Conversation with an NHS podiatrist

I had this conversation with NHS podiatrist Robyna King, answering your most asked foot questions! This blog post is in support of the We are the NHS campaign. If you enjoy it, please do share on Instagram! If you have any further questions, please visit NHS Live Well.

Robyna King graduated from the University of Plymouth in 2012 with a first class honours degree in Podiatry and currently works in the Solent NHS Trust. Since qualifying as a Podiatrist, Robyna has experience of working in a variety of NHS Podiatry roles, with both clinical and management responsibilities. She particularly enjoys the opportunity to make a real difference for people; either providing direct patient care, supporting staff or service development. Robyna is looking forward to supporting staff through a Podiatry Apprenticeship Degree later this year and is excited by the personal development this will also provide.

  1. Any advice for preventing blisters? What should you do once you have them?

Blisters for runners are very common as well as for many people when they start wearing a new pair of shoes for example.

There can be some ways to prevent blisters when running and exercising such as:

  • Wearing 2 pairs of socks or there are some double layer socks you can purchase. These can help reduce the friction on areas of the foot prone to blistering for example under the ball of the foot, heels, and toes by putting the stresses on the sock rather than the skin.
  • Using Surgical Spirit, applying to vulnerable skin with a cotton pad 2-3 times a week, which helps strengthen skin. This can also be used between the toes to prevent them become sore and too soggy when they get hot and sweaty in your trainers. Follow the guidance on the bottle and do not use on broken skin.
  • Ensuring your trainer and shoes fit you correctly. We advise footwear with a fastening such as laces to ensure they are tied and tightened to support the foot and prevent the foot from moving in the shoe causing friction of the tendons and joints from having to overwork to keep your shoe in place. Having the footwear wide enough at the toes and ball of the foot is very important so that they don’t get too much pressure in the wrong places. If you are struggling with getting footwear to fit it can be worth finding shoe or sport shops that help fit shoes.

When treating blisters, you should try to avoid bursting or popping them, instead allow the blister fluid to be reabsorbed into the skin and heal naturally.

If, however, they have already burst and the skin is open, it is very important to clean the area carefully and apply a sterile plaster or dressing while the area heals. This will not only prevent further friction on the skin but also reduce the risk of an infection by keeping it clean and dry.  If you have a large intact (not burst) or open blister, then it is worth having a rest from running or exercising where you are weightbearing (on your feet) to give the skin chance to heal.

If the skin or blister area becomes red, hot, swollen, has increased discharge or smell then it may be a sign you have an infection. If you notice these signs or the blister is taking a long time to heal, it is important you contact your GP surgery for guidance and likely will need some antibiotics. 

2. If you have a collapsed or weak arches, how do you strengthen them?

It is important to know that many people naturally have lower arches or flat feet. Most people inherit this from their family and are born with this foot shape, some with no pain and do not need treatment such as insoles. 

However, if they become painful or your feet have started to become flatter over a period of time then it is worth contacting a podiatrist for an assessment to see what individual treatment you may need and what may be causing the pain. 

If you have painful arches it is best to avoid any strenuous exercises such as running as is high impact on your feet and joint and could make it worse or more painful.

Some people find intrinsic foot muscle strengthening can help to strengthen the muscles in the feet to support the arches. There are many strengthening exercises available including videos online including ‘the big toe stretch’. If you decide to try these start them gradually and only do a small amount at a time. Its best to try get do them regularly and get the into your routine but remember if you start getting any increased pain or side effects stop. 

3. Many runners lose toenails in training or races – is this harmful? How can you stop it?

It is very common for runners to lose toenails, which to the person can cause some worry and pain. Losing the toenail itself does not always cause any harm, however if the skin on the nail bed is broken which would need a sterile dressing or plaster applied and follow similar advice to above when discussing looking after blisters that burst (Q1).

Over time if you damage a nail through regular trauma, where the nail is repeatedly knocked or the nail falls off, it can damage the nail cells (where the nail grows from) meaning the nail will grow back thicker or a different shape. This can make the individual feel the nail is unsightly or can be painful. If the nail is thicker you can help by filing over the surface of the nail to carefully thin the nail slightly as they can be difficult to cut.

If this does not manage it, I would advise they contact a podiatrist for advice on treatment whether that be how to prevent the trauma to the nail, cutting/filing the nail in a way to manage it or have the nail removed permanently to prevent it growing back.

Ways to prevent it include ensuring your running trainers fit correctly, avoiding running downhill or on rough terrain as this often puts increased pressure on the nails and cutting your toenail carefully straight across so they are not too long and pressing on ends of the trainer.

4. Should we all be moving towards zero-drop/barefoot shoes? What are the benefits, if any?

For some people this can be the right option but for many it is not. There is little research to say moving toward zero/low drop or barefoot shoes can help with performance or for any other practical reasons. Therefore, unless you have been advised to for other reasons and you are used to running in this way then I would not advise to just start this without getting further individual guidance.

5. How can runners deal with bunions? Are they always problematic?

Similar to low arches and flat feet, one reason we can get bunions is because we inherit them as part of our foot shape. They are not always problematic even if they are quite prominent or not aesthetically pleasing. 

