tag:blogger.com,1999:blog-2114727555400785652024-03-08T03:34:21.744-08:00Kim Baxter PhysiotherapyKim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.comBlogger29125tag:blogger.com,1999:blog-211472755540078565.post-3616562516308975842018-11-09T05:41:00.000-08:002018-11-09T06:46:57.215-08:00Rehab like you mean it!Guest blog by Cat Taylor (GB Orienteer & blogger @ <a href="https://cattaylor.net/news">https://cattaylor.net/news</a>)<br />
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It’s official: it’s not what you do, but how. The concept of deliberate, purposeful or deep practice has entered the public consciousness by way of books such as Matthew Syed’s UK bestseller Bounce, and Daniel Boyle's The Talent Code and become pop-psychology buzzwords. Case studies of superstars, prodigies and championsin invarious fields and how they reach dizzying heights through practice have caught our imagination. The idea that the key to success lies in the quality of practice and depth of application clearly hold implications for prospective virtuosos, but what about the rest of us? And how might understanding them help physios and their clients? This link may seem like clutching at straws, but think about it:<br />
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<tr><td class="tr-caption" style="text-align: center;">Focused and concentrating on delibrate practice.</td></tr>
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You book a physio appointment for an injury. You’re diagnosed and the problem seems simple enough. You’re given some daily exercises and start your new programme with enthusiasm - well, for a day or two. You continue on autopilot and it all becomes a bit half-hearted, maybe forgetting on some days, gradually falling out of routine. If only we could harness just a little of that super-practice to help.<br />
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First, let’s elaborate: what exactly are we talking about? “Deliberate practice” (Ericsson) or “purposeful practice” as Syed calls it are fundamentally the same thing and hinges on a central idea that’s great news for busy patients: the amount of time spent practising isn’t all-important. Instead, progress happens when practice is smart. Firstly, practice is most effective when each activity has its own highly specific and constant aim, which then links back to the overall purpose of the training. Secondly, it should be undertaken with “deep” engagement. That is, with conscious effort, or “to engage so deeply in the task that one leaves the training session, literally, a changed person.” Thirdly, activities should offer the correct level of challenge. Too easy and progress will plateau, too difficult and it will be impossible to have positive feedback. They should also be progressive over time, to keep challenging an improving subject: further, higher, faster… The role of the athlete or performer is to engage fully in practice and provide accurate feedback. The role of the coach is to identify that sweet spot of exactly the right level and progression of practice, and to work with the athlete to evaluate feedback and adjust the programme accordingly.<br />
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What does that mean for your treatment? The physio essentially takes on the role of the coach, guiding the patient back towards their desired activity level - be it a return to competition, to work or to being able to enjoy a favourite leisure activity. They need to ensure all exercises prescribed are at the correct level and intensity for each individual patient, and that difficulty is increased over time towards the treatment goal. <br />
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Of course, with healing tissues it is particularly important to hit the right balance between reaching high enough to improve without overloading these recovering areas too much too soon. Steering this increasing load requires accurate feedback from the patient of what worked, what was enjoyable and what was a struggle, and the physio uses this feedback to adjust the rehab programme accordingly. Executing the exercises effectively requires the patient to engage in their recovery programme and take on a proactive role. While this is in part up to them, engagement and ownership is helped greatly by understanding the process. This is where the patient should challenge the physio, and the physio should explain: Why are we working on exactly this aspect of strength, flexibility or movement pattern? How are this week’s exercises then going to progress to allow the person to return to sport and stay healthy? Where is it all going? <br />
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When done correctly, using these principles to guide treatment should optimise recovery and ensure goals are achieved as quickly and effectively as possible. This requires joint work by the physiotherapist and the patient, a partnership promoting deliberate practice:<br />
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Finally, it’s also important to accept that rehab won’t be perfect. As cheesy as it sounds, recovery is a journey, and mistakes and setbacks are an integral part of it. Being aware of this can be vital for maintaining motivation when something doesn’t go according to plan. To finish with another great cut-out-and-keep point from Bounce, “Excellence is about stepping outside the comfort zone, training with the spirit of endeavour, and accepting the inevitability of trials and tribulations. Progress is built, in effect, upon the foundations of necessary failure. That is the essential paradox of expert performance.”<br />
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com8tag:blogger.com,1999:blog-211472755540078565.post-7844966675777399602018-09-28T06:50:00.002-07:002018-09-28T08:09:27.577-07:00Is running going to ruin my knees? <br />
“Oh you run, that must be bad for your knees!”<br />
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“All that running you do, you’ll be a cripple when you’re older...”<br />
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Many things I hear regularly as a physiotherapist and a runner are purely folklore, with no scientific evidence to back them up. In this blog we’ll be looking at one of the most frequent examples: I hear time and again that running is bad for your knees.<br />
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It’s true that one of the main reasons people stop running is knee pain (one study of marathon runners showed that 42% of those who had stopped running did so due to knee pain). However, there are some more positive results from other studies of runners. One showed fewer hip and knee replacements in runners than non-runners, another showed that runners were significantly less likely to develop knee arthritis than walkers. The main reason for this may be that the runners had a lower BMI (more on that later). <br />
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Taken as a whole, research in this area has not delivered any conclusive scientific evidence that running is bad for your knees. Some scientists even postulate that it may be good for your knees, though we are a long way from proving this. <br />
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<b>“But what about all that impact - it must be bad for my knees!”</b></h3>
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You can see the logic. All those repetitive impact forces - every stride a runner takes, pounding the pavement, the poor old knees soaking up the impact, destroying the cartilage bit by bit until he or she is a dead cert for arthritis. But impact itself is not something to be feared. On the contrary, impact is vital for the health of our body. To take an extreme example, astronauts take months to recover when they return to earth due to the lack of impact on their bones and muscles during their space missions, which causes significant weakening of the tissue. It’s impact on the tissues of our body that prompts a reaction from these tissues, causing them to adapt and strengthen in order to be more prepared for the next impact. </div>
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The illustration above demonstrates the importance of maintaining a balance between load and adaptation. Not enough impact or too little stress on the tissue and the tissue will waste away or become weaker. Too much impact or stress with too little recovery time to adapt and you will risk damaging your tissue (injury). How much stress and impact your joints can take and how much recovery time you need depends on many factors - your genetics, how active you have been through your life, how active you have been recently, how well you sleep, how stressed you are. <br />
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If you’ve been sitting on the sofa for the last 5 years then the impact of walking 5km can be extremely challenging. If you regularly run 50km a week then an easy 5km run will put minimal stress on your joints. <br />
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<b>“But I’m overweight. Surely the extra weight will make the impact of running harmful?”</b></h3>
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What is evident from research is a clear correlation between being overweight and knee joint arthritis, and obesity is the number one preventable risk factor for osteoarthritis. For years this was indeed assumed to be due to the extra weight overloading the joints but research is now showing a link between increased fat cells in the body and joint inflammation and arthritis. <br />
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Fatty tissue is home to millions upon millions of busy fat cells. These fat cells respond to high levels of glucose by producing immune proteins called adipokines. These proteins in turn cause a low level chronic inflammation in tissue, resulting in arthritic damage to joints. You can read more on this <a href="https://www.arthritis.org/living-with-arthritis/comorbidities/obesity-arthritis/osteoarthritis-and-obesity.php">here.</a><br />
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On this note, over the last two years I have had the privilege of working with a Couch to 5K group and seen some of them using running as a way of loosing weight and then catching the running bug. These new runners end up feeling fitter, stronger and healthier than they have done for years. A side effect of all this is that they also lose weight, which we know will in turn reduce the risk of arthritis. <br />
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<b>“I’d love to run but I can’t because of my knees.”</b></h3>
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Many people with existing knee pain or who have had to give up running in the past believe they’ll never be able to start or return to running. In some cases this may be true, but without trying they’ll never know. The key is to ensure a base level of strength and fitness first - this can be achieved through other forms of exercise like walking, cycling, swimming, strength work - and then start with a very small dose of running, slowly building up as your knees adapt. This process is easiest with guidance from a good physiotherapist or coach who can work with you to find the right starting point and the right speed to build up and will then be able to guide you through the inevitable setbacks you will experience along the way.<br />
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So, in conclusion, great news - running itself won’t hurt your knees! He’s a summary of my advice when it comes to knees:<br />
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Great! Keep on running 😊 There’s no evidence you’re damaging your knees.</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Runner, knee pain</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">If you notice correlation between running and increased symptoms, it’s worth seeing a physio for guidance on how to manage your symptoms.</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Non-runner, no knee pain</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">It’s fine to get started as long as you manage the load carefully, in accordance with your current fitness and activity levels.</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Non-runner, knee pain</span></div>
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<span style="background-color: transparent; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">Knee pain doesn’t mean that you can’t start running, but it is best to seek advice from a physio before you start.</span></div>
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<b>References</b></h3>
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<a href="http://journals.sagepub.com/doi/abs/10.1177/0363546516657531">http://journals.sagepub.com/doi/abs/10.1177/0363546516657531</a><br />
<a href="http://www.jospt.org/doi/abs/10.2519/jospt.2017.7137?code=jospt-site">http://www.jospt.org/doi/abs/10.2519/jospt.2017.7137?code=jospt-site</a><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/23377837">https://www.ncbi.nlm.nih.gov/pubmed/23377837</a><br />
<a href="https://www.ncbi.nlm.nih.gov/pubmed/29342063">https://www.ncbi.nlm.nih.gov/pubmed/29342063</a></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com2tag:blogger.com,1999:blog-211472755540078565.post-43849383063524345422018-04-20T08:19:00.000-07:002018-04-20T08:19:20.626-07:00We are not camels. Managing racing in the heat.<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
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<span style="font-family: Arial; font-size: 9pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Sheffield University Orienteering Club (SHUOC) on their way to smashing the Guinness World record for the half-marathon in one hour and forty minutes.</span></div>
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<br />This Sunday is the 38th London Marathon and it's predicted to be one of the hottest. After the long cold winter this may pose difficulties for some runners.<br />
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These potential difficulties are linked to two factors: hydration and overheating.<br />
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<b>Hydration </b></h2>
We all know that we should keep well hydrated. Achieving this is not as simple as you might think. The ideal amount of fluid intake varies depending on the conditions and the individual. Drink too little and you might become dehydrated, too much and you become over-hydrated.<br />
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Both have medical and performance consequences and some argue strongly that overhydration has the far more serious consequences. Many people have died from overhydration in numerous situations including marathons.<br />
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<b>Symptoms of dehydration</b><br />
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<li>Feeling thirsty - this is the earliest and most prominent symptom.</li>
<li>Feeling weary, tired, weak</li>
<li>Feeling light headed and dizzy. These tend to present as the dehydration worsens. </li>
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<b>Managing Dehydration</b></div>
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<li>If you start to feel thirsty or have a dry mouth - DRINK. But drink to thirst - don't overdo it. We are not camels.</li>
<li>How much depends on on individual factors but about 400-800ml per hour (about two cup maximum). </li>
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<b>Symptoms of Overhydration</b></div>
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<li>Impaired performance</li>
<li>Sloshing in stomach or bloated feeling</li>
<li>Swollen hands, legs or feet (watch strap getting tighter, shoes tighter)</li>
<li>Nausea & Vomiting </li>
<li>Headache. Note headaches are not a symptom of dehydration.</li>
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<b>Managing Overhydration</b></div>
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<li>Stop taking on more liquids</li>
<li>If you are concerned or start getting the more serious symptoms of nausea / vomiting / headache then go to a medical point.</li>
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Overhydration tends to occur in slower runners as they are out for a longer length of time and have more opportunities to drink greater volumes of fluids. </div>
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<b>Overheating</b></h2>
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For the vast majority of runners London won't be hot enough for serious over heating or heatstroke to occur .<br />
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<span style="font-family: inherit;"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">Heatstroke </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">occurs when the core body temperature rises to a level which is potentially very harmful. The main parameters governing this are speed i.e. energy required per unit time, and external temperature. </span></span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Heatstroke therefore tends to occur in very hot conditions and with faster runners racing over shorter distances (5-20 Km). The faster we run the more heat we generate. </span></div>
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<span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">In the temperatures at London the speed even the fastest runners race a marathon are unlikely to be be enough to generate the heat required to cause heat stroke. However, whilst very rare, there are documented cases of it occurring in some individuals at slower speeds and in cooler conditions. </span></div>
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<span style="font-family: inherit;"><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">Whilst heatstroke is very unlikely, there is a very high probability that many runners will struggle with the far less serious condition of </span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; font-weight: 700; vertical-align: baseline; white-space: pre-wrap;">heat exhaustion</span><span style="font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre-wrap;">. Heat exhaustion is caused by external temperature rise i.e. on your skin. Your body does not like this and treats it as a warning signal generating symptoms in order to force you to slow down. </span></span></div>
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<span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: inherit;">Heat exhaustion occurs when the body just isn't adapted to the hot conditions. This will be the case for the majority of runners on Sunday. Many runners will be physiologically incapable of handling the thermal load and may then experience symptoms of heat exhaustion. </span></span></div>
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<span style="background-color: transparent; color: black; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span style="font-family: inherit;">Heat exhaustion is detrimental to performance but normally doesn’t lead to heatstroke as the conditions for the core body temperature to rise to critical temperatures.i.e. speed and external temperature, are not present.</span></span></div>
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<div>
<b>Symptoms of heat exhaustion</b></div>
<div>
<ul>
<li>Impaired performance</li>
<li>Fatigue</li>
<li>Headache</li>
<li>Dizziness</li>
<li>Short of breath</li>
<li>Nausea / vomiting</li>
</ul>
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<b>Managing heat exhaustion</b></div>
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<b><br /></b></div>
<div>
<ul>
<li>Slow down - the slower you run, the less heat you generate the cooler you'll be. </li>
<li>Use cooling techniques to lower your skin temperature - water over your head, cold drinks, ice, run in the shade etc. </li>
</ul>
<h2>
<b>Summary</b></h2>
</div>
<div>
<ul>
<li>Stay hydrated but don't overhydrate - drink approximately 400-800 ml (1-2 cups) per hour during the race. </li>
<li>Try to avoid getting too hot before you start - stay in the shade, put cold water over your head, on your neck or wrists.</li>
<li>If you know your not good in the heat consider starting at a more sedate pace then planned.</li>
<li>Keep as cool as possible during the race (shade, cold water over body, run through the cold showers provided.)</li>
<li>If you start to struggle - slow down, evaluate the cause - dehydration, over hydration, or heat exhaustion and act accordingly. If you are not feeling thirsty it's unlikely to be dehydration. </li>
</ul>
</div>
</div>
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</div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com5tag:blogger.com,1999:blog-211472755540078565.post-14266141159247974812018-02-27T03:17:00.000-08:002018-02-27T03:29:49.851-08:00What goes up must come down - the Sheffield Half. <h3 dir="ltr" style="background-color: white; line-height: 1.38; margin-bottom: 0pt; margin-top: 10pt;">
</h3>
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<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre-wrap;">This years Sheffield Half Marathon will be staged on Sunday 8th April. It’s an unusually hilly course for a half marathon with the first section uphill most of the way from Arundel Gate to the edge of the Peak District followed by a long undulating descent all the way back down to the city centre. Overall there is around 300m of ascent and descent.</span></div>
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<br /></div>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">I have raced this exciting course twice. The views over the city and moors are amazing and the </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">support </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">throughout the route is fantastic. However it places very different demands on your body </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">compared to a flat half </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">marathon. </span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYKnQRCkQHVefTNwWExjsL9oYKWd9aC2ajfuF_PATn3_mh283fg3cujXZWen9tYKP1j-88i_TCk9il2VE921q8PG2E17Ehw4eb4JkiTjK-h3o2a4zon0k_dII8wPtsrym8lK7BxPA5cvFJ/s1600/image1.jpeg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYKnQRCkQHVefTNwWExjsL9oYKWd9aC2ajfuF_PATn3_mh283fg3cujXZWen9tYKP1j-88i_TCk9il2VE921q8PG2E17Ehw4eb4JkiTjK-h3o2a4zon0k_dII8wPtsrym8lK7BxPA5cvFJ/s400/image1.jpeg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Conquering the hill on Front Runner's Sheffield half taster session</td></tr>
</tbody></table>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"><br />The hill:</span><span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;"> </span></div>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">From Hunters Bar roundabout the route goes uphill, 220m ascent in just over 5 km to the Norfolk </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">Arms. This is </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre;">the part of the course people fear most. </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">Try to keep your breathing steady and take </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">little steps. </span></div>
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<b style="font-weight: normal;"><br /></b></div>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">The first two sections of the hill - to Banner Cross and then too Knowle Lane are the steepest. </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">After that it </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">flattens out with some short sections of flat or even slightly down hill running. </span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKdJ4Mse-O6BTQK1iBgBP_wsbbhga22xQmkE4PxKzGwPd8_MZ03u2qc0lHBTI5cz76CVFwMeaG8NUarsKRg-iga7uP1WWvDjEHod7us7uJ3eNcclypkCkDosIj4ShkrizGVMwfvh8yd_qJ/s1600/2016-SheffieldHalfMarathon-5572.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1068" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjKdJ4Mse-O6BTQK1iBgBP_wsbbhga22xQmkE4PxKzGwPd8_MZ03u2qc0lHBTI5cz76CVFwMeaG8NUarsKRg-iga7uP1WWvDjEHod7us7uJ3eNcclypkCkDosIj4ShkrizGVMwfvh8yd_qJ/s400/2016-SheffieldHalfMarathon-5572.jpg" width="266" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><br />
A minion tackling the steepest section in 2016. </td></tr>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre;"><br />The return:</span></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">Back from the Norfolk Arms is mainly downhill. It is easy to underestimate this section. However </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">downhill running</span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;"> for such a prolonged period is tough on your body. </span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">The effect of gravity causes you to land more heavily on each stride. Your body has to absorb more </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">force before </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">pushing off. More load is placed on the legs increasing both the fatigue in your legs and </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">the risk of injury in the </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">lower body - from the hips down to the feet.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">This descent catches out a lot of runners with jelly legs setting in around the Prince of Wales pub. </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">The </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">occasional </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">tumble has been known as legs buckle under a tired runner. </span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">Running downhill also encourages you to stride out too much and land your foot too far in front of </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">your </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">body. This </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">overstriding increases the breaking force through your leg and causes greater load </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">and injury </span><span style="color: #222222; font-family: arial; font-size: 10pt; white-space: pre;">risk. </span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">If you know you have a particular lower-body weakness or recent injury e.g. to the glutes, kneecap, </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">iliotibial </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">band </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">(ITB), calf or foot, then racing ten kilometres mostly downhill on roads is going to test it.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">So… how can you ensure you are ready for race day and minimise your risk of injury both in training </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">and </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">during </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">the race?</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">1) Build your strength. Standard leg strengthening exercises can build up the strength in all the main </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">muscles of </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre;">your legs, helping you to power up the hills and better absorb the forces of the downhill </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre;">section. </span><a href="https://kimbaxterphysio.blogspot.co.uk/2016/11/strength-and-conditioning-exercises-for.html" style="text-decoration-line: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre;">Here </span></a><span style="color: #222222; font-family: "arial"; font-size: 10pt; vertical-align: baseline; white-space: pre;">is a 20 </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">minute workout for runners that will help you increase your strength over the </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">next six weeks. </span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">2) If you are not used to running hills add them gradually into your training program, initially at a </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">steady </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">pace, </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">especially downhill, before adding some faster hill work.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">3) Ensure adequate recovery between hard sessions. Leave forty eight hours or more recovery </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">between </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">hard or </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">long sessions to give your tendons, muscles and joints time to recover from the </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">loading before you </span><span style="color: #222222; font-family: arial; font-size: 10pt; white-space: pre;">put the next </span><span style="color: #222222; font-family: arial; font-size: 10pt; white-space: pre;">load through. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">4) Work at your downhill technique. Practice taking shorter strides landing your foot under your body. </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">This will </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">reduce the load through your legs. Try to avoid over-striding.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<b style="font-weight: normal;"><br /></b></div>
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<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">5) Practice long descents - downhill running and fatigue are a dangerous combination as you can </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">lose the </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">capacity to manage the landing forces. Practice runs should mimic the nature of the race to </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">help you build up </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">your body’s tolerance to prolonged descents. Start with runs of two kilometres uphill</span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">followed by two kilometres </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">downhill then build up slowly until you can comfortably manage the five </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">kilometres up and down.</span></div>
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<b style="font-weight: normal;"><br /></b></div>
<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">6) In training only do what your body can manage. There’s only six weeks left before race day and </span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">so </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; font-variant-east-asian: normal; font-variant-numeric: normal; vertical-align: baseline; white-space: pre;">there is </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">only a certain amount that can be achieved. Don’t be tempted to do too much and push </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">into </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">the zone where you </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">risk hitting race day overtired or carrying a niggle which will have a negative </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">impact </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">on your race .Especially in </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">the last few weeks of training there is relatively little to gain and a </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">lot to lose.</span></div>
