Friday, 10 November 2017

Hard knocks on Hard Knott - My monstrous mountain marathon.

What am I doing here? It was the sight of top fellrunner Jonny Malley looking forlorn and in despair after forty five minutes searching for checkpoint nine that made me ask myself that rather obvious question for the first time.

We were about two thirds of the way up the featureless western slope of Scafell in thick mist hunting for the mother of all bingo controls - a sheepfold. At least the driving rain and wind of the last eight hours had calmed a little. We’d endured this foul weather as we crossed much of the central Lake District - from Langdale almost to Thirlmere, across Borrowdale, round Gable and Kirkfell to the back of Yewbarrow and we still had to cross Eskdale and Hard Knott before reaching the campsite at the head of the Duddon valley.

Day 1 Course 

So what on earth made me enter the OMM Elite?

A long long time ago - well February - I was having a Valentine dinner with my dreamboat husband and the romantic talk turned to the Adventure Show and it's rather excellent coverage of last years OMM:

The power of television is such that I came away almost believing that Nick Barber is one of the world’s greatest athletes. But it was International Orienteer Jess Tullie and her partner competing on the Elite course that I found really inspirational.

And there was fell-running legend Nicky Spinks looming larger than life on my TV screen encouraging more women pairs to race the Elite. Why not I thought? There’s months to prepare and I’m already a top navigator - at least that’s what I tell anybody who will listen.

Of course another nice twist would be to run it as a Kim Baxter Physiotherapy Team and Sally agreed to join me, alas only to drop out a few weeks later due to a wedding invitation.

I wracked my brains for another partner who might be strong enough to attempt it and who I’d get along with and came up with ex-junior-international orienteer and experienced adventure racer Lucy Spain (nee Harris). After some thought she said yes - the OMM remained one of those challenges she still had to conquer.

Inspiring Patients

Over the years I have never ceased to be impressed by and often in awe of our many patients who embark upon real challenges; whether it is newbie runners challenging themselves to run five kilometres then building up to half marathons and then even marathons. Or others such as the crazy Hilary Bloor who needs a race as extreme as the Marathon de sables to put herself under a little pressure.

In all my running endeavours over the years I’ve been focusing on winning or pbs. I’ve never before taken on the challenge of wilI I finish this race? Am I actually good enough to do this? Have I bitten off more than I can chew?

Well the OMM Elite is certainly that challenge. Those questions started to haunt me. They haunted me all through the spring and summer. They were still haunting me in the car park on the morning of the event. Can I really do this? Is it possible for me?

The training

Training is about balance. Too much training with too little recovery means no progress and increased risk of injury. Too little training and I might not be good enough to finish.

I am a firm believer that your current ability is not the sum of your previous weeks or months training but the sum of your life's training.

So in my favour I have years worth of running and orienteering in the mountains. I trained hard until I was twenty five. I then had a break for travelling and kids where I averaged about two hours running per week but since 2013 I have slowly built up my hours and going into the OMM build up I was averaging six hours per week plus small amounts of strength work, climbing and yoga.

My goal in 2015 and 2016 had been the Sheffield Half Marathon so my training had been based around regular speed sessions and much of it had been done on roads.

I analysed my current ability and came up with the following areas that I believed were adequate and the areas I needed to improve.


  • Speed
  • Uphill strength
  • Basic terrain ability
  • Map reading

Need to improve

  • Endurance. I rarely ran over two hours. The OMM could test me over eighteen hours.
  • Downhill running - I've always been overly cautious, this has been amplified post kids. 
  • Rocky terrain, especially slippery when wet.
  • Running with a rucksack. I walk a lot with a heavy bag but never run.

So I structured my training around three key sessions per week

  1. Hill session - especially focusing on descending
  2. Long run - in terrain and with as much climb as possible
  3. Strength session - the goal being increased agility and lower leg strength to improve descending and downhill efficiency.  

I dropped interval training and speed sessions as these were less relevant and doing too many sessions would fatigue me and reduce the effectiveness of the key sessions.

