I’ll present one case study here, and follow up with more over the coming weeks.

Firstly though, for the avoidance of doubt, tissue issues are real things. Strains, sprains, tears, breaks – they are very real and just because they may not always be associated with pain (but in most cases they are for the reasons mentioned in Part 1), if you are in any doubt whether you have a physical injury or not, then you need to get seen by a medically trained professional – ideally someone who has experience of dealing with active people and specifically runners.

OK, now we have established that, let’s start looking at some case studies where runners have come to me with painful knees, hamstrings, ankles, IT Band etc. In many cases they have had this pain for months and months, and a few of them have had the pain for years and have seen a wide variety of very well meaning professionals that have helped somewhat but not quite got to the source of the issue. I want to give you a high-level overview of how they presented, some of the things I tried; what didn’t work and then what did work (with varying degrees of success).

Runner 1: Outside of right knee very painful for the last three years.

Introduction

Runner 1, we’ll call him Jim as that’s not his name, came to me for a running assessment as he had been getting pain in the outside of his right knee for the past three years. The only way he could run without pain was with a knee brace. He had a number of different types of knee brace from simple thin neoprene ones to more sturdy neoprene ones with built in hinges. This last type was the one he used most often as it gave the best relief, although it was quite cumbersome and very hot to wear.

Over the previous three years he had seen different practitioners, and at one point saw a physio once per week for three months. Unfortunately, nothing worked and the end result was always the same – he had to go back to running with a knee brace.

He eventually came to me on a recommendation. Jim’s thoughts were that something about his biomechanics (running technique) was leading to the knee pain and if he could improve his technique the pain would go away. Jim was also very concerned that if he ran with the knee pain (i.e. without the brace), he would be doing himself damage and severely injure the tissues.

The assessment

I always start my assessments with some basic pain and neuro education. After listening to Jim’s background and discussing his pre-submitted health forms, I explained how pain and movement works through an applied neurology lens. I often begin this education piece with the information in Post 1 of this mini series and expand from there as necessary. I find this helps to relieve some of the fear that you may have over damaging tissue when you run in pain. Let’s be clear though, running through pain is never a good idea, but the reframing of pain Vs injury helps you to take a step back and look at your situation more objectively.

Following this discussion, I stuck a load of dots on Jim and observed him walking up and down my office; taking video for discussion later in the assessment. How you walk gives me a wealth of information about how well your brain and nervous system is integrating with your muscles, and how well you unconsciously control certain movements. Jim then walked on the treadmill as it gives me slightly different data, and then he did a very small amount of running (both barefoot and in shoes) so I could capture the most important movement patterns as he ran. Now onto the really fun bit.

The rest of the assessment was made up of lots of brain-based tests and drills designed to look at Jim’s movement patterns specific to running. So in this section, I’m looking for things like coordination, agility, stability (both conscious and reflexive), balance, and your ability to express and control strength in certain movements. In Jim’s case, I also wanted to look at his sensory system in depth. From Jim’s pre-submitted forms, I had designed some tests to specifically assess how his sensory input may be contributing and impacting his knee pain.

Sensory Mapping

You may not be able to fully appreciate why this is important, so let’s take a very brief detour into the world of sensory mapping…

Without wanting to go into any complicated explanations, science has revealed to us that you have a number of virtual maps of your body that sit in various areas of your brain. These maps detail parts of your body with particular reference to controlling movement. The only way these maps can be kept to date is through the sensory input that comes in from those areas. If the maps go out of date or get blurry, your brain cannot accurately identify where that body part is so cannot move and control it well.

If the brain doesn’t feel ‘safe’ in knowing where a body part is, you won’t be able to be strong in that area and you may well be inaccurate when trying to move. Let’s just say that the body part in question is your knee. If this map is blurry, then your brain cannot identify where your knee is, so it can’t move it well. In addition, this inability to move well spills over into not being able to stabilise your knee joint.

As I’m sure you can imagine, when you are running your ability to stabilise your knees is very important. If you aren’t able to do this, your brain doesn’t feel ‘safe’ and predicts that this could lead to a physical injury. In order to get you to do something about it (initially, to stop this threatening activity of running), it gives you the experience of pain. But get this, it may not be the map of your knee that’s blurry. It could be your ankle or your hip and your brain is using pain in the knee because it knows you’ll pay attention to it.

