Patient News: Wayne Collins' Ride To Rome Part 1

Patient News: Wayne Collins' Ride To Rome Part 1

Wayne Collins, one of our physio patients, recently cycled from London to Rome with his friends Alessandro, Dot and Aileen to raise money for two charities close to their hearts. The first is The Royal British Legion, specifically for their projects supporting Admiral Nurses who work with people (and their families who are often more affected) with Alzheimers, a disease that took Wayne’s father at an early age, and the courses that they run at the Battle Back Centre. The second charity is Demelza House, which is a hospice that provides respite care and end of life care for children with severe illnesses and life limiting conditions.

Wayne has very kindly blogged his experience for us in two parts – this is the first: the run up to the big event.

Ride To Rome!

Having completed an amazing four day ride from London to Paris with the Royal British Legion in September 2018, I thought “where next?”!

“Why, London to Rome of course!”

It’s less than 1,400 miles. We can do it, of course we can! Dot, Aileen and I have only been cycling for a few years and the total of our ages is greater than 180 so we are no spring chickens and we are fairly slow.

Aileen and Dot agreed to join me in this latest crazy endeavour. Dot (we have not known each other that long) has since revealed that whilst she said yes she thought I was joking! She knows me better now. When I drove to France in January for four days to reccie the section of the route we had planned from Calais to the Alps she realised that I was serious and the event would take place!

Our Charities

During the ride from London to Paris I met some veterans who had received literally lifesaving help from the Royal British Legion, in particular through their Battle Back Centre. They are amazing, inspirational people. I have had, and still have and battle with to a degree, some major health challenges and problems in my life, but nothing compared with these people. I wanted to do more to help them.

The second charity, Demelza House, is an amazing organisation that has helped a close friend of mine, her severely disabled child and family in general for many years. Unlike many children’s hospices they focus on giving children and their families every possible opportunity and support during their lives. They make such an enormous difference daily to these families. Naturally they also provide outstanding end of life care too.

Logistics and Training

I enlisted the help of Alessandro Santangelo, an Italian Cycle guide that I had met on a cycling holiday a couple of years ago. Although our intention was to employ him, as we were raising money for these two amazing charities he only charged us for his expenses and not his time.

Alessandro planned the European mainland routes and we then drove them over two four days trips. This led to some adjustments and allowed us to identify our accommodation which we needed to book well in advance.

With regards to preparation we all cycled the Eden classic from the Eden Project in Cornwall.

Pasties after The Eden Classic.

Dot and Aileen are part of the HSBC UK Breeze cycle club in Cornwall. Breeze offers fun, free bike rides for women of all abilities across the UK. They cycle most Fridays, weather permitting, and obviously, being in Cornwall, they get a lot of hill training in!

Due to my work and other charity commitments I knew that if I was left to my devices regarding training I wouldn’t do enough to be able to survive the trip so in addition to training on my own I cycled the one day, 65 mile Poppy Ride for the Royal British Legion in May.

In June I then joined two friends for a cycle challenge/training down the Adriatic coast of Italy with Alessandro as our guide. In reality we spent very little time on the coast road as each day we came in land to view some stunning locations all of which seem to be at the top of long steep hills! We averaged around 60-70 miles a day.

Wayne and Alessandro at the end of our Adriatic training.

Shortly afterwards I followed up with the four day pedal from London to Ypres, a mere 320 miles, again with the Royal British Legion.

Ypres.

The final major training event for me was cycling the grand depart of the Tour de France one week ahead of the actual Ride To Rome. This event was raising money for prostate cancer. We suffered with extreme temperatures on the day and from a personal point of view, as I had never cycled 128 miles in one day before, it was an enormous challenge on many levels!

In addition to providing his guiding services and cycling every mile with us Allesandro also provided mechanical support whenever we had issues.

My pre-ride bike prep was generously provided by one of our sponsors, Pearson Cycles, who are still family owned and are the oldest bike shop in the UK. Next year they celebrate their 160th anniversary.

Our support van driver, daily fresh fruit and food buyer, water supply man and all round fantastic support was provided by Glyn who also volunteered his time free of charge for the whole trip and assisted with moving the van around in the build up to the event to help promote us and to have the stickers of our wonderful sponsors added. I don’t think he really knew what he was letting himself in for when he was “volunteered” by his wife and fellow cyclist Dot!

