The science of pronation

This week we're very lucky to have the wise words of fellow Physio James Cruickshank as our guest blogger…

This whole world is new to me. I was introduced to the ‘blogging’ thanks to reading some interesting and well written pieces by Tom, the owner of this blog. The articles he writes combine literature expertise with clinical knowledge, providing information both easy to understand and practical. When Tom asked me to provide information for his blog, I didn’t know why or what to write, but I was very excited to be involved.

So who am I? I trained in Aberdeen completing both my BSc in Sports and Exercise science and then my MSc in Physiotherapy. Previously I had dreams of playing football professionally, until it was curtailed by a serious leg break…..which was later to pave my career path into sports rehabilitation. I have a fantastic enthusiasm for rehabilitation, for getting people back to what they love. There is no better feeling than getting someone to run a PB, swim a length in a pool or bowl an end of lawn bowls……or even put on a pair of socks on their own.


I currently work for the NHS in Grampian, specialising in MSK (muscle and bone injuries) rehabilitation and also for a private hospital. Outwith work, I love the outdoors……if it involves adrenaline, slopes, gadgets, risk, weather and my buddies, I am there. I board, I climb, I ride, I run, I swim (not very well), I golf, I fish………..I can offer advice, hints tips on any of these areas but more importantly I love to hear what other people are thinking about all these sports so if you get a second follow me so I can read your point of view (@cruicky_05).


So enough of the shameless plug and back to the mighty job in hand…..keeping up to Tom’s High standards…The latest debate that I was interested in was one on over pronation and should we correct it, so I thought I would do a little bit of an article on this……these are my own points of view and opinions so direct questions and debates towards me, I love answering questions……



Addressing and Correcting Overpronation to Decrease Joint Stress


We all know that the foot and ankle complex is extremely important to the overall function of the human body because it is the only structure that interacts with the ground while in an upright position. The foot and ankle complex is directly responsible for the distribution of weight and pressure throughout the body when the forces of kinetic energy, gravity and the ground collide (still can’t say that word out loud without thinking how Matt Cardle murdered a beautiful BiffyClyro song). Therefore, it is imperative that the foot and ankle complex is fully functional and doing its job correctly to ensure that the force of gravity is properly dissipated throughout the rest of the body.



Common Problems in the foot and Ankle Complex


One of the main postural deviations that cause pain and injury in the foot and ankle area (and resultant compensations in the rest of the body) is overpronation.

Pronation is a normal function that occurs when the foot rolls inward toward the midline of the body. This movement causes the heel to collapse inward and the medial arch of the foot to elongate and flatten. Overpronation, however, is when the foot collapses too far inward for normal function.Consequently, this directly affects the ability of the foot to perform and can disrupt proper functioning through the entire body.

In addition to problems overpronation causes in the feet, it can also create issues in the calf muscles and lower legs. The calf muscles, which attach to the heel via the Achilles tendon, can become twisted and irritated as a result of the heel rolling excessively toward the midline of the body. Over time this can lead to inflexibility of the calf muscles and the Achilles tendon, which will likely lead to another common problems in the foot and ankle complex, the inability to dorsiflex. As such, overpronation is intrinsically linked to the inability to dorsiflex.


Pronation is Good, Overpronation is Not


The foot and ankle complex needs to pronate to make the muscles of the hips and legs work correctly. Many muscles that originate from the pelvis attach to both the upper and lower leg. For example, the gluteus maximus and tensor fascialatae (TFL) attach to the outside of the lower leg via the iliotibial band, while the abductors attach to the outside of the femur. When the foot pronates, the whole leg rotates inward toward the center line of the body. This inward rotation pulls the attachment of the glutes, TFL and abductors away from the origin of these muscles up on the pelvis which creates tension. Similarly, the muscles of the lower leg such as the peroneals, tibialis anterior and tibialis posterior originate on the lower leg and attach to the underside of the foot. When the foot flattens out, as it does in pronation, this pulls the insertion of these muscles away from their origin on the tibia. This action also creates tension in the muscles.


To better understand how the muscles and tissue structures in the feet, ankles, legs and hips are adversely affected by overpronation, imagine a person on the end of a bungee cord jumping off a bridge. If the bungee cord gets the right amount of tension on it as the person nears the ground, then he/she will be saved from smashing into the earth. However, if the bungee cord does not pull tight because it is twisted or has no elasticity, then the person will impact the ground with dire consequences (I love the outdoors, but wouldn’t wish to be that close to it J). The muscles, tendons, ligaments, and fascia of the legs and feet are the body's bungee cords. If these bungee cords work together, they can protect the joints of the feet and ankles from excessive stress, and prevent muscle and tissue damage caused by overpronation. If they do not work properly, a person will be able to see evidence of this in the feet and ankles, particularly in the alignment of the joints.


In addition to controlling forces down through the joints, the body's muscular “bungee cord system” also stores energy that can be used to create strong, powerful movements as this energy is released, much like the forward propulsion of the legs when walking. However, if a person overpronates, the energy stored in the “bungee cord system” is lost, preventing the body from taking mechanical advantage of stored energy in the muscles.


The Big Toe Breaking Mechanism


When weight is transferred correctly through the foot and ankle, the foot should strike the ground on the outside of the heel. Then, the foot and ankle should pronate to load the muscle “bungee cords” and create a powerful release that enables the foot to supinate and transfer weight over the front of the toes. When a person overpronates, however, their body weight continues to collapse toward the midline of the body. So instead of supinating and using the lesser toes to transfer and dissipate forces, the full weight of the body passes through the first joint of the big toe. This is why bunions and calluses are located on the inside border of the foot. They are usually caused by chronic overpronation.