That was the plan - but what about the reality.

Endurance: In the eight months of buildup I only managed managed to do four runs around four hours! This was due to a family life limiting available time and also a lack of motivation to get out and do the long stuff on my own.

First long training run - March 2017

Hill Sessions: Here I was a bit more successful. Thankfully the West of Sheffield is notably hilly and the majority of weeks I was doing between 1000m and 2500m climb. Still not a huge amount but more than I had done previously. 

Strength: In July I discovered Tribe (Trib3) a local gym that runs circuit classes.
For years my strength sessions had been solitary and somewhat soulless, so it was great to join a class that pushed me.

But it was brutal! It even included ten minutes interval training on the treadmill which was great for training my tired legs to keep moving. 

The idea was similar to these bench exercises by Claire Maxted of WildGingerFilms. 

All was going well up to August and our summer holiday included eight orienteering races at altitude in the Pyrenees and Alps plus some hut trekking near Mont Blanc with the kids. I also managed to slot in a long run which included a 2000m descent. The sessions were working and my downhill legs were coming on.

Using the family hut trek to practice with a rucksack.

The final countdown.

In September I lined up two longish fell races - the Totley Exterminator and the somewhat more relevant Three Shires in Little Langdale.

Totley was fine and I recorded a confidence-boosting victory. At the Three Shires I could still feel the Tribe sessions in my legs and realised my descending was still poor compared to hardened Lake District fell runners. Second place and first vet was ok but I left the race feeling quite demoralised.  

Finishing the Three Shires.

Over the next few weeks I continued with my training plan but managed to tip the balance into overtraining.

I did too many Tribe sessions too close together with too little recovery causing an old foot injury to flare up.

As we all do I adopted the classic ostrich position and ignored the warning signs. This culminated in a longer than planned run with a friend intent on collecting half a cow from a butcher’s in Hillsborough, He suggested I carry his meat and bone laden rucksack as it would be good OMM training.

But then an aborted long run in the peaks a few days later made me realise and accept my mistakes. I had to stop running and rest.

After four days I was walking pain free so I tried an easy twenty minute test run. This was twenty minutes of phantom pains and paranoia but the pain didn’t increase and there was no adverse reaction after or the next day. During the run I bumped into a long term patient who reminded me what I would be saying to him: stop your CCTV. Look outside yourself. Look at the trees, the birds, the river, the other people. Focus on something else. If the foot is a problem it will let you know. Don’t focus on it.

All was feeling fine for the British fell running relays three days later. This was my last test before the OMM. After only an hour of running the pain started to return and on the final descents I felt like I was running with a big heavy block rather than a foot.

My descending skills were back to being poor and I finished tired, disappointed and scared. At the finish the amazing Zoe Harding bounded off back up the hill to do a longer run declaring it was because she was doing the A at the OMM. I sat fatigued in the tent thinking I’m doing the Elite and I couldn’t run any further today. One hour fifty two isn’t enough. HELP.

[Zoe and her M55 Dad nailed the A course winning by over an hour.]

By now Lucy had dropped out with a stress fracture. Having run out of women to ask I found the next best thing and teamed up with Dark Peak’s Dave Sykes. With bags of experience of the OMM and long Lake District fell races and also a top descender Dave seemed to be the complete package - although he needed to work on being more imberb.

It was now too late to change anything. I just had to accept my two week taper, rest, recover, manage my demons and hope for the best.

Will my foot be ok? Can I still descend? I’ve not done enough. I’m not ready. How can I run for ten hours and then repeat it when I haven't managed more than fours?  How stupid was I to believe I could do such a thing?.


I was constantly seeking reassurance from everyone. Patients, friends, Joe Blogs. But the thing about reassurance is the more you get the more you need.

So the final week I was trying to just distract myself. This was helped by our landlady hiking our rent by almost fifty percent so I suddenly needed to find a new work premises.

