Ask the Physio!

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Jenny Branigan
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In this section, Jenny Branigan who is a Level 3 Accredited Sports Physiotherapist, Pilates instructor and the regular Physiotherapist on the Mooney Show on RTE Radio 1, will discuss common running injuries and how to manage them.

Jenny Branigan is a Chartered Physiotherapist and owns Total Physio in Sandyford (conveniently located opposite the Sandyford luas stop).

For more information, please see www.totalphysio.ie
You can follow Total Physio on Facebook at http://on.fb.me/WgFMkn or tweet @Total_Physio

Her full profile and article can be found here : http://www.runireland.com/contributors/jenny-branigan

Anonymous (not verified)

I have an IT band injury going on at present. Minute I felt it playing up , stopped running and iced , streches etc. Two weeks on , been to physio, and its still tender, and no running. Any idea how long usually takes to heal ? Also training for Triathlon so probably not enough rest too or streching! Learnt my lesson now though. Dying to get back running, as it had been built up to pretty decent level. Have a feeling will be sitting it out for while though.

Jenny Branigan
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The IT Band can be a stickler but you have caught it early so you should progress quickly. ITB syndrome is an overuse one so rest with the appropriate rehab is needed, typically 6-8 weeks to get it totally painfree.

Ensure the following:
biomechanical assessment is carried out;

strength tests for gluteus medius, Maximus and VMO (inside quad);

don't bother stretching ITB- it doesn't work. Instead use a foam roller to release it;

quads stretch (advanced), best up against the wall in kneeling so you can control it.

For more info please see www.totalphysio.ie

Good luck!

Anonymous (not verified)

Thanks for the advice. Hmmm physio told me to do plenty of streches, I will get a foam roller today. I take it can't run until it totally pain free, makes sense I suppose. Well too be honest I'd prefer to get back running when its a hundred percent right, will just have to sit out few triathlons I signed up for! Thanks again

Stuart C (not verified)

Hi Jenny,

I dislocated my pelvis prior to Christmas and had it re-inserted by a chiropractor (painful but effective). Unfortunately the pelvis appears to have slipped out again recently, but the attempt by the chiropractor was unsuccessful in re-inserting it. Is there any exercise or movement I can perform myself to assist the pelvis sitting back in?

Many thanks,
Stuart

Jenny Branigan
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Posts: 429

Hi Stuart,

The pelvis does not just dislocate, it is too stable a structure, rather you can get slight adjustments in the sacro-iliac joints which can be manipulated and release a "click" which sounds like something popping back into place.

I cannot recommend any one particular move for you to solve this yourself, I would suggest you get to your local Chartered Physio for a full assessment as to why this is happening and for treatment. In the meantime just practice gentle rotation of the lower back by lying on your back, 2 knees bent up and let the knees fall from side to side. This will help to relax the area for you.

For more info, please see www.totalphysio.ie

Good luck!

Jenny Branigan
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Posts: 429

Re ITB:
Yeah, it's best to get the ITB fully sorted as it often recurs with inadequate rehab, which is even more frustrating...

Anonymous (not verified)

Hi Jenny

Have been running about 4 years mostly injury free. During 2009 and 2010 i have upped my training. I run about 40 miles a week, have started going to the track and running hills, resulting in me knocking a significant amount of time off all my race times. Have recently completed the 10 mile county championship in Galway. I planned to have a few weeks rest before resuming proper training for more races. During this period i started developing pain in my right leg. Sometimes it felt my leg was going to collapse from under me. The pain was sometimes in lower calf and sometimes on the outside of my leg.
As this has continued decided to go to physio for some help. The physio said i had flat feet and gave me orthotics for my shoes. While also saying my buttock and calf muscles were not strong enough. She gave me some strength exercises for these areas and told me to resume light training. I ran 10 miles last week and 15 this week. During my 5 mile runs this week i have felt terrible. Usually mid run or towards the end. I have had pain in right calf, thigh and the base of my neck has stiiffened up completely by the end of the run. My question is how long does it take to get used to running in orthotics? Or are these ailments got nothing to do with my new orthotics. Should i take a complete break from running?

