If this is always true, why can we feel pain when we have not injured ourselves? 

For example, we feel neck or back pain after sitting for a prolonged periods or a trivial action like reaching for a towel causes severe back pain?
How is this possible if pain = damage? This is confusing.

What The Research Shows

The research tells a different story:

One study ( Brinjiki et al) showed a high rate of ‘pathology’ in lower back MRIs in over 3000 subjects without any pain or dysfunction – and this was in people ranging from 20 to 80 years old.

In the shoulder, many studies have painted a very similar picture. One study (Grisih et al) found that a remarkable 96% of subjects who reported no pain or issues had at least one identifiable ‘pathology’ on their ultrasound scan. 

So you can see that tissue damage does not lead to pain in many cases, and pain can arise without  evidence of tissue damage. This is precisely why we constantly remind our patients that ultrasound scans don’t tell the full story.

The general understanding of pain and injury needs to be updated so that people can overcome pain more easily and get back to living their (best) lives.

A New Understanding of Pain

The new understanding of pain is that it is an output signal created by the brain, as a warning sign. It can be out of proportion to the injury. This serves to change behaviour to prevent further damage, which is often required to fix the problem.

The issue is that most people don’t understand this, and remain stuck with a painful condition because they are fearful to move in case it causes more tissue damage. The problem with this is that people are thinking about local structures, not the whole body. There are compensations and protective mechanisms that can develop in other areas of the body that can contribute to your pain…. Where your pain is located is not necessarily where it comes from.

For example, someone can get knee pain because they had a recent back pain episode that affected the way they walked. The back pain improved, but the knee persisted because of secondary protective mechanisms that have not resolved.

A Whole Body Approach

This is why we look at the whole body and how it works together. We want be as thorough as we can and find all the contributors, both local and remote for your pain. This will enable you to get back to the things you love doing without the pain you have been suffering.

We use a 7 step process (the ridgway method) that will find the main drivers of your pain and fix them quickly. It is scientific, objective and based on the latest neuroscience research. 

If you’re not open to a new understanding of pain, you will remain stuck and restricted by your pain and fear of movement. Are you really willing to let your pain dictate your quality of life? 

Or are you looking for a new approach to regain your lifestyle, independence and get on top of your pain long term?

If you’re ready to take control of your life, book an initial consultation with us. We’d love to help you!

References

Brinjikji W et al; Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015 Apr;36(4):811-6. doi: 10.3174/ajnr.A4173. Epub 2014 Nov 27.

Girish G et al; Ultrasound of the shoulder: asymptomatic findings in men. AJR Am J Roentgenol. 2011 Oct;197(4):W713-9. doi: 10.2214/AJR.11.6971

Plantar Fasciitis Symptoms

Most people experience heel pain on the inside of the heel bone or extending into the arch of the foot. The pain is worse in the morning getting out of bed, then usually improves. It can recur during the day after periods of non-weight bearing again initially as you start to walk.
It can be worse after running or playing sport, especially after getting up from sitting afterwards.

Anatomy of The Plantar Fascia

The plantar fascia is a thick band of tissue that runs along the bottom of the foot, connecting the heel bone to the toes. It acts as a shock absorber and helps support the arch of the foot. It also shortens the foot during the propulsive stage of the gait cycle. Plantar fasciitis is essentially a biomechanical overload condition, and while there may be inflammation in the early stages of the condition, the pathology is one of degeneration of the fascia with or without micro tears. This can cause pain and discomfort in the heel or arch of the foot.

Is Plantar Fasciitis Causing Your Foot Pain?

Causes and Contributing Factors of Plantar Fasciitis

There are many factors that can contribute to the onset of plantar fasciitis, including:

1. Excessive loading: Overuse or increased loading of the foot is one of the most common causes of plantar fasciitis. This can happen with activities such as running, jumping, or standing for long periods.
2. Age: As we age, the plantar fascia can become weaker and less flexible, increasing the risk of injury.
3. Foot Mechanics: Abnormal foot mechanics, such as flat feet or high arches, can put extra stress on the plantar fascia. Reduced ankle joint dorsi flexion has also been shown to be associated with plantar fasciitis, as well as weakness in the intrinsic foot muscles which leads to less support of the arch of the foot and plantar fascia.
4. Obesity: Being overweight or obese (BMI > 27) can put extra pressure on the feet, leading to plantar fasciitis.
5. Improper Footwear: Wearing shoes with poor arch support or inadequate cushioning can also contribute to plantar fasciitis.