In these final few weeks the desire to test yourself to check you are able to run x y or z is strong. You want to prove to yourself you are in the shape to reach your goal. For me I was desperate to do a five hour run as this was my goal in training and I’d never done it before. Yet I knew that I was deluding myself. So close to the race there was just no point, no training benefit - nothing to gain and everything to lose.  

I spend a lot of time reassuring patients in their final few weeks before their big challenge. I tell them they can do it, they have done enough training already, they don’t need to stick to the schedule printed in Runner’s World or taken from the internet.

All of them look at me as if to say I’m talking nonsense. They all just want to…….

I was having to fight hard against my just want tos.

Race day

With a few minor hiccups such as a forgotten waterproof and water bottle we were off.

The weather was awful. We nailed the first but missed the second. I relocated quickly. As we left the control we passed the only female pair in the race - double Bob Graham Round legend Nicky Spinks and her partner. Running away from her over the wild fog-covered moor was a definite morale boost. At Seathwaite Fell last year’s winners Shane and Duncan piled past with  Duncan declaring he was already exhausted. I’m not I thought.

We continued on our way and as we ran up the side of Ennerdale I started calculating whether we could make it back in daylight.

Such thoughts were promptly thwarted by the sheep fold on the side of Scafell. But we were luckier than many and found it without too much delay.

I’ve raced orienteering all my life. In 1999 I came back with the leaders in the World Championships Relay on the incredibly tricky Loch Vaa. I needed all that experience and focus to find that last tricky tarn in the dark and mist after 46km and ten hours of running. Not bad I thought.

But there wasn’t much time to enjoy our victory against the weather gods. Food, sleep and all too quickly we were off again, launching into the cold chill of a cloudless but windy dawn.

This day was tough from the start. I’d been protecting my left foot the previous day resulting in a painful right knee and hip flexor. The thought of running all day with this got me down but Dave was a bouncy tigger in the sunshine so I continued to trog behind him.  

About half way round I realised we were at risk of timing out even though we were within twenty percent of the winners. At number four south of Wetherlam we were forty minutes from cut off and as we proceeded round the cut off times got closer until by the south side of Langdale we were really having to push to avoid being timed out. We covered the last half just over ten percent behind the leaders as we desperately tried to avoid what would have been a very unjust disqualification - a fate that hit several teams around us.

And then there it was. The Finish. Eight minutes to spare. I went into the tent, sat down and cried.

What have I learned?

The mental side of running fascinates me. Studies abound about how we can run farther, faster, longer with different mental cues.

Prior to the OMM one of my ultra-running patients told me it’s ninety percent mental and the rest is in your head.

Long distance running is all about willpower and it seems I’m OK at it, although the distraction of having to navigate in zero visibility followed by the pressure of potentially being timed out certainly helps.

Had it been beautiful hills in beautiful weather with plenty of time and just the thought of having to trog round to finish it would have been a lot more difficult.

Hey - I’ve found I can do eighteen hours of running and not throw my toys out the pram. Who knew? Certainly not my long-suffering husband.

Many of you will have read my blogs about the pain system. It really is all in your head. I never felt my bad foot on the second day. Not once. And once the pressure of racing the course closing times kicked in the knee pain disappeared completely.  

And now for RECOVERY

The coming weeks and months are crucial for recovery. I will wait until the New Year before returning to structured training. Until then I’ll just do what my body feels like doing.

Longer term - I really should do my physio exercises to get my foot sorted! And in the unlikely event I ever do this again I’ll need some deeper investigation into how to get my 5.25kg pack down to the 3.5kg weight of the leading male runners.

Friday, 6 October 2017

Own your roll

Whilst it’s almost always more fun to have someone else massage your sore bits it’s also expensive and time consuming. That’s why lots of runners are familiar with the strange pleasures and pains of auto-malaxation, or foam rolling as its more commonly know.

Whether gyrating on a tennis ball to release your glute, suspending yourself above the lounge floor on a foam roller whilst watching Mock the Week or driving to work perched on Rover’s Ruffer and Tuffer spikey dog ball, we all feel the need to help it all hang loose from time to time.

