Should you stretch as part of your warmup for running?

hamstring-stretch-on-floorShould I Stretch or Should I Go Now?
If I don’t there will be trouble and if I do there could be double,
so come on and let me know…should I stretch or should I go?

The great stretch debate has been going on for several years now with lots of conflicting views leaving the average weekend athlete confused and unsure what to do.  It’s a question I get asked a lot as a physio.

“Should I stretch before or after exercise and what type of stretching should I do”?

This is a quick and simple guide into the benefits of stretching for warming up and cooling down during your half vbhm-sussex-beacon-runner-smmarathon training.  At this point it’s probably worth mentioning that there is no one size fits all plan, every individual is different and because of the conflicting evidence on this subject this post is partly based on research and personal experience as a runner and physio.

A study by Simic et al (2012) concluded that static stretching as a sole activity during a warm up routine should generally be avoided, as it was found to reduce power, strength and explosive performance.  However, the negative effects were only short term and generally returned to normal after 5 to 10 minutes, these negative effects were also unlikely to occur if the stretch was kept under 45 seconds.

Behm et al (2011) documented that dynamic stretching either has no effect on performance or may improve performance especially when the stretching duration is prolonged.  However, the study also went on to say that static stretching used in a separate training session could actually improve range of movement and health.

Confused?  Join the club.

Behm et al concluded that:

“Generally, a warm-up to minimize impairments and enhance performance should be composed of a submaximal intensity aerobic activity followed by large amplitude dynamic stretching and then completed with sport-specific dynamic activities. Sports that necessitate a high degree of static flexibility should use short duration static stretches with lower intensity stretches in a trained population to minimize the possibilities of impairments”.

In other words if you’re doing an activity that uses long drawn out movements such as martial arts or ballet then static stretches may be useful.  However, if you’re a runner then short low intensity aerobic exercise, followed by dynamic stretches and finished off with a few running specific dynamic exercises is likely to be more important.

In my opinion stretching is very much a personal thing, I tend to spend 10 to 15 minutes warming up with a combination of light aerobic work followed by dynamic stretches and sports specific exercises.  When it comes to static stretches this is very much dependent on how much time I’ve already had away from the wife and kids, If I can get away with it I might spend 5 minutes doing short duration (under 45 seconds) static stretches on all the major lower limb muscle groups.

So to conclude you can find lots of conflicting views and counter arguments for all types of stretches, if you want my advice do what feels good for you but don’t spend all your non-running time stretching!  In my opinion a good balance between warm up, running, cool downs and strength work is the winning formula.

James
Sundial’s Physiotherapist

VBHM logoSundial is a partner for the Vitality Brighton Half Marathon on 26th Feb 2017  providing clinical care and advice for sports injuries for the runners. If you have any niggles then give us a call and our physio’s, chiropractors and massage therapists can see you quickly. Running the Vitality Brighton Half Marathon? Call for a free Runners MOT

 

How to manage an acute injury yourself

Runners knee pain“As a physiotherapist this is a question I get asked a lot and having just completed the Brighton Half Marathon you may be asking the yourself the same question.” says Sundial physio James Masterson.  He goes on to say “So in order to help you with your post run recovery here’s a few useful tips to ease you back to fitness and potentially your next race.”

Physiotherapists love an acronym and what used to be known as RICE or PRICE is now often  referred to in the industry as POLICE.  With each letter relating to a useful management strategy this acronym can be a helpful tool in guiding anyone suffering from an acute injury.

 Protection

Depending on the severity of your injury you may want to use a brace, tapping or in more extreme circumstances casts and crutches, this will help to prevent excessive movement and protect the site of injury.

 Optimal Loading

The key part to remember here is OPTIMAL, the right amount of loading will help stimulate the healing process of a muscle, tendon, ligament and bone. This could be any type of activity such as standing, walking or swimming, however in more serious injuries such as fractures or full tendon ruptures the OPTIMAL load might be no loading and may require casting, crutches or surgical intervention

 Ice

Applying ice during the initial stages of an acute injury can be beneficial for reducing both pain and swelling.  Although medical professionals have been recommending ice for several years the evidence is far from conclusive.  I usually advise my patients to wrap an ice pack in a flannel or thin towel and apply directly on the site of pain for 15 minutes 3 to 4 times daily within the first 72 hours of injury.

