Webchat with physio Matt Todman

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05/04/2013 at 13:12
Slow_coach wrote (see)

Hi Matt,

 

Im in a similar position to MDC. I trained to 14 then 16m without a hitch (a month before the race so plenty of rest) and on race day on a 21m run on March the 24th and my knee went at mile 13.

I did completed the distance with a combination of walking and running.


I never had a problem with this knee before, no new trainers or anything odd like that.

I used Dr Google and as my pain is on the outside boney part on the inner side of my left knee (as if I had knocked it), it sounds like it's patellofemoral pain / Syndrome.

I can walk ok with no pain but yesterday I tried to run for the first time and it hurted within a few minutes so I stopped.

I can cycle and swim with no pain.

I have my first marathon (xc) on June the 8 and I m in desperate need to train!

HELP!!

 

Hi Slow coach

Similar to MDC, and sounds like PFJD – but it’s not as advanced, yet! I think it sounds as if you’re feeling an over stretched medial retinaculum…..half of a bit a cling filmy tissue that keeps your kneecap on the front and in the middle of your thigh.

Advice is pretty similar, but I’d add get some gluteal stability – lunges, squats, single knee dips, balance work ALL with really good body alignment so you feel your bum working. Taping is great too as long as it feels better when taped, rather than just taped.

Do have a check of your knee to wall distance on the painful versus the non-painful side – it shouldn’t be tighter.

Shoes all OK?

05/04/2013 at 13:15
Janinemarie wrote (see)

Hi Matt

Sorry I'll try to not make this too long-winded!

I'm doing my 1st marathon on 5th May and training has been going really well.  i did a 20 mile run on Saturday however and my left knee started hurting a lot for the last 5 miles.  This continued hurting for the next 2 days so i went to my physio who thought it could be my shin muscles.  She worked on them and my knee did stop hurting. She told me to put heat on my shins and to try and run the next morning.  I did 6 miles the next day (yesterday) and now my knee and shin muscles hurt alot! I'd had my 1st sports massage a few days before my 20 mile run where she worked on my muscles in my lower part of my legs so I don't know if this is something to do with the shin pain now as I've never had shin problems before?

Basically I want to know what I should do now - just rest? Everything has been going so well and I'm right at the point in my training where I should be doing the most training not resting and now I'm starting to panic!!

Hi J

….not quite sure why your shin muscles would need working on, and this is most likely why you were sore when you went out to run again.

Don’t panic – follow the advice for MDC and Slow coach. You may all have slightly different symptoms, but the underlying causes may actually be pretty similar.

A foam roller should be first line of defence for any one running a marathon. Your ITBs may scream at you for rolling on them, but your knees will thank you!

05/04/2013 at 13:17
Jamie Farmer wrote (see)

Hi Matt,

Another knee problem for you.....

The inside of my right knee cap feels bruised and tender and gets worse after exercising (running or cycling). I don't have any problems with it whilst walking but do when my leg bends about half way. I can carry on bending my leg and pull it up to my bum and then I don't feel the bruising. It just seems to be when my leg is bent at a certain angle.

During runs and cycling, I feel a bit of discomfort at the beginning but this usually subsides and pretty much goes away. I work in an office and notice the bruising feeling can worsen during the day, but I try and help this by elevating it on a box under my desk throughout the day.

I have a foam and rumble roller that I frequently use but is there anything else that I should try/do to help or is it a case of taking some time off and resting?

I'm running my first marathon in October so I need to as fit as I can by June time to begin my training.

Thanks,

Jamie

Hi Jamie

At least you’ve got between now and October to nail this.

This is pretty similar to all the other knees – but just at a different stage, as you haven’t really up the load and stress, yet! The pain feels different in different ranges due to something called the patellofemoral joint reaction force and when the patella is in certain position on the front of the femur.

Feeling better during the run normally indicates an inflammatory response as the raising of blood pressure and warming up effect helps dissipate the inflammatory grot. The sitting pain is also known as “movie goers” sign and is all pretty classic stuff for patellofemoral tracking issues.

I’m not sure rest (unless you’re really upped your training) will get rid of the cause of the issue – and I think this is what needs identifying. I think a trip to your local sports physio is in order…

05/04/2013 at 13:19
Mary Edmonds wrote (see)

Hi Matt, 

Knee problems seem to be an occuring theme here. I have the London Marathon on the 21st April and completed a 20 mile on 24th March. After about 7miles and a rather large hill, my left knee started to ache and there was a dull pain under my knee cap. I continued to complete the run, but had slowed down and a few times i stopped to ease off and when i started again the pain had gone, only to return about 5 mins later.  I iced and rested and did 20 mins on the tuesday, however it started to hurt again and haven't run since. I have managed to swim and completed some aqua jog sessions but haven't tried biking. It feels tender on the inside of the knee now, rather than the actuall knee cap itself. 