Provisioning for the Ride To Rome!

Tune in next month for Part 2 of Wayne’s blog post where he tells you just how much fun he had cycling from London to Rome!

If you’d like to make a donation The Ride To Rome donations page is still live and can be found here.

Words and images courtesy of Wayne Collins.

Are you going on your own adventure and would like to share it with us? Send an email to us at info@physioremedies.com.

What Does My Physio Think About: The Most Common Injuries We Treat

What Does My Physio Think About: The Most Common Injuries We Treat

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 fourth of a series of blog posts entitled “What Does My Physio Think…?” we asked our physios and therapists “what is the most common injury you see in clinic?”

And here are their answers:

Our specialist spinal physio Shari says:

“In order:

1. Lower back pain

2. Neck pain/headaches

3. Shoulder pain

4. Knee pain

5. Mid-back pain

6. Ankle pain

7. Hip/groin pain

8. Elbow pain, and lastly

9. Hand injuries.”

Emily, our soft tissue therapist, triathlon coach and athlete personal trainer, comments:

“As a soft tissue therapist:

1. Knee pain and achilles problems from tight quads and calves in runners

2. Rotator cuff issues from incorrect stroke in swimmers

3. Above all, the most common injury is shoulder and neck pain from sitting at a desk!”

Stuart, our specialist knee and foot & ankle physio says:

“Patella Femoral Joint Pain (PFJP) - injuries associated with the patella or kneecap.”

Physio Paul, who specialises in sports injuries, says:

“Necks and shoulders.”

Physio Nick, our shoulder specialist physio, unsurprisingly says:

“Shoulders!”

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Not the best desk posture.

Help To Reduce Neck and Back Pain With Good Office Ergonomics

Shari, our spinal specialist physio, writes:

Many of my patients spend long hours working at their computer and poor desk set-up/ergonomics can lead to pain in our joints. I see a lot of patients in particular with neck, lower back and upper back pain exacerbated by poor office ergonomics.

I always recommend my patients have a thorough assessment of their work station by a specialist ergonomics physiotherapist or occupational therapist, but I have provided a few pointers below that may assist:

• Take micro-breaks: every 20 minutes you should take a break and complete 20 seconds of micro movements. This could be shrugging the shoulders back, rotating your upper back from side to side, turning your neck side to side etc.

• Your mouse and keyboard should be at the same height (elbow height) with your elbows close to the sides of your body ideally at 90 degrees. Make sure your mouse and keyboard aren’t too far away.

• Your wrists should be kept in a neutral position.

• You should work as close to the centre of our body as possible, i.e. not turned to one side.

• Any documents should be placed at the same height as your computer screen - try using a document holder.

• Allow your eyes to take a break from your screen by exercising them! Do this by focusing on objects in the distance regularly when you take a break from staring at your computer screen.

• Your head should be straight, shoulders relaxed, and your line of vision should be at the top third of your screen.

• Your chair should support a neutral posture and provide sufficient support for the length of the spine. Your bottom should be back in the chair and contact should also be maintained at the level of shoulder blades.

• Lumbar support such as an adjustable lumbar roll will help you maintain good spinal posture.

• Your knees should be bent at 90 degrees and not touch the under side of your work surface or the seat edge.

• Your feet should be flat on the floor and if they aren’t a foot stool is needed.

• Use a head set instead of a handheld phone. Handheld devices should be used only for short durations with the upper limb supported, which will reduce the strain through the neck.

• Handheld devices (phones, iPads, Kindles etc) should be held at eye level so to prevent strain on your neck from looking down for long periods.

• Your office should be well lit and well ventilated, with no glare from lights or windows on your screens.

• You should be able to manoeuvre yourself in/out of your desk chair without space restrictions or obstructions.

• Monitors should be centred on your desk.

• Stand hourly at a minimum.

• If you stand for prolonged periods, this also causes fatigue and your arms are not supported, so standing desks are not necessarily better than sitting desks in general which is evidence based supported. The key is taking regular breaks from static postures.

