Friday lunchtime Six Physio Q&A

Get your questions in for Matt Todman

21 to 40 of 66 messages
20/09/2013 at 13:31

 

Surrey Runner wrote (see)

Is there a complaints procedure against negligent physios? 

I went to a local physio who had been recommended by someone at my running club with shin back in May.

She diagnosed mtss and said it was ok to race a 10k the  following weekend.  I had weekly sessions with her thereafter until August in which she would massage my legs and advise on various excercises but all the time encouraging me to continue running, albeit a bit slower and slightly shorter than I had been doing previously.  

Leg didn't heal so a went to a Gp in June.  Going to the Gp was my own idea, the physio was not aware of it.  Finally got the results of the Bone scan back yesterday which confirmed a stress fracture - Nhs works very slowly as you know.  The physio had repeatedly assured me that i didn't have a stress fracture.

 

EEk - try the HCPC at www.hpc-uk.org they keep us all in check and will delve a little deeper.

Edited: 20/09/2013 at 13:32
20/09/2013 at 13:33
carterusm wrote (see)

I have been suffering from an ITB injury for about 6 months. I went to see a physio in March who gave me some exercises (clams, lateral leg raises, single leg squats, plyometrics etc) to do and after a month off running I started again slowly and built up my mileage. After about 3 months the pain came back again so I went to see a different physio, this time one who specifically treats runners. As the pain was only coming on after about 8 miles of running he suggested limiting my runs to 5 miles. I have been doing that for about 6 weeks now and while the knee pain is not too bad I can still feel it is there and that it could return at any minute. 

I dont feel that my knee is improving really and wondered if you had any other suggestions ? Or is it just a case of time and it should heal eventually ? Cheers

Sheriff Fatman? I hope not!

ITB never just happen. They always happen because of something….and that’s what needs to be established. You don’t sound like an overuse or too much use injury because you’ve got back to running, but I think it sounds like a technique thang.

The quality of the rehab you’ve been doing  - rather than the quantity is super important. When running, unless your foot lands in the right area with the rest of your body above and below it also following suit, you’ll breakdown.

You need to work on form (of what you’re doing) and also endurance of what you’re doing too. Do more of the weight bearing, running mimicking type rehab, but do them more often for longer.

 The longer you have ITB type symptoms, the longer you’ll have them for as the bone under the ITB will react to having to take excessive load – time is not always on your side, so make sure your rehab rocks.

Edited: 20/09/2013 at 13:33
20/09/2013 at 13:35

Hello,

I ran my second half marathon at Bristol on Sunday and gained a PB of 2:37 after my first half marathon at Cheddar a few weeks before which was 3:40 so just over an hour and twenty five minute gain ... my legs 5 days later feel fine when after my first they ached like crazy however the underside of my left foot is still aching.  I haven't been for a recovery run yet because half a mile walk flares up as it is.  I have been treating it with ice in the morning and evening.  Is there any way to tell if it is just perhaps a little bruised or needs physio?  5 days is the longest I've ever gone without a run but I don't want to cause further injury by running too soon!


Thanks

Ella

20/09/2013 at 13:35

Hi

I'm currently in training for Oxford Half Marathon on 13 October. I'd had a bladder infection so hadn't run apart from 2.5 miles in the last 2 weeks.  I went out on Sunday and ran just under 9 miles to try and get myself back on track - a mistake as I've strained my knee.  I tried going for a 3.5 mile run on Tuesday, but my knee didn't appreciate it.  I'm desperate to continue my training, but don't want to make my knee any worse.  It's not a bad strain, but it does cause a bit of dull pain when I walk around.  Any advice would be gratefully appreciated.

 

Thanks, Madeleine

20/09/2013 at 13:37
Twister wrote (see)

Yes I am moving to a more minimalistic shoe but slowly does it I have a pair of Nike Free 5.0 on there way and I am going to change my form to midfoot striking rather than heelstriking.

I figured whilst I am attempting to recover from this dull pain I may as well work on my running form aswell.

 

PS: what strength training would you recommend?

Try not to have too many balls in the air with regards to changing shoe type and running style and getting back from injury. Nail the injury, then the world's your oyster.

Old skool strength training is best - lunges, squats, box jumps (all with weight), thrusts, plyometrics...

20/09/2013 at 13:41
EllaDuV wrote (see)

Hello,

I ran my second half marathon at Bristol on Sunday and gained a PB of 2:37 after my first half marathon at Cheddar a few weeks before which was 3:40 so just over an hour and twenty five minute gain ... my legs 5 days later feel fine when after my first they ached like crazy however the underside of my left foot is still aching.  I haven't been for a recovery run yet because half a mile walk flares up as it is.  I have been treating it with ice in the morning and evening.  Is there any way to tell if it is just perhaps a little bruised or needs physio?  5 days is the longest I've ever gone without a run but I don't want to cause further injury by running too soon!