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<div dir="ltr" style="line-height: 1.68; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">7) Take it easy before race day and after. Two weeks of easier training beforehand means you will be</span><br />
<span style="background-color: transparent; color: #222222; font-family: "arial"; font-size: 10pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre;">fresh and </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">ready to race. Afterwards give your body lots of recovery time and TLC - between ten and </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">twenty days depending </span><span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">on how hard you pushed it and how much you are used to running such </span><br />
<span style="color: #222222; font-family: "arial"; font-size: 10pt; white-space: pre;">distances. </span></div>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com1tag:blogger.com,1999:blog-211472755540078565.post-4835270177025786582017-11-10T05:00:00.000-08:002017-11-10T05:00:10.245-08:00Hard knocks on Hard Knott - My monstrous mountain marathon. <div dir="ltr" id="docs-internal-guid-91625511-96eb-5d18-97f7-eeb078c35f2c" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<tr><td class="tr-caption" style="text-align: center;">Day 1 Course </td></tr>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">So what on earth made me enter the OMM Elite?</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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: <a href="https://www.theomm.com/adventure-show-teaser/">https://www.theomm.com/adventure-show-teaser/</a>. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Inspiring Patients</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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?</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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? </span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">The training</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">I analysed my current ability and came up with the following areas that I believed were adequate and the areas I needed to improve.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Adequate</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Speed</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Uphill strength</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Basic terrain ability</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Map reading</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Need to improve</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Endurance. I rarely ran over two hours. The OMM could test me over eighteen hours.</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Downhill running - I've always been overly cautious, this has been amplified post kids. </span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Rocky terrain, especially slippery when wet. </span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Running with a rucksack. I walk a lot with a heavy bag but never run. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">So I structured my training around three key sessions per week</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Hill session - especially focusing on descending</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Long run - in terrain and with as much climb as possible</span></div>
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<span style="font-size: 11pt; vertical-align: baseline;">Strength session - the goal being increased agility and lower leg strength to improve descending and downhill efficiency. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">That was the plan - but what about the reality. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Endurance:</span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;"> 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. </span><br />
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<tr><td class="tr-caption" style="text-align: center;">First long training run - March 2017</td></tr>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Hill Sessions: </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Strength: </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">In July I discovered Tribe (Trib3) a local gym that runs circuit classes.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">For years my strength sessions had been solitary and somewhat soulless, so it was great to join a class that pushed me.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">The idea was similar to</span><span style="color: red; font-family: "arial"; font-size: 11pt; vertical-align: baseline;"> <a href="https://www.youtube.com/watch?v=xJWb9qmTBMc" target="_blank">these bench exercises</a> </span><span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">by Claire Maxted of WildGingerFilms.</span><span style="color: red; font-family: "arial"; font-size: 11pt; vertical-align: baseline;"> </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span><br />
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<tr><td class="tr-caption" style="text-align: center;">Using the family hut trek to practice with a rucksack.</td></tr>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">The final countdown. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">In September I lined up two longish fell races - the Totley Exterminator and the somewhat more relevant Three Shires in Little Langdale. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpNYRyLYsaP7GtZSH4XauxqniOHyyN4ItJ1oFgQoHunEwom4CoUlzlxZ_W2bhMm8wyomzwNu9-r2O6l7njpq-jHsGFG8dlVn06RJUy-oAVMgxXMe0V7fPgS7jAZOm3pCJpoQ4w1y7GU5Vg/s1600/September2017-00405+%25281%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1570" data-original-width="1570" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgpNYRyLYsaP7GtZSH4XauxqniOHyyN4ItJ1oFgQoHunEwom4CoUlzlxZ_W2bhMm8wyomzwNu9-r2O6l7njpq-jHsGFG8dlVn06RJUy-oAVMgxXMe0V7fPgS7jAZOm3pCJpoQ4w1y7GU5Vg/s400/September2017-00405+%25281%2529.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Finishing the Three Shires.</td></tr>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">Over the next few weeks I continued with my training plan but managed to tip the balance into overtraining. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">I did too many Tribe sessions too close together with too little recovery causing an old foot injury to flare up.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">[Zoe and her M55 Dad nailed the A course winning by over an hour.] </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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?. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">I JUST CAN’T DO THIS!. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">All of them look at me as if to say I’m talking nonsense. They all just want to…….</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">I was having to fight hard against my just want tos.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">Race day</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">With a few minor hiccups such as a forgotten waterproof and water bottle we were off.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">And then there it was. The Finish. Eight minutes to spare. I went into the tent, sat down and cried.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4EzHXN_Kt5gAwu6-leZu0sIR8jrPt-natqPg-9eskbDVKa1gQeG0zRMggo9GepWXDCyUFuFgj8PhG2X0TB8dVdTzXnVWYpw1cq4wjWQD1Pv2Ivm5wx37dJUmPT-EqMcBRYmW5uVuQWa0T/s1600/171030223903_H.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4EzHXN_Kt5gAwu6-leZu0sIR8jrPt-natqPg-9eskbDVKa1gQeG0zRMggo9GepWXDCyUFuFgj8PhG2X0TB8dVdTzXnVWYpw1cq4wjWQD1Pv2Ivm5wx37dJUmPT-EqMcBRYmW5uVuQWa0T/s400/171030223903_H.jpg" width="400" /></a></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">What have I learned? </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">The mental side of running fascinates me. Studies abound about how we can run farther, faster, longer with different mental cues. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">Prior to the OMM one of my ultra-running patients told me it’s ninety percent mental and the rest is in your head.</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBnZmBcOymKv6nmj7UjYzX6UEd59YaiEd4pKAd3QJK7ZkaG3zOKdQjOblM6pUQN7QcOD9FI4W24T6GeqkrmEWsRjgguf0k5vXSt1xUkTMaVjTsI6goqZVNsjySlxeqTgt2GxyWPMW9js3F/s1600/IMG_3508.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBnZmBcOymKv6nmj7UjYzX6UEd59YaiEd4pKAd3QJK7ZkaG3zOKdQjOblM6pUQN7QcOD9FI4W24T6GeqkrmEWsRjgguf0k5vXSt1xUkTMaVjTsI6goqZVNsjySlxeqTgt2GxyWPMW9js3F/s400/IMG_3508.JPG" width="400" /></a></div>
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<span style="font-family: "arial"; font-size: 11pt; font-weight: 700; vertical-align: baseline;">And now for RECOVERY</span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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. </span></div>
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<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline;">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.</span></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com7tag:blogger.com,1999:blog-211472755540078565.post-711132493226909332017-10-06T06:24:00.000-07:002017-10-07T02:29:46.284-07:00Own your roll<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">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. </span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So what are they?</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span><br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Why might you want to use them?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you haven’t already you may be interested to read my previous </span><a href="https://kimbaxterphysio.blogspot.co.uk/2017/02/the-politics-of-stretching.html" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">blog</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> on the benefits or otherwise of stretching. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Yes, of course. Probably. </span></div>
<b style="font-weight: normal;"></b><br />
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What does the science say? </span></div>
<b style="font-weight: normal;"></b><br />
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The general consensus from available research into foam rolling is that it improves flexibility i.e. range of movement. </span></div>
<b style="font-weight: normal;"></b><br /><b style="font-weight: normal;"></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"></b><br />
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How does it work? </span></div>
<b style="font-weight: normal;"></b><br />
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When asked most people you will probably describe how it breaks down scar tissue, knots, adhesions or lactic acid.</span></div>
<b style="font-weight: normal;"></b><br />
<b style="font-weight: normal;"></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">But does this really happen? No. </span></div>
<b style="font-weight: normal;"></b><br />
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> So what are we actually doing when we roll on foam? </span></div>
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<i><b style="font-weight: normal;">"it is thought that the pressure applied by the foam rolling reduces the localised myofascial tightness by stimulating the fascial mechanoreceptors to </b>signal</i><b style="font-weight: normal;"><i> the central nervous system to alter the activity of the muscle(s) below."</i> (Science for sport)</b><br />
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<b style="font-weight: normal;">This is one hypothesis, there are other similar or more complex ideas. </b><span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">The short answer is we know it increases flexibility but we don’t really know how it does it. </span><br />
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Does it hurt?</span></div>
<b style="font-weight: normal;"></b><br />
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"></b><br />
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"></b><br />
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Which muscles should I target? </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The one’s that feel tight. </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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</ul>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtn89_Bgy2AO0hl-c61xdJHLh5D3fzop4zNxm6g80FBft2EqrQUlZYjLreATrPS9V5lA3nUa1GQ7m1pB0pCsMzmo0LirRWoDfEFDpIEyRHy2TC7zRn8k8oI1FhGTFD8xf4cby8bddM3SCw/s1600/IMG_1370.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgtn89_Bgy2AO0hl-c61xdJHLh5D3fzop4zNxm6g80FBft2EqrQUlZYjLreATrPS9V5lA3nUa1GQ7m1pB0pCsMzmo0LirRWoDfEFDpIEyRHy2TC7zRn8k8oI1FhGTFD8xf4cby8bddM3SCw/s320/IMG_1370.JPG" width="320" /></a></td></tr>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How much and how often?</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Can you do harm? </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Yes.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Trying to foam roller or use a massage ball on tendons can cause further irritation of the tendon.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I’ve seen patients hardly able to walk after too much foam rolling on already aggravated tendons. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So, would you recommend I do it? </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you have a clear reason or aim for trying it then yes. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">You may want to improve mobility through tight glutes, loosen off sore spots in your lower back or massage tight calves. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In particular, if you feel foam rolling is making you worse i.e. tighter or sorer, then stop. It’s not helping!</span></div>
<br />Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com8tag:blogger.com,1999:blog-211472755540078565.post-50834493794700815702017-08-03T07:03:00.003-07:002017-08-04T01:57:38.070-07:00Recovery, recovery, there’s no-thing like recovery.....<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">... for breaking every human bone, due to the law of gravity.</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQY4KC3SwxgcZGajKyA1AnzJcUgTjfD8hd_W8sU3tWFnc9_QvEix1zka7u-d_u3-cDUky4EM16MhoWKowrl_eKAwOC6pDp1IcYy3Ulgnviw7ASNaa7H5Oad79WVf6rSZkvEbRSSCUDfyUg/s1600/IMG_1358.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1600" data-original-width="1200" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgQY4KC3SwxgcZGajKyA1AnzJcUgTjfD8hd_W8sU3tWFnc9_QvEix1zka7u-d_u3-cDUky4EM16MhoWKowrl_eKAwOC6pDp1IcYy3Ulgnviw7ASNaa7H5Oad79WVf6rSZkvEbRSSCUDfyUg/s400/IMG_1358.JPG" width="300" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">More on that story later..</td></tr>
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<div style="text-align: left;">
<b style="font-weight: normal;"><span style="font-family: "arial"; font-size: 11pt; font-style: italic; text-align: center; vertical-align: baseline; white-space: pre-wrap;">“</span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; font-weight: 700; text-align: center; vertical-align: baseline; white-space: pre-wrap;">Recovery</span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; text-align: center; vertical-align: baseline; white-space: pre-wrap;">: </span><span style="background-color: white; font-family: "arial"; font-size: 11pt; font-style: italic; text-align: center; vertical-align: baseline; white-space: pre-wrap;">restoration or return to any former and better state or condition.”</span><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span> </span><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;">(</span><a href="http://www.dictionary.com/" style="text-align: center; text-decoration-line: none;"><span style="background-color: white; color: #1155cc; font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">www.dictionary.com</span></a><span style="background-color: white; font-family: "arial"; font-size: 11pt; text-align: center; vertical-align: baseline; white-space: pre-wrap;">)</span></b></div>
<br />
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Training theory applied to running.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><span class="Apple-tab-span" style="white-space: pre;"> </span></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">“Training is giving a large enough stimulus that it creates an adaptation” </span><a href="https://www.amazon.co.uk/dp/B00II6SY4W/ref=dp-kindle-redirect?_encoding=UTF8&btkr=1" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">Steve Magness</span></a></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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?</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="305" src="https://lh5.googleusercontent.com/GgTRe4TaVils_WG2CBPJ56DUtrboPN8eCgXkvZ0VnK1DBuEmTK5AaHVSkw7HzlJmW2SYwi1eX9kHGlODrfk1gCy4ULNAVNha1NuRnceyDuLYhyOR2albjmDv2fWfxX3rGkkhKBE7" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="624" /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: #999999; font-family: "arial"; font-size: 10.5pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span><a href="http://www.humankinetics.com/products/all-products/science-and-practice-of-strength-training-2nd-edition" style="text-decoration: none;"><span style="background-color: white; color: #1c75bb; font-family: "arial"; font-size: 10.5pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">(Zatiorsky & Kraemer 2006)</span></a></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Training theory applied to Physiotherapy treatment.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Every day. I am trying to help my patients understand how to increase their fitness, strength and robustness in some way. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How long does recovery after a stimulus take? </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Time required to recover depends on the amount of damage the stimulus has done. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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, “</span><a href="https://www.v-publishing.co.uk/books/categories/running/there-is-no-map-in-hell.html" style="text-decoration: none;"><span style="background-color: white; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">There is No Map in Hell</span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">” describes in detail how it took him months to properly recover. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How can I speed up the recovery process? </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">But…there are lots of ways you can slow down your recovery.</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Optimal recover requires time, rest, sleep and nutrition. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Cutting corners on any of these will slow the recovery process down. Other factors that delay recovery are:</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Stress</span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Poor health</span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Age. Unfortunately the older we get the longer are body takes to recover. </span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Alcohol</span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">High work or life load. This is why professional athletes have a lot of downtime - more than is possible in most jobs. </span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Does stretching help my recovery?</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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 </span><a href="https://kimbaxterphysio.blogspot.co.uk/2017/02/the-politics-of-stretching.html" style="text-decoration: none;"><span style="background-color: white; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">stretching</span></a><span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">. </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What happens if I don’t allow my body to recover sufficiently?</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Your injury probably won’t get better and might get worse.</span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Your performance won’t improve and it might get worse. (overtraining).</span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Your body will gradually be able to take less load, not more. </span></div>
</li>
<li dir="ltr" style="background-color: white; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">You will increase your risk of further injury.</span></div>
</li>
</ul>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case study - my 87 year old father-in-law</span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitZaT6GkGoqs9MMptvP_Bj0-UF59F-zIybyVY0pX3aPpREZYJ_hV8sBL2ai8aKfXMeSI_zZ9zUIxPRe_5Fu3udTG2xP9YRpqVF_7vIONs1Fh2rSytRomJcj8_we4JlDlyxw-1XrbpmZTmt/s1600/IMG_1361.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1200" data-original-width="1600" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEitZaT6GkGoqs9MMptvP_Bj0-UF59F-zIybyVY0pX3aPpREZYJ_hV8sBL2ai8aKfXMeSI_zZ9zUIxPRe_5Fu3udTG2xP9YRpqVF_7vIONs1Fh2rSytRomJcj8_we4JlDlyxw-1XrbpmZTmt/s400/IMG_1361.JPG" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The ladder (now locked up and key hidden) and shed.</td></tr>
</tbody></table>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<span style="background-color: white; font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">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. </span><br />
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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). </span></div>
<b style="font-weight: normal;"><br /></b>
<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">‘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. </span></div>
<b style="font-weight: normal;"><br /></b>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case study - International Orienteer</span></div>
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlE3QSsizFj_EP0ugvEiyXyC9BBPsWrCeNOsxAyxyFMDugC4IWZubZME8fRB-eKp47TyldH2GPPdf-KS5W_IJ4lJaweO35wewGQD2IXdxmo04rCRV0az27esjXvKrJkgV0UUE3Kb8HHtgt/s1600/charlotteward_WOC2016SprintQual+2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="529" data-original-width="800" height="263" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjlE3QSsizFj_EP0ugvEiyXyC9BBPsWrCeNOsxAyxyFMDugC4IWZubZME8fRB-eKp47TyldH2GPPdf-KS5W_IJ4lJaweO35wewGQD2IXdxmo04rCRV0az27esjXvKrJkgV0UUE3Kb8HHtgt/s400/charlotteward_WOC2016SprintQual+2.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Charlotte competing in the world championships in Scotland 2015 (Photo by <a href="http://worldofo.com/" target="_blank">World of O</a>)</td></tr>
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<b style="font-weight: normal;"><br /><span style="background-color: white; font-family: arial; font-size: 11pt; white-space: pre-wrap;">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. </span></b><br />
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When she started running again it was just for thirty seconds at a time.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">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. </span></div>
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<span style="background-color: white; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>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. </b></span></div>
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<br />Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com4tag:blogger.com,1999:blog-211472755540078565.post-31225291072101888082017-06-28T07:13:00.001-07:002017-06-28T07:21:29.918-07:00About Pain<span style="background-color: white; font-family: "arial"; font-weight: bold; white-space: pre-wrap;">The Pain System #4 - Some more of the science</span><br />
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<span style="background-color: white;"><span style="font-family: "arial";"><i style="font-family: arial; font-size: 13.3333px; white-space: pre-wrap;">"</i><span style="font-family: "arial" , "helvetica" , sans-serif;"><i><span style="white-space: pre-wrap;">Stress biology is concerned with the physiological mechanisms and behavioural strategies that enable organisms to survive or maintain homeostasis” </span><span style="white-space: pre-wrap;">
</span><span style="white-space: pre-wrap;">“Pains prime adaptive purpose is to powerfully motivate the organism to alter behaviour in order to aid recovery and survive”</span> </i></span></span></span><br />
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<span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">(Gifford 1998)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiooDvSbL8emO5zaSinCDNKxiiGs53-qRELaP9aVZubOaTvQSnXNRuq9NEdKPwngwSQkHStIIFeSW_U8iB8w7KgZXV4lMtc_-TR_tmyBT8kFB6YBQaGCmiVSjKRVhes-4cmVJ9PmkXxmNHG/s1600/figure-1707104_1920.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="1600" data-original-width="1067" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiooDvSbL8emO5zaSinCDNKxiiGs53-qRELaP9aVZubOaTvQSnXNRuq9NEdKPwngwSQkHStIIFeSW_U8iB8w7KgZXV4lMtc_-TR_tmyBT8kFB6YBQaGCmiVSjKRVhes-4cmVJ9PmkXxmNHG/s320/figure-1707104_1920.jpg" width="213" /></span></a></div>
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<span style="background-color: white;">This blog is an appendix to the previous three blogs on pain response and sensitisation. It is intended to give some more detailed background on how the brain in particular manages pain.</span></span></div>
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<a href="http://kimbaxterphysio.blogspot.co.uk/2015/10/how-our-tissue-responds-to-pain.html" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">Part 1: How our Tissue Responds to Pain</span></a><br />
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<a href="http://kimbaxterphysio.blogspot.co.uk/2016/06/amplifying-pain-central-sensitisation.html" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">Part 2: Amplifying Pain - Central Sensitisation</span></a><br />
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<a href="http://kimbaxterphysio.blogspot.co.uk/2016/10/shark-attack-its-all-in-mind.html" target="_blank"><span style="font-family: "arial" , "helvetica" , sans-serif;">Pain 3: Shark Attack, It's all in the Mind</span></a><br />
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<span style="background-color: white;"><span style="font-family: "arial";"><span style="white-space: pre-wrap;">The basic function of pain is:
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<li><span style="background-color: white;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">To protect you.</span></span></li>
<li><span style="background-color: white;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">To alert you to danger - often before you are injured or badly hurt.</span></span></li>
<li><span style="background-color: white;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">To makes you move and think differently</span></span></li>
<li><span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif;">VITAL for healing</span></li>
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<span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif;"><b>Pain is a normal response to what your brain judges to be a threatening situation.</b></span><br />
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<span style="background-color: white; font-family: "arial" , "helvetica" , sans-serif; white-space: pre-wrap;">The basic pain mechanism involves </span><br />
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<i>Input / stimulus (the nerve endings in tissue) => process and evaluate (the spinal cord and brain) => output / response (the whole body).
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“We need a system that is able to monitor health of organisms own body and provide appropriate recovery response if damage occurs” (Gifford 1)
Is Pain is all in your mind? Well, yes.
The following areas of the brain are involved in evaluating pain inputs and formulating responses:</span></span><br />
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<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">area for organising and preparing movement. </span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">area for concentration and focus.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">area for problem solving and memory.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">fear, fear conditioning and addiction area.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">sensory discrimination area.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">area for stress response, autonomic regulation and motivation.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">movement and cognition area.</span></span></li>
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">Following a potentially painful stimuli the evaluation and response also involves many different systems of the body:
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<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Sympathetic nervous system - this increases heart rate, mobilises energy stores ready for movement and releases adrenaline into the body. </span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Motor (muscle) system is very important e.g. remove limb from flame, limp, run away, hide, prevent movement of area under threat. As we have seen, one problem is once trained the body tends to maintain these patterns after the stimulus has gone.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Pain system itself - this lets you know what is going on i.e. you feel pain</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Endocrine system - Mobilises energy stores and suppresses any processes that are not vital to save energy (growth, repair processes, inhibition of inflammation, and inhibition of the immune system)</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Immune system - responds later and fights invaders, sensitises neurones, makes us sleepy to promote healing. </span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Parasympathetic system - also responds later, it nourishes cells and heals tissue. </span></span></li>
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">These systems are designed to work really hard for short periods in a threatening situation. They are the same systems that are activated when your body is under acute stress and are responsible to flight / fight responses. In the same way that prolonged stress which maintains long term activity in these systems is is undesirable, pain for a prolonged time causes sustained activity in these systems which causes over-sensitisation.
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: small;">Persistent, chronic pain:</span></span></h3>
<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">All pain is real but some pain persists after healing has occurred. This is termed persistent pain or chronic pain.