Updating Jim’s Brain Based GPS

Through the sensory testing, I discovered that Jim’s right leg had a much lower sensitivity to vibration, heat and cold. This was most pronounced around his right knee and right ankle. The maps of these areas, therefore, were not being properly updated as there were significant sensory mapping data missing. So the first part of my mission to help Jim run without knee pain was to begin updating those brain maps.

To help update the maps and to also start to improve Jim’s right sided reflexive stability, we spent a couple of sessions where we combined cold sensory input around his right leg with loaded coordination and accuracy drills. This involved exercises such as accuracy shoulder circles, banded punch outs using my reaction lights, and mobilising the nerves around his right side pelvis and right leg.

As we started to make changes, Jim started to feel better about his running and was doing a bit more – and he had ran twice the preceding week without the knee brace. We then started to see the impact of not having the required level of skill to stabilise his joints to the degree needed for an increase in his running. Over the past months, Jim had also had left heel pain but this had been secondary to his right knee pain so wasn’t an initial priority. Now, however, it started to feel worse. Jim had changed running shoes which may also have been a factor, but the main challenge was that he still hadn’t developed the necessary stability skill, and clear brain maps, that he needed in order to increase his running. Determined as ever, Jim was due to run a trail half marathon in a couple of days.

Although that race went well, it was clear that Jim’s left heel pain was now the priority. We shifted focus slightly to deal with that while Jim was still doing the brain mapping exercises for his knee. After a few weeks of doing the exercises, Jim’s heel pain had improved and we put our focus back onto his right knee.

We spent some more time clearing up Jim’s brain maps with a variety of exercises designed specifically to challenge his brain and nervous system to clear the maps up.

The Big Breakthrough

Jim could do a few runs a week now without the brace, and even went for a period of a couple of weeks where he didn’t wear it at all. However, he had become somewhat reliant on it from a comfort perspective. Jim had used his knee brace for so long that his entire belief system about his knee pain was firmly attached to his use of the knee: with the brace, he had no pain and felt fully confident in running up 13 miles. Without the brace he could run without pain, but was always on edge about the possibility of impending tissue damage because he didn’t have the knee brace supporting him.

So now I had the added challenge of changing Jim’s belief system so we could reduce his anxiety around running without a knee brace. As part of this process, we also looked together in some detail at what the knee brace was actually doing for him.

The first thing I did was to demonstrate that his knee brace wasn’t giving any real support to his knee joint at all. It was just a neoprene brace with some plastic hinges built in. Although it was a bit weighty and felt the part, the truth was that Jim could move his knee into every angle very easily and the brace didn’t stop him. If it truly was providing any kind of positional or rigid joint support, he shouldn’t have been able to do that. So if it wasn’t providing significant joint support, what was it doing that was making his running completely pain free when he wore it?

We looked next at whether the heat being generated by the brace was making up for the lack of cold sensory input that Jim had in his knee, and therefore helping to update his map on the fly. There was good logic around this, and if the brace was heating the skin then this would help clear up the map as he was running. This in turn would help his brain activate the muscles better and stabilise the joint: no threat, no pain.

Then Jim told me that at the times when he wasn’t wearing the brace, if his knee hurt he would massage it in the painful area and this often allowed him to continue running for a bit longer. So I decided to get Jim to do some safe exercises that nevertheless irritated his knee, so I could do some testing. Jim started doing single leg squats and sure enough his knee pain came back. So I checked the skin mobility around the relevant area and discovered that it didn’t move very well. Skin stretch and fascial stretch (the deeper layers of tissue) are important sensory inputs that also help to map out your joints, and for Jim the skin stretch sensitivity in that area was poor.

I had Jim squat again but this time I made contact with his skin in the relevant area around his knee at an appropriate firmness and depth, and his knee pain simply vanished. I learned from this experiment that Jim’s knee brace was giving him firm pressure and pushing layers of his skin together which was providing the necessary sensory input to complete the brain map and allow his brain to control and stabilise his knee.

