Physio webchat with Matt Todman

Tri season starter

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10/05/2013 at 13:19

Hi Matt

I usually run 5-6 miles about 2-3 times a week.  About 6 weeks ago I bought some new running shoes (proper gait analysis done and everything) and then ran a 5k race a couple of days later.  During the run I noticed a mild pain in my right knee, which I don't normally have.  It felt like it was on or just below the kneecap on the front of my knee.  I stopped and rested my knee for three weeks, then tried a gentle 5 mile training run.  By mile 3 the pain had returned and felt like it was gradually worsening, so I stopped and walked the rest of the way.  I have not run since.  The pain is not severe and only seems to manifest when I'm running.

I'm concerned about making it worse, but am also concerned at the really long time it is taking for me to get an NHS physio referral.  Meanwhile I have no idea what exercises (if any) I should be doing to try and remedy the problem, or even what the problem actually is, and am now wondering if it could have been caused by the new shoes!  Do you have any guidance that you could give me about things I could be doing while I'm waiting for my referral (apart from seeing a private physio, which I really cannot afford)?

10/05/2013 at 13:20
kittenkat wrote (see)

I've always been disappointed with physio advice about issues I've had (over the last 30 years), except I did find a good guy last time around who actually understood the level and depth of sport i was doing.

So here's my question, how 'equal' are physios when it comes to knowledge of treating people who regularly train and race?

And how do you find a good physio without spending buckets finding the wrong ones first?

 

 

We’re not (thankfully!) equal – some are great, some are terrible and lots are pretty ineffective – and that’s hard for me as a physio to accept.

It’s not all about letters-after-names, years qualified or where they’ve worked. Some elite level physios are terrible - dining out on clubs reputations, whilst some independent practitioners – be them SM,osteos or chiros are bloody great.

Reputation is everything. Participation can give a little more but more importantly is the physio asking and totally understanding what you do, how and why.

We don’t have magic fingers and definitely no magic machines,  but we must have the ability to make you move better so you can repair your self. The rehab component teaches you to move better, for longer. Unless it’s a traumatic injury symptom relief is not the same as dealing with the cause.

Ask, ask and re-ask. Someone somewhere will know who the don is. You do need to kiss a lot of frogs…

Edited: 10/05/2013 at 13:20
10/05/2013 at 13:21

 

MedicGirl wrote (see)

When I ran a marathon the last 2/3 miles were agony - not because of my legs but my lower back! Every step caused me pain in my back, and when I finished I realised it was grossly swollen - I had totally lost the curvature in my back. It was tender and I couldn't have anything touch it. It resolved itself after about 24 hours. 

I never had anything like it in training, although only ran about 21 miles in training. 

I do intermittently get very mild lower back pain - I think due to poor posture and occasional poor liftinag at work. Never had any swelling since but I'm worried it will be a problem when I do an ironman. 

I thought it might be poor posture/weak core. I now work on my core twice a week at the gym. 

 

 

Sounds very fair – grossly swollen, rather than just protected by muscle spasm, sounds like an acute bone/joint reaction and shouldn’t be taken lightly. I think your approach sounds on the money. Get more stable then stronger, then maybe think about getting your running style looked.

Edited: 10/05/2013 at 13:22
10/05/2013 at 13:23
Lindsey Oliver 2 wrote (see)

I have had knee problems for a couple of years, the symptoms being mainly the symptoms of ITB and possibly piriformus syndrome.

I have been to 2 osteopaths, a chiropractor, a podiatrist, a CHEK exercise person, pilates classes and a physio so far, tried different shoes, tried barefoot shoes, rested for ages and also tried to run through. So far, nothing has helped (and yes, I did do all my exercises I was told to do!)

The last person I saw said that, because the symptoms haven't shifted even though I have been told my body responds well and adjusts itself after treatments, there is something 'not firing properly' somewhere in my back, or trunk.

I've not been able to run for more than 30 mins for over 2 years because of this, and it is very rarely pain free even at that short time (I was previously running half marathons and training for a marathon) - do you have any advice or suggestions please?

