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.