on-holiday/9575.html

  • Six PhysioSix Physio ✭✭✭
    Cheryl Griffiths wrote (see)

    Hi Matt, I've recently upped my cross training, including boot camps, gym classes and know I haven't taken enough rest time, I stupidly tried to throw a 1/2 marathon run in the middle of that ( plus the usual aerobix, body attack ...all high impact ) I started to feel tightening up the back of my left leg that pinched into my bum at mile 9 but as I was out doors I was committed to returning to my car , I walked the last mile. The following day I could barely straighten the leg so I rested for three days and attempted a 10 k this morning managing half of that outdoors n then I came back n stretched n managed a more comfortable 2 mile on the treadmill. I visited the local uni for advice from their osteopath and they felt that my left side was slightly out of alignment. I had massage treatment and see them again in two weeks. They said I would be ok to try to continue exercising from tomorrow but that I should spend more time to warm up 

    Cheryl Griffiths wrote (see)

    Hi Matt, I've recently upped my cross training, including boot camps, gym classes and know I haven't taken enough rest time, I stupidly tried to throw a 1/2 marathon run in the middle of that ( plus the usual aerobix, body attack ...all high impact ) I started to feel tightening up the back of my left leg that pinched into my bum at mile 9 but as I was out doors I was committed to returning to my car , I walked the last mile. The following day I could barely straighten the leg so I rested for three days and attempted a 10 k this morning managing half of that outdoors n then I came back n stretched n managed a more comfortable 2 mile on the treadmill. I visited the local uni for advice from their osteopath and they felt that my left side was slightly out of alignment. I had massage treatment and see them again in two weeks. They said I would be ok to try to continue exercising from tomorrow but that I should spend more time to warm up 

     

    Cheryl Griffiths wrote (see)

    Sorry, I was trying to have your opinion or to grab some extra advice re, stretches or treatment. My whole leg goes tight from the arch of the foot , up the calf and up the leg into my hip and bum. Thank you for your time hope I explained well enough. 

     

     

     

    Beautiful description.

    I don’t think this sounds like a muscle….as it crosses too many joints and your symptoms follow your sciatic nerve rather a little too well to ignore it.

    Stretching nerve tissue, whilst it may feel nice will make it worse later. The nerve becomes irritated because you loose control of your lumbar spine either due to excessive activity or not moving well enough elsewhere.

    Work on control, balance and stability of your entire lower limb, from the pelvis/hip down and the foot up. Try to work out what does move enough and what – and get it to move (most commonly your thoracic spine) . Generally bits that don’t move very well, you won’t feel – as they don’t move. Things that feel stiff (especially spinally) aren’t really but you feel muscle stiffness protecting mobile joints…..

  • Six PhysioSix Physio ✭✭✭
    Budjude wrote (see)

    I am fairly new to long ish bike routes and at the start of the year acquired a defy 3 composite. My first road bike with drop handle bars.

    When i go out for a longer ride - 40+ miles / 2 hrs ish my left hand especially goes numb / tingly. Its always the little finger and sometimes the next one in as well.

    The bike is set up for me, via the shop - but they did it with me there - checking sizes and fits etc, but am i thinking this is a bike fit issue?

    After a couple of days it goes away again.

    Any advice would be great.

     

     

    Hi Bud

    Sounds like your Ulnar nerve is being compromised due to prolonged posture of (surprise surprise) a stiff thoracic spine and poking chin posture – see all the other posts.

    The most common bike fit issue is the distance from your saddle to handle bars – either being too far and putting lots of pressure down through your wrists or too near increasing the slouch position.

    Should be pretty easy to rectify. Make sure you’re doing lots of scapular stability and rotator cuff control work off bike.

  • Hi 

     

    Whats the best way to treat "crunchy" shoulders at 90 degrees abduction - weight bearing and non weight bearing. I have tried stretching and strength training work to key muscle groups that affect shoulder stability. The physio has told me its  not an impingement. Any other recommendations?

     

    Thanks for your help.

     

    Liz

  • Hi Matt

    I usually run 5-6 miles about 2-3 times a week.  About 6 weeks ago I bought some new running shoes (proper gait analysis done and everything) and then ran a 5k race a couple of days later.  During the run I noticed a mild pain in my right knee, which I don't normally have.  It felt like it was on or just below the kneecap on the front of my knee.  I stopped and rested my knee for three weeks, then tried a gentle 5 mile training run.  By mile 3 the pain had returned and felt like it was gradually worsening, so I stopped and walked the rest of the way.  I have not run since.  The pain is not severe and only seems to manifest when I'm running.