In these situations the brain concludes that a threat remains and you still need protection.
The brain can experience similar sensitisation to that described for the spinal chord in <a href="http://kimbaxterphysio.blogspot.co.uk/2016/06/amplifying-pain-central-sensitisation.html" target="_blank">blog #</a>2.
The pain ignition nodes in the brain increase their sensitivity so less stimulus from the spinal cord activates them. They can even start firing with no stimulus from the spinal cord.
The brain also creates more sensors in the pain ignition nodes and produces more chemicals to activate the sensors. This can be particularly powerful when it occurs in the part of the brain that deals with memory - you can relive the pain even though there is no danger to respond to. For example people with whiplash can feel pain when the car ahead stops even though they are not themselves stopping suddenly.
The brain areas devoted to different body parts or functions start to overlap making you sensitised to pain in different areas of the body to where the stimulus originally occurred. This is conceptually similar to the chemical<span style="font-size: 13.3333px;"> flooding of the dorsal horns in the spinal cord.</span>
The longer the pain persists the more advance these changes become.
When the brain is sensitised it's not just pain that is persistently produced. Other protective systems also increase their sensitivity:</span></span><br />
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<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Sympathetic Nervous System makes you more aware and vigilant - as if you have turned a CCTV onto your body.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Endocrine system directs more energy to muscles for flight or fight.</span></span></li>
<li><span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;">The Motor system keeps muscles constantly activated ready for fight or flight. </span></span></li>
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial";">These systems then send signals to the brain in a self-perpetuating feedback loop.
With a sensitive system inputs unrelated to tissue damage are judged as dangerous and can cause pain. You won’t know there is no damage or that its just your brain decided dangerous. It just hurts.
Your thoughts are real. Real chemicals are released and real nerve impulses occur.
Thought processes alone are powerful enough to maintain a pain state. </span></span><span style="background-color: white; font-weight: bold; white-space: pre-wrap;">
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial";"><b>Altered muscle activity:</b></span></span></span><br />
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial";">When you are in pain your brain alters your muscles activity. With pain being a warning sign for danger your body firstly i</span></span><span style="font-family: "arial";"><span style="background-color: white;"><span style="white-space: pre-wrap;">ncreases activation of muscles to ready you to take action - flight or fight. This reaction is to aid protection of the whole body from further threat. </span></span></span></span><br />
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<span style="font-family: "arial";"><span style="background-color: white;"><span style="white-space: pre-wrap;">It also changes how your muscles work to help protect the local tissue where the pain is top prevent further damage. These changes cause bracing / splinting of the area by increasing the tension of muscles around the pain, and altering the movement of the whole area to reduce the load on the painful area (such as limping, or grasping the area). This works through taking load off the injured tissue by putting more load through surrounding tissue. </span></span></span></span><br />
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<span style="font-family: "arial";"><span style="background-color: white;"><span style="white-space: pre-wrap;">In the short-term these are all a positive strategy by your brain to protect your body. In the long term it becomes a hindrance not a help. </span></span></span></span><br />
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<span style="font-family: "arial";"><span style="background-color: white;"><span style="white-space: pre-wrap;">Long term over-activation of these muscles makes them feel stiff and tight. This tightness can then change how you use other muscles. Smaller muscles who's role is to control and stabilise stop working as effectively as they perceive the larger muscles to be doing their job. </span></span></span></span><br />
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<span style="font-family: "arial";"><span style="background-color: white; white-space: pre-wrap;">This altered muscle activity will then change how you move, feel and hold yourself. </span></span></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiBcza0JshSUY_J76xrP36S03_fAvdWu3n52_m0c6cNXx7KwDAqXijQ_ZxEr_U7N1WjdBzBZWL_gAI8FMWul_wCDPoECXvJfnPucNR9484ey8_Y6QCtoigknwSM6mDXmfvjdpsB2CifDAi/s1600/adult-1846050_1920.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhiBcza0JshSUY_J76xrP36S03_fAvdWu3n52_m0c6cNXx7KwDAqXijQ_ZxEr_U7N1WjdBzBZWL_gAI8FMWul_wCDPoECXvJfnPucNR9484ey8_Y6QCtoigknwSM6mDXmfvjdpsB2CifDAi/s320/adult-1846050_1920.jpg" width="320" /></span></a></td></tr>
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<span style="font-family: "arial";"><span style="background-color: white;"><span style="white-space: pre-wrap;">So in rehabilitating any injury you need to address these changes in muscle activity. This is done with traditionally stretches and strengthening activities as well identifying and addressing threats and fears that are making your muscle system work so hard to protect you. </span></span></span></span><br />
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial" , "helvetica" , sans-serif;"><b>References</b></span></span><br />
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<span style="background-color: white; white-space: pre-wrap;"><span style="font-family: "arial";">Gifford L, (1998) Topical Issues in Pain 1. Physiotherapy pain Association</span></span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-family: "arial" , "helvetica" , sans-serif; font-size: xx-small;">Butler D.S, Moseley L.G (2013) Explain Pain, Noigroup Publications. </span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Mense S, Gerwin R D, (2010) Muscle Pain - Understanding the mechanisms, Springer</span></span></span><br />
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<span style="font-family: "arial" , "helvetica" , sans-serif;"><span style="font-size: xx-small;">Melzack R, Wal P.D (2008) The Challenge of Pain, Penguin Books.</span></span></span></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-25874030144187187042017-06-01T11:49:00.000-07:002017-06-01T11:49:55.982-07:00Glutes - the new core?<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">I qualified as a physiotherapist in 1998 which seems a long time ago now. It was right on the cusp of a new era of physiotherapy treatment. During my training I spent a lot of time electrocuting people with various strange looking machines with the goal of curing all injuries and getting rid of all pain. </span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Whilst I was becoming a qualified practitioner learning my trade in the health service and studying for a Master’s degree these machines were being pushed aside in favour of the next trend - suddenly all ailments could be cured not by electricity but simply by ‘activating your core’. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A new muscle was introduced to our lexicon. The ‘transversus abdominus’ the magic cure all for back, knee and shoulder pain. Just get the patients to lie on their back and work this muscle in a very specific and magical way and all would become well with the world.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I set about my job of activating patient’s cores with great gusto, armed with my new argot - “zip and hollow”, “tuck in”, “gently pull your core into your spine”. It had to be just right or it wouldn’t work. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The result of all this precise deep abdominal activation was, well, not a lot. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I then started reading the research it was all based on - a few studies by some Australians - and realised that there were significant flaws in their arguments. Further reading found that there were many ways to work the muscles around the back and many of them far more enjoyable and effective than the strange ritualistic exercises we had been prescribing. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For me the final nail in the coffin came with a study published a few years ago showing that whilst exercise does help to reduce lower back pain no particular type of exercise is any better than any other (</span><a href="https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/1471-2474-15-416" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">study</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">).</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">What next? A period of sober self-reflection, perhaps challenging ourselves and our assumptions as medical practitioners?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Or instead, how about a new wonder muscle? The Glute.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Suddenly all my patients had weak, underactive, lazy glutes that just weren’t firing. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The cause for all these deactivated bums? Too much sitting. So you poor runners with your ITB, shin splints and achilles pain had all better get your glutes firing. Squeeze squeeze squeeze. You’d better clam and bridge for all you’re worth.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So everyone got better, right? Guess what? Results were sketchy. Some patients recovered, others did hundreds of clams and bridges daily with no change to their symptoms. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So I shouldn’t bother with glutes exercises, or core, or Physiotherapists for that matter?</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Well, not quite. All these muscles are important and may need looking after but they aren’t a cure for all pain and ailments. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The largest bum muscle, gluteus maximus, is a powerful muscle that helps power you forward when you run. The faster you run the harder the glute has to work. This is why sprinters tend towards a rather large behind. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The deeper gluteus muscles (medius and minimus) support and stabilise the pelvis as you run so when you land on one leg they provide the scaffolding to keep the leg steady to enable you to push off. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So they are really important?</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Yes…... but as part of a whole system. They work with other muscles, fascia, tendons, bones, joints, and nerves. These other tissues and muscles all have their own part to play. Strengthening the glutes in isolation will rarely do very much. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In clinic I often see patients with ongoing issues after being treated by several other physios. They arrive confused and frustrated with their problems. Like many others they have been told that the cause of their problems is a weak core, glutes or both and have then engaged with their prescribed exercises for sometime with little benefit. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case study 1 </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sarah arrived in clinic with ongoing lower back and bum pain that was stopping her enjoying running. She had seen a physio previously who had declared that her glute wasn’t working. She had been given the standard bridges and clams and worked hard at getting her glute to work. But the pain continued and she still struggled to run. Her logic was that despite all the work she had done she still had a ‘weak’ glute. Her glute whilst lying on her side was very strong but in the one leg stand position which is key for running this strength didn’t translate into a strong stable leg. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">She underwent a rehabilitation program focusing on balance and control on one leg, working all the muscles including the glutes in a running relevant position. She improved quickly and then slowly built up her pain free running over time. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case Study 2</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Like Sarah, Mary came to see me after having seen several other physios. She had pain in her hamstring tendon which kept flaring up when she did a bit more running especially downhill running. She had been told she had poor biomechanics on the injured side and needed to strengthen her glutes to correct this. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">On assessment the hamstring muscle on that side was much weaker, following a previous tear, thus when running downhill the weak hamstring caused more load on the hamstring tendon. For Mary treatment was based around hamstring strength work and advice on building her running up and discussing technique when descending. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case Study 3 </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">John came to see me after nearly two years of pain and frustration following an accident which injured his knee. He had been prescribed many exercises including some of the standing exercises described below, but he had still not fully recovered. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">He had ongoing changes to strength, control and balance through his injured leg but he was also struggling with the changes the accident had had on his overall fitness and lifestyle.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For John the key to progress was developing a greater understanding of injuries, damage and pain pathways alongside guidance as to how to build his fitness and physical cofidence back up to the level he once enjoyed. This included glutes exercises to address the reduced strength and control on the right leg, but this was only a part of the overall treatment plan. </span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For more information on how pain works see these previous blogs. (</span><a href="http://kimbaxterphysio.blogspot.co.uk/2015/10/how-our-tissue-responds-to-pain.html" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">here</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, </span><a href="http://kimbaxterphysio.blogspot.co.uk/2016/06/amplifying-pain-central-sensitisation.html" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">here</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, and </span><a href="http://kimbaxterphysio.blogspot.co.uk/2016/10/shark-attack-its-all-in-mind.html" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">here</span></a><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">)</span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So how do I address the glutes when assessing and treating in clinic? </span></div>
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<ul style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If I give a strength program to help reduce the risk of injury I will always include exercises to strengthen the glutes. Including some exercises that mimic how they will be used in the person's sport. </span></div>
</li>
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">With any lower limb injury I will always assess how the glutes are working and if I have any concerns I will include glute strength exercises in any rehab program. But rarely is it just the glutes I want to target. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: disc; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I will always tailor the glutes exercise I give to the specific needs, strength and ability of the patient. </span></div>
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</ul>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So... what should you do? </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I would recommend everybody to do some form of strength work as part of their training or even just as part of their life. Its pretty clear from research that all exercise is good for us and strength exercises are one part of this.</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For people that do engage in sport evidence shows that strength work reduces injury risk and improves performance. For injuries evidence is also strong to show that exercises are one of the most useful tools we have to resolve the injury and reduce pain. </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">And when you engage in any strength program I would include some exercises to work the glutes. </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">So here are some different glutes exercises. I have split them into floor exercises and standing exercises that more closely mimic how we use the glutes when we run. I wouldn’t do all these exercises, just find two or three exercises that you find challenging but not impossible. A combination of floor and standing exercises are good. </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you find 30 reps of an exercise is easy then you need to make it more challenging. I have suggested ways of doing this at the end of each exercise. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Floor Exercises</span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>1) The Clam</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> with variations. Find the one for you. You need to feel it working your glute and not cause any pain</span><br />
<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;"><br /></span></div>
Standard clam (feet together, lift the knee up an down)<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;"> </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLkqW2tDqfIpS4GRsUFjtDDOnvb-wWzNAtWkHIIglFTxwrcEyZOtSx2e5acb7_WDZoAB2NFqSeSpTKq7Mc6BtbJMO2DfvoZ8_xFaQXNXF7OgSPBQPBYIlbUk3g31KppNSBMZhp8R4ZZFkJ/s1600/DSC08531.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgLkqW2tDqfIpS4GRsUFjtDDOnvb-wWzNAtWkHIIglFTxwrcEyZOtSx2e5acb7_WDZoAB2NFqSeSpTKq7Mc6BtbJMO2DfvoZ8_xFaQXNXF7OgSPBQPBYIlbUk3g31KppNSBMZhp8R4ZZFkJ/s320/DSC08531.ARW" width="320" /></a></div>
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<span style="font-family: arial;"><br /></span><span style="font-family: arial; font-size: 11pt; text-align: center; white-space: pre-wrap;">Standard clam with feet in air. </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwZtX7nrUPwQV44VicZg7280wPhNirlGurQHm4rKqn3XxeV0ITCh7Sj3yZ_GgnTD8sSNkoZ2ZrYn61oLKEZLB5kyqmS64_Ovi90CgE-7mH86W6actTHUY4v-Mvj0W9cRaXao0b-Frn-2EW/s1600/DSC08525.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwZtX7nrUPwQV44VicZg7280wPhNirlGurQHm4rKqn3XxeV0ITCh7Sj3yZ_GgnTD8sSNkoZ2ZrYn61oLKEZLB5kyqmS64_Ovi90CgE-7mH86W6actTHUY4v-Mvj0W9cRaXao0b-Frn-2EW/s320/DSC08525.ARW" width="320" /></a></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Reverse clam - (knees together, lift the top foot)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzlyKJFsWe0_3t2FSZIEC1rc0PdSWR3dCYMCEHV9WZzKrp1JfleZTvTCgPepdUac7GGMAoP8HBjThnXL-8_11DnCT8bPg6OCe2lE4lePoz6BSMBki1gAxOpruophfiAfnGzQKT_yZ0DogC/s1600/DSC08535.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjzlyKJFsWe0_3t2FSZIEC1rc0PdSWR3dCYMCEHV9WZzKrp1JfleZTvTCgPepdUac7GGMAoP8HBjThnXL-8_11DnCT8bPg6OCe2lE4lePoz6BSMBki1gAxOpruophfiAfnGzQKT_yZ0DogC/s320/DSC08535.ARW" width="320" /></a></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span><span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Reverse clam with feet and knees in air</span><br /><ol style="margin-bottom: 0pt; margin-top: 0pt;">
</ol>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEIL6GS7-8QDFbPM9kI5BZxRoIVfFDkOwSczlE8lREMy7UgrCr-cRbfnRro6ByF_sTYq03wUcWpmzM7G57jEIn7Ur4d5Be85oweOZi5a6Hm01WakNmUZsme70R6wslfxu2FhsQFtxr0xf_/s1600/DSC08538.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiEIL6GS7-8QDFbPM9kI5BZxRoIVfFDkOwSczlE8lREMy7UgrCr-cRbfnRro6ByF_sTYq03wUcWpmzM7G57jEIn7Ur4d5Be85oweOZi5a6Hm01WakNmUZsme70R6wslfxu2FhsQFtxr0xf_/s320/DSC08538.ARW" width="320" /></a></div>
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">To make harder add a resistance band around the knees for the standard clam and feet for reverse clam. </span></div>
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<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>2) Side plank leg raises</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> - a great exercise to work the ‘core’ and both glutes. These variations get progressively harder.</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Side leg raise</span></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span><span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Half side plank leg raise (on elbow)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLigjG5p4Scrf8y-hZueOXNxs2fMneovr2vxVrpCpN_5tcuxxlEGbwjZY-9pZ35lpDX6_J54AJ5UA7YllAnMHxmHAo6Egt2iVYi9xuyi9Goa0ceJ97ieZlTcvGLPsXZ8AUTsOSnLdU95K5/s1600/DSC08541.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhLigjG5p4Scrf8y-hZueOXNxs2fMneovr2vxVrpCpN_5tcuxxlEGbwjZY-9pZ35lpDX6_J54AJ5UA7YllAnMHxmHAo6Egt2iVYi9xuyi9Goa0ceJ97ieZlTcvGLPsXZ8AUTsOSnLdU95K5/s320/DSC08541.ARW" width="320" /></a></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
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<span style="font-family: arial;"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span><span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Full side plank leg raise (on elbow)</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Full side plank leg raise (on hand) </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQygX4gkFW13uLafDYPIyCpUtmIgb6jNM4BCboGCTHt__3YESof80mMasdscOOUfOtHw1JcGKLf6ISEUKz1IYH45vHNr40Ih_xXB9pkwMB5KZxwokBnjrrw4v1kb-o6M8re2Ajf7YIIVOO/s1600/DSC08549.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQygX4gkFW13uLafDYPIyCpUtmIgb6jNM4BCboGCTHt__3YESof80mMasdscOOUfOtHw1JcGKLf6ISEUKz1IYH45vHNr40Ih_xXB9pkwMB5KZxwokBnjrrw4v1kb-o6M8re2Ajf7YIIVOO/s320/DSC08549.ARW" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>3) Front plank leg raise </b>- extend hip by lifting foot up to ceiling</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> (mainly works glute max as well as the ‘core’)</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Standard leg raise</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRcBWNlw-C4fj60NnMgFnREL9x2ySRcNg_s7ch-SzqwiEoHMBnzki1J693lr7FbXQZuBYhengRV9MuIAgEoBt3Qenfm4F3-UkvbRqsrtGdp-JVszZVG0bePXwo8i6sLESVKMa9BZGTA0_8/s1600/DSC08558.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgRcBWNlw-C4fj60NnMgFnREL9x2ySRcNg_s7ch-SzqwiEoHMBnzki1J693lr7FbXQZuBYhengRV9MuIAgEoBt3Qenfm4F3-UkvbRqsrtGdp-JVszZVG0bePXwo8i6sLESVKMa9BZGTA0_8/s320/DSC08558.ARW" width="320" /></a></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Elbow plank leg raise</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh5GvS_lQg75-AVhrVh2Ay_YSZMru_6AVruZEU6rpTDvhR6Pl094wxY87isL4fGBulafm6oNB0rB4Cwro_OLeZR1WP4QVngZgS0FNuP9azyHhRwvRhb39PnCub643xfA6q1dTCtUpxWfKP/s1600/DSC08555.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgh5GvS_lQg75-AVhrVh2Ay_YSZMru_6AVruZEU6rpTDvhR6Pl094wxY87isL4fGBulafm6oNB0rB4Cwro_OLeZR1WP4QVngZgS0FNuP9azyHhRwvRhb39PnCub643xfA6q1dTCtUpxWfKP/s320/DSC08555.ARW" width="320" /></a></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">Hand plank leg raise</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtNsXTfGF75Fi7eweEpeVJ1kP1_oDAZoGZfFfCm73NmV5brnFKZ8glUrXWYwLyF5YnS4TFWJgfZNld5UvBa8Bt9Jzs1LNluPTT92vOp4G2Dn6K5f8KMuMH6D0gV1seJjj-Vj1j3Q4mvz56/s1600/DSC08560.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtNsXTfGF75Fi7eweEpeVJ1kP1_oDAZoGZfFfCm73NmV5brnFKZ8glUrXWYwLyF5YnS4TFWJgfZNld5UvBa8Bt9Jzs1LNluPTT92vOp4G2Dn6K5f8KMuMH6D0gV1seJjj-Vj1j3Q4mvz56/s320/DSC08560.ARW" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Standing Exercises</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">1) Step up to balance</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTJUNpluOymakdYAJhfzRoVW_dvwkvdto9U5F7UYBzeGhSGKCSxwrDhbFc_aeVDHMqeXZu1Hbo26dsl_sZQPeWxccggUb_vPWgccoz2VZ4rVZ75ueleSP4sav3IK3m1sHoM0Zh_X8Q__si/s1600/DSC08566.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTJUNpluOymakdYAJhfzRoVW_dvwkvdto9U5F7UYBzeGhSGKCSxwrDhbFc_aeVDHMqeXZu1Hbo26dsl_sZQPeWxccggUb_vPWgccoz2VZ4rVZ75ueleSP4sav3IK3m1sHoM0Zh_X8Q__si/s320/DSC08566.ARW" width="320" /></a></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">2) Side step up to balance</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">3) Single leg seated squat</span></div>
