Q. I had a stress fracture/stress reaction three quarters of the way up my tibia back in May (only diagnosed via isotope bone scan, as the MRI came back negative). I took four months off from running and have been back running since September without major issues (except occasional tightness in the tibialis anterior).
Since returning and building up distances, the highest mileage per week I have done is about 40 and I've been fearful of doing too much (prior to injury it was consistently 80-100).
Is there a period of time after which you would consider a stress fracture/reaction to be 'better'? Or is it a case of 'suck it and see'? I think a follow-up bone scan would come back positive, due to the slow renewal of bone tissue. Am I correct to assume it's simply a case of being careful with my mileage build-up and stopping if it hurts? Nick L
A. Yes, you're right a scan would probably still be positive. It's best to build up steadily, the 10% rule is always a good one and don't increase training by more than this each week.
Have you found the cause of your stress fracture? Is it your mechanics, were you wearing old shoes or did you build up too quickly? If you've eliminated the cause you'll feel more confident building up again.
Nick L: Thanks for the response. I stuck to the 10% rule but have stopped increasing.
As to the cause of the injury, it wasn't my shoes. I had a minor biomechanical issue of a dropped first ray in the foot of my problem leg. I've always used 'superfeet' orthotics. A brief experiment with other orthotics gave me six weeks of grief before ditching them.
I suspect the cause was not enough rest after too many high mileage weeks - and an off-road 100K was simply too much.
Q. I have just had to withdraw from this year's Virgin London Marathon due to retrocalaneal bursitis. It flared up on a run on the January 7, after a good solid 10 weeks of training. I've stopped running (although I'm still cycling and swimming), I'm taking anti-inflammatory drugs (diclofenac and ibuprofen - not at the same time, I might add) and using the RICE technique.
My running shoes weren't old and I'd only run 100 miles in them. They are same model I always wear (ASICS GEL-KAYANOS), although the model number has increased from a 16 to a 17. This is normally just a cosmetic change I believe, but I'm wondering if this has had an effect. I've subsequently changed to Brooks and these feel far more comfortable.
Every time it has felt better and I start running again it flairs back up (I've been having some ultrasound). I'm currently two weeks into three weeks of total running abstinence, but it's still not feeling quite right.
I'm starting to get very frustrated that it won't go away. Do you have any suggestions or exercises to accelerate things? I'm having weekly ultrasound and massage, and I'm desperate to get back out running. RunningBezz
A. I know you are having ultrasound but has anyone looked at your foot and ankle? There is normally stiffness in the subtalar joint (STJ) and around the ankle causing abnormal mechanics and pain.
Have you had your gait checked so you know the KAYANO is definitely the right shoe? I'm not sure if they have changed the heel cup, I've got the new ones and love them, but everyone is different. You definitely need to rule out any stiffness in the foot. Are you seeing a physio for the ultrasound? Make sure they are used to seeing running injuries and get that checked out.
RunningBezz: I'll pass on your thoughts tomorrow when I have my next session. Yes, he specialises in sports injuries. I've also had my gait checked last October and it was confirmed that I'm in the right shoe. It was a tossup between the Brooks or the K16's, so I stuck with what I knew. I went through the 16's, then got 17's. Now I'm giving the Brooks GTS a go. The only other change was some extensive running in trail shoes over the Christmas holidays in the snow. Could this have triggered something?
Sarah: Trail shoes are definitely a lot stiffer and the hips work a lot harder in the snow, so that could be the cause.
Q. I'm training for the Virgin London Marathon and I'm doing four runs a week (one long, slow run, one interval session, one easy run and one steady run - approximately 40 miles a week). All was going okay until the Essex 20 race, when at around 10 miles I could feel my left quad (inside middle to lower side), start to tighten.
I finished but I was very sore at end. I went for an easy run two days later and stopped at 3.5 miles as it kept getting sore, but it would go as soon as I stopped running. I rested until Friday and went for an eight mile easy run and had no issues. So I did a long slow run off-road (22 miles) and again there were no real problems. I did another eight mile easy the following day, my legs felt heavy and a little sore but that went next day. I decided to do intervals and had no issues until the last repetition when it got tight again.
I ice and stretch it every night and also use a foam roller. I've not run since yesterday morning and will not run again until Sunday (I have a half-marathon). Is there anything I can do to stop getting tight in that area? Or could it be a pull or strain that I just need to rest? Hornchurch Hammer
A. It would make a huge difference to your quad if you had your lower back mobilised, then the hip stretched out. Everything just gets tighter and tighter when you're training for a marathon - in fact I sponsor my friends with physio for that reason.
Try and do some bridging to try and activate the gluts further to take some of the load off the quads. The best way to stretch is called the Thomas stretch - you hang the hip over the edge of a bed, with other leg pulled towards you and you get someone to try and gently stretch the quad. This is shown in the video of stretching in the steeple chase water jump pit.
Hornchurch Hammer: Where can I find the video? Is it on this site? I'll do the stretches and try and get as much in between now and Sundays run (and of course after that). With a tight quad, what is the worst than can happen in my half-marathon race this Sunday, if I try and race through any tightness?
Sarah: Don't push through pain. The worst thing you will do is tear the muscle and be out for six weeks. I'm not sure where the exercises are on the site, I can't look at the moment. [RW note: Find videos of all of Sarah's key stretches]
Q. I have similar problem to _ciaran. I'm running the Brighton Marathon. I did a 20-miler two weeks ago and last weekend I ran a half-marathon. In between the two I started get problems above my knees. The chiropractors said it was an ITB problem, so to take it easy.
