NoviceRunnerNik's Top Tips On How To Crew For An Ultra Runner

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NoviceRunnerNik's Top Tips On How To Crew For An Ultra Runner

Our NoviceRunnerNik, who’s been running for quite a few years now (we probably ought to give her a new nickname!), has crewed for her husband and other friends competing in ultra marathons and here are her words of wisdom about supporting your ultra runner.

What is an Ultra Marathon?

Ultra marathons are any running races over marathon (26.2 miles) distance. 50k, 50 miles, 100k and 100 miles are all common distances but some races are even longer: The Spine, for example, is the length of the Pennine Way - 268 miles.

Runners at the start of the 2019 Arc of Attrition 100 mile coastal run.

Runners at the start of the 2019 Arc of Attrition 100 mile coastal run.

Who Are These Ultra Runners?

Ultra runners are a curious breed. They will pay a lot of money to run ridiculously long distances all in one go, through daylight, night, daylight and night, with little or no sleep, often in terrible weather conditions and usually over very tough terrain. They will spend hundreds of hours running hundreds of training miles, often alone. They will also spend a lot of money on running kit: taped seams jackets, anti-chafe running underwear, ultra light-weight hydration vests, tens of pairs of running shoes. During the actual ultra race they may hallucinate, dehydrate, vomit and cry. After the event they are likely to lose toe nails, sleep and eat for England and never stop talking about their epic race. Their lives are running!

And Crewing for Ultra Runners?

Some ultra events allow for runners to have crews to support them throughout the race (normally friends or family who drive around the route feeding, watering and generally tending to a specific runner). This helps both the runners as they can carry less food, water and gear and it helps the organisers as it means the welfare of many of the runners is managed by other people.

The first of many shoe changes.

The first of many shoe changes.

NoviceRunnerNik's Top Tips On How To Crew For An Ultra Runner

If your friend / partner / colleague asks you to crew for them for an event you need to be prepared for all of the above, so here are my top tips for crewing:

  1. As always, preparation is key. Ensure you have a meeting with your runner and co crew to talk through what your runner’s expectations are. Look at and agree locations for crew support points. If your runner is very information driven, make sure they prepare the information for you so that you have it to hand on the day – this could be expected arrival times at crew support points, distances between crew support points, distances between official check points etc. Print several copies – you’ll run into other crews and they’ll love the information too, you’ll lose a copy out of a window at some point. Guaranteed. Don’t be tempted to just wing it, unless your runner is very, very laid back.

  2. Use the largest vehicle you can sensibly drive around the route. A camper van would be ideal but a van, estate car or similar will give you lots of room for kit and for having a lie down/sleep if you or your runner need it.

  3. Have a second crew member if you can, particularly if your runner is also your partner – you have company, help with navigation, you can sleep in shifts and a third party might mean that you and your runner are on your best or at least better behaviour.

  4. Pack your kit for all eventualities. Your runner will have thought long and hard about their kit for the event and you should do the same about yours. You could be out in horrible conditions for 36 or more hours. You might not sleep. You are probably more likely to get cold / hypothermic than your runner. For me essential UK kit includes thermals, full waterproofs, walking boots, full change of clothes, waterproof gloves and hat, head torch, sleeping bag, sleep mat, blanket, food, drink, a kettle, phone, phone charger, music, books, binoculars, paper maps, change for car parking, a deck of cards, first aid kit, running kit (I always try to get out for a run in between stops if I can) - be prepared for boredom!

  5. Keep your kit and your runner’s kit separate then there’s no way that you’ll accidentally eat the very thing they are craving at Mile 90. But be prepared to give your runner (or another runner or their crew) anything from your food or kit store. Pack things into separate plastic crates or boxes so everything is found easily and doesn’t roll around the back of your van. Have a bin bag or crate / box ready for wet clothes and shoes.

  6. If you can’t always get your vehicle right up to where you’ll meet your runner, for example at checkpoints, get your runner to pre-prepare a kit bag with all the essentials they might need – spare clothes, powerbank, spare socks, extra food etc so that you can just grab the bag and arrive prepared.

  7. Have a spare waterbottle filled and ready to be swapped out when your runner arrives to make restocking them simple. Knowing what your runner will need when they arrive at your next meet point speeds things up.

  8. Keep cheery but avoid too many questions that require decisions being made by your runner. It’s really obvious but your runner is going to get more tired as the event progresses, as are you. Get on and do stuff without them having to ask.

  9. Sleep if you can and set an alarm on your phone if you need to make sure you’re awake. I’ve been in check points where runners have come in and their crews aren’t there. It’s devastating for them.

  10. Mobile phone / data reception can be really poor in areas so don’t rely only on Google maps for directions and bear this in mind if you’re following your runner on a tracker website.

  11. Be prepared to do some grim jobs, such as cleaning your runner’s feet or applying BodyGlide…

  12. Make sure your runner supplies you with fish and chip (or other takeaway of your choice) money! Check that your expected fish and chip shop is actually open. I’ve learned this the hard way!

  13. Plan your journey home from the event. From someone who has both crewed for and run ultras: you’ll get as tired crewing as you would do running but you’ll recover more quickly than your runner and keep your toenails. If you’re driving home after the event this could be just as dangerous as if your runner drives home (and runners are normally required to have a driver to get them home) so make sure you’ve taken this into consideration.

  14. Don’t get carried away and enter an ultra yourself the day after you’ve caught up on your sleep! Give it quite a bit of consideration before you commit. The hours and hours lost to training, the cash lost on kit and race entries, the toenails lost to the god (or other deity) of running. Remember the bad as well as the good!

One of the less fun support jobs, particularly at 2am!

One of the less fun support jobs, particularly at 2am!

Finisher and his crew!

Finisher and his crew!

Words and images by NoviceRunnerNik.

Patient News: We're Supporting Extreme Adventurer Alex Flynn

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Patient News: We're Supporting Extreme Adventurer Alex Flynn

We're excited to be supporting extreme adventurer Alex Flynn in his challenging new project happening later this year. More on that soon! Meanwhile we’ve asked Alex to introduce himself. Here’s his story so far:

About Me

Hi, my name is Alex and I’ve had Parkinson’s disease for 11 years now. I was diagnosed at the age 36. That’s young by most people standards but it isn’t. The youngest ever diagnosed with Parkinson’s disease was a two -year-old boy. I’ll let that just sink in for a second. Two years old! What kind of life is that little boy going to have?

About Parkinson’s

What is Parkinson’s? Most people don’t fully understand what it is. It’s about rigidity. The lack of being able to move. It’s not the over abundant movement of someone flailing around like an eight-legged octopus. No, that’s just over medication; the unfortunate side-effect of taking a daily cocktail of prescription drugs to mask the effects of dwindling dopamine in the brain over many years. The product of which will take away a persons’ ability to enjoy things that most people take for granted; the ability to write, to walk, speak, have sex, not to mention the psychological impact, and many more. The diagnosis of Parkinson’s hits hard.

Many people receiving such a colossal diagnosis give up, take the medication and slowly deteriorate. I had and still have no intention becoming a shadow of my former self and neither should anyone else. So what did I do?

#KeepMoving #10millionmetres

Well, I decided to #KeepMoving by taking on a challenge called 10 million metres. My intention was to traverse 10,000 km around the planet and only the events and challenges would contribute to the 10 million metre distance. There was no master plan other than to raise awareness of Parkinson’s disease and ultimately funds towards Parkinson’s research. That was in 2008. Between that decision and the present day so much has happened. Highlights include:

  • Completing the gruelling Marathon des Sables (250 km race across the Sahara Desert);

  • Running 160 miles across the Bavarian Alps in 52 hours;

  • Running 1,457 miles from London to Rome in 30 days to meet the Pope (400 miles of which was run with a stress fractured right tibia and completing the first 20 marathons in 10 days);

  • Becoming the first person to traverse the 3,256 miles from Santa Monica to New York using four distinct disciplines. I achieved this distance in 35 days and appeared on BBC One’s One show over two consecutive nights, raising awareness to over 10 million people worldwide and realising vital donations for charity.

  • In 2013 I crossed 200km of the Amazon Jungle, climbed and ran 90 km of the Dolomites and 236 km across the Colorado Rockies, achieving all three within an eight-week period;

  • On the 24th January 2014, the 10MillionMetres Challenge was completed at the Standard Chartered Dubai Marathon.

I’d covered a distance more than 6,200 miles around the world!

And Then

In the summer of 2015, I entered the Men’s Health USA Ultimate Guy Competition, successfully reaching the final nine competitors out of over 1,000 including Special Forces and the US Marines. I was also honoured by the then UK Prime Minister, David Cameron.

2016 brought a new challenge of completing 5,566 press-ups in 22 days to raise funds and awareness of PTSD, which affects military personnel and first responders. This was extremely tough as each day the target to be achieved increased by 22 push-ups on top of that which had already been achieved the previous day. I managed to continue for 18 days reaching total of 3,762 press-ups before the right shoulder gave out.

In February 2017, I returned from the Arctic after attempting a 450 km expedition of Sweden’s Kungsleden (Kings trail) in freezing temperatures of -29°C. My participation was cut short due to ripping a tendon in my right ankle. Undeterred, I had to continue and pulled a 135lb pulk and 10kg backpack across a further 25km, including two mountain passes before the onset of hypothermia.