Depending on the cause of the bunion it can change how a podiatrist would advise you manage them. Pain from a bunion could be from the joints or tendons being inflamed, or it could just be that because skin on top of the bunion gets rubbed and sore and could cause blisters.

Some find bunion supports or protectors to help with the bunion and skin getting sore.

Others may find insoles/orthotics can help to reduce pressure and workload on the bunion area and encourage the rest of the foot to do more. The main thing to help to reduce pain or you getting a problem is to follow guidance on footwear, including wider fitting shoes with a fastening and a stretchy material upper of the shoes that sits around the bunion to avoid pressure.

If you would like further advice on individual management of your bunions or joints in the feet then contact a podiatrist for an assessment to see what other options may be available including insoles and surgery options.

6. How did you get into podiatry?

I always wanted to do something in the health field to help make people better. I was lucky enough to do some work experience when I was 16 in a private Podiatry clinic and an NHS physiotherapy department.

I loved both but my choice was Podiatry as I felt it was a bit unusual and that there were so many opportunities for different roles in the future in the  NHS. I completed my A levels at sixth form including Biology and Psychology and then applied to university to complete a Podiatry BSc(Hons) Degree. It is a 3-year course and included both theory and practical skills which I really enjoyed, as I went on placements to different NHS Podiatry Services to learn on the job experience with NHS Podiatrists. When I qualified as a Podiatrist, I then applied using the NHS Jobs website to find roles in my local area and a couple of years later ended up in the Solent NHS Trust which is where I am now. I have loved being able to develop my skills and continue to learn things every day, which most importantly helps patients and support them with their foot conditions making a real difference for them!

As a podiatrist I have great opportunities to use all different skills including wound care, nail surgery and MSK (musculoskeletal) care. We can work in patient’s homes, hospital and health centres, meeting a variety of people along the way. 

So, I would say if you are interested in health care and do not mind looking at feet all day this is the job for you! If anyone is interested in podiatry as a career or any health profession look on https://www.healthcareers.nhs.uk/ which shows all the amazing careers out there and what to do to have a health career including going to university or even apprenticeship courses which are available for some professions.

7. Should runners be doing anything specific to look after their feet? Creams? Massage?

You will see a lot of this has already been answered in some of the other questions for example how to prevent blisters, prevent painful arches and bunions. 

Here are my top tips to look after your feet if you are a runner:

  • Wear good fitting trainers that are wide enough, have a fastening and good cushioning sole for shock absorption. 
  • Air out your trainers and footwear after wearing them and rotate the use of your shoes (so you are not always wearing the same pair) to ensure they have chance to breath and dry, which prevents bacteria and fungal spores growing.
  • Don’t save your new trainers to wear for a race or long training session. It can be best to wear them in gradually over a few shorter sessions preventing blisters and allowing your foot to get use to that style/shape of footwear.
  • Wear good quality socks to protect your skin and prevent friction.
  • Wash your feet and change your socks daily and after exercising, this can prevent fungal infections on the skin or nails and will keep the skin condition healthy and clean. 
  • If you think you have a fungal infection also known as ‘athletes foot’ speak to your pharmacist about treatments available over the counter. If not improving, then consider discussing with a podiatrist or your GP.
  • Dry feet well all over and between toes after washing them. This again prevents fungal infections and the spaces between your toes from getting too soggy and sore. Using surgical spirit as advised in question 1 can help too.
  • Using a urea base foot cream can help hydrate the skin on the feet, preventing hard skin and calluses. It is best to use daily all over your feet but not between toes after you have washed them. 

8. Plantar Fasciitis. What is it and how can it be helped? Are there any injuries assumed to be PF that are actually something else?

Plantar Fasciitis (PF) is a painful condition where there is inflammation of the plantar fascia, which is a structure that supports the foot from the heel to the toes. It can affect both feet or just one foot and the pain is normally felt around the heel and can sometimes be felt into the arch or into the calf. It is a very common condition and can affect both those that do and do not exercise regularly.

Check out the NHS website for further guidance but here are some simple ways that can help if you believe you have or have been diagnosed with PF.

  • As tight calf muscles can exacerbate and potentially cause PF therefore stretching your calf muscles (the gastrocnemius and soleus muscles into your Achilles tendon) may help. You can find safe, gentle stretches for these muscles and the Achilles Tendon online. It is important to start any exercises or stretches slowly and gradually build up. If you start getting more pain or any side effects, then it is important to stop. 
  • Footwear being changed to more supportive shoe as advised in previous answers
  • Choose more non weightbearing exercises such as swimming and cycling, whilst the foot is inflamed and painful
  • Ice to reduce any inflammation that may be present. 20minutes daily recommended either in form of frozen peas or similar wrapped in damp cloth or foot rolling over a chilled bottle or can. This can really help discomfort especially after a day on your feet.

