Welcome to the second of my summer blogs following on from June’s blog on walking your way to fitness.
For this month’s article I’m going to up the ante a little, from walking to running.

The summer is full of running events, and Bristol, where we’re based, is full of runners jogging on the Downs and in the parks, making the most of our many green open spaces. In fact, Bristol has been named the running capital of the country!
Running is great, but, no surprise, can cause injuries. If you are a novice, make sure you build up slowly, with realistic targets – you can’t get to 10k without reaching 5k first. Suitable, supportive running shoes are vital; as are warming up, cooling down and stretching properly. If you are injured, or feel an old injury re-igniting, it’s important to stop and assess, instead of carrying on, potentially making it worse.
Here is a list of some of the most common (but not exhaustive) running-related injuries and their treatments. Physio is often very beneficial in treating running related conditions and in order to return to running as early as possible early intervention is advisable to prevent a chronic situation developing.

Shin splints
Feels like: Stiffness or pain in your shins
What it is: The strain and leg pain results from strong calves pulling repeatedly on weaker muscles near the shin. The muscles of the shin become larger with exercise and sometimes the sheath that surrounds the muscle does not stretch at the same rate putting pressure on the muscle – usually tibialis anterior – and causing pain. Running on concrete is likely to exacerbate the problem.
What to do about it: Cut back on your running for 3 to 8 weeks, depending on the severity, to give the tissues time to heal. You might need an anti-inflammatory medication, such as ibuprofen, or cold packs to reduce swelling and relieve pain. In the meantime, keep in shape by training with low-impact exercises such as swimming or cycling. You should also strengthen tibialis anterior to help prevent a recurrence, such as lifting your toes up towards your shins 20 times while standing, three times on each leg.
Physio can help to release the tight tissues, guide you with regard to appropriate stretches and acupuncture can help with symptom relief. Orthotics (insoles) are often also helpful to help unload the overactive muscles.

Trochanteric Bursitis
Feels like: Soreness on the outside of your hips
What it is: Although there are many potential causes of hip pain, it’s common for the fluid-filled sacs (bursae) that cushion the muscles on the side of the hips ,to become inflamed with repetitive stress. People with one leg slightly longer than the other may be more susceptible to this condition. Weak gluteal muscles and muscle imbalances around the pelvis can also cause more stress to the area, leading to inflammation and pain. Running without ensuring that you are engaging your gluteals well and without building your distance up slowly can predispose you to this condition.
What to do about it: Instead of running, ride a static bike, swim, or do some other non-weight-bearing activity for a few weeks. Strengthening your gluteals and other core muscles is essential. Start again gradually, building from a fast walk to a short jog before taking off on a 10k! Seek physio advice early to help release the tight overactive muscles which cause friction over the bursa and to show you how to strengthen the correct muscles.

Runner’s knee
Feels like: Throbbing either in front of your kneecap or to the side of or behind the knee.
What it is: Usually a low grade inflammation which is a result of friction between the layers of soft tissues (ligaments, tendons, muscles and fascia). This is often a result of some muscles and ligaments becoming tight – commonly the quadriceps and ilio-tibial band. This can also cause low grade inflammation behind the knee cap due to altered pressure between the knee cap and femur (patello-femoral joint). Runners with weak or imbalanced thigh muscles, weak core muscles or flat feet or high insteps, are at greater risk of runner’s knee. The knee pain may occur when you’re walking downhill, doing knee bends, or during or after sitting for a long period of time.
What to do about it: Reduce or stop running, particularly avoiding hills. Change to another type of exercise such as swimming until the symptoms subside. Seek physiotherapy early, for guidance regarding changing the muscle imbalance around your knee, thighs, calves and feet and to help release tight muscles which are causing the increased friction. Acupuncture can also help to settle symptoms. Orthotics (insoles) may be beneficial if you have particularly flat feet.

Muscle Tears
Feels like: Initially it may feel like cramp which you might try to run through or it may be sudden sharp pain which stops you in your tracks. Commonly the hamstrings (muscles behind the thigh) or gastrocnemius (calf muscle). There may be a warning from the muscle of fatigue prior to either of these sensations but not always. It may also occur with a sudden increase in speed if you’re not warmed up well or again if your muscles are fatiguing.
What it is: Tears occur in the muscle fibres and this needs time to heal.
What to do about it: Rest from running for 6-8 weeks depending on the severity of the tear. Ice x 10 minutes 4-5 times a day for the 1st few days. Taping to protect the muscle from further strain is often helpful. As the tear heals gentle stretching can begin to restore the muscle length and soft tissue release from a physiotherapist will help to ensure good structural healing of the muscle. Later rehab includes strengthening the affected muscle and also other muscles in the area which will have inevitably have weakened due to disuse. Building up and maintaining general  cardio-vascular fitness by swimming will also be helpful for a successful return to running. Initially this may only be confined upper body work to avoid re-injuring the muscle.
Seek Physio input early to help with this programme of rehabilitation.