Fortunately, the big toe can act as a break to stop the foot from collapsing too far inward (overpronating). If muscles are used to pull the big toe down into the ground, it creates tension in the arch of the foot and prevents the foot from overpronating. However, people that overpronate have other muscles of the lower kinetic chain that are weak. So, it will be necessary to address the muscles of the big toe in combination with other dynamic exercises to keep the muscle “bungee cord system” fully functional and working together as it should. (so the twitter trend by @AdamMeakins where he suggested we include the assessment and treatment of the large toe is founded and should be included in all lower limb biomechanical assessments. The second point, should we correct over pronation, I believe will be answered in my piece.)


Visual Assessments for the Foot and Ankle


To easily get an idea of whether a person overpronates, look at the position and condition of certain structures in the feet and ankles when he/she stands still. When performing weight-bearing activities like walking or running, muscles and other soft tissue structures work to control gravity's effect and ground reaction forces to the joints. If the muscles of the leg, pelvis, and feet are working correctly, then the joints in these areas such as the knees, hips, and ankles will experience less stress. However, if the muscles and other soft tissues are not working efficiently, then structural changes and clues in the feet are visible and indicate habitual overpronation.


The following clues indicate overpronation:

My favourite toy, I mentioned I like gadgets, is to be the BOSU trainer. I use it in my training and incorporate it into so many rehabilitation programmes. It is a wonderful piece of kit so if you don’t have one get one, if you don’t use it use it!!!!!!!! Lecture over!


Using the BOSU Balance Trainer to address Overpronation


The soft, dynamic surface of the BOSU Balance Trainer dome surface is ideal for training the foot and ankle complex to load into pronation without collapsing into overpronation. For beginners, the dome can be inflated so that the surface has less movement. Alternatively, deflating the BOSU allows the foot to move more dynamically, creating an even greater challenge of trying to avoid overpronation when performing the following exercises.


Exercises (pictures courtesy of BOSU.com)
The following exercises help retrain the foot and ankle complex to correct overpronation. Exercises may be performed while wearing shoes, or for an even greater challenge, in bare feet.

Conclusion


So is overpronation good, bad or indifferent? IMHO (getting down with the lingo now) I feel that yes there is a degree of overpronation secondary to our lifestyle etc, but I do feel that to optimise strength, explosive power, endurance and basically anything to do with characteristics required to perform sport I think it should be assessed. With the everyday recreational runner, looking to complete 5km 10km runs I would focus on the biomechanical make up that prevents injury and ensuring footwear supports, gastrocnemius and soleus and the rest are at a length that allows optimal shock absorbing…..but fortunately our minds get tested further, when the elite athlete comes in….should we treat over pronation? is it beneficial to change the bottom of the chain and risk putting the rest out of sync…..it’s true ”if it’s not broke don’t fix it” or “if you change nothing, nothing changes” but surely if elite athletes are pushing for changes to the level of 0.01s then I believe that if you don’t recruit all the “bungee’s” potential you won’t achieve these marginal improvements……it’s not life or death but could be “gold” or “silver” which is worth a lot more……………………………….

Thanks for reading, hope its ok and makes sense, if not at least it filled my day off work….four days till I get to the big 3-0 and filling my days off getting excited about big toes….it doesn’t get any better J!


Pea Suit


James

 

 

 

Adapt and Overcome – by Anji Close

Anji is a club runner for Tyne Bridge Harriers who has very kindly agreed to share her injury story with us. What shines through is her determination, positive attitude and commitment to staying fit, which she did largely through aqua training. For more information on this, visit Anji's blog where she has details of training and videos of deep water running. Now it's over to Anji…

When I signed to my club Tyne Bridge Harriers in January this year, I had no idea how my first year in my black and white vest would pan out. I raced as a TBH only 4 times before being struck down with a serious injury, and at time of writing I haven’t run in almost 4 months. Here is my journey.

After recovering from a stress fracture (left cuboid) in early 2011, running became my life. I had been out for 10 weeks and during that time I swam twice every day, read nothing but training plans and came back knowing that I just couldn’t be without running in my life. I completed my first half marathon in September 2011 and became addicted to the buzz of racing, but often carried niggles particularly in my feet and ankles. I ran with the motto “Determination Is Everything” and never let myself feel beaten. At the end of 2011 I had set a new 10kpb by over 4 minutes as well as running my first 5mile race and my first multi-terrain 10k.


Signing to Tyne Bridge gave me more confidence and joy in my running than I had ever had before, and I’m first to admit this new vigour led me to massively increase my mileage to feed my addiction. I had entered masses of races and felt I really wanted to prove myself in the ladies team. New pain in my right foot leading into my first ever relay race in February 2012 led me to run awkwardly and during training in early March, I found myself with new severe pain in the left. I stopped running for a week or so and saw physio who diagnosed a ligament sprain in early April following an incredibly painful 10k and a niggly half marathon all in the same week. Looking back, I did everything wrong. At the end of that 10k I couldn’t walk at all and I knew something was seriously wrong. Again, I took a couple of weeks off running and returned with hope that I would make it back for my race of the year, the Manchester 10k which I was running with my coach pacing me for what would hopefully be my first sub-45.


My few runs in the interim were niggly and ended in loads of pain again, and my frustrations led my GP into recommending I had an MRI scan. The scan results came back on May 15th(the week of Manchester) and confirmed that I had two acute stress fractures in my left heel as well as evidence of a healing fracture in the fourth metatarsal on my right foot. I was devastated. I just had no idea how I was going to cope with a long period out again. The MRI images were sickening and I spent quite a long time over the following weeks just looking at them in disbelief.


