Physio webchat with Paul Hobrough

Our new resident Physiotherapist Paul Hobrough, is joining us this Friday lunchtime at 1:30pm to answer all your injury questions. Feeling a few niggles through marathon training, or still struggling with a long-term problem? Post your questions below. 

«1

Comments

  • I've recently developed what I think is IT band syndrome with pain down the outside out my left knee - what are the best ways to recover from this and how long does it usually take? And can I do any other form of exercise whilst I'm unable to run (like cycling, aerobic style fitness classes, hiking)? I'm anxious to minimize the recovery time so I can get back running again but I also don't want to lose too much fitness or jeopardise my race schedule for the next few months!

  • I keep on getting calf strain. whenever I get it, I don't run at all for two or three weeks. Last time, I had about  six weeks off running, but it came back again almost immediately. i've got orthotics. Any advice.

  • Same as Sheila, I keep getting calf strain. I rest and it eases but then often returns pretty quickly. It's happened with both calves (seperately). Also my calves ache after most runs! I'm definitely doing something wrong. I have compression socks & calf guards but they're just masking the issue.

  • I've been having a niggling pain in one of my toes for a number of weeks, which became really bad during a 16km run. I continued through the run (the pain subsided after 20 mins) and then took 10 days off running. I've been trying to start up again, but I still get a sharp pain sometimes in the end of my toe when I run. I discovered that when I press on one specific area of the ball of my foot, I feel the pain at the end of my toe. I think this could be some nerve damage perhaps? Do you have any suggestions for recovery? I've tried a week of taking ibuprofen to reduce any swelling, but I can still sense it there in the background. I was running with specially made inserts at the time it happened (I had them fitted about 8 weeks ago)...

  • HI

    Paul I  Have developed  this really deep pain in my upper right hamstring I do lot of stretching and foam roller to ease the pain but just below the right bum cheek cant seem to shift it Any advice also I bought new pair of running shoes couple of month ago And my last event I did was over 5 k which is not my distance I do more 10miles - half marathons but it seemed to start when doing shorter distances last month .

    .

  • Achilles tendonitis. Came on after PTT, which went away no problem, but the achilles just won't get better. Tried rest, heel raises, short runs, ice... Any other options or tricks?
  • Hi, I'm doing the Rome marathon at the end of March and pre-Christmas, training was going really well and I was up to 12 miles with little difficulty. Unfortunately I put my back out just before Christmas and then spent three weeks on holiday not doing any running. When I returned I pushed myself too far, too fast and my back has been niggling ever since - not enough to stop me running but enough to be of concern. Since my 13.5 mile run last weekend my knee has also been feeling a bit dodgy - walking up or down stairs has caused a strange sensation though it's been okay this week when running. I've been replacing some of my training runs with cross trainer sessions to try and lessen the impact on my knee and back - is there anything else I can do to keep my fitness up whilst also allowing my body to heal?

  • I guess you can add me to the list of people with calf issues. My right calf feels fairly tight all the time, and is sometimes painful. Not enough to stop me running, and it doesn't noticeably worsen during running, but it does tighten up more after running. I also have some occasional pain when running in my right hamstring, so I'm wondering if that's related?

    So far I've added additional stretching and a longer warm-up into my runs, and I'm using a foam roller (generally, and also holding on specific points).

    I'm not a 'pro' runner as such, in fact I'm only really just getting comfortable - this is my only real niggle. Mileages aren't high (by any standard), I'm mixing up the paces (not all fast, not all slow), and I'm getting plenty of rest.

    Any ideas on cause or exercises that I can do to ease it would be great image

    Thanks!

  • Hi paul,ive not run since 14th july 2013.the problem i have is pain in the 5th metatarsal on the side of the foot, weakness where the foot meets the bottom of the leg,all the way across.Also above the ankle on both sides.Im fine walking and the cross trainer,but Im struggling to hop on my leg.It gives way on hard impact and feels weak.Its 6 1/2 months now,been seeing physio since sept 5th..Had an Xray all fine,physio says bruised bone.

    Another 3 weeks of Heel raises,lunges and balance..and then he says we will look at having a scan.I did london last year and by may had done 650 miles.Im thinking ligament damage,would really appreciate yours thoughts.
  • Since Christmas I've started getting a sharp intermittent pain in the middle of my left leg just under my buttock. It just feels tight all the time I'm running and its restricting how fast I can run,but does'nt effect me any other time. I've been doing hamstring stretches after each run and that easies It. But in time it gradually stiffens up. Any advice would be helpfull. 