    I'm concerned about making it worse, but am also concerned at the really long time it is taking for me to get an NHS physio referral.  Meanwhile I have no idea what exercises (if any) I should be doing to try and remedy the problem, or even what the problem actually is, and am now wondering if it could have been caused by the new shoes!  Do you have any guidance that you could give me about things I could be doing while I'm waiting for my referral (apart from seeing a private physio, which I really cannot afford)?

  • Six PhysioSix Physio ✭✭✭
    kittenkat wrote (see)

    I've always been disappointed with physio advice about issues I've had (over the last 30 years), except I did find a good guy last time around who actually understood the level and depth of sport i was doing.

    So here's my question, how 'equal' are physios when it comes to knowledge of treating people who regularly train and race?

    And how do you find a good physio without spending buckets finding the wrong ones first?

     

     

    We’re not (thankfully!) equal – some are great, some are terrible and lots are pretty ineffective – and that’s hard for me as a physio to accept.

    It’s not all about letters-after-names, years qualified or where they’ve worked. Some elite level physios are terrible - dining out on clubs reputations, whilst some independent practitioners – be them SM,osteos or chiros are bloody great.

    Reputation is everything. Participation can give a little more but more importantly is the physio asking and totally understanding what you do, how and why.

    We don’t have magic fingers and definitely no magic machines,  but we must have the ability to make you move better so you can repair your self. The rehab component teaches you to move better, for longer. Unless it’s a traumatic injury symptom relief is not the same as dealing with the cause.

    Ask, ask and re-ask. Someone somewhere will know who the don is. You do need to kiss a lot of frogs…

  • Six PhysioSix Physio ✭✭✭

     

    MedicGirl wrote (see)

    When I ran a marathon the last 2/3 miles were agony - not because of my legs but my lower back! Every step caused me pain in my back, and when I finished I realised it was grossly swollen - I had totally lost the curvature in my back. It was tender and I couldn't have anything touch it. It resolved itself after about 24 hours. 

    I never had anything like it in training, although only ran about 21 miles in training. 

    I do intermittently get very mild lower back pain - I think due to poor posture and occasional poor liftinag at work. Never had any swelling since but I'm worried it will be a problem when I do an ironman. 

    I thought it might be poor posture/weak core. I now work on my core twice a week at the gym. 

     

     

    Sounds very fair – grossly swollen, rather than just protected by muscle spasm, sounds like an acute bone/joint reaction and shouldn’t be taken lightly. I think your approach sounds on the money. Get more stable then stronger, then maybe think about getting your running style looked.

  • Six PhysioSix Physio ✭✭✭
    Lindsey Oliver 2 wrote (see)

    I have had knee problems for a couple of years, the symptoms being mainly the symptoms of ITB and possibly piriformus syndrome.

    I have been to 2 osteopaths, a chiropractor, a podiatrist, a CHEK exercise person, pilates classes and a physio so far, tried different shoes, tried barefoot shoes, rested for ages and also tried to run through. So far, nothing has helped (and yes, I did do all my exercises I was told to do!)

    The last person I saw said that, because the symptoms haven't shifted even though I have been told my body responds well and adjusts itself after treatments, there is something 'not firing properly' somewhere in my back, or trunk.

    I've not been able to run for more than 30 mins for over 2 years because of this, and it is very rarely pain free even at that short time (I was previously running half marathons and training for a marathon) - do you have any advice or suggestions please?

     

     

     

    Cor – tricky! Doing all the exercises and not seeing any improvement makes me think of 2 things. Either you haven’t done enough for enough time (unlikely) or it’s not what you’re doing but how you’re doing the exercises.

    Rehab exercises rarely (if ever) need to deal with the strength or power component – this is pretty easy to overcome by just doing more exercises and increasing reps or resistance. Instead, rehab must be all about gaining better control and stability. You need to do little and often and of utmost importance is how you do the exercise. It’s never about what you’re doing, but how you’re doing them. Rehab exercises need to done totally right. If not, they are totally wrong. This is pretty frustrating, but is the key to a successful exercise program.

    Your comment about firing fits this pattern. You need to be given the ability to move better so you muscles can work optimally.

    Your body breakdown’s between 0 and 30 minutes when running. You need to know when and make sure you can control your body up to and not beyond this point, so you maintain control. If you go beyond this point you’ll loose control but ramp up on endurance and or strength. Not cool….

    At a punt – it’s all about great pelvic and lower limb control. Why? Most likely because you’ve got a really fixed thoracic spine…

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

    A quick Q in advance 

    Having seen a physio I am managing a likely retro calcaneal bursar, have built up from no miles following a months rest, this has been ongoing for best part of a year!