• If you use a laptop a separate mouse and keyboard should be used so that your arms are supported and your elbows bent at 90 degrees, and your laptop should be placed at a height such that your eye level when your head is straight is at the top third of the screen.

If your office set up is a pain in the neck (literally!), get in touch with us to see how we can help you.

Words by Shari Randall.

Body part of the month: the knee

This month our body part of the month is the knee and so we’ve asked our knee specialist, Alex Manos, to tell us about to tell us about two elements of the knee and their common injuries:

Anterior Cruciate Ligament (ACL)

The ACL is one of the four main ligaments of the knee, stabilising the knee both in a forward and back and rotational movement.

ACL Injury

Injury to this ligament is common in sports such as skiing, football, rugby and any other sport involving twisting and turning. More often than not, in contact sport, the injury actually happens without contact and occurs when an individual turns direction and the knee twists. The person usually hears a 'pop' and feels a sensation as if something has been torn.

The knee usually swells up quickly and becomes difficult to move and weightbear. Early diagnosis is key and the best route is to see a physiotherapist, sports doctor or knee consultant who will organise an MRI to look at the damage. Once it has been confirmed, there are two options: conservative or surgical management. The preference is usually surgery but factors such as age, fitness level, future goals and patient choice of course are taken into account. Either way, rehabilitation is absolutely necessary.

During surgery, the ACL is replaced with either a tendon from the patella or the hamstring, or sometimes an allogarft (graft from a donor cadaver) is taken. The rehabilitation following surgery can take anywhere from 6 months to a year depending on the extent of the damage and also how well the patient adheres to the rehabilitation program given by the physiotherapist. The goal, where possible, is to return the individual back to the previous level of function. This requires a very systematic approach and goal setting to ensure all markers are met in a safe and progressive manner. The knee needs to be strong and stable and function as it did prior to the injury in order to allow for a return to sport.

Iliotibial Band (ITB)

The ITB is a thick band of tendinous fascia which attaches to a muscle on the outside of the hip called the Tensor of Fascia Latae, a muscle which pulls the hip up and out.

ITB Friction Syndrome (ITBFS/runner’s knee)

ITBFS or runner’s knee as it’s often referred to is a condition which gives pain on the outside of the knee, the lateral side. It is mainly prevalent in runners hence the name but can also occur in cyclists and other sports. We still don't know exactly what causes it but we do know that friction between the ITB tendon and the knee joint causes irritation and inflammation of the bursae (a fluid filled sack) which sits between these two structures. The onset of pain is usually very specific. In running, for example, an individual usually has a distance or time when they can pin point the onset of pain. Once it kicks in, if acute and severe, the runner can't continue. It is described as a sharp stabbing pain on the outside of the knee. There may be local swelling but knee joint itself if not swollen. People find walking downstairs and also just bending the knee - particularly in the 0-45 degrees range - painful.

The injury is atraumatic, there is no tear so there is nothing to heal, but the inflammation has to settle. Usually within a couple days the knee feels ok again and there is no issue in day to day life until the aggravating activity is taken up again. Therefore we say that the injury is biomechanical or overuse in nature. The factors which could be contributing to it can be broken down into two categories: extrinsic and intrinsic.

Extrinsic factors are things like training loads, recent changes in training, training surfaces/hills, footwear and changing fitness levels. There is often a link between one of these and the onset of ITBFS, often a sudden increase in running load.

Intrinsic factors look at what is going on within the body, areas of tightness or weakness, imbalances, running styles or other areas apart from the knee which could be contributing.

A detailed examination of both by a specialised physiotherapist will be able to determine which factors need to be addressed and corrected. Advice, combined with manual therapy and rehabilitative exercises can be very beneficial in overcoming this problem. In recalcitrant cases, a corticosteroid injection can also provide benefit.

Is your knee giving you trouble? Call us on 02030 12 12 22 to book an appointment with one of our knee specialist physios.

Words by Alex Manos.

What does my physio think about ultra running?

What does my physio think about ultra running?

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 third of a series of blog posts entitled “What Does My Physio Think…?” we’ve asked our physios what they think about ultra running.

What is Ultra Running?