Thanks

Ella

Hi Ella - great skills and superb PB

Your time difference is remarkable, and therefore your whole body loading effect will be massively different too.

Bruises bruise..ice is good for whatever it is, but doing anything at the moment that makes it worse is not a good idea. Rest for another 5 days - your fitness wont suffer.

I'd take a punt and say this may sound like a pre clincal PF (before a mass of symptoms) and would therefore treat it as such. Find, beg, borrow or steal a roller and get to work on your calfs...

20/09/2013 at 13:42
Madeleine Harrington wrote (see)

Hi

I'm currently in training for Oxford Half Marathon on 13 October. I'd had a bladder infection so hadn't run apart from 2.5 miles in the last 2 weeks.  I went out on Sunday and ran just under 9 miles to try and get myself back on track - a mistake as I've strained my knee.  I tried going for a 3.5 mile run on Tuesday, but my knee didn't appreciate it.  I'm desperate to continue my training, but don't want to make my knee any worse.  It's not a bad strain, but it does cause a bit of dull pain when I walk around.  Any advice would be gratefully appreciated.

 

Thanks, Madeleine

Where's the pain? What makes it worse?

20/09/2013 at 13:43
SRyder4 wrote (see)

Hi there,

I have been struggling with plantar fasciitis for about 6 months now - went to see a physio who gave me some exercise to do etc. mentioned that i should start running again.  However I still have pain in my heel when I do run and am now getting sharp pain in my knee on the other leg (i.e. the heel that is perfectly fine).

Could you let me know if i should stop running or what the best course of action would be?

Many thanks,

Hello

Don’t let PF get you down! I’m loathed to say that it’s notoriously poorly looked after. The fundamentals are it’s an over stretch issue. You want your PF to stop being too long and frazzled by making sure you have adequate length of tissue elsewhere and have better control around your PF.

So don’t stretch your foot, or calf, as this just increases the PF stretch. But a tight calf will increase the load through your PF. So instead release (or roll) your calf – get the length without over loading your foot. Learn to control your foot by getting better 1-legged balance, and progress it by hopping forward onto your foot. Initially start with a trainer/shoe that gives control and progress to bare foot, when it doesn’t hurt.

Improve your glut control in a functional, running type style. Look at what your wearing on your feet during the day.

I’m not sure you should run until you’ve got enough control of your foot (either through muscular, ligamentous or the right footwear) and then slowly start to increase your loading by pyramid runs. Initially keeping it short and sweet…you can always do more, later.

Edited: 20/09/2013 at 13:44
20/09/2013 at 13:43

Thanks for all your replys. I am thinking about doing 5-10k runs three times a week again but I just worry about the dull pain all the time I suppose I just need to do it!

20/09/2013 at 13:45

The pain is around my kneecap.  It's worse going upstairs and if I squat down.  It had eased off a bit before my run on Tuesday, but it doens't seem to be easing off now.  I sit down a lot during the day at work, and I guess that's not helping.  Tried elevating it, but that seemed to hurt.

Got 2:13 for my last half marathon and wanted to get under 2 hours for this one

20/09/2013 at 13:46
Jacqui Thorpe 2 wrote (see)

Another calf-related question:

About a month ago I noticed the tendon running underneath my foot from big toe towards the heel was tight ( I do roll under my feet after plantar fasciitis some years ago) and then also a feeling of 'pulling' around the inside ankle bone. Both those eased off, but I now have a tingling in that calf muscle and some tightness in the meat of the muscle, higher up. It is most obvious when going downstairs and seems to improve when warmed up. Exercise has not made it worse, but it is not going away.

Thanks very much

Hi Jacqui

Sounds (amongst others) like you’ve got something happening with your tib post, which can look and feel a lot like PF. It’s a muscle that runs deep down your calf. The tendon appears on the inside of your shin about the ankle, runs behind the ankle bone and into your foot.

To see if it’s tight or overstretched try this. With a shoe on, in stride standing (as if you’re going to calf stretch) and wedge your forward foot (the dodgy) one, up the wall with your heel on the ground, knee bent and toes up the skirting board. How far can you bend you knee towards the wall? Here’s a vid of it http://www.runnersworld.co.uk/health/video-stretch-on-holiday/9575.html

 

Compare left to right – if it’s tight, stretch it. If it longer then stabilise it (balancing on 1 leg, eyes closed is great!).

Edited: 20/09/2013 at 13:46
20/09/2013 at 13:46

Great advise thank you - will get on a roller hunt!

Thanks!

Ella

20/09/2013 at 13:49
Twister wrote (see)

Thanks for all your replys. I am thinking about doing 5-10k runs three times a week again but I just worry about the dull pain all the time I suppose I just need to do it!

Keep to the shorter side of running, improve your running style, shorten your stride and up your cadence.

Quality not quantity...

20/09/2013 at 13:49

I've been training for two marathons, first is Nottingham next week, second Palma 3 weeks later. About 3 weeks ago I got a pain on the outside of my left knee, which I can run through, though with a bit of slowing when it really hurts, and I can control a bit with ibuprofen gel rubbed in.

