Ask The Experts: Injury Prevention with Sarah Connors

Sarah is a chartered physiotherapist who has specialised in treating track and field athletes for the past 20 years. She has worked for the British Athletics Team and was lead physio for the English Institute of Sport in London before setting up a successful sports injuries clinic.

This spring, she joins us as the ASICS Super Six physio and is working closely with our marathon contenders as they prepare for the Paris Marathon on April 10. Follow her advice - and post your own questions - in the relevant forum threads. You can also find videos demonstrating all of Sarah's key stretches mentioned in the webchat.

Read the whole forum debate


Q. I ran my first half-marathon two weekends ago at Silverstone. I've trained over 12 weeks, gradually increasing my time and distance without any injuries or pain. I’ve had a week’s rest since the event.

However, I ran 3.5 miles on Tuesday and now the sides of both of my knees hurt (it feels like bruising). Could you offer any idea as to what I may have done, or what may have caused this pain?
Neil Mayo

Sarah: Is it the inside or outside of the knees that aches?

Neil Mayo: The pain is in both knees, just behind the kneecaps and it’s both inside and outside.

Sarah: Then I would recommend loads of quad and hip flexor stretching, as this is key for anterior knee pain.

Q. My target is the Paris Marathon, so there’s just over three weeks to go. I’ve been running 60 miles per week on average for 10 weeks. Prior to that, I ran approximately 40 miles per week for eight weeks.  I’ve haven’t really had any injury niggles.

I ran a half-marathon last Sunday, not quite all out.  I had fairly sharp localised pain inside the knee joint/just above and behind the medial side of the patella, which appeared about seven hours after the race (I did a 1-2 mile jog cool down, but then I was stuck in a car for hours due to a breakdown so my knees were flexed for ages).

This is supposed to be my last big training week before the three week taper. I took Monday and Tuesday off. I felt fine Wednesday morning so ran five miles slowly. There was no pain during the run, but the pain returned later that day. I felt fine Thursday and ran in the evening a slow five miles. The knee felt tender on occasion and the pain returned half an hour after the run, but it felt no worse, in fact it was slightly milder.

I cycled on Monday (I haven’t since) and that was by far the worst thing for the pain. There’s no pain under the load/impact point when running, it happens during flexion. Going downstairs isn’t great. There’s no swelling and no pain when it’s static in any position. I’m tempted to try to run through it.

Do you think this is just a bit of bruising that will ease or is it a cartilage issue that will just get worse with running on it? Do I bother going to a physio? Do I just stop running for the next three days and then hope it is OK next Monday? Should I switch my schedule to a one-week massive cut back followed by one-week of decent easy mileage and then a two-week taper? Galbraith

 A. This sounds like your quad muscle is tight and it's compressing the patella, which is why it’s sore sitting and going down stairs. Try and stretch the quad as shown in the video and also stretch your hamstring, but focus mainly on the quads.

This should ease your pain straight away. If there are no change see a physio, as quad tightness may be coming from your lower back and this will need mobilising. Also try foam rolling the hip flexor that sits on the outside of the hip. Don't leave it to chance and ignore the problem, as it will still be there. Good luck!

Q. Is there any merit in a general stretching regime?  I'm very lax at stretching post-exercise, but could find 10-15 minutes in my early morning routine.  Is this enough time and are there any benefits from stretching muscles which haven’t been exercised? FerrousFerret

A. I'm a big advocate of stretching. I stretch before I run and if I get a chance at another time. Running keep taxing the same muscles, so I think it's really good to unwind them. Start slowly and stretch gently at first.

Hip flexors, hamstrings, gluts and calves are the key areas for runners to stretch. Try to do some lower back stretches as well. See the videos on stretching for the key ones I use.

Q. I've had problems with sciatic pain and what I think is piriformis. It has all eased off a bit, but I've had pain and some numbness in my coccyx. When this was bad I took about ten days off running.  I’ve still got slight pain and numbness there, but now running seems to help. Does this sound right? I think what I'm trying to ask is if running can do any harm? Surely being inactive is worse for the coccyx? kittenkat

A. The numbness in the coccyx won't be coming from the pirifomis. You should get your back looked at by a physio and see what the cause of this is. Is there any pain at night or weakness around that area?

kittenkat: No, there’s no extra pain at night and no weakness. I will get it checked out then, thanks for your help.

Q. I've been plagued with IT band issues whilst training for the Brighton Marathon. I've been able to get in some nice long slow runs, but they take a week to recover from due to knee pain. My 20-miler was last Saturday and between taping and pills I made it around in a great time. However, my knees are still aching slightly.