I saw three orthopaedic specialists in that first week and all of them thankfully agreed that I wouldn’t need to wear a cast. Instead I was given crutches and a walking cast “moon boot” and ordered that I couldn’t weight bear or even cycle for the first month. Heel fractures are treated like an egg shell where one crack can lead to another and they told me this could go on for up to 12 weeks. The first weekend I was in the boot I travelled to Manchester as my accommodation was already paid for and I was determined to still be there for my coach who was now going to run it sub-45 just for me. I had an extremely emotional day but I managed to meet one of my running heroes Nell McAndrew who was wonderful and very supportive about my injuries.

Week 1


What happened next was a true cruel twist of fate that was to shape my rehab and recovery over the following few months. My coach and running buddy Rob came through the finish looking laboured and in pain, went missing for ages in the medical tent area and eventually came through in sheer agony. It is still hard to believe but the following day back at home, Rob was diagnosed with an acute stress fracture in the same foot as me. Now if you’re going to be injured with anyone, best be someone who already knows all of your moans and demands in training. Together we researched rehab options and following a few recommendations from people at the club, embarked on an aqua running programme. I had recently passed my Leadership in Running UKA qualification and decided to have a go myself at adapting an aqua running plan I had found online, as well as seeking advice from marathoner Aly Dixon who had previously been out for a long period with fractures in her foot and remained strong by using pool work. The plan was epic and included “long runs”, pace work, interval sessions, pyramid sessions and daily swimming or gym work focusing on upper body or core. The sessions were designed to mimic what you would do on the road as well as raising heart rate and keeping the legs strong. Deep water running using a floatation belt is often used by athletes when injured or for cross training, and at that stage it really was our only choice.

Week 6




I’d be happy to share the plan I created with anyone reading this, but there are several good ones online worth looking at if you are going to be out for a while. My plan comes with something of a health warning. An example week would look like this:


Sunday: Pace session of 2 sets of 7×1:30 hard with 30 sec recovery

Monday: Interval session of 2 sets of 6×2:30 hard with 30 sec recovery

Tuesday: Long Run of 60 mins steady aiming to do a mile

Wednesday: Pyramid session 1min up to 5mins hard and down to 1 again

Thursday: Rest (gym work only)

Friday: Block session of 6x 5mins hard

Saturday: Swim only.

NB: All sessions include at least 5min warm up and cool down of steady steps.

‘Hard’ is aiming to get to high cadence of 180steps per minute.


The plan was progressive and led into sessions of almost 70mins with 60 at high cadence.

Aqua running became our new addiction and the burn in the quads as well as weekly photographs of my legs (!) showed us that it was working. The high cadence of 180 was initially a challenge but once it clicks it becomes natural and we now regularly finish the sessions with a minute “race” in which my PB is 227 steps with Rob’s at an epic 241!


Now I’m not going to lie to you and say that it has been easy. Aqua running can be soul destroying. Its tiring, the constant cycle of getting in and out of the pool (some days twice) 6 days a week with a very uncomfortable belt on has led to several quite explosive arguments between Rob and I, I have cried in the pool and on two occasions I have got out, taken the belt off and said “I cannot do this today”. It’s hard to keep focused sometimes when you have no way of really knowing if what you are focusing all of your energy, time and often money into is actually even working. But we supported each other and as we are coming to the end of the 9 week programme, we agree we are glad we’ve done this together.When we finish the plan this week we will have done 48 aqua running sessions and only one of those was apart.


Now the big question. DOES IT WORK?

Following a few setbacks, I am still partly using crutches and not cleared to run. My heel still swells every day and can be painful to walk on. I can cycle and I’m beginning to use the cross trainer, and I know that I’m nearly at the end of this awful time. Rob however is a different story. His fracture is almost fully healed and he is running a few times a week now, and FAST. Rob tells me the high cadence his legs are used to in the pool has translated now to the road and this style along with how strong his legs are now has led to fast miles and in his first race back, a 2mile handicap race at our club he recorded a new PB of 12:16. He inspires me all the time and keeps me believing that I will come back stronger and faster.

Anji and Rob

 

It’s 16 weeks today since that 10k which I finished unable to walk and for almost 11 of those weeks I have been on crutches. It has been one of the worst periods of my life and at times I have thought frequently that I will have to give up on the only thing I have ever really loved. I have taken myself away from the running world a few times and I have shut people out who I felt wouldn’t understand. I absolutely can’t wait to run again. I have ended up missing Sunderland 10k, Manchester 10k, Potters Half Marathon, Bridges of the Tyne 5 mile road race and the Great North 10k, and I’m slowly making peace with the fact that I probably won’t be ready for my beloved Great North Run on September 16th. I have remained an active part of my club, working for our Twitter page @tynebrharriers as well as working on registration and results for our inaugural road race at the start of July. I also recently worked as a marshal for Great Run and the GN10k in Gateshead. It can be emotional knowing I was meant to run, but the rewards have been immense. Whilst injured I have met Nell, Aly Dixon, Steve Cram, Sally Gunnell, Gemma Steel and Scott Overall, all through being part of races I was meant to run in, and all of them have signed my unused numbers so that I wouldn’t be tempted to burn them in a fit of frustration.I would urge people with long-term serious injuries to remain involved in racing wherever they can.


I really believe in the phrase “Run the mile you’re in” and not to look back or forward. It just so happens that this particular mile has been long, painful and frustrating. But it won’t be long now, and I just can’t wait.

Determination Is Everything.


You can follow Anji on Twitter; @enigmagirl81. Tyne Bridge Harriers are based in the East End of Newcastle, if you fancy joining them, you can do here.

