Pete’s knee blog Nov 20 – The Background
Despite what people think even us physios get injured and suffer with aches and pains. I’ve had my share over the years and typically it’s ‘Physio heal thy self’. That’s usually the case. Our knowledge and expertise certainly help but we also need the hands on assessment and treatment from colleagues too. A big thank you to all my team for you help and support.
I’ll try and keep the background brief. I’ve had issues with my Right knee as far back as 1999 when I ruptured my ACL. I eventually had that reconstructed in 2002 at Southmead Hospital and had a successful rehab and recovery. I’ve generally kept active most of my life, gym memberships, hill walking, mountain biking and even coaching junior rugby for a spell. More recently it’s road cycling and running in the last 4 and a half years. My knee has held up very well on the whole.
My knee started playing up about 4 months after I took up running. It’s fair to say running was my forte but it’s something I’d started and had managed to stick with (you can read about that here). Many people worry that running will damage your knees and joints but research now tells us this is not the case. My knees just needed more time to adapt to the increased load and stress I was placing on them. After a few more weeks the legs were stronger, I’d lost a few pounds and the knee pain had gone.
Fast forward over 3 years, numerous running and cycling events later, including 1 full marathon, and all was going well until….. Summer 2019 I twisted the knee awkwardly causing some pain and swelling. An MRI at the time identified a possible tear on the medial meniscus but nothing to suggest surgery at that time. 3 months of rehab, strength work, cycling and a return to running by November, enough time to train for the London Vitality Big Half marathon I had booked for March 2020.
So half marathon in the bag then lockdown hit. The knee was all good and training increased during lockdown, when we could get out more. I’d even started trail running along the Cotswold way. It was actually when I returned back to work that problems reoccurred. I was demonstrating how NOT TO do an exercise to a patient 🤦🏻♂️ that I tweaked the knee again. Stupid I know! Things were worse and a repeat MRI confirmed a definite tear in both meniscus. We’d only just returned to work after lockdown and taking time off just wasn’t an option so I delayed having surgery straight away. I went back to the rehab and strength work. Compex was a huge help and the team sorted me out with some much needed hands on treatment to release my tight quads and hamstrings. Cycling was the one thing that actually caused me more problems, so my cycling goals for the year went out of the window. Running was actually ok…. to a point. By managing the load and frequency sensibly I was able to keep going. Eventually I could tell things were not behaving themselves. I could tell I was limping more when walking. Bending past 90 degrees was a struggle. My running metrics were also showing an imbalance between my Left and Right Ground Contact Time Balance, although my times were still good. I was getting more discomfort, episodes of sharp pain and giving way. The final straw was I could tell I was compensating and was now getting aches in other places, my right hip and left calf. It was time to get things sorted. I couldn’t keep going on despite trying to convince myself otherwise.
I’m certainly glad to be covered by Tracy’s medical insurance plan. That has enabled me to get help quickly and in a timely manner. I’m so grateful, but I’m aware not everyone is as fortunate. My NHS counterparts are working through a global pandemic in some of the worst conditions the NHS has faced. Services are severely restricted and face to face contacts limited. I’m certainly hoping my recovery will be quick and efficient so I can be back at work helping my clients again.
Pete’s knee operation Blog – 24 hours post op.
Well as I’m recovering from my surgery I thought I may as well blog a bit about it for anyone interested enough or for anyone about to have a similar operation. I’ve written a separate blog here about the knee issues I’ve had in the run up to surgery.
So 24 hours after surgery. This is what’s gone on.
Operation – Medial meniscal repair
Weight bearing status – Partial weight bearing with 2 elbow crutches for 2 weeks
Restrictions in place – Flexion 0-90 degrees only for 6 weeks and no loaded flexion beyond 90 degrees for 12 weeks.
First things first, the procedure went well, no complications. Prior to the surgery I had a good discussion with my surgeon Jonathan Webb. I wanted to know what the plan was once he got in there and what his criteria were for repair vs trimming and removing the damaged meniscus. Clearly preserving the meniscus was the better long term choice if a repair was possible and we agreed that if a solid repair looked good to proceed with that. In the end I had a medial meniscal repair of the posterior root. Fortunately the joint surfaces on the inside of my knee were well preserved as too were the patella femoral joint. The lateral meniscus wasn’t as bad as the scan had indicated and was left alone. The lateral compartment however did have evidence of grade 3 osteoarthritis although reassuringly Jonathan informed me that it looked historic damage rather than recent.
So 24 hours on and the compression dressing is off. Arrow still visible! Glad to report minimal swelling or pain at this stage.
Goals for the first 2 weeks are to keep the swelling at bay. Keep pain on top of any pain. Restore range of movement from 0-90 degrees. Normalise my walking pattern and wean off the crutches by 2 weeks. Maintain muscle strength in the legs. Compex and cryocuff at the ready.
Right now I’m feeling optimistic. Hopefully you’ll find my progress updates interesting and informative. Please get in touch if you have any questions. