Stretching

Stretching: A form of physical exercise in which a specific muscle or tendon (or muscle group) is deliberately flexed or stretched in order to improve the muscle’s elasticity. The result is a feeling of increased muscle control, flexibility, and range of motion. Stretching is also used therapeutically to alleviate cramping.

Alternatively;

Stretching: the most divisive, emotive and inconclusive part of the Exercise Universe.

Because of the second definition, by yours truly, I have put off writing a blog on stretching for as long as I have been writing a blog. But here goes;

In 2015, a paper in Research in Sports Medicine called “Impact of stretching on the performance and injury risk of long-distance runners” came to the conclusion that;

“….the literature suggests that stretching poses no significant advantage to endurance runners. Acute stretching can reduce running economy and performance for up to an hour by diminishing the musculotendinous stiffness and elastic energy potential. Chronic stretching additionally appears to have no advantageous effects. In regards to DOMS, it has been reported consistently in the literature that stretching cannot reduce its longevity or intensity. In relation to injury risk, stretching shows little significance for endurance runners to chronic injury. Endurance athletes are at high risk of overuse injuries such as illiotibial band syndrome, stress fractures and plantar fasciitis,and the literature suggests that stretching cannot reduce the prevalence of these injuries. It appears stretching may hold significance for certain exercise disciplines;
however, it can be concluded that it holds no advantage for endurance runners and is not the solution to improving performance or reducing injury prevalence”

Of course this very much focusses on Running, but is pretty damning stuff. It found no benefit to stretching, and actually some negative effects of stretching. Everyone stop stretching!

But wait….

A study in 2016 called “Acute bouts of upper and lower body static and dynamic stretching increase non-local joint range of motion” found – unsurprisingly if you read the title in full – that stretching had a positive effect, and not just locally. It concluded that lower body stretching increased flexibility in the upper body at the same time – and vice-versa. Praise the lord!

 

 

I’m always asked about stretching, and people will always ‘confess’ to “not stretching enough”. On my Strength and Conditioning For Runners Workshops, we focus almost entirely on Dynamic Stretching, as running is a dynamic activity. This does NOT mean I am anti-static stretching, at all, far from it. Stretching has its place in physical therapy – of course it does.

We can see from the evidence, that science can’t agree completely on its validity as a treatment. However, for some of the people, some of the time, it is essential. But of course, much the same as everything in the fitness and health world, it is not a panacea.

My advice is always to critically appraise your routine; What are you stretching? Why are you stretching it? Is it relevant to your daily activities, or sport? Is the muscle “tight” because it is short, or tight because it is already too long…? If you stretch something, and stretch it, and stretch it, and the symptoms remain, did it need stretching?

For more information, please contact Dan@DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work

 

Hypermobility

Joint hypermobility – or to be ‘double-jointed’ – is a condition where joints are more flexible than they need to be, meaning they can extend past their required range of movement. There are 360 joints in the body and it can affect any of them, but more often than not, just a few.

It is surprisingly common across the board (it is estimated that 20-30% of the population are hypermobile to some degree, in some joints), however, it is most common in childhood and teenage years, and more common in females than males. It does, of course, tend to lessen with age – we’ve all felt the stiffening of the years! In many people joint hypermobility goes unnoticed as it is of no medically significant consequence and there are no symptoms to speak of. Hypermobility can even be seen as an advantage, to some, for example athletes, gymnasts, and dancers (you know your Yoga Teacher who does “those” positions….?). Even musicians might specifically be selected because of their extra range of movement.

Hypermobile?

However, for a small percentage of the population, far from being advantageous, hypermobility is associated with joint and ligament injuries, pain, fatigue and other symptoms. Joint Hypermobility syndrome is thought by many experts to be part of the same spectrum as Ehlers-Danlos syndrome, which is a more severe type of Hypermobility and effects around 1 in 5000 people. Despites its prevalence and symptoms, though, the International Paralympic Committee do not consider it a disability.

What causes Hypermobility?

