Here are the runners who braved 50 mph winds to complete the Brighton Half Marathon 2020. Sore but proud! Thanks to the fantastic physio students and massage therapists who took care of the runners.
Here are the runners who braved 50 mph winds to complete the Brighton Half Marathon 2020. Sore but proud! Thanks to the fantastic physio students and massage therapists who took care of the runners.
Running 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 Grand 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 Brighton Half Marathon. We want you to be fit, strong and ready to run in support of the Sussex Beacon or whichever charity you might be supporting.
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.
First off, it is important to establish exactly what is causing the problem and exactly what type of Achilles pain you have. There can be several other reasons why you may be getting Achilles symptoms, but for the purpose of this article, we will concentrate on the most common.
Recent studies have shown that injury rates are as much as 29-58% in new runners. It’s also estimated that 60-70% of running injuries are due to overuse or training error.
In other words, don’t just concentrate on the painful point! Rehabilitation from an injury can be complicated and unless you’re addressing the root cause of the problem, it’s likely to come back! This is why seeing a physio can be useful: we can help you to understand the reasons for your symptoms and help you address the imbalance and weakness which may lead to injury.
Mid Portion Achilles Tendinopathy
The most common cause of Achilles pain is mid-portion Achilles tendinopathy. This commonly affects the Achilles 2-7cm above the bony point at the back of the heel. Typically, this is likely to appear swollen, be tender to touch and will often cause pain and stiffness first thing in the morning and when weight-bearing.
Insertional Achilles Tendinopathy
This condition is less common but still a prevalent problem that I see in the clinic. The key difference between the two is that mid-portion tendinopathies are commonly caused by tensile loading and insertional tendinopathies are caused by compression.
The main presentation for the insertional kind is a pain at the heel bone where the Achilles attaches and pain with the ankle flexed to stretch the tendon i.e. the position of the foot when walking up a steep hill. This position of the foot is what causes the compression and aggravates the symptoms – and why exercises that exacerbate this should be avoided!
Below I will outline the best way to manage these conditions, along with links to some self-help videos for exercise and pain management. However, it’s probably worth mentioning at this stage that these are only to be used as a rough guide and if you are unsure about your condition please book yourself in for a physio consultation. The first appointment is free! And it may help you avoid getting it wrong and potentially delaying your healing time.
Now that you have a rough idea of why you have tendinopathy, you now need to figure out what stage of tendinopathy you are dealing with. To avoid going full physio geek on you, we’ll keep this simple and concentrate on two phases of tendinopathy, the first being the reactive type and the second being the degenerative tendinopathy.
Phase One – Reactive Tendinopathy
Commonly caused by an increase in loading exercise, for example trying to run faster or further than you’ve ever done before…we’ve all done it! This will typically cause pain during or after the activity and may be exacerbated first thing in the morning or during weight-bearing activity.
The key to your management at this stage is to reduce the load that you’re putting through your Achilles and try and calm the symptoms down. It’s pretty simple: if you carry on doing the same thing at the same pace and effort then you are likely to make it worse!
Phase Two – Degenerative Tendinopathy
At the tender age of 41 and having played sports for most of my life, sadly I would fit into this category. In fact, I would say it is almost normal to have a degenerative tendon somewhere in your body if you’ve been active for most of your life, especially with high impact sports such as running, football, netball and basketball. So do not fear – this is common!
Basically, if you’re older and have a previous history of Achilles pain and a grumbly tendon that is prone to flare-ups, it’s likely that you will also fit into this category. The typical presentation is a thickened tendon, which is painful to touch and is often sore first thing in the morning and during weight-bearing activity. Again, load management is important. If you keep aggravating it, there is potential to make the situation chronic and potentially lead to a partial or full Achilles rupture.
It is also possible to have a reactive, degenerative tendon. An example of this would be a 60-year-old man who has a history of Achilles pain with symptoms which have been under control for several years, but a recent increase in tennis has caused his degenerative tendon to become reactive. If this is the case with you, then start your management at the reactive phase i.e. reduce the load, pain management, rehab exercises then graded return to activity. Tendons are complicated and there is no one recipe for treatment. Finding the right treatment is an important part of your recovery.
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 marathon 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.
Sundial 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
“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
Depending on the severity of your injury you may want to use a brace, tapping or in more extreme circumstances casts
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
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.
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.
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!
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.
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.
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.
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.
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 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.
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.
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.
If you have any queries or want more help then book in for a free Runner’s MOT.
Next: Do I need orthotics?
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!
Shin splints 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.
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.
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 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.
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:
In addition to the specific treatments for each cause there are a few other things which also help resolve runners knee.
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.