Webchat with physio Sarah Connors

Hi Sarah, another relative newbie with a knee issue. I had my gait analysed (neutral) did the Couch to 5k in May-June 2011 and went on to run a half marathon in November 2011 - all with no problems, not even a blister. I developed a knee problem that I've had before on walking holidays, the one where it's excruciating to go downhill and down stairs but all other movement is pain-free. I started barefoot running in spring 2012 to try and sort the knee pain, but after a few months I started getting knee pain in the same knee but a different place.

From googling various anatomy pics, the pain is in the area of the tendon that attaches the vastus lateralis to the knee: about 1 inch above my knee cap to the outside of my thigh. I was continuing to run with this but eventually it was too painful to continue and I haven't run since September 2012. At first I only had this pain when I ran, but since about November I've been experiencing it on and off every day, while sitting, standing and walking. I went to a biomechanic clinic who said I needed an ultrasound to diagnose the soft tissue damage he could feel (he said he could feel a lump that might be a cyst), but my GP told me to take Ibuprofen for a week (it didn't help), sent me for x-rays (they came back normal) diagnosed "probable tendinitis" and suggested a steroid injection (if he's not 100% certain, he's not sticking a needle in my knee!).

I'm still in pain and don't know what to do next, and would really appreciate your advice - thank you.

Hi Sarah,

 I had ITBS about 3 months ago. After some treatment it was ok, not perfect but ok. Recently ive upped my mileage, not much just 500m extra every week on my long run. After about 20 mins i get an ache in my gluteus medius (thats the one near the top of the buttock right?). 10 mins later this ache has moved around to the outside of my hip which restricts my push off somewhat. Then the pain moves again,  to my hip flexor, which makes it painful to lift my leg so im ending my run with a shortened stride and in a bit of pain. After stretching, the next days ache is only in the hip flexor.  Is all this related to a weakness somewhere? But where? I played tennis to a high level for  afew years and have an over developed right side of my upper body. Could this be anything to do with it? Are there any strength tests i can do to identfiy a muscle weakness? Please dont say rest!

Many many thanks

Hello Sarah

I have a lot of pain and what appears to be stiffness behind my left ankle. It seems to ease as I run, after a few miles..However is very tender immediately after running also. Again it eaes off but i am aware of the tenderness and do not know what to do for the best in terms of treating it..or indeed what is causing it..As I have a HM and 10k booked I am concerned I may do more harm than good running so regularly. I would be grateful of your/others advice. Thank you.

Andre this sounds very much like an achilles issue? Are you able to be a bit more precise with the location description?  If it is the achilles then you need to tread and treat it very carefully as it has a habit of lingering and being hard to get rid of
Check out some eccentric loading exercises and in the meantime I would rest  and reassess
Could also possibly be a peroneal tendon problem and I would probably take the same advice

Hi - my achilles have been sore for about 8 months.  I do calf raises once or twice a day, in addition to stretching all the other major leg muscles and it seems to keep it in check and prevent it getting worse.  Is this ok or do I really need to get it fully cured ?

Welcome to today's injury prevention webchat - a  big thank you to physio Sarah Connors for joining us today to answer your training questions.

Over to you, Sarah...

Annie RW

 Hi Hackett yes def seek advice with this one. The numbness is indicating pressure on the nerve at some point presumably from a grumbly disc. You need to make sure there isn’t any muscle weakness so yes get it checked sooner rather than later and hopefully you’ll training will then be easier.

Hi Suz

The best way to decide is to see how your body is responding to all the training as she will have seen you before you can ask how much tighter you feel than last time. If you’re much tighter and generally more sore then bring it forward a week, don’t have one immediately prior to the race go about a week before or after your last long run.

Hi Stewart,

Sounds like you still have a weakness in that leg . What is your one leg dip like compared to the other knee? Try in front of a mirror and see if the knee turns in. Are you trainers giving you correct support trying twisting them and see if one gives more than the other. Helping your gluts get stronger will def help and foam roller around the gluts and Tensor fascia lata the muscle at the top of the ITB.

Hi Angela, you say that calf is weak have you done anything to strengthen it up. A simple calf raising programme will help starting on 2 legs then one and initially off the floor then on a step dropping the heels. Was there a definite tear and sudden pain last year or was it a gradual onset. If it was gradual may be worth getting your back checked out to make sure the nerve isn’t tight causing the calf twinges. K tape is great if it eases your symptoms.

Hi Lisa, try a different approach, you are doing all the right things to help your lower back and hamstring you might have just reached their max range. What you can look at is your hip flexors if these are tight then this pulls the back out of line and stops the gluts activating hence overloading the hamstrings. Try the lunge stretch on one knee stretching the back hip flexor. If you can get someone to help you do the Thomas test (should be on the website) your knee should hang in a straight line with your body if it’s higher than your hips are tight.

Hi lewis sounds like you need a good mot. There are so many issues with that leg it’s difficult to know where to start. The quad sounds like it’s weak and def needs to do a structured strengthening programme staring with 2 leg squats and progressing to 1. Though would be good for someone to look at its’ strength and function. Are your calfs very tight and what is the stretch like when you bend your knee, are the soleus tight?? If these are weak try 2 different calf raises leg straight and knee bent. You don’t say how much running you do and it would be good to know if you’ve done a structured rehab and stretching programme. Let me know if you can.

Kate the best way to minimize the effects of camber is to vary your run and run in different directions.

Hi Also-ran, did the physio ever mobilise your lower back?? If this is tight it can also be causing the hamstring to be tight. It’s one of the first things I do with a patient with a hamstring issue and it takes the pressure of the nerve and the muscle. Try that and see what happens. Also try the hip flexor stretch that I mentioned to Lisa above. The big thing for me is to look above the muscle and address the cause, esp if on one side then even more likely to be coming from the back. You like lisa have done all the obvious stuff so you may need some help with this one.

Also try and stretch the adductors that run along the inside of the leg. There is a great trigger point about a hand breath up from the knee joint that you can hold while stretching to try and release the pes a bit more

Hi Ben you don’t say where in the hip the pain is can you let me know and I can help you with what to stretch. If it’s at the front try the Thomas test to see if the muscles are tight and causing an impingement. If at the back try stretching the gluts. A foam roller is a good investment to help with some trigger point soft tissue release. There will be some videos on the web showing which areas to target.

Hi Iain, I presume you mean your knee joint? If it’s on the inside over the joint then it could either be the pes enserinus tendon which is your medial hamstring and adductors so try and stretch these out. If very specific over the joint line and pain on squatting you need to get checked to make sure there is no meniscal/ cartilage damage

 Hi Grant are you taking into account the race when you do you long run and easing back on the distance or speed slightly? Your body needs to recover from races.

Buy yourself a foam roller and start bringing in more stretching to allow the body to help recover.

Hi Diana don’t try and play catch up you’ll only make them sore again. Absolutely right to try and do a cross training session. Also try and do some of your running off road as this is definitely better for the shins.

Have you been stretching the deep calf muscles, do this by putting the toes on a step and then bending the knee. You can do some self massage into the inside calf muscle to release some of the tension stay away form the bone and acute pain though, Ice is good after this. You can do some cliniband exercises to strengthen the foot muscles pulling the foot in and out against the resistance of the band.

Lastly make sure you trainers are not old and that they have the correct support quite often the cause of shin splints is over pronation so if your  trainers are not supportive enough that may not be helping.