 

 

Mental Health and Running – Liz’s story

This post is the first in a series of articles on RunningPhysio looking into mental health and running. It's a huge topic in the running community and many people run to help their mental well being, so we are very lucky to have Liz to share her story with us. Liz is a blogger in her own right and has a fantastic blog which I have to admit is one of my favourites, you can also follow her on Twitter – @4races4cities. It's a very personal story but one I'm very glad she felt she could share with us…


Twelve years ago, my Mum took her own life.

Initially, I wrote ‘my Mum killed herself’ at the end of that sentence, but I deleted it. ‘Took her own life’ sounds warmer somehow, doesn’t it? It’s less harsh, and those black words seem less stark against the white background of this blog post.

I’ve spent a lot of time writing about my Mum, mental illness, and the charity fundraising I do for Mind. You can read more about it all here.

I have spent less time, however, writing about my own personal struggle with mental illness. When Tom asked me to guest blog for him, I wasn’t sure what to write about. My own running blog is quite light-hearted and a bit silly, so when Tom suggested I write about the affects of exercise on depression and anxiety, I realised that it would be a good opportunity to share my experiences, in the hope that it might strike a chord with someone out there.

Anxiety has been part of my life for a very long time. The grief surrounding my Mum’s death was channelled, not through crying and pining, but through severe anxiety, culminating in terrifying panic attacks and OCD. I saw different types of therapists and was prescribed strong anti-anxiety medication, at one point I was very nearly sectioned under the Mental Health Act.

Nothing worked.

Years passed by, and I just learnt to live with my mental health problems, I became a shadow of the person I was and lived half a life – anxiety and OCD clung to me tightly, suffocating my every move, and I couldn’t shake them off.

You’re probably wondering why I’m sharing this on a physiotherapist’s blog, right?

Perhaps you came here to read a post about IT band pain, or curing your plantar fascitis, or find specific exercises to strengthen your leg muscles.

You’re probably a runner.

Well so am I.

I haven’t always been a runner. Running kind of crept up on me two years ago, in the midst of the heartbreaking end to my eight-year relationship. My anxiety levels at the time were sky-high and I was struggling to cope. I don’t know what provoked me to put on my trainers and go for a run.

I guess I didn’t really know what else to do.

So I just ran.

I didn’t go far, only up to the end of the street and back, but it was enough, enough to quell the panic that rose in my chest and quieten the racing thoughts that darted back and forth in my mind. My heart rate soared, and yet instead of culminating in a panic attack, the way it always did, I felt euphoric and alive.

The next day, I laced up my trainers and went out for another run, this time venturing a little further. I had taken part in a 5 and 10K race in the past, and knew that my legs were capable of covering a longer distance, so I just kept going. I think I ran about 5K in total, but it could well have been 26.2 miles. I felt strong, capable and empowered. Again, I returned home exhausted but elated. My anxiety levels seemed to lower and I felt like my head was clear for the first time in years. Running seemed to distract me from the cycle of worries that fed the anxiety – something really resonated deep within me, and unlike my past forays with running, this time it stuck.

I noticed a local half marathon advertised on a lamppost, which I saw when, yes you guessed it, I was out running. I impulsively signed up for it, knowing that I would have to train hard. I scoured the Internet for half-marathon training plans, and bought myself a pair of proper running trainers, clothes and a Garmin GPS watch. My days were arranged around my running schedule, and I constantly read books and magazine articles to garner tips and advice on becoming a better runner. Weeks went by and I started to feel so much better, I lost weight and began to pay better attention to the way I fuelled my body so that I could run faster and for longer. Most importantly, I slowly felt the powerful grip of anxiety releasing its hold on me.

My attitude towards the way I viewed myself also started to change. I had always thought that I wasn’t capable of doing things; I’d spent so many years hiding in the shadows, too afraid to step up and challenge myself, and yet here I was, training for a half marathon on a whim and pushing my body and mind to places I’d never been before.

There were days when I wanted to give up.

I’ve lost count of the amount of times that I would sit under a tree in the local park, part of my running route, head in hands, crying with frustration. Running challenged me in ways that I’d never experienced – it pushed and prodded and hurt and dared me to run further, faster, and harder. It would have been so easy to just bail, let myself be beaten, but I didn’t. I wouldn’t allow it.

I don’t quite know how running relieved me of the years of suffering with my personal demons; there’s been a lot of research over the last few years, and scientists aren’t quite sure either. All I know is that it worked for me. These days, I am free from anxiety and the panic attacks, and I can honestly say that I am the happiest I have ever been. My life is filled with enriching experiences, energy and laughter. And running.

It’s all about the running.

Stunning views, escapism and “care in the community”

The last couple of weeks things have really come together for me and RunningPhysio. We've now had over 12,000 lovely visitors including nice people from the US, Canada, Brazil and Vietnam. I've had a chance to chat to some of the online running community including @4races4cities who has one of my favourite running blogs and @_mattdunn who did an awesome guest blog.

It's really good to see people benefitting from the blog, that's what it's there for! And some of the comments we've had have been so nice, thank you to everyone for that! As a Physio there are few things more satisfying than seeing your treatment work. My patients don't get to see the hugely geeky “victory dance” I do as they leave the department! In the last 2 weeks I have 2 patients in particular that come to mind. 1 with achilles tendinopathy that was told he shouldn't run again and is now running pain free. And another who has returned to running, football and cricket for the first time in 9 years. Both still have some rehab to do to keep things going but I'm delighted for them.