Do you have any advice to make sure that i get to the start line at the end of April. 

I have never had any issues with my knee before and have been training and racing in my trainers since November and it doesn't hurt when im walking or on it during the day. Just getting very nervous that i am loosing fitness for the marathon as was on target for 3.15!

Thanks very much,

Mary. 

Hi Mary

Same as the rest! The tenderness is where the medial retinacular (like a cling film) attached to the inside border of the kneecap is stretched. The kneecap is pulled to the outside of your knee. This is either by your thigh rolling in underneath your kneecap or the structures on the outside of your kneecap getting tighter. 

This soon to the end, see a Physio or roll your ITB, calf and quad. Get your kneecap taped into better alignment. Keep icing. Don’t stress it – 20m is great!

05/04/2013 at 13:20
LucyT wrote (see)

Hi Matt

During my last couple of long runs I experienced quite a bit of hip tightness and aching afterwards. My hips still feel very tight, even though I'm now in the middle of tapering for Brighton Marathon. Is there anything I can do to loosen them up a bit before then?

Thanks!

Lucy

Hi Lucy

I’m never quite sure this is ever to do with where you feel the tightness – It’s more likely to be due to your back and pelvis which have too much movement because you don’t have enough control of your gluts. This lack of control is replaced by stiffening up the front of your hip and quads. Stretching will now take away this “splinting” effect, which will just mean it’ll get tighter next time…

So, improve your glut control (lunge, squat, single knee dip, running man etc) and get your thoracic spine moving more (lying on a foam roller with your knees bent up is great), as less movement here more movement in your back and pelvic.

The longer the distance, the heavier your breath, the more your slouch, the stiffer your thoracic spine becomes…

05/04/2013 at 13:22
Rebecca Hammersley wrote (see)
Hiya Matt
Another knee question! I am currently training for my first marathon on April 28th.
I hurt my knee a while back after getting my mileage up to 18 miles. Since then it's hurt during all my runs but I've still managed a number of times between 11 and 16 miles. I went to see a physio and she said rest was the only thing to get it right but understood I wanted to run the marathon first. She gave me some stretches to do and told me to ice it as much as possible and it's really helped and I can feel an improvement. At the weekend I did a slow 20 mile run and keeping the pace down made loads of difference and I actually enjoyed the run for a long time in ages. This has helped my confidence because I was worried that I was not going to get through the marathon.
I tried a tempo run today though and the pace meant my pain returned and I had to stop and walk.
This is my first marathon so all I want to do is complete it hopefully with a smile on my face and so I now realise that a quick pace is not important.
My question is this-
This weekend I had been planning on doing another 20 miler, possibly 22 before starting my taper. Do you think I would be ok to go for it at a slow and steady pace or would it be better to start my taper now? I don't want to risk hurting my knee further but I want to be fully prepared to complete the race.
Also do you think I should continue with the short quick training runs or keep it slow and steady?

Thank you so much for your help.
Rebecca

Hi Rebecca

I think your physio speaks sense, and also tells you what you can do to influence your knee pain.

You sound like an over strider, but due to soft tissue inflexibility at the front of your hips you don’t have enough available length in the tissues to do this. So you cheat by letting your thigh roll in (of your behind leg). This isn’t apparent and is compensated by making your pelvis roll out….your tummy button is the giveaway when running.

So either get more length dynamically and better glut control to control this new length, or take smaller strides.

It depends how you want to play this…taper now and congratulate your self for doing 20m – do a shorter run this weekend with smaller paces or really bust a gut to get stability and control and push on for an extra week.

05/04/2013 at 13:24
Leenie wrote (see)

Hi Matt,

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?

 

Thanks!

 

Eileen

Hi Eileen

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.

05/04/2013 at 13:25
VieuxLilleBlonde wrote (see)

Hi Matt,

 

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?

Thank you for any advice.

Cathy

Hi Cathy

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….

05/04/2013 at 13:27
Jellybeans28 wrote (see)
Hi Matt,

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.

Thanks for any advice!

Hi Jellybean

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.

