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Doug T. - I love your sports medicine info and I'm excited to see the new changes. I'm trying to get back in shape for the summer and I'm having ongoing knee pain that never seems to go away. The pain is mostly below my kneecap and it hurts when I move my knee after sitting for a prolonged period of time in a movie or on a plane. I'm 42 years old but this is making me feel like I'm 80 years old! What can I do?? Thanks for your help.

Mike Ryan (April 25, 2010): Hi Doug,
The new website will be very cool with easy to use videos and a cleaner overall format.

As for your knees, you are probably getting classic patella tendonitis or, if it's at the very tip of your kneecap, it is referred to as Jumper's Knee.
You need to do three things to get this tendonitis pain under control:
1. Get your quads stronger.
2. Improve your lower extremity flexibility, especially your quads.
3. Warm-up before any knee-related activities.
These three will redistribute the force from the activity to other areas such as the quad muscles and the hips to reduce the strain at the patella tendon.
Key Tips:
1. Use a Roller - a roller on the quads and the outside of the thigh is a great way mobilize the muscles and save your knees. The Trigger Point Therapy link on my website shows you the best options.
2. Avoid stop-and-go activities such as tennis and basketball as much as possible until they are pain-free.
3. Maintain a knee range of motion (ROM) of no more than 90 to 20 degrees. Use pain and/or excessive patella crepitation or grinding as an indicator to limit the ROM to less than the 20 to 90 degrees.
Keep me posted and stop thinking that you're old, Doug. Go have fun!

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Charles S. - It appears I bruised the second finger knuckle playing tennis. There is a small bump (similar on uninjured left hand) just left of the knuckle. Very sore and difficult to grip and return forehands. Will Voltaren and ice help?

Mike Ryan (January 30, 2010): Hi Charles,
As with most bruises or contusions to the hand, you usually know when it happened. Based on the uncertainty related to your question and the lower probability of hitting your knuckle while playing tennis, I would suspect more of a ligament sprain or a bone spur.
X-rays and an evaluation with an orthopedic doctor would be the best place to start.
The collateral ligaments of this metacarpophalangeal (MCP) joint tighten with finger flexion or bending. Therefore, when you grip a tennis racket, the fibers of the ligament are stretched. When an injuried collateral ligament of the MCP are stretched, the pain worsens and your grip strength decreases considerably.
X-Rays will show most bone spurs, stress fracture and arthritic changes that could be creating the symptoms you describe.
When the doctor clears you, here is the best plan for your to get back to pain-free tennis:
1. Take a mild over-the-counter pain medicine 30 minutes before playing tennis.
2. "Buddy tape" your second and third fingers together when playing tennis or being active to support the injured joint.
3. After every hot shower or bath, get int he habit of stretching out your fingers, hands and wrists. They are kind of important for an active lifestyle.
4. Ice your finger after any hand-based workout.
I wish you a fast recovery and many years of pain-free tennis.
With Healthy Regards,
Mike

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John D. - Mike, I'm a 49 year old male and I've been an avid runner and part time triathlete for over 15 years. I have had my share of lower-leg injuries but NOTHING has ever been as persistent and stubborn as my current heel problem. About six months ago, on the morning after a medium-long aerobic run (8 miles) in a brand new pair of shoes I woke-up with pain and inflamation in and around my left heel. The pain was primarily on the outside of my left heel where the achilles inserts into the heel bone. I have iced, rested, elevated, and NSAID's this injury for months now and every time I start to run again it flares-up. I can walk forever and I can ride my bike without pain, but as soon as I run even a 100 yards the pain and inflamation return. The pain is limited to the outside of the left heel bone and does not seem to extend up the achilles tendon. I am at my wit's end. Someone recommended I write you. Can you help me?

Mike Ryan (January 06, 2010): Hi John,
Heel pain and running are too commonly linked and I'm sorry to read of your problem.
I think I can help and get you back to running pain-free. First of all, I strongly suggest that you see an orthopedic physician who specializes in ankle and foot injuries. You would benefit from a full workup on the ankle seeing how long you have been in pain and how debilitating this injury as been. I'll explain....

Your calcaneus or "heal bone" is one of the dense bones in your body. Damage to this bone for younger athletes (I did say younger!) like you is difficult but not unlikely.