Jenny Branigan
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We normally recommend that orthotics are worn in gradually; walk in them for an hour on the 1st day, 2 hours on the second day etc for a week. Then you will need to do the same thing running in them, gradually building up your tolerance to them over a 3-4 week period.  Some people are more sensitive to the change and may take longer. Bear in mind that while the orthotics will feel weird initially, they should still be relatively comfortable for you when you first put them into the shoes.
It is certainly frustrating for you that you seem to be worse off now than when you started out. It sounds like you increased your mileage quite quickly, from the recommended light training to 10 then 15 miles. I would suggest calling your physio again to discuss your symptoms with her, especially the new ones.
I would take a break from high level running while this is being sorted out. It will be up to your physio to decide, based on the assessment, whether it would be suitable for you to do some light running, and get him/her to define what that is so you do not overdo it and set yourself back again.
You can find our contact details on www.totalphysio.ie
 
Good luck!

Seb
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Hi Jenny,

Seb here from runireland, I actually have a question for you, I am a normal guy after all !

I have some tension head ache which I find difficult to manage and stop me to train as much as I want.

I always had them, and do get massage on it which does not solve the problem, just make it better for a short time.

The tension starts behing the bulb and gets worst to the parietal region, then I need to line down.

It seems to be due that I have a strong neck which pressurise the back of my head......

Any suggestion ?

Siobhan Moore (not verified)

I have just been diagnosed with Retrocalcaneal Bursitis....I ran a 10k in the Phoenix Park 3 weeks ago today...I'm still limping...I know now it was overtraining that did it. I'm desperate to get back running but I feel it'll be a long while yet before I can do so. I'm hoping to keep my fitness levels up with swimming and cycling. I'm so upset that I can't run. I know everyone's recovery is different but is there any idea of recovery time for this injury?I

Jenny Branigan
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Posts: 429

Hey Seb, how's it going?
The best thing to do for a tension headache like that is to massage the base of the skull daily when in the shower. Let the hot water run down the back of the head and massage across (east-west direction) over where the upper traps attach to the base of the skull. Do for 1-2 mins on each tender point. If it is extremely tender and feels bruised afterwards for the day, only do this every 2 days.
There is another great self-massage technique to ease this problem; lie on your right side to relax the right shoulder blade. Bring the left arm around the neck (as if giving yourself a hug) and feel along the inside top corner of the shoulder blade. Any tender points you find, massage for 1 minute. It works brilliantly. Always compare to the other side.
If the headaches do not ease after 2 weeks of doing this, you will need to present for a full assessment as there can be other issues with the neck that can cause this. Check www.findaphysio.ie for a local Chartered Physio.
Hope this helps Seb!

Jenny Branigan
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HI Siobhan,
Thanks for the message. Retrocalcaneal bursitis is not the worst injury you can get, as it recovers quite quickly compared to some of the other oversue injuries.
Typically it takes 6-8 weeks to settle. You ca speed this up by icing very regularly, wearing a heel wedge to ease the pressure on the achilles tendon and resting from any aggravating activities.
It's not enough to just rest however. You should see your Chartered Physio to make sure that the flexibility of the lower limb is sufficient for the training you like to do and to ensure optiumal lower limb and especially ankle and calf strength. This will prevent the bursitis coming back. If you just rest it without building it back up again, you have a much higher chance of this recurring.
Good luck with it!

Seb
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Thanks Jenny I will try this and will come back to you on this :-)

Siobhan Moore (not verified)

Thank you so much for that advice Jenny, I really appreciate it and you have given me hope :-)

Best regards,

Siobhán

tom mc donald (not verified)

at the moment i am training for the dublin marathon my first. ihave been running the last few months once a week on road 10 miles and two other 10 mile sessions on grass and track . in my last two road races i have got a pain in my left foot underneath i changed my foot wear about three months ago this pain is gone away in about three days

Jenny Branigan
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Hi Tom,
I would need more information about where the pain is under your foot to give you more information.
There are many causes of foot pain and obviously this can wreak havoc with your training schedule. You will need to attend your local Chartered Physio with experience in running injuries and get a biomechanical assessment of the lower limbs. This is vital before you try any stretches/strengthening work.
Bring in your runners on the first visit and any insoles you may have.
Good luck!

Al (not verified)

Hi Jenny

Two weeks ago i strained / pulled my hamstring slightly, its not that bad, but i can feel it a little when i stretch it though. havent run in two weeks, but done a bit yesterday evening and like i said i can still kinda feel it there, icing it and resting it as much as possible. maybe you need more info.?? went to a physio last week and he got to work on it, much better than before but im just wondering about your opinion, as regards, recuperation, what to do, treatment, not to do, length of recovery, etc?!? next race is - supposed to be - half marathon in july! Thanks very much.