Achilles Tendonitis
Feels like: Soreness, pain and stiffness in the tendon connecting your calf to your heel.
What it is: It is a tendinopathy which is likely to begin with inflammation around the tendon sheath.
What to do about it: Rest from running until symptoms settle. Ice the tendon for 10 minutes 4-5 times a day in the early days. Use a heel wedge to take the strain off the tendon – especially if you are experiencing symptoms when walking. Taping can also be useful to reduce the load on the tendon.
As symptoms settle it is important to begin a programme of graded stretching and strengthening of the tendon and muscle.Strengthening other muscle groups is also important – strong core muscles and gluteals are important as always to help to relieve the strain on the calf muscles by driving the body forward from the pelvis.
Seek physiotherapy early for guidance regarding appropriate rehab. for you. Soft tissue release, acupuncture and ultrasound can also be helpful to encourage good structural healing of the tissues.

Morton’s Neuroma
Feels like: Pain in the ball of your foot.
What it is: Probably the least common of the conditions here. If tissue surrounding a nerve near the base of the toes thickens, it can cause tingling, numbness, or pain that radiates to surrounding areas. It may feel as though you’re treading on a marble. This condition, known as Morton’s neuroma, usually develops between the base of the third and fourth toes. It’s up to 10 times more common in women than men, possibly because women’s feet are structured differently and because women tend to wear narrow, high shoes or very flat ones with poor support.
What to do about it: Treatment varies from simply wearing roomier shoes to surgery, depending upon the severity of the neuroma. Physio can be helpful in order to assess and address muscle imbalances around the foot and lower limb which can help to relieve the pressure. If problems continue custom made orthotics (insoles) or pads that relieve pressure and absorb shock may be helpful. Make sure that your walking and running shoes have a spacious toe box. Ladies -limit your time in high heels, and if you need to wear them, travel in comfortable shoes and then slip on the more stylish pair later.

Above all remember that given the numbers of people running these days injuries are relatively few and correct footwear and a steady graded running programme will go a long way to keeping you on track and injury free.

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Winter sports – the thrills, and unfortunately the spills…

For those of us who love to ski or snowboard, there’s little to match the thrill of flying down a shimmering white piste, with clear blue skies above, pine trees and mountain peaks offering up a feast for the eyes, and barely a sound bar the swish of skis slicing through powder.

However, for those of us who love our winter sports but only get to do them once a year at most, it’s also a time when we suddenly make extreme physical demands on a body unused to this type of exercise, and rusty skills can make us more likely to come a cropper. So here are a few tips on how to avoid injury, and if you are injured, how to minimise the damage and heal soonest.

Taking care of your body – before, during and after 

• Preparation is key

Spend some time at the gym. Most gyms run ski-fit courses, and these will get the quads and other key muscle groups primed for action. Attaining a higher level of general fitness will put you in a far better position to enjoy an injury-free holiday, while it’s also important to take into account any existing injuries, and their healing time, before heading off.

A good pre-ski programme at the gym will prepare you over 6-8 weeks, while if, for example, you have had knee surgery, you should take your doctor’s advice on when it will be ready for the challenge of winter sports. 

• Heading for the slopes

Warming up each day before setting out for the cable car or ski lift will minimise the risk of injury and muscle strain – simple bending, stretching, loosening the shoulders and priming the thigh muscles will all help. Wear plenty of warm, breathable layers for insulation and remember to take plenty of water to stay hydrated.

Don’t push yourself to do “one last run” when you’re already tired. This is when accidents often happen.

• On kit, nerves, alcohol and lifts

Firstly,check your equipment – if it’s hired, make sure it’s right for you, as injuries are staggeringly, 800% more likely to occur with hired equipment. If your own boots are 15 years old, it will almost certainly be worth replacing them or at least changing the foot beds.

If you are a nervous skier, invest in a one-to-one lesson and learn some relaxation techniques – falling on a tense body is likely to cause more injury than a more relaxed one.

Alcohol will also seriously undermine your capacities, so as enticing as it may seem, you’ll do better to leave the glühwein until you’ve safely reached base at the end of the day.

Be careful getting off chair and drag lifts, especially if travelling with someone of an incompatible weight or skill level – the vast majority of knee injuries happen here, as one skier or boarder accidentally bumps another out of the way, leading to a twist or fall on dismounting.

Finally, make sure you wear a helmet and goggles, test your bindings and know your limits.