 

 

 

Cor – tricky! Doing all the exercises and not seeing any improvement makes me think of 2 things. Either you haven’t done enough for enough time (unlikely) or it’s not what you’re doing but how you’re doing the exercises.

Rehab exercises rarely (if ever) need to deal with the strength or power component – this is pretty easy to overcome by just doing more exercises and increasing reps or resistance. Instead, rehab must be all about gaining better control and stability. You need to do little and often and of utmost importance is how you do the exercise. It’s never about what you’re doing, but how you’re doing them. Rehab exercises need to done totally right. If not, they are totally wrong. This is pretty frustrating, but is the key to a successful exercise program.

Your comment about firing fits this pattern. You need to be given the ability to move better so you muscles can work optimally.

Your body breakdown’s between 0 and 30 minutes when running. You need to know when and make sure you can control your body up to and not beyond this point, so you maintain control. If you go beyond this point you’ll loose control but ramp up on endurance and or strength. Not cool….

At a punt – it’s all about great pelvic and lower limb control. Why? Most likely because you’ve got a really fixed thoracic spine…

Edited: 10/05/2013 at 13:23
10/05/2013 at 13:27
M...eldy wrote (see)

A quick Q in advance 

Having seen a physio I am managing a likely retro calcaneal bursar, have built up from no miles following a months rest, this has been ongoing for best part of a year!

I am using ice massage, heel drops, calf strengthening and am part way through a transition to a more mid foot gait, I rarely have any pain now when running, varying degrees of a feeling of bruising afterwards and minimal effects the next morning, I have really good dorsi flexion and hopeless plantar flexion!

what exactly is a bursar, do they 'go' completely or is it a case of reducing the inflammation? Anything else I can try to get back to 'normal'?

Retro calcaneal bursa's are totally normal - and in everybody.

A bursa is a fluid filled sac that acts as in inflamed air bag(but with fluid) to protect bits of bone and tissue crashing repetatively into each other.

They get bigger and smaller depending on if they are excessively loaded or not. Water-on-the-knee or housemaids knee is a really common bursitic problem from too much kneeling, just as lots of lateral hip pain is a trochanteric bursa problem due to TFL flicking over it...

10/05/2013 at 13:37
IronCat5 in the Hat wrote (see)

Hello Matt,

I seem to suffer from tight calves, which in recent months has caused my left achilles to become inflammed and sore to touch/pinch after running & racing.

I've taken it easy over the past month in training to allow me to race hard on two occasions. Each race has required a long warmup to get achilles to work. The day after each race I have been stiff but not sore, even on the achilles.

My last run was a 10km race on the 6th May. Today my achilles is not sore to touch when extended, though there is feeling if I pinch it when slack.

I'm now on a proper rest from running though still cycling to maintain fitness.What can/should I do to resolve the calf/achilles issue, and yet allow me to smash a 5km run at the end of a GBR qualifying triathlon on the 26th of May?

Many thanks.

 

Hi

I'm not so sure you've got tight calfs...but instead you've got calfs which are being used at their end of their range and so feeling tight. Look as far over your left shoulder as possible. Your neck feels tight, but you'd never dream of stretching it further to the left.

I wonder if your shoes are controlling the amount of pronation (rolling in) your foot does, which produces a continual over stretch on the calfs?

If the shoes are good then go for getting stronger rather than getting more lenght. And instead of stretching your calfs try releasing them a la foam roller. The RWIC has some great video clips

 

10/05/2013 at 13:41
Lizwalkersport wrote (see)

Hi 

 

Whats the best way to treat "crunchy" shoulders at 90 degrees abduction - weight bearing and non weight bearing. I have tried stretching and strength training work to key muscle groups that affect shoulder stability. The physio has told me its  not an impingement. Any other recommendations?

 

Thanks for your help.

 

Liz

Hi Liz

An impingement is when something crashes into something else without any control. Gets swollen, painful and less to restriction in strength or function.

Crunchiness ain't that. Unless it's painful I don't think I'd worry. It may go away with rehab exercises and tape, but I think it'll take months and not weeks...

