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Overuse Injuries

Posted on 12th February 2018 by

What is an overuse injury?

An overuse injury is normally a chronic injury that gradually occurs over a period of time, rather than a sudden acute traumatic injury. Repetitive trauma to a muscle, joint, ligament or tendon such as a tendinopathy or stress fracture are just a couple of examples of overuse injuries.

What causes overuse injuries?

Overuse injuries are often linked to training overload in athletes, or sudden changes in activities that put stress through the body which they are not used to and therefore overload the soft tissue or bone. When we take up a new hobby, sport or activity or increase training levels/load this will put increased stress onto our body, this will lead the body having to adapt. However, if the body is not given time to adapt and the body is overloaded then this can, in some cases, lead to repetitive ‘microtrauma’ to the tissues. This can be unnoticed for a long time, or thought to be just a muscle ache. Some causes of this include:

  • Poor Technique
  • Muscle imbalances
  • Training overload/level
  • Biomechanics of your foot

What might it feel like?

Depending on the affected tissue or body part will depend on how it will feel. Common symptoms include:

  • Pain that starts initially during a warm up that then eases of and returns at the end of your sport or activity
  • Consistent pinching or sharp pain on specific movements
  • Constant dull ache

How do the symptoms progress?

Overuse injuries can be slow in developing and last a long time. The longer the problem is ignored the worse or more frequent the symptoms can become. This may lead to pain every time you engage in your sport or activity and may also lead to pain/swelling afterwards.

How is it diagnosed?

If you think you may be suffering with an overuse injury, it is important to get an assessment by a physiotherapist or sports therapist. The key to effective management of an overuse injury is accurately identifying exactly what’s causing it and addressing this. This will help to prevent any of those niggles turning into a bigger problem and possibly preventing you doing the sport of activity that you love.

What is the best treatment for overuse injuries?

There are lots of treatments that can be used to help, depending on the injury. Treatment will often start with easing the symptoms of the injury, such as pain and inflammation. In parallel to this, addressing the underlying cause and working on strength and stability to prevent reoccurence is key. Treatments may include:

Outlook

When the underlying issue is addressed and appropriate changes are made, overuse injuries can be solved. They can often be a very frustrating injury, as they inevitably need a bit of rest and trial and error to work out exactly what’s causing the issue. That’s where we come in, seeing an expert can guide you through the puzzle of injury and help get you back doing what you love as quickly and painlessly as possible.

Read More 

Achilles Injuries

Running injuries – The basic principles

Treatment of calf pain in runners

Runners knee (patellofemoral pain)

What’s physiotherapy got to do with a dripping tap?


 


Selective Rest – When to rest and when to keep running?

Posted on 6th February 2018 by

“Should I keep running or not?” is a question we get asked a lot by runners here at goPhysio.

There are many factors that can lead to injury from excessive training loads, running technique, poor foot mechanics and muscle imbalances, to name a few. But, whatever the cause of your pain or injury total rest is rarely advocated, as this will, in general, only slow down your progress and can cause many more secondary, longer term issues.

At goPhysio, we prefer the term ‘selective rest’

This means to selectively rest from the aggravating (pain causing) activities. So, if you’ve got an ankle injury and you’re a keen runner, it is usually better to rest from running until you’re recovering but gentle walking and alternative non-aggravating activities such as swimming or cycling to maintain movement and fitness can be really helpful.

Essentially, your body’s tissues (muscle, tendon, ligaments and bone) will adapt to the demands you place upon them. When you rest the muscles may tighten and weaken, joints will stiffen and your whole body will also de-condition. The long term effects of complete rest will often prolong injuries, with you suffering unnecessary secondary complications and time off running due to inactivity. We’re designed to move, hence movement and exercise is therapeutic.

So, if you’re feeling the odd niggle or pain when you run, our top tips to help keep you running are:

  • Pain during a run? If you feel pain during your run and it is getting worse throughout your run then stop. Make a mental note of the distance or duration at which the pain started (that becomes the point you’ll use to gauge progress on your next run). Avoid running for the next 48 hours, use ice and anti-inflammatories to help settle any inflammation. Then attempt another run within 2-3 days, running to the point at which you felt your pain on your previous run. If you make it to that point and beyond great, just gently progress your running over the next few weeks, ensuring you don’t progress more than 10% distance or mileage in any one run.
    However, if the pain and distance is the same or worse than you experienced on your previous run, it will be indicative of an overuse injury. So, stop and seek an expert physiotherapy assessment to identify, modify and remove all the predisposing factors, to get you back to running quickly.
  • Rest days are training days If your training/distance has been increasing and you feel your legs are finding it hard to reach your planned distance it may be time to rest to allow your body to recover and repair. This selective rest will allow yourself to continue progressing whilst also preventing injury. Intersperse running with other activities such as swimming, cycling, Pilates, yoga or strength training. These activities will allow your body to recover from the repetitive, high loading forces of running but will still help with your running training in other ways.
  • Listen to your body It’s important to use common sense and listen to your body. We all experience natural aches and pains during running, due to the natural high loading forces of the activity. These symptoms are often one-off red-herrings, that subside within 24hrs. However if the pain is sharp in nature and doesn’t feel quite right, or persist’s for a few runs, it’s your body warning you that something is wrong and you need help.
  • If in doubt, see a specialist By seeing a specialist like a Physiotherapist or graduate Sports Therapist when you have an injury, we’ll be able to reassure you what you should and shouldn’t be doing to help your recovery. We spend a long time with you 1-2-1 to fully understand your problem and answer all your questions. You’ll go away knowing exactly what is wrong with you and exactly how to help it get better. There’s nothing worse than sitting around worrying about what may be wrong and whether you’re doing the right thing. We’ll help alleviate your fears and the result is a speedier recovery, getting back to running pain-free quicker, without the worry of the unknown.

Good Luck & Enjoy your Running!

The Injured Runner Project
We are trying to find out more about what injured runners do to get back to pain-free running, and would love to hear from you! If you’re interested in helping us out, please take a few moments to answer a couple of questions by clicking on this image. Many thanks.

Principles To Managing Running Injuries

Posted on 2nd February 2018 by

This is a great infographic, summarising the key principles that play a part in running injuries, from Physio Edge.

Running Injuries Recommendations

What is load tolerance?

In running terms, a load can be defined as a demand placed upon your body – so this can be training intensity, frequency, distance, duration, terrain etc. All of these parameters, in varying combinations, demand your body to be able to cope with them. These are all external factors.

Tissue capacity is your body’s ability to cope with the demands placed upon it. So that’s how well your muscles, ligaments, tendons and joints can tolerate the running loads. This is dependant on your own natural physicality, your biomechanics, strength, flexibility, movement efficiency etc. These are all internal factors.

Load tolerance is the interplay between these 2 factors. So, if your tissue capacity matches the loading, no worries! However, if the loads that you are subjecting your body to in terms of your training exceed your tissue capacity, this is when your body starts to complain. It basically can’t cope with the demands.

So, what can you do to manage running injuries?

Manage your load well

  • Train appropriately for your level
  • Progress loads gradually
  • Vary your training
  • Be realistic
  • Have rest days

Optimise your tissue capacity

  • Incorporate strength and conditioning work into your training
  • Cross train – swimming, cycling and Pilates are great examples
  • Have your running style analysed and take professional advice
  • Get adequate sleep
  • Have a biomechanics assessment if you think that there may be issues with your foot position
The Injured Runner Project
We are trying to find out more about what injured runners do to get back to pain-free running, and would love to hear from you! If you’re interested in helping us out, please take a few moments to answer a couple of questions by clicking on this image. Many thanks.

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Should I run through pain?

Posted on 22nd January 2018 by

In my experience, I’ve found many runner’s to have a high pain threshold, which can be a help when you’re a runner. However, deciding whether to run through pain is a dark art and filled with many pitfalls!

So, in this blog, I’d like to help you avoid unnecessary injuries and share with you some insider information built up over a lifetime of clinical practice treating runners, offering you some clarity and debunking these myths related to running through pain:

Pain is weakness leaving the body!

Pain is a sensation and all sensations are pleasurable, so enjoy the pain!

No pain no gain!

So, “should I run through pain?” Well, in a nutshell it depends on what type of pain you’re experiencing. Broadly speaking there are 2 types of pain related to running and it’s crucial to be able to distinguish between the main 2 types.

1. Delayed onset of muscle soreness, also known as DOMS for short, which is a normal part of any successful exercise training programme. It’s often described as “heavy legs” and in runners is mostly felt as a broad, dull, heavy, ache in the large propulsion muscles of the leg i.e. gluteals, quadriceps or claves.

DOMS is often experienced the day after a run, when you’ve increased the mileage or done a hard hill or speed session, when you are doing day-to-day tasks that work those muscles, such as getting out of a chair or walking downstairs. It’s entirely normal and desired for the training effect.

Physiologically, one way to describe what’s happening within the muscle in DOMS is that during the harder exercise session, you get microscopic tears within the exercised muscle. The body is then in a phase where it’s laying down new muscle fibres, increasing muscle cross sectional area (getting larger) and increasing strength and endurance, hence the desired “training effect”. It normally peaks day two after the exercise session and then subsides. Read more about DOMS here.

