Injury Q & A with Physio Sarah Connors

Q16) I have been injury free for a long time, and here it comes, I did a hill session and ever since I have a stain in my calf and ankle. I can still run, but it needs ice after each run. Have you any treatments or exercises you can recommend or should I be taking some rest before I make it any worse? - Reef

A16) If it’s painful to run then you need to ease back and allow the area to heal and strengthen it up. See my last post for exercises. If sore after a run and the ankle is stiff then you may need some help to mobilise the joint. Watch it’s not the achilles at the bottom of the calf as this can take hold and be really stubborn to shift.

Q17) Would really appreciate your help - I have picked up a fairly bad case of ITB and would like your advice on getting back on the road as soon as possible. I know stretching is part of the answer but how much time should I take off (if any!) – Michael Prout

A17) If painful to run the best tack is don’t as it will just make the ITB worse. Get a foam roller to roll the ITB and the tensor facia lata - the muscle at the front at the top of the ITB. Also roll the glutes and start a glutes strengthening programme with bridging and one-leg dips with other leg supported by the wall making sure you have knee over second toe. Pilates is good to try if can’t run as will address all the above.

Once you're walking pain free and going up stairs you can try five mins of running to see how it feels. Also check your shoes as incorrect shoes can be the cause.

Q18) After my long run I have developed acute pain along the length of the back left of my right knee. I have never had knee trouble when running and am quite worried. It hurts in that area when I raise my knee only slightly off the ground, also when rotating. Stair climbing is quite painful. Any suggestion appreciated as I have a marathon in 8 weeks. – Gary Rutherford 2

A18) Sounds like you have damaged one of the hamstring muscles or the popliteus - both sit over the back of the knee. Would be worth getting it checked out to make sure no underlying knee damage and to help you start releasing the area and that above. If you can’t get help, start with easy hamstring stretches and gradually increase the range with ice after.

Q19) I'd like to get some exercises that will help stretch my hip flexors. I get a dull ache between the inside groin and knee and the front of my hip gets tight - just on the right side, but v annoying. Also, some exercises for a sore achilles tendon (not very sore, but worried it could get worse!) – Giraffe Lady

A19) Calf stretches are good for the achilles, leaning into the wall and progress to dropping your heel down on a step. For the hip, the Thomas stretch is great if you can get some help - it'll be here on the website soon. If not then a lunge stretch keeping your back straight will stretch the front of your hip. Try some bridging to help strengthen the glutes as well.

Q20) I am a 70 year old runner experienced for over 30 years, I should be running my 20th London marathon in April, however I damaged an ankle tendon before Christmas last year which stopped my training and now have been suffering from a trapped nerve on the same ankle. Manipulation has now freed it but when attempting a light run this week I suffered a recurrence of plantar fascilitus on the same heel. I don't think I will be able to get enough training to compete this year's London marathon - do you think I should save my entry for next year's event? - john hain5

A20) It sounds like you need to spend some time getting the ankle strong again as it’s getting lots of niggles around that area. I would probably put off the marathon until you can handle the training. Start with balance exercises standing on one leg then shut the eyes. Try one leg dips and calf raises so you can assess how strong the ankle is. 

Q21) I have been injury free for a year or so, but after having a small two week break due to sickness I cannot clear an achilles tendon ache. I've stayed off for 10 days or so but it just doesn't clear. There is no major pain but it turns to jelly after a run over 4-6 miles. As I train for 1/2 marathons and later this year Berlin I need some day to day advice to gradually strengthen the tendon - apart from stair 'tip toes' and 'hot - cold' treatment – Martin Frohock

A21) Did you go straight back into your normal training after your illness? If so then the body probably wasn’t strong enough to cope. When you say it turns to jelly do you mean the tendon or the muscle being weak? Look at the one leg function - can you jump? Can you hop? Can it hop as far as the other leg? Back off the running and build back up the functional strength. Add one leg dips, calf raises, lunges and squats and see what the legs are like in comparison. I don’t like the idea of it turning to jelly! That’s not good so let these symptoms settle.

Q22) I've developed pain underneath my left kneecap below the knee and to the inside. I don't feel it at all when I'm running or cycling, but it hurts going up and down stairs, sitting and squatting, especially in the morning. No heat or swelling, but I'm concerned as I've had it about 4 weeks and have cut back my training mileage but it doesn't seem to be improving. I've been endurance training for the past 3 years, with a very gradual build-up to about 70 miles per week during marathon training in the Spring and Autumn. I have a neutral gait (with a little supination on the left foot). I run in neutral shoes and enjoy wearing quite minimalist models (Kinvara/Green Silence). Any suggestions much appreciated. - Caf

A22) It would be really good to see how tight your quads and hip flexors are. They could have tightened up gradually with running and caused an overload of the knee and tendon. You also need to look at the biomechanics of your knee - does it turn in on a one leg dip? Is the kneecap being pulled tight by the ITB on the outside causing impingement of the inside of the kneecap? The Thomas test is a good way to assess quad and hip tightness and ITB - if the leg is pulled out then it indicates a tight ITB, if pulled up then it's the hip and try to bend the knee for quads.