Al

Anonymous (not verified)

Hi There,

For the past month or so, my left knee has been clicking when I go downstaris for example. In the past occasionaly it would click for a few days, and go again - but for the last month is has been consistent.

It is not causing me any pain at all, but now and again it fells different ( like for 30 seconds) say when I am just standing or walking around on flat surface and it's a tough something has landed in wrong place but it is not sore and when I move my leg again it is fine.

I am not sure where to go with this symptom, a doctor for an X-ray, Physio for a consult.

Can you please advise.

Thanks

Devastated (not verified)

Hi Jenny,

I hope you are well. I have had a sore ankle now for about 2 months and attended a physio today who said that I have a tibialis posterior injury. She said that I have to rest my ankle and not run for at least 2-3 weeks...However I had been resting it for 2-3 weeks before I went to see her and its still sore...She gave me some strengthening exercises to do and another appointment. Is there anything else I can do for this injury and is it a bad injury? She also said that I have very flat feet and I have to get insoles to correct this. I am worried that I will have to give up running altogether and just when i have been bitten by the running bug!! Any advice would be greatly appreciated, thanks.

Jenny Branigan
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Posts: 429

Hi Al,
Thanks for your message. The main issue we see with hamstring strains is that people are great at resting them and getting soft tissue work done on them, but they fail to realise that if you strain the muscle, there are fibres actually torn. These fibres need to be built back up again as they heal.
So you will need to embark on a programme of strengthening the hamstrings in isolation and then progress to core and hamstring work together and make sure there is no imbalance with the quads.
It will usually take from 4-6 weeks (in the case of a mild strain) before the muscle will be back to previous strength levels.
The half marathon in July is not unrealistic once you get your strengthening programme started immediately.
If you have any more queries, please contact us via www.totalphysio.ie
Good luck Al!

Jenny Branigan
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Hi Friend with the clicking knee,
This sounds like the beginnings of something. Now is the time to deal with it before you develop pain.
Clicking descending the stairs can be a sign of irritation of the cartilage at the back of the kneecap or patellofemoral syndrome.
You may also be suffering from a gradual tightening of the Iliotibial band on the outside of the knee.
You may also have a loose body in the knee that is moving around depending on the position the knee is in.
It is likely that you will have weakness of the gluteus medius muscle which gradually happens and can exacerbate this type of symptom.
In short, you will need to see your local Chartered Physio with experience in treating running injuries - no xrays are necessary now and your doctor will do nothing much with it as you have no pain.
If you have any more queries, please contact us via www.totalphysio.ie
 
Good luck!

Jenny Branigan
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Hi Devastated,
It's tough to have to take time out, but if you continue to run on this injury, it can get significantly worse.
The tibialis posterior (tib post) is a deep calf muscle that comes around the inside of your ankle bone and attaches to a bone along the inside arch of the foot.
When the foot is flattened, it can cause excessive pull on the tib post where it attaches, causing tightness, irritation and pain.
Typically resisting inversion will hurt, lunging (affected leg behind) will hurt and swelling can happen along the tendon on the inside of the ankle.
In my experience, these take rather longer than 2-3 weeks to heal if the injury is in the tendinous part (most common), usually more like 4-6 weeks.
Resting alone will not help; you must get the muscle loosened and the tendon frictioned. Biomechanical assessment is vital as this is often the root cause. You will also need to ensure general calf flexibility and build up the tib post again with strengthening work.
If you have any more queries, please contact us via www.totalphysio.ie
 
Good luck!

Devastated (not verified)

Hi Jenny,

Many thanks for your message and the advice - It is much appreciated.

Something that caught my eye about your message, you mentioned "the inside of your ankle bone" a few times. I have no pain on the inside of my foot at all...would this be normal? My pain is focussed on the outer part of my ankle behind the lateral malleolus. Two days ago I had pain running down my second toe but that has gone now which could be why tib post was suspected? The pain around the lateral malleolus has been the pain that I have had for about 2 months - Would the tib post cause the pain behind the lateral malleolus if it runs down the inside of my foot? Thanks Jenny, appreciate your help.

dshel08
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Hi jenny
I have been told that i have anterior compartment syndrom in both legs could you give me some advice on it i have had physio on it and i just want to know what kind of treatment should be given and how long it takes to heal any advice you could give would be most helpful
Thanking You
Derek shellyy

Al (not verified)

Hi Jenny

Thanks very much for your response and advice, I'll work on the advice you've given me!