Here's what I think...

1. Stress Fracture? It's not likely to happen with a runner who I assume is progressing wisely and training smart. The new shoes will alter your alignment and this may prove your need for orthotics.

2. Bone Bruise - The posterior aspect of the subtalar joint (STJ) is slightly in front of the base of the Achilles and is commonly mistaken for lower Achilles pain. Pointing the foot downward, slightly rotating the foot outward and then banging on the heel can prove to be a way assess this joint for pain.

3. The Freak Finding - Sometimes the seasoned endurance athlete can present with an injury that defies all logic and reason. I've seen crazy things like cysts, extra bones and infections that have presented with unexplained findings.

My advice: See a specialists, stick with running shoes that work for you, strengthen your feet, enhance your ankle/hamstring/hip flexor flexibility and progress slowly with your running on level surfaces once the docs find the source of your pain.

Please keep me posted. I like challenging injuries and I'd love to know what you find. I wish you a speedy recovery.
MDR

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Jade A. - Hi Mike,
I think I have hurt my metatarsals. I do a lot of running and tramping and went on a tramp which went down a steep hill for about 1 1/2 hours. I noticed my feet started to feel a bit weird, like a pebble underneath my foot.

The physio I saw for the sprained ankle referred me to a podiatrist who said I had hurt the bone. He gave me insoles but they seem to make the weird feeling turn into pain.
I don't know what to do. it has been about 2 1/2 months now I happened to see my GP who said that he thinks it is more a tendon problem. He said rest is the best thing for them but I really am starting to go crazy not being able to get out and about. If you could answer my questions I would really appreciate it.

Do you think that I should keep wearing the insoles? Should I be icing and elevating the area? Should I be massaging my feet? How long does it take to recover from sore metatarsals?

Thanks so much!
Jade NZ

Mike Ryan (December 08, 2009): Hi Jade from New Zealand,
You have been through allot of pain along with too much downtime so I understand your frustration.
I'm sure you can appreciate the importance of the biomechanics of the arch and the alignment between the front of the foot to the heel of your foot. Both of them are reasons why your initial nerve injury never improved.

Based on your initial "pebble under the foot" description, the increased pain with insoles, the mechanism of injury and the prolonged symptoms, I would strongly suggest that you have a metatarsal neuroma.

A neuroma is a localized inflammation around a nerve. The nerve becomes chronically irritated which created more inflammation and the limited space between the metatarsals created more pressure on the nerves which increases the pain. This cycle continues and your pain worsens. Because of the pain, your body compensates to avoid the pain which changes your biomechanics. After a couple of weeks the entire foot is "off" and the pain remains. Does that sound familiar, Jade?
I'm assuming that you have had the necessary tests to rule-out a stress fracture and a sesamoid injury under your big toe?
A properly fitted orthotic will help normalize your pressure pattern throughout the foot compared to an insert which simply pads the foot and heel.
Okay, the heavy medical stuff done....what can Jade do to get back to running and tramping? (you have to tell me what "tramping" is!)

1. Place your foot in an ice bucket for 10 minutes 3-5 times per day. I know this will hurt but I've been to your beautiful country of New Zealand and I've learned how tough you NZer's are so toughen up and do it.
2. Ask your podiatrist for a metatarsal pad to be placed in your walking shoes. A metatarsal pad is a small teardrop-shaped pad placed about 3 finger widths behind your middle toe. This pad will raise your MT heads and maintain your cross-arch of your MT heads and allow space between the MT heads for the nerves to move freely.
3. Moderately aggressive and PAINFREE massage of your arch, achilles and calf will improve range of motion (ROM) of your foot and ankle. Ankle ROM is a must for you, Jade.
4. Toe and arch strengthening is important to improve stability of your entire lower extremity. Picking up marbles/stones with your toes, towel curls and barefoot walking are great ways to accomplish this.
5. Take some type of anti-inflammatory to reduce the swelling from the inside.
6. Comfortable shoes with lots of toe-space as much as possible is key.
Keep me posted on your progress and I hope that you are back to tramping, whatever that may be, very soon.
MDR

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Diane D. - During my Tae Kwan Do class, I suddenly felt that something hit the back of my calf. As I realized nothing was there to have hit it, my first thought was a charlie horse. The pain was too severe for that and I could not put any pressure on my leg and I could not step on the ground without excrutiating pain. I belive I tore my calf muscle. It is swollen and painful. Do you have any advice for tteatment? Do I need a doctor or will this heal o it's own. It is 24 hrs later and my leg is still swollen and painful. Help!