Many of you will already be close friends with these torture tools and will use them on a regular basis whilst others may feel more than a little curious as to what exactly they are and what they can and can’t do for you.

So what are they?

Put simply, we’re talking about any implement or tools that allows you to do deep massage to your own fascia and muscle, with foam rollers being perhaps the most well known.

Why might you want to use them?

As an alternative to stretching to restore ‘normal’ flexibility, mobility and range to muscles and fascia (myofascia), or to increase flexibility in chronically tight myofascia.

If you haven’t already you may be interested to read my previous blog on the benefits or otherwise of stretching.

Does it work?

Yes, of course. Probably.

Foam rolling is an even more divisive topic than stretching. Many physiotherapists, coaches and athletes swear by them and use them in an almost ritualistic manner. Others find very little benefit and some find they can aggravate pain and tightness in their tissues.

What does the science say?

The general consensus from available research into foam rolling is that it improves flexibility i.e. range of movement.

It can also reduce soreness after a workout. Whether this is a good thing or not is another question - some see this soreness as part of the adaptation process and by easing it you may be reducing the effectiveness of this adaptation process and hence of training. However if you have another race the next day then reducing soreness could be beneficial.

How does it work?

When asked most people you will probably describe how it breaks down scar tissue, knots, adhesions or  lactic acid.

But does this really happen? No.

To ‘break down’ tissue in the way described above you would need to apply significantly higher forces than a human is able to exert on themselves.

So what are we actually doing when we roll on foam?

"it is thought that the pressure applied by the foam rolling reduces the localised myofascial tightness by stimulating the fascial mechanoreceptors to signal the central nervous system to alter the activity of the muscle(s) below." (Science for sport)

This is one hypothesis, there are other similar or more complex ideas. The short answer is we know it increases flexibility but we don’t really know how it does it.

Does it hurt?

It’s not necessary for it to hurt to be helping. Applying pressure to the point of mild discomfort results in the same increases in flexibility as more painful rolling.

The more it hurts the greater the risk of you aggravating your symptoms. In particular if your system is already sensitised to pain due to an injury then subjecting it to further significant pain is unlikely to aid recovery.

Try to adjust the pressure so that you get the sensation you want - it should feel like it’s doing something but not too painful.

Which muscles should I target?

  • The one’s that feel tight.  
  • The one’s that feel tired and used - if you’ve just run a race with lots of downhills then target the quads, if you’ve been doing lots of fast running on hard surfaces or jumping exercises then try the calves.  
  • The one’s above and below an injured site - if you have a sore hip then target the lower back, glutes, quads and hamstrings. Hopefully this may loosen of the surrounding area allowing the injured area to move as it should.

How much and how often?

Research suggests two to three sets of thirty to sixty seconds rolling per muscle repeated  three to five times per week - although if I’ve learned anything in my career as a physiotherapists it’s that individuals are individual.

Can you do harm?


Trying to foam roller or use a massage ball on tendons can cause further irritation of the tendon.

I’ve seen patients hardly able to walk after too much foam rolling on already aggravated tendons.

It’s also possible for the pain system to perceive the massage as a threat i.e. something that might damage the tissue. In some cases this can cause muscles to tighten further to protect the area causing more tension and discomfort not less.

So, would you recommend I do it?

If you have a clear reason or aim for trying it then yes.

You may want to improve mobility through tight glutes, loosen off sore spots in your lower back or massage tight calves.

If it's achieving what you want then continue to use it. If you don’t feel it’s helping you then try other methods or see a physiotherapist who can work with you to establish why something is tight or sore and how to address it.

In particular, if you feel foam rolling is making you worse i.e. tighter or sorer, then stop. It’s not helping!

Thursday, 3 August 2017

Recovery, recovery, there’s no-thing like recovery.....

... for  breaking every human bone, due to the law of gravity.

More on that story later..

Recovery:  restoration or return to any former and better state or condition.”                                                              (

Somewhat like Homer Simpson I spend much time thinking about taking it easy. Not exactly plotting how to get away with watching the game with a stack of beers, more how best to allow my body to recover. Sometimes I seem to spend my life thinking about recovery -  my own and that of all my patients.

