Friday lunchtime Six Physio Q&A

Join us here at 1pm on Friday 20th September as we have Matt Todman from Six Physio answering all your training and injury related questions. 

Matt Todman is a consultant physiotherapist with 20 years of physiotherapy experience and is clinical director of Six Physio.

Post your questions below. Thanks. 

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Comments

  • I've suffered from a couple of low grade calf strains this year.  The first, in the gastroc, cleared up after a couple of weeks, but I've recently had problems with a soleus strain that I think was a result of an over enthusiastic game of football.  The soleus strain, whilst appearing to relatively low grade has persited and put me out of running for over two months. 

    I do bent and straight leg calf raises and stretches, but is there anything else I should try to reduce the likelihood of future problems?

  • Am recovering from a tibial stress fracture, physio suggested I start making a slow running return 4 weeks post incident. Pain started up again within 2 weeks after building up gradually to 10min continuous running - how long should I refrain from running again before I re-start again.

    I am continuing to undertake other exercises as advised including weighted squats, lunges and dead lifts, as well as stretching calves and hamstrings religiously. I have also just bought 'the stick' which will hopefully help out with the tight calves - any other suggestions?

  • hi, after a track speed session 6 weeks back ive been having slight discomfort on the back of my leg, directly behind the knee height, its ok to run and stuff and not that painfull I just notice its there when im going fast e.g. i noticed it in a 5k race and put me off a bit, any suggestions what it could be and how to treat it? thought it would go with time as small stuff like that usuall do, but it hasnt this time. cheers.

  • Is there a complaints procedure against negligent physios? 

    I went to a local physio who had been recommended by someone at my running club with shin back in May.

    She diagnosed mtss and said it was ok to race a 10k the  following weekend.  I had weekly sessions with her thereafter until August in which she would massage my legs and advise on various excercises but all the time encouraging me to continue running, albeit a bit slower and slightly shorter than I had been doing previously.  

    Leg didn't heal so a went to a Gp in June.  Going to the Gp was my own idea, the physio was not aware of it.  Finally got the results of the Bone scan back yesterday which confirmed a stress fracture - Nhs works very slowly as you know.  The physio had repeatedly assured me that i didn't have a stress fracture.

     

  • I have been suffering from an ITB injury for about 6 months. I went to see a physio in March who gave me some exercises (clams, lateral leg raises, single leg squats, plyometrics etc) to do and after a month off running I started again slowly and built up my mileage. After about 3 months the pain came back again so I went to see a different physio, this time one who specifically treats runners. As the pain was only coming on after about 8 miles of running he suggested limiting my runs to 5 miles. I have been doing that for about 6 weeks now and while the knee pain is not too bad I can still feel it is there and that it could return at any minute. 

    I dont feel that my knee is improving really and wondered if you had any other suggestions ? Or is it just a case of time and it should heal eventually ? Cheers

  • Hi there,

    I have been struggling with plantar fasciitis for about 6 months now - went to see a physio who gave me some exercise to do etc. mentioned that i should start running again.  However I still have pain in my heel when I do run and am now getting sharp pain in my knee on the other leg (i.e. the heel that is perfectly fine).

    Could you let me know if i should stop running or what the best course of action would be?

    Many thanks,

  • Another calf-related question:

    About a month ago I noticed the tendon running underneath my foot from big toe towards the heel was tight ( I do roll under my feet after plantar fasciitis some years ago) and then also a feeling of 'pulling' around the inside ankle bone. Both those eased off, but I now have a tingling in that calf muscle and some tightness in the meat of the muscle, higher up. It is most obvious when going downstairs and seems to improve when warmed up. Exercise has not made it worse, but it is not going away.

    Thanks very much

  • Thanks for all the questions...let's crack on. image

  • kittenkat wrote (see)

    Hi Matt,

    which muscle groups (in general) should a runner with sciatic pain work on? I'm assuming glutes for one...

    Thanks.

    Kate

     

     

    Hi Kate

    All depends on why you’ve got sciatica. You can drill loads of muscles to death, but unless you move well and allow the muscle to work properly, it won’t do much for your sciatica.

    Saying that, I’d plump for recruiting your deepest of deep tummy muscles, pelvic floor and diaphragm (all together and not individually), work on control of your glutes and adductors and try to get some length in your quads and hammies – but instead of stretching them try lengthening by keeping good spinal alignment when running.

    Oh and go wild with you tib post, too!

  • Lou Diamonds wrote (see)

    I've suffered from a couple of low grade calf strains this year.  The first, in the gastroc, cleared up after a couple of weeks, but I've recently had problems with a soleus strain that I think was a result of an over enthusiastic game of football.  The soleus strain, whilst appearing to relatively low grade has persited and put me out of running for over two months. 

