Sports injuries live chat: our expert answers your questions on sport and health

12 September 2012

With the warmer weather - and hopefully some sunshine, too - Summer is a great time to play sport and get fit.


Our sports injuries expert Dr Alasdair Wright was on hand to answer your health questions on this topic for our live chat on Thursday 23rd August - and gave advice on a range of sports health queries from our readers including running pains, Pilates, tennis elbow and more.

See what Dr Wright had to say during this busy session below:

Hungry_Healthy_Happy asked:What is the best way to prevent knee injury when running?

Dr Alasdair Wright:Hi. To prevent injuries - including knee problems it's best to build up training/running distance slowly. always warm up for at least a few minutes with fast walking gentle jogging/skipping on the spot. It is also important to make sure you have the right running shoes with adequate support. Once you have finished a run spend time stretching and warming down. A physical trainer or physiotherapist will be able to show you appropriate quads/hamstring/calf and ankle stretches.

Hungry_Healthy_Happy asked:  I have been doing all of that, yet I still get knee pain when running.

Dr Alasdair Wright: Hi HHH, If you get pain when running then there are a variety of common problems which may be responsible. 1. kneecap maltracking due to quadricep imbalance..i.e. need to work on specific muscle strength of quadriceps, 2. iliotibial band syndrome ..tightness on the outside aspect of the knee from constant rubbing of the iliotibial tract which attaches just past the knee on the may also have foot balance problems which can contribute to both of these conditions ... a sports physio assessment would be worthwhile.

Hungry_Healthy_Happy: Thank you anyway. I think I just need to give it time to adjust to running, as I am a beginner.

Julia asked: Hi Dr Wright. I was a regular gym goer and then went skiing over a year ago. The conditions weren't great - icy. Anyhow, upon my return I started developing pain down my left side of the leg and bum. I saw a physio and they think it could be some sort of sciatica... I now don't really do any impact sport i.e. running for fear of irritating the problem - do you have any advice on how to improve the condition?  Thanks in advance.

Dr Alasdair Wright: Hi , it sounds like you may have a nerve entrapment originating from your lower back. Pilates type exercise is a great way to strengthen without causing further damage. once you have built up core back & pelvic strength you may be able to introduce other forms of exercise. it would be worthwhile getting a physiotherapist to have a look at your back first & to give you a programme of appropriate exercises.

Julia: Hi Dr Wright - thank you for that advice - I'll give Pilates a go!

Clarissa asked: Hi, My question is: Is it okay to continue to exercise/do activities when your knee is popping every time? I injured my knee a few months ago; it swells and has pain when I walk a lot or do physical activity. I'd like to push thru the pain and get back to exercising, but my knee pops every time and I am wondering if that is a bad sign or if it's okay.

Dr Alasdair Wright: Hi Clarissa, It can be normal for knees to pop and click but this should not be painful. Popping is normally due to ligaments moving & fluid pressure changes within the knee. If your knee swells and is painful then it is likely there is some damage within the knee - possibilities include..kneecap maltracking, ligament injuries, cartilage damage or even early arthritic changes. It would be worth seeing a musculoskeletal doctor or physio/osteopath/chiropractor for an opinion. It may be that you just have muscle imbalance problems that needs correcting but get the knee checked out.

Caitlin asked: I get a sore neck and shoulders when completing sit up exercises. What is the best way to prevent this from happening?

Dr Alasdair Wright: Hi Caitlin - flexion (bending forward) movement of the neck commonly causes problems - neck stiffness & sometimes shoulder & arm pain/tingling. There are lots of ways to work your abdominals without excessive neck movement. Firstly just keep your neck in neutral position as you come up and miss out the last bit of flexion. alternatively you could use a gym frame with controls the sit-up movement. or you could try lying flat and slowly raising up and down with your legs straight/or knees bent out in front. There are a variety of gym machines which also work abdominals without neck flexion.

Joe Hall asked: Hello, any exercises that I could do to prevent tennis elbow?