After some more experimentation, I came up with a personalised taping strategy that provided the same pushing together of Jim’s skin and fascial layers. So I managed to replicate the benefits the knee brace was giving him with a simple single piece of kinesiology tape strategically applied, that was both more comfortable and more practical than lugging a hinged knee brace around. Jim found he could complete all of his runs totally free of any knee pain as long as he had used the taping strategy before he ran.

So the big lesson here is that Jim’s lack of sensory input from his skin and deeper layers of tissue in a small area near his right knee, was confusing his brain and stopping the brain maps of his knee from being correctly updated. Combine this with the other sensory deficits and the brain maps were constantly out of date. Because the maps were blurry, his brain couldn’t properly control his knee when he was running. This meant he wasn’t handling the forces correctly which was creating a large threat level for his brain. His brain interpreted this as being unsafe and produced a pain experience to get Jim to stop what he was doing.

Was Jim’s issue fully resolved? No, he still needs to use the tape until such a point where the sensory deficit has been improved. This is going to take time and dedication, and Jim may decide it’s easier just to use a small piece of tape on his knee each time he runs.

So No Strength Work Then?

It’s very common in cases of knee pain for you to be given a load of strength work to improve the activation and strength of the knee and surrounding areas. While this can work in some people at some times, I often find that this doesn’t address the source of the issue. Is strength the ultimate output we want? Yes, but how you go about achieving it is the key.

Jim, like you, already has an abundance of strength in his muscles without doing additional lifting. The goal wasn’t to add more strength. Jim simply wasn’t able to access the existing strength available to him. The goal then, was finding a way for Jim’s nervous system to effectively activate his current strength and help his brain in stabilising his ankle, knee and hips.

Through all of the mapping exercises we did, and then finally with the specialist taping, we were able to do just that. We did use resistance bands at times, but I used these to stimulate stability with light and moving resistance rather than direct lifting work.

As an added benefit, Jim had always had very tight hamstrings – so much so that he couldn’t forward bend towards his toes very far at all. In problem solving his knee and heel pain, we also hugely improved his hamstring flexibility and strength without ever directly working on his hamstrings. Things like that happen a lot when I work at the level of the nervous system.

Main Takeaway

If you’ve had knee pain (or ankle, hamstring, hip pain etc) for more than six to twelve weeks, maybe you need to be looking wider than just some calf raises, clams, squats and lunges. Perhaps your sensory system needs testing to see if there are reasons why your brain won’t allow you to access your current strength. My motto, learned directly from two of the experts I’ve been following for many years, The Gait Guys, is:

1. Develop the skill first.

2. Add endurance to that skill.

3. Finally, add more strength to that skill if it’s needed.

In Jim’s case, he had to develop a joint stability skill that was currently beyond what he had. We achieved this through mapping exercises, sensory therapy and taping. He is currently adding endurance to this skill through his running and other exercises, and a natural part of this process is accessing more of the strength you already have.

The post Why Does My Knee Hurt? Case Study 1 appeared first on RunTeach.

While over pronation and collapsing knees (known as knee valgus) is often down to a number of factors including gluteal and abdominal activation and strength, one area that runners often overlook is shin and foot strength.

The muscle down the front of the shin, called the tibialis anterior, plays a very important part in stabilising our ankles and feet. We have other posts (shin strength, shin splints, ankle testing) that go through some exercises to help strengthen this muscle, and here we add another one.

This is an eccentric exercise and means that we pay attention to resisting the relaxing movement of the muscle rather than the contraction. Make sure you have the volume on for the videos.

Direct strengthening of the feet can also help provide stability and reduce excessive pronation. If you already have flat feet, you’re naturally starting in a more pronated position. The towel grab exercise in the video below is great for general foot strengthening.

The post Stabilise your feet appeared first on RunTeach.

According to the available research and expert discussion, arriving at a “normal” range of motion is pretty tricky. Some labs use fancy geometry equipment such goniometers, but there is a simple test that has been proven to be very reliable – and according to some people, more reliable than the fancy equipment. This test also provides us with a easy benchmark for the range of motion we can work towards achieving.