My running has taken off again too and my mileage is coming up nicely. Yesterday I ran a cheeky half marathon along Brighton cliff tops. 13.1 miles in just under 1:44 – not bad for a training run. And I burned off over 1700 calories which is around 10 pints of Guinness. It's a shame my Garmin watch doesn't display pints per mile or fry-ups per hour, I'd find that hugely motivating. I can see it now, glancing at my watch and thinking, “5 more minutes running and I can have an extra sausage tomorrow!” Dont get me wrong, I'm not too worried about my weight it's just I love to eat. Really love it. Running helps me eat virtually what I like, it's a big part of why I run (hence the slogan above, “later I shall have pie”).

I've talked about why I love running in Brighton before, the characters in Brighton are amazing but yesterday it was all about the views. I did an “exploratory” run. One of my favourites, you start on an established route and see where you end up, you never know what you'll see. I was running up steep hills, overlooking a stunning blue sea in the shadow of a paraglider floating by overhead. I descended to a cliff side walk way, sea on one side, towering white cliffs on the other and hardly a person in sight.

@runningokinuk hit the nail on the head with his recent blog about trail running. As he put it “total escapism” and what a place to escape to!

It's all part of what makes running amazing, but I think the community we run in is a huge part too. Look at all the wonderful blogs and forums, the support people offer each other, the stories we share and the good people do for charity. There is a great deal of care in our community.

That brings me to my final thought, there are a lot of really nice runners online, why not say hello and read about their adventures…? Here are just a few…

@4races4cities Liz has an excellent blog and raises money for Mind

@_mattdunn an Ultra Marathon runner with a great blog raising money for the Brathay Trust

@runningokinuk Ian did his first half marathon in 1986! Great blog of his news, views and reviews.

@afxonline Matt's a creative innovator when not on Daddy Duty! Very knowledgeable chap too!

@ThePhysioRooms Mike's a top Physio, runner and tweeter of all things useful!

@jogblog Cathy's blog is one of my favourites, a runner with a cracking sense of humour!

@runwestyrun marathoner, triathlete and a fan of cake! Top blogger too!

@runblogger Pete is regularly mentioned here on RunningPhysio and rightly so. Fantastic blog.

@carlawalakoala Carla has been a big supporter of RunningPhysio, she's a runner aiming to raise £1 million for the British Heart Foundation. That's right £1 million. Amazing.

@cmmercer Strongman, marathoner and banaphobic blogger!

@SP_Physio fellow Physio and soon to be guest blogger on RunningPhysio

If you'd like to add your name or blog to this list, pop it in the comments section!

 

 

Matt’s story – 10 marathons in 10 days

RunningPhysio has a real treat today – a great story from ultra marathon runner Matt Dunn (@_mattdunn) who attempted the infamous 10 in 10….


The Brathay 10 Marathons in 10 days (aka 10 in 10) is an event I’ve followed for the last few years. It consists of a full marathon (26.2 miles) starting at Brathay Hall near Ambleside and doing a complete circuit of Windermere, England’s largest lake – every day, for 10 consecutive days. I remember following it for the first time in 2009 and thought it was something I’d never be in the position to contemplate doing. Fast forward to 2011 and the event took place whilst I was training for my first 100 mile ultra marathon, and I found myself applying for a place in the 2012 event.

At that point I had only been a runner for 4 years, but I was already a multi-marathoner and had also run a few ultra marathons and the training for the 100 miler got me in pretty good shape. I started planning races – I needed lots of marathons and some back to backs. The obvious one was the Enigma Quadzilla in early February – 4 marathons in 4 days. I initially had some trail races (inc. ultras) in my list but somebody quite rightly pointed out that I still hadn’t done many road marathons and I should plan more of those in ahead of the 10 days on the roads in the Lakes. I ended up fitting in 15 marathons (only two off-road) in between the NDW100 in August and the 10 in 10 in May, plus a couple of HMs and 20 mile races.

As well as planning my training, I had a big job on to raise funds for the Brathay Trust, the charity who organise the 10 in 10 and the Windermere Marathon. Brathay are a small charity who work with underprivileged children and young people around the UK. The other runners and I agreed to raise sponsorship as part of our contribution to improving the lives of those young people who are most disadvantaged or vulnerable. As a bit of a social media nut, I spent a lot of time using Facebook and Twitter to promote what I was doing and I was lucky that the running community are so generous and I was able to raise a lot of money through those channels.

In mid-Jan, we all headed up to Brathay Hall for a “training weekend”. Train up on Friday, lots of sessions going over logistics, fundraising, media and filming, health and safety, nutrition, physio and so on. Oh, and a quick 5 miler on the Friday as soon as we got there, ran the whole course on the Sat morning and then a 5 mile recovery run on Sunday morning as the sun started coming up. It was great to meet all of the other runners and the Brathay and BodyRehab (physio) teams. The advice we received from Graham at BodyRehab was quite blunt – basically we shouldn’t be trying to do this – there will be injuries. Hmm. Running the course was great – it was cold but sunny and the lake and surrounding countryside looked stunning. However I was a little concerned about the course – I knew it was a tough course but 3:52 (including stops for drinks etc) felt much too much like hard work for a training run.

Fast forward to May.. an average of 200 miles per month Jan-Apr in my legs and only one injury; a self-inflicted ingrown toenail. Was it enough mileage? At the time I wasn’t sure, but it was what I’d been able to do. I’d consciously not ‘raced’ marathons so far in 2012 and instead concentrated on fuelling and recovery which had gone really well, but left me unsure as to how to pace things. A sub-90 HM at Reading in April did boost my confidence in that regard though. Fundraising had been a constant stress but had gone well and I got up to Brathay on May 10th with no injuries or niggles. Exactly as planned. My high-mileage, low intensity training and regular sports massage had got me into decent shape.