Training theory applied to running.

It is not during the training session that the body makes the required positive changes and adaptations that we runners are seeking. It's during the recovery time after.

“Training is giving a large enough stimulus that it creates an adaptation” Steve Magness

An optimal training stimulus causes fatigue and breakdown of the body’s systems and muscles - for example small amounts of tissue damage - micro tears - which weakens the tissue. During recovery the body repairs damage and replenishes energy stores. With adequate recovery the body super-compensates, rebuilding itself stronger and more efficient than before in anticipation of the next challenge. This process improves performance as well as reducing the risk of injury.

I have a passion to improve my own running - to run faster, to run longer, to improve my results on the fells and in orienteering and to improve my times on the roads.

To achieve this I spend much time, usually whilst out running, musing on what training stimulus my body needs to get fitter, stronger and more robust. Too much and I will place myself at greater risk of injury or illness, too little and I won’t improve.

But, perhaps unusually for a runner or a running coach, I spend an equal amount of time thinking about my recovery. When is my body ready for the next stimulus? Has it recovered yet? If I run Park Run hard on Saturday and race, a classic distance orienteering course on Sunday then can I do the Burbage Fell Race on Tuesday? Will I have recovered enough?

If the gaps between hard sessions are too long  I will start to get slower and weaker. But if the gaps are too short the same will happen - I will get slower and weaker. Much thought is invested in getting that balance right. Sometimes tough decisions are needed - for example to miss out on a race I’d really like to be doing.

Figure A: Level of preparedness becomes depleted by training stress, only to be restored as time moves on through recovery. According to the model, you leave compensation through recovery, and surpass earlier preparedness opening a window to reintroduce training stress. (Zatiorsky & Kraemer 2006)

Training theory applied to Physiotherapy treatment.

The process of training - stressing the body beyond its natural tolerance and then allowing it to recover and supercompensate - applies also to treatment and rehabilitation of injury.

Every day. I am trying to help my patients understand how to increase their fitness, strength and robustness in some way.

It could be specific to the injured or painful tissue or to connected tissue and muscles around the injured area, or it could be to the whole body. Almost every long term treatment involves a stimulus - specific exercises, a series of training sessions or a low intensity activity such as walking for ten minutes once a day. The goal is to tailor the stimulus so it is just right for that patient. Too much and I will cause more pain and put the patient at risk of further injury - to little and their body won’t repair itself to the level it was before the injury.

But… as with with my own training it's not just about the stimulus, I need to also consider the recovery from the stimulus. Without that the treatment is as likely to be damaging as beneficial. Just as for my own running training, helping each patient to heal is about striving to find the optimal balance between stimulus and recovery specific to that person.

How long does recovery after a stimulus take?

Time required to recover depends on the amount of damage the stimulus has done.

Very gentle easy exercises or activities will cause little damage or fatigue and so can be repeated again very quickly, even within the hour. With very painful or acute injuries I frequently prescribe these very gently exercises or activities. Little and often.

Exercises or activities that provide a greater stimulus and challenge to the body need a much longer recovery time, between six and forty eight hours depending on how demanding they are. This sort of stimulus is what I am aiming for both with my own training and longer term patient rehabilitation once any acute symptoms have settled down.

Races and challenges that are really demanding need even longer for recovery. If the body has been significantly deplinished from the stimulus it may need days or even weeks to recover. An extreme example is Steve Birkinshaw’s record-breaking run round the summits of all 214 Lake District Wainrights in seven days. He covered 321 miles with 91,600ft of ascent and descent with only a few hours rest each night. His story of the challenge, “There is No Map in Hell” describes in detail how it took him months to properly recover.  

How can I speed up the recovery process?

You can’t. And nor should you want to. It's during the recovery period your body is getting stronger and fitter. Try to speed this up and you will reduce the training effect.

But…there are lots of ways you can slow down your recovery.

Optimal recover requires time, rest, sleep and nutrition.