Keep doing what you're doing, don't let it get painful.

10/05/2013 at 13:48
Alex Rendall wrote (see)

Hi Matt

I usually run 5-6 miles about 2-3 times a week.  About 6 weeks ago I bought some new running shoes (proper gait analysis done and everything) and then ran a 5k race a couple of days later.  During the run I noticed a mild pain in my right knee, which I don't normally have.  It felt like it was on or just below the kneecap on the front of my knee.  I stopped and rested my knee for three weeks, then tried a gentle 5 mile training run.  By mile 3 the pain had returned and felt like it was gradually worsening, so I stopped and walked the rest of the way.  I have not run since.  The pain is not severe and only seems to manifest when I'm running.

I'm concerned about making it worse, but am also concerned at the really long time it is taking for me to get an NHS physio referral.  Meanwhile I have no idea what exercises (if any) I should be doing to try and remedy the problem, or even what the problem actually is, and am now wondering if it could have been caused by the new shoes!  Do you have any guidance that you could give me about things I could be doing while I'm waiting for my referral (apart from seeing a private physio, which I really cannot afford)?

Hi Alex

Absolutely got some free advice. I think your right about the shoes - they maybe too stiff. The resolution of this is to walk around in then for a few days to see if you can soften them up a tad.

It sounds more like patella tendon pain rather than knee cap tracking issue, so I think I'd have a good roll on your quads and ITB which will kill 2 birds with one stone.

I'd also tryu some standing staic holds on a single knee bend in about 20 degrees of knee bend. This is early enough in range so it doesn't mash your knee cap, but also far away from being straight to load up your tendon. You can feel mild discomfort only - hold it for 40 secs and repeat 3 times 4 times a day.

 

10/05/2013 at 14:00

That's your lot!

Have a great weekend.

IronCat5    pirate
10/05/2013 at 14:01
Six Physio wrote (see)
IronCat5 in the Hat wrote (see)

Hello Matt,

I seem to suffer from tight calves, which in recent months has caused my left achilles to become inflammed and sore to touch/pinch after running & racing.

I've taken it easy over the past month in training to allow me to race hard on two occasions. Each race has required a long warmup to get achilles to work. The day after each race I have been stiff but not sore, even on the achilles.

My last run was a 10km race on the 6th May. Today my achilles is not sore to touch when extended, though there is feeling if I pinch it when slack.

I'm now on a proper rest from running though still cycling to maintain fitness.What can/should I do to resolve the calf/achilles issue, and yet allow me to smash a 5km run at the end of a GBR qualifying triathlon on the 26th of May?

Many thanks.

 

Hi

I'm not so sure you've got tight calfs...but instead you've got calfs which are being used at their end of their range and so feeling tight. Look as far over your left shoulder as possible. Your neck feels tight, but you'd never dream of stretching it further to the left.

I wonder if your shoes are controlling the amount of pronation (rolling in) your foot does, which produces a continual over stretch on the calfs?

If the shoes are good then go for getting stronger rather than getting more lenght. And instead of stretching your calfs try releasing them a la foam roller. The RWIC has some great video clips

 

Thanks Matt.

I tend to over pronate so have motion control shoes, though my pace has really picked up over the past 6 months. Could it be that at faster paces my pronation changes?

I have recently bought some neutral shoes for short races.

11/05/2013 at 07:43

Hi

Absolutely. The faster you run the quicker the pronatory movement the more control is needed. I still think you're running at the end of your calfs available range so you need to protect this range by either your shoes doing it or your foot does it by getting your calf stronger in a neutral foot positIon. 

Lots of calf raises but make sure you keep you foot in a neutral position when lowering down. 

Irs always good to race in lites as long as you've got enough control in the training.....

Dustboy    pirate
17/05/2013 at 22:28

How on earth did my rubber hat comment get in here?

Bouncing Barlist    pirate
25/05/2013 at 21:42

Well said, having a thread like this stickied for 3 weeks now is overkill in the extreme, can't RW limit it to a a few days?


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