 

05/04/2013 at 13:32

Hi Matt, Last 22 miler last Sunday, broken toe on Tuesday, Xray had confirmed break of middle toe, on bone that is actually inside the forr (if that makes sense!). Any chance that I could run VLM? Plenty of RICE but still hard to walk on, Drs have said very unlikey - any thing you can recommend?

 

05/04/2013 at 13:32

forr - foot

05/04/2013 at 13:34

Hi Matt,

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 fother than just rest?

05/04/2013 at 13:36
Hi Matt,
Not strictly a physio Q but as you know about sports medicine....
I was also having slight knee issues 2 weeks back after 20 mile run but physio gave me same advice you are giving & that seems loads better. However, following that I was off work with a virus for a few days. First comeback run was great but since then my 10k tempo runs feel awful & heart monitor shows BPM 5-7 secs higher for same pace as a few weeks back - so I reduced my effort. Feel like I've lost loads of fitness suddenly & cough cold may be returning! How long is this likely to last? Could I be OK for 21st April? Will I retain fitness despite illness? Any advice welcome. Physiologically what's going on?!
Thanks, Mike
05/04/2013 at 13:41
Hi Matt,

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, nbut 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 proplerly and can ITBS cause long-term damage?

Thanks Matt.

Mark
05/04/2013 at 13:46
Chunky Chops wrote (see)

Hi Matt, Last 22 miler last Sunday, broken toe on Tuesday, Xray had confirmed break of middle toe, on bone that is actually inside the forr (if that makes sense!). Any chance that I could run VLM? Plenty of RICE but still hard to walk on, Drs have said very unlikey - any thing you can recommend?

 

Nope! lie in

05/04/2013 at 13:48
Richard Abbotts wrote (see)

Hi Matt,

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 fother than just rest?

Hi Rich

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

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

05/04/2013 at 13:50
Mike Scott 11 wrote (see)
Hi Matt,
Not strictly a physio Q but as you know about sports medicine....
I was also having slight knee issues 2 weeks back after 20 mile run but physio gave me same advice you are giving & that seems loads better. However, following that I was off work with a virus for a few days. First comeback run was great but since then my 10k tempo runs feel awful & heart monitor shows BPM 5-7 secs higher for same pace as a few weeks back - so I reduced my effort. Feel like I've lost loads of fitness suddenly & cough cold may be returning! How long is this likely to last? Could I be OK for 21st April? Will I retain fitness despite illness? Any advice welcome. Physiologically what's going on?!
Thanks, Mike

Sounds very viral - and herein lies the problem. Which one, how and why

Eat well, rest well and don't return too soon. Build up gently but positively

05/04/2013 at 13:52
Mark Boustead wrote (see)
Hi Matt,

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, nbut 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 proplerly and can ITBS cause long-term damage?

Thanks Matt.

Mark

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 stylee?

Slow_coach    pirate
05/04/2013 at 13:53
Slow_coach wrote (see)

Hi Matt,

 

Im in a similar position to MDC. I trained to 14 then 16m without a hitch (a month before the race so plenty of rest) and on race day on a 21m run on March the 24th and my knee went at mile 13.

I did completed the distance with a combination of walking and running.


I never had a problem with this knee before, no new trainers or anything odd like that.

I used Dr Google and as my pain is on the outside boney part on the inner side of my left knee (as if I had knocked it), it sounds like it's patellofemoral pain / Syndrome.

I can walk ok with no pain but yesterday I tried to run for the first time and it hurted within a few minutes so I stopped.

I can cycle and swim with no pain.

I have my first marathon (xc) on June the 8 and I m in desperate need to train!

HELP!!

 

Hi Slow coach

Similar to MDC, and sounds like PFJD – but it’s not as advanced, yet! I think it sounds as if you’re feeling an over stretched medial retinaculum…..half of a bit a cling filmy tissue that keeps your kneecap on the front and in the middle of your thigh.

Advice is pretty similar, but I’d add get some gluteal stability – lunges, squats, single knee dips, balance work ALL with really good body alignment so you feel your bum working. Taping is great too as long as it feels better when taped, rather than just taped.

Do have a check of your knee to wall distance on the painful versus the non-painful side – it shouldn’t be tighter.

Shoes all OK?

Thank you Matt, much apprecciated. Do you think my marathon is still doable? how should I go about getting back to run training?

Edited: 05/04/2013 at 13:53
05/04/2013 at 13:54
Angela Muddle wrote (see)

Hi Matt

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? 

 Many thanks

A

 

Hi Angela

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. Its 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!

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