Dr Alasdair Wright: Hi Joe. Tennis elbow is often caused by forceful repetitive gripping and wrist movements. Firstly try to identify the activity that may be causing it and modify the way in which you perform that activity/sport/work. Even something as simple as RSI from overuse of computer mouse can do it. Elbow clasps ( available online) can help take pressure off the point of the elbow where the forearm muscles attach. Warm up before sports, massage the tender gently . Ice packs after activity and stretching after activity will help too. Most importantly identify the activity causing it and modify this.

Sue asked: Hi, I don't run, but like to walk a lot and fine that when walking at pace the front of my legs get sore (almost like a growing pain) - I'm not warming up beforehand, however as only walking, didn't think I would have to. Thanks

Dr Alasdair Wright: Hi Sue. pains in the thighs could just be muscular (thigh muscles) but there is a possibility that these pains could be coming from nerve entrapment in your lower back - this can cause pain which affects both legs & progressively gets worse with walking. If the pain is mild/feels muscular and eases as you go then it is more likely to be just muscular. Loosen & warm up before you start. compression shorts/tights can also help with comfort. If you have any back pain then seek physical therapist assessment.

David Bojangles asked: Hi Dr Wright - I play (and have played previously) a number of impact sports. Lately I have been finding I get shin splints quite commonly, even when simply going running. Is there anything you would recommend to work in to my pre or post workout/sport routine to help reduce either the likelihood of this occurring, or the recovery when it does?

Dr Alasdair Wright: Hi David, Shin splints is one of those injuries that really needs a decent period of rest to allow things to settle. Exercise tends to develop the muscles of the anterior shin which compounds the problem. Look at your footwear & make sure you have decent arch supports in..see a sports podiatrist if you are unsure - you can get specific insoles made to correct your foot posture-this helps a lot. If the pain is mild then you can still do a bit of impact sports but this is not ideal. Keep fit with other forms of exercise..biking, swimming , gym work but let the shin splints settle otherwise it can take many months to recover.

Jonathan asked: Hi Dr Wright. When I run I get a pain on the base of my big toe - the pad (not the toe itself). It goes after time - but don't want to do damage - any advice? thanks

Dr Alasdair Wright: Hi Jonathan. Under each of the toes you have a soft pad of fat which helps cushion the impact of landing when walking/running. These pads become inflamed with overuse and you can also develop a bursa- which is fluid around this area which & is nature's way of protecting the bony structures. Rarely a stress fracture can cause toe pain but the pain would normally be getting worse as you walk/run. If you are a forefoot striker then lots more weight goes through the toes...have a look at your running foot strike & try to modify this. It may also be worth seeing a podiatrist to get specific insoles made to take the pressure of the Metatarsal bones of the feet- a soft orthotic bar is placed just in from of the row of bones under your foot..this may help.

232690 asked: I am currently training for a marathon - is it really true that intensive training and repetitive distance running is dangerous and can cause long-term damage?

Dr Alasdair Wright: It all depends on how fit you are/age/weight etc. The question is at which point (time or distance) does exercise start to become bad for your joints/body. This is very hard to give an exact answer as it depends on the individual. For example an elite marathon runner with cover the distance in a much shorter time with great technique and much less strain on joints/tendons and muscles than a novice who will have tired muscles relatively quickly allowing poor support for joints. It is always best to build up to long distance gradually - listen to your body..if your muscles are tired or joints ache then reduce the mileage until you are ready. specific muscle strengthening and gym work is important too.

Philippa asked: Hi Dr Wright - I just wondered if you had any warning signs of sports injuries that hardcore runners like myself would be wise to look out for?  :)

Dr Alasdair Wright: Hi Philippa, If you are an experienced runner then you are actually at much less risk of injury than the novice but the question is how hard/far can you push yourself before things start breaking down ? Common injuries include : shin splints, iliotibial band syndrome, back pain/ tarsal tunnel syndrome of the ankle, kneecap maltracking to name a few. Firstly make sure that you change your running shoes regularly if you are doing high mileage. It's worth having 2 or 3 pairs - alternate these - get medial arch supports if you have flattening of the arches. Money spent seeing a good podiatrist is well spent. warm up first, stretch at the end. do specific gym work to keep your core pelvic/ back strength which is so important - Pilates is a great form of exercise for this. If you add in gym work and Pilates you should notice an improvement in performance without the need for excessive mileage and will be at les risk of injury generally.