    I do bent and straight leg calf raises and stretches, but is there anything else I should try to reduce the likelihood of future problems?

    Hi Lou

    Gotta know why….

    Strength - should be able to do at least 20 single calf raises on straight and bent knee.

    Stability - what’s your single knee squat doing, especially when you dynamically lunge onto it – where do you cheat? Hips, knees or feet?)

    Style (mid foot, heavy hind foot?)

    and finally Structure - what your foot’s doing in your shoe – if you roll your foot in uncontrollably, then it’s your calf muscle structure that acts as a brake (and breaks!) rather than the structure of your foot.

  • Good Afternoon

    I have been running for 8 months and training for a half marathon. Two months ago I got pain around the side and under my knee cap but than the pain would move to the back of my leg where the joint is in your leg to move your leg up and down.

    I took a step back from training and did gentle runs and I run two X half marathon distances in 10 days and everything was fine during the runs but now I get the pain back again mostly at the back of my leg though opposite the knee. Its strange that it moves around... I am doing glute/quad excercises and foam rolling but the niggle is still there its just dull pain but is really annoying and I do not feel like I could do any speed training with it. I have rested for two weeks but still it is there. any help or ideas please?

    Kind Regards

    Mark

  • Lisa123 wrote (see)

    Am recovering from a tibial stress fracture, physio suggested I start making a slow running return 4 weeks post incident. Pain started up again within 2 weeks after building up gradually to 10min continuous running - how long should I refrain from running again before I re-start again.

    I am continuing to undertake other exercises as advised including weighted squats, lunges and dead lifts, as well as stretching calves and hamstrings religiously. I have also just bought 'the stick' which will hopefully help out with the tight calves - any other suggestions?

     

    Hi Lisa

     

    As a rule of (web) thumb only attempt to run when it’s pain free – you are still experiencing a periosteal reaction on the bone surface, which tells me you’re putting too much load through the bone, so pull back to zero.

    All the other stuff sounds great; I’d be tempted to get you loading up in a pool (running) or on a trampet first. Take a step back to go forwards

     

  • Twister wrote (see)

    Good Afternoon

    I have been running for 8 months and training for a half marathon. Two months ago I got pain around the side and under my knee cap but than the pain would move to the back of my leg where the joint is in your leg to move your leg up and down.

    I took a step back from training and did gentle runs and I run two X half marathon distances in 10 days and everything was fine during the runs but now I get the pain back again mostly at the back of my leg though opposite the knee. Its strange that it moves around... I am doing glute/quad excercises and foam rolling but the niggle is still there its just dull pain but is really annoying and I do not feel like I could do any speed training with it. I have rested for two weeks but still it is there. any help or ideas please?

    Kind Regards

    Mark

    Hi Mark

    I take it there is no swelling or it doesn't feel like it's going to give way? If so go for obvious things first, such as patella tracking issue (which can spread/refer pain) to the back of your knee or and ITB type thing, which also has similar origins to a patella tracking issue.

    The rehab your doing sounds OK, but the crux of it is how your doing it. If you're getting stronger - great, but it won't help with the stability or the endurance componant, which is I think the key.

    Lunges, squats and all the variants in between need to be done functionally, weighbearing and with great dynamic control....

  • cliff781 wrote (see)

    hi, after a track speed session 6 weeks back ive been having slight discomfort on the back of my leg, directly behind the knee height, its ok to run and stuff and not that painfull I just notice its there when im going fast e.g. i noticed it in a 5k race and put me off a bit, any suggestions what it could be and how to treat it? thought it would go with time as small stuff like that usuall do, but it hasnt this time. cheers.

    Hi Cliff

    Could be a hammy (the most obvious) so try a little stretching and strengthening or could be an over stretched popliteus, which controls the last bit of tibial (leg bone) rotation when you straighten your knee.

    Failing all of the above, your knee cap – if moving poorly, can refer to the back of your knee. Try rolling out your ITB on a foam roller

  • Thanks for your reply.. No swelling at all. When I first got the problem It felt like it was going to give away twice and that was whilst walking never whilst running but that was two months ago and I have not had that give away feeling again and also back than I was limping but no limping at all now.

  • Hi Matt,

    I finished ran my first half marathon on Sunday and the week prior to it I had a niggling pain in my left calf.  My calf actually seized up on a run last week.  On the day of the race, evening walking to the line I could feel a little pain, but I never noticed anything during the race and finished in good time. 

    However, the pain did come back and although it is not significant, I am a little concerned that it is more than just delayed onset muscle soreness.  Any recommendations on how to take care of it, other than some R&R of course!