Plantar Fasciitis Treatments

There are many treatments available for plantar fasciitis. Some of these are considered Plantar Fasciitis treatment at home and can be quite effective.

Most of these treatments have been shown to have some impact on the pain:

1. Rest: Resting the foot and avoiding activities that aggravate the condition can help relieve symptoms in the short term. To achieve long-term gains short periods of rest,or modified loading, need to be interspersed with higher loading and strengthening exercises.
2. Ice: Applying ice to the affected area can help reduce inflammation and pain in the early stages
3. Stretching: Stretching exercises have been shown to improve outcomes in this group of patients but outcomes have been improved with the addition of strengthening exercises.
4. Footwear: Wearing shoes with good arch support and cushioning can help reduce stress on the plantar fascia.
5. Orthotics: Custom-made orthotics can be used to correct abnormal foot mechanics and provide additional support to the arch. Compared to sham orthotics, one study found an improvement in pain and function with custom-made and prefabricated orthotics.
6. Medications: Over-the-counter pain medications, such as ibuprofen or acetaminophen, can help relieve pain and reduce inflammation in the short term but do not address the causes of the condition.
7. Corticosteroid Injections: Corticosteroid injections may be used to reduce inflammation and pain in severe cases of plantar fasciitis, but there is limited evidence to support long-term results. Other risks associated with this procedure include rupture of the PF or fat pad atrophy.
8. Autologous blood injections (including Platelet-rich plasma injections) have been shown to have an 80% success rate at 3 months in one study.
9. Shockwave therapy: this procedure has gained more popularity recently and uses acoustic sound waves to penetrate the tissues and create more blood flow, and introduction of growth factors to stimulate healing. Several good-quality studies have shown that SWT can reduce pain and improve function in people with PF when compared to control groups.
   You can learn more about Shockwave Wave Therapy here.

Surgery is rarely necessary for plantar fasciitis and is only considered in severe cases that do not respond to other treatments.

Plantar Fasciitis Treatment At Home

Plantar Fasciitis Treatment- Our Physiotherapy Approach

Good physiotherapy management of PF will involve a careful and thorough assessment of all factors that may contribute to the onset of the condition, including biomechanical , social and any limiting beliefs the patient may have around pain. Once the key contributors are identified, treatment is aimed at addressing all of these, which can involve many of the options listed above, in a measured and coordinated manner.
At NWPG, we know that pain is a protective output from the brain, and where you feel your pain may not be where the main driver of the pain is. We look beyond the foot and leg to assess any dysfunctional muscle or joint in any region of the body that may also have an input to the pain.

Read here about a success story which involved remote contributors to a case of PF.

We also have a SWT unit and can administer this treatment if we determine that it is indicated for a particular person’s condition.

Plantar Fasciitis At Home Summary

Plantar fasciitis is a common condition that can cause pain and discomfort in the heel or arch of the foot. It is more common in middle-aged individuals and women. There are many causes of plantar fasciitis, including overuse, age, foot mechanics, obesity, and improper footwear. The best treatments involve through assessment of all the contributors, and a coordinated approach involving any of the treatments detailed above.

It can be a chronic condition, but responds to the right treatment, which is individual specific. Surgery is rarely necessary and is only considered in severe cases that do not respond to conservative management over a long period.
If you’ve had this condition and it has not responded to previous treatments or plantar fasciitis treatment at home, get in touch with us at the clinic and we’d be happy to discuss your case and how our approach can help you get back on your feet again!

Plantar Fasciitis References

Trojian T, Tucker AK. Plantar Fasciitis. Am Fam Physician. 2019;99(12): 744-750.

Landorf KB, Keenan AM, Herbert RD. Effectiveness of foot orthoses to treat plantar fasciitis: a randomized trial. Arch Intern Med. 2006;166(12):1305-1310.

Rathleff MS, Mølgaard CM, Fredberg U, et al. High-load strength training improves outcome in patients with plantar fasciitis: a randomized controlled trial with 12-month follow-up. Scand J Med Sci Sports. 2015;25(3):e292-e300

Vahdatpour B, Kianimehr L, Ahrar MH. Autologous platelet-rich plasma compared with whole blood for the treatment of chronic plantar fasciitis; a comparative clinical trial. Adv Biomed Res. 2016;5:84.

Lou J, Wang S, Liu S, Xing G. Effectiveness of extracorporeal shock wave therapy without local anesthesia in patients with recalcitrant plantar fasciitis: a meta-analysis of randomized controlled trials. Am J Phys Med Rehabil. 2017;96(8):529-534.