Where your bones meet at a joint, the ends of them are surrounded by a capsule filled with fluid and held together by strong ligaments, which stop the joint from moving further than it should, and so dislocating. The muscles surrounding the joint are attached to your bones with tendons, allowing you to bend, twist and run. In those affected by hypermobility, the collagen fibres which make up any of these soft tissues is of lower quality and strength, meaning they move beyond their normal range.

How is it diagnosed?

Clinically we use The Beighton Score, which consists of a series of five tests, the results of which can add up to a total of nine points.

  • 1 point if you can place your palms on the ground while standing with your legs straight
  • 1 point for each elbow that bends backwards
  • 1 point for each knee that bends backwards
  • 1 point for each thumb that touches the forearm when bent backwards
  • 1 point for each little finger that bends backwards beyond 90 degrees

If your Beighton score is 4 or more, it is likely that you have joint hypermobility. However, this cannot be used to confirm a diagnosis, because it is important to look at all the joints. Blood tests and scans are sometimes recommended to rule out other conditions.

1 point!

For more information, please visit http://hypermobility.org/

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

If you are suffering with aches and pains, please contact Dan@DC-InjuryClinic.co.uk

Should Sports Massage Hurt?

…it’s all relative. Thanks for reading!

Sports Massage is a popular and much used therapy, recommended by N.I.C.E as a treatment for Low Back Pain. “Sports” Massage is a little misleading, and as a treatment it is fast becoming known as “Remedial” Massage, or Soft Tissue Therapy. Often thought of as being not for the light-hearted, “No pain, no gain” and “If it doesn’t hurt, its not helping!”  are both commonly heard in clinics all over the country.

But how much pain is acceptable? How deep, is deep enough??

Not everything that helps is painful, and not everything that is helpful is painless. But ultimately, Sports Massage does not have to hurt to be effective. Whilst working on a problematic area may certainly cause some discomfort, it shouldn’t leave bruising or cause you to leap off the table! (and anyway – very generally speaking -where the pain is, the problem isn’t…) If you do find yourself consistently bruised after Sports Massage sessions, your therapist may be going too hard and you have every right to ask them to ease off.

Often, people will talk about the “good” pain whilst having a Sports Massage, that sweet point between pain and relief. Is there a skill, as a therapist, to this? I think there is, but I don’t think its so much the skill of the chosen technique, but the skill of communication. I have heard of someone having a sports massage, and when answering “no” to the question Does this Hurt?, the therapist went harder, and deeper. “No pain, no gain”, right? Crazy.

And of course, there is also the “bad pain”, where the person on the couch will involuntarily tense up, or try to move away from their pain. Bad pain is pain beyond a persons individual pain threshold, and is NEVER acceptable as it offers no therapeutic benefit. As mentioned, the person is inclined to involuntarily tense up – the polar opposite, generally speaking, of the appointment. Some people will say they feel better when it has stopped, but that will be….because it has stopped.

Different parts of the body also react differently to sports massage, and pain threshold can change depending on where the therapist is working. Again, communication is the key tool of the therapist. There are certainly some parts of the body that simply should not be worked on.

 

intense-massage

“Does it hurt?”

Massage is a therapy as old as time, and an inbuilt reflex to pain – what’s the first thing you do after banging your knee (ok, second, after swearing)? You rub it better. And often, it feels better straight away, without beating it half to death.

So as I say, “No pain, no gain”, and “If it doesn’t hurt, its not helping!” may both be commonly heard in clinics all over the country, just not from me.

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

Injuries are a pain in the bum! PART 2 – Proximal Hamstring Tendinopathy

Part 2 of the “injuries are a pain the bum” saga!

Following on from the previous instalment, the other common complaint we see in clinic is Proximal Hamstring Tendinopathy (PHT). Similar to groin pain, this is one of those injuries that people are almost apologetic in their embarrassment; some people going as far as mouthing the description to avoid saying it out loud. The most common symptom is pain at the hamstring attachment to its origin, the ischium – as seen in the image (the white tendon at the top of the hamstring muscles).

ham-tendon

Have you got PHT? People often refer to the pain as in the “sit bones”, or similar, and PHT is mostly characterised by buttock pain in the area just under the glute muscle – as the leg turns into the bum! Area of pain is often consistent with the size of the tendon – generally 2 fingers width. Generally, sufferers have pain upon waking in the morning, with the pain decreasing as they start to move throughout the day. However, it can be aggravated by the simplest of things due to its location; sitting – in a flexed hip position – for prolonged periods compresses the tendon (see; desk workers, driving, cycling [highlighting the importance of a Bike Fit]), as do deep lunges and squats, running fast or uphill, and lastly…..stretching! Yes, you read that correct; hamstring stretching will not help PHT. So if your PT or injury therapist is getting you in the below position, please ask them to stop 🙂

hamstring-stretch

This will not help.

