Q&A highlights: Physio Matt Todman

Catch up with the highlights of this week's webchat

Q10. I am away from home for the next few weeks and will be racing a 10k about a week after I get back. I'm able to keep up with my training plan so far, but at home I have a foam roller that I regularly use to keep loose. (I work at a desk and not only get aches from running but from sitting at a computer all day!) I don't have a foam roller here and can feel the tightness when I'm running and on rest days.

Any tips for how to get a good stretch and loosen up achey muscles without a foam roller? -Leenie

A10. Try either this, or that. Get a towel – roll it up like you’re heading off to the beach and put either tape or elastic bands around it, et voila a foam roller.

Or get two tennis balls and tape them together with 2 figure 8 tapes (use strapping tape) and use these to roll, nurdle and get into the tight spots.

Q11. I am meant to be running Brighton next Sunday but am having mega trouble with my right leg.  It started off with just a very tight sartorius: sore but managed to run a MP 16 miles on it. The day after that I couldn't walk properly, and the pain had transferred itself through basically my entire leg. The most pain I am now getting is behind my knee and into my lower hamstring, as well as the original problem with my sartorious. 

I have seen a chiropractor about 5 times, and she's given me acupuncture and keeps readjusting my dodgy bits but can't work out what's up. I have had two sports massages and have only run 12 miles in the last 3 weeks. I am still struggling to walk properly and the pain in the back of my knee can be really bad...

Any ideas as to what could be wrong? I am not convinced it is just uber-tightnes. What would you suggest vis-a-vis trying to run the marathon in 10 days time? -VieuxLilleBlonde

Thank you for any advice.

A11. Cor – sounds really nervy rather than just singularly structural. And on that I’m not sure that stretching your way of this is the right approach. Wherever there is anything tight, there is something equal and opposite to this, which is not doing very, much and so is a big baggy or over stretched.

I think I’d be more included to try to decrease movement in place where you move too much (your lower back/pelvis) by becoming more stable and encourage other bits (thoracic spine, front of your hip) to move more.

For the next 10 days I’d strictly taped to zero! Gentle roll a few things (ITB, quads, calfs and thoracic spine).

Then lace up and game face on….

Q12. My training for London was going well until a month ago. At the beginning of March I did a 20 miler and since then I've been getting pain in my right inner thigh up into the groin area when I run. It starts in the quad and then seems to move into my inner thigh and inside of my hip.

Last year I had an MRI scan on the left side of my back as was experiencing pain when I ran. It turned out to be a bulging disc and after several physio sessions I've not had any pain on my left side since.

I do a weekly Pilates session on the reformer and use a foam roller and stretch most days. I also have regular sports massages.

For the past 2 weeks I have been doing brisk walking without any problems instead of running. Last night I decided to go for a short easy run and after a mile or so I could feel tightness in my right quad and then this morning a dull ache in my inner hip area, down through my hamstring and down to my ankle.

I have noticed when running that my right ankle feels like it needs more support. I have worn the same brand of trainers for 2 years and regularly change them. I also have high arches. Could it be an overuse injury, as my pace has increased along with my training, or should I be looking at maybe getting orthotics. I've had my running form assessed in previous physio sessions and I have a neutral gait. – Jellybean28

A12. Sounds like your back again, but may well be due to the instability on the left causing an imbalance and strength differential on the right….

Overuse, absolutely. It now needs to be dealt with but make sure your not just looking at and treating the painful side.

Q13. I have a problem with the outside of my ankle starting to hurt after a few miles running. Often it then eases off but when I stop it can be sore for a few days. It started when I was doing a lot of muddy/snowy trail running.

I assume it is my Peroneal Tendon and I do the usual RICE thing and it gets better in a day or so (at least doesn't hurt in normal life). I then just rest for a couple of weeks but then when I try to run again it starts hurting again.

My main problem is how long to rest it as it feels fine when not running. Or should I be doing something else other than just rest? – Richard Abbotts

A13. Need to find out why....balance work is really important as is what are your shoes doing as is what's your running style up to.

No sure rest, in your case does much apart from prolong the waiting.

Q14. New to running (eight months), completed first half about a month ago, think I upped mileage to quickly, knee now seizes up after only short amount of running, have to stop and head home. Once I apply finger pressure to TFL the pain goes, but side of knee still tender.

Physio said it's weak gluteus medius causing ITBS, have been doing side leg lifts, lunges, squats, planks, to strengthen my core and glutes, but doesn't seem to be getting any better (been doing these for around three weeks) and I use foam roller and stretch the band / TFL as well.

There's also a clicking noise in my hip area when I flex my left leg (the one with tight IT Band).

Any advice on how long it may take to strengthen the glutes so they start working properly and can ITBS cause long-term damage? – Mark Boustead

A14. Sounds like some sound advise BUT the glut work must be functional - not on your back or not in a dynamic position. Think of training the control and when the muscle switches on and off rather than just getting stronger.