I did two six milers this week but it's much more sore, not awful, I just know it's there. Anyway, my regular chiropractor is away, so the new person said it's actually TFL problems. She gave me laser treatment and told me to miss the long run this weekend, and just to run four or five miles. She said I should be okay if I pace myself.
My question is, have I peaked too early with my long run (next weekend I should start to taper with a 15, then 12, then race)? Should I attempt another 20-miler next weekend or should my 20-miler five weeks before my race be sufficient? Also, is my chiropractor correct in saying I can carry on running? I have no pain at all when I walk. Liam Baldwin
Sarah: Have the chiropractors been helping you stretch the hip and back area out? This will relieve lots of the tension. It's important to get as free as possible before the race, then you can keep going longer without pain. Get them to focus on freeing you up more than laser treatment. If you've done your 20-miler you should be fine in terms of training. Try not to run with pain as this creates more inflammation.
Liam Baldwin: Thanks Sarah. I think my back is okay, though they pointed out that my hips are tense. Anyway, I've got exercises for the hips but only one for the IT band - could you point me in the direction of any more?
Sarah: It's really hard to do anything for the IT band, it's best to address the hips.
Q. At the beginning of my marathon training back in December, I suffered with a lot of pain in my knee at the end of a 13 mile run, with pain also going across the top of my thigh. I visited a sports injury clinic who put it down to having a tight hip flexor. After having regular sports massages and doing lots of foam rolling, I have been able to complete my training for Brighton without much problem.
However, I did a half-marathon on Sunday, where I put in a high pace and come mile 12, my knee began to hurt a lot. As I was on path for a PB I continued, and at the end of the race I had extreme pain in my knee on the outside and the top, and found it hard to walk for a few days. Whilst it feels okay now, I had a sports massage on Wednesday and was told that I might have inflamed my ACL and not to do any running for a week.
My concern is that there is only three weeks until the race. Whilst I realise I should start the taper, will doing nothing for a whole week set me back? If I have inflamed my anterior cruciate ligament (ACL), am I going to be okay to run a marathon in three weeks? I don't want to do it and injury myself further. Victoria Bailey 3
A. You won't have damaged your ACL, as this is one of the stabilising ligaments inside your knee normally injured in football or skiing. You have probably got inflammation of the ITB, which is the long fibrous band that runs down the outside of the thigh. If this is tight it can pull the patella (kneecap) out of line and cause knee pain.
Definitely keep stretching the hip and foam roller the TFl, the soft fleshy bit at front of hip, and also try and get your lower back loosened. Do this and try some easy running, you need to know you are okay before you start the race.
Q. I was on a run nearly three weeks ago and I've done something to my achilles. It felt tight when I started running but I hoped it would ease up. However, after the run, it felt very tender.
I rested for three days and tried a short run, then rested for five days before trying again. Both times the pain was there as soon as I started running, although bearable. I have run three miles this morning, after nine days of rest, and the pain is back with a vengeance.
How long should I be resting for? I have pulled out of the Wilmslow Half-Marathon on March 27th, but I am so looking forward to running the Chester Half-Marathon on May 15th.
I really don't want to lose any training time! Can you recommend any home treatments? Jackie Hislop
A. It's really hard to treat your achilles by yourself, other than stretching and strengthening it. It's good to do eccentric work once the initial acute phase has passed. Drop your heels down on a step then lift up, initially with two feet.
You need someone to assess your gait, look at your trainers and your foot to see what has caused the problem, as this is the key to eliminating achilles problems. Are your trainers old or do they give when you try to twist them? Is there stiffness around you heel altering the mechanics of your foot? All these things are difficult to assess by yourself.
I would seek some advice. Try the local running shop first and get them to look at your shoes and gait, then go from there.
Jackie Hislop: I had my gait analysed last July and have trainers to correct overpronation. I have kept to the same type and have been running in my current pair since mid January, so can't see them being the problem. I'll book a physio appointment for this week and will pop back to the running shop to see if anything has changed.
Q. I am running the Brighton Marathon in three weeks, my first for 15 years. Training was going well until I went out for a run on Feb 27th, when I had pains in my inner thigh. I assumed this was a groin strain, so I stopped training for a week. I then did the Eastbourne Half-Marathon on March 6th without too much difficulty but the pain in my thigh returned the day after.
I rested again and waited until the pain subsided before doing a 20 mile run at the weekend. Now the pain has come back again and this time does not seem to be subsiding too quickly.
I guess I am returning to running too quickly? In which case what should be my strategy to ensure I am recovered for the Brighton Marathon on April 10th? Rob Love 5
A. If the groin is sore you need to stretch all the muscles around the hip to loosen it, including the adductors on the inside of the thigh and the hamstrings. Is your pelvis level? If not then you will be putting unequal strains through the hips. Try standing and see where both hip bones are and if they feel level.
It's worth stretching the hip and working the gluts to off load the area. These stretches should all help. Keep cross-training and try some easier runs to see how feels prior to race.
Q. I've got IT band pain below the knee after ramping up mileage significantly and never had it before. Is this an indication of TFL weakness, or of some other muscle structures getting overloaded? Ian M
A. IT band pain is more a sign of gluteal muscle weakness, as the TFL then has to overwork to compensate. Try some gluteal exercises to take the pressure off your ITB and make sure you increase your mileage slowly.