What we can do? As we’ve seen, PHT is aggravated by tension and compressive loads. To reduce pain, we need to decrease these loads to a level that is manageable. This means reducing compression from sitting and activities involving hip or trunk flexion; avoiding stretching the hamstring and reducing running or lifting to a relatively pain free level (I aim for below 3/10 on your pain scale). Tendon research has shown changes in muscle function when pain is present; isometric hamstring exercises, such as the Hamstring Bridge – as seen in the below video – can help reduce pain and maintain muscle strength (Ref 1)

Like the achilles and patella tendons, the tendon at the origin of the hamstrings is thick, fibrous, and has a poor blood supply, which can make healing difficult, and slow. Similar to these two more common tendon injuries, tendinopathy of the high hamstrings appears to be a degenerative process, not an inflammatory one, meaning that the fibers of the tendon are becoming damaged, or are ‘spiltting’. In a 2005 paper, Fredericson et al argue that the key to successful rehablititaion of PHT is eccentric strengthening of the hamstring muscle group, improving the ability of the muscle and tendon to manage the load required. This should be graded, and ideally, in a limited position of hip/trunk flexion.

REFERENCES

Ref 1 A meta-analytic review of the hypoalgesic effects of exercise http://www.ncbi.nlm.nih.gov/pubmed/23141188

Ref 2 Fredericson, M.; Moore, W.; Guillet, M.; Beaulieu, C., High hamstring tendinopathy in runners: Meeting the challenges of diagnosis, treatment, and rehabilitation. Physician and SportsMedicine, 2005,

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Injuries are a pain in the bum! PART 1 – Piriformis Syndrome?

Being injured is a pain in the bum, right? But what if the “pain in the bum” is, well, your backside??
This is the first blog of a couple of common derrière based problems.

Piriformis syndrome has been described in literature for over 70 years (ref 1); yet, it remains controversial. To the extent that there are on-going debates as to whether it is over-diagnosed, or under-diagnosed! Confusing? Maybe, but lets start with the things we can agree on;

We can all agree that the symptoms presented both in the general population, and in runners particularly, are:

  • Pain in the buttock, tightness/loss of movement, tingling/pins and needles, and/or weakness/numbness which can sometimes radiate into the lower back and down the backs of your legs, sometimes as far as the toes.

But how do these symptoms manifest themselves? We need to take a look at 2 structures;

The piriformis is a small, relatively short muscle buried deep within the glutes, one of only 2 muscles joining the spine to the legs. It runs from the sacrum (base of spine) to the greater trochanter – the outside of your hip. Because of its position, the piriformis muscle helps rotate your leg outward when your hip is extended, but rotates your leg inward and into abduction when your hip is flexed. During the running gait cycle the piriformis is most active during the stance (foot planted on the ground) – approx. 60% of the cycle.

The sciatic nerve is a very thick nerve which originates from your lower back (L4-S3), through your glute muscles and down the backs of your legs, all the way to your toes…..The sciatic nerve passes directly under the piriformis muscle in most people, however it is thought that in between 15%-20% of the population it passes through the piriformis.

Piriformis

Let us also acknowledge the word ‘syndrome‘; Oxford Dictionary defines a syndrome as “A group of symptoms which consistently occur together, or a condition characterized by a set of associated symptoms . Essentially – medically at least – a syndrome is nothing more than a group of symptoms: True cause varies. See; Illiotibialband syndrome, patellofemoral pain syndrome, irritable bowel syndrome.

So whilst we have to accept that there is no universally agreed-upon criteria for piriformis syndrome, a systematic review paper published in 2010 by Hopayian et al (ref 2) defined piriformis syndrome as “sciatica caused by compression of the sciatic nerve by the piriformis muscle.”