Often with these treatments and over a couple of weeks it can resolve and reduce in pain. But if these treatments do not help it may be that you do not have PF and could instead have another issue or need more individual advice or care. It is important to contact your GP for further advice or contact a local podiatrist. The podiatrist would be able to do an assessment to look at the lower limb and foot structures, review your gait (the way you walk) and much more to help to diagnose PF, another condition and give more treatment options including insoles/orthotics and specific exercises.

9. What’s the most common issue you deal with as an NHS podiatrist?

At the moment in my local NHS Podiatry clinics, we are prioritising the most poorly feet in the service during the COVID-19 pandemic, therefore, the main conditions we manage are foot ulcerations using our wound care skills and knowledge. This is often for patients with medical conditions that cause reduction in circulation to the foot and/or loss of sensation due to nerve damage. Our main goal the podiatry treatments we provide is to aid with wound healing and reduce, where possible, infection and amputations from occurring. 

The second condition we see a lot of are ingrowing and painful toenails conditions. We complete a lot of nail surgery clinics where we carry out a minor surgery under local anaesthetic to remove a painful toenail. Those are only two areas of specialisms we deal with in podiatry and we do so much more with supporting the management of foot and lower limb conditions including pain management and mobility support.

10. What’s your favourite foot fact?!

My favourite foot fact is your feet can continue to ‘grow’ even into older age. Meaning there is always an excuse to go shoe shopping and buy new shoes! The reason behind this change in size despite normally finishing their growth stage by age of 20, is that feet can either swell or your tendons and ligaments loosen in the feet causing the feet to spread, making the foot wider and longer. This can happen with age, certain medical conditions or even pregnancy! 

Many thanks to Robyna for answering these questions!

Robyna is supporting NHS England’s ‘We Are The NHS’ campaign. To find out more about a career in the NHS, please search NHS Careers’ or visit We Are The NHS to find available roles and training support on offer.

The best experts to follow on Instagram

Running

The Running Channel is full of information and content for runners!

The Running Channel

While potentially more exciting to subscribe to on YouTube, The Running Channel shares great running advice, myth busters and relatable running content, all backed in good science.

Emma Kirkyo

Emma Kirk Odunbi is a strength and conditioning coach who specialises in running shoes, having previously worked in a trainer store. She shares running motivation, kit advice and lots of info about feet and shoes!

Rush By Nature

Holly Rush is a running coach and GB athlete. She knows what she’s talking about when it comes to running and produces plans to suit all abilities. She is also the co-host of Marathon Talk podcast which is great!

Carla Molinaro

Ultra-athlete Carla Molinaro has recently completed a 100km road race, and is the LEJOG world record holder, an incredible feat. As an endurance athlete, she knows a thing or two about nutrition, and preaches balance in all things.

Renee McGregor

Sports dietician Renee McGregor specialises in REDs, overtraining and eating disorders, especially in athletes. Follow for no-nonsense advice about fuelling properly when running. She also takes part in many ultramarathons so really knows what she’s talking about.

Run 4 PRs

This is an online run coach and strength training guide, but also shares loads of interesting information about various elements of running. They also interview some great athletes to hear their stories.

Physio

The Irish physio has loads of great videos for runners and others!

The Irish Physio

Physiotherapist Aiden O Flaherty specialises in running injuries and performance, and promotes exercise for both the mind and body – something I also feel strongly about. Follow for useful vids and sensible advice if you’re a runner.

Manni O

Manni is a Nike running coach and physiotherapist and shares some great drills nd physio sessions on his page. As with everyone else on this list, he preaches balance – not performance at the expense of health, or health at the expense of happiness.

Lucy Tri Physio

Lucy Sacarello is a hello ultra-runner who enjoys the trails as much as me. As a physio she also shares information and videos about keeping healthy and mobile while running.

Adam Meakins

Physio and S&C coach Adam Meakins provides simple, evidence-based advice on almost everything to do with living as a human being, especially various pains and aches. Very no-nonsense.

Nutrition

If you fancy recipes, evidence based nutrition info and a great podcast look no further than The Food Medic

The Food Medic

Dr Hazel Wallace is an NHS doctor and nutritionist. She shares SO much great and balanced information on her page, I honestly think everyone should be made to follow her. She also has a great podcast that’s worth a listen.

Doctor’s Kitchen

Dr Rupy Aujla suffered from burnout in his early hears of being a doctor, and since has shared information about how to live a healthy and balances lifestyle. He has loads of great recipes and balanced advice on his page, as well as a great podcast!

Rhitrition

Dr Rhiannon Lambert is a dietitian aiming to help people build healthy relationships with food. While not vegan, she promotes a plant-heavy diet and balance above all else. Follow for tasty recipes!

Dr Joshua Wolrich

Dr Joshua Wolrich is one of my favourite ‘myth-busting’ accounts on Instagram. He promotes HAES (health at every size) and works to reduce weight stigma.

The Gut Health Doctor

Dr Megan Rossi is a gut-health expert, sharing science-based information on diet, immunity and various recipes too. She has a great book that I’d recommend!

Food and Psych

Kimberly Wilson explores the links between diet and brain health. There’s lots of interesting evolutionary science, history and psychology woven into her posts, which cover a variety of topics.