The Thursday afternoon/evening saw us get settled into our new home, Shackleton Lodge – a hostel style cabin in the woods near Brathay Hall. I was sharing a room with Paul Dewar (landlord of pub in nearby Ulverston), Paul Foster (Scottish bloke, likes to swear) and Jim Meta (Scottish bloke, purple beard, definite Billy Connolly stuff going on). Great lads. Then followed the first bash at getting drinks ready for the first marathon. There are 12 drinks boxes put out on the course, roughly every 2 miles or so. We had big containers of hydration and energy drinks available to us (in ‘Wild Berry’ and ‘Orange and Passion Fruit flavours), supplied by Team Nutrition, as well as water or anything we wanted to bring for ourselves. I rarely use energy drinks but I’m a big fan of hydration drinks such as high5 zero. When it comes to racing, I don’t get too hung up and generally use what’s available on the day, and that goes for gels etc too. So I made up a selection of drinks, got myself thoroughly confused and basically hoped for the best. I didn’t think I’d need something every 2 miles but in the end decided that if I didn’t need it, it wouldn’t hurt if it was there just in case. We had a get together to go over some logistics again and a lovely dinner with the Brathay CEO and trustees, and the legendary fell runner Joss Naylor. And then a beer in the bar. I was pretty nervous, but I don’t think I was alone!


Friday morning started for me at 7:30. After a quick shower and brekkie I headed off to get started on a research study that was taking place – half of the athletes were to have posterior chain power taping (taping entire “movement chains” to reduce fatigue and enhance muscle activation) daily and everyone was to be measured by a machine whilst performing squats, balancing etc, twice a day (before and after each marathon). I think the idea was not only to see how the daily marathons affected our posture, balance, flexibility, etc, but also to see if there was any major difference between those of us with the tape and those without. I got taped up, from each hip, across the lower back and up to the shoulders. It felt like a gentle bit of postural support – all good. We had a ‘media start’ where the groundskeeper fired his shotgun and we ran off as if starting the race, whilst being filmed for BBC regional news etc. I may have been a bit excited and ran off at the front! After that we ambled down to the road for the real start and off we went. I decided to run comfortably for day 1 and not to push the pace and ran for the first 4 miles or so with Keith, Lee and Foxy and then I pulled ahead a little. Somehow I finished quite comfortably in 3:44:21, second place and about 5 mins behind Sally. Then it was time to get into the post-race routine. We had a room in the hall set aside for us (the athletes room) and there was soup, sandwiches, crisps, recovery drinks and a couple of beer fridges, which we’d stocked up pretty well. After some food and a guinness, one of the bodyrehab team helped me with some light stretching and I was feeling good. It was then time to face the ice bath.. Fozzy (Paul F) and I shared the pain. The shock of the 2.6 degree water at first made me feel hot and dizzy and not at all good, but that passed. The pain of the water eventually started to pass as everything from hips down started to go numb. Somehow, with lots of swearing and gritting of teeth, we lasted the whole 10 minutes. Walking back to the hall with completely numb legs and feet was very odd, and once the feeling started coming back, my toes were killing me. By the time I had a nice hot shower though, I could already feel the benefit.


That evening I made a list of what drinks, gels, etc I wanted in each drinks box, which I stuck to for the rest of the event bar a few tweaks. Fab dinner (the food was amazing) and some treatment (massage, elbows in glutes, etc) and I went to bed.


Day 2 started with some treatment again which was a bit of a battering – I didn’t realise I was that tight. I didn’t really feel properly woken up and that together with some warmer weather set the tone for my run. It seemed so much harder than day 1, which was a little worrying with still 8 days to go. Had an amusing moment about 8 miles in when, at a drinks station, Aly (amazing Brathay lady who along with her husband Mac is basically in charge of the 10 in 10) asked if I wanted the top off as she held out my gel. I responded with a cheeky “just off the gel thanks” and a bit of a running joke was started! I finished 5th (by about 4 secs) in 3:52:28. That evening after treatment, dinner, etc, I went to the bar to blog and was joined by some of the others. A beer and two glasses of red and I was ready for bed!

Day 3 was much better. I got to the start line with two breakfasts in me and I felt somehow fresh. I used the first 4 miles to Hawkshead to see how things were feeling and I felt great and pushed on, passing Sally and taking the lead. I felt like I was flying around the course – the uphills weren’t bothering me and I let myself go on the downhills. It was very odd being at the front of a race, and from about 4 miles in. I finished really strongly in 3:30:36 and I was over the moon to win a marathon!

Day 4 was another good day – first home again in 3:33:23. Starting to get much tougher though, even though I put in another good time. By now the daily routine was well established – up, breakfast, treatment and taping, breakfast 2, get race kit on, assemble, run, eat, stretch, ice bath, dinner, treatment, bar. The evening blog/beer/wine contingent was growing daily also 🙂

Day 5 and a couple of nice surprises – some lovely photos from home and a care package from a friend in Scotland. The run felt much more like a race early on, with Sally and I passing each other a few times. I developed a bit of pain in my right knee which indicated a tight IT band – not a surprise at this stage. First again, 3:33:04. Three wins in a row which was incredible and not something I expected at all. The Brathay PR people published a story bigging up the competition between Sally and I – Sally was still ahead overall but the gap was narrowing. Neither of us found that particularly helpful – we were only halfway through and I think it added a bit of unwanted pressure. Treatment that evening was painful, and straight after a big dinner. More painful quad and ITB massage in particular. During a couple of particularly painful moments, when the moans and screams (and moo noises if you’re Rob) come out, I erm.. passed wind. Whoops, sorry! It was quite amusing though (for everyone else) – I was mortified.

