Physio webchat with Paul Hobrough

We are hosting a webchat this Friday lunchtime, get your questions in now.

41 to 58 of 58 messages
24/01/2014 at 14:13
Sara Collins wrote (see)

Hi there, can you advise me achilles pain please. Tried icing, heel,lifts, gait analysis, stair drops.. I tore one of them 3 years ago which was operated on and I s. Perfect now, but the other one is just getting worse, I can't stop running- it's my passion but I have read conflicting advice about heel drop stretches (alfreddson? ) and whether they can cause more damage. Please help? 

Sara.  Since i started to use the Alfredson protocol I haven't ever caused anyone harm and I have a stratospheric rate of getting people back to full health and running. The application of this protocol is vital that it is right, see my earlier post.  are you sure that you have an a chillies issue as it sounds more like plantar is to me 

24/01/2014 at 14:15
Sara Collins wrote (see)

Hi there, can you advise me achilles pain please. Tried icing, heel,lifts, gait analysis, stair drops.. I tore one of them 3 years ago which was operated on and I s. Perfect now, but the other one is just getting worse, I can't stop running- it's my passion but I have read conflicting advice about heel drop stretches (alfreddson? ) and whether they can cause more damage. Please help? 


Sarahphys wrote (see)
I've been very lucky so far with injuries just resolving with a few rest days. However Achilles tendinitis more stubborn. It eases with not running for a few days but is then aggravated by even a short gentle run. 12 weeks to go to london marathon. Any thoughts on how best to treat this apart from rest, ice, core work, cross training please?



can you take a look at the previous replies on a chillies and the protocol.  if this doesn't answer your questions then please come back to me.

24/01/2014 at 14:17
Catherine Hannan wrote (see)
Weird one this.. ive injured my right bicep recently and as a consequence have "tightened up" my top body and find this has ruined my run flow.speed ad stamina have suffered cos i get tired more quickly. Any idea how to solve this while arm is healing?

Catherine.  Yes this is a little strange…  running technique in the upper portion of the body is as important as the lower (well nearly) and when we become tense and loose this technical flow then it has an effect on the stride length and potentially our use of our lung capacity (if the rib cage isn't being allowed to open fully)  I suspect that this sums up your issues and I wish you a speedy recovery.

24/01/2014 at 14:23
Katy1 wrote (see)

Hiya, last year I had to defer from marathon one week before due to knee pain. private mri diagnosed this "soft tissue oedema beneath the iliotibial band at the level of the lateral femoral condyle in keeping with iliotibial band friction syndrome" after 3 months of rest, glute, hip and general leg strengthening - the pain was still there so I had a cortisone injection back in june which was amazing no pain since. i have regularly been running 30+ miles a week since. I am marathon training again - building up my long runs am upto 15 miles, however my knee is very slightly achy again. 

any tips how I successfully train this time around? Am still doing lots of strength/stretching and regular sports massage.  Am i always going to have a weakness there?  would be really gutted if the same happens again! Any help gratefully received! 

Thank you for any advice


Katy, once again I don't want to go over old ground and I have spoken in 'some' detail about ITBS earlier in this forum, however you also mention cortisone injections and ask if you will get the issue back again.


Cortisone worked for you, because it took away the last bits of inflammation I suspect, but you were also fixing the underlying issue with some good rehab by the sound of it.  It does seem like you are doing a lot right, but there is a great strengthening exercise for TFL which I will add in my article for the next mag,basically stand side onto a step and dangle the uninjured side off the step.  on the injured side bend the knee, pronate the foot, but the keep the knee over the middle toe.  Drop the hip on the unaffected side and then start to swing this leg slowly back and forth.  25 reps X 3 AM and PM and you will feel stronger and able to run further without pain (I hope)

24/01/2014 at 14:25
samsunguser wrote (see)
Have been suffering with posterior tibialis tendinitis for about six weeks now. I tried a run last sun since feeling stronger but my ankle still doesn't feel right. How much longer? I have been strengthening and stretching massaging. I managed 10k at the weekend.

A very difficult time line to be accurate with.  Text book answer is 6 weeks of rest for all soft tissue injuries.  You are clearly back running and still in pain!!


The exercises you mention do not specify that they have been "eccentric"  if this is the case then without eccentric loading I can't see how it will resolve.

24/01/2014 at 14:27
Ben Seymour 2 wrote (see)

Hi Paul,

over the last week I've felt a little bit of tightness at the top of my left heel. It never really hurts during the run, though I feel it a little, but after it does feel quite sore. I ran Monday and Tuesday, rested Wednesday, ran again on Thursday and after asking myself some honest questions have settled for taking the next two days off. At the moment my heel feels ok- the only sign is it clicks when I rotate my foot. Can I expect this to clear up in the next couple of days with RICE and anti-inflammatory medication? does it just sound like a niggle that will clear up quickly?

Thanks, Ben 

BEN…. impossible to say.  When you say the top of your heel, i envisage your a chillies tendon, but I don't seem to feel that I am on the right track here, can you be a little more specific as to where you refer to as the top of your heel?  If it is the achillies then poles see all the posts earlier.  if not then I await the next instalment. 

