Injury Q & A with Physio Sarah Connors

ASICS Pro Team Physiotherapist Sarah Connors recently joined us for a webchat on beating injury. Catch up on the highlights here.

Sarah is a chartered physiotherapist who has specialised in treating track and field athletes for the past 20 years. As well as working for the British Athletics Team, she was lead physio for the English Institute of Sport in London before setting up a successful sports injuries clinic.

Q1) As I have stepped up my training, I have started to get an ache in my lower back on the left hand side. During my long runs I start getting aches and numbness down the top of my leg and as the run gets longer the front. The numbness has stopped me doing any tempo work but I have managed to keep plodding out on long runs but need to stretch at regular intervals. Is this a sciatic problem and should I get some physio prior to Brighton Marathon? - Hackett

A1) Yes definitely seek advice with this one. The numbness is indicating pressure on the nerve at some point presumably from a grumbly disc. You need to make sure there isn’t any muscle weakness so yes get it checked sooner rather than later and hopefully you’ll training will then be easier.

Q2) I've decided to have regular sports massages while training for my first marathon to try and keep the aches and pains at bay and avoid injury. So far I've had one (after 4 weeks of training) and have another one booked for the end of Week 8 (half way through my training plan). How often do you recommend booking them as the mileage increases towards the race? – Suz

A2) The best way to decide is to see how your body is responding to all the training. As the massage therapist will have seen you before, you can ask how much tighter you feel than last time. If you’re much tighter and generally more sore, then bring it forward a week. Don’t have one immediately prior to the race; go about a week before or after your last long run.

Q3) I've always suffered from joggers/jumpers knee, but since I've lost weight I no longer require a patella strap during exercise. Over the last couple of weeks I've notice my left calf at the top towards the outside tightens up around 9 miles into a run and the pain seems to radiate to the knee. I currently do lots of foam rolling of the calf and outside of thigh and this helps and I recently started a body balance class to help with stretching and core. Is there anything else I could be doing to help resolve the issue? – StewartC

A3) Sounds like you still have a weakness in that leg. What is your one leg dip like compared to the other knee? Try in front of a mirror and see if the knee turns in. Are your trainers giving you correct support? Try twisting them and see if one gives more than the other. Helping your glutes get stronger will definitely help, and foam roller around the glutes and tensor fascia lata the muscle at the top of the ITB.

Q4) I had a pulled calf mid-last year early on in my training for NYC marathon.  I used KT tape on it after a lot of rest, and was able to get back to running in time for the race (that never happened). I'm now training for a spring marathon, and although no pain, I have noticed that sometimes the top of my foot is quite achy on that leg, and sometimes I do get some twinges in my calf towards the back of my knee whilst I am running.  I think the calf is still relatively weak compared to the other. Would you recommend I continue to use the KT tape? - Angela Isherwood 2

A4) You say that calf is weak - have you done anything to strengthen it up? A simple calf raising programme will help starting on two legs then one and initially off the floor then on a step dropping the heels. Was there a definite tear and sudden pain last year or was it a gradual onset? If it was gradual it may be worth getting your back checked out to make sure the nerve isn’t tight causing the calf twinges. K Tape is great if it eases your symptoms.

Q5) I have really tight hamstrings, so much that I can just about reach my shins on a good day. I do pilates 3 times a week to help with stretching and flexibility and also work on strengthening my glute muscles so that my hamstrings don't always kick in, I also try to foam roller at least once a week. However there has been no improvement. I sometimes really struggle with lower back pain and have been advised by many professionals that it is all linked with my tight hamstrings and I need to stretch them, which I am constantly trying to do! I have also tried sports massage, osteopaths, etc, but I am just not sure what to do next. – Lisa 123

A5) Try a different approach, you are doing all the right things to help your lower back and hamstrings, but you might have just reached their max range. What you can look at is your hip flexors - if these are tight then this pulls the back out of line and stops the glutes activating, hence overloading the hamstrings. Try the lunge stretch on one knee stretching the back hip flexor. If you can get someone to help you do the Thomas test, your knee should hang in a straight line with your body - if it’s higher than your hips are tight.