Danielle asked: Hi I have lower back ache and it seems to get worse when playing sports, it just feels like it needs stretching out! I'm not sure whether I need to see a physiotherapist or an osteopath? I don't really know the difference between the two/.

Dr Alasdair Wright: Hi Danielle, It is certainly worth seeing a physio, osteopath or chiropractor to determine the nature of the problem...the key to getting the back right is strengthening of the core muscles that support the back and pelvis. Pilates is a great form of exercise for this but as I said in earlier comment to Neil- do not do any exercise that hurts. Pilates instructors will often be happy to design a programme for you. These exercises can be done at home - don't have to go to group classes.

Neil M asked: Hi, I suffer from back pain and I'm looking to get fit but I don't want to cause my back any problems, what exercises would you recommend? I get lower back pain most days and occasionally my neck and shoulders can be problematic to the extent that I can't sit up properly

Dr Alasdair Wright: Hi Neil. Pilates is a good way to develop core muscle strength which will help support your back. It important to get advice from your physical therapist/doctor first as to the specific nature of your problem. A Pilates instructor would be able to design a programme is best not to do any exercise that hurts though.

AS asked: Hi Dr Wright I currently have an injury to my left leg, I hurt it training (squatting) and it has been causing me a fair bit of discomfort. The injury itself is down the outside of my leg in the IT band region (almost as if it runs along the join between the quad and the hamstring), the area is painful even on lighter lifts at the moment and there is some bruising in the area. I suspect it may be a minor muscle tear but was wondering if you could offer any advance on the injury and potential remedial activities?

Dr Alasdair Wright: Hi As - just found your question now. Bruising around the distal lateral aspect of the knee could suggest a tear either of the hamstring attachment or the iliotibial band. This may be a partial tear at the moment so it is important that you ease up otherwise this may progress to a complete tear ( hamstring) Physio advice/ICE..relative rest. avoid heavy squatting for now. build up hamstring strength again very gradual through non weight bearing hamstring exercises..start very light..sports physio can advise..would certainly be worth sports physio assessment here. (Bruising means tears .)

Jade asked: Hi, I was told I had sports induced asthma 4 years ago, is there such thing? I really struggle with my breath when I am exercising and it seems to be worse in certain weather conditions, I am fit and as far as I am aware healthy. I have been prescribed an inhaler ( I have tried 3 different ones) and  have settled on the blue one however it doesn't seem to work/help. I am very sporty and find that this really has affected it, I used to run long distance and now I struggle. I also sometimes get heart flutterings when I exercise and my doctor did an ECG for me. However this wasn't when exercising just normal rest heart pace. Is there anything you can recommend as I can't seem to beat this thing!

Dr Alasdair Wright: Hi Jade - Yes exercise induced asthma is a recognised diagnosis. The blue Salbutamol inhaler is just for symptomatic relief but if this is not helping then you will need to try a regular daily inhaled steroid. Sometimes overuse of the blue inhaler may induce palpitations but it is important that other causes are excluded - see your GP again for further inv./assessment. If this is just exercise induced asthma a steroid inhaler and long acting version of blue inhaler should make a big difference.

Kirstylieberthal asked: Hi Dr Wright, I notice that I sometimes get a pain in the muscle area between my shoulder and my neck when out running. I don't carry a water bottle so don't believe it is related to carrying anything. It doesn't happen every time I run, and the shoulder affected alternates when it does have the pain. It does seem to occur when I am running on road surfaces rather than paths. Is this common and do you know what could be causing this? Thanks.