In 2018, I undertook the brutal and extremely challenging Lost Islands Ultra in Fiji. Two weeks after finishing the Fiji ultra, I completed the Virgin Money London Marathon, notwithstanding my medication failing to work after 10 miles and running the remaining distance with muscle cramps and pain. Lots of pain!

Last September was spent in British Columbia, Canada. I had flown there to take part in Primal Quest. As part of a team, which included five times world adventure racing Champion Mike Klosser, we took on the Primal Quest Pursuit Race. An event there would take us across 240 miles of mountainous and challenging terrain including glaciers, and white water rapids situated in big Bear country. The team completed the challenge in four days and five hours.

Next Challenge

None of the above come without impact on the body, whether caused by Parkinson’s or just bad luck. Primal Quest left me with whiplash after coming off my mountain bike a total of nine times while descending the second mountain stage. This is one of a long line of injuries I have had over the years which have been treated by Paul Martin at Physio Remedies. With Paul’s help, I intend to train harder than ever before for my forthcoming challenge this September where, as part of a team of four, I will take on the world’s toughest race.

Alex will be unveiling his next challenge very soon. Watch this space!

Words by Alex Flynn, image from Alex’s website.

Training For Different Court Surfaces In Professional Tennis

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With the French Open round the corner followed by the grass court season during the summer our lower limb specialist physio Alex, previously a full time physio for GB tennis player James Ward, wants to talk about some of the differences that tennis court surfaces have in terms of stresses on the body and also how the players’ training changes to accommodate them.

Training For Different Court Surfaces In Professional Tennis

Tennis is played on three main types of surface: clay, grass and hard:

Clay

Clay is the slowest of all surfaces. The ball bounces much higher and the points are much longer so the number of shots per rally increases quite dramatically. As you may all be aware, the slide is a skill that players develop playing on clay. It allows them to reach balls which on other surfaces would not have been possible. These qualities of clay have the following performance and training effects:

  1. As the points tend to be longer, there is an added cardiovascular element to the match. Tennis mostly draws on the anaerobic system which is shorter intervals, but playing on clay taps into the aerobic a little more. This means that any CV training can be tweaked prior to the clay court season to prepare for this, and also training itself on court will consist of longer points to add that endurance element.

  2. Due to the slide element of clay, players often find themselves in lengthened lunge type positions. This requires a different type of strength, flexibility and stability than the other surfaces. It requires 'strength in length' where the muscle is under tension for longer, and works eccentrically for longer. In preparation for this players will use slide boards and slide pads to replicate this. There is also a slight shift to more flexibility work particularly around the hips area. The knee patellar tendons are exposed to more loading due to the slide so gym exercises are tailored to heavier loading of this.


Grass

Grass is the surface with the least grip. The ball bounces lower and is faster. Points are shorter and players rely much more on their serve as a weapon. The biggest challenge on grass is footwork. As there is little grip, it makes it very hard to change direction. With this in mind, players tend to use shorter steps, especially when moving laterally, keeping the feet closer together as this will stabilise the body and allow for greater push off ability.

Grass, like clay, does also have a slide element to it, but it is not as prolonged as the clay, and is a lot less secure. You often see players on the grass slipping and this can lead to over stretching injuries. In training it is imperative to work hard on footwork, short quick steps to keep everything tight. There will also be a focus on hip mobility especially into squat position due to the low bounce so exercises in the gym will replicate this. The advantage of grass is that it is softer so the pressure on the joints is less.


Hardcourt

Hardcourt is what we would say is the most stable surface and offers the best grip. The advantage of the hard is that the bounce is very true and more consistent than certainly the grass.

The main disadvantage of the hard court is the pressure on the joints. There is greater impact vertically through the body as it has little shock absorption. This can lead to joints feeling stiffer and more worked during training or playing on hard. It's important that the muscles are trained suitably to cope with the added load so they can protect the joint. The pressure can translate all the way up the body so areas like the back can be prone to stiffness due to the impact from the floor. Even more so than before, it’s important to look after joint health by ensuring good mobility programmes and also necessary strength work for the whole kinetic chain right from the feet up to the neck.

So as we can see, the different surfaces pose different challenges for players. The overall training doesn't hugely differ, but there are some subtle changes made in types of exercises, focus of exercises to prepare as well as possible fro the varying pressures and load on the body.

Want to talk about your tennis game with Alex? Call us on 02030 12 12 22 for an appointment.

Words by Alex Manos.

What does my physio think about Pilates?

Do you ever wonder what your physio thinks about your favourite forms of exercise or whether your health or lifestyle choices are a good idea? In the first of a series of blog posts entitled “What Does My Physio Think…?” we’ve asked our physios, and our support staff, what they think about Pilates.

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What does my physio think about Pilates?

What is Pilates?

Pilates was developed by Joseph Pilates in Germany where he was a carpenter and gymnast. He invented Pilates, which he originally called Contrology, as an exercise program for injured dancers and soldiers. He believed that physical and mental health were closely connected.

Pilates is a form of exercise, similar to Yoga, which concentrates on posture, balance and flexibility. It also focuses on the mind-body connection. While doing the various exercises your mind needs to be constantly aware of your breathing and the way your body moves.

Why is Pilates good for me?

Pilates is good for building core and whole body strength which is vital to hold form for any sports or just holding good posture for sitting on a desk. It’s great for improving your balance, increasing your range of movement and making you more body aware so that you think about how you sit, stand, walk and breathe much more.

What we think of Pilates

Our spinal specialist Physio Shari says

“There are many styles of Pilates and a good class can be quite dependent on the teacher/instructor. Also there is "mat Pilates" vs "equipment Pilates". Equipment Pilates is excellent and I much prefer it to mat based. 1:1 sessions are the best, and then classes once progressed. I wouldn't recommend YouTube videos unless the person has no injuries or physical issues. YouTube videos are very generalised so not all the exercises are appropriate for people with injuries/issues also there is no one there supervising for correct technique which is really important in Pilates. Prescribed Pilates exercises at home from a physiotherapist will be specific to the patient and their injury and needs and also the physiotherapist will provide the patient with cues to optimise the exercise.”

Physio Paul who specialises in shoulder & elbow, hip & groin and sports injuries says

“Used well, Pilates can be a very useful approach to exercise - it is very useful for activating muscles that may otherwise be hard to work. I normally recommend a couple of one-to-one sessions with an instructor to try to understand the approach and some of the language. Find out what the exercises should feel like and once you have established a good routine of exercises, a YouTube video might be enough.”

Our NoviceRunnerNik says

“I’ve been doing Pilates classes for 6 – 7 years and I really rate it. It has improved my balance and core strength and I feel that it’s helped my running a lot. It’s made me far more body and posture aware and I always recommend it to my runner friends.”

NoviceRunnerNik's Top Tips On Starting Running

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NoviceRunnerNik's Top Tips On Starting Running

Has the London Marathon inspired you to take up running or return to running? Our NoviceRunnerNik, who took up running a few years ago, gives us her top tips on getting started:

  1. Start with a Couch 2 5K app or program such as the NHS Couch 2 5k – this introduces you slowly to running over 9 weeks and gradually builds up your fitness and stamina. Much more sensible than my approach of just going for a 3 mile hilly run just like that and hating the feeling of my lungs exploding out of my chest! I very nearly didn’t run again after trying that!

  2. Run more slowly – particularly if it feels like your lungs are exploding out of your chest. If you can hold a conversation with someone (you might need to imagine that someone if you’re running alone) whilst you’re running, then that’s a great pace to run at. If you can’t, then slow down. You’ll enjoy it more - promise!

  3. Buy decent, comfortable running shoes - have your running shoes fitted by a specialist running shop. Tell them your budget and what you want to do. They needn’t cost the earth. You’ll be less likely to pick up an injury wearing shoes that fit you and are fit for the job.

  4. Don’t increase your longest distance or number of miles in a week too quickly, however much you’re enjoying it, or you risk overuse injury. An often quoted rule of thumb is to increase both by no more than 10% per week. Use a free phone app such as Strava to record your runs so that you know how far you’ve been.

  5. Run your own run – don’t worry about what speed or distance someone else is doing. Run to how you feel, rather than a pace you think you should run at on your GPS watch.

  6. Run with other people – join a running club or run walk group or find a friend to run with. Running with others takes your mind off the running and motivates you to turn up and run. Running clubs will have varying routes with leaders so that you don’t even have to think about where to run. In my experience running club members are really friendly and approachable. They aren’t all elite athletes racing for TeamGB (some of my running club members do run for TeamGB but you wouldn’t know it!). And you always have running to talk about.

  7. Buy some proper running clothes - you’ll be more comfortable and you’ll feel the part more and be more motivated to run. You don’t need to spend a fortune. Always wear a decent, supportive sports bra or chest support if you need it. They're vital bits of kit, especially if a few extra grams are being carried in that part of the anatomy.

  8. Vary the routes and surfaces you run on – to keep you interested and to get your body moving in different ways - try footpaths, coast paths, grass, mud etc but be careful.