Charlotte F Nutrition

Charlotte Fisher shares a lot of the same sentiments as I have when it comes to nutrition and performance. Nutrition needs to be healthy for the mind as well as the body. These posts are great for anyone who doesn’t have a perfect relationship with food.

Faye Nutrition

Faye is a sports nutritionist looking at the scientific evidence behind various popular diets, sport-related topics such as overtraining and myth busting a lot of the bro-science you see on the internet.

Fitness

If you’re looking for workout videos and a lot of easy to understand science, follow Natacha

Natacha Oceane

It’s rare that someone gets so famous for sharing science, but Natacha is the perfect example of someone who is well known for literally all the right reasons. As a biophysicist and athlete, she shares science-based information in lay terms on her Instagram and YouTube, as well as great workout videos and challenges.

Sohee Fit

For more evidence-based information on fitness, health, nutrition and the industry as a whole, give Sohee a follow. She delves into the primary literature (so you don’t have to) and supports a balanced approach to nutrition and lifestyle.

LittleLyss Fitness

Alyssa Olenick is great for promoting a variety of types of fitness both for health and enjoyment. While she’s currently trining for an ultramarathon, she promotes healthy lifting for the health benefits. She is also very open about where her areas of expertise start and end – kudos for that.

Alice Liveing

Women’s Aid ambassador and Women’s Health columnist Alice Liveing is a qualified Personal Trainer with over a decade of experience in the industry. She hosts live workouts daily and promotes the use of training to support everyday life, not the other way around. Everything is about balance!

Shona Vertue

Ex-gymnast Shona Vertue is a qualfied personal trainer and psychology student. She shares home workouts, strength training sessions and mobility work – useful for runners!

Conversation with an NHS physio

I had this conversation with Emily Davies Physiotherapist, answering your most asked physio questions! This blog post is in support of the We are the NHS campaign. If you enjoy it, please do share on Instagram!

1. How do you know whether a pain/a niggle is something you can run through or something to rest and check?  

Symptoms such as swelling, pain when weight bearing, redness, the joint area giving way, numbness, pins and needles, reduced strength/ movement due to pain can all be worth a professional opinion.

Ask yourself how long have you had this pain for. It’s not uncommon to get pins and needles after exercise as well as redness/ swelling if you’ve been working hard but this can often resolve on its own. If this is something that’s happening persistently it’s definitely worth getting it looked at. 

If symptoms aren’t persistent and you’ve only had this pain/ niggle recently when running, rest is your best friend! Listen to your body if it’s in pain. Our body needs rest to strengthen and adapt. Rest, ice and elevation can often help these niggles! If after this you are still getting pain, ignoring it will only end up doing more harm and the recovery is likely to be worse. 

2. What’s your best advice for those that sit at a desk all day?   

Planning your day in advance is a massive help in ensuring you achieve what you set out to. If you are sitting at a desk all day, getting up every hour is so important; whether that is just going to the kitchen to make yourself another cup of tea! (Check out this blog post on how I keep active when working a desk job).  

If your job means you aren’t active during the day, make up for this in the evening, it doesn’t have to be something intense! It could be going for a walk outdoors- this will be great for your mental health too, releasing those endorphins and improving your mood! Try and set yourself a goal, that way you are more likely to stick with it e.g. how many steps do you want to achieve each day? 

If it means you are sitting at a desk all day, you need to look after your posture and your musculoskeletal system. Make sure you are sat at a chair you find comfortable with back support, feet flat on the floor, screen at eye level, try and avoid crossing your legs! Working at home during the pandemic is not easy but it’s important you have the correct equipment to ensure you aren’t straining your posture/ body. Speak with your workplace if it is concerning you. 

3. How is it best to return to running after a long period of time off?  

Build it back up slowly, if you dive straight into the level you were previously at, your muscles and joints will be at risk of injury.  Stretching your calves, quads and hip flexors after your runs will help to reduce risk of injury. 

Make yourself a goal! What would you like to achieve with your running? But it is really important you make this goal realistic to yourself and over a realistic time frame! How far do you want to be able to run and by when? 

Make sure you take some days off to start with to give your body time to recover. Even just going for a gentle walk, cycle or swimming (when we can access swimming pools again!) can also help build our endurance/ strength. Swimming is brilliant as it is a non-weight bearing form of exercise which provides our joints with a bit of a rest!  

Footwear is also so important! Make sure you’ve got some correctly fitting trainers with good shock absorption qualities for running and are supportive for you! There are more top tips on running form in one of the answers below!

4. Words of wisdom for someone starting physio at university?  

One thing I wish I’d have had a better understanding of before I started my degree in Physiotherapy was the range of areas involved in this profession. Having a good understanding of this will put you in a great position at your lectures on all the different areas e.g respiratory, musculoskeletal and neurology 

Don’t be afraid to use your course mates for studying! The best way I found to learn anatomy/ practical treatments was with my course mates. Remember you aren’t the only one learning this whole new topic, your course mates will be in the same position as you so learning together will widen your depth of knowledge! 