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<span style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">4) Bulgarian split squat - drop hips down and bend knee (like your seating down)</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7MUH4jZ2kS7E768ZcZSUwizH3FOmMIy1gxfH6PIT_UXfkvLMdnSNBcHt-jjiWUbZh1ibKgr6ZIHrd9Kw-NY9ar91UVF4rki7SO14YwFoa-tVT_0LR-9c-UtIIkmNFotxbi10_jPLt2cTl/s1600/DSC08574.ARW" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="1067" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh7MUH4jZ2kS7E768ZcZSUwizH3FOmMIy1gxfH6PIT_UXfkvLMdnSNBcHt-jjiWUbZh1ibKgr6ZIHrd9Kw-NY9ar91UVF4rki7SO14YwFoa-tVT_0LR-9c-UtIIkmNFotxbi10_jPLt2cTl/s320/DSC08574.ARW" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Make these harder:</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Higher step (exercises 1 & 2)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Lower seat (exercise 3) </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Add weights (kettlebell, weight plate, dumbbell, bar, rucksack with bags of sugar in!) </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do the exercise very slowly and controlled (builds balance and control)</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do the pushing up phase of each exercise as fast as possible (builds power)</span></div>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com2tag:blogger.com,1999:blog-211472755540078565.post-3132421528200351882017-04-28T06:49:00.002-07:002017-04-28T06:49:26.780-07:00Sally's return to the roads - Sheffield Half 2017<div dir="ltr" style="background-color: white; font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 12pt;">
I gave up road running 4 years ago after finally achieving my marathon sub 3 with <span class="aBn" data-term="goog_675329429" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">2:57</span></span> in the Amsterdam Marathon (at the 8th attempt!).<br />
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Road running for me had become a chore, a slave to the watch. Each session was spent chasing times, rather than enjoying what was after all a hobby. I was enjoying fell and trail running much more. The variety of terrain made each mile different so there was no point trying to work out paces, instead, it was more about running to feel and running each mile on merit. I was getting some good results from this approach, gaining selection for the Great Britain team for the Trail World Championships at ultra marathon distances for the last three years.</div>
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So, what made me suddenly come back to road running for this years Sheffield Half marathon? It was a local race but most importantly hilly!<br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTHI1tbBW_nRwnb4ZcncJDUSkgiBzk2RBGMXWqtNNmKcyYFWti2e-q9B0RwCLNvQ1rotmyjOyFCWPBIUQXoKGjPU8yzy-fMY2rLhshhIDv5pfDSLMfM6Ago7SHFbmXlpAYT3vfFmwRAnF0/s1600/2016-SheffieldHalfMarathon-5569.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhTHI1tbBW_nRwnb4ZcncJDUSkgiBzk2RBGMXWqtNNmKcyYFWti2e-q9B0RwCLNvQ1rotmyjOyFCWPBIUQXoKGjPU8yzy-fMY2rLhshhIDv5pfDSLMfM6Ago7SHFbmXlpAYT3vfFmwRAnF0/s400/2016-SheffieldHalfMarathon-5569.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The Sheffield Half Hill</td></tr>
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The uphill first half, followed by 6 miles of fairly steep downhill appealed to the fell runner in me. I was a much stronger runner than when I was previously road running due to all the hill running as well as regular strength and conditioning work.<br />
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So, the experiment was, how much speed had I lost through fell running and could a half marathon be done on fell fitness? Instead of the speed intervals and tempo runs I was going to stick to what I enjoyed, shorter fell races for speed work and a hilly Dark Peak road run of 10 miles or so on a <span class="aBn" data-term="goog_675329430" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">Wednesday</span></span> night.</div>
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My half marathon build up included:<br />
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<li style="margin-left: 15px;">Weekly mileage (20 weeks) of 55-76 miles.</li>
<li style="margin-left: 15px;">7 Fell races, varying from 6 - 21 miles, the last of which was Edale Skyline (21miles) 2 weeks prior to the half.</li>
<li style="margin-left: 15px;">Howarth Hobble ultra marathon (33miles), 5 weeks before, also the GB selection race.</li>
<li style="margin-left: 15px;">1 Parkrun, 6 weeks before.</li>
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The Parkrun was the first time <span class="aBn" data-term="goog_675329431" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">in 4 years</span></span> I had run fast and consistent miles. It was a PB at <span class="aBn" data-term="goog_675329432" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">19:04!</span></span> The mile splits were <span class="aBn" data-term="goog_675329433" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">6:00</span></span>, <span class="aBn" data-term="goog_675329434" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">6:08</span></span>, <span class="aBn" data-term="goog_675329435" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">6:04</span></span>. I wouldn't have thought I could do 1 mile at that pace, never mind 3 in a row!</div>
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Come half marathon day, I had no idea how I was going to do. I didn't work out any splits, targets or paces, instead I planned to ignore the watch and run to feel. After all, this is how I'd been running all my fell races. On the climb up to the Norfolk Arms, around 5 miles in I over took 2nd lady and from then onwards I held onto 2nd place. I had to work incredibly hard towards the end, I was feeling the lungs more than the legs by the 11-12th mile but was aware 3rd lady was right behind. The last mile was done in 6:01min/mile despite a slight uphill, and I only finished 10 seconds ahead of her in the end! My overall average pace was 6:27min/mile, giving me a time of <span class="aBn" data-term="goog_675329436" style="border-bottom: 1px dashed rgb(204, 204, 204); position: relative; top: -2px; z-index: 0;" tabindex="0"><span class="aQJ" style="position: relative; top: 2px; z-index: -1;">1:24:47</span></span>. This was 2 minutes slower than my PB but that was set on a pancake flat course at the North Lincolnshire Half, 4 years ago.</div>
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So what did I learn:<br />
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<ul style="background-color: white; font-family: Calibri, Arial, Helvetica, sans-serif; font-size: 16px; margin-bottom: 0px; margin-top: 0px;">
<li style="margin-left: 15px;">Speed and interval training is not needed for me to race a fast half marathon. When chasing road times I felt I picked up niggles from the high intensity sessions on hard surfaces. To perform at half and marathon distances the risk of these sessions (greater loading on tissue) may not make up for the reward (faster top end speed). </li>
<li style="margin-left: 15px;">Consistent miles over months and years is the key to progress. The majority of these miles need to be done at an easy pace, but this race showed me that these base miles don't have to be race specific. Hilly off road routes which involve walking can be a valid method of getting these base miles in and are kinder to your body than high road mileage. </li>
<li style="margin-left: 15px;">Adding strength and conditioning to my training seems to have helped me both maintain (or even improve) my road speed and reduce the number of 'niggles' I experience. This is in line with current research findings. </li>
<li style="margin-left: 15px;">You can take the stress away from road running by ignoring the watch and running to feel. And it can be just as successful!</li>
</ul>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTVFQT4h8ct-gy0SW0YiyB4YJVgclaQ3Uw8Pfk9wbTB_CvNb0MXNOHzgF-MsAwVX25xfeLCQOLFys9vrnkSdxMK8-UJAFDRp8pY6pbX2McDzLmklc6uH2aLzHsFkbMvLbRklA4qFrPqA5v/s1600/unnamed+%25282%2529.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTVFQT4h8ct-gy0SW0YiyB4YJVgclaQ3Uw8Pfk9wbTB_CvNb0MXNOHzgF-MsAwVX25xfeLCQOLFys9vrnkSdxMK8-UJAFDRp8pY6pbX2McDzLmklc6uH2aLzHsFkbMvLbRklA4qFrPqA5v/s400/unnamed+%25282%2529.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Howarth Hobble 2017 - I finished 2nd lady securing selection for GB. </td></tr>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-17366706763335615552017-03-06T03:13:00.000-08:002017-03-06T03:14:50.201-08:00Ankle Strengthening<blockquote class="tr_bq" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 11pt; vertical-align: baseline; white-space: pre-wrap;">“</span><span style="font-family: "arial"; font-size: 11pt; font-style: italic; vertical-align: baseline; white-space: pre-wrap;">Wibble wobble</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></blockquote>
<blockquote class="tr_bq" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Wibble wobble</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></blockquote>
<blockquote class="tr_bq" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Jelly on a plate</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">”</span></blockquote>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-left: 36pt; margin-top: 0pt; text-indent: 36pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">(unaccredited)</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sprained ankles lurk around every corner, particularly for fell runners and orienteers who are maladapted to pavements and other flat surfaces. Other potential victims include beginners and road specialists heading out to the countryside for some spring air. And of course if you’ve sprained an ankle before then you likely to be more vulnerable.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Thankfully ankles are an area where the research is clear, albeit from other sports - ankle exercises reduce the incidence of sprains and re-injury.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Start by emulating a flamingo and stand on one leg.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhMI8iqeWEmdMvcuL387Yx4SX_-33ja-x12oALQT6ge1V6aAdh8LaES2I2PVhQYFlBpKoLsUfXMQX6pwfxb2-qyeXhE7ivYVafWIO4xlp7yyUIez4yLWufkGTVX_6fqizJ-MfSKJOs0zFq/s1600/Flamingo-4255.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjhMI8iqeWEmdMvcuL387Yx4SX_-33ja-x12oALQT6ge1V6aAdh8LaES2I2PVhQYFlBpKoLsUfXMQX6pwfxb2-qyeXhE7ivYVafWIO4xlp7yyUIez4yLWufkGTVX_6fqizJ-MfSKJOs0zFq/s400/Flamingo-4255.jpg" width="400" /></a></td></tr>
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<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;"><b>Technique</b></span><br />
<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;"><b><br /></b></span>
<span style="font-family: "arial"; font-size: 11pt; white-space: pre-wrap;">Technique is important. Keep you foot and leg relaxed but stable, not rigid and fixed. Try to feel strong through the core and glute. Hold onto something to stabilise if you need to.</span><br />
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<br />
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As confidence grows start moving your arms and your other leg - anything that throws you off balance.</span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Increase the difficulty by finding an unstable surface, using a wobble cushion or even a pillow, bed or sofa. </span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Other options include jumps and hops where you land on one leg and stabilise, and standing on tip toes on one leg which builds control when your on your fore-foot/mid-foot.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Technique, again</span></h2>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The options are endless. What is important is how you do the exercises. You need to be relaxed, stable and strong - not just wobbling all over the place. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Example program</b></span></div>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Here are a set of exercises, to build your own program. Choose two from the static set and one from the dynamic set. </span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Try to practice them two to three times a week. </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Your chosen exercise should be ‘just’ manageable with a focus on good technique. If it is too easy you won’t be challenging and improving your balance. If it is too hard you won’t be able to master it. </span></div>
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<br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If you find an exercise too hard start by holding onto something and progress by reducing the amount of support you use.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>The static set </b></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Choose two. Spend two minutes working on each one in sets of five to six repetitions with a short break between.</span><br />
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">Standing 1 leg:</span><br />
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">Star taps:</span><br />
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; text-align: center; white-space: pre-wrap;">Run on one leg:</span><br />
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">One leg stand to calf raise:</span><br />
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">One leg stand wobble cushion:
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiJCWt7ZoT1ol3ioLem3aLlQz9XkMqjiumGSSbB5IOcyJRZ_dlS-UW2rv3G-KPr8VR-g9oR7L_6nL2AEVUyKYRU8tTKcqLe6wlIa_5cjbzqu22qIeep87oPzBeo5ZGxw7I5h4A6Uu6DXGk/s1600/image1.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiJCWt7ZoT1ol3ioLem3aLlQz9XkMqjiumGSSbB5IOcyJRZ_dlS-UW2rv3G-KPr8VR-g9oR7L_6nL2AEVUyKYRU8tTKcqLe6wlIa_5cjbzqu22qIeep87oPzBeo5ZGxw7I5h4A6Uu6DXGk/s320/image1.JPG" width="240" /></a></div>
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<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">One leg stand rotation (very challenging!):</span></div>
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dxK7huqqVUaP6Dx76HrpPJ1curoQktQG9AdhK5Eegq1G0AM7-L7qsOaBemPaK-i5E4k4IuKud_ERDPfZSrNQw' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div style="text-align: center;">
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<div style="text-align: left;">
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;"><br /></span></div>
<b style="font-family: arial; font-size: 11pt; white-space: pre-wrap;">The dynamic set </b><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 11pt; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Choose one. Do up to ten repetitions and repeat three times.</span></div>
<br />
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">Lateral hops:</span><br />
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dypkx5aqQv2pQrODESuGqC-AAK75jjiWJeHQOz95a4uS5jt2jpe56iygSoONnHBLCYJBv4fsBYhuFhgjLwcoQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><br /></span></span></div>
<div>
<br />
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">Hops to wobble cushion:</span><br />
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div style="text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dytOB8XxeW-yKKbuY8UBMiFkQtNGp2TJkS2fRdirx1Yo3pvWdqJo5ianl7hTEoc5nbKWScO2rP-7DmcaFDg-A' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><br /></span></span></div>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><br /></span></span><span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;">Back lunge to hop forward:</span><br />
<span style="font-family: "arial"; font-size: 11pt; line-height: 1.38; white-space: pre-wrap;"><br /></span></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dzh57bsEubWKensgHaOi-PZJLo2OEt1A5sagNLXPxueGjQmjuNilylN7--12ERXqiV-1VoVWr_-AEX0wq59HQ' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><br /></span></span>
<br />
<span style="font-family: "arial";"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Photos and videos taken in <a href="http://www.fairplaysport.co.uk/" target="_blank">Fairplay Sport</a> Personal Training studio, below our practice:</span></span><br />
<ol style="margin-bottom: 0pt; margin-top: 0pt;">
</ol>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDtPH04b5mo41bEt1kT6I1jfxRIEBiyhESOLup_vhrhpuRljr8fzqDS5sZNExm5NjK6evtrudLkz6hVeTaH5uYarE4mhZJYXhfIr-c8IXvqSMgLwBw5Vp5MKi0QB2gbCv5TJNu7tqruk3i/s1600/Kenya-57.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDtPH04b5mo41bEt1kT6I1jfxRIEBiyhESOLup_vhrhpuRljr8fzqDS5sZNExm5NjK6evtrudLkz6hVeTaH5uYarE4mhZJYXhfIr-c8IXvqSMgLwBw5Vp5MKi0QB2gbCv5TJNu7tqruk3i/s400/Kenya-57.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Why not practice with friends?</td></tr>
</tbody></table>
<br />
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
</div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-2512615277667433922017-02-14T00:29:00.000-08:002017-03-06T03:26:08.802-08:00The politics of stretching<div>
Vitamin C is good for colds. Fat is the cause of the world's obesity epidemic. Milk is vital for growing children. </div>
<div>
<br /></div>
<div>
What
do the above statements have in common? They are all statements that at
one time were believed by a majority. They probably still are. Yet they
have been researched extensively and evidence is, at best, mixed. </div>
<div>
<br /></div>
<div>
Misconceptions
relating to stretching and exercise are one my biggest bugbears. Much
like Windows or Mac many people - athletes, coaches, physiotherapists -
have an almost religious belief in the benefits of stretching, sometimes
to the point that they struggle to take-in alternative explanations.
As someone who wants to get people back running again this can be
somewhat frustrating.</div>
<div>
<br /></div>
<div>
"I've been stretching for weeks but it still hurts and I'm not getting any better"</div>
<div>
<br /></div>
<div>
"I stretch all the time but I still get injured"</div>
<div>
<br /></div>
<div>
"Did my calf go because I didn't stretch before running?"</div>
<div>
<br /></div>
<div>
"Did my calf go because I didn't stretch after running?"</div>
<div>
<br /></div>
<div>
This blog is an attempt to explain my thinking with respect to stretching in athletes.</div>
<div>
<br /></div>
<div>
<b>Reach for the sky</b> </div>
<div>
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
If
you're a climber it's pretty obvious stretching is a key component to improving
your performance. Greater mobility directly improves your ability to
place a foot on a high hold. But, this is of no consequence if you don't then have the strength to push up!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU_wWSjhbuGOvvKFxE6IALnOtmJ_fwyqHSG5lg3fjze_cvq_SBRj_PMTa9-y69AJ52psegjBBgwRlV8FpNEz6ofQee-rJtn6E4NhtvuKNawj8ghQVDgOVJ3omXlgHTyaprWouJCXeAKpj5/s1600/Ella.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgU_wWSjhbuGOvvKFxE6IALnOtmJ_fwyqHSG5lg3fjze_cvq_SBRj_PMTa9-y69AJ52psegjBBgwRlV8FpNEz6ofQee-rJtn6E4NhtvuKNawj8ghQVDgOVJ3omXlgHTyaprWouJCXeAKpj5/s400/Ella.jpg" width="258" /></a></div>
<br /></div>
<div>
<br /></div>
<div>
What if you're a runner or a cyclist?</div>
<div>
<br /></div>
<div>
Take
a look at the picture of physio Dave Sprot below. He is running at 2.30 min/km pace. Can you get into this position? The answer for most of you is yes. You don't need to stretch
to achieve that range of mobility. But can you race at 2.30 min/km pace? That pace would equate to a 12.30min parkrun!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIhNWOuyUj2J4lT-KLjepscRgx76uxSl3Y59q8r3VFeburdIS7s32422r8NQtpua5xpn2nrlJqggtIlDT7kTl0Rw-te2VH3gaEnsDalEHNe_L56jEomnY46cfMwlvcKyDvg8tVcQDpq8VO/s1600/dave_sprot+800m.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="278" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjIhNWOuyUj2J4lT-KLjepscRgx76uxSl3Y59q8r3VFeburdIS7s32422r8NQtpua5xpn2nrlJqggtIlDT7kTl0Rw-te2VH3gaEnsDalEHNe_L56jEomnY46cfMwlvcKyDvg8tVcQDpq8VO/s400/dave_sprot+800m.png" width="400" /></a></div>
<br /></div>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div>
</div>
<div>
<br /></div>
<div>
A very small percentage of us are strong, powerful and aerobically fit
enough to run like that except for very short distances (Dave is racing a 800m). Most of us run
with a greatly decreased range. Stretching isn't going to change that.<br />
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLqVm9w_ICDQztGqesQ39IeS0cFX3uW1LIp4jQ9Sk-E5Z88SmDoK5beivohOh36kAY1y4metLT1Dcp-PX7BqhgQWd065NG4zpkUE8MIa9qISvtAVjoGC8ZbHG3o2qUd5XIcJdyFS3lcwQT/s1600/AliciaHuddlestonBobGraham2016-05497.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLqVm9w_ICDQztGqesQ39IeS0cFX3uW1LIp4jQ9Sk-E5Z88SmDoK5beivohOh36kAY1y4metLT1Dcp-PX7BqhgQWd065NG4zpkUE8MIa9qISvtAVjoGC8ZbHG3o2qUd5XIcJdyFS3lcwQT/s320/AliciaHuddlestonBobGraham2016-05497.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Alicia Hudleson - top American ultra runner on her way to completing the Bob Graham</td></tr>
</tbody></table>
<br />
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtm7IPZ5ILZ0wh86sznsjLLcE1bFFK8779siFIIwDqVCz31ylJGjZRinaHgjx4loStLNcz1PYug6WUsnmwMPapNnKBjBE1jjsVuq9i0WG12jxRjk9eZNIEyECySEwvHsU2TmPaqiwzX6G_/s1600/2016-SheffieldHalfMarathon-5586.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjtm7IPZ5ILZ0wh86sznsjLLcE1bFFK8779siFIIwDqVCz31ylJGjZRinaHgjx4loStLNcz1PYug6WUsnmwMPapNnKBjBE1jjsVuq9i0WG12jxRjk9eZNIEyECySEwvHsU2TmPaqiwzX6G_/s320/2016-SheffieldHalfMarathon-5586.jpg" width="213" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Andy Preston - top Bamford dentist "striding" out to finish Sheffield half in 85mins </td></tr>
</tbody></table>
<br />
<b>What can stretching do and what can't it do?</b></div>
<div>
<br /></div>
<div>
Stretching
does not make the muscle stronger. This has been
studied extensively and the scientific evidence is fairly clear. In most cases stretching will not directly prevent an overload injury nor will it help
it to get it better. </div>
<div>
<br /></div>
<div>
Stretching
can alter the distribution of loads through the body. This can be
beneficial, detrimental or irrelevant, depending on how your body is
working. Muscle tightness that causes other muscles to take more load
than they normally would is a potential source of injury so should be addressed. </div>
<div>
<br /></div>
<div>
The
vast majority of runners and cyclists are sufficiently mobile and don't
need to increase their mobility. Some are hypermobile and in runners
this can increase the risk of joint injuries although in most cases if
someone has been running regularly for a long period their muscles are
strong enough to prevent this.</div>
<div>
<br /></div>
<div>
<b>Case Studies:</b></div>
<div>
<br /></div>
<div>
Here are two contrasting case-studies to illustrate this point:</div>
<div>
<br /></div>
<div>
A
female athlete ran a marathon whilst ill. She was strong enough and fit enough to manage the load of a marathon, but in her fatigued state she overworked the muscles
around her hips which tightened causing reduced range of movement. This
led to an overload on the tissue at the knee. The cause of the injury
was greater load on the iliotibial band. However the injury continued
and didn't resolve until the hip muscles were loosened and stretched
back to their normal length - alongside her normal strength work and
careful load management as she built up her running again.</div>
<div>
<br /></div>
<div>
A
male athlete presented with the same injury. He had been stretching his
glutes and hips on the side of his injury, the left, such that he now
had greater range of movement on that side than the other. Nonetheless
the injury persisted. His cause had been overloading due to a much longer
than normal run. Despite the stretching his left glute was still much weaker
than the right. He had restored mobility but not restored strength. The
injury was resolved through strength work and careful load management as
he built up his running again. </div>
<div>
<br /></div>
<div>
<b>Conclusion:</b></div>
<div>
<br /></div>
<div>
Feel
free to stretch if you feel it helps you. But it is not a panacea. If
you neglect strength work and load management you will very probably get
injured.</div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-66961893914740104792016-11-18T03:14:00.001-08:002016-11-29T01:38:29.711-08:00Strength and Conditioning Exercises for Runners<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-align: center;">
<div style="text-align: left;">
<span style="font-family: "arial"; font-size: 14.6667px; line-height: 1.38; white-space: pre-wrap;">As runners one of the best sessions you can add to your weekly routine is a strength routine either at home or the gym. It will not only improve your running form but can also help with reduce your risk of injury.</span></div>