    I am using ice massage, heel drops, calf strengthening and am part way through a transition to a more mid foot gait, I rarely have any pain now when running, varying degrees of a feeling of bruising afterwards and minimal effects the next morning, I have really good dorsi flexion and hopeless plantar flexion!

    what exactly is a bursar, do they 'go' completely or is it a case of reducing the inflammation? Anything else I can try to get back to 'normal'?

    Retro calcaneal bursa's are totally normal - and in everybody.

    A bursa is a fluid filled sac that acts as in inflamed air bag(but with fluid) to protect bits of bone and tissue crashing repetatively into each other.

    They get bigger and smaller depending on if they are excessively loaded or not. Water-on-the-knee or housemaids knee is a really common bursitic problem from too much kneeling, just as lots of lateral hip pain is a trochanteric bursa problem due to TFL flicking over it...

  • Six PhysioSix Physio ✭✭✭
    IronCat5 in the Hat wrote (see)

    Hello Matt,

    I seem to suffer from tight calves, which in recent months has caused my left achilles to become inflammed and sore to touch/pinch after running & racing.

    I've taken it easy over the past month in training to allow me to race hard on two occasions. Each race has required a long warmup to get achilles to work. The day after each race I have been stiff but not sore, even on the achilles.

    My last run was a 10km race on the 6th May. Today my achilles is not sore to touch when extended, though there is feeling if I pinch it when slack.

    I'm now on a proper rest from running though still cycling to maintain fitness.What can/should I do to resolve the calf/achilles issue, and yet allow me to smash a 5km run at the end of a GBR qualifying triathlon on the 26th of May?

    Many thanks.

     

    Hi

    I'm not so sure you've got tight calfs...but instead you've got calfs which are being used at their end of their range and so feeling tight. Look as far over your left shoulder as possible. Your neck feels tight, but you'd never dream of stretching it further to the left.

    I wonder if your shoes are controlling the amount of pronation (rolling in) your foot does, which produces a continual over stretch on the calfs?

    If the shoes are good then go for getting stronger rather than getting more lenght. And instead of stretching your calfs try releasing them a la foam roller. The RWIC has some great video clips

     

  • Six PhysioSix Physio ✭✭✭
    Lizwalkersport wrote (see)

    Hi 

     

    Whats the best way to treat "crunchy" shoulders at 90 degrees abduction - weight bearing and non weight bearing. I have tried stretching and strength training work to key muscle groups that affect shoulder stability. The physio has told me its  not an impingement. Any other recommendations?

     

    Thanks for your help.

     

    Liz

    Hi Liz

    An impingement is when something crashes into something else without any control. Gets swollen, painful and less to restriction in strength or function.

    Crunchiness ain't that. Unless it's painful I don't think I'd worry. It may go away with rehab exercises and tape, but I think it'll take months and not weeks...

    Keep doing what you're doing, don't let it get painful.

  • Six PhysioSix Physio ✭✭✭
    Alex Rendall wrote (see)

    Hi Matt

    I usually run 5-6 miles about 2-3 times a week.  About 6 weeks ago I bought some new running shoes (proper gait analysis done and everything) and then ran a 5k race a couple of days later.  During the run I noticed a mild pain in my right knee, which I don't normally have.  It felt like it was on or just below the kneecap on the front of my knee.  I stopped and rested my knee for three weeks, then tried a gentle 5 mile training run.  By mile 3 the pain had returned and felt like it was gradually worsening, so I stopped and walked the rest of the way.  I have not run since.  The pain is not severe and only seems to manifest when I'm running.

    I'm concerned about making it worse, but am also concerned at the really long time it is taking for me to get an NHS physio referral.  Meanwhile I have no idea what exercises (if any) I should be doing to try and remedy the problem, or even what the problem actually is, and am now wondering if it could have been caused by the new shoes!  Do you have any guidance that you could give me about things I could be doing while I'm waiting for my referral (apart from seeing a private physio, which I really cannot afford)?

    Hi Alex

    Absolutely got some free advice. I think your right about the shoes - they maybe too stiff. The resolution of this is to walk around in then for a few days to see if you can soften them up a tad.

    It sounds more like patella tendon pain rather than knee cap tracking issue, so I think I'd have a good roll on your quads and ITB which will kill 2 birds with one stone.

    I'd also tryu some standing staic holds on a single knee bend in about 20 degrees of knee bend. This is early enough in range so it doesn't mash your knee cap, but also far away from being straight to load up your tendon. You can feel mild discomfort only - hold it for 40 secs and repeat 3 times 4 times a day.

     

  • Six PhysioSix Physio ✭✭✭

    That's your lot!

    Have a great weekend.

«1
Sign In or Register to comment.