Thus, the theory goes; irritated piriformis – irritated sciatic nerve – pain = Piriformis Syndrome (PS)

So what can we do about PS?

As you can imagine with limited conclusive research, and much ambiguity around the true cause of this syndrome, treatment studies are not in abundance. Most treatment modalities naturally treat what is thought to be the causing factor, a problematic piriformis muscle. A conservative place to start would be to stretch the muscle (ref 3). This can be done in a multitude of positions, some of which can be seen in the following video.

It may be that the underlying cause of the pain is less simple that a ‘tight’ pirifomis, and it may be a case that you need to strengthen the muscle, or indeed your hips in general (ref 4). Again, due to the lack of high-quality studies, and the absence of research on treatments specifics, there is limited scope to describe specific advice in a general forum. Befriend your local therapist if symptoms persist!

Anecdotally, other popular methods to address the symptoms include massage, foam rolling and a few lifestyle changes; avoiding doing things that irritate the piriformis muscle such as prolonged sitting (standing desks are becoming more and more popular), and if you are able to still run, avoiding antagonistic workouts such as speed sessions and dedicated hill repeats.

Remember, it is important as part of the diagnostic stage of PS, that other conditions that can cause similar symptoms are identified, either by objective medical tests like an MRI scan (herniated discs or other low back/pelvis issues) or in a clinical setting.

For more information, or to attend a Strength and Conditioning Workshop for Runners, please visit www.DC-InjuryClinic.co.uk

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

—————————-

REFERENCES

REF 1 Benson E, Schutzer S 1999. Posttraumatic piriformis syndrome: Diagnosis and results of operative treatment. Journal of bone and joint surgery

REF 2 The clinical features of the piriformis syndrome: a systematic reviewhttp://www.ncbi.nlm.nih.gov/pmc/articles/PMC2997212/

REF 3 Christensen K 2006. Rehab recommendations for piriformis syndrome. Dynamic Chiropractic.com

REF 4 Tonley, S. C.; Yun, S. M.; Kochevar, R. J.; Dye, J. A.; Farrokhi, S.; Powers, C. M., Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report. Journal of Orthopaedic & Sports Physical Therapy 2010

 

Marathon Training Blog #5

….and it’s done!

Bournemouth Marathon Festival is a great event; on Saturday I visited the race village and managed to see Swindon runner Gary O’Brien finish 2nd in the Supersonic 10k, before the Supernova 5k started – something that the Clayton family hope to participate in next year. The following morning, the half marathon was off at 8am before the marathoners took to the start line for 10am. The marathon route was great – coming from a landlocked town, there is always going to something special about a coastal run. There a few long out and back segments, which allow you to see the elite guys coming back the other way (at the start!), which I like, and I enjoyed the layout of the course; it is described as flat, but there are hills, however there are always going to be over that distance and I think they actually work really well. The ‘main’ hills are at miles 11 and 17, and I found them ok, having ran plenty of hills in training. Hills aside, the race itself didn’t go exactly as planned for me, but I really enjoyed the experience. I’m not commenting on whether or not I will do another one…

bmf-altitude

Bournemouth Marathon Altitude Graph

So, things that I have learnt, or that have been reaffirmed:

There is no substitute for time on feet. Emphasis on time, not mileage. If (MASSIVE “if”) I were to do this again, I would definitely do more runs of over 2 hours in duration. Looking at the process as a whole, in my lifetime I have ran for longer than 2 hours less than 10 times. In my lifetime. To run for almost double 2 hours with that background was always going to be tough.

A marathon is not simply two half marathons. I mean, technically it is…… but for me it is so much more. Many a wise man has said that a marathon is a race of 2 parts; a 20 miler and a 6 miler, and for lots of runners, the race “starts” at mile 20. For me, it was a race of 16 and 10. To break it into two half marathons, I ran a positive split (a slower second 13 miles) of 17 minutes. Oops.