Q6) I have been researching an issue that has been fairly persistent over the past few years. I'm 19 years old and I occasionally suffer with knee pain. I also find that my soleus muscles ache more than any other muscle after running and can sometimes cramp during a run. Could this be related to the patellofemoral pain syndrome (runner's knee) symptoms that I am getting? I used to get the pain whilst cycling and going upstairs too. It probably doesn't help that in the summer I had a partial dislocation of the same knee when standing up from the sofa. I have also suffered with a partial tear of a quadricep muscle on the same leg which has created a permanent lump and a likely weakness. – Lewis Tissington

A6) Sounds like you need a good MOT. There are so many issues with that leg it’s difficult to know where to start. The quad sounds like it’s weak and definitely needs to do a structured strengthening programme starting with two leg squats and progressing to one. It would be good for someone to look at its strength and function. Are your calfs very tight and what is the stretch like when you bend your knee, are the soleus tight? If these are weak try two different calf raises - leg straight and knee bent. You don’t say how much running you do and it would be good to know if you’ve done a structured rehab and stretching programme. Let me know if you can.

Q7) I've had problems with tight hamstrings before I started running and it lead to some achilles issues. Since taking up running I've had a few injuries, and tight hamstrings are usually involved. The last 6 months I've had pain at the pes anserine and put a lot of time into stretching the hamstrings and gracilis to no avail. I follow my physio's stretching / strengthening rehab routines, go to pilates where the teacher sees my hamstrings as a personal challenge, rolling, static and dynamic stretching, and have just started trying some Active Isolated Stretching. I just can't seem to lengthen out those hamstrings, especially the right leg. Please help the Tight Hamstrings Contingent! – Also-ran

A7) Did the physio ever mobilise your lower back?? If this is tight it can also be causing the hamstring to be tight. It’s one of the first things I do with a patient with a hamstring issue and it takes the pressure of the nerve and the muscle. Try that and see what happens. Also try the hip flexor stretch that I mentioned to Lisa above. The big thing for me is to look above the muscle and address the cause, especially if on one side then even more likely to be coming from the back. You like Lisa have done all the obvious stuff so you may need some help with this one. Also try and stretch the adductors that run along the inside of the leg. There is a great trigger point about a hand breath up from the knee joint that you can hold while stretching to try and release the pes a bit more.

Q8) I keep getting an on off niggle in my right hip, any exercises to relieve this? As I'm not in my 70's I believe it's just a muscle problem. I have tried bathing after a run, saunas and cooling gels, but they only last for a while. – Ben Leach 2

A8) You don’t say where in the hip the pain is can you let me know and I can help you with what to stretch. If it’s at the front try the Thomas test to see if the muscles are tight and causing an impingement. If at the back try stretching the glutes. A foam roller is a good investment to help with some trigger point soft tissue release. There will be some videos on the website soon showing which areas to target.

Q9) When I start running at the moment I am getting a pain in the inside at the joint. Have been told one side of my hamstring or quad may be stronger and pulling it over. What is the best way to solve this? – Iain Cowieson

A9) I presume you mean your knee joint? If it’s on the inside over the joint then it could either be the pes enserinus tendon, which is your medial hamstring and adductors, so try and stretch these out. If very specific over the joint line and pain on squatting you need to get checked to make sure there is no meniscal/ cartilage damage.

Q10) Having recently upped my mileage as part of VLM preparation I have started to get sore calves and quads . Although I know I need to ease off I am not sure how much as I don't want to lose touch too much with mileage build up. I am a seasoned cross country club runner and soreness started after a long run following race the day before. – grant corton

A10) Are you taking into account the race, when you do you long run and easing back on the distance or speed slightly? Your body needs to recover from races. Buy yourself a foam roller and start bringing in more stretching to allow the body to help recover.