  9. Get parkrunning! If you haven’t heard of parkruns they are free, timed weekly 5k runs, happening all over the country, every Saturday at 9am. You can walk, jog or run them so they are perfect for new runners and they are great for measuring your progress, if you wish. They only happen because people volunteer to organise and marshal at them so give something back now and again and volunteer too.

  10. Running can be really addictive! Don’t blame me if your running habit starts to escalate out of your control!

Words by NoviceRunnerNik.

Getting ready for JLL Property triathlon (or other triathlons at Dorney Lake)

With triathlon season warming up and the JLL Property Triathlon on the horizon at the end of June, we asked our soft tissue therapist and Triathlon Coach Emily to give us her best tips for preparing for your triathlon. She’s even given her top tips for racing at Dorney Lake:

Getting ready for JLL Property triathlon

(or other triathlons at Dorney Lake)

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Dorney Lake is an ideal venue for a sprint distance triathlon - pancake flat course and calm lake water to swim in. It’s beginner-friendly and a good place for seasoned triathletes to gauge their fitness. After competing in more than a dozen races there, I’ve come up with some useful Dorney-specific tips to make your race day as smooth as the lake.

Getting there

From London, you can take your bike on to the train to Windsor & Eton Riverside or Windsor & Eton Central. From there, it’s a 3.5 mile ride to Dorney Lake, perfect for warm up. Be sure to ride down Bovney road which will get you to the start line side rather than the car park side at the far end of the lake. Take a look at this map.

If you are driving, make sure you get there at least 1.5 hours before your wave starts, so you have time to park and get down to the other end of the lake to register and check in.

Swim: Sighting

Normally, I would suggest to my athlete to sight every 6 strokes or so, and trust no one in a race. At Dorney Lake, the small buoys are actually attached to each other under the water like a lane rope. So depending on where your starting pontoon is, sight for the first buoy, from there, keep your head down and follow the ropes underneath to complete the swim lap.

For those of you who are doing the 2.2 km swim, the trick to holding a straight line is a symmetrical stroke. Bilateral breathing, enter your hands into the water at 10 o’clock and 2 o’clock position with good full body rotation.

Bike: Counting laps

This is by far the trickiest part of the whole race… counting to 4 is surprisingly difficult when in race conditions… you can use 4 bits of sticky tape on the handle bar where you would take one off per lap, just be sure to remember whether you did it at the start of the lap or at the end of the lap (can you see now how confusing it could get?)

A bike computer is useful, just remember to start it, and that GPS can be slightly out. Unlike other sprint tri’s the bike course is 21.2 km.

Transition

For a sprint distance triathlon, every seconds count in transition. Think how hard it would be to take 1 min off your 5km run time or your 750 m swim time In transition, all it takes is to be calm and a little bit clever:

  • Lay out your transition with the shoe holes facing you; sunglasses open and inside helmet; helmet straps open with its inside facing up so you can flip it on to your head; race belt under your shoes ready to be stepped into.

Transition layout.

  • Practice dismounting your bike on the fly:

 

Kirsty demonstrating a flying dismount.

 
  • If you’re a strong swimmer, ditch the wetsuit and use a swim skins tri suit instead. (At that time of the year, it is likely for a race there to be wetsuit optional).

  • Instead of bike shoes and clip-in (aka clipless) pedals, you can use courier straps on flat pedals and trainers. That way, you can roll straight off the bike and on to the run, for a 20km flat ride, bike shoes and clipping in make negligible difference (I’ve tried both multiple times).

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Whether you use road cleats, MTB cleats or just trainers with straps, such a flat course at short distance, it makes no difference.

  • Instead of wearing socks, put plenty of talc powder in your shoes and go sock-less.

Wind

Dorney Lake is always windy, for some reason you’ll get a constant side or head wind wherever you are in the bike lap. This is the place for Time Trial bikes if you have one, if you don’t, practice riding on the drops and stay low. Make sure whatever you’re wearing is tight fitting and nothing is flapping about.


Pack list

  • Trisuit (wetsuit if you’re wearing one, lube for your neck)

  • Goggles (you may want tinted ones if it’s sunny)

  • Running shoes

  • Talc powder

  • Race belt for putting your race number on

  • Bike in good working order

  • Helmet

  • Sunglasses

  • Bike shoes if you’re using them.


Good luck, have fun!


Words by Emily Chong. Image by Scott Collier Photography.

A Physio's View: The End Of The UK Football Season

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A Physio's View: The End Of The UK Football Season

Our knee and foot & ankle specialist physio Alex has worked as Head Physio at Crystal Palace Football Club for six seasons and experienced most of the highs and the lows of the UK football season from behind the scenes, so we’ve asked him to fill us in on the gory details of what happens at the end of the UK football season. It’s a really interesting read!

Staying Focused

This time of the year in the football world is mixed with an array of emotions and circumstances, depending on the team’s position. It may seem that there is a group of teams who 'have nothing to play for', i.e they are safe from relegation and are not involved in any fight for the title or promotion or European qualifying spots. Whilst this is true, all teams and players are competitive right until the end. Everyone wants to finish as high up the league as possible, not only for financial reasons to the club and its staff but also to achieve the best possible league position. So, wherever the club may be, the structure of training, the discipline, the organisation etc, all stay as they are right until the very final whistle. Any lack of focus will show up on the training pitch and then be carried into the matches.

Behind the Scenes

Personally I have been fortunate enough to have experienced all the emotions possible! I have been relegated with a club, promoted, fighting for survival, fighting to get into the top half, and been in FA cup finals. It can be a very hectic time: exciting, worrying, nerve racking, from sheer elation to deflation in the blink of an eye. As staff it's important to stay as grounded as possible. Even though the entire club goes through all these emotions, its the players who are out there and ultimately it comes down to how they perform on the day. You have to keep as level headed as possible, whilst not denying the highs and the lows of the weekends’ results, its crucial to not get carried away either way and allow either complacency or negativity to creep in.

Behind the scenes this is actually a very busy time for the club. It's a short off season nowadays, 5-6 weeks maximum so lots of planning goes on. Pre-season tours, matches, training schedules all need to be in place prior to leaving for the break. This is the only downtime staff and players get throughout the year so most people end up being away at the same time.

Rest and Rehab Through Off Season

As a medical department, unless you have been lucky and timings have worked out, it's rare not to have any injured players who will be carrying something into the off season. For these players, it's a difficult time to be doing rehab as the club is often very quiet: their team mates are all on holiday and so mentally it can be tough for them. So again this requires careful planning as they too have families who have been waiting for a break. It's important to strike a balance between time off and also rehab, it's always our aim to give the manager as full a squad as possible on day one of pre-season.

As well as the inured players, it's also important to monitor what the squad does during the off season. We used to give players individual rehab programs during the summer to work on things especially if they had picked up injuries in the season. Typically everyone is advised to have a couple of weeks off and just rest up, keep active but allow the body and mind to recover. Then it’s a combination of strength work and cardio vascular work but we aim to keep impact work down. Rest is really important but these athletes have to keep up a level of training so the body doesn't have too big a shock when training starts as that can lead to injuries.

It Never Really Stops!

The end of season is actually quite a strange time of year. Working for a professional football team is non stop, it's fuelled on adrenaline, days roll into one, you don't really feel that Monday to Friday rush then weekend break and then all of a sudden, mid May, it’s done! It's a long season, physically, mentally and emotionally draining for everyone involved, even more so if there is a crucial position to be played for so everyone deserves as much down time is possible, but behind the scenes in June there is lots still going on!

Words by Alex Manos.

Marathon preparation: taking care of your knees

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Marathon preparation: taking care of your knees

It's hurtling towards us at a huge rate of knots, like Brexit, Christmas and Whitsun all rolled into one, but none of these require the same volume of physical, mental and emotional preparation as the London Marathon* (except perhaps Christmas....). As your mileage racks up, certain areas can get tighter, having a knock-on effect elsewhere - in particular the outside of the knee.

If you notice that your running style has started to involve a little more of either your foot turning outwards whilst your knee is facing forwards or your knees turning inwards whist your foot is facing front, this can often end up to soreness in the outside of the knee, increased tension in the iliotibial band (ITB) and/or tightness in the outside of the hip. As the miles increase and this pattern is repeated, it can become very sore. However, there are a few things you can do to check the cause of this.

Where does it come from?

The reason the knee will be turning inwards, or the foot relatively turning out will be related to one of 3 areas:

  • Tight calf muscles

  • Weakness/inhibition of the hip rotators

  • Overactive lateral hamstrings

Knee valgus - this isn’t A Good Thing.

Knee valgus - this isn’t A Good Thing.

Tight calf muscles:

If the alignment issue corrects by doing a decline small knee bend (see images below), it is likely the calf muscle (particularly the gastrocnemius, fact fans) is likely to be part of the main drive of the problem.

Decline small knee bend

Decline small knee bend

If you think you aren't stretching your calves out sufficiently, then start. As soon as possible. If not sooner.

As we fatigue when we run, certain muscle groups will become less effective leaving us with few options to propel us forwards. It often comes down to the calf to drive this and if they aren't getting a sufficient stretch, then the change in mechanics can become problematic. Stretching the calf with a straight knee (fully straight) and holding for up to 20 seconds at a time will help. Not only after a run, but check and stretch regularly through the next few days too.



