Ask a Physio

Ask a Physio

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How do you prevent running injuries? Ask our expert Physiotherapists.

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

Dr Brad McIntosh and the team at Sydney Physiotherapy Solutions have partnered with Blackmores again for the 2018 Sydney Running Festival.  This is the 8th year that Brad and his team of experienced running Physiotherapists have helped out by answering your injury prevention and management questions.

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



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Hi Brad

I started running 12 months ago (at 50 yo), completing a couple of half marathons and shorter races. This year, I have been training for my first full marathon and have developed a problem with a very sore Achilles tendon, so much so that I stop running for a week or two a couple of times, without success and have just started running again after a 2 month break to try and recover - after a couple of short runs (4 & 6 km) over 4 days, there is some soreness but very minor. The problem seems to arise after I cool down and seems to coincide with tight hamstrings, the next day. I have not changed anything I do, compared to last year, other than having a slight lower back strain in January, after some water skiing.

Would more stretching help this or will I just need to rethink my ability to run longer distances, if so, what stretches should I do before and after running (I have typically not been a great stretcher, so I would appreciate assistance)
Simon 11 Jul 2018
Hi Karen,

Sorry to hear your feet are getting in the way of your training! It’s quite a common complaint with runners and there can be several causes and solutions.

One of the first things to consider if you are having this problem is what footwear you are using (which you have already thought of – well done!). When thinking about what running shoes to choose, you need to consider the following:
• The correct size: Our feet naturally heat up and swell during exercise, so if there isn’t enough room your circulation can be restricted and there can be increased friction on your skin, leading to burning pain and blisters.
• Laces: A common mistake we make is doing them up too tightly which can also restrict circulation or irritate the nerves in your foot. Check to see if you have some wiggle room under the knot and across the front of your foot. Perhaps when the burning sensation kicks in during your run you can try to loosen the laces and see if that reduces the pain?
• Cushioning and Insoles: If you are aiming to up the mileage, you might need to consider shoes that have slightly more cushioning under the balls of the feet and the quality of the insole in the shoe
• Socks: As your feet will sweat while running, make sure you have moisture wicking socks that will aid in keeping your feet cool (cotton is not good for this!).

However, if you have already tried these options with your shoes/socks and haven’t noticed a difference, there are several other things to consider:
• Running technique: There are many components to your running technique which, if not executed correctly, can lead to overloading of the tissues in your feet. In the clinic we can perform a Running Assessment where we video you and see if there are any changes we can help you make.
• Muscle imbalance: Tight calves, poor arch control, poor hip/knee/ankle stability are just a few areas which could also contribute to your problem.
• In some cases, burning pain can be an indicator that there is some nerve irritation, such as Morton’s Neuroma, which isn’t cancerous but can be quite painful!

Karen, I recommend seeking an assessment from a Health Professional. If you only experience this pain when trying to increase your running duration, not at any other time during your day, I would be inclined to suggest seeing a physiotherapist first who can look at your lower limb and foot, as well as your running technique. If you have a history of foot pain prior to this, or during activities other than running, then a Podiatrist would be a great option.

I hope this helps and you can get past that 50-minute mark with your running soon!

Warm regards,

Talia Kruger
Sydney Physio Solutions Castlereagh St

“This is general advice only & shouldn’t take the place of a consultation with your healthcare provider. For private consultation with our expert team of physiotherapists or massage therapists, please contact Sydney Physiotherapy Solutions on 9252 5770 or”
Brad 18 Jun 2018
Hello, I pulled a calf muscle last week and it is still sore. I haven't exercised since then -should I continue to rest or is it ok to run?
Thanks for your advice
Geoff 15 Jun 2018
Dear Brad and team,

I am very prone to getting blisters and hot spots on the balls of my feet (under the big toe and to the side) which makes running quite painful at times, and is really getting in the way of my training and increasing my mileage. This area of my foot usually starts to burn at around 35min and I can usually make it to 50min before needing to stop, but I can't go further. I've tried different types of shoes and yet continue to experience the same issue. Would you recommend that I see a podiatrist and is this simply related to not wearing the right shoes?

Any advice you could offer would be much appreciated

Thanks so much, Karen
Karen 12 Jun 2018
Hi team,

I ran the half marathon last week and am aiming to run the full marathon in September. I always stretch and warm up appropriately before running, however towards the end of the half marathon I found my knees were in pain, my calves in particular were incredibly sore, and my left ankle/heel (on which I have suffered a supination sprain years ago) was aching heavily.
Could you recommend any specific stretches, strapping, or warm ups to alleviate these symptoms?

Wade 26 May 2018
Hi Brad,

I've registered for my first full marathon this year (with a respectful sense of fear).

I've just completed my 3rd half marathon on the weekend. However, I've found that ITB pain seems to plague me from around 15k. Once it starts, it seems to progressively worsen to the point of needing frequent walk breaks.

I feel this is a potential showstopper for the full unless I start to address the issue now. I would appreciate any suggestions you may have.

Hi Ham,

It sounds like there could be a few reasons as to why your toes are aching or you are beginning to feel cramping set in. Cramping has historically been associated with dehydration and/or an imbalance in electrolytes; but the current thinking has derived itself more towards muscle fatigue.

Muscle fatigue can be caused by many factors like dehydration, overtraining, or lack of circulation. Magnesium and increasing fluid/electrolyte intake help in reducing an effect of any role of dehydration. Making sure you are drinking at your 2L of water/day.

Other possible fatigue factors would be your increase in training and mileage. Are you doing too much, too soon? Have you increased your mileage or added speed work recently? In general you should be following the rule of increasing weekly mileage volume by no more than 10 percent a week.

Another factor that can contribute to muscle fatigue are your shoes, both your running shoes and your day-to-day shoes. Be certain your shoes are not limiting your circulation in any way. Ensure that you are not tying the laces of your running shoes too tightly. For your dress shoes, be sure the shoe and the toe box are wide enough to accommodate your foot.

I think the most basic way to attack this issue before the race on Sunday would be to use a spikey ball (trigger point ball) to roll under the arch of your foot. There are a vast array of muscles which could be working too hard to control your running style. You may be over pronating (rolling in) or gripping your toes too much when you run to help propel you forward. All of which require the body to work harder during those longer runs. Spend at least 5-10mins at the end of each day rolling out the arches of your feet and look into getting your running properly assessed if you wish to continue running longer distances without pain/ache.

On a final note, it is important to keep in mind that frequent toe ache or cramping may be a sign of other, more serious, medical issues. If your aching persists or worsens, be sure to consult your physician to rule out anything more serious than muscle fatigue.


“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, please contact Sydney Physiotherapy Solutions on 9252 5770”
Brad 14 Sep 2017
Hi Brad, I have been training for the 10k run on the weekend and over the last few days my toes have started aching. not painful per se, more the pain before a cramp sets in. I am taking magnesium and have never had this issue before...any ideas?
Ham 14 Sep 2017