24/01/2014 at 14:27


24/01/2014 at 14:32
AndyRuns wrote (see)

I've had a bit of achilles tightness over the last few months, where I wake up in the mornings and my ankle is a bit stiff and painful to walk on, but this pain dissipates over an hour or so or quicker if I do some stretches, heel drops on the stairs mainly. However last week during an easy run the out side sole of my foot (same side as the tight achilles, related?) started hurting to the point I couldn't walk properly for the rest of the day, I iced it and all that! and haven't run since. It feels much better in that I can walk OK but still not 100% or even to the point I feel happy to run on it. Is there anything I can do to speed recovery? Should I go for a tester run to see how my foot copes? I'm meant to be training to run 26.2 miles, and sitting around with a painful foot isn't helping. 

Andy, this sounds like the start of something called Plantar fasciitis.  When you push the base of your heel, just before the inside of the foot arch does it hurt there?  does it hurt the first few steps in the morning? do supportive shoes help?


if so then please follow my 8 top tips for plantar fasciitis.


1) no bare foot walking (not even to the loo at night)

2) Write the alphabet with your foot before moving in the morning or after a prolonged sit

3) use a strassburg sock at night

4) stretch the Gastrocnemius and soleus muscles 4 -6 times per day for 45 seconds

5) ice the foot after any heavy use

6) use supportive shoes, or shoe insole such as Scholl orthoheel

7) Drag a towel across the floor using your toes 2 min X 2 per day

8) DO NOT run until you can press your heel and it doesn't hurt at all

24/01/2014 at 14:38
MsLauraH wrote (see)

Hi Paul,

thanks for taking the time to answer some questions.

I had shin splints in my right leg last year after training for a half marathon. I saw a physio, didn't run for 6 weeks, started wearing insoles as I overpronate, did a lot of stretching and added some extra glute strengthening exercises. I recovered and started running again but now I have shin splints in my left leg, which is a bit unfortunate as I'm training for a marathon in April. I've started with the stretching, icing and strengthening exercises again but I'm still in too much pain to run. I will see a physio next week but my question is whether you think I'll still be able to run the marathon in 10 weeks' time and whether it's better to stop running completely for a bit or just stick to shorter, slower runs?

I'd be very grateful for some advice.


I think it is very possible for you to run, but agree its tight on time!!


Is there any chance you can make it to see me, I have a lot of success with these sort of things?? or 

I would suggest really strengthening your tibialis posterior if you aren't already and plenty of core strength to be going on with.  You need to start building your training up with cross training and dove tailing in some running with interspersed stretches.  Do your strengthening before bed so you aren't overloading the muscles during the day and get adequate recovery.  I wish you all the best, this will be a tough journey but all the more rewarding when you make it….. (I have got people over the line with far less time and in a worse place than you before now, so don't give up hope)


24/01/2014 at 14:39

Thanks everyone, I've really enjoyed this today, back next month and please see my Column each month in Runners world magazine.


Great questions and hopefully its been of some help.  I will be posting the exercises mentioned on  so you can find them at a later date.


Thanks again

Paul Hobrough

Physio & therapy UK Ltd

24/01/2014 at 14:41

Thanks for the advice and encouragement Paul!

24/01/2014 at 14:46

Thanks Paul, your explanation does sound like what I have. First few morning steps do hurt, never tired the heel test before but yes there is a small pain near the arch when I do that! I spend all my time at home barefoot and don't own supportive shoes! guess I need to go shopping for fancy sock things and supportive shoes.

I assume cycling is not going to make things worse?

24/01/2014 at 15:47

Thanks Paul, I'll google as you suggested and keep working on this. Something tells me you will probably not have any clinics near me as I live in the Scottish borders but will have  a look. Thanks again.

24/01/2014 at 16:37

Thanks Paul. I will try more regular heel dips. Patience is a virtue with these injuries hey! It's always difficult to know how much rest to have when you are not in constant pain but when things definitely don't feel 100%

24/01/2014 at 17:02

Thanks for answering my question paul and for giving me an excersise to do.  Will start them tonight! Many thanks again, kind regards katy

12/02/2014 at 14:51

Hi I've developed an annoying pain in my left knee, feels like it's behind the knee cap. Been running again for about 6 weeks. Up to 20 km on a good day, all off road.Not a problem whilst running just sort of dull ache after

17/02/2014 at 16:34

Hi, I have had a problem with my hip and haven't been able to run since Sept 2011.

I have a sharp pain over my left hip joint, which can make me limp.

It started when I went for a long walk. I stopped running and usual ice and rest for a couple of weeks.  Then gave up running.

I saw my GP, gave me a cortisone injection, made it feel better for 2 weeks. Then the pain came back.  Had x-ray, that was fine, then had a ultrasound scan done, showed inflammation of tendon over hip joint and small tear.  Saw a consultant, who said I didn't have a tear, just an inflamed tendon. I was then sent to a physio, had accupuntre and stretching exercises to do.  I have also taken ibuprofen and iced the area.  The pain comes and goes. It flares up if I go for a walk usually a couple of miles.  Also gets worse if I sit down too long. GP is no longer interested.  Physio told me I would have to learn to live with it. 

Please advise

20/02/2014 at 16:54

Hi Paul,
I'd greatly appreciate your advice for an achey left knee. For the past few months, I've had a slight ache in my left knee, only when running, and so slight that I've managed to run through it (and forgotten about it). But this morning, the ache was worse. I could still run through it, but the ache lasted for the rest of the day. I feel it in the medial aspect of my left knee, sort of on the medial aspect of the patella. It's not tender at all, I can press the area firmly. And I can do a squat and not feel anything. Running and walking seem to be the only things that bring on the ache.
I'm planning to run on Sunday (training for a 10K race) but I'm not sure what to do now.
Thanks for your help,

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