As we head into spring and summer, more people are getting out of their winter hibernations and returning to exercise. If you have fallen out of your exercise routines, or are starting new ones, this blog is for you!
Why is Volume, Frequency and Intensity so important? Because getting the mix wrong could cause a nasty injury, or at a mimimum cause you to burn out or experience fatigue… your more likely to stop exercising again and lose your momentum and consistency, which are so important for making gains.

You also want to be able to enjoy your training, whatever it may be, and feel like you’re moving towards your goals…. improve your performance. The VFI mix is quite important for this.

VFI is essentially about load management…. gradually building up the exercise and resistance loads that your body experiences, and allowing it to adapt, gain fitness, strength and conditioning over time without having the setbacks of injury, pain or fatigue.

So let’s break these fundamentals down and look at what may be the optimal mix for best performance and injury prevention. We’ll focus our discussions on running, but some of these principles may be transferable to other sports, or even just returning to the gym.

The ideal mix will be dependant on certain variables:

1. Your training goals, ie are you training for a specific distance event, or just beginning running or an exercise program, or building a base of fitness for future events.
2. How conditioned you are as a runner or individual, ie beginner, intermediate or advanced.
3. The time available to you for training.
4. Your level of motivation!

Volume

This refers to the total amount of kilometers/miles you run, generally expressed on a weekly basis, but can also be averaged over a month. It can also signify volume of activity, such as total hours spent in personal training, Pilates or gym. It can also measure amount of weight lifted over a set period, eg a week. With a running example, as a beginner, your running volume may be 15-20km/week, as an intermediate it may be 30-40km/week and if you are more advanced it may be 50-60km/week or more.

As a general rule, most people believe that you would benefit from not increasing your weekly volume by more than 10%/week to reduce injury risk. However there is little evidence to support this. In the running literature, increases in volume by> 30% are associated with higher injury risks, but less than 30% there was no increased risk. However the 10% rule is a nice conservative measure.
For gym goers, this rule can apply to resistance increases for each exercise. If you do three sets of an exercise, you can choose to conservatively only increase your maximum set by 10% (if you pyramid your sets), or increase each set by 10%, which is more aggressive.
If you are only increasing your long run distance, it is also prudent to use this rule. It is much safer to increase your running or training hours slowly over time, and leveling out every 4 weeks to allow your body to adjust to increasing demand. Use your body as guide to further increases, ie be aware of niggles that don’t settle as a sign that your body is reaching its adjustment limits.

Frequency

Frequency relates to how often you train or run, and is usually expressed per week. Your particular frequency will relate to the variables mentioned at the start of this article. If you would like to maintain your running at a particular level, it is generally accepted that running 2-3x/week would enable you to do this. To improve your running, frequency of 3-5x/weekly is optimal, but it is best to only increase you frequency by one extra run a week, and this is best maintained for about 6 weeks before increasing frequency again. This allows your body time to adjust to increasing training load.
If you’re starting back at gym, a good starting point would be 2 x weekly for 2-3 weeks before adding an extra day. This is a good rule for PT classes or Pilates, or sports like swimming or cycle classes.

Intensity

This is all about how hard a training session is, and can be measured in several ways. From a running perspective, there are 2 main ways it can be calculated.

1. Rating of Perceived Exertion (Borg Scale)

This a universally accepted scale of how intense a person may be exercising. It is completely subjective, and based on a person’s perception of their own effort, using indicators such as fatigue, breathing rate, perspiration and how long they think they can sustain an effort. It has been tested to correlate closely with actual heart rate.

The scale is as follows:

6 No exertion at all
7 Extremely light
8
9 Very light – (easy walking slowly at a comfortable pace)
10
11 Light
12
13 Somewhat hard (It is quite an effort; you feel tired but can continue)
14
15 Hard (heavy)
16
17 Very hard (very strenuous, and you are very fatigued)
18
19 Extremely hard (You can not continue for long at this pace)
20 Maximal exertion

On this scale, an easy long run would be around 11-12, a tempo run(maintaining a steady moderate pace) would be 13-14, and an interval/speed session would be 15-19. This would also depend on the length of the session, with shorter sessions being able to be done at a higher intensity. A beginner-intermediate runner would not perform more than 1 of these per week. If you are relying on this method of rating, you need to be quite in tune with your body.