Since it started I've still managed to race (5k, 10 mile hills, 10k, all PBs) and managed a couple of LSRs (20 miles with a niggling background ache rather than pain).

The pain is to the side of the kneecap and sore to touch. I suspect my hips/glutes are weak, and achilles tend to be rather tight and sore too.

Any ideas?!

20/09/2013 at 13:49

Hi

If you were going to lead a group of completely unfit, novice runners on a couch to 5K programme...  what would be your top 3 pieces of advice, to make sure they stay fit and motivated?

The outline structure will be a dynamic warm up...  follow the walk-run programme...  then do some stretches.

Thanks

Edited: 20/09/2013 at 13:50
20/09/2013 at 13:51
Six Physio wrote (see)
carterusm wrote (see)

I have been suffering from an ITB injury for about 6 months. I went to see a physio in March who gave me some exercises (clams, lateral leg raises, single leg squats, plyometrics etc) to do and after a month off running I started again slowly and built up my mileage. After about 3 months the pain came back again so I went to see a different physio, this time one who specifically treats runners. As the pain was only coming on after about 8 miles of running he suggested limiting my runs to 5 miles. I have been doing that for about 6 weeks now and while the knee pain is not too bad I can still feel it is there and that it could return at any minute. 

I dont feel that my knee is improving really and wondered if you had any other suggestions ? Or is it just a case of time and it should heal eventually ? Cheers

Sheriff Fatman? I hope not!

ITB never just happen. They always happen because of something….and that’s what needs to be established. You don’t sound like an overuse or too much use injury because you’ve got back to running, but I think it sounds like a technique thang.

The quality of the rehab you’ve been doing  - rather than the quantity is super important. When running, unless your foot lands in the right area with the rest of your body above and below it also following suit, you’ll breakdown.

You need to work on form (of what you’re doing) and also endurance of what you’re doing too. Do more of the weight bearing, running mimicking type rehab, but do them more often for longer.

 The longer you have ITB type symptoms, the longer you’ll have them for as the bone under the ITB will react to having to take excessive load – time is not always on your side, so make sure your rehab rocks.

Sheriff Fatman, thats me !

You say "running mimicking type rehab" - I'm currenly doing some plyometic hopping about and single leg squats. Could you recommend anything else ?

Thanks

20/09/2013 at 13:53
Madeleine Harrington wrote (see)

The pain is around my kneecap.  It's worse going upstairs and if I squat down.  It had eased off a bit before my run on Tuesday, but it doens't seem to be easing off now.  I sit down a lot during the day at work, and I guess that's not helping.  Tried elevating it, but that seemed to hurt.

Got 2:13 for my last half marathon and wanted to get under 2 hours for this one

Under 2 hrs? Gotta be in the bag, so....

Sitting doesn't help as your knee sits at 90 and this raises the pressure at the back of your knee cap (where I think the issue is coming from). A short blast of anti inflams (if you can take them) wouldn't go amiss. Certainly grab a foam roiller and hack away at your ITB's. Taping (your knee cap) can also help too...but best put on by someone who knows what they're doing.

Glut med exeercises are really important....as is a little more rest

20/09/2013 at 13:54

Hi

I have for over two years suffered from ankle pain in my left foot when I run. I have seen doctors who referred me to a physiotherapist who was very supportive and after 8 sessions of various exercises referred me to another physiotherapist who was trying a new form of exercises for pain from tendonitis (which is what I was diagnosed with) which again failed, he offered me injections but to me that would only mask the pain, in my view we suffer pain so the body can warn us something is wrong. I had  6 sessions with a podiatrist and again still have not overcome the problem. I have conceded and given up running but am now really missing it is there anything else I can do for my condition. 

20/09/2013 at 13:57
Iccle Jim wrote (see)

I've been training for two marathons, first is Nottingham next week, second Palma 3 weeks later. About 3 weeks ago I got a pain on the outside of my left knee, which I can run through, though with a bit of slowing when it really hurts, and I can control a bit with ibuprofen gel rubbed in.

Since it started I've still managed to race (5k, 10 mile hills, 10k, all PBs) and managed a couple of LSRs (20 miles with a niggling background ache rather than pain).

The pain is to the side of the kneecap and sore to touch. I suspect my hips/glutes are weak, and achilles tend to be rather tight and sore too.

Any ideas?!

Hey Jim

Sounds like an over stressed ITB, where it attaches into the outer side of the knee. Foam rolling is good as a pre run reliever. Some of the velcro bands can also help. Ice post run is a must.

With Notts next week it's probably a little too late to try to alter your cadence, as it sounds as if you may be an over strider...maybe for the next?

20/09/2013 at 14:00

Thank you for your advice it has been very helpful.

I do have one more question though. Do you thinking normal running shoes from running shops have too much padding and support?

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