 Compression

Similar to ice compression can be used for managing swelling, applying a simple tubigrip or neoprene strap can help to compress the injury site.  The applied compression should be tight but comfortable with good circulation above and below the strapping, I often ask patients to remove the compression for short periods throughout the day and take the strapping of at night to allow the skin time to breath.

Elevation

Can also be very useful in reducing swelling.  For example, if you’ve acutely sprained your ankle lying on your back with your leg raised and supported can reduce the amount of blood rushing to the effected area.  With this specific injury you may wish to do a few ankle pumps to improve the blood flow and help with the healing process.

 At this point it is probably worth mentioning that I recommend anyone to seek medical advice if you are unsure about an injury.  Although the POLICE protocol is a useful tool for managing an acute injury it is not a one size fits all strategy!!  If you are having difficulty weight bearing or have symptoms such as bony tenderness, considerable swelling, loss of range of movement or the feeling of instability in a joint then I recommend seeing a medical professional ASAP.

Sundial Clinics offers a free 20 minute physiotherapy assessment to anyone who would like advice about an injury, this session is a great way to get some useful tips on how best to manage your injury and to see if physiotherapy is right for you.  Why not call the clinic today to arrange a free informal consultation and stop that niggle turning into a pain!

Runners MOT – Brighton Half Marathon

physio or chiropractic for PFS in BrightonRunning injuries often start with a niggle. Knee pain, muscle strain, tendon pulls, bursitis, ligament sprains and all sorts of other aches and pains are a constant reminder that marathon training and actually running it can be a hazardous business. Many people who enter for the Vitality Brighton Half Marathon will not complete it because of injury. We aim make sure you are not one of them.

For the next few weeks we are offering a free Runners MOT especially aimed at runners in the Vitality Brighton Marathon. We want you to be fit, strong and ready to run in support of the Sussex Beacon.

Our physios will check you out top to bottom concentrating on your footwear and leg and foot movements. We will check all the usual things like over-pronation but also things that often over-looked like jamming of the hinge joint of the ankle which changes stride length. We will look at knees, hips and backs too. At the end of our Runners MOT you will have an in depth risk profile of the likelihood of future running injuries and a plan for prevention. If you are having problems currently then we will give you a plan for the best recovery.

So don’t let a niggle turn into a pain, call to make an appointment.

VBHM logo

 

 

 

 

Do I need orthotics for running?

Orthtoics for Runners KneeWhy would I need orthotics?

Although running shoe design and technology has progressed leaps and bounds over recent years, there are certain foot types that will require more support, explains James Masterson, physio here at Sundial, Brighton.  However not everyone will benefit from orthotics and it’s important to gain professional advice before deciding on whether an orthotic is right for you.  A full biomechanical assessment from a physiotherapist or chiropractor can help determine whether the underlying root of the problem stems from your feet and whether or not an orthotic is appropriate for your foot type.

Orthotics can help running and are designed to optimize the alignment of the lower limb, which can improve shock absorption in the lower extremity and realign joints from the foot all the way through the kinetic chain to the spine, preventing problems foot, knee or hip.  The main role of an orthotic is to restore a neutral alignment which will in turn reduce the stress carried throughout the body during weight bearing activities.  This is particularly important during running as (hopefully!) the feet are the only part of your body in constant contact with the ground.

An orthotic can either be an off the peg prefabricated orthotic, with a selection made to fit most general foot types, or a custom made orthotic, normally constructed by a podiatrist which is made specifically for the individual. The off the peg orthotics work well for most people and are considerably cheaper. We sell Superfeet orthotics at Sundial.

Another important factor worth considering with orthotics is that most people change their shoes several times throughout the day.  Although your running shoe will provide you with support whilst you’re wearing them, it’s likely that you will spend more time out of these shoes than in them.  This can potentially lead to overuse injuries during regular every day activities, especially if your profession requires you to spend large amounts of time on your feet.  This is another way in which an orthotic can be useful as it can often be taken from one shoe and placed in another.  However orthotics aren’t your only option and if possible should only be used as a short term solution, please see my future posts on physiotherapy exercises to improve overpronation.

The three basic foot types:

Firstly, it should be noted that pronation is a natural movement of the foot’s mechanics.  It occurs at the joint below the ankle called the subtalar joint and this movement allows the foot to roll in slightly during the stance phase of gait and helps the lower limb deal with shock.  Although this process is not necessarily detrimental to your body it can affect your running style and possibly lead to injury.