Day 6 was a major wobble. I felt emotional and a bit fragile and Sally and I were interviewed before the race about our “battle” for the top spot. We both played it down brilliantly. I set off first at my now usual pace, but I felt like I was working harder than usual. It was a little warm which could have been a factor, but I didn’t feel like I could get my breathing under control. My quads were really stiff and my right knee started making itself known about 16 miles in and I think I started feeling a bit sorry for myself. About 19 miles in, Sally flew past me going strong. She had an army of support out on the course and they got to see her take the lead in style which was pretty cool. With about a mile to go I noticed Keith wasn’t far behind and I pushed on to hold onto second place, somehow putting in my fastest mile in 3 days to finish in 3:35:42. I really don’t know how I managed to hold onto such a good time on that day. I felt mentally and physically exhausted after the run, although some fish and chips that one of Sally’s supporters got for us perked me up. 


Day 7 came and I had made a decision. I was going to go out more steadily and lift the pressure off myself to try and win. I didn’t enter the 10 in 10 to try and win it, and I had already massively exceeded my own expectations of myself, so what was I trying to prove? It was cold and wet at first but I kept it as relaxed as I could and enjoyed the run much more. Not much after halfway, my right quad became really tight and painful and felt like it was going to go every time I went downhill. On the up side, I had some friends from my running club (UKnetrunner.co.uk) out in support and it was fantastic to see them. I finished fourth in 3:55:06 – much slower, but overall happier.

Day 8 and for a few days now sleeping had been getting more difficult. General tightness and soreness meant it was hard to get comfortable and then I’d wake myself up in pain when turning over. I felt a lot more positive though, probably due to the knowledge that my family were arriving that afternoon. The painful right quad of the previous day was behaving, although my left quad now started coming out in sympathy. It was Sally’s turn to have a rough day and Keith pushed on into the lead. I caught him at around 20 miles and passed him, finishing first in 3:37:31.

Day 9 and the end finally felt in sight. I’d tried a herbal tea before bed which helped get me off to sleep so I felt reasonably rested in the morning. I’d had acupuncture on my right quad the evening before which seemed to help, but by the morning my left ITB had really tightened up. Some treatment in the morning sorted that out and the bodyrehab team were in party mode – party bags and banging tunes at morning treatment. The run started well – Foxy led us out (he was reaching 1000 miles round the lake early on in the run) and I soon passed him and took the lead. Things went well until about 8 miles when the outside of both quads (IT bands really) got very painful very quickly. I stopped a few times to stretch my quads which didn’t really help – in fact it seemed to make things worse. By now we were all pretty exhausted and I wasn’t really thinking straight – I was trying to stretch my quads out when it wasn’t really my quads that were the problem at that stage. Sally, Keith and Paul D passed me. I saw my family at Lakeside and pretty much broke down in tears. I struggled on and Fozzy caught up – we ran together for a bit before he pushed on. Aly suggested that bodyrehab meet me further down the course for some emergency treatment which I thought would be a good idea. I got to 14 and a bit miles and they found me – Maz and Tamara (two of the amazing physios) got to work on some trigger point massage whilst I was sat on a broken slate wall on Maz’s car mats! That got me going again and the support out of the course was a real help too, including bodyrehab giving out jelly shots and party food on top of ice cream mountain at 21 miles. A very painful 4:22:43 and sixth place. Keith got his win which was really good – the overall competition was now between him and Sally.

Day 10 and up at 6 as our run was starting an hour earlier than normal. Lots of IT band and quad treatment and I got both taped up in cow print rocktape! Our normal quiet pre-race routine had been transformed into a frenzy of activity with hundreds of runners getting ready to run the marathon, starting an hour after us. We were led out of the hall to an amazing reception and had a huddle and a few inspiring words before walking down the drive to the start. Loads of people came to cheer us off – amazing! Off we went and after the excitement and noise of the start, it soon quietened down and I made myself settle down into a steady pace, not wanting a repeat of the previous day. I soon found myself in 5th place and made it my own. It was a much warmer day than we’d had for the previous 9 and I shed my compression top after 6 miles – much better. Twinges of pain in my legs came and went, reminding me to keep it steady. Somehow after about 12 miles, things started to loosen off and I gradually sped up. I got through the 4 hilly miles before Bowness and the lead runner in the marathon passed me just before ice cream mountain. By now I was on a mission – sub-4 had looked a bit of a stretch early on but now it was how much under 4 hours could I manage. At around 22 miles, the second place marathon runner passed me and he looked knackered. Pete soon passed me and had the other guy in his sights, passing him not far ahead of me. That was awesome to see and put a big smile on my face. I got progressively quicker over the last 4 miles and stormed up the Brathay Hall driveway, as I had done every day. I had the finishing straight to myself, my name being called out on the PA and loads of support. I loved it. 3:54:34. My family were at the finish and each put a medal around my neck 🙂 So, 37:39:28 overall and 3rd place out of 18. Approximately 3:45 on average.

I hugely exceeded my expectations, as did the event as a whole. It was mentally and physically very hard, but we were treated like athletes for 10 days and that was incredible. The few quiet moments we got in the athletes room after each run, or around the breakfast table at the lodge in the mornings, or in the bar in the evenings were really special. I got through this without much in the way of injury, but some of the others had some terrible injuries and still got through it. Amazing strength of character. I’ve made bonds with people that can never be broken – the other runners, the Brathay staff (particularly Aly and Mac), and bodyrehab team. It’s absolutely incredible what the human body and spirit can achieve. As well as all 18 of us completing the 10 days, we’ve raised over £150,000 for Brathay, which will allow them to do so much good.