Cutting corners on any of these will slow the recovery process down. Other factors that delay recovery are:

  • Stress
  • Poor health
  • Age. Unfortunately the older we get the longer are body takes to recover.
  • Alcohol
  • High work or life load. This is why professional athletes have a lot of downtime - more than is possible in most jobs.

Does stretching help my recovery?

No. That doesn't mean you shouldn’t do it, it’s just not a part of your recovery process. Here is a previous blog on stretching.

What happens if I don’t allow my body to recover sufficiently?

  • Your injury probably won’t get better and might get worse.
  • Your performance won’t improve and it might get worse. (overtraining).
  • Your body will gradually be able to take less load, not more.
  • You will increase your risk of further injury.

Case study - my 87 year old father-in-law

Three weeks ago my father-in-law, who generally walks with a stick and sometimes with a zimmer, thought it would be a good idea to climb up a ladder onto the garden shed to try to remove some sapling shoots from the garden wall.

The ladder (now locked up and key hidden) and shed.

Unsurprisingly he lost his balance and fell backwards of the shed leading to five broken ribs,three broken back bones and a week in the spinal unit at the Northern General. A former regional standard pole-vaulter who spent his life working in the Lake District mountains his initial recovery was impressive given his age.

He has now been back home for a week. During that week I have been working with him and his excellent NHS physiotherapist to ensure a balance between his training stimulus (activities) and recovery (rest).

‘Just right’ for him at the moment are the daily activities of getting dressed, showering, making his own breakfast and lunch, twice daily physio exercises on the bed and two walks of about 100m. This is the little and often approach. In between these activities he needs to sit and rest to allow his body to recover from these small loads.

If he does too little he will get weaker which at his age is a serious risk. His ability to walk and look after himself will deteriorate. He will also not apply the required stimulus to allow the broken bones to heal well.

However when he does too much the pain in his back and ribs increases and he feels very fatigued. This then forces him to take much longer rest and recovery time which leads back to him feeling sorry for himself and doing too little. So it’s important to get the balance just right.

If he keeps doing the little and often his body will get stronger and the amount of ‘just right’ will slowly increase. He will build up the length of the walks, add more exercises eventually doing them whilst standing rather than lying, and eventually return to his weekly exercise class.

Case study - International Orienteer

Charlotte competing in the world championships in Scotland 2015 (Photo by World of O)

Back in January Charlotte sustained a significant injury to her achilles tendon. Her normal training stimulus was 80km running a week including three tough speed sessions and twice weekly gym sessions.

Following the injury even walking one mile or cycling was too much load for her achilles. Every time she put slightly too much stimulus through the achilles the pain flared up for several days forcing her take even more recovery time.

I regularly see athletes with achilles injuries who have taken more than six months to recovery. Typically they yo-yo, resting until there is no pain and then returning to normal training too quickly, at which point the pain returns. Tendon recovery has been well researched and the scientific consensus is that tendon’s require loading to heal.  

Over the next five months I worked very closely with Charlotte aiming to find the optimal stimulus and recovery to build her back up to a full training week.

Initially this was a short walk or a few calf raises with recovery time between each dose. As the injured tissue got stronger the doses were built. At this point we moved to a stimulus that caused a slight aggravation of symptoms, followed by forty eight hours recovery before applying the next stimulus.

When she started running again it was just for thirty seconds at a time.

Occasionally we needed longer recovery time following an activity, usually because other loads such as having to walk further led to delayed recovery from a run.

As the tendon tissue got stronger we were able to build up the stimulus through adding small amounts of faster running and re-introducing hill running alongside building up the length and frequency of runs.. All the time we were listening to the reaction from the tissue and ensuring adequate recovery before the next stimulus.

After five months of this gradual process she was finally able to put in a normal training week. Charlotte is now fully recovered and although not fully back to her best she is winning local five and ten kilometre races and raced successfully in a World Cup series in May.

If you're interested in understanding more about recovery and how it links to your own injuries and training we will be putting on two evening workshops in September and December 2017.