Ultra running is defined as running any distance longer than a marathon (26.2 miles). Classic distances for ultra events are 50km (32 miles) and 100km (64 miles) but every year there are more events at almost any distance over 26.2 miles, including 100+ miles. Most events are trail events but some are held on tarmac or even on 400m atheltics tracks!

Is Ultra Running good or bad for me?

Emily, our soft tissue therapist, triathlon coach, athlete personal trainer, comments:

“For ultra distance, athletes usually work at low intensity, aerobic pace: it’s not uncommon to adopt walk/jog/run combinations. In that sense, there’s less stress on the joints and cardiovascular system than in shorter distance running. As long as the athlete gradually increases mileage during training, listens to their body (and their physio / trainer / coach), human bodies can adapt to many things that “modern human beings” find “impossible”.”

Our spinal specialist Physio Shari says:

“Whilst this isn't my expert area, my personal opinion is that I would be concerned about the long term effects on the person's joints. However, I will support my patients with their ventures and help to get them in the best form possible to compete in ultra running as long as it isn't aggravating existing injuries/issues. Complementing the ultra running with cross training and strength/stability training is really important as well.”

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

“As with any exercise, build gradually into something as demanding as ultra-running. Not everyone is designed for it but if you are, take a long term plan to build up to distances you would like to reach. Whilst increased volume will mean increased load on joints, the impact of this might be spread out if you build up sensibly.”

And Nick, another of our sports injuries specialist physios, recommends specialist training for ultra events to avoid injury.

Patient News: Alex Flynn takes on the 4 Deserts Grand Slam Plus in 2020

Patient News: Alex Flynn takes on the 4 Deserts Grand Slam Plus in 2020

In 2020, our patient Alex Flynn will take on the 4 Deserts Grand Slam Plus – racing 1,250km / 780 miles unsupported on foot across some of the most inhospitable landscapes in the world in the Namib Desert, Gobi Desert, the Great Caucasus of Georgia, the Atacama Desert and Antarctica - and we’ll be supporting him in the lead up to this epic challenge.

Alex was diagnosed with Parkinson’s disease in 2008 at the age of 36. His diagnosis became the catalyst in his life for showing people the possibility of creating positive change in the face of adversity.

Only eight people in the world have ever completed the 4 Deserts Grand Slam Plus and Alex Flynn is set to join this unique group of super athletes while being the first person with Parkinson’s disease to ever to attempt any RacingThePlanet / 4 Deserts ultra.

Endurance events are not new to Alex. He has completed marathons, ultra endurance races and triathlons, but nothing quite as challenging as this one. Alex’s endurance achievements so far include:

• Covering more than 6,200 miles to meet the 10MillionMetres challenge he had set himself.

• Completing the Marathon des Sables (a 250km race across the Sahara Desert).

• Attempting a 450km expedition in Sweden’s Arctic Circle in freezing temperatures.

RacingThePlanet’s 4 Deserts Grand Slam Plus poses Alex’s biggest challenge so far. Not only will temperatures rise well above 40 degrees C in the oldest desert in the world and well below freezing in Antarctica, but Alex will also be crossing the world’s highest sand dunes, waist deep rivers, fighting sand storms, racing above 10,000 feet and being at the command of Mother Nature in Antarctica.

Alex’s driver is to raise more than £1 million towards vital research to find a cure for Parkinson’s disease while inspiring and educating people about the illness along the way.

“I want a cure for millions around the planet and hope you do too. Together we can make change happen!” #KeepMoving

Alex Flynn is living proof that Parkinson’s disease is not an obstacle for success!

Back To Gym

Back To Gym

Summer holidays done and dusted? Check. Good food, good drink, good volumes? Check. Not quite managed the level of fitness work you’d hoped to fit in? Check. Looking at getting back in the gym to create some space for December? Check.

Ease your way back in there! As with any significant break in training routine, there will be a level of deconditioning and picking up exactly where you left off might not be the most comfortable approach to getting back into the swing of things. It is better to come out of the first two to three sessions feeling like you could have done more or that previously reactive areas or muscles don’t feel fully worked on than charging back in full pace and hurting yourself, leading to a longer period out.