2. Pain as a result of injury This type of pain is undesirable as any part of a training programme. Unless there is a definite memorable traumatic incident whilst out running either a slip, trip or fall (which you would be able to remember), all other running injuries can be classified as overuse injuries.

By their very nature, overuse injuries, will start gradually and mostly occur when there is a perfect storm of intrinsic and extrinsic factors.

Intrinsic (Internal) Injury Factors

These are factor internal to your body, namely:

  • A recent increase in body weight
  • Your running technique
  • Poor or altered foot & lower limb biomechanics
  • Long term muscle imbalance
  • Muscle strength & control
  • Muscle flexibility

Extrinsic (External) Injury Factors

These are factors that are external to your body and focus generally around your training parameters, namely:

  • Running volume – frequency, duration or distance
  • Running intensity and speed
  • Running terrain – hilly or flat, road or off-road
  • Inadequate warm-up
  • Running footwear

When we assess runners at goPhysio we will often find a unique mix of these factors. When combined together, they lower their body’s loading capacity or ability to cope with the demands that are being placed on their body. This results in the body complaining, often with a sharper, more niggling pain, where injury has occurred. An important part of our job as physiotherapist’s is to prioritise which factors, if addressed, will give the quickest, best outcome i.e. return to running symptom free long term.

However, if you continue to mindlessly run on this type of sharper pain without addressing the predisposing factors, it will likely worsen in severity and frequency, being felt earlier into a run and to a greater severity, eventually limiting your ability to run.

At this stage, what is usually happening physiologically, is the DOMS described above has developed into pain from injury. The micro-trauma, if left unaddressed, becomes inflammation, pain and eventually an injury.

So, if you think you’re experiencing these worsening, sharper symptoms over 2-3 runs in a week to 10 day period, stop and seek an expert physiotherapy assessment to identify, modify and remove all the predisposing factors getting you back to painfree running quickly!

Happy Running and don’t enjoy the pain!

By Paul Baker, Clinical Director of goPhysio


Treatment of Calf Pain in Runners

Posted on 11th August 2017 by

Calf pain for runners is common complaint. Your calf muscles are used extensively and repeatedly during running, so it’s no surprise that sometimes they can become overloaded and develop pain. Here’s a great infographic from Tom Goom from the PhysioEdge series of podcasts, that highlights the recommendations for the treatment of calf pain.

So, what does it mean for you if you’re a runner with calf pain?

  1. Exercise Therapy is a crucial part of the treatment of calf pain. Exercises should be specifically targeted to increase your calf’s capacity for the demands of running. There are some great examples below. Your Physio would be able to identify exactly where any weakness may lie and subsequently advise on the most effective exercises for you. It may not only be your calf muscles that are weak, muscles around your hip and knee support the work of the calves during running, so strengthening these muscles is crucial too. Pilates is great for this! And don’t forget your feet. Working on the static strength of the muscles in your feet that bend your toes can help your running technique.
  2. Neural Mobility is how well your nerves ‘slide’ or move in your body. We all know that our joints and muscles move and stretch but our nerves also have to be able to move freely. When they don’t, this itself can cause pain and restricted flexibility. Reduced neural mobility may not be local to your calf, it could be originating from a more central source (your back/spine). Your Physio would be able to identify whether you have reduced neural mobility and advise on the best exercises to improve neural mobility. It may be that some manual therapy would help too.
  3. Training Loads, so distance, time, speed, terrain, will all have an impact on calf pain. Our aim is to always try and keep you running wherever we can (always keeps runners happy!). So, we offer customised advice in modifying your load to keep you running whilst your calf pain is addressed. This is not always possible though and there are cases where resting from running and doing some specific rehabilitation is essential to your recovery.
  4. Gait Retraining can have a massive impact on recovery and prevention of calf pain. Your running technique and style can improve your efficiency of your running and reduce demands on the structures involved in running. Here at goPhysio we offer a specialist Running Rehab service, where a biomechanical and video running analysis is carried out to guide any beneficial changes to your running technique. Small adjustments to technique can often have a massive impact on your running.

Treatment of calf pain in runners

The trap many runners fall into when they get calf pain is to stop running, rest completely until their pain is gone and then go straight back to their normal running routine. Then they’re frustrated when the pain comes back again and they repeat the cycle. When you pick up an injury, particularly an overuse injury like calf pain, it is crucial to identify and address the cause to prevent the potential long term cycle of injury.

Read More

What’s physiotherapy got do with a dripping tap? Overuse injuries explained.

Top 6 Pilates Exercises for Runners

Top Tips for Injured Runners

Running Rehab Service