</div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Spending long periods of time in a sitting posture, at a desk or driving causes a gradual shortening and weakening of key muscles such as the hamstrings, hip flexors, glutes, abdominals and back extensors. After a long working day we then expect these muscle to fire on demand for the duration of the run. Inevitably a point comes where you begin to sway your hips to the sides, lean forwards, over stride and your running form is putting you at risk of injury. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A key to preventing such injuries is improving their strength and endurance. Below is a base level circuit and more advanced circuit of five simple exercises that will challenge all the key running muscles. </span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The circuit should be <b>repeated three times</b> and can be completed <b>one to three times weekly</b>, on nonconsecutive days. Start with the base level and if it's too easy progress to the more advanced circuit. </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<br /></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Base Level Circuit</b></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<br /></div>
<ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.6667px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Step Up</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: stand with one foot on the step, drive through this foot to bring the other leg into the air and balance before slowly lowering back down again. Keep your head up to ensure your upper body remains upright throughout. </span><span style="font-size: 14.6667px; font-weight: 400; white-space: pre-wrap;">10 repetitions on each leg.</span><span style="font-size: 14.6667px; font-weight: 400; white-space: pre-wrap;"> You can make it harder by using a higher step. This exercise works to strengthen the hip flexors, quadriceps and glutes. </span></div>
</li>
</ol>
<div>
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dzt54fcO21xzKQvXlxaBleNfydqPzZgZy4DfU5EEHRP8gMM_eRBozLYrxUu9rd-tpS6NdS9B6ZymnGT2Pxuog' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
<div>
<br /></div>
<ol start="2" style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.6667px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Wall Squat</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: stand with your back flat against a wall and feet about half a meter from the wall, slowly lower down until your knees are at 90 degrees and hold for 45 secs. 5 repetitions. This works to strengthen glutes and quadriceps.</span></div>
</li>
</ol>
<div>
<span style="font-family: "arial";"><span style="font-size: 14.6667px; white-space: pre-wrap;"><br /></span></span></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVAf3AfvXMgwOFz4t5HjEaiBHBsO-hQ6nfd2uwGHLCQLseBxkNphso3oqAdBJZr1A2CbbZ2kGTOn_2urWXnqa0rVkAaTcUtR5TepwCrrQmvCtjjSCpLMMPc5PA6sJQwx64dhLPuWRsRgnK/s1600/Exercises-06551.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgVAf3AfvXMgwOFz4t5HjEaiBHBsO-hQ6nfd2uwGHLCQLseBxkNphso3oqAdBJZr1A2CbbZ2kGTOn_2urWXnqa0rVkAaTcUtR5TepwCrrQmvCtjjSCpLMMPc5PA6sJQwx64dhLPuWRsRgnK/s400/Exercises-06551.jpg" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><br /></td></tr>
</tbody></table>
<div>
<br /></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.6667px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Bridge</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: lying on your back, heels as close to your bottom as possible, raise your bottom to extend through your hips. Dip from the hips to hover just above the floor, then push back up using your bottom muscles.1</span><span style="font-size: 14.6667px; font-weight: 400; white-space: pre-wrap;">0 repetitions. </span><span style="font-size: 14.6667px; font-weight: 400; white-space: pre-wrap;">This works to strengthen the glutes. </span></div>
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<li dir="ltr" style="background-color: transparent; color: black; font-family: arial; font-size: 14.6667px; font-style: normal; font-variant-caps: normal; font-variant-ligatures: normal; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Clam into Running Man</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: Lying on one side, knees bent and feet in the air (for an easier version keep your feet on the floor), lift the top knee to approximately forty-five degrees keeping the feet together. Then slowly lower until knees are together again. 10 repetitions. Then stand up and balance on the same leg you have just worked. Bring the non- standing leg forwards at the same time as you lean forwards, then extend the leg behind you. Repeat 10 times then lie down on the opposite side and repeat the sequence on the opposite leg. This works to strengthen the glutes and then challenges their endurance in a running specific position. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Plank Knee Drive</b></span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-style: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">: From a plank position either on a table (easier) or chair (harder) ensure your back is straight and bend alternate knees to the chest. 20 repetitions. This exercise works on the core muscles and strengthens the hip flexors as you pull your leg inwards. </span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-style: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><b>Advanced Circuit</b></span><br />
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<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><b>Lunge back</b></span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">: stride back with alternate legs, keeping your feet facing forwards, dipping as low as comfortable with the back leg. Keep your head up to ensure your upper body remains upright throughout. </span><span style="font-family: "arial"; font-size: 14.6667px; white-space: pre-wrap;">10 repetitions.</span><span style="font-family: "arial";"><span style="font-size: 14.6667px; white-space: pre-wrap;">This exercise works to strengthen and lengthen the hip flexors and quadriceps. </span></span></li>
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<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><b>Single Leg Deadlift</b></span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">: standing on one leg, keep both legs straight and bend forwards, bringing your fingertips as close to the floor as possible. Ensure you tighten the abdominal muscles to keep your back straight throughout. 10 repetitions each leg. This works to strengthen and lengthen the hamstrings, glutes and calves. </span></li>
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<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><b>Single Leg Bridge</b></span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">: lying on your back, heels as close to your bottom as possible, raise your bottom to extend through your hips. Lift one leg, bending at the knee, keeping the raised leg still, dip from the hips to hover just above the floor, then push back up using your bottom muscles. <span style="font-size: 14.6667px;">10 repetitions each side.</span> This works to strengthen the glutes.</span></li>
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<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><b>Hip Abduction into Running Man</b></span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">: Lying on one side, top leg straight, lift the top leg to approximately forty-five degrees and slowly lower to hip height. Repeat for 20 repetitions. Then stand up and balance on the same leg you have just worked. Bring the non- standing leg forwards at the same time as you lean forwards, then extend the leg behind you. Repeat 10 times then lie down on the opposite side and repeat the sequence on the opposite leg. This works to strengthen the glutes, and then challenges their endurance in a running specific position. </span></li>
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<li><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><b>Mountain Climber</b></span><span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">: From a plank position ensure your back is straight and jump inwards with alternate legs to the chest, keeping as light as possible on your feet. 20 repetitions. </span><span style="font-family: "arial"; font-size: 14.6667px; white-space: pre-wrap;">This exercise works on the core muscles, strengthens the hip flexors as you pull your leg inwards and also helps with calf strength as you spring forwards.</span></li>
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<iframe allowfullscreen='allowfullscreen' webkitallowfullscreen='webkitallowfullscreen' mozallowfullscreen='mozallowfullscreen' width='320' height='266' src='https://www.blogger.com/video.g?token=AD6v5dwo8Ul2RhHoyovTTj4s9aS_DAIv6kxfxmFiEdOMqkEc4ueRN4qBg0OnvvOXGI0VyUUxq6iX4MSHy0DC3Znx' class='b-hbp-video b-uploaded' frameborder='0'></iframe></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Here’s two pictures of me taken from the end of races, one from a few years ago prior to doing any strength and conditioning work, one after following S&C circuits:</span><br />
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="350" src="https://lh5.googleusercontent.com/Ro7n1NgEZwgn1mHK3o2UCWgEFgz21pfzsuuKAMdVRWa5xdODSg_ukTiA-jyfur5eDLFJ8ydzfUouxPp5gfsw9oszuFYUHUx4LS8nqjsfRsNeEV4nvl4FrX8NLBuXouCmnvuZX5R1" style="border: none; transform: rotate(0rad);" width="465" /></span></div>
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<div style="text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Over-striding, leaning back, very little knee lift or hip extension, arms swinging across my body.</span></div>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="379" src="https://lh6.googleusercontent.com/qg2QL3lOG6jYQ6y3pI8UrnPdPntb7pmEeBLHDu0mL0qWy6FC5LiZeq-WqACLOWAu0UxbZZTZM4FUHbbRd-WKclMmcKXSC3Jk0JpghQnzUxJ-w5ojTjA_x0CANhyWNWoiqVMxHNhj" style="border: none; transform: rotate(0rad);" width="284" /></span></div>
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<span id="docs-internal-guid-7afe19e5-5322-dca8-0a02-9b7289d14355"></span><br />
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<div style="text-align: center;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Driving from my hips, leaning forwards using my core muscles, weight on my toes.</span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; white-space: pre-wrap;"><br /></span></div>
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.6667px; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><i>(By Sally Fawcett, Physiotherapist and GBR Trail Runner)</i></span></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com12Sheffield, UK53.381128999999987 -1.4700850000000453.078144999999985 -2.11553200000004 53.684112999999989 -0.82463800000004006tag:blogger.com,1999:blog-211472755540078565.post-38203982856692901482016-10-17T05:02:00.001-07:002017-03-06T03:27:03.098-08:00Break or Break<h4>
Guest Blog - reproduced with Author's permission from Abingdon AC website. </h4>
September always used to be regarded as the end of one running year and the start of the next –
track was coming to an end and cross country had not yet started. Many distance runners are
compulsive animals for whom the very thought of life without any running would be an anathema,
especially when autumn is such a fantastic time of year for simply getting out for a few relaxing miles
while we still have some daylight in cool and maybe even dry evenings. What’s more combining this
sort of training with the speed we’d accrued over the summer was an ideal set up for enjoying a few
relays.<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm99-tKU-6KZ5ZWSca_8R9WRPSUO1PChib8-eLDNiF0yoeHi3fQbWN40EIzsKJF_Xz0m2LqTHsu8H9o7A0kI8g9fZr3OjRFBKgQua-L2NtZ82jmq6sPR1MJxlBhN2ShNJX2hjeNPhrIWdZ/s1600/Autumn2016-6312.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjm99-tKU-6KZ5ZWSca_8R9WRPSUO1PChib8-eLDNiF0yoeHi3fQbWN40EIzsKJF_Xz0m2LqTHsu8H9o7A0kI8g9fZr3OjRFBKgQua-L2NtZ82jmq6sPR1MJxlBhN2ShNJX2hjeNPhrIWdZ/s400/Autumn2016-6312.jpg" width="400" /></a></div>
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Relaxing autumn miles.....</div>
<br />
After bashing out fast stuff on track or road over the summer this period was as much a
mental break as a physical one before getting down to the rigours of winter work.
Things have changed somewhat nowadays, road races of varying distances are available year-round
and for example September and October now seem to be the Great Run season.<br />
<br />
In December a few
years ago I was talking to a seasoned senior athlete who said he’d lost all zip when it came to the
cross country season and was fed up. A look at his Power of Ten page showed that after a busy
summer on the road (with some track) he’d gone straight into 3 or 4 half marathons in swift
succession that he’d specifically trained for. By December, he wasn't injured, just basically running
on empty. He agreed to try a few weeks of low-key running, no long or hard stuff, just easy half hour
runs, whenever possible in daylight and in pleasant surroundings. No getting home from work with
the thought of a tough ten miles in the dark hanging over him. Within a few weeks his motivation
returned, he had lost very little physical condition and he went back to full training with renewed
vigour.<br />
<br />
Not everyone catches this problem in time and what I want to emphasise here is that we are much
better off having a planned break rather than having one enforced upon us by illness or injury , or
indeed by completely losing that essential joy of running. It is all too easy to plough on after track
has finished but then be forced to stop at the very time when training should be building towards
the big cross countries. Not everyone follows the same yearly cycle and clearly if you are aiming say
at a big autumn marathon or one of the Great Runs then September is not the time for a low-key
few weeks. Just sort out what your priorities are and when they come up and plan an easy period
accordingly.
And for those who just cannot manage without their daily fix, fear not, “break” need not mean lying
in bed all day – in this case a change really can be as good as a rest.<br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTmTpxKxZhUAHs6QpoCBbypjfsitSGdwshb4BDMmiPU_GfGjv7oJG9EIUaN6W1-XAGZ_Q1Xn3zTBo2QnjMq0IlPtKCOi73b1KJxrM3caKs3qx9-GkN6BcBEoIDEwpkC0SMiqoI-kmu7p7p/s1600/2015-Autumn-03261.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiTmTpxKxZhUAHs6QpoCBbypjfsitSGdwshb4BDMmiPU_GfGjv7oJG9EIUaN6W1-XAGZ_Q1Xn3zTBo2QnjMq0IlPtKCOi73b1KJxrM3caKs3qx9-GkN6BcBEoIDEwpkC0SMiqoI-kmu7p7p/s400/2015-Autumn-03261.jpg" width="400" /></a></div>
<div style="text-align: center;">
and some more autumn miles.....</div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-47495805917935354762016-10-07T03:00:00.001-07:002016-10-07T03:00:40.780-07:00Shark attack! It's all in the mind.<span style="background-color: white; font-family: "arial"; font-size: 13.3333px; font-weight: bold; white-space: pre-wrap;">The Pain System #3.</span><br />
<i><br /></i>
<i>"On 31 October 2003. Bethany Hamilton was surfing with her best friend, Alana Blanchard. At first, Hamilton didn’t realize what had happened. She saw a grey flash and felt a short tug. But when she looked down, the water was bright red and her left arm and a large chunk of her surfboard were missing.</i><br />
<i><br /></i>
<i>“I’ve just been attacked by a shark,” she stated calmly, and started paddling towards the shore with one arm." (The Guardian, 2016) </i><br />
<br />
We've already seen in previous blogs something of how the body generates pain signals chemically and electrically in response to external stimuli.<br />
<br />
<a href="http://kimbaxterphysio.blogspot.co.uk/2015/10/how-our-tissue-responds-to-pain.html" target="_blank">Part 1: How our Tissue Responds to Pain</a><br />
<a href="http://kimbaxterphysio.blogspot.co.uk/2016/06/amplifying-pain-central-sensitisation.html" target="_blank">Part 2: Amplifying Pain - Central Sensitisation</a><br />
<br />
But our slippery-tricksy brains have the final say in any pain experience. At the extremes they can generate pain with no external stimulus. Conversely they can ignore external stimulus that is causing the body harm so that no pain is felt at all, usually when a greater threat is present - as Bethany experienced.<br />
<br />
For the majority of us there are many factors that cause the brain to respond in a certain way, generating more, stronger pain messages on some occasions or fewer, weaker ones on others. What is useful is that it doesn't take a rocket scientist or brain surgeon to recognise these behaviours. Most of us are reasonably self-aware. Just as we can train our bodies to be fitter for purpose we can train our brains to be better at pain interpretation.<br />
<br />
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3s580mGg_tNpv2L7FefcdZTsXlOMyKXhZVlE2wZOmmt23J80ZFg7tPSpAzWU1pRfyMY3XXVaVSOwX2IF7cBz-03xGz7y5CcfGyo19VfzaaYH9AGZ6_pJO8EmfsGbseUMAYHxKlhQGyqK2/s1600/TotleyTerminator2016-6257.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3s580mGg_tNpv2L7FefcdZTsXlOMyKXhZVlE2wZOmmt23J80ZFg7tPSpAzWU1pRfyMY3XXVaVSOwX2IF7cBz-03xGz7y5CcfGyo19VfzaaYH9AGZ6_pJO8EmfsGbseUMAYHxKlhQGyqK2/s400/TotleyTerminator2016-6257.jpg" width="266" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pain Face. Finishing The Exterminator</td></tr>
</tbody></table>
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The brain is your body's command centre. Danger messages and pain messages arrive at the brain which then processes them alongside other messages such as "there is a lion over there." Even though the pain systems in the other parts of the body can generate signals in response to real stimulus and can become oversensitised, you won't feel pain without the brain's involvement.<br />
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The brain's challenge is to construct a sensible story based on all information arriving along with the information already stored in the brain. With any pain experience hundreds of parts of the brain are involved simultaneously.<br />
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There are some consistent patterns in this brain activity but the exact parts and amount of activity in each part varies from person to person and within each person. Each and every pain experience is unique. Particularly those of my husband.<br />
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<div style="text-align: center;">
<i><b>“It's the brain that makes the final decision whether or not you should be in pain”</b></i></div>
<div style="text-align: center;">
(Butler & Moseley)</div>
<div style="text-align: center;">
<br /></div>
<h3 style="text-align: left;">
Are you experienced?</h3>
<div>
<div>
Your past and recent experiences have a huge effect on how the brain interprets pain signals. Factors include: </div>
<div>
<ul>
<li>previous injuries, </li>
<li>past experiences, both your own and of others</li>
<li>your knowledge</li>
<li>your beliefs</li>
<li>Past successful behaviours</li>
<li>Past successful behaviours in others</li>
<li>and of course those unhelpful behaviours the human resources department keeps going on about.</li>
</ul>
</div>
<div>
All pain is produced by the brain. </div>
<div>
<br /></div>
<div>
No brain = no pain. </div>
<div>
No pain = no gain.</div>
<div>
No brain => no gain. QED. </div>
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<div>
In an perfect Brave New World - scientific, empirical, logical, evaluated and analytical - we would build a bank of good responses to pain. Our subconscious and conscious decisions would support and reinforce recovery, prevent more damage and maintain function. </div>
<div>
<br /></div>
<div>
Humans use logic to predict the future (often badly) which enables us to then plan for future events. This gives us the capacity to identify potential dangerous situations and plan appropriately. </div>
<div>
<h3>
<b>Everyone's an expert.</b></h3>
</div>
<div>
In the ‘good old days’ there was a very limited amount of outside resources to help us evaluate danger signals. The modern era has dramatically increased this influence of others in how we respond. </div>
</div>
<div>
<div>
<br /></div>
<div>
The internet has brought forth an army of experts, pesudo-experts and self-styled opinion makers, some well-meaning, others purely opportunistic. Many are unhelpful. </div>
<div>
<br /></div>
<div>
There is also access to a wide array of health professionals; GPs, nurses, consultants, physio's, osteopaths and chiropractors. All put their own slant on our pain stories. </div>
<div>
<br /></div>
<div>
A good experience with health experts can increase your knowledge, calm your fears and give you a good plan of how to move forward. </div>
<div>
<br /></div>
<div>
Alternatively each expert offers his own opinion, you receive lots of conflicting advice causing doubt, increasing uncertainty and even fear. The bedside manner of some busy health professionals leaves much to be desired and it is common for them to deliver catastrophising messages without meaning too which we then filter and reinforce </div>
<div>
<br /></div>
<div>
<i>“I need to strap my calf to stop it snapping", </i></div>
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<br /></div>
<div>
<i>"My back is twisted"</i></div>
<div>
<br /></div>
<div>
<i>"My spine is crumbling"</i></div>
<div>
<br /></div>
<div>
<i>"I have chronic arthritis in my knee, therefore I can't do anything" </i></div>
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<br /></div>
<div>
<i>"I must never run again" </i></div>
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<br /></div>
<div>
<i>"My core is weak"</i> </div>
</div>
<div>
<br /></div>
<h3>
The Cosmo Pain Management Quiz - which one are you?</h3>
<h4>
Score 0 - 10: The Ostrich:</h4>
<div>
<div>
You ignore your pain. You're an ignorer. The ultimate ignorers have no pain sensation and don't tend to live very long! </div>
<div>
<br /></div>
<div>
There is a rare condition called congenital insensitivity to pain (CIP) and sufferers are unable to feel any pain. Sadly their life expectancy is significantly reduced as a result. </div>
<div>
<br /></div>
<div>
Other people have a high tolerance to pain, tend to ignore it and push on. Such people are likely to ’get away with’ pushing on through many pains but they will eventually hit a pain that doesn't resolve. It's possible Alastair Brownlee has been one of these.</div>
<div>
<br /></div>
<div>
Push-on'ers can end up in a very confused place once the injuries build up. They can then become Yo-Yos.</div>
</div>
<div>
<br /></div>
<h4>
Score 10 - 20: The Spooks:</h4>
<div>
<div>
Him indoors loves his spy stories, both real and fictional. A common theme is that once you start thinking like a spy setting up plays, misinformation and double-crosses then everything becomes evaluated through that distorted prism.</div>
<div>
<br /></div>
<div>
Spooks tend to listen too much to their pain and consequently act too much. </div>
<div>
<br /></div>
<div>
<i>"Pain is harmful therefore I must rest until it completely goes". </i></div>
<div>
<br /></div>
<div>
<i>"I’m not running again until I am pain free." </i></div>
<div>
<br /></div>
<div>
In the mind of the spook pain means "damaged", no pain means "healed".</div>
<div>
<br /></div>
<div>
<i>"It hurts a lot so I will tape it to stop it breaking." </i></div>
<div>
<br /></div>
<div>
<i>"I can’t do X/Y/Z because it hurts and I will break."</i></div>
</div>
<div>
<i><br /></i></div>
<div>
<i><b>Score 30 - 500: The Yo-Yos:</b></i></div>
<div>
<i><b><br /></b></i></div>
<div>
<div>
Yo-Yo oscillate between the Ostriches and the Spooks. They do too much, often too quickly, which leads to pain and possibly injury. In response they STOP. Everything.</div>
<div>
<br /></div>
<div>
But stopping training reduces the body's tolerance to load and general robustness. But they've stopped so the pain goes. Then they start again, perhaps tentatively but they very quickly return to the loading levels they were putting the body through that caused the injury with obvious consequences.</div>
<div>
<br /></div>
<div>
With each cycle the body becomes more sensitised, less tolerant and more fearful of pain in a feedback loop that increases the magnitude of the Yo-Yo.</div>
<div>
<br /></div>
<div>
At Kim Baxter Physiotherapy we see many Yo-Yos. I regularly treat runners who have been Yo-Yoing for long periods and for whom it has been many years since they have put together sustained periods of injury-free training.<br />
<br />
The key to successful management for Yo-Yos is to break the cycle. This is done by starting with a base load the body can tolerate and systematically building up the load and training. This is easier said than done. </div>
</div>
<div>
<br /></div>
<h3>
Understanding pain helps reduce your fear</h3>
<div>
<div>
Fear has a huge effect on your pain experience. Anything that increases the brain's perception of the need to protect can increase pain.</div>
<div>
<br /></div>
<div>