Thanks again,

Al

Jenny Branigan
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Posts: 429

Hi Devastated,
The tibailis posterior does not cause pain on the outside of the ankle. It is likely that some other structure is causing your problem if it is on the outside of the ankle. There are 5 calf muscles; 3 deep ones that go to the inside of your arch, big toe and other 4 toes, all via the inside of the ankle. The 2 superficial ones join to form the achilles tendon.
There are other structures that cause pain on the lateral / outside of the ankle including the lateral ligament (complex made up of 3 ligaments) or the peroneal muscle group (3 muscles in this group).
I would check the diagnosis you have been given.
 
If you have any more queries, please contact us via www.totalphysio.ie

Good luck!
 
 

Jenny Branigan
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HI Derek,
How are you? If you have anterior compartment syndrome in both legs, it is obviously an overuse thing rather than traumatic. I take it that you tried to keep running through it, as we normally see it start on one side and as it gets worse it moves to both sides.
Do you have any pins and needles? This is important as this could indicate that the nerve is being compressed in the compartment.
Biomechanical assessment is paramount. You'll need to have plenty of soft tissue work to loosen the fascia of the compartment and the muscles. It can take varying amounts of time to settle this, depending on how long you tried to continue through the symptoms initially, how severe the pain is, how quick it comes on when you exercise and how long it takes to ease once it does come on.
If you have any more queries, please contact us via www.totalphysio.ie

Good luck!
 

Siobhán Moore (not verified)

Hi Jenny, A couple of weeks ago I contacted you because I thought I had retrocalcaneal bursitis. Following an MRI it turns out I have a stress fracture of my calcaneus bone. No wonder I was in such pain running that 10k 6 weeks ago! I've been wearing the hideous moon boot (cam walker) and was on crutches. Back for MRI this week. I'm back swimming, using a pull buoy so I'm not using my legs. I'm losing my fitness not having done anything meaningful for the past 6 weeks and it's awful. This is my second stress fracture in 8 months. The first one was in a bone in my left foot also caused by running. I had my gait analysed and got the correct runners for my second attempt when I started back running in January. This second stress fracture has knocked me back terribly and I'm now thinking that perhaps the fact that I have osteopina is a contributing factor. I am anxious not to let this second stress fracture stop me as ultimately I have my sights set on a novice triathlon. Realistically speaking do you have any idea when I might be able to resume running after a set back like this? Perhaps it's worth mentioning that I'm 44...may be I'm too old :-( Many thanks for your advice....Siobhán

Spinner
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Posts: 27

 Hi,
Just wondering what the usual treatment for plantar fasciitis is? I haven't been fully diagnosed but had an issue last week in my foot. Doctor said it wasn't fractured so thought it more likely to be PF. I went and got new runners on Sat as my other ones were quite old. went out this evening for a light run with no major problems touch wood. Just wondering if there are ongoing stretches etc I could be doing to help it. Have a half marathon in July and just hoping I can make it to then without the problem worsening.
 
Thanks a lot.

Jenny Branigan
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Posts: 429

Hi Siobhan,
You poor thing, 1 stress fracture is bad enough, but 2 is very unlucky.
When stress fractures rear their ugly heads you must be guided by the pain. It's that simple. The fact that this is your second one recently, I would expect that you will  be told to rest for a long period to be absolutely sure that it has healed - this is also because the calcaneus is a difficult bone to heal.
I would visit your GP to chat about options here - it is common to have hormone levels checked, have a DEXA scan, diet analysis and of course the biomechanical assessment.
I would be looking into aqua running for when you are out of the boot - Muriel Haire runs classes in the National Aquatic Centre in Dublin and they are a great help for runners who simply cannot run.
Keep in touch about it. If you have any more queries Siobhan, please contact us via www.totalphysio.ie
Good luck!

 

Jenny Branigan
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HI Spinner,
The usual treatment for plantar fasciitis is lots of deep transverse frictions over the site as well as a biomechanical assessment and lower limb (especially calf) flexibility work.
It's difficult one to manage yourself, so I would advise that you get into your local Chartered Physio who has an interest in running injuries and get started, especially if you have that deadline in July.
If you have any more queries, please contact us via www.totalphysio.ie
Good luck Spinner!