Q11) I'm more than half way through my training for a half marathon and have had to stop running for a week due to shin splints.  I am due to start running again and am a bit apprehensive as I feel I have some catching up to and need to step it up but I need to take it a bit easy as well. I plan on replacing one of my four weekly runs with a different type of cardio with less impact but what else can I do to gain strength in my legs that I have lost over the week of not running? – Diana Curamen

A11) Don’t try and play catch up, you’ll only make them sore again. You're absolutely right to try and do a cross-training session. Also try and do some of your running off road as this is definitely better for the shins.

Have you been stretching the deep calf muscles? Do this by putting the toes on a step and then bending the knee. You can do some self massage into the inside calf muscle to release some of the tension - stay away form the bone and acute pain though, and ice is good after this. You can do some cliniband exercises to strengthen the foot muscles pulling the foot in and out against the resistance of the band.

Lastly make sure your trainers are not old and that they have the correct support. Quite often the cause of shin splints is over pronation so if your trainers are not supportive enough that may not be helping.

Q12) I have been suffering from bad hip pain if I run for more than 30 mins and it takes several weeks to go away.  It feels very localised and the pain is especially bad when getting up out of a chair/out of a car- Emma Fair3

A12) If you have a pain bad enough that it lasts three weeks from a 30 min run I would get it checked out. You could try your GP first and see if you need an X ray. If that’s ok, get them to refer you to a physio as this doesn’t sound like something that simple stretching will sort out.

Q13) I suffer from cramping in my calf muscles which seems to happen most often the week before my period. Is there a link?  I've spoken to my GP and she said she can't think of any reason why it should happen.  If I try to run through it I get pins & needles and then numbness in my feet.  No amount of stretching will loosen those muscles once they cramp up! In fact I have hurt myself trying to stretch them out. Fortunately when it does happen I can't get much more than a mile down the road so I don't have too far to limp home.  Once I've sat down for 5-10 minutes the cramping eases and I feel fine again.  Any ideas how to stop this happening, or how to relieve it when it does? – Joanne Hansell

A13) I’ve come across back pain prior to a period and if this is happening then it could be causing the calf to get all the pins and needles and numbness. It could be from an increase in hormones and ligament laxity, but that’s not really my field. Why don’t you look at trying to cross train that week or do some gentle core work first to make sure the back is working and protected? I wonder if we are more dehydrated this week too - try upping the fluid intake and see if that helps. Sorry there's no magic answer!

Q14) During last year's VLM my hamstrings became very painful over the last 6 miles, this had never happened before. I'm just wondering what I should do if it happens again this year. Last year I carried on through gritted teeth, but should I have stretched, stopped & rested or something else? The thought of it happening again fills me with dread. – John Freeman 2

A14) It’s difficult to predict how the body will cope with racing over a marathon. All you can do is make sure you have done all the right training including your long run and some race pace runs. Do you do a long race during your training ie at 20 miles? If so, how do they cope then? If you are fitter and better prepared than last year that will help also getting your core as strong as possible so the fatigue sets in later and later, preferably at the finish. It’s very difficult to stop and stretch at the end of a race - it's best just to slow slightly, let them recover if they will and try and keep moving. Stopping seems to seize you up even further.

Q15) I am 37, been sporty all my life & have been jogging my dog for 5 years just above walking pace. Last year I ran my first half marathon Leeds in 95 minutes and ran over 20 parkruns. I also introduced interval training, 400m & mile reps. I have a calf niggle and have backed off running in fear of injury, which is frustrating as Leeds half is in 12 weeks. I was doing intervals twice a week, parkrun & a long run for 3 weeks, then an easy week. Could you offer advice on how hard I can train & stretch please? Also, any advice on sessions that are less punishing on calfs? – Tim Crew

A15) Can you jog pain free? This will be the most stress-free way back. Once you are ok with jogging you can bring in tempo, so a faster pace for longer rather than short intervals. Can you hop pain free? This is always a good pre-running indicator. Is there pain when you stretch the calf? Have you been stretching to ease the tightness? Also try stretching the hamstrings and lower back to ease the pressure on the calf. Try a foam roller to get rid of some more persistent tightness. To strengthen, start with two-leg calf arises on the flat, then one, then repeat on a step.