Dr Alasdair Wright: Hi Kirsty , neck and shoulder pain that comes on during running is likely to be due to muscle spasm. the neck and back supporting muscles are working very hard to stabilise the spine when running. Have a look at your technique, video analysis ( even DIY home version) can be helpful in identifying imbalances when running. A sports physician or physio will be able to go into this in more detail. If you get tingling in your shoulder and this + pain goes beyond your elbow then this could be a sign of a neck discal compression...if this is the case then an MRI scan of the neck would be helpful.

kirstylieberthal: Thanks Dr Wright, it's just a mild pain rather than the pain beyond elbows which is good!

Dr Alasdair Wright: Hi Kirsty , If the pain is mild/no tingling/numbness and does not occur at other times then this sounds like muscular spasm/tiredness..there will be an aspect to your technique which could be corrected...sometimes just correction of foot posture/corrective insoles sorts things out. Have a think about Pilates too for spinal control.

AXA PPP healthcare asked: Philippa, a blogger from skinny latte strikes back asks: what is the best way to avoid shin splints and what other exercises can I do to strengthen my knees as occasionally, despite my regular pistol squats and yoga, I get a few niggles. Is it a question of improving my running technique, perhaps?

Dr Alasdair Wright: Hi Philippa, firstly make sure your foot position/ground strike is correct. if you tend to go over a bit on your foot/ankle when you rung this puts excess strain on the muscular/tendon structures of the shin. Foot insoles may be needed is so. Good technique is also important. have a think about foot strike position - alter this to see if helps. relative rest is best when shin splints comes on otherwise it can trouble you for many months. Ice packs can help after runs + specific anterior shin/ankle stretching-see sports physio. keep fit through other sports/swimming cycling /gym work when the symptoms come on.. Shin splints is a problem which really needs rest from running/impact sports. If you catch it early/rest it will settle more quickly- rather than pound on. Avoid squats if possible. Try non weight bearing quads & hamstring exercises. i.e. Gym machines. cycling will also build the quads but make sure your saddle is quite high i.e. don't cycle with a bent knee.

AXA PPP healthcare: Laura, a blogger from Keeping Healthy Getting Stylish asks: How can I still work my legs in strength training without aggravating my knees and IT band?

Dr Alasdair Wright: Hi Laura, Stick to non weight bearing exercises, gym machines allow better control than squats. cycling is great for quads /hamstring/calf development. machine based Leg extension/hamstring curls..but build up slowly. These exercises can also be done without a machine e.g. ankle weights + 'theraband' work can be done at home.

Dannii: a blogger from asks: what is the best way to avoid knee problems when running and what to do if you still get knee pains?

Dr Alasdair Wright: Dannii.  Make sure that your foot position is correct. If you have wear on one side of your shoes then it would be worth seeing a podiatrist to get some custom made insoles.  Always warm up before you go running.  If you do feel pain when you run then slow down or stop to prevent a more serious injury.  If an injury occurs see a sports physio quickly to prevent the injury progressing.  Try to make your running style as smooth and efficient - a running coach can help. 

AXA PPP healthcare: Michelle,a blogger from asks: what is the best way to address my pelvic tilting issue when running in terms of repositioning my pelvis/training myself to run in a more ideal and less injury inducing position?

Dr Alasdair Wright: Michelle. Most people have a slight left and right side but the muscular structures learn to cope with this without any trouble. If you have a more significant leg length difference, thigh, hip or lower leg rotation then you are at greater risk of injury. Work on core muscle strengthening. Pilates is an excellent way to do this. Make your running style as efficient as possible - ask a running coach can help you with this.

Nicole: Hello, I am a 27 year old female who is experiencing daily discomfort in my SI joint for the last 8 months. I did not injure the joint, or have had back problems before so it is strange to me how this injury has persisted for so long despite my best efforts at rehabilitation. I have had NHS physiotherapy, primarily focusing on core strength and some acupuncture, neither which have helped. I am a runner and experienced these issues whilst training. After a lay-off of 6 months I can run now, but in moderation and wearing a sacro-belt to keep my pelvis stable which naturally tilts backwards due to my posture. I have always worn orthotics to help my flat feet. I wondered what could have caused this problem and what the best way of sorting it could be? I am interested in trying osteopathy but I am reluctant due to the cost, which I cannot afford at present if many sessions of treatment are required. Can you give me any advice? Thank you.

Dr Alasdair Wright: Nicole. Sacroiliac joint problems in runners usually arise from a biomechaniscal misalignment which becomes apparent when the volume of training or distance is stepped up too quickly. It is most likely that there will be a tilt or rotation of the pelvis which has caused extra force pressures on the SI joint. You have already corrected your feet position and worked on core strengthening but you now need to look at your running style and technique. Small differences in foot strike position, leg lift, stride length and back position can make a big difference - a running coach should be able to help you.  Stick to short distance low volume at first and build up slowly. Consider other sports such as swimming or cycling to keep your fitness while you are on a low volume running programme - it can be surprising how non-impact sports can help strength and stability without causing further damage. In most areas of the country it is possible to get access to NHS osteopathy and chiropractor treatments although sometimes this is limited to only a few sessions before you have to start paying. 

Mrs Pauline Carey : The sole's of my feet have become so sore I can hardly walk feels as if I have something in my shoe.I am trying to cope with soft spongy innersoles but they are not working, even bought new shoes. Standing on cold bathroom tiles eases the pain. What can I do please?

Dr Alasdair Wright: Mrs Pauline Carey. There is a condition called 'metatarsalgia' in which the balls/pads of the feet become very tender usually through a recent increase in volume of walking, running or just standing. It is likely you have foot posture problem and it would be worth seeing a podiatrist to get custom made insoles - not just soft padding ones which you can buy at the chemist or sports shops - you will need a firmer supportive insole. Podiatrist's quite often use a metatarsal bar orthotic which offloads the pressure away from the balls of the feet allowing things to settle. If the pain is only around one or two of your toes and you get shooting pain into the toe then another possibility is a thickening in the nerve that runs between the toes called a Mortons neuroma. This can either resolve through injection therapy or may need an operation. Rarely a stress fracture could cause persistent pain in your foot. It would be worth seeing a podiatrist or your doctor to get the diagnosis.     

Brenda Dixon: Hi, I have been recovering from a deep hamstring injury, it only throbs now when i'm running, all streatches and walking are ok, it's just when i run, is this just the final healing stage and should i still lay off running until there is no niggle? thank you

Dr Alasdair Wright: Brenda Dixon. Hamstring injuries can niggle on for many months after the original injury. The problem is that the scar tissue which has resulted from the natural healing is can be tight and will twinge when running.  The key is to build up to full activity slowly persisting with lots or hamstring stretching at the end of each session. Consider other non-impact exercise to keep your fitness while recovering to a full running programme. You may find that swimming or cycling does not affect the hamstring at all and this with allow you to regain the necessary muscle strength to help the muscle/tendon function recover more quickly.

Zoe Dean: Hi, I attend the gym 3 or 4 times a week to take part in classes, aerobics, LBT, zumba etc and have been doing so for approx 6 yers now. Over the last 6 months or so I have started to experience pain under the ball of my left foot after doing impact classes, particularly aerobics. I'm told this is likely to be tendonitus. The pain occurs after the classes have finishes when walking. During the class there is generally no pain. What is your opinion? I have had my foot xrayed as i do have Rickets and this was returned clear. If it is tendonitus what do you suggest to heal and not return. I have been doing this type of class throughout my 6 years attendance.

Dr Alasdair Wright: Zoe Dean. You may have a condition called 'metatarsalgia' which is can be caused by pounding of the balls of the feet through repetitive impact activity. The sore area on one or more of the balls of the feet becomes inflamed and can take many months to settle. A podiatrist can fit you with a metatarsal bar insole support which will help offload the tender spot allowing things to heal more quickly. Another possibility is a 'Mortons neuroma' which results from a thickening of the nerve between the toes and typical causes a shooting pain into one of your toes- this can sometimes settle after injection therapy but more often this may need surgical correction if it has been going on for many months. I would see a podiatrist or foot specialist to get an opinion.