Q. I did a short four-mile run a fortnight ago and I noticed a slight pain in my left knee the day after. I went out for a 13-miler last Saturday, it started to niggle at five miles and by ten miles I couldn't run on it at all. By the time I walked back I couldn't put any real pressure on it.
I’ve had two sports massages this week and the pain has alleviated. I went for a three-mile test run last night and the knee went through a range of different pain levels - today I can definitely feel it! The lady who did my massage said it was too much pressure, but I'm not sure.
The pain is all around the knee cap with more pain to the left side of it today. Any advice would be appreciated – I have the Milton Keynes half-marathon next Sunday. sian lewis-evans
A. Pain around the knee cap is normally caused by tight quads. These probably got tighter and tighter through your training until on the long run the knee cap started rubbing as it's being pulled into the wrong place. And yes, as the muscles are tight they add extra pressure on the knee cap against the bone.
You really need to release these muscles by stretching the quads and hip flexors. The best way is the Thomas stretch. Get someone to help you very gently push the knee down, so you feel a comfortable stretch but no pain.
If you can do this, then try to stretch the quad in a lunge position, keeping the back and stomach tight and not letting the pelvis tilt. Ask your sports masseur to help you stretch the quads.
Q. How important is stretching and regular sports massages in injury prevention? I know runners who do both and still get injured and I know runners who do neither and don't get injured. What would you advise? mitiog
A. Yes, some do, some don't – it’s very frustrating. On the whole a stretching programme to unwind tight muscles is a very good thing once or twice a week.
Sports massage is a great recovery tool and helps release tight muscles. It’s great if you can access this monthly, especially in hard training.
The stretching is very easy to add to your weekly programme and it’s a really good way of having active recovery on an easy day. If a muscle is tight, it will stay tight unless you address the issue.
Some people are more injury prone than others and you will find because of this they tend to do more to combat it. Often those who aren't injury prone only start when they get a problem. A good habit is to have a two stretching sessions at home per week.
Q. Do you have any view on whether yoga or Pilates is best to help maintain flexibility and work on my core strength? Is one better than the other in terms of running benefit? Realistically I only have time to do one or the other and enjoy both - or should I do one session of each per week? Would I still improve my proficiency if I mix and match? Sleepy Bear
A. I think this is a matter of choice. I love yoga but I’m about to start a Pilates class taught by a runner so I’m looking forward to that.
Pilates is more core based and yoga is more about strength and flexibility through range. A lot depends on a good teacher, see which you feel better after and stick to that one rather than trying to mix and match.
Are you stiff or weak in your core? I would tend towards yoga if your issues are stiffness and Pilates if you have a weak core. Enjoy, whichever you choose.
Sleepy Bear: Bridging at the gym, yoga at home then. Thanks Sarah - I will!
Q. What are your thoughts on the minimalist running revolution? I've been struggling with medial knee pain for approximately 12 months, following an impact injury whilst playing football. It has severely affected my ability to do a decent amount of mileage.
I've had physio and a biomechanical assessment, which resulted in being prescribed orthotics, but I still have an annoying niggle. I'm now considering going down the minimalist route (admittedly after reading the barefoot bible Born to Run) to see if evolution can cure me! Carl Scully
A. It sounds like you first need to get to the bottom of the knee injury. Did you ever have it looked at? Have you damaged any of the structures in the knee like the meniscus or articular cartilage? If so, this needs treating first. Have you played a lot of football? Is there possibly some wear in the knee?
Barefoot running takes a lot of training and coaching, I think, to get it right. You will be completely changing how you run and losing any cushioning from your trainers, which your knee may need.
You also need to start very slowly and get your body used to the change as you are going from an awful lot of support, including orthotics, to none. You will need to do an awful lot of work to make sure your posture is right. Seek some help from someone who knows about coaching this first. Good luck.
Q. For a couple of months now I’ve been getting stiffness and pain around my lower back and down the back of my legs, which starts approximately ten minutes into a run. It eases off around 50 minutes and disappears completely after about an hour running. Do you have any tips or advice? MarcD1337
A. It sounds like you have an issue with the lower back. You may have a grumbling disc or just general biomechanical stiffness of the pelvis and lower back. Try stretching your hip flexors before you run as this can release your lower back.
As it's been going on for a few months, I would go to see a physio used to dealing with runners to try to release the tight structures. This should ease your running and stop it getting worse. They will also be able to prescribe some exercises specific to you - good luck.
Q. I'm training for the VLM. Training has been going well, I'm following the RW sub-3:30 plan. I’ve hit 50 miles in a week and completed the first 20-miler. After a Sunday 20-miler I felt fine. I rested on Monday and Tuesday and did a five-mile tempo session, again no problems. Then by Wednesday afternoon I had a strange sensation in my knee which moved around a lot - up my quad to my glutes. I did the sensible thing and rested for a week. After that I did a slow four-miler and the next day had a bad case of DOMS. The problem hadn't gone away.
I had a sports massage last night at Birmingham University and they didn't see any particular issues, they just recommended I do some foam rolling.
It's probably a biomechanics issue, as I know one leg is slightly shorter than the other; I’m neutral in one foot and pronate in the other. I have been doing Pilates for a while now which is excellent. However, I can't afford to keep resting.
I'm wondering whether it could be the trainers. I'm on 375 miles in my ASICS 1160s. The Super Six team last year at the selection day recommended them for me and I've never had problems before. In your experience can a simple thing like replacing shoes really help? I thought 375 miles was still OK but perhaps they do need changing. At the moment I'll try anything! Tempo Tom
A. It sounds to me like you've got a tight lower back which is causing the strange pain in your quad. This can be fixed with physio to your lower back and then stretches, including nerve stretches to the quad.
Q. I have just taken up running to increase my fitness for tae kwon do. However, I have found my shins really hurt while I'm running and the following day I have painful ankles. My trainers were fitted professionally by a well-known running shop as I am quite flat footed. Do you have any advice? Wendy Bayliss
A. How much running have you done initially? You may have done too much to start with and your shins are not used to it. Try to stick to 20-minute runs every other day, preferably offroad to start with.
Wendy: I started running three times a week following an app Couch to 5K. I started with one-minute runs but I have built up to 25-minute runs (around 6K). Perhaps I should cut back a bit then
Q. I saw a physio on Tuesday because I've developed posterior shin splints in my right leg. She showed me some stretches to do, but I've forgotten how often I should be doing them. I've been doing them twice a day. Is this enough or should I be doing them more often? Black and Tabby
A. As often as you can really, twice a day is good. What you'll find as the muscle releases and the stretches get less effective, you'll do them less, which is fine. Keep going as long as you feel the stretch working. You won't do too much.
Q. Do you have any advice for hamstring issue? I tore both 15 years ago playing cricket. Usually it’s fine, but when I hit higher mileage the right one gets very tight and sore. I do the ice and rest stuff but I can’t shift it. Do you think it’s an old injury that didn't clear up properly? Prior to the 2010 VLM I pulled it in training doing fast intervals, rested up for a month and then got going again. Any suggestions appreciated. mcs
A. I wonder if it's all coming from your back, especially if it was a cricket injury and it’s strange to tear both. Try some lower back and core strengthening work to see if that helps.