Go the distance

Ever wondered about the best ways to manage those overuse injuries?

Or the best diet to produce that personal best?
Berkshire-based runners took charge of their running performance by joining us this winter for a free educational evening of top tips, equipment demonstrations and networking.

Running 10 miles from his workplace to Circle Reading Hospital was no-questions-asked for Luc, a local athlete.

Luc’s running club coach recommended to Luc and his teammates that they attend Circle Rehabilitation’s educational event last November to hear expert talks and try out high-tech equipment – all to take their running to the next level.

But Luc was already familiar with Circle’s prowess. In the past, he was treated by one of the event’s speakers Nick Gallogly, a consultant orthotist at Circle Health.

‘I had a previous long-term running injury, and Nick helped me get back to full-strength again,’ Luc said.

Luc was among over 60 runners – recreational joggers, marathon competitors, triathletes and members of various running clubs – from the Berkshire area. Although not everyone ran to Circle like Luc (it seemed most drove in by car), they had a unified purpose: they were attending the event ‘Go the distance: expert advice on perfecting your run.’

Dr Kate Hutchings, Consultant in Sports and Exercise Medicine at Circle Rehabilitation, has experience treating elite athletes such as Olympians and English National Ballet dancers. So her talk ‘Managing overuse injuries in running’ was a treasure trove of insight on training, nutrition, symptoms, risk factors and rehabilitation.

‘The reason we start to get overuse injuries in our bones and our tendons is because they don’t adapt to load as well as muscle,’ Kate said. ‘These are really common problems, but we can prevent a lot of them.’

Kate delved into common injuries throughout the lower limb kinetic chain: ITB syndrome, shin splints, bone stress, Achilles tendinopathy and plantar fasciitis.

How do you prevent bone stress from progressing to a fracture? The key is in proper diagnosis, according to Kate. She often has shin pain patients telling her that an x-ray over the weekend at an A&E resulted in negative. So the patients say the problem couldn’t be their bones; it must be something else, right?


Early signs of bone stress, such as fatigue and micro damage, don’t actually show up straightaway in an x-ray, Kate said.

‘What you need is an MRI scan,’ she said. This shows the bone edema – accumulation of excessive fluid as the result of an injury. The MRI, therefore, shows the injury at the really early stages, whereas an x-ray spots the injury only after it has gotten worse.  But Kate cautioned there is no silver bullet. In addition to MRIs, she considers ‘a high index of suspicion’ (levels of concern for the injury), in depth patient histories, symptom reports, risk factor evaluations and physical examinations.

‘What we want to do is catch you in the early stage so you don’t progress to the fracture,’ Kate said.

Runners who suffer from Achilles tendinopathy have changes in the tendon structure – degenerate micro tears – near their heel bone. To treat this overuse injury, Kate strongly recommends physiotherapy. But be sure to tack on the appropriate load in the exercises, lest you cause even more damage to the tendon, she warns. The event attendees saw examples of pristine load management systems, such as the AlterG antigravity treadmill, during the equipment demonstrations (see below). Runners can also use medication, shockwave therapy, injections, orthotics, gait analysis and tactical return to running.

‘Shockwave is a great piece of kit,’ Kate said. ‘You basically put soundwaves on the tendon. It tries to restore that tendon, the normal blood flow and lubricin – a tendon glides with a lubricin molecule.’

Did you know your running technique could not only help your performance, it could also hurt you?

In ‘Will my running technique hurt me?’ Stuart Wylie, Deputy Lead Physiotherapist at Circle Rehabilitation, presented styles of running technique. He discussed the evidence behind running injuries, rationales of runners changing their technique and gait analysis.

With ease, Stuart  – or ‘Stu’ as he is called around the hospital’s physio gym – demonstrated his biomechanics expertise to the audience. He analysed photos and videos of running forms, including that of Sir Mo Farah, Britain’s most-successful-ever distance runner.

‘Lovely running form,’ Stu said of Mo’s photo, ‘triple flexion pattern on the front leg, triple extension pattern on the back leg.’

He presented academic research and his own findings on forefoot strike, midfoot strike and rearfoot strike – ways runners strike their foot to the ground – and their effect on efficiency and injury. Interested to know the answer? Watch the full video of Stu’s presentation below.

You may or may not have been counting, but ‘cadence’ – the number of steps per minute – has an impact on running performance, Stu said. That step rate can affect stride length, knee flexion, hip rotation, Patello-femoral Pain (PFP) Syndrome, tibial stress fracture and energy consumption at the hip and knee.