Regardless of whether your workouts are class based, load based or volume based, take it down a notch or two for the first few sessions back. Spend this time during your workouts getting a feel for what is working well and what might need a bit of attention to get back up to full speed. E.g if some muscle groups are perhaps not responding as well as they might have done pre-break, what might you need to do to get them back to pre-holiday levels and how might that affect the rest of your workouts.

Once you have ironed these little creases out, pick it up again over the next two to three sessions and you’re back in the game!

Happy holidays!

Words by Paul Martin.

Jetlag and how to minimise it

Travelling long haul this summer? Our physio Paul has given us his top tips for reducing jetlag.

What is Jetlag?

Jetlag is the mismatch between the timing of the internal body clock and the external timing of the environment brought about by crossing several time zones in a short space of time. Such large shifts in time zones result in immediate changes to time cues which are driven by the new timings of day (ie light) and night (ie dark). Whilst there is an immediate change in environmental time cues, the the body clock(s) do not adapt immediately - the body clock resets slowly, so 'lags' behind.

Linking this with travel fatigue, a form of tiredness brought on by transition from one location to another or the demands of door to door travel, can lead to sleep disruption, fatigue, mood changes and risk of illness. As a guide, flying east will take one day to recover per hour time zone changed (ie six days for a six hour time difference), flying west will take one day per 1.5 time zones (ie four hours for a six hour time difference).

The type of person you are (eg more effective in the morning or more effective at night) may impact your recovery as well. Evening types will travel west better, delaying their body clock, morning people will do better travelling east, advancing their body clock. As always, some people are never affected by jetlag, but others have a constant battle with the changing of time zones. In general the risk of extreme jetlag crossing fewer than five hours is low and as a result most changes will likely be due to travel fatigue, so travelling west for fewer than five time zones will have little jetlag associated with it. However, this becomes more problematic if you are travelling east for more than six time zones.

Every individual will have their own strategies, but if jetlag is something you struggle with when going away, here are a few tips for pre-flight, in-flight and post-flight periods that may be of some benefit:

Pre-flight

To ensure you arrive in the best shape, prior to a long haul flight, it has been recommended that you try going to bed 30 minutes earlier or later for three to four days prior to flying. In theory this should start to shift sleep patterns, if not (especially if delaying sleep) the risk is being sleep deprived if it doesn't work - fitting an extra couple of hours in bed at the other end may not be compatible with work schedules as wel!. Ideally allow yourself to get enough sleep in the build up to the flight and minimise events that take place early morning or late evening and minimise time away from home.

In-flight

Some strategies focus on time for changes to be made during the flight, however this can be a difficult environment where limiting problems might be a better strategy. The plane environment can be unpredictable (eg turbulence, noisy neighbours, food and drink services) so starting your strategy here is quite high risk. As far as the flight is concerned, sleeping when you feel sleepy is the advised approach to attain more sleep leading to better wellbeing on landing. This sleepy time is likely to be between your usual bed and wake up times. It is unlikely that you will get seven to nine hours undisturbed sleep on a plane!

Post-flight

Due to the immediate changes in environmental time cues, the body clock will begin to align gradually. This can be aided by light exposure as an environmental cue. If trying to advance your body clock (ie on heading east) avoid light in the morning and seek light in the afternoon and vice versa for heading west (lots of light in the morning, less in late afternoon). Start small (eg for eight time zones east seek light for a couple of hours in the morning to begin with) and increase gradually eg by half an hour per day.

These are guidelines that may help, however many people have individual strategies that work best for them. If you do have your own strategies that work it is unlikely these will speed any processes up, however if jetlag is something that affects you, some of this advice may help reduce its effects on you.

Enjoy your trip!

Words by Paul Martin.

What does my physio think about joint health supplements?

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 second of a series of blog posts entitled “What Does My Physio Think…?” we’ve asked our physios what they think about joint health supplements such as glucosamine.

What does my physio think about joint health supplements?

Do supplements for joint health, such as Glucosamine, really help / work? Are there any you'd recommend for preventative or treating purposes?