 Neutral foot:Over pronation, Brighton physio

This means that you’re a neutral pronator, meaning your foot rolls in slightly and you push off evenly through the front of the foot.  Sometimes you can tell if someone is a neutral runner by looking at the sole of their shoe, running from the heel to the big toe along the outer surface there will often be signs of S-shaped wear and tear.

Underpronator:

Underpronation, or supination as it is often referred to, is when the outer surface of your foot hits the ground at an increased angle causing minimal or no natural pronation.  Again this leads to access shock throughout the lower limb and can be potentially damaging to your body when running.

Overpronator:

There is significantly more inward rolling of the foot meaning more weight is transferred to the inner surface of the foot late in the stance phase.  This causes instability and leads to compensatory movement patterns throughout the kinetic chain, potentially leading to injury throughout the lower limb and within the spine.

If you have any queries or want more help then book in for a free Runner’s MOT

 

Happy running.

Running shoes – top tips for the marathon season from Brighton physio

Choosing running shoe, Brighton physioIf like me you’re considering starting your preparation for the up and coming marathon season then take a look at my top tips for staying injury free and completing the 26.2 miles with a smile on your face says James Masterson,  a physiotherapist here at Sundial, Brighton.

Which running shoe shall I buy?

Inappropriate footwear is the root of all evil when it comes to running.  Before embarking on the long and tedious road to the finish line every runner should start with their feet.  Visiting your local running shop for a gait analysis is a good place to begin. As well as being advised on the most appropriate running shoe for your foot type it’s also an opportunity to view yourself in action.  Video analysis taken during these consultations will allow you to look at your lower limb alignment whilst you’re walking and running, giving you a good idea of movement patterns which could potentially lead to overuse injury.

 Top 5 running injuries caused by over use and inappropriate footwear:

1. Plantar fasciitis

2. Achilles tendinitis

3. Medial tibial stress syndrome (aka shin splints)

4. Patellofemoral pain syndrome (aka Runners knee)

5. Iliotibial band syndrome

When it comes to purchasing your shoe it’s likely that you will come across the below terms. Remember it’s not all about what foot type you are!  Take the time to get a feel for the shoe, being able to stand, jump, walk and run before handing over your cash is a great way to find out if the shoe works for you and reduce the risk of injury later in your training.

Useful tips for purchasing your running shoe:

  • Try having a foot analysis in the late afternoon/evening as your feet swell as the day goes on and may give you a false feel when purchasing your running shoes in the morning.
  • Pick a shoe that matches the contour of your arch, you won’t be able to feel this by just standing in them so always make sure you take them for a spin before handing over your cash.
  • Try and have your feet measured before trying on your shoe, this will give the running shoe assistant an idea of the size and width of your foot.  Different brands suit different foot types and not all shoes will equal in size, for example, Nike shoes tend to be good for wider feet and Adidas tend to be better for a narrow foot type.
  • Don’t buy your shoes too small, the fabric will loosen as time goes on but generally if a shoe has hot spots that aggravate your feet whilst trying them out in the shop then it’s likely this will occur during your training.  Remember! Tight shoes equal blisters and potential toenail damage, this will limit the amount you’ll be able to train and will also look horrendous in a pair of flip flops.
  • Lace your shoe up from the bottom up, not just at the top two eyelets!  This allows you to support the shoe around your foot equally and avoids excess movement.  Your heel should fit snug within the shoe and your toes need to have some wriggle room at the front.  A good test for this is to see if you can still scrunch up your toes whilst the shoe is fully laced up.
  • Change your shoes according to your individual usage, most manufactures will recommend that you change your shoe roughly every 300 – 500 miles but this is dependent on so many factors, for example a person’s weight, gait mechanics and running terrain will all play a massive factor in your choice to change your shoes.  Let’s be honest running shoes are expensive, so my advice is look for signs of wear and tear and as soon as the natural cushioning of the shoe starts to depreciate this is probably a good time to start looking for your new runners.

If you have any queries or want more help then book in for a free Runner’s MOT.

Happy running.

Next: Do I need orthotics?

 

 

The 7 R’s – Brighton Marathon Training Tips

Jewel runs Brighton Marathon
Jewel runs Brighton Marathon

The Brighton Marathon is the highlight of our sporting calendar. We have supported Brighton runners and their charities for many years but we have noticed that many people are not getting the support and advice they need to complete the marathon injury free. One in five people who enter the marathon will not complete it because of injury. We aim to make sure you are not one of them!