Physiotherapists analyse more than foot strike, stride length and cadence. Running problems also stem from pelvic drop, glut weaknesses, knee rotation, shin bone rotation and weakness in hamstrings, to name a few. A 3D gait analysis can help determine whether elements of the running form are ideal, excessive or reduced, Stu said. Also that night, Stu demonstrated Circle’s 3D Gait Lab (see below).  Gait re-training is another route to improve symptoms.

All-in-all, despite what you might read in magazines or online, there isn’t one optimal cadence and running style for all runners. Rather, these are person-specific.

‘Think carefully before deciding to change any gait habits,’ said Stu, who used to treat academy players at Reading Football Club before he joined Circle. ‘Any changes to the gait style need to be slow and gradual to avoid tissue overload.’

Eat more protein at breakfast!

That was one of many helpful suggestions in the the presentation ‘Fuelling the runner: top nutrition tips.’ Carin Hume, Consultant Registered Dietician at Circle Rehabilitation, explained that to optimise the effects of training, runners must understand they need to spread their protein intake across each meal, not just gobble a whole day’s worth in one sitting.

An athlete can synthesise up to about 0.25 to 0.30  grams of protein per kilogram of their own body weight during a meal. Thus, a 70 kilogram athlete, for example, ought to plan a maximum of about 20 grams of protein per meal.

To get that protein boost at breakfast – which is often overlooked – eat eggs, Greek yoghurt and smoked fish, Carine said. Add hydrolysed collagen powder – an animal-based protein – to porridge, cereal and smoothies. Collagen is a source of a rare amino acid, glycine, which helps the joints and cartilage.

‘I’ve got a general interest in eating well,’ Luc said. So the messages Carin gave across nutrition really piqued his curiosity – messages like ‘the importance of protein distribution and getting enough Vitamin D and calcium,’ he said.

Runners should also ensure they eat magnesium rich foods throughout the day, especially dark, leafy greens. Every cell in the body requires this micronutrient.

Also, to maintain immunity, you need to feed your healthy microbes in your body.

‘Intense exercise is essentially a stress to the body, and research has shown that after intense exercise, your gut wall is a little permeable or leaking,’ Carin said. ‘So if there are ways in which we can try to make your gut wall a little bit more sealed or less permeable, then it will certainly help in terms of immunity and general health.’

Eat fermented foods, prebiotic foods and probiotic supplements (see sidebar).

Carin has studied diabetes, dietary management of gut disorders (including FODMAP training), behaviour change and functional medicine.

From Reebok’s humble beginnings in the 1890s to the high-tech of 3D scanning, athletic footwear has come a long way. At the educational event, Nick Gallogly, Consultant Orthotist at Circle Rehabilitation, presented the past, present and future of the running shoe. Nick was London Irish Rugby team’s on-call orthotist during the 2015 Rugby World Cup. He is also a member of the medical team at GB Rowing and provides clinical support to the Reading Football Club academy and Bath Rugby.

Since the 1970s, running shoe companies have been claiming injuries spur from high impact forces and pronation – that inward roll of the foot – Nick said. So the companies have modified their designs with gels, cushions, air pockets and arch supports. The result of these so-called advancements? Injuries have remained unchanged. There isn’t enough ‘clinical evidence to back-up what they’re doing,’ Nick said.

But as the footwear industry advanced its technology, the end-users were becoming doubtful. A storm was brewing, Nick said. In the noughties, notable authors wrote reports that barefoot running would be the way forward. So the pendulum swung to the other side.

Footwear companies then sprang into minimalist shoe designs, like the Vibram FiveFingers. These models purported to ease the load off runners’ knees. This is a particularly useful feature if a certain runner typically suffers from knee injuries. But research couldn’t show that redistributing the load from one joint to another necessarily thwarted injury for all cases. Rather, that could in some instances redistribute the injury from one joint to the other. Moreover, research couldn’t support the claims that minimalist shoes categorically give better speed and endurance. Therefore, specialists need to monitor and fine-tune on runners’ performance with footwear on a case-by-case basis.

Nick tracked footwear’s history further, delving into motion control trainers and maximalist shoes. He also analysed how and when the foot makes contact with the ground and what this means for footwear.

As for the future? Technological advancement will continue to be on the agenda of footwear companies. Footwear materials, for example the popular polyurethane, will be evermore important. But runners should be more cautious at buying into gimmicks or over-complicated modifications. Keeping to your status quo of footwear could the best route to top performance. Nick highlighted a golden rule from veteran biomechanics expert, Benno Nig: ‘If it feels right, it probably is right.’