  • Hi  I've been diagnosed with a Morton's Neuroma, whats the best way of dealing with this, is it worthwhile paying for special insoles, would a change of shoe help, currently run in Brooks Adrenalin as I'm an overpronator, not sure if something like Hokas would help. I want to be able to run another marathon and just don't think my foot would let me at the moment.

    Thanks

     

     

  • I'm similar to Daniel above. Developed a persistent nagging ache in my upper right hamstring/glute. Self diagnosed as proximal hamstring tendonopathy...driving hurts and touching my toes is the killer stretch (normally done with ease). I'm stretching, rolling and strengthening. Should I stop running altogether?

  • Similar to Kemmaw, I have pain to the side of my left knee which comes on 2 miles into a run. This is my 3rd episode of IT band trouble in just under 3 years. I managed to train for the London Marathon last year with no problems. I was training for this year's London Marathon and had completed one 20 mile long run. The physio this time thinks I should try orthotics as I overpronate. Do orthotics help much for IT band problems? Does it make a lot of difference going for custom made as opposed to off the shelf ones? I have also been doing hip and glute strengthening exercises as well as using a foam roller.
  • After 3 months of thinking I had a hamstring injury my doctor has diagnosed a trapped nerve in my back. This is at times causing pain from my buttocks to my ankle but pain is always there in the hamstring area of my leg. Is there anything I can do that might help ease the pain. I do lots of stretches and also pilates to try to ease it and really don't want to give up running as I am starting training for my first half marathon. Sports physio says glutes & hamstring all ok, plenty movement in leg etc.

     

  • Hi there, can you advise me achilles pain please. Tried icing, heel,lifts, gait analysis, stair drops.. I tore one of them 3 years ago which was operated on and I s. Perfect now, but the other one is just getting worse, I can't stop running- it's my passion but I have read conflicting advice about heel drop stretches (alfreddson? ) and whether they can cause more damage. Please help? 

  • I've been very lucky so far with injuries just resolving with a few rest days. However Achilles tendinitis more stubborn. It eases with not running for a few days but is then aggravated by even a short gentle run. 12 weeks to go to london marathon. Any thoughts on how best to treat this apart from rest, ice, core work, cross training please?
  • Weird one this.. ive injured my right bicep recently and as a consequence have "tightened up" my top body and find this has ruined my run flow.speed ad stamina have suffered cos i get tired more quickly. Any idea how to solve this while arm is healing?
  • Hiya, last year I had to defer from marathon one week before due to knee pain. private mri diagnosed this "soft tissue oedema beneath the iliotibial band at the level of the lateral femoral condyle in keeping with iliotibial band friction syndrome" after 3 months of rest, glute, hip and general leg strengthening - the pain was still there so I had a cortisone injection back in june which was amazing no pain since. i have regularly been running 30+ miles a week since. I am marathon training again - building up my long runs am upto 15 miles, however my knee is very slightly achy again. 

    any tips how I successfully train this time around? Am still doing lots of strength/stretching and regular sports massage.  Am i always going to have a weakness there?  would be really gutted if the same happens again! Any help gratefully received! 

    Thank you for any advice

    Katy

  • I have had medial knee pain when going downstairs and soreness when running for about 2 months now.  Came on after my longest ever run [5 miles] and have been struggling to get rid of it.  Had an accident 18 months ago where I was tripped and landed with all my body weight [11 stone] onto this one kneecap.  Am icing and taking ibuprofen but don't want to damage any further as I am due to do the Berlin Half Marathon at end of March.

  • Have been suffering with posterior tibialis tendinitis for about six weeks now. I tried a run last sun since feeling stronger but my ankle still doesn't feel right. How much longer? I have been strengthening and stretching massaging. I managed 10k at the weekend.
  • Hi Paul,

    over the last week I've felt a little bit of tightness at the top of my left heel. It never really hurts during the run, though I feel it a little, but after it does feel quite sore. I ran Monday and Tuesday, rested Wednesday, ran again on Thursday and after asking myself some honest questions have settled for taking the next two days off. At the moment my heel feels ok- the only sign is it clicks when I rotate my foot. Can I expect this to clear up in the next couple of days with RICE and anti-inflammatory medication? does it just sound like a niggle that will clear up quickly?