Weak hip rotators:

If the decline small squat doesn't correct things, it is likely to be a problem with the rotators in the hip, including gluteus medius and some of the deeper rotators. Some light conditioning work can help resolve this problem



Overactive lateral hamstrings:

Difficult to spot on yourself, but if after toe off, your foot tends to turn outwards as the knee comes forward, the outer hamstrings might be dominating the movement. Exercises to balance out knee flexion by using the more medial hamstrings can help, as can identifying which of the other two problems need addressing and working on all of them



Anything else?

Lateral quads stretches can be really useful for this. Think of doing a normal quads stretch (i.e. heel to backside) but stretch using the opposite hand to the affected leg and pull it across to the opposite buttock and push your hip forward. This should favour the outside of the quads around the tight area



Do I really need to stretch?

Stretching is a bit of a faff and it means extra time added onto your run, however it is one of the key practices at this stage to return you ready to run again when you need to train. Just do it!


* other marathons, indeed, other long distance races do exist.



Don’t ignore your niggles or pains this late in your marathon training. Call us for an appointment on 02030 12 12 22.



Words by Paul Martin. Images courtesy of www.medi.de and runningreform.com.

Emily's top tips for marathon (training) recovery

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Emily's top tips for marathon (training) recovery

Manchester, London and other marathons are coming up soon and we hope your training is going well. Recovery is as important as getting those miles in, so make sure you're well prepared for your marathon or marathon training recovery.

Our sports massage therapist and partaker of extreme challenges, Emily Chong, writes: A few days ago I ran up a skyscraper 10 times for charity. Specifically, I climbed 420 floors in 1hr 29min taking the fastest female title and 4th overall. Naturally, I was bracing myself for DOMS (delayed onset muscle soreness) from hell. 24 hours later, my legs felt good, 48 hours later, nothing hurts!

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After years of experimenting with recovery routine, I’ve finally found the combination that works for me. After leaving the tower, I stood at a high table and stretched my glutes, quads and hamstrings while waiting for my anchovy, spinach and mushroom pizza, washed down with a litre or so of water and a glass of orange juice. I stood in the Tube on the way home using the over head bars to stretch my lats. Once I got home I had a cool rinse followed by a warm shower and a 45min nap. That evening, I went to swim club: the main set was suitably a mixture of technique and a small amount of 70%-90% short sprints.

Maybe that doesn’t sound like most people’s recovery (other competitors seemed to have spent the next 4 hours sitting in the pub!) but if you prefer your legs to be intact the day following your marathon, here is my magical (aka sensible) recovery regime. With running and triathlon seasons starting you may find it useful.

  1. Don’t sit down, or you’re just shortening already shortening muscles. Straight after a race (or training), keep walking, eat while you’re standing and while you’re standing, do some gentle static stretches.

  2. Cool dip - where it’s available, such as the Brighton marathon or a lake side triathlon, walk thigh high into the water, walk around or stay there for 2 - 5 minutes. The cool water temporarily constricts the blood vessels. As you come out of the water, they’ll dilate and encourage blood flow, carrying oxygen and other recovery material to your muscles.

  3. Rehydrate - Most people are under-hydrated in a race. As you heat up, electrolytes (various salts) come out with your sweat. It is very important to replenish both and not just the water. You can buy water soluble electrolyte tablets, or ones that come in a capsule form. For a natural alternative, bananas and pomegranates are full of electrolytes.

  4. Refuel - catch that 30 minute post-race window of opportunity to get some easily digestible carbs and protein into your system to kick start recovery. Many national teams swear by chocolate milk but for a dairy free alternative, try nut butter toasts or an avocado honey smoothie.

  5. Active recovery - getting blood circulated through your muscles is key to recovery. While a brisk walk and an easy swim is fine, what works better is some short, low impact maximal effort such as 5-10 repeats of 10 seconds max efforts kick in the water. Alternatively, spin with medium to low effort on a bike for 30 minutes or so, interspersed with 3-5 repeats of 10 seconds high power and high cadence.

  6. Sports massage - again this encourages blood flow with the bonus of some assisted stretching thrown in - definitely good for recovery. A post-event massage is meant to be gentle, so don’t expect or ask for a deep tissue massage as it could cause damage to already tired muscles.


If you’d like to book an appointment for a post London Marathon or post any other marathon or event recovery massage with Emily, call us on 02030 12 12 22. Have a great race!


Amazing views!

Amazing views!

Words by Emily Chong. Images courtesy of Emily and Shelter.

The Long(est) Read: Ultra Running Tips

Colin Bathe Arc of Attrition ultra runner

The Long(est) Read: Ultra Running Tips

NoviceRunnerNik’s husband Colin ran The 2019 Arc of Attrition, a brutal 100 mile race around the Cornish Coast Path in the depths of a chilly February weekend, finishing in a Gold buckle winning time of 29 hours and 40 minutes. Billed as The South West’s Toughest Winter Footrace, The Arc has a DNF rate of around 54%, reflecting just how hard this event is.

This was Colin’s first 100 mile event and he’s shared his top ultra running tips and experience of the race with you:


1. Preparation

Preparation is key. Know what you’re taking on. Read as much as you can about the race – many people blog about races so there’s a wealth of information out there. Join the race Facebook group if there is one. Learn from other people’s experiences. Put together a training plan and try and stick to it but don’t overdo the miles and risk injury. If you are local to the event, reccie the course in sections so that you know exactly what the terrain, elevation and actual route is to reduce the risk of losing your way in the event.

Colin ran around 30 miles per week and did four long runs of around 25 miles and tapered to almost nothing in the last couple of weeks before the race. He’s fortunate enough to live local to the event and reccied the whole course, sometimes with fellow entrants and on occasion with previous entrants (picking their brains).


2. Mental Game

Getting your head in the right place on an ultra is more important than running ability. You’ll often hear that ultra running is 90% (or similarly large %) mental strength. Keeping nutrition, hydration and physical comfort in a good place for the duration of the race all help to keep your mental state there too. Being prepared will give you confidence and help your mental ability.

Colin nailed the nutrition and hydration and apart from a bit of a low, with the threat of tears, at Mile 78 when he realised he couldn’t see out of one eye (more on this later), he was in a great place all through the race.


3. Nutrition and Hydration

Ultras are actually a series of All You Can Eat contests with a bit of running in between. You have to eat and drink well all the time to keep your body properly fuelled and hydrated and this will keep your mood buoyant too. Everyone knows this but it is something that can be very difficult as your body can just straight refuse to take anything down. Eating real food, rather than gels, seems to work for many people as evidenced by the very well provisioned check points on the Arc.

Practice eating real food on your training runs to work out what goes down well whilst running and what doesn’t and try lots of things. Also practice running straight after large meals so that you can have the confidence to eat well at check points and then continue running.

Keep drinking all the time and don’t wait until you feel thirsty – it’s too late then. Make sure your fluids are easily accessible – use a bladder and hose hydration system or a hydration vest with soft bottles held at the front. You should be peeing regularly all the way around your event so practice this on your training too.

Colin ate cocktail sausages, pork pies, baby tomatoes, radishes, grapes (stolen from crew supplies!), Snickers, Bounty, mini cheddars, soup, rolls, pizza, peanuts and very high calorie flapjack with just one gel right at the end to get him up the final hill.


4. Clothing

Your choice of clothing will obviously be dependent on the expected weather conditions but again train wearing the gear you expect to wear on race day. Chafing can be a painful problem during ultra runs so run-specific underwear is worth considering.

Colin wore waterproof shorts on top of long running tights and with a waterproof running jacket, taking care not to put too many layers on his top half to avoid overheating and sweating too much. The jacket and shorts kept his core dry which meant he didn’t suffer from the dreaded chafe.


5. Feet

Looking after your feet is also really important. Make sure your shoes have plenty of life left in them whilst you train. Test methods of foot care whilst you’re training to work out what works for you to avoid the near trenchfoot condition and blisters that 36 hours of running in wet socks and shoes will afflict on you. Regular sock (and shoe) changes and feet cleans will help. If you have to run any long sections of different terrain, e.g. road / pavement when you’re running a coast path event, then consider changing shoes at the start and finish of these sections, if you can.

At most sock changes, Colin cleaned his feet (or had it done for him!) of the worst of the mud using wet wipes, dried them off and then applied a new thick layer of Vaseline. It kept his feet dry and also helped with avoiding blisters. He changed socks six times and went from trail shoes to road to trail and then a second pair of trail shoes through the event. His feet were almost perfect at the end of 100 miles. Others looked as if the soles of their feet had been turned into relief maps of the whole course!


6. Crew

If race rules allow, having crew who drive round the event with you and pop up every so often for sock and shoe changes, refilling water bottles, handing out food and cheering you on makes your run easier. It means you can carry less weight in your pack and change clothes easily too. Treat them well as it’s a long and often dull job! Make sure you’re clear about your expectations and requirements from your crew. Plan where you expect to see them and communicate well. If your crew is a runner they will really understand what you’re going through.

Colin’s crew consisted of his wife Nik (a runner) and good friend Lee (an ultra runner), who they had crewed for in the Arc 2017 and 2018. There’s another blog post about how to crew for your ultra runner coming up!


7. Navigation

If the course is self-navigated, take time to work out what and practice with technology that will help you on your route finding as getting lost not only takes up valuable time, it can be really demoralising just when you need to keep your spirits up.