2. Heart Rate

This is a more reliable and accurate way of measuring intensity and is based on the following formula:

HRmax= 220 – age

Thus, if you are 40, your HRmax is approx 180. Then, with the aid of a HR monitor, such as a GPS watch, you can observe how hard you are training. It is generally considered that if you are exercising at 70-85% of HRmax you are in the aerobic zone(11-14 RPE scale) where most of your training would be. Over 85%, you are likely to be in the anaerobic zone, where you produce lactic acid as a byproduct of energy production. This intensity cannot be sustained for that long and is best reserved for interval sessions of shorter duration.

For classes and gym work, you can still use the HR rule to calculate intensity, but if your just lifting weights you may be better to use volume of weight lifted or sessions/week as a guide.
If you’re just starting out, one high intensity session/week may be enough. Increase this slowly depending on your goals.

Some General Principles

1. Don’t increase more than one variable at a time. that is, if your adding to your frequency of training, don’t increase your intensity or session volume at the same time.
2. Make sure you do a good cool down and warm up for each session, which can include some active warm up and some easy running/cycling or brisk walk as a cool down.
3. Your warm up and cool down should be for at least 5-10min, and longer for more intense or longer duration training sessions.
4. Recovery between sessions is important. There is a lot that can be written here, but in general, recovery is where you allow your body to recoup and restore its balance. It can consist of stretching, foam rolling, massage, yoga, easy running, a brisk walk, or just resting. Do this at least once weekly, and increase when your training variables increase.
5. Good sleep is also important, and hours banked before midnight have been generally believed to improve general health and reduce chronic disease risk.
6. If you’re training frequently, you will need a good amount of carbohydrates in your diet, as well as protein to develop muscle and help tissue repair.
   
   Happy training!
   

A few years ago I started to notice some mild tingling in my feet, which would come and go, but was more apparent after a long run or a hard training session around Princess Park( I was in a running group back then, and our coach liked to push us!).

As a Physio, I sort of knew what this may be, but it wasn’t affecting me much so I just kept doing what I was doing.

Then in 2019 we renovated our house. Most people who’ve been through this know how stressful it can be, and although we had a great builder, I was quite involved in the whole process. There was a lot of physical work to do, like moving and getting rid of furniture, putting together flat packed furniture( I will outsource this next time!) painting and landscaping, as well as the stress of moving out temporarily and managing the budget. I was still running a lot at this time, because I felt it helped me relax and I enjoyed it.

But soon I started to develop back pain, which would often radiate down the back of my legs on both sides. I remember coming home from work back then, and feeling much worse than the clients I was treating! I also remember umpiring at my son’s tennis games and having real difficulty standing for a set of tennis…my back and legs would be aching, and often my feet would be tingling.

The pain was also affecting my running, in fact I had to stop completely and go to walking on several occasions due to acute episodes. I remember one weekend after a flare up, I couldn’t walk more than 2 km, whereas 1 week earlier I had run 18km! ( 18km is not that far when you’ve done 6 marathons!). I was often tired and cranky at the end of the day, and it was even affecting my relationship with my wife and kids… mainly because I was tired and in pain… and a pain to live with!
 

I had an xray in 2019 and later in 2020 an MRI of my lumbar spine. The results of the latter are below. It looks pretty bad doesn’t it? Essentially I had a forward slip of the L4 vertebral segment on the L5, severe facet joint degeneration at that level, and stenosis(narrowing) of the spinal canal due to disc bulging and swollen facet joints. This really did explain most of my symptoms, especially the tingling in feet and legs, which was nerve irritation.

My doctor had referred me to a spinal surgeon, and cortisone injections were on the cards.

So what did I do:

1. I didn’t panic or catastrophise! With my knowledge of pain and the body, I knew there are a lot of contributors to pain signals being created by the brain, and stress/anxiety is a big factor!
2. I made more time for meditation and managing my mental health, and was more conscious of overdoing and overthinking! This calmed my central nervous system( completing the renovation and settling into a beautiful house also helped!).
3. My colleagues assessed my posture at work and found that I was over straightening my thoracic spine(mid back) when  was leaning over to treat. My back was too straight because I thought this was the right thing, but it was placing more load on my spine, contributing to my pain. Making some postural changes here, working on motor control (thoracic flexion movements) and having my thoracic spine treated regularly made a big difference.
4. I reduced my running volume, slowed down my pace, focussed on more recovery between sessions and worked on my core, back and gluteal strength.( I also started drinking Mangosteen juice daily, known for its anti- oxidant and anti inflammatory properties).
5. I had regular tune ups with the team and regular massage, which prevented strain in my body accumulating, and allowed me to slowly build more strength and capacity for load.
 

