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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My marathon journey – the lowdown

When I was asked in December by Asics whether I wanted to run a marathon in Tokyo I was so excited – for any long distance runner, being flown out to Tokyo to run 42km is an absolute dream come true. However it took me a little while to respond to the offer – believe it or not I’ve actually spent my life saying that I have no interest in running a marathon. I’m a short distance runner (5km is my vibe) and have been plagued by injuries since I started running properly at uni. Not only that, but I don’t see running a marathon as the epitome of fitness – so many people seem to sign up, train, run it and then give up running altogether, as though they have ‘proven’ their fitness and can now give up forever. I much preferred running for fun (with the occasional 5k parkrun to assess time), and the thought of training for a marathon over 2-3 months (and probably giving up my other favourite sports, such as boxing), was daunting to say the least. I’m a runner in the sense that I like to run, but I wouldn’t say my skills are anything special, and marathons definitely take something special to complete.

However, after much thought (and my general attitude of ‘say yes now, think more later’), I accepted the invitation to race. For the first time in my life, I was given coaching by someone who understood the purpose of the running for me: to enjoy the process and not hate running at the end. It’s a personal challenge for everyone, and for me the marathon was about getting over the fear of running on my injured knees. I think sometimes the fear of pushing yourself too far and failing can stop you doing things you desperately want to do, and I made a pact with myself last year to stop being afraid and just jump, so I did just that! My training plan was tailored to me, and it suited me perfectly – approx 3 runs a week with time to rest, do boxing, do resistance training and look after my knees. Within the first few weeks of training I got my 5k pb (21.20) and 10k pb (45 something) in training runs (before being told off for running too fast and that I would need to slow down if I was ever going to complete a marathon) XD

Training went well for the first few months, and I loved testing my body. I’m built for power and speed, so to be able to show myself that I could run further than I’d previously imagined my body could handle was amazing. However, around 3 weeks before the marathon my old injury flared up again. I knew it would at some point (I’ve never run consistently in the last 4y without it doing so, which is why I used to only run maximum 10k once per week, to keep it at bay), but I was hoping it’d either be early in my training (leaving plenty of time for rest and rehab) or on the marathon day itself. If you’ve ever suffered from IT band syndrome you’ll understand the pain. It starts with a dull ache on the side of your knee(s) before becoming a sharp pain and spreading up your IT band all the way to your hip. After a while the pain becomes unbearable, and at its worst requires crutches (as I did frequently when I was at uni because I kept running on it, as my coach told me it ‘wouldn’t cause lasting damage’). *Eye roll*. Anyway, it’s a literal pain and the only real short-term solution is rest. Unfortunately this cut out my biggest training week – my longest run of 17 miles and all the other runs that week. Even my 5 – 10km runs were causing minor pain, and I worried I might have to pull out of the marathon (either in advance or half way through). I recorded some of my thoughts pre-marathon here.

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After a week of tapering (including just a few slow, short-ish runs), we headed out to Tokyo for our second taper week, arriving 4 days before the marathon. One thing I hadn’t taken into account was the jet lag, until Chevy, our coach, reminded us that any race done on jet lag was an extra-special achievement. My main concern was running form – tiredness causes poor running form and poor running form causes injuries!

Regardless, it was incredible to be out in Tokyo for the 4 days before the marathon (which felt like about a month!). We walked around the city plenty, even fitting in a short 6km run around one of the parks. Every day was 20,000 steps or more, which potentially isn’t the best way to prepare for a marathon, but it was good to keep the body moving, especially after such a long journey from London (17h of sitting down door to door pretty much)! If anyone is thinking of doing a marathon with a big time zone difference, I would allow one day per hour of time difference (advice I got from someone else) – I think the jetlag was a minor issue but an issue nonetheless.

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Race day came (after an impressive amount of carb-loading on ramen and sushi) and we left the hotel at 7am for the 9am race. I have never seen so much chaos before a race – thousands and thousands of people unsure of where to go, running around in the pouring rain. Having never done a big race before it was pretty overwhelming (but also very exciting!). We were probably far too early to the race – we were dressed in our racing kit (a couple of layers) and standing in the rain for almost an hour after warming up, meaning that by the time we got started at about 9.20am, pretty much everyone was shaking from the cold! Piece of advice (which probably every marathoner knows) – if it’s a cold/wet race, bring a couple of extra layers to chuck in the charity bins as you set off – they collect everything and donate it to charity (from what I heard), which is preferable to everything being chucked on the side of the road mid-race. It ‘only’ took me about 45 minutes to warm up, but unfortunately my once freshly activated glutes were flabby and cold by the time we started, so my IT bands started hurting around 8-10km in (since ITBS is usually caused by having weak gluteal supporting muscles). Obviously not ideal, but not a disaster.