Colin used a Garmin Forerunner 235 watch to give him a rough map to follow so that he could check the route ahead and see if he was grossly off course or not. He also had a detailed map on his phone using the Locus Maps app and a downloaded offline copy of OpenStreetMap. He used a portable power pack to charge his phone and Garmin at check point stops.


8. Kit

Pack weight can make a difference to pace so pack carefully. If you have crew, carry the mandatory kit and leave as many of the ‘nice to haves’ with your crew, particularly if you’re seeing them very regularly.

Colin carried the mandatory safety kit (of course) but very little else. Without water and food, the carry weight was 2.1kg, around half of what some other people were carrying and he’s certain this made a difference.


9. Ultra Runner Issues

Corneal Oedema

A few miles before the St Ives Checkpoint at Mile 78, Colin noticed he had lost the vision in his right eye – all he could see was a white fog. Whilst concerned about the deterioration of his eyesight, his biggest concern was that he would have to retire when the race was going so well for him! The medics at the check point told him that Corneal Oedema, swelling of the cornea causing it to go cloudy and restrict vision, isn’t unusual in ultra runners. It is thought to be caused by dehydration, cold, wind and etc.

It had also affected around 10 other runners during the Arc. Colin was blind in the right eye for the last third of the race but it started to recover at the finish and he was 100% back to normal the next day. Some were less lucky with at least one person suffering vision loss in both eyes and having to retire from the race. More details on Corneal Oedema and Ultra Marathons are available here.


Vomiting

During the 2018 Arc of Attrition, with temperatures hovering around the freezing mark and a strong wind, many runners were struggling with constant vomiting and were unable to keep food and sometimes even water down. Being unable to refuel and rehydrate can have dire consequences for someone who still has 60 miles to run. Lee, Colin’s crew, suffered this but somehow managed to finish! It’s likely it was a symptom of mild hypothermia so getting Lee warmed up was the first thing we did. Another tip given by one of the checkpoint staff was to get him to drink lukewarm water instead of the chilled water in his pack. This is less of a shock to the stomach and certainly reduced the chances of seeing the water again - it worked a treat!


10. Stats

And because every ultra runner I know loves stats, here are Colin’s from the Arc:

  • 101 miles

  • 12,300 feet of ascent

  • 160 starters

  • 67 finishers

  • 29 hours 40 minutes 45 seconds

  • 218,000 steps

  • 11,000 calories burnt

  • 1.6kg weight loss

  • 2 very small blisters

  • 1 gold buckle

  • 1 very big smile (make that three)!


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Words by Colin Bathe and Nik Bathe. Images courtesy of MudCrew Events Ltd.

9 weeks to the London Marathon - our top tips and injuries to avoid

Always choose your running kit with care!

Always choose your running kit with care!

9 weeks to the London Marathon - our top tips and injuries to avoid

Congratulations! You are now only 9 weeks from the London Marathon (other marathons are available).

Here are a few tips on how to keep going and avoiding breaking down:

  • Follow a training plan that not only says run. Two short runs and a long run on a weekend. Add in strength and conditioning, plyometrics, cross training and yoga/pilates. This can help with injury prevention and potentially faster times.

  • Your training will hurt. The marathon will hurt. The massages will hurt, everything will hurt. You need to stay motivated and have discipline. You will have good and bad days during your training. You have to be motivated to get out and run, but to keep this up takes discipline. Remember why you are running this race.

  • Be realistic with your finish time especially if it’s your first marathon! Race management is essential. Don’t go off to hard and fast! You can't just double your half marathon time adding 10-15 minutes and expect to run the marathon in that time. Aim to finish your first marathon.

  • Race nutrition: find what works for you! Sweets and Lucozade for energy can help, but be aware of overdoing it with these, try dried fruits, nuts and electrolyte drinks.

  • To stretch or not to stretch! The evidence is conflicting so do what works best for you.

  • Tapering is essential in those last 2-3 weeks. Don’t try and squeeze in one more long run.


Here are the 7 most common injuries and how to manage them:

  1. Runner's Knee: Patellofemoral pain syndrome (PFPS), is the irritation of the cartilage on the underside of the patella (kneecap). This can flare up during or after long runs. Be aware of foot over-pronation (excessive inward foot rolling) and weakness of the quadriceps, hips, or gluteals. Introduce rest days and reduce mileage. Uphill running can be less painful. Work on strengthening of gluteals, quadriceps and hamstrings. Avoid downhill running. Introduce low impact exercise like cycling, cross trainer or swimming. Try shortening your stride.

  2. Iliotibial Band Syndrome (ITBS): the ITB lies along the outside of the thigh from the hip to the knee. ITB irritation occurs if you take up your mileage too quickly. It’s a stubborn nagging injury. Be aware of foot biomechanics. Hip and gluteal weakness maybe a factor. Rest days and ease off mileage can help. Use a Cross trainer. Mix up the direction of your runs. Try shortening your stride.

  3. Achilles Tendonitis/Calf injuries: Achilles tendon connects the two major calf muscles to the back of the heel. Increasing your mileage too quickly, hill sessions and sprints can aggravate the Achilles. Be aware of tightness of your calf muscles. Stop if you have pain during or after running. You cannot run through this injury. Early diagnosis is essential. Days off will significantly increase your chances of getting back to running. Eccentric stretching and calf strengthen gastrocnemius and soleus muscles are advised.

  4. Hamstring Issues: Muscles that run down the back of our thighs. Be aware of muscle imbalance of quadriceps (thigh) over powering the hamstrings. Sudden strong pain and bruising, significant injury, extended rest required. Less intense, chronic overuse injury, you can usually run. Running a slow, easy pace is usually less difficult than attempting intervals or hills. Cycling, pool running, and swimming helps. Strengthen and stretching your hamstrings will help avoid injuries.

  5. Plantar Fasciitis: Small tears or inflammation of the tendons and ligaments that run from your heel to your toes. Pain is a dull ache or bruise along your arch or on the bottom of your heel, is usually worse first thing in the morning. Be aware of foot biomechanics, high or flattened arches. Avoid increasing mileage too quickly. Tight hip flexors, weakness and tight claves, weak core muscles, and a history of lower back pain can also contribute. This is a nagging injury, running is possible but can delay healing. Pool running and swimming to the keep pressure off your feet. Calf stretches and strengthening. Good fitting shoes are essential.

  6. Shin Splints: Achy pain that results when small tears occur in the muscles around your shin bone. Prevalent in new or returning runners doing too much, too quickly, wearing the wrong shoe or a pair with too many miles, and high arches or flat feet. When pain strikes, ease off your running to a comfortable level for a few days to a week, then slowly up your mileage using the 10 percent rule (no more than 10 percent increase per week). Bike, pool run, and swim.

  7. Stress Fracture: Stress fractures develop due to cumulative strain on the bone. Runners most often have stress fractures in their shins, feet, hips or heels. They are one of the most serious of all running injuries and are a result of over training. More common in women than men. You cannot run through this injury. Expect 8-16 weeks off from running depending on the severity of your injury.


If you suspect you have any one of the above injuries do not hesitate to make an appointment with us by calling us on 02030 12 12 22. Correct management of your injury is essential.

Deferred Entry

If you do have to withdraw from the 2019 London Marathon, you are guaranteed a place in the 2020 race – unless you had already carried your ballot entry over from 2018 or are running for a charity. You have until 20:00 on Saturday 27 April 2019 to complete the withdrawal form on the Virgin Money London Marathon Deferrals page.

Words by Nick Smith.

Andy Murray’s famous hip

Andy Murray playing tennis

Andy Murray’s famous hip

Over the last six months or so there has been quite extensive media interest in Andy Murray's hip injury. It has been quite well known for a couple of years that Andy suffered from hip issues which at times was very evident to see during his matches, yet still he was able to compete at the highest level and win the games’ biggest prizes.

Andy first underwent surgery back in January 2018, an arthroscopy which is more commonly known as 'keyhole surgery'. This minimally invasive surgery is designed to repair any damage to the hip joint, maybe repair the labrum (a cup like cartilage structure which helps stabilise the hip joint) and more often than not, some bone is shaved off from the ball (of the ball and socket) to allow for more clearance and less impingement of the joint. Whilst Andy managed to get back to paying he was still suffering with pain and couldn't get back to the level he was competing at before. This lead to a second operation earlier this year, a more extensive type of surgery which involved placing a metal cap on top of the ball and a metal surface on the socket side of the joint. The hope is that this will allow Andy to return to tennis, but perhaps more importantly lead a more comfortable life where normal activities of daily living are manageable.

Tennis is an extremely dynamic sport, involving lots of twisting and turning. As the distances are relatively small, but the changes in direction are often sharp and repetitive, this places a lot more stress on the joints than it does on the muscles compared to say a larger area sport, like football. Combined with predominantly hard surfaces, this increase the impact forces through a joint.

