Webchat with physio Matt Todman

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27/03/2013 at 11:40

Join us this Friday 5 April at 1 - 2pm for a webchat with Six Physio physio Matt Todman. 

The theme will be on last-minute race help - if you're struggling with an injury in the lead up to a half or full marathon and would like advice from a physio, post a question below.

Matt qualified as a physio 20 years ago and has spent the past decade at the forefront of sports medicine. He works as a consultant in private practice dealing with everyone from elite level runners to beginners.

Edited: 02/04/2013 at 16:42
03/04/2013 at 09:57

Hey Matt,

I'm running London on April 21. A week or so ago, my nephew fell knee first onto my foot. To begin i could walk ok and the pain (centre of the foot, just above the toes) was manageable. i iced it, used anti-inflammotories and rested it for a week, which seemed to help. Last weekend was my final long run – a 20-miler. I could feel the foot but it caused no problems until 15 miles when the pain started to increase, so I struggled through the final five at a slower pace. The next morning was agony. At first i could hardly walk or put any weight on it. However, as i moved it more and walked to work (slowly), the pain eased. My foot seizes up with inactivity, but eases with movement. it still hurts with certain movements, but i don't know how to handle the next couple of weeks leading up to the race. 

04/04/2013 at 10:57

Hi Matt,

In the run up to Reading Half Marathon I started getting pain around the ball of my foot. This has continued since the race and I'm now training for another next month and am worried about aggravating it more with the added speed work.

The pain occurs around the ball of the foot and is painful when I press on the inside of my foot at the rear of the ball. No major pain if I press on the top or bottom of the ball. The pain occurred on both feet at almost exactly the same time.

It eases with rest and I don't really notice it while running, but after a run it becomes painful and activities like using the big toe to push a shoe off are quite painful. I can feel a slight pain while standing on tip-toes or when walking fast, but this often passes quite quickly.

 

Edited: 04/04/2013 at 10:58
MDC
04/04/2013 at 11:59

Hi Matt,

During my last long (20 mile) run last Sunday, my left knee started to hurt. I got to around mile 17 and it brought me to a walking pace and was too painful to run.

Although I didn't want to make things worse, I did still want to complete the distance. I managed the final few miles with a combination of walking and running (the pain would sometimes allow me to run again for a few minutes, before bringing me to a walking pace again).

I tried to rest my knee after and missed my scheduled Tuesday 7-miler as a result. I went out this morning (Thursday) but only managed 3 miles - my knee definately felt tender still and felt likely to bring me to a walking pace again if I pushed it much harder.

I'm now really concerned about how to ensure I'm fit for London on the 21st. What advice would you give in terms of treatment and training distances during the next couple of weeks please?

Slow_coach    pirate
04/04/2013 at 12:14

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!!

 

Edited: 04/04/2013 at 12:40
04/04/2013 at 13:51

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!!

04/04/2013 at 13:59

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

04/04/2013 at 14:33

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. 

04/04/2013 at 14:56

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

05/04/2013 at 02:14
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
05/04/2013 at 10:23

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

05/04/2013 at 10:31

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

05/04/2013 at 11:12
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!
05/04/2013 at 11:32

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

 

05/04/2013 at 11:41
Hi Matt,   I actually have a question of my own for you! 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! Thanks, Annie 
05/04/2013 at 13:01

Hello everyone, 

Welcome to today's webchat! Handing over to you Matt...

05/04/2013 at 13:03

Dry fit is on and laces are tied....

This near to the start of the Spring Marathon Season seems to all about help for the knee-dy.

Simple anatomy check: The knee (and especially the kneecap that sits on the front and tracks up and down….and a bit in and out, the thigh bone when running) is the victim of what happens above it at the hip/pelvis and what happens below it at the ankle/foot.

Where you feel the pain is unlikely to be where the problem lies. Depending on how near your marathon is dictates the best approach to treatment. Within the next 10 days deal with the knee, within the next 3 weeks deal with everything above, below and in the middle and within the next 3 months respect the symptoms but deal with above and below them.