Here are some common fear factors related to pain:</div>
<div>
<ul>
<li>Fear of the seriousness of the cause of pain - is it cancer, is it very damaged etc</li>
<li>Fear of the unknown - not knowing what it is</li>
<li>Fear of not being believed, not being listened to</li>
<li>Fear of certain movements / activities</li>
<li>Fear of re-injury</li>
<li>Fear of delaying / preventing injury</li>
<li>Fear that it hasn’t healed</li>
<li>Fear of doing more damage</li>
<li>Fear of not being able to work, train, garden, look after kids etc</li>
<li>Fear of not being able to do race or having to pull out of race</li>
<li>Fear of injury reducing performance</li>
<li>Fear of the garden turning into a jungle or the house becoming a bombsite</li>
<li>Fear of pain meaning you're getting old</li>
<li>Fear that your joints are wearing out</li>
<li>Fear that this is it - its never going to get better than this and will only get worse</li>
<li>Fear of having a nervous breakdown </li>
<li>Fear of gaining weight</li>
<li>Fear of what other's think</li>
<li>Fear of possibly having to have surgery</li>
<li>Fear of the treatment - it might hurt, don't like needles, anaesthetic</li>
<li>Fear the medical professionals won't be able to help</li>
<li>Fear I am doomed</li>
</ul>
</div>
<div>
Fear affects your mood. Your mood affects your pain. Yet another feedback loop.<br />
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<tr><td class="tr-caption" style="text-align: center;">Fear makes your pain worse</td></tr>
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<br /></div>
<div>
A study of patients post breast-surgery found that those who attribute pain to returning cancer experience more intense and unpleasant pain than those who attribute it to other causes regardless of what is actually happening to the tissue. </div>
<div>
<br /></div>
<div>
The reporting of pain is also affected by social factors: studies show males have a higher pain threshold if tested by females whilst patients with an attentive caring spouse has a lower pain threshold than patients with uncaring spouses. This of course explains why my husband is so pain sensitive.</div>
<div>
<br /></div>
<div>
We need to train our brains to really understand pain, what it is and what it is not. This is especially important when pain persists, spreads or seems unpredictable. </div>
</div>
<div>
<br /></div>
<h3>
So what does this mean for you? </h3>
<div>
<div>
It is important to understand pain and how it works. The more understanding you have of pain the better you can manage pain events. This is the art of listening when you need to and ignoring at other times. </div>
<div>
<br /></div>
<div>
<i>Understanding</i> and <i>practice</i> can help you make sense of new pain events and break old patterns of behaviour. </div>
<div>
<br /></div>
<div style="text-align: center;">
<b>Hurt does not equal harm. But hurt does need to be listened to and evaluated.</b> </div>
<div style="text-align: center;">
<br /></div>
<div style="text-align: left;">
And, as everyone is individual i.e. different, this must necessarily be empirical but it can still be logical and scientific. You need to objectively evaluate what works for you and what doesn't.</div>
</div>
<div style="text-align: left;">
<br /></div>
<div style="text-align: left;">
<div>
<br />
Butler D.S, Moseley L.G (2013) Explain Pain, Noigroup Publications. </div>
<div>
Mense S, Gerwin R D, (2010) Muscle Pain - Understanding the mechanisms, Springer<br />
Melzack R, Wal P.D (2008) The Challenge of Pain, Penguin Books.</div>
</div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-57831663924303061102016-07-12T05:53:00.001-07:002017-03-06T03:27:26.631-08:005 tips to Avoid Running Injuries (By Sally Fawcett) <ol style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-size: 14.6667px; font-weight: 700; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;">Vary your running paces</span><span style="font-size: 14.6667px; line-height: 1.38; vertical-align: baseline; white-space: pre-wrap;"> - doing all your running at a hard pace is a recipe for disaster (injury, overtraining, fatigue, illness) and also won’t make you a faster runner. Your runs should be broken up into recovery runs, (very easy pace), steady runs (trundling along and able to have a full conversation), tempo runs (able to talk but it's a struggle) and hard runs (conversation just isn't happening). As a rough guide 80% of your running should be at the recovery or steady pace and 20% faster. Make sure you give yourself plenty of time to recover after tempo and hard runs by doing recovery or steady runs for at least 1-2 days, and remember recovery time lengthens with age.</span></div>
</li>
</ol>
<b id="docs-internal-guid-af6a4a11-debe-0c0a-a74d-3a1f61efbd74" style="font-weight: normal;"><br /></b>
<br />
<ol start="2" style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Vary your running terrain</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> - try softer surfaces (grass, moorland or fields) if you are feeling particularly tight and stiff, conversely run on harder more even surfaces (roads, good trails) if you are feeling fatigued with reduced balance / control .</span></div>
</li>
</ol>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<ol start="3" style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Add some strength and conditioning</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> - There is much research supporting the use of strength, balance, core stability and plyometric work to not only reduce injury but also improve running speed. Therefore, including some strength work a few times a week is a good way to ensure you don’t over do the running mileage whilst still doing purposeful training. </span></div>
</li>
</ol>
<b style="font-weight: normal;"><br /></b>
<br />
<ol start="4" style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Do some cross training</span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> - reduce the impact load and give the joints a rest with some cycling, swimming or power walking. If you are training for a long distance event the likelihood is you will be walking for large sections so don’t neglect this in your training. Instead of running, go for a hilly power walk.</span></div>
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</ol>
<b style="font-weight: normal;"><br /></b>
<br />
<ol start="5" style="margin-bottom: 0pt; margin-top: 0pt;">
<li dir="ltr" style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; list-style-type: decimal; text-decoration: none; vertical-align: baseline;"><div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Don’t let niggles get out of hand </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">- quick effective management of a niggle will ensure it doesn't progress to a full blown injury. A few easy running days or cross training days can often allow your body to recover and let the niggle calm down. After that, for many types of injuries resting is </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">not </span><span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">the best course of action, but for others it's critical - if in doubt seek professional advice. </span></div>
</li>
</ol>
<b style="font-weight: normal;"><br /></b>
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<span style="background-color: transparent; color: black; font-family: "arial"; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Balsalobre-Fernandez C, Santos-Concejero J, Grivas GV (2015) The effects of strength training on running economy in highly trained runners: A systematic review with meta-analysis of controlled trials. Journal of Strength and conditioning research.</span></div>
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<span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;">Lauersen JB, Bertelsen DM, Anderson LB (2013) The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Me</span><br />
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<span style="font-family: "arial"; font-size: 14.6667px; vertical-align: baseline; white-space: pre-wrap;"><br /></span>Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-71631755629060046662016-06-13T10:45:00.002-07:002016-06-14T04:31:11.380-07:00Amplifying pain: Central SensitisationAnyone remember William of Ockham? (Thanks Wikipedia). Occam’s razor? The simplest explanation is usually the best?<br />
<br />
Well, it’s rarely like that when explaining the body. It turns out the pain system has a middle bit. A bit between the nerve endings and the brain. Who knew? And why? Why make it so complicated?<br />
<br />
In this article we concentrate on this middle bit of the pain system, the spinal cord. It starts at the coccyx and travels all the way up your back to your brain.<br />
<br />
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The peripheral nerves, discussed in the last blog, provide the inputs to the system. They can be thought of as alarm bells. They feed messages to the spinal cord from all parts of the body: skin, tendon, muscle, bone, organs and even nerve tissue itself. </div>
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These messages are simply danger signals. It is then the job of the spinal cord (the preprocessor), and the brain (the main command centre) to analyse them and create a meaningful experience/response. This experience may or may not include pain.</div>
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The messages from the peripheral nerves are quite basic e.g. the temperature in the tissue has increased, the acid level has decreased, there is more pressure etc.The complex sensations that we feel in response such as strong pain, tearing, stretching, throbbing, aching, crawling etc are all created by the brain. </div>
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What occurs in our tissues is only one part of the pain experience. The messages from the tissue require evaluation by the rest of nervous system. The spinal cord is the first part of this evaluation process and it determines what messages are transferred from the peripheral nerves up to the brain. </div>
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The spinal cord is a network of nerves with vertical lines up to the brain and back down from the brain along with collateral lines connecting the vertical lines. There are many junctions or synapses where peripheral nerves connect.</div>
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<b><i>The spinal cord acts as a preprocessor, "sorting" the incoming signals. It can both block and amplify messages. </i></b></div>
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<b>Blocking: </b></div>
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One of the nerves back down from the brain is able to flood the junction of the peripheral nerve and the spinal cord with chemicals that block any messages travelling up. It does this when the brain perceives that the whole body is in imminent danger of some external threat and it needs to act to escape the threat. </div>
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Blocking pain in this way enables someone with a broken leg to run away from a lion or to complete a 400m relay race in the Olympics - as Manteo Mitchell did for the U.S. Team in the 2012 Olympics qualifying race.</div>
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<b>Amplifying (Central Sensitisation): </b></div>
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The peripheral nerves from different parts of the body have their junction with the spinal cord at different levels of the back. The foot connects at the very bottom of the back whereas the hand connects at the bottom of the neck. On one side of the body there are thirty one entry points called dorsal horns that run down the spine from the neck to the lower back. </div>
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A message from the peripheral nerve causes the end of the nerve to release chemicals into the gap or junction at the dorsal horn. These chemicals attach to the end of the nerve coming down from the brain causing a message to fire up to the brain.</div>
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When we get a long lasting or strong input from a peripheral nerve to the spinal cord and up to the lower brain (the brain stem) the neurons (the cells of the nervous system) change their reaction to the input. They become more sensitive and send up a greater reaction than the input represents.</div>
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Such changes do not take long to develop. </div>
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<b><i>A few minutes of strong input from a peripheral nerve is sufficient to change the sensitivity. </i></b></div>
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This “central sensitisation” is similar to an unwanted learning process. Once it has occurred the pain experienced can become more intense and continuous than the stress or load in the tissue warrants. In this state messages from the junction can be fired up the spinal cord to the brain even when there has been no input from the peripheral nerves. </div>
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These changes in firing patterns occur not only at the level that the initial strong input was experienced, but also to adjacent junctions above, below and on the opposite side of the spine.</div>
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Current research is investigating theories that phantom pains which manifest in areas of the body disconnected from the original injury can be caused by chemicals flooding the gaps between the dorsal horns. Whilst an oversimplification it perhaps helps understand what might be happening.</div>
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<i><b>The theory is that whilst a referred pain may be bio-mechanical it may also be, in effect, chemical i.e. caused purely by the pain system’s chemical transmission of the original stimulus, not by a bio-mechanical consequence of the original stimulus. </b></i></div>
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What happens when central sensitisation develops?</h3>
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The result of this increased sensitivity is that the brain is being fed messages which do not represent the true state and abilities of the tissue, so that an area that hurts a little can hurt a lot, and an area that didn’t hurt at all can start hurting.</div>
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Once sensitisation has occurred preventing the pain becomes more difficult.It may not simply be a case of removing the stimulus that caused the initial nerve signal or allowing the tissue to heal. </div>
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<b><i>You also have to unlearn the pain response.</i></b></div>
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A patient who has suffered a sudden short-lived pain that is relatively mild is unlikely to have central sensitisation. Treatment can often produce a dramatic resolution of symptoms and the patient can sometimes feel immediately better.</div>
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However if central sensitisation has occurred this sudden turnaround rarely happens and in some cases hands-on treatment can make the patient feel worse as it further stimulates the irritated nerves. </div>
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Changing this learned behaviour requires a gradual calming down of the system, which takes time.</div>
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What are the indicators of a sensitised nervous system? </h3>
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In the clinic I start to suspect that sensitisation is part of the picture when:</div>
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<li>Pain continues after the expected healing time</li>
<li>Pain starts in a very local spot where the ‘injury’ first occurs then spreads and moves around the tissue.</li>
<li>The pain becomes ‘illogical’ in that it doesn't fit the pattern of how much stress or load has been put on the tissue. It becomes less predictable.</li>
<li>Random stabs and twinges are experienced for no apparent reason</li>
<li>Random pains occur in other tissue e.g. a hamstring starts to hurt when it is the calf that has been injured. </li>
<li>The pain is mirrored on the other side of the body. </li>
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Case study - no central sensitisation </h3>
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The physical input e.g. load, damage is proportional to the physical output e.g. pain, swelling, etc.</div>
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Note this is an idealised scenario comprising an amalgamation of the experiences of several patients.</div>
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Active fellrunner Mr T arrived at the clinic with achilles pain. He had just done his first parkrun. When asked where the pain was he pointed with one finger to an exact spot on his achilles. </div>
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His achilles tendon wasn’t used to the different loading patterns of running flat out on tarmac for a relatively short period of time. </div>
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The pain worsened with any faster running and uphill running, but did not occur with activities such as walking and long slow runs, which place less load on the achilles.</div>
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There was a consistent pattern to the manifestation of the pain - it was very localised and increased and decreased with increasing and decreasing load. </div>
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After tuning his training load and adding extra strengthening work he returned to normal training but understood that he needed to build up to races that would place his achilles and other tissues under different loads.</div>
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Case study - with central sensitisation</h3>
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Mr P booked in for physio 3 weeks after he sprained his ankle. The pain he was experiencing seemed commensurate with the severity of his initial injury, a quite nasty sprain right at the start of a fell race which was very swollen for several days with significant bruising. </div>
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Three weeks on he had regained full movement and reasonable balance and could hop with only mild ache. He was set for moving forward with rehabilitation to get back to running and racing.</div>
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However Mr P was concerned. The ankle was still painful. He could feel it throughout the day even with walking and especially worrying was that the light pressure of his trouser leg or the duvet caused pain. Due to this pain he was trying to protect the ankle and avoid anything that could harm it further. </div>
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Assessment of strength, movement and function combined with knowledge and experience of typical healing times lead me to feel confident the ankle was mending well.</div>
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So why the pain? This was a classic example of a type of central sensitisation called allodynia - “Mechanical allodynia (other pain) is a painful sensation caused by innocuous stimuli like light touch (Lolinger et al 2015).”</div>
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Once this was explained to Mr P his concerns regards damage and harm were alleviated and the process of building up strength to return running could begin. </div>
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References:</h4>
<div>
Lolignier S, Eijkelkamp N, Wood JN (2015) Mechanical Allodynia, Pflugers Archive</div>
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Butler D.S, Moseley L.G (2013) Explain Pain, Noigroup Publications. </div>
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Mense S, Gerwin R D, (2010) Muscle Pain - Understanding the mechanisms, Springer</div>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com1tag:blogger.com,1999:blog-211472755540078565.post-24898466022300640132016-05-11T01:04:00.000-07:002016-05-11T01:04:02.526-07:00Welcome Sally<div class="MsoNormal">
<span style="color: #1f497d;">We'd like to welcome Sally
Fawcett who is joining the team as a new physiotherapist. Initially Sally will be
working at the Fairplay Sport clinic on Fridays.<o:p></o:p></span></div>
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<span style="color: #1f497d;">Sally qualified as a
physiotherapist from Sheffield Hallam University in 2008 and has since worked
in private practice treating a range of private and NHS patients with a wide
variety of ailments, including sports injuries.<o:p></o:p></span></div>
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<span style="color: #1f497d;">Sally is a keen fell and ultra
runner who races for <b>Dark Peak Fell Runners</b>. In 2015, she was selected to
compete for <b>Great Britain</b> at the <b>Trail World Championships</b> in Annecy over an
86km course with 5200m ascent. This was her first international trail race
where she placed a creditable 27th. In the 2015/16 seasons she had wins at the
Lakeland 50, the High Peak 40, the Speyside Way Ultra and was 2nd at the
Highland Fling 53 mile ultra, a GB selection race.</span></div>
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<span style="color: #1f497d;">In 2016 she is also racing for
</span><a href="https://www.montane.co.uk/en/athletes/sally-fawcett" target="_blank">Team Montane</a><span style="color: #1f497d;"> and hopes to be selected
for GB for the Trail World Championships in Portugal. Prior to taking up trail
and ultra running she enjoyed success on the road with bests of 38 mins, 82
mins and 2 hrs 57 mins for 10km, half-marathon and marathon
respectively.</span></div>
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<span style="color: #1f497d;">We asked Sally to introduce her background as a Physiotherapist and general sports-conditioning expert:<o:p></o:p></span></div>
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<span style="color: #1f497d;">"Prior to qualifying as a
Physiotherapist I worked for six years for a large health club as a Gym
Instructor and Personal Trainer. I gained a number of qualifications in gym
instruction, personal training, core stability, posture assessment and
correction, kettle bell and spinning instruction. This interest in health and
exercise has continued and complements my physiotherapy assessment, treatment
and exercise prescription. I firmly believe in giving patients control of their
injuries through exercise regimes alongside hands on treatment. I have attended
APPI Pilates Matwork courses and often prescribe Pilates exercises to patients.
You would be amazed how many runners need glute muscle strengthening Pilates
exercises!"<o:p></o:p></span></div>
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<span style="color: #1f497d;">"</span><span style="color: #1f497d;">Since graduating I completed a
post graduate course in Strength and Conditioning for Runners and now lead
weekly Strength and Conditioning Classes aimed specifically at Runners.
Speaking personally I find these exercises are critical in allowing me to train
and compete over the distances I do - an average week includes 50-70 hilly
miles of road, trail and fell running."</span></div>
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<span style="color: #1f497d;">"Another particular area of
interest is acupuncture, specifically trigger-point release to complement
sports massage when treating muscular injuries. To date I have progressed from
the Foundation Acupuncture to attend courses in Acupuncture for Myofascial
Release, 50 Most Common Acupuncture Points and Trigger Point Acupuncture. I
have also completed a Massage for Physiotherapists, and Kinesiology Taping
course."<o:p></o:p></span></div>
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<tr><td class="tr-caption" style="text-align: center;">Finishing the World Trail Championships 2015 for Great Britain</td></tr>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com2tag:blogger.com,1999:blog-211472755540078565.post-22944163430911049902016-01-14T04:43:00.000-08:002016-01-14T05:58:37.080-08:00Inspirational Patients - Al Churcher<div style="margin-bottom: 6pt; margin-top: 20pt; text-align: left;">
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">My husband and I were innocently promenading down Ecclesall Road one day, minding our own business, when we were distracted by shouting from the terrace at Nonnas. Al Churcher was celebrating his 70th birthday. And as usual with Al, he was doing it in some style - having just come from performing a gig in his own honour the champagne was flowing.
Our reporter made her excuses and left.