Q23) I'm 57 and love hill running 10-20k races. I have used running as a back-mobilization exercise after a L5/S1 discectomy in 2002. If I keep racing, I keep training, and my core strength and mobility keeps up to a great level. However, my current fitness is being seriously hampered by recurrent achiles pain. I had an episode over a year ago diagnosed as tendonitis, and laid off for 3 months, but during a training run before Christmas I had a sudden pain and couldnt run properly. I stopped running completely for 5 weeks (but continued mountain biking), and then resumed training and racing this year but have been getting achilles pain after racing which sounds just like that mentioned in Scott Mitchell's blog! I feel I really need to know how to recover properly this time, and how to avoid it again, as not-running doesn't seem to do enough - Phil H

A23) Have you had anyone assess your mechanics lately? Your spine could have got a lot stiffer and this could be contributing to the extra load. If you’ve tried rest then you really need some help to address the cause and reduce the scar tissue/inflammation around the tendon and a physio can give you a structured back to running programme. Make sure though you see someone who is used to treating runners so they can assess the cause and treat appropriately.

Q24) I am training for my first marathon at 35 year old.  My fitness is good and training was going well until this week I ran 13 miles on my long run and all around my left knee ached.  It is still aching now although not as severe.  The top of my left leg has started aching as well.  Is this just my body getting used to the extra mileage and if so what is the best form of treatment to reduce the pain? – Danny Orrell

A24) Sounds like you have a tight quad and hip flexor, try stretching this area and see if that eases the ache. You have to be careful building up for a marathon to make sure you do the TLC stretching and recovery as well as the training as you build up the mileage.

Q25) I tripped and fell whilst jogging on New Year's Day landing hard on my right knee, it cut & bruised but appeared healed after a week or so. I then continued on with my normal exercise routine without any niggles until about 2 weeks later when I went for an early morning 10k run. It was fine during the run but by the afternoon it got really stiff, made me limp and made it awkward walking up and down stairs.

I went to see my doctor who prescribed anti-inflammatory tablets for a week as well as plenty of rest but it has now been 2.5 weeks since that point and I can see no improvement. When I walk on it after a short while it seizes up and stiffens and is worse up and down stairs. I am not sure my doctor knows what is wrong, he said he could feel no fluid and see no obvious signs to the surface of my knee but I am getting really frustrated now as it is not improving and the fall was about 6 weeks ago! – Hollie Holden

A25) Sounds like you may have bruised the bone at the back of the kneecap. Try ice and stretching the quad and let it settle. Sometimes these areas just need to heal, but get on the foam roller for the quads and try and ease off the pulling on the kneecap. Try moving the kneecap a bit yourself with leg relaxed move it side to side and up and down to prevent any stickiness beyond there and help it heal. If not settling go back to your GP and see if you can have an x rays as well as physion referral. Once it feels easier, try gentle loading on two legs then one before geting back into running.

Q26) I fell very badly on my left ankle last May and heard/felt something click/snap. Prior to this I had been going to gym, doing some running etc on a regular basis for around 6-9 months. I rested, raised and put ice on it etc, it was heavily swollen, badly bruised and painful to walk/run on for a number of weeks afterwards.

I recently started jogging/running again at the beginning of this year and have noticed a similar pain on the outside of my left foot, half way down my foot, as well as a small raised quite hard lump. I have had an x-ray, which has come back negative, but whenever I run on it the pain returns and lump quite prevalent. I guess it's muscle, tissue damage but was wondering if you could give me your opinion on what it could be, how to prevent further damage and how to get running again without the pain/with less pain? – Markus Schickhoff

A26) I wonder if you had broken the 5th metatarsal at the time - though you should be able see an old injury on X ray. If so it’s the bone healing you can feel. Is the pain bad to run or and getting worse? Then it could be a stress fracture in the area. Did you strengthen the ankle up properly and have treatment to ensure full range of joint mobility? If not you could have altered mechanics so it would be worth getting it looked at if you can.

Q27) I have started to get a numb foot and then a sore shin whilst out on runs of 6 miles plus, also the whole leg feels weaker than other leg and compared to before, the same doesn’t happen in speed sessions.  I have flat feet and new shoes that I wear with my insoles from the podiatrist. I’m just wondering if you think this is a shoe problem (not enough support) or something else? - Jamie

A27) If the foot is numb and gets weaker when running then get it checked by your GP as it could be a disc problem in your lower back Don’t try and run through it as you could do more damage and cause permanent weakness.

Q28) I have had the same problem for a couple of months and had to take three weeks off at one stage. Now it seems to go away after about 5 miles, and only recur about 2-3 days after my long run. Should I be bothered, or just carry on?  I do the step exercise which has been fantastic and got rid of it when it was quite bad, also do a bit of foam roller when it hurts and take some neurofen.  Am doing Manchester Marathon and don't want to overdo it, but also don't want to slow up too much as have just got back on track after the last shin splints prob.  It is not terribly painful, not there while resting and only really bothers me in case I am doing what others suggest and making something worse each time which will come back to haunt me soon! – Hilary Woof

A28) As long as it's settling then it's OK, but as soon as starts to get more sore back off. As before, vary your surface, check your shoes and carry on with the stretches. Also try some self-massage (though not into pain) around it to ease the tightness along the shin bone but not over the bone.

Q29) I’m training for the Brighton marathon in April and due to do the half marathon this Sunday, however for a couple of weeks Ive been struggling with my ITB and, I did 9 miles Sunday after a week of rest but struggled, I haven’t run since Sunday and have been foam rollering/ice and elevating, I’ve also ordered a strap to try, in the hope that will get me through Sunday! I should add I have been having fairly regular sports massage on the area to try to help loosen it. Have you any advice that might help?! – Louise sparks 2

A29) The ITB can be pretty persistent, if you can get a physio session in to assess the cause that would help. Look at your trainers - are they correct fitting or old? Are your glutes weak - can you do a one leg dip with knee over toe or does it turn in? Try some bridging and foam roller the muscle at the top of the ITB in the TFL muscle.

Running the half at this stage will probably make it a lot worse and damage your chances for Brighton. Let it settle now to give you chance to train and try some pain free cross training.