Printing off lecture power points and annotating them as you go is another tip I recommend! With permission of you lecturer, recording lectures was hugely helpful for me. This way, for anything I didn’t understand or was struggling to learn I would listen to the lecture over again to confirm my understanding. 

And finally, your placements! This is where you get to transfer all that you’ve learnt into real life situations. Really make the most out of your placements, get as much experience in different professions that work alongside physios so you are aware of the bigger picture of your multidisciplinary team! And ask as many questions as you can!

 5. What’s the most common issue you see as a physio and the easiest way to avoid it?  

Achilles tendinitis is a common injury we see a lot of, especially during lockdown where more people are taking up running due to gyms being shut.  Most Achilles injuries can be treated at home with support of a qualified physiotherapist. It is important to get issues like this checked as overuse of our tendon can lead to a rupture, resulting in surgery in worst cases.   

To avoid injury in the first place, increase your activity level slowly whilst stretching and strengthening the area. A good tip is being aware that we have two calf muscles (gastrocnemius and soleus) so we must stretch them both! 

Again, having good fitting trainers with enough padding to help with shock absorption will help prevent this injury. 

6. What makes a good physio?  

A good physio knows the importance of building trust with you, as it is likely you will see your physio over a period of sessions, so it is important to make sure you have a mutual regard and respect during the sessions. I’d check for continuity reasons that you will have the same physio for all your treatments rather than have to build up a rapport with a new physio on each session! 

7. Should you stretch? If so, how often? Any specific stretches you’d recommend? 

Stretching is SO good for your body! Stretching can improve range of movement, decrease stress levels, reduce pain/stiffness, reduce risk of injury and improve blood flow and circulation.  

Stretching once in a blue moon will not make a difference to your flexibility, consistency is key!

I would start off with a manageable amount of stretches each day e.g. 5 and as long as the stretch is not painful, I’d recommend holding for between 30-60 seconds. Try to implement stretches into your daily routine, even better after you have been exercising so your muscles are warmed up.  

Be aware that as the muscle we are stretching becomes more flexible, it is at risk of becoming weaker so completing strengthening exercises of the same area is recommended.   

The main stretches I would recommend to anyone starting off would be targeting our main muscle groups! This would include the hamstrings, hip flexors and glutes. I also think that stretching out our muscles in the shoulders/chest (trapezius and pectorals) is important in improving posture, especially now people are working from home more.  

8. Any general advice on running form?   

Be aware of your posture, it is so easy when you are running to forget about posture but try to be aware of your shoulders, keep your back straight and make sure you aren’t leaning forwards. Having a stooped posture when running can lead to back, shoulder and neck issues in the future.  

Find a stride that works for you; land gently to help prevent any injuries. Elbows tucked in by your side and good arm swing will help maintain a rhythm and propel you forward also.   

Again, completing frequent stretches and strengthening exercises for our big muscle groups e.g. abdominals and glutes will help stabilize your running technique. 

9. How is it best to support recovery e.g. on a rest day, after training etc? Top tips?  

Stretching after training will support our recovery by eliminating lactic acid build up and improving our blood flow. Try and incorporate stretches after every work out to support your recovery. A gentle walk on a rest day will also help reduce joint stiffness by circulating the blood flow. Correct nutrition will also support our recovery e.g.  Consuming an adequate amount of protein will help recover muscle fibres that may have been damaged through exercise as well as helping to replenish any depleted energy stores. Recovery days are important as these are days which allow our muscles to repair and therefore strengthen and improve performance. Everyone is different in regard to how many rest days a week they should have but I would recommend to rest the muscle group the day after you exerted it. Definitely make sure you are sleeping enough also, our body needs sleep to recover, try to get a good 7-9 hours. 

I would also recommend foam rollers, ice/ heat packs and even a sports massage to also aid recovery for more intense training schedules.  

10. How should I treat/prevent runner’s knee? 

If you start to experience pain around the knee (patella area more specifically) when you are running, bending your knee, kneeling, walking down hill/ downstairs, you may have runners knee. It’s a very general term for knee pain that may not have stemmed from running.

It is a problem that can often resolve itself.

To treat it I would recommend resting the knee from strenuous activities for around 2 weeks e.g. running, squatting, lunging. Not everyone will get swelling with this pain, but a cold ice pack on the area for 20 minutes or so every 4-5 hours can ease not just swelling but the pain also. Elevating your knee when you can will also help with swelling. 

To treat / prevent this condition, correct footwear can help improve position of your feet and therefore pressure around the knee. I’d also recommended stretching and strengthening the area around the knee. For stretching, I would target the quadriceps, calf, hip flexors and hamstrings. For strengthening I would recommend calf raises, wall slides, clams, step ups and glute bridges. As always, if this pain persists, get it looked at by a professional. 

Many thanks to Emily for answering these questions!

Emily is supporting NHS England’s ‘We Are The NHS’ campaign. To find out more about a career in the NHS, please search NHS Careers’ or visit We Are The NHS to find available roles and training support on offer.