Pre-Training/Training Tips

Before you begin marathon training, you should be able to run for at least 30 minutes without stopping. Distance is not important right now. You just need to get your body used to running.
Combinations of runs/walks are great to use during pre-training because they ease your body into the exercise and minimize the chance of experiencing a running injury. Follow a set schedule or rota of training leading up to the event, so that you can set yourself small goals to work towards on a weekly basis.

Recovery Tips

Take recovery days equally as serious as your running days.
You should not run every day as your body needs to rest between runs, so it can recover from one run to the next, getting stronger between each run.
Use your non-running days to rehabilitate and to refuel with the right foods.  Ice any soreness, particularly in your knees or shins, four times per day for 15-20 minutes.  Stretch all the muscle groups in your legs, spine and upper body as you use them all!

Injury prevention

Never run through an injury, get it checked out by a professional!  Most of us are aware to use the RICE (rest, ice, compression and elevation) principle if we sustain an acute injury such as an ankle sprain or shin splints but there are other, less acute pains to be aware of, that may turn from a niggle into a strain.
Wear the correct footwear.  Your trainers should be no more than 6 months old or have been subjected to 500 miles of running.  Older shoes lose shock absorbing ability and increase the risk of injury. Check the soles of your trainers for abnormal wear as this could indicate a biomechanical problem elsewhere.  When choosing new running shoes go to a running shop staffed by experienced runners who can advise you on the correct shoes for your foot and running style.

The 7 R’s for marathon training

Run for 30 minutes before starting specific training
Rota – set up a schedule of training with goals
Rest is important because your body builds muscle, strength and stamina in this recovery phase
Refuel – improve your diet with our video program to get the right building blocks for recovery
Rehabilitate – stretch all over and ice any injury
Replace worn out running shoes
Runners MOT – this free check up is available to all Brighton Marathon runners – don’t let a niggle turn into a pain
Our physios and chiropractors support Brighton marathon runners with the offer of our Runners MOT at either of our Brighton clinics.  So if you have an injury or just a niggle, call and get it checked out!

How to treat Shin Splints

Shin splinPhysiotherapy leg examts or Medial Tibial Stress Syndrome (MTSS) is easy to treat if the problem is caught early. If symptoms of pain along the inner border of the shin bone (tibia) goes on for too long then significant damage can occur to the muscle and bone bone coverings and the condition becomes chronic. Brighton physio, here at Sundial, James Masterson explains.

What can I do to help myself?

Rest and ice – Ice can be an extremely effective pain relief for shin splints as it acts as a local anesthetic by numbing sore muscle tissue. It also helps to slow down the inflammation and swelling process which occurs with injury.

Take down inflammation – Anti inflammatory medication may help to reduce any swelling and speed up your recovery time. Please consult your doctor before taking any medication.

Wear appropriate footwear!! – It may be beneficial to visit a specialist running shop where you can be advised about what might suit your needs. On average running shoes should be replaced when worn for between 300 and 600 miles, depending on factors such as body weight, running style and training surface. In some cases orthotics (inner soles) may be used to help abnormal loading throughout your lower limb and correct issues such as over-pronation and supination. More information on orthotics here.

 

What can the physio’s at Sundial do to help?

The first stages of rehabilitation may include advice to rest from aggravating activity for a while. We can give you ice packs to use of the first 2 day after the pain starts or is aggravated by the offending activity. We will help you switch to low impact exercise such as swimming and cycling and advise on how best to incorporate changes to maintain strength and fitness. Only in extreme cases is protected weight bearing necessary.

Foot alignment

An important part of the recovery process is assessment of foot alignment and walking/running analysis to highlight any potential problems. Advice on appropriate footwear and the
In more severe cases our physio care involves laser therapy which improves healing, reduces pain and takes down inflammation. Soft tissue techniques such as massage may also help to ease tight muscles associated with shin splints or MTSS. application of inner soles may also be of benefit. We are experts in this sort of advice and work with local running shops to get the best footwear for you.

We will also advise on a home exercise plan consisting of stretching, balance and strength exercises to help too. This is an important part of your recovery along with a graded return to activity with symptom free progression.

 

Causes of Shin Splints -more here

Knee pain in runners: the 2 most common causes

Knee pain running is common. With the marathons in London and Brighton we’ve seen an increase in people coming into our clinics with knee pain associated with running. The 2 most common causes of knee pain in runners are “Runners knee” and ITB syndrome. In this posting we’ll talk about runners knee pain, what it is and how to treat it. Next we’ll do the same for ITB syndrome.

