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If there has been one positive outcome from the past year, it’s been seeing the amount of people out increasing the amount of time running and walking. This increase in activity means that more people are now reaching the recommended weekly guidelines of 150 - 300 minutes of moderate intensity exercise or 75 - 150 minutes of vigorous intensity activity, as set out by the WHO (https://bjsm.bmj.com/content/54/24/1451)


With meeting these targets, we know that the evidence overwhelmingly confers benefits for the following health outcomes: all-cause mortality, cardiovascular disease mortality, incident hypertension, incident type 2 diabetes, incident site-specific cancers, mental health (reduced symptoms of anxiety and depression), cognitive health and sleep; measures of adiposity may also improve.


However in this noble pursuit of increased activity and wellbeing, we can find ourselves sometimes unfortunately picking up different types of musculoskeletal injuries. Plantar foot pain, achilles tendonitis, calf strains, anterior knee or joint pain, and hip pain are some of the most common overuse running and walking injuries that we have seen in clinic over the past few months.

Most of the time this is simply because we go either too hard or too much too fast!

Simply put, the demand placed on the body is greater than our muscle, bone, tendon, ligament capacity to cope with it.


Capacity = Strength of tissue and how strong we are to meet the demand of an activity.


 

Here is the step by step process that we use in clinic to help overcome injuries and enable people to build that strength capacity to return, perform, and enjoy their activity of choice.


Assessment and Diagnosis

Provide as accurate differential diagnosis as possible through subjective and objective testing.

Imaging can also be a tool, but in overuse injuries initially does not need to be used.


Educate and Inform

Advice on the ‘why’ surrounding the injury.

The importance of Load management and strength.

Create a roadmap back to recovery with mutual set timelines, goals and targets.


Reduce Symptoms

How can we alleviate your pain;

Alter/reduce load, take away aggravating factors, introduce and increase easing factors.


Address Underlying Causes

Identify any strength and/or biomechanical deficits or asymmetries that may be contributing to the injury.


Progressive Strength and Conditioning

Research shows that strength training 2/3 times a week (also recommended by the WHO) can increase running economy performance. You use less energy during a run when you’re stronger. It also increases the elastic storage property of tendons reducing the chances of developing injuries to the tendons and associated muscles (Blagrove et al 2017).


Graded Return to Sport

Gradually re introduce walking and running. This is dictated by the length of time you have been off running. Progressive load, stress/adaptation - the right level of stress to drive adaptation.


Monitor, review, progress

Continue with weekly strength work following your return to your activity. Maintenance is key, as once you have had an injury once you’re at an increased chance of re injury to the same area.


Running into trouble
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When pain and/or dysfunction are present, the body can respond by compensating in various ways. If this happens over a long period it can become habitual movement. In order to change this, you need to address it with corrective exercises or rehabilitation.


An understanding of habits is important in the rehabilitation process, as we are addressing habitual movement. Firstly, it takes on average 66 days (2 months) to form a new habit or to change an old habit into a new one. Secondly, habits form due to neurons / brain cells developing. This process is called neuroplasticity, which is the ability of the brain to adapt to changes in an individual's environment by forming new neural connections over time.


A simple analogy to explain this process is a pianist playing an out of tune piano. The pianist can be compared to the mind in that a decision is made to play the piano or to perform a movement in our case. The piano can be compared to the brain in that unless it is tuned, or in our case trained, the tune or movement will not sound or perform as desired. Basically your mind decides to move the body, but the brain isn't wired to support that movement, thus you can have pain or dysfunction i.e lack of balance or control.


Consistency becomes an important factor in the tuning or training process. Another simple analogy can be used to explain this. Imagine you are standing at the top of a field with long grass and need to reach the gate at the bottom of the field. Initially your course through the field might be meandering. However, the more you walk through the field the more familiar you are with it and the easier it becomes until you have trodden a path in to the field. Once a path is trodden it becomes much more efficient and direct. This can be compared to the forming of neurons / brain cells and eventually the development of habits, i.e the path.


Therefore in order for habits (neural pathways) to form, high repetitions coupled with high frequency is needed. We place a lot of importance in the first three weeks of your rehabilitation process. Here are the main reasons why:


Increase in blood supply to the muscles & cellular changes.

This means that the body becomes more efficient at moving. You will see increases in strength and fitness and overall sense of wellbeing.


Increase in waste removal.

This means that you improve the environment in which you became injured, making healing quicker and more effective. Like the saying goes "You cannot heal in the environment that made you sick."


Good kickstart for forming new habits.

Fitting your rehab program into your daily routine consistently for the first three weeks, makes it easier for you to carry that on with you into the coming weeks and months.


We make it easier for you in the first three weeks by providing rehabilitation sessions, either online or in clinic, between treatments. This means that you can:


1. Be more specific with your exercises.

2. Be confident that you are performing the exercises correctly.

3. Communicate any difficulties that you are having.

4. Be more efficient with your time.



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