Dealing with injuries as an athlete

At university, I undertook a short course on sports psychology, hoping to garner some insight into what makes pro athletes tick, and how the rest of us can improve our own psychology to improve our sport. The topic that stuck with me most, however, was talking about the effects of injuries on athletes, and not just professional ones. Since sports have strong mental as well as physical benefits, the stress and anxiety caused by injury can sometimes be almost incapacitating. Figuring out how to keep fears and potentially serious mental health problems at bay is both vital and complex.

While I’m no expert, I have an unfortunate amount of personal experience dealing with recurring injuries, namely IT band syndrome, caused by doing ‘too much, too soon’ in most athletes, but initiated and exacerbated almost solely by road running for me. My first physio told me to ‘stop running’, in favour of all other sports, which did nothing to help the actual problem, since I was always going to run, I just needed to know how. And so commenced 6 years or recurring injury.

After a huge flare-up during training for and running Tokyo marathon in early 2019, I worked with my second physio, Zoe, from Physio Motion (London based) to figure out the cause of my particular injury (weak glutes, poor running form to compensate) and work on those issues. Since then, I’ve been able to run two ultramarathons and 50+km weeks on trail (big for me – previously 5km would hurt) with no pain until recently, on a very tiring 10km road run around Bristol.

So, in my current mindset, I thought it might be helpful to share my top tips for dealing with injuries, both mentally and physically.

Get a diagnosis

For many people reading this, your injuries will be recurring, so you’ll have a good idea of what the pain is, and what it means. However, for many others, you’ll have a ‘lateral knee pain’ or ‘calf niggle’ and won’t know what’s gone wrong. Getting a diagnosis is vital to taking the right steps to recovery. Taking time off until it doesn’t hurt and then going straight back to what you were doing before doesn’t treat the root cause of the problem, so you might have the same issue again. Get a diagnosis and a plan to recover.

Know what’s gone wrong

This might be personal to me, but when things go wrong, I need to know why. Understanding the details of why something went wrong, what happened in the lead up and what I can do next time to avoid the same thing happening helps me feel in control of the issue. It also helps prevent it happening again. If I think about it, the recent cause of my flare up was: 2 weeks off followed by 3 very stiff road runs in quick succession, followed by a lack of stretching on top of 9 months without a regular or sufficient physiotherapy strengthening routine. Know your triggers and work to fix them.

Accept reality

If you are injured, the chances are that you felt a niggle before it turned into a full-blown injury. If you had taken a step back at ‘niggle’, it may never have turned to ‘injury’. So now you’re injured, it’s time to accept that reality. It may not be the reality forever, but for now, pushing through the pain doesn’t make you hardcore, it makes you stupid (speaking from experience). It also means your injury will likely take longer to heal and you’ll spend more time away from what you love. Accepting your current state means that it’ll likely last for less time.

Treat recovery like training

If you’re anything like me, you get pretty exciting when a new training plan comes your way, but groan at the idea of a physiotherapy/rehab plan. However, technically, a rehab plan is the same as any other training plan – it’s taking small steps to improve from the position you’re currently in, to the position you want to be in. Switching your mindset from ‘rehab is a chore’ to ‘rehab is training’ can help keep motivated. The more you stick to your rehab plan, the sooner you’ll be back to the training you love.

Enjoy the time off

When you know you can’t run/do the sport you love, it seems like all you want to do is that thing, but in reality how many times did you think ‘I wish I didn’t have to go on this run’ when you still could? Time off is a chance to take stock, recover both physically and mentally, and improve other skills too, be it in the gym or at work. You’ll be amazed how much free time you have all of a sudden! Again, this is about mindset – you can choose to resent the free time, or you can choose to do something productive with it (rest is also productive).

Speak to others

While being pragmatic is always best when it comes to injuries, sometimes speaking to someone else who can share your frustrations can make you feel less alone. Sharing tips and irritations can be helpful, and having a downright bitch about your injury every now and again can feel good. It’s unfair that I’m injured. I read my body well, I rest well, I eat well, I don’t do huge mileage, and yet here I am once again. It’s immensely frustrating. Once you’re done, pick yourself back up and get on with your rehab plan.

Go back slowly

At the end of your 6 weeks or 6 months, you’ll likely be trepidatious but excited to get back to running/whatever sport you love. However, these are the tentative first steps after months of recovery and work. Don’t go out all guns blazing, however fresh you feel. Work with your physio to plan your return to training. A 2km run is as valid as your previous 20km runs. Don’t let ego or excitement get in the way of a slow and sensible return to training – your body will thank you in the long run (so to speak)! And if anything, you should be finishing your sessions feeling like you want to do more.

This piece has been helpful to write for myself at least, so I hope it also helps a lot of you! Save it, share it, bookmark it on your laptop. 65% – 80% of runners get injured each year, so it’s likely that you’ll need this advice at some point, whether that’s now or in the future. Good luck with your recovery!

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Should you workout twice a day?

A recent UK announcement clarified that people would be allowed to workout an ‘unlimited amount’ outdoors as part of the gradual easing process of lockdown. Whether you agree or not that this should be allowed or encouraged, it’s led to a spike in articles preaching the benefits of working out twice a day.