What is the test? It’s a lunge against a wall and the video below shows how easy it is:

Ideally, we want to be able to be 10cm or more from the wall and still keep the heel of our front leg on the ground. However, many of us can only get to 5cm or fewer.

If you can’t get to 10cm or more, the solution is also very simple. You can use the test exercise as the exercise to increase your range of motion. There’s also a variation that you can do, as shown in the following video:

This range of motion is known as “dorsifletion” and is the movement where your toes get closer to your shins.

In addition to the exercises in the last video, you can increase dorsiflexion by:

• Releasing restrictions in the ankles, calf muscles and hamstrings
• Improving the strength of your shin muscles

To release restrictions, you can foam roll, self-massage or see a professional such as a physio or body worker. We’ll have a post up soon to help you increase the strength of your shin muscles, so stay tuned.

The post Ankle testing for runners appeared first on RunTeach.

So you would be forgiven for being confused when specialist running companies such as ours, charge anywhere from £60 to £120 for a gait analysis service. What gives?

Well, not all is how it appears. The simplest way to highlight the difference is to point out that the running shops are using a very basic gait analysis as a sales tool to encourage you to buy a pair of shoes from them.

That’s not to say that this basic service isn’t of value or that the staff in the running shops aren’t knowledgeable – many of them are experts in their field with a wealth of experience. However, they are doing it for one reason and one reason only. You need to decide why you want to get gait analysis:

1. To be recommended a pair of shoes that may work with how you run today but offers you nothing else.
2. To identify current injury causes, improve your running and reduce your future injury risk.

If it is number 1, then the basic gait analysis from a shoe shop may be good enough. But please don’t think it will highlight areas for you to work on to improve your running or reduce your risk of future injury. Even if you are told that you have an issue (such as overpronating), you are highly unlikely to be told why this is the case and what you can do to fix it. Rather, you will be recommended a pair of shoes that will compensate for this apparent overpronation. But two things to keep in mind:

1. Your shoes can’t fix how you run, but YOU can!
2. Research has shown that misprescribing motion control shoes can cause a higher rate of injury

In 2009, a review of the available research concluded that “the prescription of shoe type to distance runners is not evidence based” (Richards et al, 2009). So to a certain extent, prescribing a particular type of shoe is purely based on what the manufacturers have told the shoe shops and not what any clinical research may say.

In addition, the gait analysis from the shoe shop will generally only either look at your feet, or at best from the knees down. Gait analysis from a professional looks at your entire body – running is actually a very complex set of coordinated (or not!) movements that involves far more than just feet and knees!

This is all a bit like continually putting sticky tape over a sticky plaster to keep it stuck over a blister that you get from shoes being too small. Wouldn’t it be better to get a pair of shoes that didn’t give you blisters?

And that bring me to the gait analysis service a specialist in running, like us, offers…

Why would you want to spend up to £120 on this type of service? It’s a lot of money, so you’ll be wanting value for that. OK, here’s why:

• According to recent research, up to 80% of runners will suffer a running related injury in every 12 month period.
• The average amount of time these injuries last is 8 weeks.
• Almost all of these injuries are preventable.
• Many of us spend at least £40 per session with a sports physio to help with these injuries. Our fully comprehensive RunTest assessment is only £79.
• A lot of the work physios do in their session is pain relief and soft tissue work. While a very valuable part of the process and absolutely necessary, the onus is often on you to find out why the injury happened (or keeps happening). In many cases, you are just sticking a plaster on a recurring wound rather than solving the problem at source.

The real, tangible benefits to you are:

• You find out what is really going on.
• You save on physio costs because you can now get the issue(s) fixed at source.
• You have the choice to sort the issue(s) yourself with a deeper understanding, or work with the professionals to deal with the root cause and not just the symptoms.
• You miss fewer races and you’ll enjoy running them more. We all know that we have to book and pay for races so far in advance these days – do you really want injury to cost you your race fee as well as additional physio?

Summary

Gait analysis from a shoe shop is a sales tool for the purpose of choosing a pair of shoes, not improving your running or reducing your injury risk. Indeed, if you are prescribed an incorrect pair of shoes, you can actually increase your injury risk.