Since then Al has become the European Silver Medalist at Triathlon in the 70 year old age category. In the last few months he’s also recorded the age-group record at all six Sheffield Park runs, including a time of 22.18 at Sheffield Hallam Park Run.</span></span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">I first met Al when he was recovering from a knee injury which had stopped him running for four months. He then injured his other knee requiring arthroscopic surgery. Overall he was out for a year.</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"></span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><br></span></div>
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>"When I first saw Kim I was, to say the least, pretty depressed. For the first time ever I'd injured my "good" knee - the left one. The right has an unreconstructed anterior cruciate ligament and there is no cartilage on the inside of the knee so I'm used to that giving me a bit of trouble. The left knee pain had started after one hard 5km run. Two other professionals had been unable to diagnose the source of the problem. Not knowing what the problem was made it even worse and I was struggling to face up to a future that would not include triathlon..</i></span></span><br>
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<i style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><b> "... realising this might be my last chance I was determined not to blow it again."</b></i><br>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>"It took only a few minutes for Kim to be fairly sure that I'd torn the cartilage - a referral to a specialist soon confirmed this. Following the arthroscopy I put myself completely in Kim's hands - realising this might be my last chance I was determined not to blow it again. Runners & triathletes are their own worse enemies and I'm a perfect example. We love what we do, we're addicted to it and as a result we over-train, ignore warning signals and when we do get injured we think we can immediately bounce back to our pre-injury level."</i></span></span><br>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Some people are motivated by goals and it is said that we must set our goals beyond what we really want to achieve. Al’s goal was to win a medal at the European Championships, after a year of no running at all, at the age of 70.</span><br>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">As a physiotherapist who deals with many runners one can understand how challenging that goal really was. It takes self-belief, patience, objectivity and a willingness to take the setbacks and pick yourself up - most importantly a willingness to keep focusing on that goal. </span></div>
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Add to that the perception of many in the general population, and in the medical profession, of how a seventy year old should be and should behave.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Many runners I know struggle to race 5km: firstly, if you are racing then it's painful, and pain isn’t pleasant. Secondly, your speed when racing such a short distance places more load on your body and, unless you have trained for it, it is easy to get injured. Particularly as you get older ...</span></span><br>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Al started just running a few minutes at a time. He built up slowly over the year in a very methodical and disciplined way. The results speak for themselves and I find his achievements inspirational.</span><br>
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<i style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><b>"I've finally learnt a little patience and to listen to my body"</b></i></blockquote>
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>"One of Kim's great strengths is her positive attitude and the way she transmits her belief that if you do the right things it will come right again. She is also pretty strict with me. This time I stuck religiously to her recovery plan and guess what - it worked - so much so that I've started Duathlon again and won my class at Carsington in October. That was TWO hard 5km runs separated by a 30km bike. Thanks to Kim I've finally learnt a little patience and to listen to my body - well most of the time - and now I'm targeting this year's world Duathlon champs in Spain, hoping to finally land that elusive Gold medal."</i></span></span><br>
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"></span></span><br>
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"></span></span><span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">I should have mentioned - that gig he played - was one of his first ever after a life long passion for music and guitars. He is now a regular on stage at the Yellow Arch.</span></span><br>
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<br>Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com1tag:blogger.com,1999:blog-211472755540078565.post-37279824241944976192016-01-11T04:28:00.000-08:002016-01-11T04:28:25.070-08:00Inspirational Patients - Alison HiltonLots of people run marathons these days. So why should I find it inspiring when an experienced runner manages to run one?<br />
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Well, most of us who are runners are familiar with being too injured to run properly. Sometimes for weeks, sometimes for months - but thankfully relatively few of us become so injured that we can't run properly for several years. How many times would we think we would have to give up? How many of us would believe we can recover? And how many of us do?<br />
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I first saw Alison in 2013 when she had been suffering painful achilles problems for nearly three years. Prior to this she had been regularly running 20 to 25 miles per week, but had reduced this to one long Monday run with her running club.<br />
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Regular readers of these missives won’t be surprised that I felt that pattern had to change - from the one weekly long run to several much shorter runs of 20 to 30 minutes. Of course this is very frustrating to someone who is used to and enjoys running further. But her achilles needed both the right levels of loading and time to adapt. <br />
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After four months of gradual build up she was back to running 8 to 9 miles but with only a minimal reaction. Through the next six months she slowly built up her running load. There were a few setbacks, but she backed off and stayed sensible.<br />
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<b><i>Steady progress? Time for a marathon then!</i></b></div>
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After 12 months she was running at the level she had been four years earlier - it can be a long road. Then, in August 2014, Alison mentioned she wanted to run a marathon, twice the distance she had raced previously, within a year. Ambitious maybe?<br />
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As is often the way in life, she was coming back from a setback - chickenpox. Often innocuous in children it is almost always serious for adults. She had been wiped out for a while and needed to build up carefully.<br />
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She chose as her goal the Loch Ness Marathon in September 2015, appropriate perhaps as it is sponsored by Baxters. I thought a year should be enough time to prepare - but it might be a good idea not to aggravate the old injuries along the way. So we worked together on a plan that built up her mileage slowly at a level I thought her body could manage.<br />
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Another setback occurred in spring with an ITB injury which led to several weeks of no running. As Alison understates <i>“there were one or two points along the road with my little setbacks that I genuinely thought I was going to have to give up running and find something else. I do tend to catastrophise and setbacks can become big mental hurdles for me. However Kim’s confidence in the approach we discussed and her general positivity made a huge difference and really did encourage me to stick at it.“</i><br />
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What I find particularly inspirational as a runner myself is the way she followed the plan, sensibly choosing to back off when she received the early warnings, not when it was already too late. This marathon was a real challenge for her but she approached it with both determination and common sense. Had either one of those been missing she probably wouldn’t have succeeded - something I’m still learning myself.<br />
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<b><i>"My achilles feel better than they have in years."</i></b></div>
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<i>“Looking back, I can absolutely see that the steady build of load was the way to go...having run hundreds of training miles and the marathon itself in a controlled and sensible way my achilles feel better than they have in years. Oh, and the cold baths were a revelation!”</i><br />
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As a runner who works with injured runners almost every day I am trying hard to follow my own advice, training consistently without breaks and building up the volume slowly year on year. This means having the good sense to back off when I have to - which is tough. I get doubts all the time.<br />
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I constantly have to fight the desire to push on too quickly and need to keep reminding myself the longer-term goals are usually more important than the immediate ones: this or that unimportant race, this or that non-critical session, this or that mileage total etc. Alison's recovery from years of injury and her sensible approach to setting and achieving her goals are a big source of inspiration for me.Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-18407787002754534812016-01-07T10:34:00.000-08:002016-01-07T10:59:21.013-08:00Inspirational Patients - Susan X<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Chronic pain can be life destroying. Chronic is from chronos, meaning time. For Susan, this started four years before retirement, and in the two years since, she has morphed from being a full time professional teacher into a full time professional 'patient'. Numbness in two regions of the body after operations and immense, increasing pain have become an intrinsic part of her life.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">So what does medical science have to say?</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Susan started with a hip replacement at the age of 56, followed by a knee arthroscopy almost immediately after. Numbness in her feet followed swiftly on, and eventually another hip replacement upon retirement, further numbness in another area of the body and the chronic pain. There has followed numerous X-rays, MRI scans, Ct scans, nerve conduction tests, blood tests, a lumbar puncture, thermal threshold tests and bone density scans.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Nothing. No diagnosis. Nothing.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">She’s seen four consultants with a referral to the fifth on the way, all flavours of physiotherapist - NHS, NHS HLP (High Level Professional), Private, Pet Detective, Saga Norén etc.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">She’s been prescribed drugs, lots of drugs. Injections. And exercises. Oh how we Physios love to dish out the exercises. More exercises. Exercise classes. Then more exercises. </span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Nothing. No change. Nothing. </span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">At this point many people would give up. That would be understandable. Logical almost. Susan hasn’t.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">The pain persists. No explanation is forthcoming. And for the last nine months it has been getting worse.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><b><i>“What have I done to cause this pain? Will I be like this for ever?”</i></b></span></span></div>
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<i style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">“My before-sleep mantra for the last two years has been obsessive and negative, like a record that never moves from a certain groove: ‘What is wrong? What has gone wrong? What have I done to cause this pain? Will I be like this for ever ?”</i></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>“I was living everyday with a sense of helplessness and hopelessness. Recently, in desperation, I joined the gym to start regular swimming as walking, gardening and any other form of exercise, which put pressure on my back and leg was unbearable. It was a chance meeting at the gym with another of Kim’s patients, which led me to make the phone call which has connected us.“</i></span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">My ego isn’t sufficient that I can believe all these other professionals have missed something. Perhaps they have but I think it’s unlikely. So Susan and I are going on a journey. A journey that starts with respect for her as an individual. </span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Necessarily our explorations must be empirical - a repeated cycle of testing and evaluation - guided by my experience and knowledge but led by Susan’s open mind, willingness to listen to new ideas and her ability to adapt and innovate. </span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>“At the first consultation, Kim explained with a drawing and clear explanation what had been happening to cause my chronic pain. It was refreshing to meet a practitioner who sat at my side and talked rather than check me out and provide me with a list of exercises, which I knew would cause even more pain.” </i></span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i> “The Todd Hargrove book she recommended has been revelatory. It has turned all my thinking upside down. “Pain is a real feeling, but that does not necessarily reflect real (tissue) damage in the body”. This was just one of many statements which opened my eyes wide to future possibilities. This book, together with Kim’s support has changed my thinking and outlook.”</i></span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">I wanted Susan to play at moving her body within its pain free range. Susan chooses to do exercises whilst listening to music and she lets her body become the conductor of the orchestra. Perfect.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">We are having some success. Susan can now move pain free whilst lying down and has recently walked more than a mile with minimal discomfort. This is great news as Susan can now slowly start to build up by sharing enjoyable walks with friends. </span></span></div>
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<b><i><span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">“It is as though I have given my body permission to work towards change.“</span></span></i></b></blockquote>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>“Knowledge and understanding of the cause of my pain has enabled me to take control. I feel empowered. It is as though I have given my body permission to work towards change. I have joined yoga classes and have started relaxing and putting my body into positions last experienced over 6 years ago. I had no idea that my body still had this level of flexibility.“</i></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>“The pain in my lower back and part of my hip and leg is easing, but I know it is still a long journey to gradually re-train the neural pathways and mend the nerve pain mechanisms. This will require regular practice and some considerable discipline, but I do know that Kim will be there explaining and cajoling me along my road to recovery in at least some of my complex issues.”</i></span></span></div>
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<span style="font-family: Arial; font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Susan has had a really tough six years but she is still determined to live life and enjoy it. She’s an inspiration to me and it is an honour to be able to support her. </span></div>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-90985888538478785272016-01-04T06:50:00.002-08:002016-01-07T11:00:52.756-08:00Inspirational Patients - Cat Taylor<div dir="ltr" style="margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">Happy New Year … although it often doesn’t feel like it in gloomy January. With that in mind I thought I would use the next four blogs to highlight some patients from 2015 that I personally found inspirational.
Although their challenges and achievements are very different there is a common theme of working towards their goals in a logical long-term manner and dealing sensibly with all the setbacks they face along the way. I wish them all the best for 2016.</span></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;">“The amazing Catherine Taylor”, to quote the commentators at the 2015 World Cup Final, needs no introduction to orienteers around the world. But as a junior, despite possessing outstanding raw talent, she was relatively unknown. Because she was injured.
Cat first showed her international potential with a Long Distance Bronze medal at the European Championships in 2014. A good season in 2015 saw her place an excellent 5th in the Middle and 6th in the Long at the World Orienteering Championships in Scotland and pick up the title of Swedish Champion for club OK Linne in the Relays.
But at the season’s finale in Switzerland we watched in awe as she destroyed the World’s best by a huge margin - the prize for all that effort being a rather large, rather solid, wooden bench that had to somehow make it’s way back to Sweden. Who said orienteering wasn’t like the Krypton Factor?
It wasn’t always this way.
I first met Cat when she came to the clinic back in February 2007. After finishing her A-Levels the previous year she had just returned from an abortive attempt to live her dream as an orienteer in Sweden. She had been unable to run for months due to injuries. Cat and I have worked together since that day.
Whilst her results are amazing, it is her fortitude that is an inspiration to me. The last eight years has been a long journey full of injuries, frustrations and some dark times …</span></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><img height="649px;" src="https://lh6.googleusercontent.com/1O5x9G-0xesv_f6ptjh8YvaXVDLksXySFmWH328Jth0RjfCHQl1YdTUY6RJ6gmHOptIr205IWTl_0m8D2cO4qSUulWFZqinPnr_nlVCWZUatXhgIP6rwwOq_ZXaNfYYQW6XcfrtG" style="-webkit-transform: rotate(0.00rad); border: none; transform: rotate(0.00rad);" width="624px;" /></span></div>
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<span style="font-family: Arial;"><span style="font-size: 14.6667px; line-height: 20.24px; white-space: pre-wrap;"><i>“Working to compete at the top level in orienteering has meant a lot of focused hard work over many years. It's been quite a journey from when I was 18, injured and hardly able to run, to training long hours each week and challenging for great results in international races. It's meant moving country and shaping my lifestyle around sport but I love what I do and feel really lucky to be able to spend a few years of my life chasing my goals in the forest.” </i>
Through all this Cat has never given up and has always been ready to learn - to learn more about the art of orienteering, the art of consistent hard training and the art of listening to and understanding her body - aiding her in managing niggles, aches, pains and serious injuries:
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“Working with Kim for the first time marked a turning point in my recovery from injury and the start of my learning to understand and manage my own body's reactions to training, which has been vital to the process. Today, Kim is still the first port of call when I have any problems or questions - she's both very knowledgeable and very helpful!”</i>
It has been a real privilege to see her move from an athlete who was perpetually struggling with injuries to putting together four years of consistent training at a high level - in the last week alone she has done fourteen hours running, seven of those orienteering in the cold and often dark forests of Sweden.
Well done Cat, you deserve it.</span></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Photos courtesy of </span><a href="http://worldofo.com/" style="text-decoration: none;"><span style="background-color: transparent; color: #1155cc; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: underline; vertical-align: baseline; white-space: pre-wrap;">http://worldofo.com/</span></a><span style="background-color: transparent; color: black; font-family: Arial; font-size: 14.666666666666666px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">, still older than Google.</span></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com3tag:blogger.com,1999:blog-211472755540078565.post-8186215784343446002015-10-19T07:52:00.000-07:002015-10-23T02:46:01.296-07:00How Our Tissue Responds to Pain.<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The Pain System #1.</span></div>
<b id="docs-internal-guid-5c56c02c-808b-3f3d-53f4-b2716ea9a69a" style="font-weight: normal;"><br /></b>
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<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This is the first of several blogs I’m planning covering the pain system. In this blog I’m going to look at how tissues detect pain, whilst the next blogs will cover how the spinal cord and brain responds to these signals. </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Pain is the reason most patients come to see me. There are other reasons: clicking, stiffness, swelling or pre-emptive injury prevention; mostly people who see me come because they are in pain.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The purpose of pain is to act as a warning signal. It occurs when the brain </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: italic; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">perceives</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> damage or the threat of damage and wants to alert our body to take action.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Where does pain come from?</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In most situations the perception of pain in the brain is fuelled by messages from the tissue where the threat is occurring, typically tendon, muscle and skin along with many other less well-known tissues such as fat pad and synovia.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">All these pain-reporting tissues contain nerve receptors that alert the brain to what’s happening within the tissue due to stimuli such as stretching, pressure, heat, cold. As the stimulus increases so does the frequency of discharge of the receptors. Above a certain level of stimulus they start to report what we know as pain. </span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc2qWICOa7USihdVie00WU60e2L5eKH5Viu8MDmJk6JiDsqUC50m38PQN3ZRaz2gHXUQiXL1g5ViAL7g6gHTJ9M_7wrLoKZ9RSxAULffvXfttTDJiab3_VooXeewoTALitDnCZj6qyRyM6/s1600/Autumn2013-1080895.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjc2qWICOa7USihdVie00WU60e2L5eKH5Viu8MDmJk6JiDsqUC50m38PQN3ZRaz2gHXUQiXL1g5ViAL7g6gHTJ9M_7wrLoKZ9RSxAULffvXfttTDJiab3_VooXeewoTALitDnCZj6qyRyM6/s320/Autumn2013-1080895.jpg" width="213" /></a></div>
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Slow onset injuries:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">With slow onset injuries the tissue is put under successive stress. As it starts to get close to the damage threshold it sends early warning signals. A result of these is that we experience pain but no actual tissue damage has yet occurred.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If we then to continue to load and stress the tissue we might go on to cause actual tissue damage and injury. So listening to early warning signals is a key part of managing the everyday load and stress on our body.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">If we sit too long our back starts to ache due to prolonged compressive static loading on the tissue. So we get up and move around. If our achilles starts to niggle due to increased mileage we take a few rest days or drop our mileage down to let it settle before increasing at a more conservative rate. Well, in theory at least.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sudden, acute injuries:</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">With a sudden onset injury such as a sprained ankle or torn muscle a one-off load smashes through our pain and damage thresholds in one go. Pain and actual damage occur simultaneously</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This type of pain tends to be far more intense and generally has a reasonable correlation with tissue damage. It is very effective in making us stop so we don’t cause further damage.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How does the pain threshold vary?</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The load a tissue can tolerate before damage occurs gets higher the more load and stress we put through our body – this is why we train.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The achilles in a trained thirty-year old runner will normally have a much higher tolerance to loading than a seventy-year old sedentary person.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In ‘normal’ tissue the pain threshold shadows the damage threshold. As the tissue becomes stronger the nerve endings adapt and increase their threshold-level so it stays just below threshold for actual damage.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Conversely, when we damage tissue it becomes weaker. The load it can then tolerate before further damage occurs is decreased.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In this case the pain threshold is lowered. This occurs through a complex network of chemical and cellular interactions resulting in the production of a group of chemicals that directly lower the tolerance levels of the nerve endings. Below is a diagram of the various receptors of a nerve ending (Mense 2010). </span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5Jvq9geUCLMA57Iwy4S7bRTsedlXYLwWnXzjzS06sP6JcJ1px_CDgYZGZHdGrs3tt1BPS3n6cIIvF7fDdfzTEufRvnhKfo1-p1I3kYU8J_E9Joks6c7cLsFOWhihfq-wbh9lH6tiYIBz1/s1600/image1+%25282%2529.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh5Jvq9geUCLMA57Iwy4S7bRTsedlXYLwWnXzjzS06sP6JcJ1px_CDgYZGZHdGrs3tt1BPS3n6cIIvF7fDdfzTEufRvnhKfo1-p1I3kYU8J_E9Joks6c7cLsFOWhihfq-wbh9lH6tiYIBz1/s320/image1+%25282%2529.JPG" width="320" /></a></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"><br /></span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">For example when the skin is damaged by sunburn the pain tolerance of the nerve endings is lowered so that taking a hot shower causes significant pain. Taking the shower is not actually causing any further tissue damage, but the tissue’s threshold is now much lower.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">When is pain helpful and when is it not?</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This lowering of pain tolerance is useful in the early days of an injury so that we ensure tissue loading is well below tolerance load and healing is allowed to take place. As healing and tissue repair take place the tolerance threshold should rise back to ‘normal’ levels.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">But this doesn't always happen.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Researchers have built up a good body of knowledge relating to the phases of tissue healing and repair and how long damage takes to repair under optimal loading conditions. We have a pretty good idea how quickly your injury should heal.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sensitised Tissue</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">However the pain threshold can remain lowered even though full healing has occurred. The tissue is said to be sensitised. In this state pain messages continue at levels of load and stress that are not causing further damage and would have previously been fine.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt; text-indent: -18pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">·</span><span style="background-color: transparent; color: black; font-family: 'Times New Roman'; font-size: 9.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">This can also occur during healing if the pain tolerance doesn’t rise again in tune with the tissue getting stronger.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">As the tissue remains sensitized and reports “false” pain the nerve endings adapt in another way. The number, density and sensitivity of nerve endings increase. There are more receptors to be stimulated by a given stressor and the pain messages sent to the brain are greater.</span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">In sensitised tissue the lowered thresholds and increased number of receptors result in the tissue losing its capabilities as an early warning system and significant pain is produced even when loading is well below damage threshold.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Sensitised tissue e.g. the achilles, can be sore to touch, even though there is no actual tissue damage.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">How do we treat sensitised tissue?</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Applying sensible loading to sensitised tissue stimulates cellular responses which promote both structural change i.e. strengthening, along with lowering of both the number of nerve endings and their sensitivity.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">The terms Mechanotherapy and </span><span style="background-color: white; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mechanotransduction are</span><span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> often used in this context.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Mechanotransduction refers to the process by which the body converts mechanical loading into cellular responses. These cellular responses, in turn, promote structural change. Mechanotherapy is then “the employment of mechanotransduction for the stimulation of tissue repair and remodelling.” Simples.</span></div>