It did take some time for things to settle and to build load capacity again, but if you give your body the right conditions(including your positive thoughts and beliefs), and have the right guidance…you can overcome many physical conditions. This also shows that you cannot make decisions about your health based only on scan results, because often they do not correlate to symptoms. There is now lots of evidence to support this. If I had another MRI now the results would not be much different… the same degenerative changes would be there… but I’m essentially pain-free, enjoying my running again…. and my wife and kids are happier!:))
 

If you have recently had a spinal or joint scan and are a little concerned about it, feel free to contact us at the clinic and we’ll be happy to discuss it with you.

Just pause and take a breath.

What was it like? In through your nose or mouth, relaxed or tense, from the diaphragm or chest?

Our mouths are designed for eating and talking, breathing is a primary responsibility of the nose.  You can use your mouth as a backup when you are exercising hard or if our nasal passages are congested but efficient effective breathing is in and out through the nose.

I started researching breathing because I was instructed by my wife to stop snoring. I realised I was mouth breathing and began a breath training program which has greatly improved my capacity to nose breath at night. My wife is a lot happier now.  

Why is it so important to nose breathe?

There are very convincing reasons why nose breathing is essential for our health.

When we breathe through our nose we release a gas called nitrous oxide from our paranasal sinuses. This does a number of things:

1. It sterilizes the air we breathe in and assists airway opening to allow  more air to get to our lungs.
2. It also enhances our performance in sport and bringing up blood from the lower lobes of the lungs to get better oxygenation to the blood and to our tissues.
3. Nose breathing can improve the transport of oxygen from the lungs to the blood by 5 to 15%.

One of the most critical aspects of nose breathing is that it controls the amount of carbon dioxide(CO2) we breathe out (different to nitrous oxide). This is a bi product of our normal metabolism. Carbon dioxide acts as a doorway between the blood and the tissues. If we over breathe through our mouth or breathe too fast, that doorway stays shut and prevents us from getting oxygen from the blood to the tissues. However if we breathe in a calm controlled manner that doorway remains open and oxygen flows more freely into the tissues.

The background to nose breathing.

A Russian physician, Dr Vladamir Buteyko researched breathing through his professional life. He found that one of the reasons that asthmatics have problems with breathing is that they tend to over breathe.  A central part of his approach is to teach a relaxed breath pattern that doesn’t blow out (exhaling) too much carbon dioxide. 

Interestingly further studies have shown chronic over breathing correlates with chronic disease states, such as heart disease, asthma and diabetes. Good health is linked to a relaxed breathing pattern.

How to start breathing better

Your breath is a truly amazing thing and integral to life. Take advantage of the power of your breath. All you have to do to begin, is gently inhale through your nose and exhale slowly through your nose, taking mindful small, barely perceptible breaths in and out. This has a very powerful effect on your state by activating our calming parasympathetic nervous system as opposed to being tense and anxious and over stimulating the opposite system -the sympathetic.  How have you felt when you have been angry or tense? Tight and tending to breathe quickly and over breathe?

So by switching to a relaxed nasal breath pattern you can reduce those responses and help your body adapt to stress.

Added benefits

1.    Nose breathing moisturises the incoming air, which improves transference of oxygen in the lungs.
2.    It triggers the release of antibacterial molecules to improve function of the immune system.
3.    Nose breathing brings air to the paranasal sinuses that assist the pituitary gland to regulate body temperature.
4.    It helps regulate sleeping patterns.

Nose breathing is an essential part of life and adds quality and calmness to your life.

Try it, it is a very small  change to your routine for potentially significant benefits to your general health and well -being.

References

1. Powerspeedendurance.com/nose-knows.
2. Breathingretrainingcentre.com/nose breathing.
3. Normalbreathing.com/breathing slower and less.
4. Powerspeedendurance.com/the training effects of nasal breathing.
5. XPTlife.com/breathing articles.

Heel pain or plantar fascitis, can be a real nuisance, stopping you from putting your best foot forward! In our experience, the 2 biggest myths around this condition are:

1. That where you feel your pain is where the problem is.
2. That the degree of damage on your scan results will determine your ability to recover.

Through a thorough assessment, we often find other areas in the body that contribute to heel pain.

Research shows that scan results are not consistent with your functional restrictions and are not an accurate predictor of recovery.

This case study is a good example of this.

History

Miss C is a 30 year old nurse who presented to our rooms on 28/3/18 with a 5 month history of right heel pain and plantar pain. This had began while overseas and walking a lot in high heel shoes. It had slowly worsened and the plantar foot pain had started in January 2018.