For the vast majority of the population, however, working out two times a week would be more than their usual. Is promoting double-days sensible, and is it a tactic that could work for many? Here are some of the pros and cons of working out twice a day.

Pros

  • Double workouts can allow you to fit in more ‘accessory’ workouts, strength and conditioning and physio sessions, reducing imbalances and weaknesses. Some people feel they don’t have time for these if they’re aiming to train 5 days a week and fit in sufficient rest days. Doubling up means you can do an intense session in the morning and a low intensity stretching or physio session in the afternoon.
  • Doubling up but doing the same number of workouts per week can mean that you allow yourself more rest days. Rather than working out 5h a week over 5 days, you can do 2 double days and a single day in just 3 days, thereby allowing yourself 4 rest days a week. You will need them!
  • Splitting a session in two and doing half in the morning and half in the afternoon means you’re able to do each part of the session with more intensity, as you’re better rested for the second half.
  • Splitting a session in two can also allow you to fit it in on a busy day. 30 minutes in the morning and 30 minutes after work in the afternoon is sometimes easier than an hour all at once.
  • Working out twice a day reduces your sedentary time. We know that sitting for long periods of the day can be incredibly detrimental to our health, so even fitting in a short workout morning and evening can mean moving more overall.

Cons

  • Even splitting the same workout in two can lead to injury or overtraining, as you’re working already fatigued muscles. If you’re not used to training a lot, working out twice a day will take its toll.
  • Overtraining compromises your immunity, leaving you more vulnerable to even small illnesses. 72 hours after a long run, your immunity is reduced. For obvious reasons, this is especially problematic now. Doubling up leads to a greater likelihood of overtraining, if not done correctly.
  • Workouts lead to micro tears in our muscles. Doubling up workouts can mean that these tears are not given sufficient time to repair, potentially leading to injury.
  • Running has such a high injury rate that all runners are advised to increase mileage and intensity slowly. Doubling up can mean that it is possible to do more mileage, quicker, leading to common injuries such as shin splints, ITBS, plantar fasciitis and tendonitis.
  • It can be hard enough to convince yourself to get out once a day. By trying to force yourself to head out twice a day you can take all the fun out of exercise.
  • Doubling up is unsustainable for many. Overdo it and you may need to take off significant amounts of time, reducing any benefits you get from your double days.

 

In my opinion, there are more downsides to working out twice a day than there are positives, for the vast majority of people. I have been receiving a record number of messages about people picking up injuries from suddenly increasing the amount they are running, or starting new training programmes without a strong baseline of fitness.

Of course, there will be people who thrive off doubling up workout sessions, especially those who do so with the help of a coach, or who are already experienced in their sport. With proper planning, double days can allow for longer periods of rest between workouts, aiding recovery. They may also help people fit in enough strength and conditioning sessions that they could not otherwise, whilst also fitting in rest days.

The best way to be able to gain all the benefits of working out, even getting fitter during lockdown is to work on one thing at once. If you’ve taken up running, don’t increase intensity and distance in the same week. Your mileage should increase by no more than 10% week on week to avoid injury, but if you do your longest run one week, don’t also start adding in sprints or intervals sessions in the same week, or even the week after. Most of the sessions we do should be at moderate intensity – we do not always need to be pushing the boundaries of our ability. Be kind to yourself – this is a tough time for all and putting your body under extra physical pressure may cause you to reach breaking point.

Perhaps you want to start taking advantage of double days because you’re lacking time or want more rest days. That’s absolutely fine – maybe just try one double day a week (thereby taking one extra rest day too) and see how you get on. Take it easy and remember that recovery (and food) is as important as the session itself!

TL;DR

  • While exercise can improve mood, fitness and your immune response, too much exercise can have exactly the opposite effect.
  • If you are not a professional athlete or highly experienced with a well thought-out training plan, double days are probably going to increase your risk of fatigue, injury and may dampen your immune system.
  • Provided you are not doing more workouts per week, double days can be effective when linking together a S&C session/physio session and a short run.
  • As ever, stick to the 10% rule. If you’re a runner, increase your weekly mileage by no more than 10% per week. Any more than this increases your risk of injury, even (or especially) when taking on double days.
  • Overtraining often takes several weeks to take its toll, so watch out for signs of it, and read this blog post to know when you may have pushed it too far.
  • Listen to your body! If your workout doesn’t perk you up and you feel constantly fatigued, take an extra rest day. Yes, we have a lot of time at the moment and exercising can feel like a welcome break, but the consequences of overdoing it can be serious and long-lasting. Be sensible!

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Shin Splints – what are they?

With so many people taking up running since lockdown, the number of physio-related questions I receive over on my Instagram has increased exponentially. One of the most common questions I’m asked (at least once a day at the moment) is how to cope with shin splints, an issue common with runners, especially those increasing the amount of running they are doing too quickly.

As someone who isn’t a physio, I never feel comfortable answering these questions (aside from giving personal advice and opinions on injuries I’ve personally experienced), so instead have asked my physio Zoe from Physio Motion to write something to help you all out. I understand that not everyone can afford/has access to a physio, so I hope this helps! That being said, if you continue to struggle with injury even after rest and rehab, I would really recommend getting in touch with a physio to ensure you’re treating the right issue, and that the problem isn’t something bigger.

