Webchat with physio Matt Todman

hi matt,

i picked up plantar f. in july,and spent 2 months doing cycling instead.i have been able to run again since september and as god as before with very little pain except when ive finished the run/race,when it then is inflamed and uncomfortable for a day or two.

ive been recommended to not have a cortisone injection/and to have one,so am not sure what to do.will it go if i just keep racing,then massaging as i am doing?

thanks

Welcome to Matt from Six Physio!

Thanks for joining us on today’s physio webchat, Matt.

Matt will be answering the questions that you’ve posted through the week, and any more you have over the next hour.

Over to you Matt…

Katie RW

On your marks......

Hi Everyone, thanks for the questions....here goes

Hi I've been getting pain in my left hip when running.  It only started recently and only when I plant my foot.  I've had some therapy on a trigger point in my TFL, it only starts to hurt 2/3 miles into a run.  Any ideas?

Malcolm - PF is an over stretch issue, and because of this really doesn't do well in the long run with excessive stretching. It needs to restored to its normal lenght but not beyond.

The issue with jabs is that they may well deal with the inflammation, but if you haven't dealt with why you've got the inflammation then problem may go, and then reappear later.

Jabs into the PF are at best very painful (sorry!) and controversial, BUT do helpwith some people especially if evrything else has failed....

Go easy on the massaging, go big on the stability and control - what's you 1 legged balance like?

Gaz, where is the pain?

Bex - are you sure that it's muscle stiffness from use or is it your muscles protecting the nervous tissue below?

You maybe able to differentiate the 2 by if your slouch when sitting then straighten your leg to feel the tightness and can change (better or worse) the tightness sesnsation by putting your chin on your chest or looking up to the sky (without changing your slouchability) you may well have the latter and will need to aproach it very differently.....

Kate F - Go very large and very big on improving your gluteal stability and control. This is not the same as getting stronger.

It seems you are doing all the right things thus far, but there is a correlationship better ITB and glut (med especially) stability.

Control, form and weightbearing are key. Lunges, single knee squats and running man are great...

In my left hip area, across the front into the groin area.  Feels like a sharp pain when running on it and then a dull, dead leg feeling after.

Wetfish - How about using a PNF (proprioceptive neuromuscular fascilitation…huzzah!) pattern such as Hold/Relax.

Take your muscle to the end of the available range and make it contract here, without any movement. Hold if for 15 seconds, then relax. Try now to increase the range and repeat.

However, every muscle has an equal and opposite. If one is short and tight the opposite must be long and baggy….why not try addressing these?

MCS - Yes!

Start simple. Is it your shoe lacing or fitting? Where is the P&N’s?

one leg balance is good as i do a good session of plymetric stuff each week,if that makes sense

Hi Matt

I have a history with achilles problems on my right side following a calf tear and a scm tear in the achilles back in 2005/2006.  I followed a rehab programme under the guidance of a physio and have continued with running/cycling/swimming since then.  I have always been aware of the problem and on occaisions I get the morning tightness and never run on consecutive days and I suppose have managed what I now treat as normal.   I do my exercises (less religiously I admit) heel drops and stability work, stretch and roller and gym work.  I have completed 20+ marathons and 5 out of 7 Ironman events

Roll forwards to this year and following a fair amount of walking around various Olympic events I seem to have developed a problem on the opposite heel, I believe this is the very bottom of the achilles insertion point rather than anything PF related as there is no pain on the underneath of the foot at all and no tightness, the heel feels bruised and occaisional tightness in the morning, I have done very little running since July/August as it never seems to feel 'right'.   I am unsure as to how to progress with rehab as this one has me a little stumped
I have continued with cycling/rowing/gym et.c


I am sorry for chapter and verse but the history may well be relevant !!!
To pinpoint the location if that helps, if you were to draw round your foot whilst stood on a piece of paper, it would be where the pen touches the heel at the back 

Many thank yous !!

Gaz - sounds more like a back issue rather than a direct hip problem due to the time it takes to come on when running.

You don't need to have back pain with a back issue, but I'd go for trying to run tall, not overstride and get some more movement into your thoracic spine. I think I'd stay away from stetching your hip

Have a try of this stretch: Roll up a towel as if your heading off for a swim. Put it on the floor and put a pillow at the top of the towel, like a "T" shape. The pillow should be bigger than the towel. Now lie on the towel (between your shoulder blades) with your head on the pillow and shoulders off. Bend your knees and hang out here for 10 minutes. It can be painful.....but should feel like you're lying on a towel.

Tempo Tom -

Simple! You need to get your stiff thoracic spine moving more and better. The lower back moves too much, and so is painful.

You need to change your work and possibly your running posture. Stand, sit and run tall.

I wouldn’t train with pain – the issue being that the back pain causes the stabilizing muscle to fail and fall asleep. In doing so you’ll temporarily loose the stability that these muscles provide to your lower back. This increase the instability and pain, making your thoracic spine (mid back) stiffen in compensation…..and the process goes around.

Get more movement in your thoracic spine and learn to stabilize your low back

Colin -

Sounds very PFJ (kneecap!) – the 90 degree is the give away. It’s where you load your kneecap up maximally during a squat.

The back of the kneecap is covered in cartilage and is thickest on the portion of kneecap that takes the 90 degree load. If you’ve over loaded or poorly loaded the cartilage then it starts to fail, and the bone below (subchondral bone) become irritable and painful.

It does need a bit of rest and a period of time where you don’t over load your kneecap in this range. Foam roll your ITB, try taping your patella (or get someone to) into better alignment and really concentrate of ramping up the control around your pelvis (glut med), knee cap (VMO) and foot (tib post).

Great thanks. Daft as it sounds I now have symptoms of shingles but without any skin rash.  Doctor says it could be some injury related neuralgia but I'm feeling this on my right side.  Any chance of the two being connected?

M.....eldy - Wow! You've got heaps of miles and experience under your belt...odd that it's the other heel.

I take it because you are pretty OK with the rehab aspect then we shoud look at other things that may or may not be so obvious, such as your sciatic nerve, that can very much feel like this. And as with one of the qustions above you need to differentiate the nerve from the achilles - if your stretch your achilles and feel the pain at the boney point can you change it if you moves another part of your body? Head on chest or bending forward from the waist?

Gaz......maybe, just maybe!