Gait analysis from a running professional such as RunTeach, is designed to help identify the cause of current injuries, reduce future injury risk and to improve your running performance.

If you would like to find out more about our gait analysis services, please click here.

If you would like to talk to us about how we can help you improve your running or with injury prevention, please contact us here.

The post What is Gait Analysis? appeared first on RunTeach.

I’m frustrated! It’s been going on for too long and I just want it to get better! I want to run properly again!

For the past 10 months, I have been nursing some kind of hamstring or glute injury. Most of the time it doesn’t stop me from running, but it does stop me from running fast. It hurts when I increase the pace and I’m completely fed up with it.

I’ve seen a few different professionals with more in-depth knowledge on these things than I thought I had. As it turned out though, I knew as much or more than all of them. But it was a valuable learning experience, and although it didn’t fix my injury, it did boost my self-confidence 🙂

One other huge benefit l got was the opportunity to access services that ruled out any structural injury. No torn ligaments, no severely damaged muscle, no destroyed nerves. Phew! At least I could look for a solution knowing it was nothing serious.

If my story is familiar to you, keep reading because I have re-learned something I already knew. Something so obvious that, as soon as I discovered it, I couldn’t believe it didn’t click earlier. So, why wasn’t my injury healing?

Simple – I wasn’t giving it a chance to!

Yes, I was resting. Yes, I really backed off from my running. Yes, I was foam rolling and getting deep tissue massages…

But, crucially, I did nothing to actively help my injury heal. What do I mean by that?

 The majority of running related injuries (RRIs) are actually some form of damage to our soft tissue. This is our connective tissue: the body-wide network of fascia. And there is only one reason why this happens:

At some point we have overloaded those tissues.

Whether through overuse or a traumatic event (like going over on an ankle), the tissue suffered damage because it couldn’t handle the load put on it. It really is as simple as that.

Now, when the tissue is damaged, it’s ability to handle load is reduced. Often, it is reduced dramatically. This is why your injury might be OK when walking, but as soon as you run, the pain is right back where it was.

Running places extreme loads on those tissues of up to 7.5 times your body weight with each step.

Depending on how you run, those forces will be loaded more or less on different parts of your body. And your body is amazing at adapting to that. But, when something goes wrong, it has to find a new way to handle those forces. Your body needs to rely on different muscles, different areas of soft and connective tissue to take the load.

But what if they can’t?

And here is the very core of The problem. This is why rest alone often doesn’t help as much as we think. This is why rehab exercise on the injured area won’t have the impact we are promised. This is why you have to remortgage your house to keep up with the physio bills!

There is something missing. Something that you’re not doing. But what is it? Can you guess..?

When the body calls on different muscles and fascia to take the load and they can’t step up and take it, your body has no choice other than to use what it has always used: the injured tissues.

You will most certainly use other muscles & fascia, but your body will fall back to what it knows because it simply has no choice.

 This is why your injury doesn’t heal.

So what’s the answer? Well, the answer is two-fold:

1. Strengthen the structures that should be stepping up to take the load.
2. Learn how to use those structures by moving better and in a way that gives the injured tissue a chance to recover.

If your injured structures are still stronger than the structures around it, your body will always use the injured structure leading to continual overuse.

But, by combining all the things you may have already have been doing:

1. Running less
2. Reducing the intensity
3. Foam rolling
4. Rehab on the injured area

with strengthening the other structures (muscles and fascia) and learning how to move better and use those structures, you will create the best chance you can for your injury to heal. It will still take time, but you’ll get back to running quicker and be a stronger, faster runner as a result.

This is what we specialise in at RunTeach. We have had remarkable success by following this simple system. 

The hard part is knowing what to do and when to do it.

But that’s what we’re here for 😉

So why didn’t I follow my own advice? Well, when do we ever? Isn’t it much easier to help others than ourselves? But I’m pleased to report that I have now been doing exactly that and I’m well on the way to full recovery. Watch out London Marathon!

The post Why isn’t my injury healing? appeared first on RunTeach.