The hip joint is by nature a stable joint and, being a ball and socket joint, allows it to cope with such levels of rotation but it also has its limits. Having worked in professional tennis, I know first-hand how much the hips are used. They are often a source of stiffness in tennis players as they recruit so much muscle energy to stop and start, the muscles around the hip get tight and this then stiffens up the joint. There is also a lot of repeated bending forward/lunging, and this means a lot of pressure on the front of the hip joint. If there was already a congenital deformity of the hip which caused impingement, this would easily aggravate it, but equally there is the opinion that that this repetitive nature can also lead to the changes. Even just the action of serving which is performed thousands of times a season is extremely load bearing for the hip. Tennis players do take preventive measures to allow for joint protection by having strict strength and conditioning programmes, as well as having mobility and flexibility routines.

It was definitely the last hope for Andy to try and return to top level tennis. Having been privileged enough to spend time with him during my time working with James Ward, it's no surprise to say that he is one of the most dedicated professionals I have met and he has a great team around him to give him the best possible chance. The jury is out and it could go either way but I know that everyone who follows tennis and sport around the world will be hoping to see him compete again at the major events.

Good luck Andy!

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.


Words by Alex Manos.

An introduction from Raph Rinaldi

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An introduction from Raph Rinaldi

Raph joined Physio Remedies as a specialist spinal physiotherapist in January and we've asked him to introduce himself in the following blog post. Here he talks about knowing how you, as a patient, feel, hints at his ongoing work with the British Bobsleigh team and mentions his favourite sports.

I've been where you are

As a valued patient of Physio Remedies, I thought it would be useful to talk about a few experiences that made me understand how most of you may feel when not in great shape.

I suffered a few recurrent episodes of low back pain a few years ago. It all started with a mild niggle after a walk.

I ignored it at first and kept being active and working. I took a few tablets and kept going, firmly thinking that knowing a bit about low back pain would grant myself exemption from doing the things I was preaching everyday.

In less than a week I was crippled with pain and unable to do simple things without spending a great deal of energy to focus, feeling exhausted at the end of the day. Most worryingly, I felt embarrassed to experience low back pain whilst I was taking care of fellow sufferers. The best move I made then was to seek help from my colleagues at work; having an external eye made me realise what was wrong with me and get a disciplined, simple approach to manage it.

Londoner = high performance sportsperson!

The second point I learned over the years is that being a Londoner is for performers! The total amount of mental, physical and emotional load stemming from commuting, working, lunch breaks, social life, home and family is very similar to the multi-dimension stress affecting athletes travelling and competing around the world.

I had the opportunity to work full time in high performance sports, most recently with the British Bobsleigh Team.

We lived six months per year out of our briefcase, soldiering winter weather, crammed into a car or a van for hours, often straight after racing, trying to sort out food and battling cold bedrooms.

Commuting with the British Bobsleigh team!

Commuting with the British Bobsleigh team!

In a way, I felt there is not much difference for a Londoner to rush back on a train straight after performing for your best presentation or task at work in an adrenaline-fuelled meeting. For that reason the amount of mental fatigue sometimes prevails, making you focussing on essential, urgent tasks without adopting regeneration or decompression days.

Do simple things that you enjoy

Raph inline skating!

Raph inline skating!

I have been a high-performance race walker and cross country skier in my younger days. The benefits vastly outweigh the costs. It’s very low tech and gives the opportunity to recharge mentally and physically.

Due to chronic paucity of snow in London, I love use inline skates with cross country poles. It’s a fantastic way to exercise your core with very low risk of falling – the poles help you to balance.

The only thing to aware of is the myriads of tourists taking shots as you are passing by in Hyde Park. There are suitable courses of roller-skiing or roller skating in Hyde Park and Richmond Park but I will be always happy to go for a session in either!



Raph is currently supporting the GB Bobsleigh team at the World Cups and World Championships until the 11th of March but if you’d like to make an appointment to see him when he returns, please do call us on 02030 12 12 22.



Words and images by Raph Rinaldi.

Tips for a happy, healthy and (hopefully) injury-free skiing trip

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Physiotherapist and Director of Physio Remedies, Paul Martin writes: If you fail to prepare you are preparing to fail. This and hundreds of other nags from childhood frustratingly seem to prove themselves as we get older. This is just as true with a ski trip as anything else, so here are a few things to consider.

1. Prepare well

Try to arrive in good physical condition. Being stronger and well coordinated helps you be more robust as you hit the slopes, but aerobic fitness is important with regards to acclimatisation. The earlier you can start working on this, the better, however it’s never too late to start to make changes (starting three days beforehand might be pushing the bounds of physiological adaptation a little bit).

Ideally aerobic fitness levels should be worked on two tot three months prior to your holiday, whether it is running, swimming or biking. Increase your effort gradually over this time and then two weeks before keep training at a maintenance level appropriate for you.

2. Take a relaxing walk on arrival

Carrying bags, skis, kit and other peripherals adds extra load to travel, which is in itself an energy sapping experience. When you arrive at your hotel/chalet and have checked in, go for a walk to loosen off so you are not hitting the slopes tight and tired.

3. Stay hydrated

Dehydration can have effects on many body systems from the annoying (bad breath and dry skin) to something more important for physical activity (muscle cramps and slow response times).

On the plane/bus/car journey ensure you drink water or diluted juice drinks and during your trip be conscious of how much alcohol, drinks high in sugar and caffeine you are consuming, especially if you are unable to get water on board.

Quick checks are colour of urine (should be more straw yellow colour than milkless builder’s tea) or pinch a small area of skin – it should return to shape within two seconds if hydrated enough.

4. Get extra sleep

Get extra sleep on the first few days, better to go to bed early than having a lay in.

5. Pop your goggles on early

Start wearing your goggles half an hour before you are due to start your first run, as it allows your eyes to adapt to the change in colour which in turn will improve your reaction time on the run. Good reactions minimise risk of injury.

6. Allow time to find your 'ski-legs'

If it’s been a while since you last skied, allow yourself time to acclimatise and get your 'ski-legs'. Keep it simple, stick to easier runs initially and don’t push too hard too soon. After the first couple of runs and when you feel you have got your rhythm – enjoy!

7. Eat sensibly

Be sensible with your diet – keep it balanced with a slightly higher volume of carbohydrate as these break down most easily into useable energy.

8. Warm up and warm down every day

Make sure you warm up and warm down as what may seem no problem on day two, might well be a problem on day five. Tight and tired muscles can impede reaction time and enjoyment of skiing.

9. Do you really need to fit in that 'last run of the day'?

In the vast majority of post-injury physio sessions, when asked what happened to cause the problem the opening line is very often ‘It was the last run of the day and I thought I could just squeeze another one in’. If you are tired (but might not be feeling it), if things are getting icier (especially if your reactions are slowing down), if you have half a mind on what you are doing that evening rather than the slopes, is it worth the risk of a nasty injury?

10. A word about knee injuries

Although skiing injuries usually affect multiple areas of the body, the knee is the most commonly injured body part, with evidence indicating 42% in some studies. Further to this, the ACL (Anterior Cruciate Ligament) is the highest injury observed within the knee occurring in all ages, genders and technical levels.

Our knee specialist physio, Stuart Mailer, has written a blog post dedicated to avoiding knee-related skiing injuries.

Take home:

  • Prepare well if you‘ve not been as active as you would have liked in the previous few months.

  • Be mindful of what you eat for fuel and drink to remain hydrated

  • Don’t take silly risks, especially early on in your holiday and at the end of the day

Stay safe and have a fabulous holiday!

If you do have an accident or pick up an injury whilst on your winter hols, call us on 02030 12 12 22 to book an appointment. We work with the top surgeons in the UK and can help put you back together again.

Words by Paul Martin.

Die Another Day PART 3: Total Hip Replacement - Ivan's Story

Forty-nine year old Physio Remedies total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 3, preparing for surgery, the operation, rehab and today’s update.

In Part 1 Ivan gave the background to his diagnosis, and in Part 2 Ivan talked through how he made his decision to have a total hip replacement (THR).

Preparing for surgery (Hint - Find a Buddy If You Can)

The date for my operation was set and I spent the preceding weeks preparing myself for what the immediate days after the operation would be like and also thinking through what my rehab plan would be like.

It is very personal choice as to how much information you want to know about any operation. For me though, I thought since I was going to have a new body part to keep me company hopefully for the rest of my life, I should find out at least what it was going to be. A visit to Professor Haddad’s clinic for my pre-assessment provided all the information I needed.

The femoral head (the round top of the hip bone) was to be cut off, shaving off the cartilage inside the socket. A titanium shell would then be placed into the socket and a titanium stem would be fitted inside my thigh bone. Finally, a plastic liner would be placed inside the socket, like a washer, and a ceramic head fitted on the femoral component. The stem in my femur would have special coating that would create a “biologic” fixation between my femur bone and the implant, which would prevent weakening of the bone in my femur around the stem. It all seemed very high tech and I was impressed by the apparent strength and robustness of the materials.

The other really helpful thing I did, again more through chance than real planned intention was that I found myself a ‘THR buddy’. I learnt at a work seminar that an old colleague of mine had only just been through a THR six months previously. Although ten years older than me he was a wonderful source of encouragement and advice in the weeks that led up to the operation on what to expect, what to take to hospital and what the immediate days afterwards would be like.

Finally, symptomatic with my nature and character I could not help myself writing down with the help of Sarah Lawson and Nick Smith a rehab plan (see the chart below). Maybe this sort of level of detail is not for everyone but having milestones and targets certainly helped me on the road to recovery post-op. They talked through the restrictions that I would need to adhere to to start with while my new joint settled down post-op, returning to a normal daily routine, taking up gentle sports and finally getting back to impact loading sports.

