I love running but often get sharp pains just behind my shin bones when I'm running regularly. I think it might be shin splints, but a relatively mild case. I have tight calf muscles too, and have noticed the pain is worse when my calves are feeling tight. I stretch them as much as I can but it doesn't seem to help. Any suggestions? I don't want to give up running.

L, Herne Hill

Your problem sounds as if it may be related to foot over-pronation which is similar to flattening of the foot when you run or hop and take weight through the foot. Over pronation can alter lower limb biomechanics and cause twisting of the muscles in the lower limb. It can also mean that you take weight through an area of the foot or lower limb that was not supposed to take so much weight. Tightness in the calf muscles is common with this condition. Over pronation is common and often found in runners.

What you need is a biomechanical assessment from a physiotherapist and most likely orthoses (insoles) to correct the foot position. You also need to stretch the calf, hamstring and quadriceps muscles and the iliotibial band (ITB).
You should also make sure that you have good running shoes with a firm heel cup to prevent foot rolling when you run. If this problem is assessed and corrected you should be able to go back to running.

Our physios would be happy to have a look at you. We also have a podiatrist who is an expert in foot biomechanics and we can prescribe orthoses at a cost of £35. Get in touch!

I suffered a major anterior cruciate ligament injury while playing rugby which meant I had to keep my knee straight for two months before undergoing two surgical procedures. Now I'm six months into rehab phase and struggling to get back muscle strength in my leg and mobility and movement range in my knee.

I'd like to get back to playing rugby as soon as possible - do you have any tips or useful exercises for speeding up the rehab process?

- S, Brixton

This sounds like quite a problem. I cannot think why you had to keep your leg straight for 2 months before surgery and this may be a reason why it is taking you so long to recover. You do not say what kind of surgical procedure you had but I am assuming that it was a repair using the hamstring muscles. We see a lot of ACL problems at esph and I have to say that normally we have the client back to full training if not match fit by 6 months with a good range of movement and good muscle strength.

You seem to have been unlucky!

You need to get back full range of motion up to a full squat (non weight bearing to begin with) and strengthening the hamstring muscle will help to give added support to the ACL repair. One of the best exercises to strengthen the hamstring muscle is to do the bridging exercise on the floor and progressing to doing the bridge on the gym ball.

Doing knee bends and mini squats in water will help to increase mobility.

We would normally use isokinetic computerised muscle testing to evaluate the weakness and balance of the muscles supporting your affected knee.

Obviously diagnosing your problem without seeing you is difficult. I would advise seeing one of our physiotherapists for detailed advice on your final rehabilitation. Give us a call!