You can’t control the elements. Pretty obvious, in reality. I’m not one to look for excuses (ha!), but the weather was warmer than forecast  (to which my wife’s sunburnt nose will attest 😉 ), and this did throw out my fuelling a little. Expect the unexpected; Failure to prepare… etc etc

The crowd really does help. Support is so, so important. I had my DC Injury Clinic T-shirt on (standard!) and had lots and lots of shouts of “c’mon DC”, which was really lovely. Also, seeing lots of Swindon faces in the crowd, hearing their support, really meant a lot and at time when you are physically and emotionally drained it is a great pick me up. Also, seeing friends, my incredibly supportive wife, my two little girls (who were far more interested in the sand than daddy running!) and my parents was amazing. I thank you all. Marathon running is a team event.

Its a psychological battle. At mile 16.5, I was done. Finite. Show me the way to go home. I suffered from cramp in both of my calves, something I had never suffered from previously, and my head literally said “you can not do this” – see the pictures below, courtesy of Greg Wells, and witness a heart breaking.

bmf4

Not happy…

bmf1

 

 

 

 

If I am proud of anything from Sunday, it is that after giving myself a few stern talking to’s, I picked myself up and carried on.

When I was 17, I was told that I should stop playing football, and that I was to never run on roads as I had “shin splints”. It took me a while, but on Sunday 2nd October, 2016, I ran a marathon. It didn’t go 100% to plan, but that doesn’t matter. I ran not for a “time”, but for no other reason than I can. Because I get to. Because it is a privilege not afforded to everyone, which is something I see day-in day-out.

And do you know what? I’ll probably do it again.

Song; Chvrches – Make It Gold

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Foot pain

Not just for runners, foot pain is incredibly common, and – unsurprisingly – pretty complex. There is a lot going on down there!

foot

Let us take a look at the most common diagnoses, in no particular order;

Morton’s Neuroma – Morton’s neuroma is a painful condition in the ball of the foot, most commonly between the 3rd and 4th toe. It is caused by a thickening of the soft tissue around one of the nerves which leads your toes. Often described as feeling as if you are standing on a sharp object, other symptoms include sharp, burning pain in the ball of your foot, or a stinging, burning or numbness in the toes.

Metatarsalgia – essentially “painful metatarsal”, this is very similar to Morton’s Neuroma, with pain in the ball of the foot the primary symptom. Metatarsalgia is thought to be caused by various different conditions affecting the foot, and so is a symptom, rather than a condition, as it were.

mortonsneuroma

Stress Fracture – the curse of English Footballers! A stress fracture is a small crack in a bone, or sometimes severe bruising within a bone, most commonly the 2nd or 3rd metatarsal (long thin bones of foot). Most stress fractures are caused by overuse, or high impact activity – “Insanity” training, for example. Symptoms include pain that starts and increases during normal activity; pain that decreases at rest; pain on palpation (touch). There will sometimes be associated swelling or bruising.

Bunions – Also known as hallux valgus, bunions are a deformity of the big toe, where the big toe angles towards the second toe causing a bony lump on the side of the foot. This can lead to a large sac of fluid forming – known as a bursa – which can then become inflamed and painful. There are various causes, however it is thought to hereditary, so choose your parents carefully!

bunion

Gout – Gout affects around 1 in 40 people, and is a type of arthritis where swelling and pain develops in joints, primarily the base of the big toe. The joint will start to ache, then swell up and become red (sometimes ‘shiny’), hot and very painful. A temperature and fatigue are also common with gout. Gout is caused when crystals build up and form around the body’s joints, causing inflammation and pain. These crystals are a result of the body not ridding itself of enough of a product called urate – more detail can be found here.

Plantar Fasciitis – a commonly treated foot problem that affects a variety of people. Although plantar fasciitis is a common problem, little scientific evidence exists concerning the most appropriate intervention. So what it is exactly? Well, anything with ‘itis’ on the end means ‘inflammation’, and the plantar fascia is a thick band of connective tissue that runs the length of our feet, from your heel to your toes. So inflammation of the sole of the foot! However – as is the inconsistent nature of PF – this isnt always the case with the condition! See previous blog for full information.

Stubbed Toe – if you do not know what this is, it’s probably not a sports therapist that you need. More painful than childbirth*. (See also, Standing on Lego.)