Mike Ryan (November 18, 2009): Hello Diane,
Welcome to the world of Calf Strains! Not many of us brag about being a member of this painful club but with time and treating this injury smart, you will be happy with the outcome.
The calf muscle is actually two muscles: the Gastronemius (the outer muscle) and the Soleus (the deeper muscle). Generally speaking, both are treated similar but the Gastroc tends to be the lazy healer of the tandem.
MRF Sports Medicine Tips for an Acute Calf Strain:
1. No Stetching - Avoiding the urge to stretch the muscle. This only increases the bleeding and lengthens the recovery time.
2. Shorten the Muscles - A simple heel-lift of about 1/2 inch takes some stress off the Achilles Tendon and calf muscles to reduce the forces on the healing tissue.
3. Anti-Inflammatory - A simple over the counter (OTC) anti-inflammatory medication for the initial week can reduce the swelling while allowing the surrounding muscle to continue to do it's job with walking and all the fun things you do every day.
4. Compression if Key - Compression sleeves, socks or nylons help dissipate the blood & waste products from the injury sight.
5. Legs in the Air - Elevate the legs whenever possible. You will notioe that much of the swelling and "black & blue" is travelling to your foot and ankle. You want to get that "stuff" heading north and not south so your body can remove it from your tissue.

Did you notice that those tips were not overly complex? There is a reason for that. Trust me on this one: If you are too agressive during this first week with stretching and deep massage, you will create excess bleeding and DOUBLE the time during which you will be limping and watching others having fun.

Allow the body to properly heal this very important muscle group for 1-2 weeks before you return to, in this order,.... massaging the muscle, stretching the muscle, strengthening the muscle and running on the muscle.

I hope you feel great soon and keep me posted on your quest to staying Healthy & Happy!
MDR

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Terri D. - I have had what I thought was a hip flexor injury for almost a year! I can not run without pain and resulting in limp for days! But it is not with flexion. It hurts with weight bearing! Walking is painful. Nothing about cycling hurts! I have had MRI and an x-ray. A year after those two studies another MRI with contrast was performed. First two studies were unremarkable. Have taken 3 weeks off running with no change! Help!

Mike Ryan (November 02, 2009): Hi Terri,
Your frustration is justified and I want to help you get back to doing what makes you happy.
Based on what you've told me, the major structural concerns such as fractures, labral tears, loose bodies and bone bruises have been ruled out. Some people WANT to find those bad things to justify their pain but smart athletes like you should celebrate that you don't appear to have any of those serious problems to be concerned about!
"But that does not help my pain!" you say.
I agree and now let's focus on returning your body to moving functionally without pain.
It will be helpful to remember....You have to walk (without pain) before you can run (without pain).
For almost 12 months your anterior hip has been contracted and tight. Meanwhile, your fitness and pelvis stabilization strength has probably decreased which increases the tightness of your hip and surrounding muscles.
It's time to relax and open the front of your hips bilaterally.

Hip Hop Plan:
1. Start Manual Therapy - Make an appointment to see a registered physical therapist or license massage therapist to get some aggressive deep manual therapy and massage work performed.
2. Prone Lying - 2 to 5 times per day, lay face-down on a firm floor with a medium size pillow under your knee. Relax your entire body, calmly breath and visualize your anterior hip "opening up" as your hip flexors relax. As the hip relaxes, larger pillows are add to gradually increase hip extension.
3. Hydro Therapy is Your Friend - Pool running and swimming is PERFECT for you, Terri. It will help you to relax your pelvis region while strengthening your hips, Abs and groin muscles.
4. Stretch and Strengthen - Get with your athletic trainer or personal trainer to improve your flexibility and strength. Improvements in these two areas will pay you back big time as you quickly start to walk without pain!

It took 12 months to get to this point, Terri, so it will require some patience as you increase your walk/run
program. Implement the steps above and get excited about your athletic future.
Keep me posted on your progress. I'm sure my readers would love to read your story as you return to pain-free running.
With Healthy Regards, MR

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