• If you are injured… 

Some of the most common skiing and snow-boarding injuries are as follows:

• Errant skis and bad falls can cause knee injuries, particularly to the anterior cruciate ligament (ACL).
• Using your arms to break a fall can cause injuries to the rotator cuff or shoulder dislocations, while skiers often injure thumbs due to holding ski-poles during an accident.
• Collisions can result in head injuries like concussions as well as bruising, pulled muscles and ligament tears.

Sledging is especially dangerous lying on your stomach heading face first, as collisions are the most common type of injury, whether with a rock, tree or another sledger, so it’s advisable to sit upright facing forward and use a sledge with steering controls – and to sledge on a clear, obstacle-free hill.

In all cases, it is vital to seek immediate help and follow the P.R.I.C.E. recovery protocol if injured: Protection (such as strapping up the injury immediately to immobilise it).

Rest with the limb elevated and supported comfortably.

Ice – to reduce swelling and bruising.

Do also see a doctor and invest in physio at your resort, and follow their advice in the days and weeks that follow, with a follow-up visit to your own GP and/or physio on your return.

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The summer is finally with us, and with it comes all the sports that many of us love to both watch and play, whatever our level of ability. Wimbledon, Test Cricket, the US and British Golf Opens… the evenings are light, the weather is warm, and full of enthusiasm we head out to the nearest court, course or pitch.

But even people who exercise and train regularly can be prone to injuries, and the likelihood is greatly increased if you suddenly throw yourself into a sport without having got your body used to the idea. Golfers and tennis players can fall victim to elbow problems. While in cricket bowlers will be more likely to experience lower back, shoulder or knee pain, and batsmen or women can get hamstring injuries, caused by the sudden need to sprint from a standing start.

This article is a quick guide to identifying the symptoms, and how to treat them before they get worse.

Tennis elbow, or pain in the outside elbow area

Clinically known as lateral epicondylitis, tennis elbow often occurs after overuse of the muscles and tendons of the forearm, near the elbow joint.
You may notice pain:

• on the outside of your upper forearm, just below the bend of your elbow
• when lifting objects such as a kettle
• when bending or fully extending your arm
• when gripping small objects, such as a pen
• when twisting your forearm, such as turning a door handle or opening a jar

Physio can provide fast relief, especially when followed by simple extension exercises which you can practice anytime, anywhere, to strengthen the muscles and stretch out scar tissue. Bags of frozen peas will relieve pain and swelling in the meantime, and of course it’s important to stop the activity which has caused the strain so the tendon can heal.

Golfer’s elbow – pain in the inner elbow

Golfer’s elbow is the opposite – pain along the inside elbow area, but it is the same kind of injury, involving an inflamed tendon. It is most commonly caused by overuse of muscles in the forearm that flex (curl inwards) the wrist and fingers. Sports such as golf or other activities which involve repeated gripping or flexion of the wrist and fingers and overuse of the tendons can cause degeneration in the form of microscopic tears. This then causes the symptoms of golfer’s elbow, for which, similarly, physio, simple exercises and bags of frozen peas provide fast relief, while the exercises will strengthen the muscles around the tendon, so they take more of the strain, and help stretch out the tendon to alleviate the impact of swelling and scar tissue.

Cricket injuries

Cricket, that seemingly most gentle of sports, involving long periods of standing around with a tea break in the middle, actually puts a surprising amount of strain on the body. Bowlers often fall prey to muscle sprains through one side of their body from their shoulders down to their knees, due to the one-sided action required of them, while batsmen are most likely to strain their hamstrings from the impact of a sudden sprint.

Warming up properly is especially important for cricketers, and as with golf and tennis elbows, ice packs will reduce swelling while physio and deep tissue massage will start to repair damaged muscles.

Tips for avoiding sports injuries

However, we would all rather stay healthy and avoid injuries all together. Here are my top six tips for a happy summer of sport:

1. Over-use injuries are preventable. If you haven’t played all winter, do some ‘pre-training’, working the relevant muscle groups in the weeks before the season starts.
2. Warm up properly, focussing on the actions and parts of the body which may be most affected.
3. Wear protective clothing as needed – whether it’s a cricket helmet or a support band.
4. Quit while you’re ahead – muscle fatigue takes away your protective mechanisms and increases your risk of injuries. After all, you can always come out to play again next weekend, if you don’t get injured today.
5. Drink plenty of water.
6. Stretch and cool down afterwards – it will protect the muscles for next time.

And finally, if you do find yourself with an injury for which ice packs and painkillers don’t do the job or it’s not getting better – please do call. Physio is very effective for all these sports injuries, and you can speed up recovery and get back out there far quicker if you treat your injury properly!
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