If you’d like to know more about the event visit the Brathay website. You can read my blogs from during the event here and you can see the daily video diaries. If you’d like to make a contribution to Brathay you can do so via our Justgiving page. – many thanks!

Jeepers! What have you done? (A personal post on tib post)

In my recent piece on Posterior Tibial Tendon Dysfunction I mentioned Carol (AKA Jeepers on the RW forum) and her problems with this. She’s very kindly agreed to give RunningPhysio her story, in the hope it might be helpful to others. Even if you’ve never heard of PTTD it’s a heartening story to read, to hear how someone has overcome a potentially serious injury.

Over to you Jeepers!

I have extremely flat feet – something that I didn’t know until I ruptured my tib post tendon. I woke up one morning, stretched just before getting out of bed and felt a sudden, excruciating pain in my foot. The sharp pain disappeared to be followed by an a persistent ache and when I stood up, my foot collapsed under me completely. I realised that I had done something, but as an ex-school, club, county and England netball player, because I hadn’t incurred the injury while playing, assumed that it was not important. Wrong!

I have an extremely high pain threshold, so once I’d got used to the ache, got used to the fact that my foot didn’t work properly, I just carried on, thinking that it would get better in the next few days, then weeks. But it didn’t. My foot was swollen, red, very hot to the touch, painful and completely collapsed, but I still thought that it was nothing. I limped and by supinating, managed to get by. It was only when I had to attend a funeral, three months after it had happened and realised that I couldn’t get my shoe on (and other people noticed my foot) that I thought about getting medical advice.

On my first visit to the GP I was told that it was a broken bone. Having wasted a few weeks waiting to get an x-ray, it turned out not to be broken. The next diagnosis was DVT. Wearing the support hose helped (obviously supporting the broken tendon) but it was third time lucky when it was diagnosed by a GP who had an interest in sporting injury – apparently the symptoms were classic “text book”.

I was referred to a biomechanical specialist who strapped the foot up, put me on crutches and referred me to a specialist surgeon. He agreed immediately, said the other foot was on the point of going too. Instead of a sudden rupture across the tendon, due to the stress placed on the tendon by flat feet, years of heavy-duty netball playing in nothing more sophisticated than Green Flash plimmies and years or running around after two young boys (in “sensible” flat shoes), I had gradually shredded the tendon along its length, with filaments breaking off gradually until the last one went as signalled by the pain.

He confirmed the extent of the damage via MRI scan and then, 6 months after the initial incident (almost to the day) carried out tendon replacement surgery. He removed the damaged tendon, replaced it with one from somewhere else in my foot, repaired the tib anterior (?) tendon on the other side of the foot that I’d damaged by the way that I’d compensated for the ruptured tib post and then cut into my heel bone, to correct my biomechanics.

He pinned my heel bone back into a new position and stitched all the bits back up. I spent the next three months or so in plaster, every 3 / 4 weeks a new plaster cast was fitted, the foot being turned slightly each time to encourage the tendon to work properly. I was then giving a walking plaster but soon after discovered that I’d developed osteopaenia from being non-load bearing for so long as the bone was crumbling slightly and tearing the new tendon. So it was back onto crutches for a short while followed by around three months in an aircast.

Physio was nothing more than massage along the scar lines to start with, every other day, but after a month or so, I was able to do some limited mobility exercises. Then it was a case of building up strength in the tendon and leg (my calf muscle in that leg is still smaller) and it was about 12 months before I was allowed to do any form of activity.

Once I was out of plaster, I was fitted for full length orthotics which I wear religiously every day, in all footwear – not just runners.

The other foot should have been done, but for various reasons, it was not an option. I do Pilates and mobility / flexibility exercises and stretching every day and so far, have had not a twinge. About two years after the surgery, I started running and to date, have worked up to 40 – 50 miles per week, have done a few HMs and am training for maras. I do HR training which suits me, my age (mid 50s) and my feet! I have a pod who I see every 12 – 18 months to check on the orthotics, wear support shoes as well and as she says, see no reason why I shouldn’t be able to continue running – as long as I’m sensible. At my age, I’m too old and too ugly not to be!

 

Crazy Coomba and Swino Hynes are running an Ultra!

2 of my lovely friends, Amie (Swino) and Andy (Coomba) are running a double marathon of 52 miles to raise money for the Rockinghorse Foundation. Considering they got lost on their last Ultra and ran an extra 4 miles this one could be closer to 60!

Andy, who is a Physio too and soon to be RunningPhysio’s first guest blogger has given me a little summary;

My fiancée Amie and I have been training for probably around a year now. It started with the 2011 Brighton Marathon, after which we decided to try and go a bit further. Since that time we have completed 1 more marathon and 2, 30 mile ultra marathons. There have been some hard times (running up and down the same 2.5 mile stretch of road for 3 1/2 hours in 30 degree heat in the south of France is one I would care to forget) and some sacrifices (giving up whole weekends to run 35-40 miles). But lets not get carried away, we entered this off our own backs and for the most part enjoy running, as one of my friends has commented I always seem to be smiling in every photo taken of me on race day. The 50 mile event means a lot to me and Amie, it is a challenge that is going to take a hell of a lot of hard work, some pain (probably a lot) and mental determination (a famous ultra runner said “the first 25 miles are a physical challenge the second 25 miles are a mental challenge”). Many of the children helped by the paediatric teams and the rocking horse foundation will endure a lot more than Amie and I will on 1st September, and they trump us on determination and we feel that showing our support is the least we can do.

We like to support charities on RunningPhysio so we ask if you could help Andy and Amie in raising money for a worthy cause. Any donation will be greatly appreciated.


You can donate online here.

Thanks!