 

Friend with Clicking Knee (not verified)

Hi Jenny,

Thank you for you advice.

I will visit a physio for a full assesement of it.

Thanks again.

Siobhán Moore (not verified)

Thank you so much Jenny for coming back to me I really do appreciate it. I will certainly look into the Aqua Running, a biomechanical assessment and nutritional advice is definitely required. I don't think I'm past it yet and I'm definitely not giving up...

I will keep you posted....

Thanks again, Best regards, Siobhán

Anonymous (not verified)

Hi Jenny,

I have a question on Achilles pain. I did the Connemarathon this year and couple of weeks before the race both of my Achilles were in quite bad shape; pain after 15 min run and limping badly day after a run. I went to my local physio and she instructed me to continue running (shorter distances though) and stretch, ice treatment and ibuprofen to get me through the race. Also we did some deep tissue massage and some sort of laser therapy. I did get through it and I was out from "proper" running for 3-4 weeks. I kept on walking, cycling and swimming during the time off. Now I have tried to get back to the road but I feel that the same situation continues as I had before the marathon; I went for a 30 min run and the pain was back after about 20 min run. I did my stretches and ice treatment but still the following day both of the Achilles were stiff and sore.

I am looking to compete in couple of adventure races this summer but if I can only do it with help of Ibuprofen, I think there must be something else wrong. Any ideas?

Thanks for your advise.

TR

Spinner
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Thanks Jenny,
 
I kind of knew what the answer would be so am hotfooting it to the local physio. Just hope it's not a long expensive process.
 
Thanks again
 
Spinner

ben31 (not verified)

Hi jenny,ive been ready all these guys and girls problems andyou sound marvellous at the advice.so im hoping you may be able to help me.I keep regularly fit,but have been unable to "up" any type of training,would love to do some triathlons etc.
About 2 and a half years ago,i was doing some training to climb some mountains,as the altitude was a factor,id train carrying a large pack weighted down,id climb local mts and in between do high staircases.
I remember hurting my left foot,at the beginning it was terribly painful,it was like having a pebble in my heel.My then physio said i have a heel spur.
SO ,2 and abit years on im still suffering,albeit ,not as bad,but i feel it constantly,even as soon as i wake up.The pain has switched and can vary from day 2 day.Ive been going to afoot doctor who has said that its my achilles.AT present im stretching it ,as he reckons my left leg is shorter than my right.The pain can go up my leg and my knee often feels hot.could you please advise me as im getting fierce annoyed with my limits.
Thank you jenny
excuse the moan
ben

Jenny Branigan
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Hi TR,
 
I agree with you - it is ridiculous to try to complete races by getting through the pain with ibuprofen. Especially an achilles tendon problem.
Achilles tendinosis problems tend to become chronic very quickly and if you cannot continue to run without pain, then you must take running out of the equation until the pain and swelling settles and then you gradually build back up to your previous levels of running.
It can easily become a major problem so I would advise you to get back to your Chartered Physio who specialises in running injuries and keep working on it. 3-4 weeks is usually not long enough for this to settle, particularly if the problem has been going on a while before you address it.
Hope this helps. Contact us if you need more info on 2000501 or at our new premises in Stillorgan -www.totalphysio.ie
Good luck!
Jenny

Jenny Branigan
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Hey Ben,
The heel pain sounds like a very common running injury called plantar fasciitis - in chronic cases you may develop a heel spur in the area.
It is usually worse in the morning and when you move into standing from a prolonged sitting position. It will usually ease as you move around and it warms up and stretches out.
Treatment consists of lots of deep frictions, lower limb and sole flexibility work as well as a biomechanical assessment.
It very quickly becomes a chronic problem so sort it out immediately with your local Chartered Physio with an interest in running injuries.
Good luck Ben! Contact us for more info at www.totalphysio.ie or on 01-2000501.
Jenny

TR (not verified)

It seems that my this summer half & full marathon and the adventure challenges are not the wisest idea. I have scheduled a time with my Physio and I think I'm off from the longer runs for a while. Bugger!

Thanks for your reply and have a nice summer!

TR

Jenny Branigan
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No problem TR,
Good luck with it!