Can I avoid running until Brighton but keep my fitness levels up by swimming and cycling four times a week?  Or should I test the waters and attempt a few runs in my taper?  _ciaran

A. You need to find the cause of your IT band tightness. Is the tensor fascia latae (TFL), which is part of your hip flexor tight? Are your gluts weak? Are your shoes correct for you or worn out?

Do you use a foam roller on your TFL? It’s at the top of the ITB, just to the front of the hip. This muscle pulls the ITB tight and overworks when the gluts fatigue. Bridging is a great exercise to strengthen your gluts and take some pressure of the TFL I'm sure bridging is described earlier on this website. Let me know your thoughts on the above.

_ciaran: The main pain is on the left side of the left knee. The hip flexor is not tight. I have three pairs of shoes (Brooks GTS) which I alternate on each run, and my gait has been checked. I can do squats and lunges and walk without any problems. 

I sometimes doubt it’s an IT band issue and think it could be a lateral collateral ligament issue, as that’s the location of the pain.

Post race, I do the whole RICE shebang and in a few days it is okay. Thanks for the bridging tips, I'll add them to my daily routines

Q. I've been running on roads up to half-marathon distances for the last few years with no injuries. I  tried running on a treadmill three weeks ago and ever since I've been suffering from shin splints in my left leg (on the outside of my shin). I rested for two weeks and tried again, but I felt pain after ten minutes.

What is the fastest way to get back running? Should I take a total rest or are there any exercises or stretches that could help? I have a race in May, which I am trying to train for.
Kevin Mcadam

A. When you talk about the outside of your shin, do you mean the small bone that runs along the outside or the outer part of the tibia (the large shin bone more at the front)? The later injury can come from having to lift the foot more on a treadmill.

It could just be a build up of forces, which has caused the start of a stress reaction in the bone. Is the bone tender to touch? Is there pain whilst at rest or at night and any pain on hopping? Lots of these symptoms indicate a stress reaction, which will need rest and cross-training.

Kevin Mcadam: The pain feels more like a bruise to the muscle on the outside of the main shinbone. The bone does not hurt at all and there’s no pain when resting. I can feel pain when I stretch it by keeping my heel on the floor and lifting the front of foot up. I can also feel pain when pushing my thumb into the muscle about half way between my knee and ankle.

Sarah: Stretch this by trying to sit on your heels and stretch the front of your foot. Get your thumbs into it and massage to try and release any tension.

Q. I've been running 10K three times a week since early January with a local running club.  I had the usual aches and pains to start with, but I've now had an achy feeling in my right hamstring for about two weeks.

It doesn’t stop me from running, there is no direct pain or bruising, but I feel it most when I'm sitting down.  I regularly stretch after running and only run slowly before starting any run. Do I need to stop running or should I do any specific hamstring stretches to help? Stephen Wall 4

A. It sounds like it’s more of a dural pain (nerve) coming from tightness in the lower back, rather than just the muscle, which is why you can't stretch it. Try and stretch the hip flexors first and do some gentle rotation stretches for the lower back.

Lie on your back and rotate one leg across the body to the floor. Then try lying on your back with your leg in the air and pull the foot down 3x10 times to release the sciatic nerve - don't hold this position. Then try and stretch the hamstring, which should be easier. If there’s no change, try and see someone to help mobilise your lower back, then look at core work to strengthen the area.

Q. I took a calf strain on Sunday morning, which at the time was very painful. There’s no bruising, though it’s tender to touch. When walking in shoes it feels okay, I feel it a bit when walking barefoot and on stairs, but I can't believe how much better it is already.

I don't want to start running again until I'm completely sure I have recovered.  Given that it’s not too bad, how long do you think I should wait and what sort of programme should I follow? I live in a very hilly area and was running six miles, four times a week. I’m not currently training for anything, I just love running. moonrunner

A. You need to strengthen and stretch the area prior to running again, so you know it will cope. Try the usual calf stretches, whilst leaning into a wall and then bend the knee. Then as long as that feels okay, drop your heel down on a step.

To strengthen, start with two feet calf raises on the ground and then progress to one leg once you feel able - go up to 3x20. Then go to a step and drop the heel and lift two legs, then one. This will help you with the hills. You can also try some circuits, step-ups, squats and lunges to help strengthen around the calf.

If you can hop pain free once you’ve done all that, then you should be fine to run.