ITBs can be problematic especially with the timing - stuff to do with a neuroimmune response. Ice, tape, foam roll and make sure your know why you've got it - apart from too much too soon, what about your style?

Q15. I'm due to run Paris Marathon this Sunday, but my right calf muscle has been extremely tight and causing me pain when I run.  I've run 2 marathons, and numerous half marathons over the past 18 months and never had any trouble.  My training had been going well, with gradual progression up to 20 miles, until about three weeks ago when my calf muscle gave out about 5 miles into a run on a treadmill (I'm normally an outdoor runner). I think the likely cause was a stupidly-high pair of stilettos I'd worn for a few days (including the night before the run) which probably shortened the muscle slightly, and then didn't cope so well with being stretched out on a flat treadmill.  It hadn't even crossed my mind at the time that heels would impede my training.

I've spoken to a physio, had a sports massage, taken anti-inflammatories, done strengthening exercises, and tried to rest as much as I can (thankfully, being the taper weeks, i was winding down the mileage anyway).  I managed one 16 mile run just after the injury, but i've not done anything further than 3-4 miles for the past few weeks in case I exacerbate it any further....it has improved, but there is still a niggle of pain - sometimes minor, other times quite sharp.

The problem is, now I don't know whether I am capable enough to do the 26.2 miles in less than 2 days time. I know the run is challenging enough at 100% fitness, and I'll be lacking in confidence, for fear of it all going wrong part way through and having to pull out or hobble home.  My head says maybe just forget it and wait for an autumn marathon...my heart (it is the city of love, afterall!) wants to do it, regardless of the time, as I've spent months training through a bitter winter, and I'm heading on the train to Paris tonight anyway, with roam roller tucked in my bag!

What are your thoughts, and what's your advice for the next 40 hours, if I do want to run? – Angela Muddle

A15. It all depends on your shoes….I think they may have lost control and your calf is tight because it’s been over stretched due to the lack of control over a long period. The high heels may have been an accelerant rather than a direct cause.

I think I’d be on the start line – after all it’s paid for and I’d enjoy a “fun” run. Whether you finish or not (and the not is important) is not the question, it’s how the injury feels. It’s better to duck out at mile 10 and have enjoyed Le Paris vibe rather than finish in tears with a big hole in your calf….or you can sip a café au lait and eat an extra croissant because you can!

Q16. I'm due to run VLM in 2 weeks and it is my first marathon, training was going a bit too well up until 3 weeks ago, had reached 18.5 in my long runs with no real problems and then my calf flared up after a speed session.   

I foolishly attempted a long run a few days later anyway and had to cut short at 9 miles due to calf and a secondary injury or my adductor. I had treatment for this and it seemed like the adductor was the result of a 'control' issue so have been doing strength work on it but essentially limping around for last 3 weeks. Have been able to cross train on both bike and cross trainer and doing lots of stretching and strength work in the meantime/trying not to freak out.

I haven't and won't get to 20 miles as planned but have readjusted my time goals for the race quite a lot accordingly. My main aim now is to get to the start line in one piece. Everything was feeling a bit better so ran for an hour yesterday, very slowly due to stiffness and a bit of soreness but mainly OK. Calf still feels tender however and am tentative on it. There is no heat or swelling but can feel discomfort on the lower calf where it meets the tendon. It feels good after self massage but there is almost a 'crunchy' bubble wrap feeling which lessens after massage but then builds up again particularly after it's stressed by running or through exercises such as lunges.

My question is: what do you think the best plan of action is running wise for the next 2 weeks? And how do you think I should proceed with the calf? Any wisdom would be much appreciated. Marathon training has proved to be an emotional roller coaster!

A16. Sounds like an issue with your musculotendinous junction, rather than just the belly itself. The crunchiness is an inflammatory reaction due to the over stress.

Here’s the plan. Do lots of single leg balance work for 40 seconds often during the day. Get on your (emotional) foam roller(coaster!) and roll your calf BUT not over the sore bottom bit. Make sure your shoes have enough support –it’s not the end of the world and there are options rather than attempting to change at this late stage.

After 3 days of doing this (so Mondayish) start also walking around on tip toe for periods of 2 minutes  (which you can build if pain allows) – little and often and do this for the week until Friday. Now go for a paced run after rolling all normal things.

Think of this as a pre taper, taper!

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Hi Matt, I've been have a problem with I think my hamstring at the back of my knee. When running a couple of months ago I felt to tendon(?) at the back of my knee becoming uncomfortable. I stopped running for a couple of weeks, but it never felt 100%. I've run two half marathons since with no problem but still not perfect. Last week on a training jog I felt the tendon(?) again start to become unconforable so I stopped my run. I've not done anything for the last week and I can still feel its not right and I can even feel it when driving (a stinging feeling). I am sure I could run on it but would like it to clear up 100% this time. Would you have any advise. 

Posted: 26/04/2013 at 20:25

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