The Operation and Rehab Journey (Hint - prepare for small steps)

The details of the operation are beyond the scope of this article save for saying that I was unlucky to have some form of psycho-symptomatic shutdown of the muscles in my operative leg which slowed me to getting back on my feet in the hours and days following the surgery. It was also shocking to be on crutches and having to relearn to walk but the physios at Physio Remedies were absolutely brilliant. Nick Smith ‘absorbed’ my frustration at literally not being able to run before I could walk. Throughout the early part of 2017 he gradually guided me and supported me along my rehab journey from taking baby steps without the crutches, to isometric and proprioception exercises in their gym, to strengthening exercises using the multi-gym, to more advanced intensive work to rebuild the muscle bulk that I had lost as a result of the operation.

I will always remember that one day when my ‘Trendelenburg gait’ (an abnormal gait caused by post-operative weakness of the abductor muscles of the lower limb, gluteus medius and gluteus minimus) had disappeared and Nick saying to me in his broad Yorkshire accent “look at that Ivan, you have got your swagger back”. I certainly had.

Today’s Update (Hint - take the risk – millions have and will continue to do so)

As I conclude, the discomfort, pain and anxiety of those pre-op days are but a faint memory. So too are the nine months of rehabilitation. I can’t even imagine how I would be today if I had not taken the leap of faith to get on with it. I completed my first sprint triathlon on the 17th of September 2017, nine months after the surgery.

Since the operation I have kited in Mauritius, windsurfed in Maui, Hawaii, skied in Kitzbuhel, Austria and returned to a life of sport. The guys at Physio Remedies have recommended that I don’t ever run a marathon again – there are THR patients that unbelievably do as well as even ultra-marathons and IronMan triathlons – but I am ok with that.

Sprint Triathlon Nine Months After Total Hip Replacement Surgery, September 2017.

Sprint Triathlon Nine Months After Total Hip Replacement Surgery, September 2017.

It is easy, having ‘come out of the other side’, to say this but the benefits far out weigh the risks of an operative nature.


My top five tips to aid a successful total hip replacement are:

  1. Get the best advice.

  2. Consult and work as early as possible with Phyisos who are deeply experienced with THR rehabilitation such as Physio Remedies.

  3. Research as much or little as you need about the operation.

  4. Find a THR buddy.

  5. Set some goals to help you on the road to recovery.


Finally, with the recent arrival of my first child, Molly, it has become apparent that I made the right decision to have the THR early. As she grows up, although there is always a chance in ten to fifteen years’ time that I will need a revision to the THR, I can guarantee you that she will never know how the early onset of hip arthritis nearly killed me but I really have lived to die another day.

Ivan with Molly on the kite surfing beach at Hayling Island August 2018.

Ivan with Molly on the kite surfing beach at Hayling Island August 2018.

Words and images by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.



Injury of the month: Office Christmas Party Inuries

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Injury of the month: office Christmas party injuries

The office Christmas party season is in full swing and much as we always love to see you, we prefer it even more if you remain uninjured. So we have some helpful tips to help you avoid injury at this treacherous time of the year:



1. Don't Drink and ice skate

To avoid painful falls, ice burns and sliced fingers, stay off the Mulled Wine until you've cleared off the ice.

And go easy on the triple toe loops. No one likes a show off.


2. Take care with the office decorations

RoSPA says that around 1,000 people a year are injured by their Christmas decorations. Nasty things those baubles!

Be sensible: use step ladders, rather than that spinning office chair, or get someone else to put the decorations up and take the risk.


3. Pull those crackers carefully

Christmas crackers can contain not only ridiculous hats and stupid jokes, but also explosive charges and missiles.

Don't pull crackers close to someone's ear, however much you dislike them and certainly don't pull a cracker with so much vigour that the plastic toy/magnifying glass/miniature pack of cards flies out at such a speed as could cause blindness should they strike someone in the eye.


4. Don't Drink and Drive

There's no need to risk it when you have a world class public transport system on your doorstep and a pair of feet to get you home after the office do.

In fact, book that taxi before you go out.

Stay Safe and enjoy the Christmas Party Season!

Words by NoviceRunnerNik aka Nicola Bathe.

Avoiding skiing-related knee injuries


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Avoiding skiing-related knee injuries

Many of us will be getting ready to go on our skiing trips within the next few weeks or months and enjoyable as this will be, unfortunately can cause injuries. Skiing does not affect only one anatomical area and injuries can occur to the head, shoulder, wrist, thumb and of course the knee. The knee is the most commonly injured body part in skiing with the evidence indicating 42% in some studies. Further to this, the ACL (Anterior Cruciate Ligament) is the highest injury observed within the knee occurring in all ages, genders and technical levels.


Injuring the ACL

The ACL is one of the knees biggest stabilisers and injury normally occurs from a fall, either forward and with a twist or falling backward. Normally the knee will rotate internally causing knee valgus (knee caves inwards towards your mid line). It is not uncommon to injure the meniscus and the medial collateral ligament (MCL) at the same time as the ACL - this is known as the unhappy triad. Interestingly it has been seen that a lack of fitness is one of the most contributing factors indicating that physical preparation can assist in injury prevention measures.


Exercise Intervention

When we land on one leg the hip muscles help to prevent the knee joints rolling inward (knee valgus) while the quadriceps help reduce forces on the knee joint helping deccelerate the body. The hamstring and calf muscles also work to help reduce knee joint forces, stabilising the pelvis and knee and ankle.

Undergoing a basic injury prevention exercise plan can significantly help in not just reducing injury but also improving your skiing consistency as you can improve, muscular strength, endurance, anaerobic fitness, stability, agility and flexibility.


Muscular strength

Recreational skiing is associated with the high muscular use of the quadriceps, hamstrings, gluteal and calf muscles. Evidence has shown that prolonged skiing causes increased eccentric fatigue of the quadriceps and hamstrings that may contribute to injury. To help reduce this lower body exercise such as squats, lunges and single leg squats are all beneficial in improving your lower limb strength and stability.


Neuromuscular/Proprioceptive training

Undergoing some sports specific training, particularly neuromuscular or proprioceptive training, can be beneficial in helping to reduce technical mistakes while skiing. These are training methods that can involve jumping, landing or pivoting or balance work that can help stabilise your knee and leg. These can be undertaken by using a variety of equipment such as the Bosu, inflatable discs, foam pads, wobble boards and jump mats. Improved joint awareness and ability to stabilise can help in skiing performance and injury prevention.


Mobility/Flexibility

A reduction in flexibility of muscle groups and poor joint mobility can cause increase loading on joints and other tissues due to limitations in our movements. For example, tight calf muscles will reduce the ability to squat without lifting the heels. This may cause knee valgus that can then put higher forces into the knee joint. Maintaining good flexibility of the lower limb muscles can help you move more efficiently and improve muscular activation and proprioception.


How physiotherapists can help

We can perform a musculoskeletal screening to help to find your imbalances, biomechanical dysfunctions and then implement a plan to help address these aiding to your injury prevention and performance.


To book an appointment with Stuart or our other physios call us on 02030 12 12 22.


Words by Stuart Mailer.




Die Another Day PART 2: Total Hip Replacement - Ivan's Story

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Die Another Day PART 2: Total Hip Replacement Gives Physio Remedies Patient, Ivan, A New Lease of Life

Forty-nine year old Physio Remedies total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 2, making the decision.

In Part 1 Ivan gave the background to his sporting life and his diagnosis.

Making the Decision (Hint: look at what other THR patients are doing worldwide)

So the mind games began. There must be a mistake? I have hip osteoarthritis, that’s what my mother had that preceded her total knee replacement when she was seventy five. There must be a mistake, I need a second opinion surely? It is nothing that a few anti-inflammatory and pain killers won’t nail. I must have reached a threshold of discomfort.  Why don’t I wait a few years, let’s set a date? When I am fifty or maybe fifty five?

Mr THR Bionic

Sometimes in life you have to believe in fate, even if it seems that we ‘filter in’ events and information which will help us solve problems – events or information that in our normal life we would ignore. My turning point in making the decision to go ahead with the operation was one afternoon, following the consultation with Professor Haddad, at a water-ski lake outside London. I got chatting to another water-skier who happened to be an orthopaedic surgeon. Not surprisingly he knew of Professor Haddad and his excellent reputation but, of more relevance, he said to me “Did you see the guy before you mono-skiing on the lake?” I had indeed seen a guy, about mid-fifties, canning it back and forth between the water ski buoys like a pro but I had not paid him much attention. “That was so and so” my new acquaintance said adding with a smile, “by the way he has had both his hips replaced”. I could have cried for joy!

Once I understood, from seeing Mr THR bionic water-skier man in action, that a THR did not mean the end of the life as I knew it, I researched all I could find on sports after total hip replacement surgery. It blew my mind. I thought hip replacements were an end of life last resort to keep the aged in their eighties mobile with the aid of a walking stick. How wrong could I be?