Miss C was a keen runner and this pain had stopped her from running. As the pain worsened, she found walking difficult and would often limp after an exercise class or walking a lot. She had seen a podiatrist, had 3 bouts of shockwave therapy, dry needling and had seen a specialist who had ordered a cortisone injection.

All this had not helped and Miss C was becoming increasingly frustrated and down about not being able to walk properly let alone run.

Scan Results

An MRI of the foot had confirmed plantar fascitis with a small split tear in the plantar fascia, as well as significant degeneration (osteoarthritis) of the sub talar joint (heel joint).

Assessment findings

We used whole body systematic problem solving approach to treat Miss C and get her back to running as soon as was possible.
On examination we found a poor gait pattern with a significant limp and reluctance to take weight through the heel. She was unable to perform a heel raise, and knee to wall lunge was 4cm on right and 6cm on left.  The the sub talar joint was “locked”, ie it was not able to be moved side to side. This movement is referred to as a passive accessory glide of the joint, and all healthy joints in the body should have a certain amount of “passive glide” when tested. The cuboid joint in the foot was also very stiff, as well as the deep calf muscle(tibialis posterior).

Remote assessment revealed Miss C held a lot of tension in her neck and shoulders, especially the left shoulder, which had reduced internal rotation (hand behind back). There were also stiff joints in the thoracic and lumbar spines.

Treatment

Through a process of trial treatments and elimination, we found that release of the left shoulder (subscapularis muscle) was making significant changes to the assessment signs around Miss C’s right foot. Treatment here improved the knee to wall lunge range and heel raise, as well as the mobility of foot joints, when retested immediately after release of the muscle.

Local release was also performed, and as Miss C’s pain and movement signs improved we gradually increased her walking and load bearing exercises. Within 4 sessions, Miss C’s knee to wall lunge had improved to 12cm and she could heel raise without pain x10 on the right leg.

At this point, Miss C started to increase the load on the foot by alternating walking with short periods of running. We progressed the running intervals and reduced the walking intervals over a few weeks until she was running continuously for 30min. We then added faster pace interval sessions to her training.

Miss C emailed us after approximately 2 months telling us that she had just completed a 10km charity race, coming 6th in the field of women! Her foot had held up well, and she was not sore afterwards! As you could imagine, we were absolutely amazed and impressed with her recovery.

We posted her result on our Facebook page.

How do we explain this?

To understand this we need to think about pain in a different way. Modern neuroscience research tells us that pain is an output signal created by the brain to warn the individual and protect them from further damage.

Pain is not in the “tissues” of the body. These tissues have receptors in them that pick up excessive strain or inflammation, but it is the brain that decides whether this is important enough to warn the individual. If the brain is receiving lots of nerve impulses from other tissues in the body, which may be remote from the site of pain, these add to overall level of “danger” signals the brain is receiving. If the sum of these signals exceeds what the brain determines as a safe threshold, then it will create the warning of pain. The brain then allocates an area for the pain based on what is most likely to change the behaviour of the individual, so that they will either take a rest or seek treatment that will restore the body’s balance.

This is why working on other primary areas of the body that are under strain can lower the overall level of  input signals to the brain, and hence reduce the output signal of pain and the associated protective responses in the body.

More information is available at Why do Whole Body Assessment.

Intrinsic Factors

These are factors that relate to the individual runner, and for the most part are within the runner’s control. If you are able to get all of these factors right, you have an excellent chance of running injury free and even achieving some personal bests!  These include:

• Running technique / posture
• History of Previous Injury
• Musculoskeletal dysfunction / Imbalance
• Number of years running

We will now look at each of these factors in depth and what key elements you need to consider to give you the best chance of remaining injury free. 

Running Technique / Posture

Correct running technique and posture play an integral role in helping to maximise efficiency with forward propulsion and to prevent overload and strain on the body with running. We have outlined in detail all of the optimal technique and postural elements associated with running gait, which can be found in our biomechanics of running report.  Essentailly, these elements include:

1. Head straight and shoulders relaxed
2. Elbows bent between 60-90 degrees, kept compact by your side, with arms straight forward and back (not across body)
3. Pelvis tilted forward slightly, helping to facilitate a forward lean from the ankles.
4. Foot strike occurring between rear and midfoot, with the ankle sitting directly below the knee when you land
5. Approximately 25 degrees of knee flexion in stance phase for ideal balance between spring and stiffness/stability in leg.
   