Without further ado, onto Zoe! If you enjoyed this post, please do share and tag @physiomotionlimited and @foodfitnessflora so we can see 🙂

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Zoe and me on a run in Hyde park

What are shin splints?

Shin splints is a generic term that describes any disorder that causes shin pain.  This historically would be called medial tibial stress syndrome.

It is typically found as pain along the shin bone (anterior tibia), which will settle with rest but will reappear when you start running again and at worse when walking.

With all of these conditions that cause shin pain, it is typically due to repetitive strain injury that is common in runners when they are starting to run or suddenly increase their amount of running.

The characteristics of shin splints can also be an identification of different conditions.

 

What other conditions can have shin splint characteristics?

It is important to know that it could also be due to tibial stress fracture (break within the bone that doesn’t move) or compartment syndrome (high pressure within the muscle caused by swelling).

 

How can I distinguish between these conditions?

If it is true shin splints, the pain will subside with rest and slowly build up again if not managed adequately. Also, people that have just started running will notice that the pain improves over time as your legs get used to the new loads being put upon them.

With stress fractures and compartment syndrome, however, the pain is persistent or can get progressively worse.  If your pain does get progressively worse, it is a good idea to seek medical advice and investigations in order to rule out a stress fracture or compartment syndrome.

 

Why have I got shin splints?

The main cause for shin pain is the load that you are putting through the lower half of your leg when running, and that you do not have the capacity to manage these loads.  This could be due to increasing your training too quickly; increasing the running speed; or inadequate rest periods between your runs and other training.

There is no evidence that a certain type of running footwear will stop you getting shin splints, but if you have been using the same trainers for many years and they are hanging off your feet it might be an idea to treat yourself to a new pair.

 

Do I need to stop running?

For most people you can continue running, but you need to return to running a distance, speed and frequency that previously did not cause you problems. 

If you are new to running then it might be better to start with slow interval running (run walk, or run stop run) and build up the duration that you are running in each interval before continuously running. 

If you are still getting pain then it maybe necessary to stop running for a short period and swim or cycle instead for this period in order to maintain cardiovascular capacity. 

 

What can I do to help with my shin splints?

As shin pain is due to overloading the legs, you need to make sure that the legs are strong enough to absorb running forces.  Therefore, you need to have a strengthening regime to ensure adequate strength in your calf complex, but it is also important to increase the strength in your gluteals and thigh muscles.

We would recommend exercises such as calf raises, slow step ups and bridges, athough we always assess our patients for areas of weakness in the lower limb and tailor a programme to their needs.

Due to the shin pain you can get a secondary response of tightness in the calf.  You can stretch this out, but it will only provide you with temporary short term relief until you start walking and/or running again.  It is more important that you make sure you find out what is causing your shin pain in the first place. Failure to do so could result in a stress fracture or compartment syndrome.

 

What can I do to prevent reoccurrence of shin splints?

When the pain has completely disappeared at the running mileage that is comfortable or after a period of rest, you need to think about how you progress your running programme. Typically coaches recommend 10% increases, but something to remember is that this doesn’t have to be every week and also every run doesn’t have to be to your maximal capacity.

It is also important to have strength and conditioning days, and recovery days in your training regime.

As shin splints are now categorised as a bone stress response, it maybe worthwhile looking at whether your vitamin D and calcium intake is adequate for bone recovery, especially when you start running during the winter or at the start of the spring, when it is shown that vitamin D especially is low for us Brits!

 

How long will it take me to recover from shin splints?

It can take between 6 weeks and 6 months to make a full recovery from shin splints depending on the severity of the condition.  So it is important to be patient and consistent with your treatment and advice given.

 

If you’re currently experiencing injuries, you may find this Q&A vlog with Zoe interesting, as well as this chat with my coach, where we cover running injuries and the importance of recovery, especially in such a stressful time. 

 

References:

 1. Heiderscheit, B. C.; Chumanov, E. S.; Michalski, M. P.; Wille, C. M.; Ryan, M. B., Effects of Step Rate Manipulation on Joint Mechanics during Running. Medicine & Science in Sports & Exercise 2011, 43 (2), 296-302.

2. Bennell, K. L.; Malcolm, S. S.; Thomas, S. A.; Reid, S. J.; Brukner, P.; Ebeling, P. R.; Wark, J. D., Risk factors for stress fracture in track and field athletes: a twelve-month prospective study. American Journal of Sports Medicine24 1996, 6 (810-818).

3. Madeley, L. T.; Munteanu, S. E.; Bonanno, D. R., Endurance of the ankle joint plantar flexor muscles in athletes with medial tibial stress syndrome: A case-control study. Journal of Science and Medicine in Sport 2007, 10 (6), 356-362.

4.. Lappe, J.; Cullen, D.; Haynatzki, G.; Recker, R.; Ahlf, R.; Thompson, K., Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits. Journal of Bone and Mineral Research 2008, 23 (5), 741-749.