05/04/2013 at 13:06

Dav99 wrote (see)

Hey Matt,

I'm running London on April 21. A week or so ago, my nephew fell knee first onto my foot. To begin i could walk ok and the pain (centre of the foot, just above the toes) was manageable. i iced it, used anti-inflammotories and rested it for a week, which seemed to help. Last weekend was my final long run – a 20-miler. I could feel the foot but it caused no problems until 15 miles when the pain started to increase, so I struggled through the final five at a slower pace. The next morning was agony. At first i could hardly walk or put any weight on it. However, as i moved it more and walked to work (slowly), the pain eased. My foot seizes up with inactivity, but eases with movement. it still hurts with certain movements, but i don't know how to handle the next couple of weeks leading up to the race. 

 

It sounds like you’re doing exactly the right thing – feet are lots of bone and tendons without much fat or muscle around to protect them. Your nephew (bless him!) has bruised your foot, which has swelled very slightly. There is nowhere for the swelling to go and so is painful….so you start to move very slightly differently to feel less pain. This tiny bit of differentness over a prolonged 15m becomes quite a big biomechanical difference, and more painful.

Hopefully you’re already feeling better – take it easy, stretch your calf, don’t lace too tight and you’ll be back in no time.

05/04/2013 at 13:08
skipoles wrote (see)

Hi Matt,

In the run up to Reading Half Marathon I started getting pain around the ball of my foot. This has continued since the race and I'm now training for another next month and am worried about aggravating it more with the added speed work.

The pain occurs around the ball of the foot and is painful when I press on the inside of my foot at the rear of the ball. No major pain if I press on the top or bottom of the ball. The pain occurred on both feet at almost exactly the same time.

It eases with rest and I don't really notice it while running, but after a run it becomes painful and activities like using the big toe to push a shoe off are quite painful. I can feel a slight pain while standing on tip-toes or when walking fast, but this often passes quite quickly.

 

Hi skipoles

Sounds a bit like sesamoiditis  - which are small bones on the base of your big toe. Excessive loading can irritate the bones.  Do you train in different shoes to which you race? Is there enough support at the front of your shoes? Have you over stretched in training – especially up hill?

You want to try to use your foot properly – preserve the arch and push off properly through the big toe, and not off the edge of it.

I think I’d try to get a cheap off the shelf orthotic from the chemist to help maintain a better foot position so you push off properly. Also really work on single leg balance (bare footed)– improving muscle recruitment with your foot in a good position will help. Try balancing for 30 seconds 4 or 5 times a day and progress to waving your arms around and eyes closed. Ice may help too.

05/04/2013 at 13:10
MDC wrote (see)

Hi Matt,

During my last long (20 mile) run last Sunday, my left knee started to hurt. I got to around mile 17 and it brought me to a walking pace and was too painful to run.

Although I didn't want to make things worse, I did still want to complete the distance. I managed the final few miles with a combination of walking and running (the pain would sometimes allow me to run again for a few minutes, before bringing me to a walking pace again).

I tried to rest my knee after and missed my scheduled Tuesday 7-miler as a result. I went out this morning (Thursday) but only managed 3 miles - my knee definately felt tender still and felt likely to bring me to a walking pace again if I pushed it much harder.

I'm now really concerned about how to ensure I'm fit for London on the 21st. What advice would you give in terms of treatment and training distances during the next couple of weeks please?

EEK!

This is unfortunately fairly common around this mileage, and is all to do with the loading pressures on the under surface of your kneecap.

Your kneecap is covered in a cartilage to help protect it as it slides over your thigh bone. The issue is you have loaded your kneecap above and beyond what its used to do. The cartilage swells to protect itself but in doing so raises the pressure on the underlying bone. Ow!

You need to limit your mileage for the next 7-10 days, but maintain your fitness – bike, swim, gym. Roll your ITB and calfs. Stretch out the front of your hip. Take anti inflams (if you can) and get your patella taped (and maybe learn to tape) to relieve the pain. When running try running with greater cadence (smaller steps).

If needs be and all else fails a jab can help….but this is absolutely last resort stuff

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