Niall Crowley (not verified)

Hi Jenny,

About six weeks ago during a ten mile run (which involved a steep road incline) i felt a sharp intense pain in my left knee which forced me to stop running. After walking for a half a km or so i could then run for another 2-3 km before it came back again on the same run. I rested the knee for a week or so and started some 10km runs which were going fine until 2 days ago when it came back again. Not as intense, (i didnt have to walk home) but it was a familiar pain. I am now resting again and concerned that it may be meniscus or bursitis. I am not sure. At the moment, even resting it resembles a general ache around the knee, mostly internal

Any ideas?

Many thanks
Niall

Jenny Branigan
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HI Niall,
Well you are doing the right thing resting it for now, but as soon as you try to run again it will return.
Running injuries are typically overuse injuries, so resting will help as long as you plan to do nothing. Once you increase the intensity again, the pain will return, simple as that.
What you need to do is go and get a diagnosis and begin active recovery rather than hoping it will go with rest.
 
Go and see you local Chartered Physio with experience in running injuries and start doing the right work on it now.
Please contact us if you need any more info www.totalphysio.ie
Good luck!

Chris Metcalfe (not verified)

Hi Jenny,

This isn't a physio related question, but I want to throw you some compliments on what you are doing here. I think providing your time and expertise in this medium is just fantastic.

I think the physiotherapy community worldwide would benefit tremendously if there were more people out there like you willing to provide their expertise to others!

I want to know how you would feel about contributing your knowledge to Mavenlive a physiotherapy software which offers decision support to therapists when prescribing treatments for their patients. Our system intelligently recommends treatments based on the entered patients assessment. We would love to be involved with such a respected member of the community who is clearly pushing the limits of what is achievable on the internet within their profession.

Keep it up!

Jenny Branigan
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Posts: 429

Hi Chris,
Thanks for your message. It's great to be appreciated!
You can send me more information on your Mavenline via email info@totalphysio.ie
All the best
Jenny

Chris Metcalfe (not verified)

Thanks Jenny I will send you some information on Mavenlive and our exercise prescription software in the coming week.

Thanks for the prompt response!
-Chris

Munsterman
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Posts: 9

Hi Jenny,
Hope you can help me out . About 6 weeks ago I started to get a pain below my left inner ankle ( it seems to curve along the ankle to the sole of my foot ). Didn't think much of it , but after a couple of weeks I was speaking to someone , and they advised me my runners were spent . So I purchased a pair of Asic's 2150's . The pain isn't very severe just very irritating , the area seems to swell a little especially when sitting , But this problem hasn't gone away . I have iced area , used Voltoral , but to no avail . I purchased an ankle support and wore it running yesterday but it hasn't changed , hope the ankle support will help . I only get or feel this pain when sitting down relaxing . Don’t really have any pain when walking . It doesn't hurt when running ??? Please help.

Jenny Branigan
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Posts: 429

Hello Munsterman!
Thanks for your message. It sounds to me like you are suffering from a tendinitis - most likely tibialis posterior or if it goes towards your big toe could be the flexor hallucis longus.
At the very least you will need to get seen by your local Chartered Physio who treats running injuries. You will need a biomechanical assessment to make sure your arches are not flat.
Swelling means you must ice it regularly for 10 mins (wrap ice in a towel to prevent an ice burn), gently stretch it out until you can move it without pain and then you build up strength before you gradually resume your running.
The ankle support will only keep it warm. If you keep running on it, it will get to the point where you do feel it walking and running, so get help now!
Contact us if you need to at www.totalphysio.ie
Good luck,
Jenny

Munsterman
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Posts: 9

Thanks Jenny, Have an appointment with my local Physio tomorrow morning. Thanks for advise
Munsterman :)
 
 

Jenny Branigan
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Great stuff Munsterman, get it sorted!!

Munsterman
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Posts: 9

Hi Jenny, I went to a physio and told explaination is as follows : I have a tibialis posterior dysfunction . It is overworked and now strained because I have over-pronated subtalar joints. Therefore when I'm running, the impact action places alot of strain on this muscle. Its main action is to support the arch and second action is the push off phase when running. It can't do both successfully and then becomes a problem. If I can keep it under control with exercises great. If I cannot then I need to support arch with external method ie. insole so then it doesn't have to do the two jobs! . I was hoping your could give me you opinion on Orthotic insoles ? what's your take on them . thanks again   . Munsterman