Runners knee

“Runners knee pain” is more correctly termed patella femoral syndrome and can affect as many as 1 in 4 runners. The symptoms are typically pain under the knee cap and around the front of the knee and used to be called chondromalacia patella.

Anything where the leg is bending and straightening can become painful, particularly when weight bearing, and there may be creaking or cracking under the knee cap, a symptom termed crepitus. Of course running, particularly once milage when training for a longer distance event is increased is a common cause. Aggravating factors also include going up and down stairs, running, in particular up or down hill, leg extensions/quad strengthening in the gym, often sitting for a prolonged times at work or in the car for instance.

Cause of Runners Knee Pain

The causes of runners knee are related to the anatomy of the area. The underside of the patella (kneecap) has a ridge which slides along a narrow groove in the femur (thigh bone). Every time you bend and straighten your knee the patella slides up and down the groove. Trouble can start when your kneecap moves out of its track or groove and rubs up against its sides causing friction. This is called patella misalignment or maltracking. That it becomes painful when you run is not surprising when you realise that there are on average nearly 1000 steps per mile.

Common things that can cause misalignment and how to fix them are:

  • Quadriceps imbalance: This is perhaps the most common cause of runner’s knee. The quadriceps muscle on the front of the thigh is made up of four parts and running strengthens the outer part more than the middle part, thus the patella is pulled out of alignment. This usually resolved with some specific rebalancing exercises for the muscle group.
  • Foot instability: Often your feet imbalanced every time they hit the ground, and you’re feeling the constant pounding and repetition of this mistake in your knee. Over pronating, which means your foot is rolling in too much when you run, is the most common type of this, something that is often associated with fallen foot arches. A combination of orthotics (these are special insoles; at Sundial we use Superfeet orthotics) for your running shoe and exercises is usually enough to rebalance and stabilise the foot. You should also have your running analysed to make sure your shoe is the suitable for you. For more on orthotics and running go here.
  • Tight muscles at the back of the calf or thigh: If the calf muscles are tight the foot will have to pronate further when running or walking causing an increase in rotation at the lower leg bones, if the hamstrings are tight when running or walking the knee is not fully straightened, this also means the foot has to roll more into pronation. Both of these can cause patella misalignment and are treated with specific stretches and rebalancing exercises.
  • Gluteus medius weakness: One of the muscles that make up the buttock, it often relatively weak in runners. If the gluteus medius is not strong enough the upper leg rotates inwards and causes an unequal pull of the patella over its groove. Again, some specific strengthening and stretching exercises usually resolve this.

In addition to the specific treatments for each cause there are a few other things which also help resolve runners knee.

  • Ice: Wrap a cold packs around each knee, with the pack at the front for about ten minutes, a few times a day to bring down the swelling. Make sure the cold pack is wrapped in a thin cover to avoid cold burns!
  • Rest: Not what a runner wants to hear close to an event, but where possible, stopping or decreasing your running will help then problem settle whilst treatment takes effect.
  • Laser treatment: This is useful in reducing the inflammation around the patella and encouraging faster healing
  • Taping: Specific taping techniques, particularly kinesio or Rock taping, something our physio Quentin specialises in, can help straighten the pull of the patella
  • Running/gait analysis: Many running shoe shops offer this and it’s a good way of screening your running for problems and also seeing if your shoes are suitable for you

If you would like a check to see if you have runners knee then call us for our free Runners MOT with our physios or chiropractors.

How to prevent running injuries? – Runners MOT

Knee pain, muscle strain, tendon pulls, bursitis, ligament sprains and all sorts of other aches and pains are a constant reminder that marathon training and actually running it can be a hazardous business. One in five people who enter for the Brighton Marathon will not complete it because of injury. We aim make sure you are not one of them.

For the next few weeks we are offering a free Runners MOT especially aimed at runners in the Brighton Marathon and the half marathon. We want you to be fit, strong and ready to run.

Our physios will check you out top to bottom concentrating on your footwear and leg and foot movements. We will check all the usual things like over-pronation but also things that often over-looked like jamming of the hinge joint of the ankle which changes stride length. We will look at knees, hips and backs too. At the end of our Runners MOT you will have an in depth risk profile of the likelihood of future running injuries and a plan for prevention.

So don’t let a niggle turn into a pain, call to make an appointment.