  • Twister wrote (see)

    Thanks for your reply.. When I first got the problem It felt like it was going to give away twice and that was whilst walking never whilst running but that was two months ago and I have not had that give away feeling again and also back than I was limping but no limping at all now.

    Sounds more knee cap related then. They can present with a "false" giving way feeling.

    Check your shoes, long distance technique ie related to fatique and maybe add in some strength training too.

  • Yes I am moving to a more minimalistic shoe but slowly does it I have a pair of Nike Free 5.0 on there way and I am going to change my form to midfoot striking rather than heelstriking.

    I figured whilst I am attempting to recover from this dull pain I may as well work on my running form aswell.

     

    PS: what strength training would you recommend?

  • LazyDave wrote (see)

    Hi Matt,

    I finished ran my first half marathon on Sunday and the week prior to it I had a niggling pain in my left calf.  My calf actually seized up on a run last week.  On the day of the race, evening walking to the line I could feel a little pain, but I never noticed anything during the race and finished in good time. 

    However, the pain did come back and although it is not significant, I am a little concerned that it is more than just delayed onset muscle soreness.  Any recommendations on how to take care of it, other than some R&R of course!

    Hi Dave

    Sounds like it's knackered - but not too literally. Fulls and halfs involve endurance and strength - and for your calf you're going up and down on tip toe 1000's of time. The muscle tires, doesn't have enough strength and starts to give up. Adrenaline helps, but when it's knackered, it's knackered.

    There maybe some try of remedial gel/rub/arnica etc that you can apply, but I go for the rest route for the next 10 days. Let your body do what it does best and heal. Gentle stretches, bit of ice if sore but don't try to hurry it along. Small run next weekend please!

  •  

    Surrey Runner wrote (see)

    Is there a complaints procedure against negligent physios? 

    I went to a local physio who had been recommended by someone at my running club with shin back in May.

    She diagnosed mtss and said it was ok to race a 10k the  following weekend.  I had weekly sessions with her thereafter until August in which she would massage my legs and advise on various excercises but all the time encouraging me to continue running, albeit a bit slower and slightly shorter than I had been doing previously.  

    Leg didn't heal so a went to a Gp in June.  Going to the Gp was my own idea, the physio was not aware of it.  Finally got the results of the Bone scan back yesterday which confirmed a stress fracture - Nhs works very slowly as you know.  The physio had repeatedly assured me that i didn't have a stress fracture.

     

    EEk - try the HCPC at www.hpc-uk.org they keep us all in check and will delve a little deeper.

  • carterusm wrote (see)

    I have been suffering from an ITB injury for about 6 months. I went to see a physio in March who gave me some exercises (clams, lateral leg raises, single leg squats, plyometrics etc) to do and after a month off running I started again slowly and built up my mileage. After about 3 months the pain came back again so I went to see a different physio, this time one who specifically treats runners. As the pain was only coming on after about 8 miles of running he suggested limiting my runs to 5 miles. I have been doing that for about 6 weeks now and while the knee pain is not too bad I can still feel it is there and that it could return at any minute. 

    I dont feel that my knee is improving really and wondered if you had any other suggestions ? Or is it just a case of time and it should heal eventually ? Cheers

    Sheriff Fatman? I hope not!

    ITB never just happen. They always happen because of something….and that’s what needs to be established. You don’t sound like an overuse or too much use injury because you’ve got back to running, but I think it sounds like a technique thang.

    The quality of the rehab you’ve been doing  - rather than the quantity is super important. When running, unless your foot lands in the right area with the rest of your body above and below it also following suit, you’ll breakdown.

    You need to work on form (of what you’re doing) and also endurance of what you’re doing too. Do more of the weight bearing, running mimicking type rehab, but do them more often for longer.

     The longer you have ITB type symptoms, the longer you’ll have them for as the bone under the ITB will react to having to take excessive load – time is not always on your side, so make sure your rehab rocks.

  • Hello,

    I ran my second half marathon at Bristol on Sunday and gained a PB of 2:37 after my first half marathon at Cheddar a few weeks before which was 3:40 so just over an hour and twenty five minute gain ... my legs 5 days later feel fine when after my first they ached like crazy however the underside of my left foot is still aching.  I haven't been for a recovery run yet because half a mile walk flares up as it is.  I have been treating it with ice in the morning and evening.  Is there any way to tell if it is just perhaps a little bruised or needs physio?  5 days is the longest I've ever gone without a run but I don't want to cause further injury by running too soon!