The atmosphere was incredible during the race. Japan is one of the friendliest countries I’ve ever been to, and every few meters there was another group of people offering fruits, sweets and nondescript homemade goodies. Every few kilometres there was also a water/sports drink station. I think I had water about 4 or 5 times during the race, which felt about right for me (but probably ask your own coach what they’d recommend for you). The first 21km sailed past – none of it was easy, per se, but I felt like I was gliding through at exactly the right pace without really having to try. Perhaps I should have just signed up for a half XD

Around 30km in, my non-injured (left) knee suddenly became incredibly painful, changing my pace from about 6 mins/km to around 6 mins 25/km, which is back to the pace I first ever ran a 5k at (albeit 30km into a race). I ended up running with pretty much totally straight legs for 10km until I hit 40km. I stopped for a drink and that was it for me – both knees buckled and I nearly fell to the floor. It was pretty depressing to think that I might have to pull out of a 42km race at 40km in.

Being crazy I decided that I would walk the last 2 kilometres, being overtaken by runners everywhere. Despite the fact that I overtook 870 runners during the course of the race overall, I will always struggle with the face that I lost 62 places in that last 2kms. It took me 18 minutes to complete the last 2k, but through gritted teeth I did complete it!

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I would usually never advocate running through extreme pain (or really pain of any sort) but you can’t really quit a marathon at 40km, which is why I kept going. Running through pain is what got me the recurring injury in the first place, so please, if you’re training and you feel pain don’t do as I did in the race – please rest up!

As mentioned multiple times on my Instagram, my main goals for the marathon were to complete it and to soak up the atmosphere. I completed both of those things with flying colours, and for that I am so proud. Competitive me will not stop beating myself up for not completing the marathon in my self-imposed unofficial time goal of 4h, but having said that, if I were to read someone else being disappointed in their time of 4h, for example, I would feel really crap about my time of 4.28.50, which is why I can’t exactly complain about such a time. Running a marathon is amazing regardless of the time you do it in, and we all have our strengths and weaknesses – you don’t have to be amazing at everything, even choosing to take part can be the most impressive bit sometimes!

TL;DR

Would I recommend running a marathon? Yes absolutely, if only to find out what you’re made of and show yourself that you can do things you never believed possible (42km is a bloody long way).

Am I happy with my time? Yes, in hindsight under the circumstances, I am absolutely bloody impressed that I finished the marathon, let alone in under 4h30. If you can do it faster than that, that’s great! If you are slower that’s also great! It’s pretty cool that we’re all running marathons, don’t you think?

Would I run another? Tough question. Logical me says no. I know my hips are misaligned and that I’m injury prone, so marathon training will never really benefit me as much as all the other training I do. However the me that likes crazy challenges may well say yes to another marathon or ultra marathon, especially if it’s in a cool place or for a good cause! Never say never 😛

Would I recommend Tokyo marathon specifically? Yes, especially if you’re looking for a personal best – it’s pretty much totally flat/even slightly downhill and has lots of long roads and few sharp corners. The atmosphere is amazing and don’t worry too much about the weather – apparently we got the only rain they’ve had on marathon day in over 20 years!

Advice for running a marathon?  I think more than anything, don’t over train. More is not necessarily better, and injuries are easier to prevent than they are to cure. Slow running is very valuable (a skill I’m still learning) and finding a few running buddies makes it far more bearable. I’ve got a general running tips vlog here (although I’m no expert, just sharing what I’ve learned).

What did I learn?

  • I am capable of far more than I thought (4 years ago running 2km was impossible due to injury, and 5 years ago my 5k pb was 32 minutes).
  • Slow running is as hard as fast running. Harder mentally.
  • Marathons are hard.
  • I’m really fit (I never ‘hit the wall’ during the marathon, probably because I was forced to run much slower than planned), but that could be better put to use over shorter distances and doing more races per year.
  • Running a marathon can be kinda boring at times, but also the biggest feeling of achievement ever.

@jason_halayko_030319_asics_5386

Just after I stopped crying

Check out my favourite running gear and supplements I took during training for the marathon.