*more research needed.

lego

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

Marathon Training Blog #4

So the big mileage is now done! 3 weeks out and its time to taper. I would love to be writing this full of beans, raring to go, but as it happens, you find me at the back of 3 of the worst training runs of my entire programme! Frustrating, but trying to rationalise how far we go in training for such events. Also, respecting what it is that we undertake. The marathon is an endurance event: as the oxford dictionary will tell us, this means;

“The ability to endure an unpleasant or difficult process or situation without giving way”

Lots of experienced marathon runners describe the event as a “20 mile race” and a “6.2 mile race”. My reading of this is very much that the second race is very much a psychological thing as much as a physical. Lots of runners have a mantra in their head to keep them going as they enter the ‘dark miles’. Paula Radcliffe once said that she outran Geta Wami to win the New York Marathon by chanting “I love you Isla” (her daughter), over and over (Ref 1). Lovely bit of oxytocin use! I think all runners find their own version of a pep-talk, some going as far as to write them on their hands pre race. Lynsey Sharp is a famous example of this in the 2014 Commonwealth Games.

LSharp

For me, I always have in mind something I talk about when working with Runners – the 4 C’s, in order:

Concentration: Do NOT go off to fast.

Composure: Keep calm, it’s just running

Confidence: in your training

Commitment: to your training and your goal

Part of the 3rd C, Confidence, is knowing that you have done the hard part; you have made the start line! In his book Bounce, Matthew Syed talks about “purposeful practice”, which I am strong believer in. In my S&C Workshop For Runners, I talk about the relevance of our practices and so I have tried to take my own advice and incorporate this in my training. For me, this is researching the course route, knowing your weaknesses and trying to limit the potential negative effects on the day! We need to mentally strong for any endurance event. As Irish boxer Steve Collins once said;

“I’d rather be 75% physically ready, and 100% mentally ready, than 100% physically ready and 75% mentally ready”

Hopefully I am 100% both on October 2nd…..ask me half way through the dreaded taper…

Song:

REFERENCES

Ref 1. Running With The Kenyans, A. Finn

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 

 

Marathon Training Blog #3

I am writing this blog on the eve of my only pre-marathon event. Lots of people enter a half marathon a few weeks before race day as part of their preparation; to test out pacing, nutrition, running amongst a big crowd. So, tomorrow, I head to Snowdonia to Race A Train! I assure you, there will only be one winner! (SPOILER: it will have wheels). I had entered this event before entering the marathon, but it actually fits my plan quite nicely. Reviews read that although it is “only” a 14 mile event, due to terrain (hilly: very hilly) and conditions (forecast: rain and 45mph winds) it actually feels more like an 18-20 miler, so although It wont be so much “race pace” training, it will be good solid miles on mixed terrain, which I am a big fan of as mentioned in Blog #2.

Race-The-Train

Also in my previous blog, I alluded to my battle with getting nutrition correct. Throw into that particular hat, hydration. It took me a few training runs trying out various methods of carrying fluids, always with the aim of (besides hydrating appropriately) training using the method I intend to use on Race Day. I have settled on using my camelbak. Benefit of this is that I am hands free, as I find carrying anything in my hands when running incredibly frustrating. Limitation of this is that you are hydrating ‘blind’, as it were. Because the bladder is on your back, in a rucksack, you don’t get to see the fluids go, so even though you may think that you are drinking lots, it’s very hard to judge. I’ve had runs where I’m convinced my intake has been great and yet had half of the bladder still full at the end; conversely, I’ve ran out of fluids miles from home. So, still practice to do there.

Back to nutrition. Most research demonstrates that the rate of absorption of carbohydrates (the main source of energy for someone who isn’t ‘fat adapted’) when exercising is around 1 gram per minute, this can increase to 1.5 grams per minute with glucose-fructose mixtures – so look out for sports drinks with a 2:1 Glucose – Fructose ratio (ref 1 and 2). This means it doesn’t make much sense for most people to consume more than 60g of carbohydrates per hour during a marathon To flip that on its head, however, I find it incredibly difficult to get 60g of carbs on-board. For those of you au fait with energy gels, that translates to roughly 3…….. an hour! Fairly early in my training I discovered that my stomach simply does not like too many gels. Running for approx. 3 hours in training, 2 gels in total seems to be my limit. So with this fairly large shortfall, I have been using plain old real food! Again, lots of trial and error, but I seem to have found a) a source that my stomach likes, b) a source that my taste buds enjoy and c) a good dosage.