Running is an activity that places load through a lot of joints and muscles in our body.  Adopting postures that are less than ideal is going to increase the strain placed on these structures, in turn increasing our risk of injury. There are many common postural and biomechanical issues that we see with running gait, and these along with their specific implications have been outlined in the biomechanics of running report.

Tip: It is often difficult to know yourself if you are adopting each of these optimal postures when running. Get someone to video your running and look to see if you are incorporating the general principles above. If not, try to add in one element at a time.  Be patient as it will take time for any change in technique to feel natural. If you are still unsure, further analysis with our detailed running assessment can provide valuable insight into any biomechanical issues and how best to address these. 

History of Previous Injury

While this may appear obvious to some, it is worthwhile to clarify the key reasons for this. If you have suffered an injury in the past, particularly to a lower limb muscle, joint, ligament or tendon, this can increase your risk of developing a running injury, as outlined in the research.

This is especially relevant if you have not had the injury treated or undertaken the appropriate rehabilitation. There may be residual muscle weakness, tension or shortening, joint stiffness, neural tension, proprioceptive loss (loss of joint position sense), scarring or motor control deficits.  These will often only come into play when the body is placed under increased load with running. Most of these dysfunctions may not be detected by the individual, as they are often not causing any symptoms, until increased load is placed through them (such as running). They will affect the way the body moves, which can include running posture and technique and also affect recovery from running.

Upper body injuries can also affect running, as the arms and shoulders move, and the torso rotates as you run. It is not uncommon to see hip pain that is being triggered by shoulder dysfunctions, and foot pain that can be linked to dysfunctions in the thoracic spine. This is because the body is largely interconnected, and one region will affect another at some level. This concept is called Regional Interdependence, and there is a growing body of research to support it.

Tip: Make sure you get all injuries checked out by a qualified health professional, and follow through with your rehabilitation as prescribed by the practitioner. If you are just starting out, or wanting to increase your volume or intensity, it may be worthwhile having a thorough musculoskeletal assessment by a trained health professional.  This will help to detect any imbalances/dysfunctions before they become a problem…as we know, prevention is better  cure!

Musculoskeletal Dysfunction / Imbalance

While a history of previous injury can place you at increased risk of muscle imbalances and dysfunction, it is important to remember that you do not need to have had a past injury to have a musculoskeletal dysfunction.

All of us have some dysfunctions throughout our body, in varying degrees. These commonly include muscle tension/knots/guarding, joint stiffness, neural tension, reduced muscle flexibility and/or strength and decreased muscle control/activation. They usually result from prolonged postures, repetitive movements, poor postural habits and altered movement patterns.  It is a particualrly likely if there are a combination of these factors present. 

Common daily activities such as prolonged sitting or driving, bending, lifting and reaching all place some strain on the body and can lead to dysfunctions developing.  This is particularly likely if these activities are done with poor movement patterns and less than optimal postures.  This places increased strain on the body and muscle, joint and nerve dysfunctions are much more likely to develop.

These dysfunctions can build up over time and will affect how well your body moves and recovers from exercise. For example, a shoulder dysfunction will affect the rotation of the torso and shoulder movement during running, impeding free rotation, which can cause compensatory changes in the way the opposite hip and leg move. A problem may manifest as pain in the hip or knee, but the real source is the shoulder, and local treatment at the site of pain is unlikely to fix the problem.

In our clinical experience, these dysfunctions are the primary cause of most non-traumatic running injuries (those conditions that have developed slowly over time). Increases in volume, intensity or other extrinsic factors can trigger these issues, but these exist well before hand, lying dormant until the strain threshold in the body is exceeded.

Tip: see tip above!

Number of Years Running

Generally, the more experienced you are as a runner, the less likely are you to get injured. There are 2 main reasons for this:

1. Adaptation by the body to the forces experienced in running. The human body has an amazing ability to adapt to the conditions and loads placed on it, as long as it has time to adapt. Muscles and tendons become stronger with increased years of running, and joints also adapt to loads placed on them. Over time, the central nervous system (brain) also finds more efficient muscle recruitment pathways to perform the same task, thereby increasing the overall efficiency of the activity. This applies to any sport or motor skill, with running no exception. Eventually, less muscle effort and energy is required to perform the same task.

2. Increased body awareness. The more experience you have as a runner, the better able you are to read your body and watch for signs that it needs a rest. You become more attuned to those little niggles, and you have either learned ways to manage them, or are aware when your body needs a rest to recover. You are probably also more aware of the benefits of strengthening exercises to prevent injuries, good diet and stretching to aid in recovery, and have developed a stable routine for running.

