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Ask a Physio

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How do you prevent running injuries or get on top a "niggle" fast? Ask our expert Physiotherapists.

Got a question for Brad and the team at Sydney Physio Solutions? Ask them in the comments section below!

 Dr Brad McIntosh and his team at Sydney Physio Solutions are excited to partner with Blackmores again for the 2022 Sydney Running Festival, helping everyone get to the line in good shape! Amazingly, this is the 11th year that Brad and his team have helped out by answering your injury prevention and management questions.

Sydney Physio Solutions is a group of leading Physiotherapy, Pilates and Massage clinics based in the CBD of Sydney.

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Hi there I've a relatively minor but longstanding shoulder pain in my right arm, right around the rotator cuff. It's only painful when doing certain strength exercises, the most common kind being those requiring weighted arm raises such as dumbbell fly and dumbbell front raises. The latter of these I can feel a click occur in the shoulder as the arm approaches shoulder height. Pain in the area isn't debilitating and lessens as the arm warms up. Just wondering if this is a common / clearly known issue and what kind of measures would be best to address? Thanks so much in advance.
Hi Brad and Team, I run a minimum of 10km every day, on the road, but I often struggle with tightness in my hamstrings, groin and glutes. Is it as simple as more stretching before and after I run or should I be doing something else?
Hi Annette, thanks for the great question!
There are a few points here worth discussing. Firstly, the VMO (Vastus Medialis Oblique) is the inner quad muscle above the kneecap (patella) and the Vastus Lateralis (VL) is the outer quad muscle. When you utilise the leg during exercise, both these muscles activate and turn on. By turning on in the correct way, they pull on the patella from opposite directions to maintain a central position in the knee joint. Everyone has a VMO, thankfully, and yours is probably not too bad considering you can run a half marathon!
There was a time where the VMO was considered the culprit of most knee problems and we tried to isolate and strengthen it. We thought we were specifically strengthening this particular VMO muscle, but the latest research indicates it's impossible to target strength work to the VMO specifically. Rather, the VMO and VL fire up together, so in actual fact we're strengthening the entire quad.
As you build your training and optimise your strength program, you develop strength not only in the quads, but also in the hip, calf and core. This all contributes to increased stability of the knee during your running.

The best advice in building quad strength would be to perform single leg strength exercises that are pain free. Some examples are single leg squats, lunges and Bulgarian split squats. These should be individually tested and assessed, and we usually dose these exercises in the clinic to appropriately match your capacity. What you now experience with crunching and creaking in your knee is very common and if it's not associated with pain, it's most likely nothing serious. There are many theories on what causes it but nothing scientifically conclusive. So don't worry, it is most likely not the cartilage grinding away as one may think. One probable idea may be a tight rectus femoris muscle (midline quad muscle) which is causing compression of the patella in to the knee joint. This alters the line of pull of all the muscles attached to the knee and can cause this flicking/creaking/crunching sensation.

Best of luck and let us know if we can help you further!
Regards, Vincent Yang, Physiotherapist
This is general advice only and shouldn’t take the place of a consultation with your healthcare provider. For a private consultation with our expert team of physiotherapists or massage therapists, please contact Sydney Physiotherapy Solutions on 9252 5770 or
Hi, just completed the bay to bay half and got a nice deep tissue on legs today, the guy told me i had basically no VMO in my left knee (have had knee issues in the past but touchwood since training better they seem to be ok, except for being super loud and crunchy!) is there anything specific i can be doing or working on to prevent this from becoming an issue with my next half and my current training. Many thanks
Hello Dr McIntosh, and team! I've had some some lateral knee pain on and off for some years, pretty much always on the side of the knees while descending on technical trails. I've been able to manage this with regular glute activation exercises and foam rolling before my runs. Recently though, I have started to notice some grizzliness under my my left kneecap on long climbs, which ia a new, unfamiliar and unwelcome pain/annoyance! Do you have any thoughts as to what might be causing this? I have been taking fish oil and glucosamine supplements to see if this helps, and also paying more attention to quad stretching, but it doesn't seem to be making a huge amount of difference. Any advice you can offer is most welcome!
Hi! I have joint hypermobility, which is particularly bad in my ankles. I'm wanting to start running and wondering what sorts of preventative action I could take to avoid any running based injuries? Thank you!
Hello, My hamstring on the left side that runs to my knee feels like its pinching, especially when I go up hills and run. I am doing bridges to strengthen my butt muscle and only walking at present. I was doing triathlons and parkrun last year but have stopped since having this problem which I thought was sciatica? Will running worsen the issue or should I see a physio?
Hi Dr Brad and team! Apart from a weekly 2-3km run, I'm a beginner who has aims to run the 10K this year :). Being on the heavier side, I do get a sharp pain in my left knee after high-impact activity like running and other heavy cardio, however this is manageable and my trainers have advised that weight loss will play a role in easing stress on the knees. A physio advised that my ITB is very tight and I've tried foam rolling as well. Is there any way I should be protecting the knee as I embark on the 10K run program? I've tried wearing a knee sleeve but find it pretty uncomfortable. Any guidance is so appreciated, so thank you in advance!