Medjool-Dates

Mileage wise, July was my biggest mileage month ever, but still less than the mileage clocked up in a week, for some. Some good runs, some not so good, but the not-so-good ones are still over distances I simply have never ran before, so I still have to be pleased. In the next blog I will go a bit deeper into the psychology of long endurance events as this is something that’s really helped.

6 weeks to go.

Song: (special mention to Tame Impala – Feels Like We Always Go Backwards)

REFERENCES:

1. Jentjens, R. L. P. G.; Moseley, L.; Waring, R. H.; Harding, L. K.; Jeukendrup, A. E., Oxidation of combined ingestion of glucose and fructose during exercise. Journal of Applied Physiology 2003
2. Burke, L. M.; Hawley, J. A.; Wong, S. H. S.; Jeukendrup, A. E., Carbohydrates for training and competition. Journal of Sports Sciences 2011

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk

 

Marathon Training Blog #2

This blog comes in a ‘down’ week in my training schedule; the miles have been building and building for the last 4 weeks….with mixed results….and so this is a lower mileage week to allow the body to recover a little. As I say, a mixed bag; one week you feel like you will never be able to run 26.2 miles, the next, you feel like you’re getting somewhere. Then, repeat! I think its fairly common, anecdotally at least, for that to be standard when training for endurance events. Its one of the best and most frustrating parts of running – the consistent inconsistancies! For me, the ‘bad’ runs are just as important, if not more important, than the ‘good’ ones’ though; every Long Slow Run is a lesson learned, whether that be on pacing, hydration, nutrition, route planning…. And of course, with every “Furthest Distance Ran” Trophy your Garmin watch awards you, the body adapts and strengthens. Talking of which….

One important thing for myself in this block is that I have gone through the 2 hours of running mark. This is something that had always been an aim as, A) its something I hadn’t ever done previously, and B) clearly, I am not going to run sub-2 hours in the marathon! Another reason that the 2 hour mark was such an interest for me is that research suggests that’s once we run though this benchmark, the aerobic adaptations are actually relatively insignificant, meaning that even after running for 3 hours, the aerobic benefits (capillary building, mitochondrial development) aren’t much better than when you run for “only” 2 hours. So, in theory at least, a long run of over 3 hours builds about as much aerobic fitness as one lasting 2 hours (reference 1). This is one of the reasons that the Long Run on the Hanson Training Plan, for example, maxes out at 16 miles, focussing more on accumulative fatigue. So the importance comes in the form of strengthening the body to withstand the demands of running for more than 2 hours – the adaptation of the muscles, tendons, joints. On my Strength & Conditioning for Runners Workshops we talk about the various forces going through particular joints, with some really phenomenal amounts; huge numbers! So we cant go wrong getting strong.

It is also suggested that the body carries enough glycogen – on average – to last around 2 hours (reference 2), and this merely highlights the need to get your nutrition on-point for anything longer. This is one of the areas I have struggled with – and will touch on in more detail in the next blog.

Ridgeway

The Ridgeway – hottest day of the year!

Strength work has been going well, which has definitely helped with recovery, which has so far been really good. I enjoy a cold water bath now, and I’m a big fan of active recovery. I’ve mixed up terrain and routes, as I feel this can be beneficial. I’ve taken in the lakes of Ashton Keynes, the hills of Wanborough and Liddington, the 5000 year old Ridgeway path, and of course the hard streets of Swindon! Got to keep it interesting, as the miles are going up and up again, before another down week.

10 weeks to go.

Song:

REFERENCES

Reference 1. Influence of exercise intensity and duration on biochemical adaptations in skeletal muscle. http://www.ncbi.nlm.nih.gov/pubmed/6295989

Reference 2. https://runnersconnect.net/coach-corner/marathon-long-runs-on-an-empty-stomach-or-fully-fueled/

N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.

For more information please visit www.dc-injuryclinic.co.uk