Our specialist spinal physio Shari says:

“Unfortunately, there is very limited research evidence. I don't routinely recommend them, although anecdotally some patients see improvements. If taking Glucosamine for joint health it needs to have chondroitin in it as well. Here's what the Arthritis Foundation has to say. ”

Emily, our soft tissue therapist, triathlon coach, athlete personal trainer, comments:

“Again, there are conflicting studies with supplements. As a coach, I find psychological / placebo effect outweighs all, so if an athlete really believes in it, I certainly won’t stop them unless their doctor deems it dangerous.”

Stuart, our specialist knee and foot & ankle physio says

“The early studies in Glucosamine and Chondroitin seemed positive with Osteoarthritis, however more recently there are mixed reviews but many people find improvements though taking this. Others such as Omega 3 fatty acids have anti-inflammatory properties and may assist in reducing cholesterol but again the evidence is mixed.”

Bodypart of the month: the foot and its common injuries

This month our bodypart of the month is the foot and so we’ve asked our foot & ankle specialist, Stuart Mailer, to tell us about to tell us about two elements of the feet and their common injuries:

Achilles Tendon

The Achilles tendon is an extremely thick and strong tendon that attaches the calf muscles, Gastrocnemius and Soleus, to the heel. It aids in providing propulsion during walking as well as running and any explosive activity. The Achilles tendon has to endure high forces during jumping, hopping or running and it regularly absorbs 2 x body weight during running, thus it is not surprising to hear that it can be injured.

Achilies Tendonitis

Common injuries are tendonitis, a short period of increased inflammation due to overloading. This can cause some swelling and pain but normally settles quickly.

Achilies Tendinopathy

Longer-term injuries are known as tendinopathies where one has had long periods of microtraumas and the tendon has failed to recover. This tendon becomes more degenerative and disrupted without the inflammatory response tendonitis has. This will present with stiffness and will ease after light activity but be painful after prolonged activity.

Treatment and Recovery

Rehabilitation of either tendon injury involves flexibility and strengthening exercises that are suitable for the health of your tendon at that time. This may involve strengthening your hips and gluteal muscles as well as your foot and ankle musculature.

Unfortunately, tendinopathies can take a long time to recover as tendon regeneration may take more than 3-4 months to occur. Full recovery taking more than 6 months is not uncommon, so patience and diligence are the keys to getting back.

Plantar Fascia

The tight band of fibrous tissue underneath the foot is known as the plantar fascia.

Plantar Fasciitis and Plantar Fasciopathy

Plantar fasciitis (short term) or plantar fasciopathy (longer term pain) is a condition whereby the plantar fascia becomes injured. This typically presents as pain at the heel area of the foot and is categorised as a sharp pain with the first step in the morning but reduces as we start to move. This injury progresses gradually over time and as it becomes more problematic it can then can be painful wearing flat shoes or unsupported footwear or standing for a long period of time.

There can be many contributing factors such as high arches or flat feet, change of footwear or increasing exercise volume too quickly to having tight calf muscles.

Treatment and Recovery

Treatment normally consists of stretching and strengthening the foot and surrounding musculature if there are imbalances. This can then help address the underlying weaknesses or biomechanical issues that may have contributed.

There have been many other interventions utilised that can assist such as orthotics, that can help reduce pain at the plantar fascia and improve your walking by giving the appropriate support your foot requires.

Night Splints, Shockwave therapy, acupuncture and cortisone steroids are all other common interventions, however each has a specific time to be utilised depending on your contributing factors and foot health. It is advisable to first undergo a course physiotherapy intervention and podiatric assistance to help determine causes, start an appropriate rehabilitation plan and aid your recovery.

If your feet are causing you pain or other issues, call us on 02030 12 12 22 to book an appointment with one of our foot & ankle specialist physios.

Words by Stuart Mailer.

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

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.

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.

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!

Finisher and his crew!

Words and images by NoviceRunnerNik.

Patient News: We're Supporting Extreme Adventurer Alex Flynn

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

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.

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

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)

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.

View fullsize

Transition layout.

• Practice dismounting your bike on the fly:

View fullsize

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).

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.

Image by Scott Collier Photography.

Good luck, have fun!

Words by Emily Chong. Image by Scott Collier Photography.

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

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

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.

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

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

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 soft tissue therapist and Triathlon coach (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!

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!

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

The Long(est) Read: Ultra Running Tips

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)!

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