    Thanks

    Ella

  • Hi

    I'm currently in training for Oxford Half Marathon on 13 October. I'd had a bladder infection so hadn't run apart from 2.5 miles in the last 2 weeks.  I went out on Sunday and ran just under 9 miles to try and get myself back on track - a mistake as I've strained my knee.  I tried going for a 3.5 mile run on Tuesday, but my knee didn't appreciate it.  I'm desperate to continue my training, but don't want to make my knee any worse.  It's not a bad strain, but it does cause a bit of dull pain when I walk around.  Any advice would be gratefully appreciated.

     

    Thanks, Madeleine

  • Twister wrote (see)

    Yes I am moving to a more minimalistic shoe but slowly does it I have a pair of Nike Free 5.0 on there way and I am going to change my form to midfoot striking rather than heelstriking.

    I figured whilst I am attempting to recover from this dull pain I may as well work on my running form aswell.

     

    PS: what strength training would you recommend?

    Try not to have too many balls in the air with regards to changing shoe type and running style and getting back from injury. Nail the injury, then the world's your oyster.

    Old skool strength training is best - lunges, squats, box jumps (all with weight), thrusts, plyometrics...

  • EllaDuV wrote (see)

    Hello,

    I ran my second half marathon at Bristol on Sunday and gained a PB of 2:37 after my first half marathon at Cheddar a few weeks before which was 3:40 so just over an hour and twenty five minute gain ... my legs 5 days later feel fine when after my first they ached like crazy however the underside of my left foot is still aching.  I haven't been for a recovery run yet because half a mile walk flares up as it is.  I have been treating it with ice in the morning and evening.  Is there any way to tell if it is just perhaps a little bruised or needs physio?  5 days is the longest I've ever gone without a run but I don't want to cause further injury by running too soon!


    Thanks

    Ella

    Hi Ella - great skills and superb PB

    Your time difference is remarkable, and therefore your whole body loading effect will be massively different too.

    Bruises bruise..ice is good for whatever it is, but doing anything at the moment that makes it worse is not a good idea. Rest for another 5 days - your fitness wont suffer.

    I'd take a punt and say this may sound like a pre clincal PF (before a mass of symptoms) and would therefore treat it as such. Find, beg, borrow or steal a roller and get to work on your calfs...

  • Madeleine Harrington wrote (see)

    Hi

    I'm currently in training for Oxford Half Marathon on 13 October. I'd had a bladder infection so hadn't run apart from 2.5 miles in the last 2 weeks.  I went out on Sunday and ran just under 9 miles to try and get myself back on track - a mistake as I've strained my knee.  I tried going for a 3.5 mile run on Tuesday, but my knee didn't appreciate it.  I'm desperate to continue my training, but don't want to make my knee any worse.  It's not a bad strain, but it does cause a bit of dull pain when I walk around.  Any advice would be gratefully appreciated.

     

    Thanks, Madeleine

    Where's the pain? What makes it worse?

  • SRyder4 wrote (see)

    Hi there,

    I have been struggling with plantar fasciitis for about 6 months now - went to see a physio who gave me some exercise to do etc. mentioned that i should start running again.  However I still have pain in my heel when I do run and am now getting sharp pain in my knee on the other leg (i.e. the heel that is perfectly fine).

    Could you let me know if i should stop running or what the best course of action would be?

    Many thanks,

    Hello

    Don’t let PF get you down! I’m loathed to say that it’s notoriously poorly looked after. The fundamentals are it’s an over stretch issue. You want your PF to stop being too long and frazzled by making sure you have adequate length of tissue elsewhere and have better control around your PF.

    So don’t stretch your foot, or calf, as this just increases the PF stretch. But a tight calf will increase the load through your PF. So instead release (or roll) your calf – get the length without over loading your foot. Learn to control your foot by getting better 1-legged balance, and progress it by hopping forward onto your foot. Initially start with a trainer/shoe that gives control and progress to bare foot, when it doesn’t hurt.

    Improve your glut control in a functional, running type style. Look at what your wearing on your feet during the day.

    I’m not sure you should run until you’ve got enough control of your foot (either through muscular, ligamentous or the right footwear) and then slowly start to increase your loading by pyramid runs. Initially keeping it short and sweet…you can always do more, later.

  • Thanks for all your replys. I am thinking about doing 5-10k runs three times a week again but I just worry about the dull pain all the time I suppose I just need to do it!

  • The pain is around my kneecap.  It's worse going upstairs and if I squat down.  It had eased off a bit before my run on Tuesday, but it doens't seem to be easing off now.  I sit down a lot during the day at work, and I guess that's not helping.  Tried elevating it, but that seemed to hurt.

    Got 2:13 for my last half marathon and wanted to get under 2 hours for this one image

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