    Thanks, Ben 

  • Forgot to add I'm 19 and run 5-6 times per week normally, usually 40 miles with a couple of sessions.

  • Hi everyone and welcome to our lunchtime webchat! 

    We are delighted that Paul will be joining us from 1.30 to answer your questions. We will be posting supporting information following this webchat to explain Paul's advice further and please note if your question is similar to someone else's, Paul may group his responses. 

    Finally please be aware that, any physiotherapy advice provided on the Runners World forum online or in the magazine is based upon limited information provided by the subscriber/reader to Paul Hobrough from Physio&Therapy UK. You should aways seek medical advice from your GP or from a local physiotherapy clinic, where a full examination can be achieved. Any advice, exercises or possible diagnosis provided are done so with the full knowledge that our readers will not pursue any action before seeking medical advice first. Runners World, Physio&Therapy UK and Paul hobrough accept no liability for the advice provided.

     

  • I've had a bit of achilles tightness over the last few months, where I wake up in the mornings and my ankle is a bit stiff and painful to walk on, but this pain dissipates over an hour or so or quicker if I do some stretches, heel drops on the stairs mainly. However last week during an easy run the out side sole of my foot (same side as the tight achilles, related?) started hurting to the point I couldn't walk properly for the rest of the day, I iced it and all that! and haven't run since. It feels much better in that I can walk OK but still not 100% or even to the point I feel happy to run on it. Is there anything I can do to speed recovery? Should I go for a tester run to see how my foot copes? I'm meant to be training to run 26.2 miles, and sitting around with a painful foot isn't helping. 

  • Hi Paul,

    thanks for taking the time to answer some questions.

    I had shin splints in my right leg last year after training for a half marathon. I saw a physio, didn't run for 6 weeks, started wearing insoles as I overpronate, did a lot of stretching and added some extra glute strengthening exercises. I recovered and started running again but now I have shin splints in my left leg, which is a bit unfortunate as I'm training for a marathon in April. I've started with the stretching, icing and strengthening exercises again but I'm still in too much pain to run. I will see a physio next week but my question is whether you think I'll still be able to run the marathon in 10 weeks' time and whether it's better to stop running completely for a bit or just stick to shorter, slower runs?

    I'd be very grateful for some advice.

  • I've got collapsing arches and have found that the tendon that runs down the inside of my left calf is excrutiating after run - it even hurts to touch. It also results in the calf tightening up too. I'm slowly getting back into running but don't seem to be able to shift this issue which his hampering me quite a lot. I'm icing the area, stretching my calves a lot and also using Ibruprofen gel to reduce the pain.

    Any ideas on strength training (or other ideas?) to alleviate this issue?

    Joe

  • Ok everyone here we go… I ail try to answer in the order that questions came in.  For all your calf related questions

     

    Sheila Wilson wrote (see)

    I keep on getting calf strain. whenever I get it, I don't run at all for two or three weeks. Last time, I had about  six weeks off running, but it came back again almost immediately. i've got orthotics. Any advice.

     

    A recurrent calf strain like this has an underlying issue for sure.  You need to find the reason this calf keeps giving up on you.   perhaps your current trainer support level is not enough? perhaps you are running too far too soon?   what rehab have you done between injuries, a weak calf won't become stronger with rest so if this is all you have done then your calf will continue to break down faster and faster each time you return.   Try to stretch and strengthen the area, basic calf and soles stretches (the deeper calf muscle) ail help with the range of movement around the ankle, but doing some eccentric calf exercises will really help.  For example stand on your tip toes on your bottom step, take the good foot off and then slowly (6-10 seconds) lower your heel all the wary down as far as it will go, put the good foot back on and use this to push you back up onto your tip toes and then repeat 15 times X 3 (rest 1-2 min between)   hope it helps
  • Sarah Fencott wrote (see)

    I've been having a niggling pain in one of my toes for a number of weeks, which became really bad during a 16km run. I continued through the run (the pain subsided after 20 mins) and then took 10 days off running. I've been trying to start up again, but I still get a sharp pain sometimes in the end of my toe when I run. I discovered that when I press on one specific area of the ball of my foot, I feel the pain at the end of my toe. I think this could be some nerve damage perhaps? Do you have any suggestions for recovery? I've tried a week of taking ibuprofen to reduce any swelling, but I can still sense it there in the background. I was running with specially made inserts at the time it happened (I had them fitted about 8 weeks ago)...