Total Hip Replacements - The Statistics

There are now over 1.4 million total hip replacements performed globally each year, over 230,000 in the USA and 80,000 total hip replacements alone in the UK, 60,000 carried out by the NHS. And the trajectory of THR operations is expected to increase with estimates that they will exceed 575,000 in the USA by the year 2020.

In fact, the clinical improvement now achievable from modern total hip replacement surgery is known to be second only to major heart surgery, as the single most life-value adding surgery. The procedure is into its fifth or sixth decade of development. As surgical techniques and the prosthetic biomaterial and technology have improved in the past three decades, THR has almost become a standard, highly routine, procedure to deal with the pain of end-stage hip osteoarthritis.

The lifetime of the prosthetic has increased dramatically encouraging surgeons to recommend THRs to a younger and younger demographic of the population. For example, from 2001 to 2007 in the USA, the incidence rate of total hip arthroscopy (THA) in patients between the ages of 50 and 59 increased by 50 percent. This far outpaced the incidence in persons aged 60 to 69 (15%) and 70 to 79 (9%). But what would I be able to do after my surgery? 

Total Hip Replacements - A Who’s Who

I read up more and my research turned up some surprising ‘A’ list athletes who had undergone THR at relatively young ages and since returned to high level activities, including sports and physically demanding vocations. I am sure you may recognise some of the following (age of THR):

  • Jo Durie – British tennis player (53)

  • Andrew Castle – British tennis player (50)

  • Mark Covell – British sailor, British Olympic Silver Medallist (48)

  • Scott Mckercher – Australian pro windsurfer (46)

  • Patty Lane - US triathlete (50)

A decision!

My mind was made up. I was through the mental anguish. I was going to do this to get back on the water, back on the bike and running again. And besides, I was desperately hoping to have a family one day, how could I ever imagine not being able to windsurf or kite or even run around with my children?

Words by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

 

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Paul Martin or Alex Manos.

 

Next month – PART 3, preparing for surgery, the operation, rehab and today’s update.

Injury of the month: ACL Injuries

The Anterior Cruciate Ligament (ACL) is one of two main internal stabilisers of the knee. Along with the Posterior Cruciate Ligament (PCL), the cruciate ligaments work in concert to reduce shear (to the front and into rotation) of the tibia on the femur. This is only one of many functions of the ACL and is one of the main reasons why the ACL becomes damaged.

The anatomy of the knee

The anatomy of the knee

As you can see from the above diagram, the ACL has close links to the medial meniscus (cartilage), which is in turn attached to the medial collateral ligament. Remember this, it will become important later….

Main Functions of the ACL

The main function of the ACL is to reduce anterior translation and rotation of the tibia on the femur. It also has an important role in the brain’s understanding of where the knee is in space.

How Does It Go Wrong?

There are a number of ways ACL injuries occur:

  • intrinsic - i.e. occur due to movement or loading of the individual knee in a way that overloads the ACL to the point of damage or

  • extrinsic - i.e. trauma caused by a blow causing overload of the ACL to the point of damage.

Classically, the ACL becomes damaged during deceleration movements with the lower leg is turned outwards relative to the knee, which is why physios keep banging on about hip, knee and foot being in alignment as this reduces this type of shear. This can come from sudden changes in direction, poor landing from a height or pivoting with a fixed foot.

Extrinsic (traumatic) can be caused by force striking (usually) the outside of the knee. In the most severe cases, due to the close links between the structures, an ACL tear can also involve the medial meniscus and medial collateral ligament - also known as the ‘Unhappy Triad’ injury.

What can I do to reduce the risk of ACL injuries?

Much of this needs to be taken care of through management of well aligned movement patterns. If the resting position of the lower limbs tends towards either knees facing forwards with feet turned out or feet facing forward with kneed facing inwardly, stress on the ACL is increased. There are two main contributors to this, either poor hip and trunk control and/or tightness in the calf (especially gastrocnemius) muscle. There seems to be some unpublished data suggesting a predeterminant of ACL injury can be recent poorly/incompletely rehabilitated ankle injuries which then place more load upon the knee.

Read our blog post on how to avoid skiing-related ACL injuries.

What happens if it goes wrong?

An ACL injury is generally accompanied (but not always) by significant swelling. A feeling of the knee giving way (especially on going down slopes or hills) is also a good indicator, however there is usually a significant loss of range of movement and pain that are more obvious indicators.

What should I do?

That depends upon the severity of the injury and what you would like your lifestyle to include. A surgical opinion is highly recommended, however there is quite a trend currently to eschew surgery and rehabilitation in favour of non-operative management.

In my experience this tends to prolong the inevitable surgery and rehab if you are interested in an active lifestyle with multidirectional sports/activities. Rehabilitation can be a long, frustrating process (between 9 and 12 months) however whilst it won’t ever return the knee to the ‘perfect’ pre-operative state, it will give you a strong, functional knee that will allow you to continue the vast majority of activities with minimal restriction.

If you’re having knee trouble, call us on 02030 12 12 22 to make an appointment with one of our knee specialists.

Words by Paul Martin.


Die Another Day PART 1: Total Hip Replacement - Ivan's Story

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Die Another Day PART 1: Total Hip Replacement - Ivan's Story

Forty-nine year old Physio Remedies’ total hip replacement (THR) patient Ivan describes how his knowledge of the modern day advances in hip replacement technology, famous sportsmen and women that had undergone THR surgery and the first class physiotherapy and referral advice he received from Sarah Lawson and Nick Smith of Physio Remedies enabled him to make the decision to have surgery early and start realising the benefits of doing so – PART 1, diagnosis.

Introduction to Ivan

Every athlete, sportsman or woman dies twice: once when they take their last breath and once when they hang up their jersey or so the popular adage goes. No matter the level of competition or ability, once that part of someone's life ends it creates an unfillable void and an insatiable desire to play again. No real death is experienced obviously, but a major part of that person's life vanishes. This popular phrase played through my head on repeat as I sat in my orthopaedic surgeon, Professor Fares Haddad’s, office in dejected terror and disbelief in September 2016 trying to let his words sink in.

“I am afraid it’s bone on bone, there is no cartilage left. You are going to need a new hip. It is a simple as that” he said. “I am only forty-seven years old” I thought! But that was that. The camera, or in this case, an x-ray, never lies. This is the story of my journey from that day, now more than two years ago, to a happy place today. A place where my old life has returned. Not only am I hundred percent pain free but I am back to the same activity levels and lifestyle pre-operation.

A Life of Sport

I am a sportsman and waterman. That’s who I am. That’s what I do. At school I played every sport under the sun. County hockey, football, rugby, cricket, golf, squash, badminton, tennis, rackets, but real tennis was my passion. I was a British junior national champion in all junior age groups and I played for GB in the 1988 Bathurst Cup (the Real Tennis equivalent of the Ryder Cup). My first sailing experience was at fourteen months old in my father’s Swallow keel day boat. This led on to a lifetime of dinghy sailing, windsurfing from twelve years old, kitesurfing, water skiing, wake boarding, surfing, stand up paddling (SUP) and yacht racing. I have kite surfed and windsurfed in most of the best locations there are worldwide and I ski and snowboard in the winter. And I run. Nothing dramatically spectacular but I run. Cross country at school, ticked off the marathon sub-four hour on the to-do list and I have run my fair share of half marathons. In the last ten years, I have taken up triathlons. Add swimming and cycling to the list. You get the picture.

Physio Remedies Referral (Hint: get the best advice you can afford)

The pain started gradually at first. It was autumn 2015, three years ago. A post run deep sharp pain in my pelvis after I got up from my desk at work left me hobbling for a couple of minutes. This progressed from post sport discomfort to pain on a daily basis. I had to stop running. I developed a limp. Pushing down on the clutch pedal in slow traffic hurt. By April 2016 I was in real trouble. A walking holiday in the Atlas Mountains, Morocco proved to be a struggle. Despite ongoing release and mobilisation work from Nick Smith, Physio Remedies’ Senior Physiotherapist, the symptoms were getting worse not better.

After a tennis match in September 2016 I was not able to walk back home from a local restaurant without the supporting shoulders of my girlfriend and her mother. Not a good moment, believe me! I remember walking two minutes from a tube station to a work event and standing there, champagne glass and canapé holder in hand, grimacing at the shooting pain in my left hip.

Sarah Lawson, Senior Physiotherapist and Physio Remedies’ founding Director, was brilliant at recommending who I should be referred to see from her London network of top orthopaedic surgeons. She considered who would be the best match for my situation, taking into account many factors such as my age, the suspected pathology of my hip injury, my sporting needs and the specialisms of the surgeon. She recommended I should go and see Professor Fares Haddad who has a worldwide reputation for treating sports related knee and hip injuries.

Following on from my consultation with Professor Haddad he wrote to me with his diagnosis. I had hoped, like an idiot that it was not structural, maybe a lower back ligament or tendon issue? But there it was in black and white. I read his letter, ‘he (me) is now bone on bone on the left-hand side (hip), he will need to manage the symptoms but will end up with arthroplasty surgery (a total hip replacement)’.

Words by Ivan. Ivan runs an IT professional services company, Snell Consultancy, and he can be contacted at www.ivansnell.com.

If you’re experiencing hip pain call us on 02030 12 12 22 to book an appointment with one of our hip specialists: Alex Manos or Paul Martin.

Next month – Part 2 - Making the decision.