Hopefully this has added further insight into the factors you need to consider to help stay injury free while you run and how best to address these. If you want any further help, please book a session with one of our physiotherapists who will be able to provide advice and recommendations specific to your circumstances. 

Happy running!

References

1. Yeung EW, Yeung SS (2001). A systematic review of interventions to prevent lower limb soft tissue running injuries. British J Sports Med (35):383-389.
2. Niemuth PE, Johnson RJ, Myers MJ, Thieman TJ (2005). Hip Muscle Weakness and Overuse Injuries in recreational Runners. Clinical J Sports Med(15) 1:14-21

It’s not surprising that injuries do occur, and recent research reports that up to 75% of runners experience an injury every year.   So what’s the best way to prevent these injuries? This is a question that has been researched and debated for decades, even before recreational running became popular in the 1970s. To give yourself the best chance of preventing injuries, you first need to understand the factors that contribute to injuries. We can broadly group these into 2 factors:

1. Extrinsic factors- these are generally external to the individual or more environmental.

2. Intrinsic factors- relating to the individual.

We will discuss each of the extrinsic factors here, with the next report outlining all of the intrinsic factors that contribute to injury.

1. Extrinsic Factors

a. Weekly volume
Consistent loading is essential to help the body become conditioned to the physical and functional demands of running and therefore prevent injury over the long term. While regular loading is required, this needs to be carefully balanced with ensuring you don’t overload your body with too many weekly kilometers.  Running causes an accumulated strain on the body, and those stressors need to be managed.  One of the main reasons for runners sustaining an injury is due to increasing their running volume and/or intensity too soon. Volume increases should be incorporated gradually over time, especially if you are starting out. Recovery days, where you rest or cross-train (cycle, swim, strength train) are vital in allowing your body to adapt to changes in volume. Good quality sleep and diet are also imperative to allow your body to recover and adapt.

Tip: Do not increase your volume by more than 10% per week, which is a rule you can also apply to your weekly long runs if you are training for a half or full marathon. If you are starting out, do not run on consecutive days. Good recovery days are essential in preventing injuries. 

b. Training Characteristics
These include duration, frequency, intensity and the surface you run on. This will depend on what you are training for and how experienced you are as a runner. In general, sudden changes in duration, frequency or intensity will all increase the risk of injury. Interval/threshold training sessions should not exceed 45min excluding warm up/cool down, and these should not exceed twice per week. Again, it’s important to have adequate recovery between your harder sessions, and do not perform hard sessions on consecutive days. 

It is also important to mix up your running surfaces. Remember, the concrete of a cycling track is harder on your body than the bitumen/tar of a sealed road. This again is harder than a gravel track, which is firmer than grass. While there is evidence that your leg muscles will either stiffen or relax to attenuate forces transmitted from the terrain, it is a good idea to run at least half your miles on softer surfaces.
Tip: The total volume of your harder sessions (threshold, interval and repetition) should not exceed about 25-30% of your total weekly volume. Mix up your running surfaces as much as you can, running at least half of your miles on softer surfaces.

c. Footwear
The shoes you wear are very important in your ability to stave off injury. This may seem obvious, but it’s vital you run in shoes designed for running, as opposed to cross trainers or more casual sneakers, as they have more support and cushioning for transmitting ground reaction forces. It is also good to rotate your running shoes regularly – ie. have at least 2 pairs which you can alternate on different days. Make sure you replace your shoes as they are required, and the volume you get for each pair will vary with brands and the type of running shoe. It is usually somewhere between 600-1000km’s.  This will be less for lightweight / racing shoes. Another guide for determining when it is time to replace your runners is by the way your legs feel after a run…. undue muscle or joint soreness may mean the absorption characteristics are wearing thin.

It is also important to ensure the motion control profile of the shoe is appropriate for your foot. Some retailers offer video or force plate analysis, but our opinion is that such technical analysis is best left to health professionals, such as Podiatrists or Physiotherapists. About 80% of the population are over-pronators, and up to 5% are supinators, so only 15% of runners have a neutral foot. Having the incorrect motion control in the shoe for your foot will increase your injury risk.

Tip: Have at least 2 pairs of running shoes to rotate. Do not run in shoes past their use by date, and have your foot biomechanics tested by a health professional before choosing the right shoe.

We hope you have found this information useful.  Using these guidelines relating to the extrinsic risk factors for running will go a long way in reducing your risk of injury.

If you need further clarification or guidance with any of these factors, simply schedule in a time with one of our physiotherapists who will be able to assist you accordingly.