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<span style="background-color: white; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case study – Recovering from a stress fracture in the fibula</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 16px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A runner presented with a stress fracture in the fibula. After three weeks of initial rest from running the fracture site was pain free. We then closely managed a slow build-up of tissue load through running. Initially, after each increase in run length, the injured area was tender to touch and ached. We listened to the pain feedback to optimise the loading recovery programme. After eight weeks the runner was back to full training. Bang on target.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: white; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 700; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">Case study – Poor initial management of a hamstring injury</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">A runner presented with an overloaded hamstring tendon – classic case of too much too soon. There had probably been structural damage but this was poorly diagnosed and treated. No guidance on loading levels was given. Subsequently the runner yo-yo’ed between resting, but not enough, then running for thirty minutes, which was too much.</span></div>
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<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;"> </span></div>
<div dir="ltr" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="background-color: transparent; color: black; font-family: Arial; font-size: 13.333333333333332px; font-style: normal; font-variant: normal; font-weight: 400; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;">I first saw the patient six months after the initial injury. At this time the hamstring was still weak and sensitised. We undertook a gradual loading program but this was difficult due to the sensitisation – the runner felt pain even though no tissue damage was being caused. Even when the hamstring was as strong as the other leg there was still pain with running short distances. We then worked to reduce the sensitisation through a running-based loading program. </span></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Reference</span></b><br />
<b><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;"><br /></span></b>
<a href="http://www.amazon.co.uk/Muscle-Pain-Understanding-Siegfried-Mense/dp/3540850201/ref=tmm_hrd_title_0" style="line-height: 27.6000003814697px; text-decoration: none;"><span style="color: #1155cc; font-family: Arial, Helvetica, sans-serif; font-size: xx-small; text-decoration: underline; vertical-align: baseline;">Muscle Pain - Understanding the Mechanisms Siegfried Mense, Robert D Gerwin (Editors) Springer, 2010</span></a>Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-9464600877087906162015-05-01T06:32:00.000-07:002015-05-01T07:37:30.864-07:00A Tale Of Two Calves<div dir="ltr" id="docs-internal-guid-b2a1414a-0f87-ece2-79bc-a3674d71aecd" style="line-height: 1.38; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline;">Him indoors is always complaining about his calf. And, whilst Mr B may not be the swiftest runner, he compensates for the lack of </span><span style="font-style: italic; font-weight: bold; vertical-align: baseline;">a</span><span style="font-style: italic; vertical-align: baseline;"> </span><span style="vertical-align: baseline;">in Newton’s second law with an excess of </span><span style="font-style: italic; vertical-align: baseline;">m. </span><span style="background-color: white; color: #252525; font-style: italic; font-weight: bold; vertical-align: baseline;">F</span><span style="background-color: white; color: #252525; font-style: italic; vertical-align: baseline;"> = m</span><span style="background-color: white; color: #252525; font-style: italic; font-weight: bold; vertical-align: baseline;">a </span><span style="background-color: white; color: #252525; vertical-align: baseline;">indeed</span><span style="background-color: white; color: #252525; font-style: italic; font-weight: bold; vertical-align: baseline;">.</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="background-color: white; color: #252525; font-style: italic; font-weight: bold; vertical-align: baseline;"><br /></span></span></div>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">Calves and Achilles can cause real problems for runners. But there is hope, even if you’ve been troubled by ongoing calf problems for a long time.</span><span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">With care it’s possible to run and race through overload calf injuries where there are no signs of damage if you know under what situations and conditions they are vulnerable. For those with repeated or longer term problems a structured loading program can improve matters greatly, as long as it’s done with discipline and common sense.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">In this blog I’d like to outline my reasoning backed up with a couple of local case studies - Charlie Adams and Pete Gorvett - by way of example.</span><span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"></span>
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<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8vWXM5z8aPOn_3Bg74Kcd1bagEOfwtyXOmX7IbijGYIMYzBY4gcCLTaISkYpNA3C3ED_pzL54L3aBqlRJMFvHFYT6Z0lD2tOitEU9bkwRtEEUInaF7X5pmMlsNfQxvCv4d5GEKSDrp-G9/s1600/Charlie_BOC2015.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8vWXM5z8aPOn_3Bg74Kcd1bagEOfwtyXOmX7IbijGYIMYzBY4gcCLTaISkYpNA3C3ED_pzL54L3aBqlRJMFvHFYT6Z0lD2tOitEU9bkwRtEEUInaF7X5pmMlsNfQxvCv4d5GEKSDrp-G9/s1600/Charlie_BOC2015.jpg" height="640" width="426" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Charlie Adams grinds it out at the British Orienteering Championships 2015</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">Reasoning</span></h3>
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">Calf pain is very common in runners, particularly as we get older. Whilst there is a lot of scientific research published on muscle tears in the calf there is much less literature on ongoing calf pain where there is no significant or obvious tissue damage.</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">We see a lot of patients who don’t appear to have torn their muscles but for whom running is too painful.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">In such cases it is hard both for the runner and the medical specialist to know how bad things really are. Muscle tightness and pain tend to be the main indicators but there is little evidence that either are correlated closely with actual damage.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">Scans can of course be useful but they may not be decisive and will often show changes which may be perfectly normal and completely unrelated to the pain and problem at hand. Results of scans must therefore be interpreted carefully and logically.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">Understandably physiotherapists will tend to err on the side of caution. If the patient is reporting too much pain to run then, for many reasons, it is unlikely the physiotherapist is going to encourage them to do so. For many years that was one of my guiding principles.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">However there were some nagging doubts, reinforced by my own experiences as a runner, where I knew that in some circumstances it was possible “run through the pain.”</span><br />
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;"><br /></span>
<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">In the good old days of the Four Yorkshiremen, French and Saunder’s Stuff and Nonsense and the Black Knight’s “Tis but a scratch” running through injuries was common and worked for many. So maybe there is something in it.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline;">Whilst researching the issue I read an interesting book - </span><a href="http://www.amazon.co.uk/Muscle-Pain-Understanding-Siegfried-Mense/dp/3540850201/ref=tmm_hrd_title_0" style="text-decoration: none;"><span style="color: #1155cc; text-decoration: underline; vertical-align: baseline;">Muscle Pain - Understanding the Mechanisms Siegfried Mense, Robert D Gerwin (Editors) Springer, 2010</span></a><span style="vertical-align: baseline;"> - which helped explain what we know about muscle pain and what we don’t.</span></span><br />
<span style="font-family: Arial, Helvetica, sans-serif;"><span style="vertical-align: baseline;"><br /></span></span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">In particular pain is governed by a complex system and there is a poor correlation between the amount of pain and actual damage to the body. This is a topic I’ll go into in more detail in later blogs.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">I began to wonder whether in some cases an overcautious physiotherapist could instil risk aversion and fear in runners which in turn could lead to poorer outcomes.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">Of course this does not negate good diagnostic practice where the most serious conditions must be considered and ruled out first.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">My experience since then has been that with some calf problems running through the pain can be successful. I would caution that this requires an experienced and skilled assessor and a patient that is sensible enough to do it but not overdo it - and we all know how easy that can be.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">For ongoing, long term or repeated problems, the “rehabilitation” process is similar, gradually strengthening the muscle and building up the load. There are two benefits </span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">the muscle gradually becomes stronger and able to cope better with the loading required for the specific activity</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">the pain system gradually downgrades the sensitivity associated with that muscle.</span></div>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">Doing too much could reverse the process, potentially injuring the muscle or increasing the sensitivity of the pain system so it seems as if there is more pain.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgle0_sbvPGxYk6WwAA2Mg5T2TEN8qJOoJr0CYu8IZTBbd5BIsRE-ILI9_IERAWtMtThKhFxHmLcZZoHXl8K8FzicVzZQ_Ggoh94uLo2RTRULMeZmtvLGKGoiKAwIwzVAeQywVfXTa22UjF/s1600/Pete_and_Charlie_Winning_the_JK_Relays.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgle0_sbvPGxYk6WwAA2Mg5T2TEN8qJOoJr0CYu8IZTBbd5BIsRE-ILI9_IERAWtMtThKhFxHmLcZZoHXl8K8FzicVzZQ_Ggoh94uLo2RTRULMeZmtvLGKGoiKAwIwzVAeQywVfXTa22UjF/s1600/Pete_and_Charlie_Winning_the_JK_Relays.JPG" height="266" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The winning South Yorkshire SuperVets team - Nick, Charlie and Pete at the JK Relays 2015<br />
(Photo courtesy of <a href="http://www.lines.org.uk/">Rob Lines</a>)</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; font-weight: bold; line-height: 1.38;">Case Study: Pete Gorvett</span></h3>
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">Pete is a regular with Dark Peak Fell Runners and South Yorkshire Orienteers. He is currently ranked 2nd in the National Orienteering Rankings for the over 65s.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">In the 2015 Wolf’s Pit race his left calf ‘cramped’ on the climb. After slowing down he managed to finish the race. He limped for two days then the pain started to ease.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">On day three we met for an assessment. He was walking freely, able to go up on tip toes on his left leg but was aware of his calf.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">The recommendations were to walk lots, swim, bike, and do some calf raises, holding the position for a few seconds to work the calf a bit. Once pain free with these activities he should try a short run.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">A week later thirteen minutes flat running was fine but a slight hill led to tightening again, which led to a re-occurrence of the slight pain when walking.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">It was now only five days to the Jan Kjellstrom trophy - one of the most prestigious orienteering races in the calendar. At this point there was no purpose in further testing.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">He was advised not to run until the race, not to the run the sprint race on the first day as short-fast urban racing puts a greater load on the calf, but to run the two forest races and to just go for it.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">The terrain for these races was as rough as it gets - steep, muddy, rocky Lake District woods. Strangely these are ideal for nursing a sensitive calf as each foot strike and load is different and there were no sections where high running speeds were achieved. Had his goal been a 5km Park Run he’d have been advised not to race it.</span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuFNnNCx_13GrOLdgJyeevE7UoooObKc-o5E-3JjTtPbpZQ36u22uau-nYnF6xnlj7yhPrT3FlECCXgTwBEBA6hgn0K9txRPL9H2osavZWr32QOIVQIS3qbM_MAQwBHt3TippycVmG5kK8/s1600/Pete_JK2015.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuFNnNCx_13GrOLdgJyeevE7UoooObKc-o5E-3JjTtPbpZQ36u22uau-nYnF6xnlj7yhPrT3FlECCXgTwBEBA6hgn0K9txRPL9H2osavZWr32QOIVQIS3qbM_MAQwBHt3TippycVmG5kK8/s1600/Pete_JK2015.jpg" height="264" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Pete Gorvett on his way to becoming JK Champion 2015</td></tr>
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">Pete was aware of the calf on the first day, raced better on the second day, and won - beating the top seed in the over-65s who is ranked 100 places ahead of him in the open rankings.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; font-weight: bold; line-height: 1.38;">Case Study: Charlie Adams</span></h3>
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">Charlie has been a top ranked orienteer for as long as there have been rankings and has won many major titles. He is currently ranked 3rd nationally in the over-50s.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; line-height: 1.38;">For more than five years now he has suffered repeated calf and Achilles problems in both legs. He has had lots of advice and treatment including strength work, massage, compression socks, orthotics etc.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">For the last three years he has failed to finish the two-day Jan Kjellstrom trophy; in 2012 he tore his calf in a marsh on Day 1, in 2013 he didn’t start due to a pre-existing Achilles problem and in 2014 he injured his calf on the Day 1 sprint race and couldn’t run days 2 and 3.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">For the first years I treated him with the standard physiotherapist’s tools - massage, exercises and in later years running load management.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">As the issues continued both Charlie and I became more frustrated, Charlie especially.</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif; vertical-align: baseline;">In the spring of 2014 I thought hard about why there was no progress. What am I missing? What more can I do? What more can Charlie do?</span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">The pain:</span><span style="vertical-align: baseline;"> the level of discomfort seemed out of proportion to the level of damage. There was no sign of a significant calf tear but he was still unable to run for weeks at a time and any attempt led to pain walking again.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">What is the cause of this problem such that it keeps happening?</span><span style="vertical-align: baseline;"> I had investigated all biomechanical aspects. Yes, he has funny feet and a distinct running style but orthotics and running technique correction had not helped.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">What does Google say? </span><span style="vertical-align: baseline;">A search of research papers and blogs revealed very little information on this type of problem. I did find a reference to the Mense/Gerwin book and reading that started to help me answer the first question - leading to Charlie’s famous ‘its all in my head’ post on his online training diary. </span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Tentative Conclusion?</span><span style="vertical-align: baseline;"> The bottom line of all my research and reading was that Charlie’s calves were no longer strong enough (or the brain didn’t perceive the tissue to be strong enough) to manage the significant loads his strong fit body could put through them during an orienteering race - or even a training run. He had by this time had extensive time out from running in the previous years but when he did run he still ran at a fast pace which put high loads through the calf.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">What to do?</span><span style="vertical-align: baseline;"> We agreed on an extensive long term (two-year plus) program of strength work alongside a managed running program of three to four runs per week, slowly building duration, speed and surface. Thankfully Charlie had the discipline to stick to do the boring exercises, and logged them online to help keep to the routine. He also saw a masseur for regular calf massages when he felt the tension was building. I kept an unofficial eye on his training diary and we discussed things informally at races as well as formally during appointments.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Progress: </span><span style="vertical-align: baseline;">Seemed steady and generally upward. There were a few blips but the more advanced knowledge of the pain system gave me the confidence to believe all was going to be well and to communicate that.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Setback:</span><span style="vertical-align: baseline;"> The first, and to date only, major obstacle to date occurred just after New Year away running with friends. There was an acute onset of pain and tightness whilst running with no obvious or dramatic cause.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Confidence: </span><span style="vertical-align: baseline;">It seemed as if we were back to where we were exactly a year ago. This time however I felt confident that this innocuous event had not caused more damage to his calf and that the over sensitive nerve endings had switched into hyperdrive again. Charlie would get better quickly and would be running again in two weeks. I did my best to reassure him that he would be running the JK.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">More Progress: </span><span style="vertical-align: baseline;">Things panned out as I said and training continued with minor soreness in the achilles and calf only and no periods without running.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Sensible approach to racing</span><span style="vertical-align: baseline;">: Charlie adopted a sensible approach to racing - taking short flat Sprint races at a steady pace and concentrating on racing at full speed in the forest when it was important to do so. Like Pete he also missed the JK sprint to concentrate on the more prestigious two day forest trophy.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Result:</span><span style="vertical-align: baseline;"> Charlie finished the JK for the first time in four years - and, being Charlie, won. He also anchored the South Yorkshire team to the National Relay Title at the British Championships two weeks later.</span></span><br />
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<span style="font-family: Arial, Helvetica, sans-serif;"><span style="font-weight: bold; vertical-align: baseline;">Going Forward: </span><span style="vertical-align: baseline;">Continue to build load-specific strength and slowly build tolerance to faster road running, acceleration and deceleration so he can return to sprint racing as well as longer forest races.</span></span><br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgco6TQPTfm_WnC_VzegTNgW9F0EKEg0xhiAIqXI3I1oXdXZ4_3WkwdjQULRURINeUi5YMvrkqreIReE4j6m7E1ifHZi3OMlUzSqznRwrE-OsY0aDFf-QzngbYG3zWuwDC0wcvLmGwpz8-h/s1600/kim_jk_podium-2.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgco6TQPTfm_WnC_VzegTNgW9F0EKEg0xhiAIqXI3I1oXdXZ4_3WkwdjQULRURINeUi5YMvrkqreIReE4j6m7E1ifHZi3OMlUzSqznRwrE-OsY0aDFf-QzngbYG3zWuwDC0wcvLmGwpz8-h/s1600/kim_jk_podium-2.jpg" height="300" width="400" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The author, injury free, also managed to win her age class...<br />
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alas now practicing what she preaches for a grumpy calf following the Sheffield Half Marathon!<o:p></o:p></div>
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Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0tag:blogger.com,1999:blog-211472755540078565.post-31844258030232212712015-03-06T02:13:00.001-08:002019-07-12T02:06:57.731-07:00Remote Physiotherapy Service<div dir="ltr" id="docs-internal-guid-72fb15b1-ee8e-6f58-8ee7-5d3de6b028c4" style="line-height: 1.2; margin-bottom: 0pt; margin-top: 0pt;">
<span style="font-family: "arial"; font-size: 16px; font-style: italic; vertical-align: baseline;">Kim Baxter & Associates is launching a new remote-physiotherapy service aimed at runners of all types (road, fell, ultra, orienteering). In this blog I describe how my past experiences and recent thinking have led me to believe this can be a valuable offering.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">I’ve been a competitive runner since I was a child, and have had my fair share of injuries, including an ankle ligament reconstruction. My most recent injury was last year, in my foot. It put me out of the Sheffield Half Marathon, my goal for the year. As ever, I didn’t follow my own advice - I pushed too hard in training and then didn’t listen to the warning signs as things started to unravel. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">After fourteen years as a GB Orienteering Squad member I joined British Orienteering as physiotherapist for the Junior Squad in 2007, under the then Performance Director Gareth Candy, and moved to lead physiotherapist in 2009. At this point we both felt that the squad physiotherapy intervention needed to change from being based on physical presence i.e. at squad weekends and competitions, to be more generally available. Athletes would tend to wait until a squad weekend to get their injury assessed. We wanted athletes to become much more proactive in their injury management.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Injuries are a time where athletes face many negative emotions - fear, doubt, worry, even depression and grief. I felt an important part of regular contact with the athletes was to support them through these difficult times.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Initially our longer term goal was to build a network of “approved” physiotherapists based around the country that were available to provide diagnosis and treatment at short notice. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">What I hadn’t realised at that point was the prevalence of online training logs, the fact that many Squad athletes were using them, and, after a suitable period of building trust, might even be happy for me read them. This allowed me to be more proactive in contacting them when they started with an injury and also allowed me to more closely follow their progress. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">In 2010 and then for the whole of the 2012/2013 season I collected data that included training hours and the number of days training lost due to illness or injury for most of the Squad athletes. It would be entirely inappropriate to label what I’ve been doing scientific and the results don’t stand up to that kind of scrutiny. Throw in personal bias and placebo and you’ve little more, in scientific terms, than a suggestion of an area where further research might be fruitful.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">However I have to work with what information I can get and the information was revealing. Whilst athletes were in general training at a high level the average time lost through injury and illness was astonishingly high. This was evident through the winter months November to January but also showed following the stresses of major competitions. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">This started me thinking more about how their training might be affecting their injury and illness levels. </span></div>
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<span style="font-family: "arial"; font-size: 16px; font-weight: bold; vertical-align: baseline;">How has my thinking about injuries changed?</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Much of my education has focused on the intrinsic factors for injuries - biomechanics, the structure and movement of the body, and associated theories such as core stability, functional stability and muscle imbalance. Extrinsic factors such as training load, specificity of activity, equipment and surface were only covered in passing.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">The general idea is that improved biomechanics will reduce injuries and your injury, when not caused by falling on slippery ice, has been caused by imbalance in your biomechanics. Rectify that and the injury will go away.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">At some point many of us will have been told we have weak gluts, tight calves, a weak core or tight hamstrings, or that we over-pronate, supinate, have poor hip control or weak inside knee muscles. It may have been me that told you these things.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">And of course it’s probably true, we probably do have these things when they are diagnosed and they probably do have an effect on injury development. But are these the factors that really tip us over into injury?</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">I’ve seen patients with relatively good biomechanics get serious long-term injuries through overtraining, and I’ve seen patients with terrible biomechanics who have been running competitively for years and only recently come to see me with their first real injury.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">The concept that load as opposed to imbalance is an important factor in injury development is gaining ground. I’m using load in a very general sense. It could mean a breaking load that causes an acute injury, load applied over a long time that causes progressive breakdown, or a variation in load e.g. suddenly running on roads when you’ve been training on the fells.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Obviously acute injuries sometimes happen - there is not necessarily a lot that can be done, but the other two types of load can be managed. For one, recovery-time between loads is important, for the other common sense is quite useful. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">But, if you are anything like me, sometimes common-sense needs external input.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">I believe the biomechanical analysis and approach is valid in many ways and there will always be patients where it is the most significant factor. But if I’m having to hunt to find a significant biomechanical issue then I start to question how much of a factor is it? </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">The difference in thinking about loads is that it is much simpler. If your body is strong enough to resist the required load it doesn’t matter if you are biomechanically unsound. Sure, all things being equal you would perform better if your biomechanics were better, but it doesn’t mean that is the best route to avoid injury.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">A nice example are climbers, who tend to be have very good core strength and excellent movement patterns through the biomechanical chain. They often present with better strength and control than many seasoned runners. They also often like running, but in my experience they tend to break pretty quickly when they start running seriously, simply as their bodies aren’t used to running specific loading. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Put in simple terms, I believe many injuries can be overcome through a managed programme of activity-specific strengthening and many injuries can be prevented through appropriately managed training. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Something as simple as just being sensible.</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">I recently helped a 60 year-old patient who was injured after walking a 50 mile ultra-race. He told me he was “getting too old for this”. I remembered he had recently completed a 60 mile run for his 60th birthday. A few questions later he realised that the latter was in hilly terrain, he was used to running long distances and he had trained for it, the former was walking, on the flat, and he hadn’t prepared. It didn’t seem as if age was the most significant factor.</span></div>
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<span style="font-family: "arial"; font-size: 16px; font-weight: bold; vertical-align: baseline;">How has this changed my approach with British Squad athletes?</span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">I now focus far more on trying to spot training errors. For example, too many hard sessions without recovery, sudden increases in training, sudden variations in training or activities, even just athletes starting to sound tired. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">Dealing with injuries has also changed. I now focus much more on helping the athlete to find the right load levels to allow the injury to heal and the supporting structures to strengthen without further aggravation. Sometimes this can mean suggesting they back off, sometimes it might mean giving them the confidence to push a little harder. </span></div>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">With online training diaries and free video-conferencing tools such as skype this approach to injury prevention and rehabilitation can be done almost as effectively remotely as face-to-face. It is based on developing an understanding of the athlete’s goals, training, lifestyle, activity levels and the external and internal stressors they have to overcome to reach them. </span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGHkAtIVWUTNj9Bii7oj_eRoRxiCTheyh5i4dWwWhofrlUhcqiZnrCuWZm1NBq3_kyeRAdHi8Bzyskgu1gYx1H9-2SRKASxt-7e829yOI_jihg-XTIUU5-I5BgGx_2Xls7Hgvze6oHTxNL/s1600/27629312_1764678563550994_7515455830563412031_o.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1066" data-original-width="1600" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGHkAtIVWUTNj9Bii7oj_eRoRxiCTheyh5i4dWwWhofrlUhcqiZnrCuWZm1NBq3_kyeRAdHi8Bzyskgu1gYx1H9-2SRKASxt-7e829yOI_jihg-XTIUU5-I5BgGx_2Xls7Hgvze6oHTxNL/s320/27629312_1764678563550994_7515455830563412031_o.jpg" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Rehab exercises can easily be emailed after discussing over the phone the next progressions. </td></tr>
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<span style="font-family: "arial"; font-size: 16px; vertical-align: baseline;">If you want to learn more take a look at the Remote Physiotherapy FAQ on </span><a href="http://www.kimbaxterphysiotherapy.co.uk/" style="text-decoration: none;"><span style="color: #1155cc; font-family: "arial"; font-size: 16px; text-decoration: underline; vertical-align: baseline;">http://www.kimbaxterphysiotherapy.co.uk</span></a></div>
Kim Baxterhttp://www.blogger.com/profile/09855489000153566935noreply@blogger.com0