The runners sat attentively in the hospital atrium, writing notes while listening to the expert talks. But they also laced-up and headed to the Circle Rehabilitation physio gym to experience first-hand how athletes accelerate their recoveries and manage their conditions. At no cost, they tried out cutting-edge technology and equipment: the 3D Gait Lab, Biodex Balance SD and AlterG. They also saw a demonstration of the Hydro Physio.

Most gait analysis systems capture information in two dimensions, for example using a basic video recording. But Circle’s 3D Gait Lab uses infrared cameras to precisely measure the movement patterns of a runner’s ankle, knee, hip and pelvis – in 3D.

After six months of developing the 3D Gait Lab, Stu was pleased to unveil the lab – one of a few in the country – to the runners. Thanks to a partnership with the running clinic at the University of Calgary, the lab’s results are analysed against the world’s largest database of 3D biomechanical walking and running. Circle’s physiotherapists set benchmarks according to the database’s segments, such as gender and running style, and generate biomechanical reports.

‘We get a really valuable resource to tap into,’ Stu said.

This is to assess pain, injury, performance and footwear. Ultimately, the lab, along with the patient history and other assessments, guides the areas for rehabilitation.

‘I think a lot of people would find that useful,’ said Robert, one of the runners at the event, ‘and I think I might try that myself.’

Another way to assess and improve athletes’ performance is with the machine Biodex Balance SD. The event attendees tried balancing while standing on varying angles of the machine’s platform. The Biodex Balance SD produces a printed report.

The AlterG anti-gravity treadmill uses technology NASA originally developed for astronauts. It speeds up rehabilitation by getting athletes moving sooner in a pain-free environment. Thus, athletes can train longer and harder than if unaided, without risk of injury.

‘The AlterG was really interesting to see,’ Robert said. ‘My friend from the athletics club has been using that to come back from an injury.’

Boosting running performance isn’t limited to land-based exercises, especially for runners who want to start their rehabilitation sooner and recover more quickly. The event attendees saw a demonstration of an alternative solution: the Hydro Physio machine.

It is a walk-in unit in a private room for individual athletes to use. It has an integrated treadmill and can be filled with water from calf to shoulder height. The Hydro Physio lets athletes improve their gait, balance and strength in a controlled environment.

Athletes use it to walk forwards, backwards and sideways and perform exercises such as squats. The warm water provides buoyancy to reduce the load on painful joints, while cushioning and relaxing weak muscles and limbs to reduce pain.

It is suitable for those recovering from spinal, lower and upper limb injuries and also for neurological patients.

Overall the event was deemed ‘excellent,’ according to feedback gathered from the runners, athletic club coaches and other attendees. They followed-up with Circle’s physiotherapists and medical consultants to book appointments and find out more about the equipment.

The themes nutrition and osteoporosis stood out to the runner Robert in particular because he has recently came across these topics in the news. So he feels male and female athletes, both young and old, should take heed.

‘It was a really, really interesting night,’ Robert said.

Meanwhile, one of Luc’s takeaways from the event was from Nick’s talk. Despite purports for new running technologies, ‘not one right thing is for anyone. Very much a bespoke approach is the key,’ Luc said.

This bespoke approach is echoed throughout Circle Rehabilitation’s ethos. Circle Rehabilitation boasts a multidisciplinary team, technological innovations and purpose-built centres. The athletes and patients collaborate with the staff on tailoring their very own therapy programmes.

Circle Rehabilitation has been successful at treating at their centre in Circle Reading Hospital. Athletes can stayover at the hospital as inpatients, for example if they are recovering from an injury or surgery. Or they can come-and-go to visit the centre’s clinics, physio gym and staff. Circle Rehabilitation is building an even larger facility in Birmingham, to open in 2019.

‘We now have the opportunity to do something incredibly innovative and rewarding,’ said Massoud Fouladi, Group Medical Director, ‘and give people what they deserve: a happy, healthy and independent life.’

Thanks to Circle Rehabilitation’s Nick Gallogly, Luc was able to get back to running at full-strength. Luc ran 10 miles to get to the Circle Rehabilitation event ‘Go the distance: expert advice on perfecting your run.’ He also ran to work that morning and ran home after the event that evening. So you could say he certainly has been ‘going the distance.’ And with the help of Circle Rehabilitation, you can ‘go the distance,’ too.

For more information, contact Debbie Friel, Physiotherapy Administrator.
Call 0118 922 6980 or email physio@circlereading.co.uk

Join the conversation on Facebook at www.facebook.com/CircleRehabilitation/

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