    Hi  there is every chance you have a nerve issue, I would like to know if this pressure point you describe in the ball of your foot is between the 2nd and 3rd Toe or the 3rd and 4th toes?  if so then you may well have a morons neuroma or "Morton's metatarsalgia" so as not to confuse the term with more serious conditions associated with a neuroma.  Think of it as a bundle of swollen tissue around your nerve which causes symptoms with pressed (e.g. running/walking).  You can try squeezing your toes together and see if you can feel or hear a little click between the toes, this will give further evidence to the fact that this might be the case.   In order to help….  orthotic devices have been known to have some benefit, although in many cases surgery is the best option, albeit not always totally successful.  In the mean time, try not to wear shoes that are tight fitting, use anti inflammatory medications, rest and look for some of the gel inserts that you can use to reduce impact on the area.  Anything that squeezes the metatarsal heads together will make your symptoms worse.  Caveat: I still don't now the answers to your initial questions so I may be totally wrong about this possible diagnosis.

     

  • daniel hornsby wrote (see)

    HI

    Paul I  Have developed  this really deep pain in my upper right hamstring I do lot of stretching and foam roller to ease the pain but just below the right bum cheek cant seem to shift it Any advice also I bought new pair of running shoes couple of month ago And my last event I did was over 5 k which is not my distance I do more 10miles - half marathons but it seemed to start when doing shorter distances last month .

    .

    Proximal or high hamstring injury is becoming much more frequent in my clinics of late.  I have seen this increase with the number of people taking up more track running, although in most of these cases the issues has been on the left side (inside leg).  Your issue may well be similar in nature as I have been finding high percentage of these runners have significant asymmetry in their pelvis. The hamstrings originate from the seat bones which are all part of the pelvic innominate bone, therefore asymmetry within the pelvis can lead to an increase rotation of one side and therefore the origin of the hamstring also moves, causing tension within the muscle.  It might be that the shorter distances you ran were on the track rather than straight line running such as the longer distances you usually do, or that your tech niche changes slightly when you run faster (higher leg kick for example - therefore more exertion on the hamstrings).

    You have tried stretching already, so why not try some knee rolling, side to side whilst laying flat on your back to mobilise the lumbar spine.  Then try stretching your piriformis (deep in the glutes) just to be sure you aren't slightly trapping the sciatic nerve and causing some coexisting nerve pain.  Also to help the hamstring perform some eccentric repetitions on the hamstring (slow lowering against weight without the lift phase of the exercise).  I use a specialist piece of equipment called a digital pelvic inclinometer in my clinic which helps me to diagnose if the pelvis is out of alignment.  Much has been written about the clinical benefits of identifying asymmetry and its relationship to pain and possible cure of sports injuries.  Those who display asymmetry and have other key clinical factors to build the picture and therefore cause of the injury,  often benefit from treatments which reduce this asymmetry, so a visit to your local physio may well be of use. Caveat: not everyone with asymmetry will have pain and not everyone with pain has asymmetry!! I hope this helpful and not confusing for you, in most cases what I suggest really helps.

  • Martin Hook wrote (see)
    Achilles tendonitis. Came on after PTT, which went away no problem, but the achilles just won't get better. Tried rest, heel raises, short runs, ice... Any other options or tricks?

    Achillies tendon issues are very successfully fixed using the Alfredson protocol http://www.ncbi.nlm.nih.gov/pubmed/9617396.  The heel drops must be eccentric, slow, with weight and every other day.  The protocol takes 12 weeks to full completion and I require my clients to come bi monthly for the duration for treatments.  Running is ok as long as you do not run with a pain over 4/10 (0 being no pain 10 being the most pain you can imagine) and that the pain doesn't increase either during a run or over a weekly period.  If the pain does fall into these categories then rest will be required for a week and then try again.  The way that I prescribe this protocol is as follows (there may be subtle differences) months 1 is 3 x 15 reps (alternate days for all of these - not every day!!)  as described, month two =  4 x 10 reps with a heavier weight and the final four weeks are 4 x 6 reps again with a heavier weight. 

     

«1
Sign In or Register to comment.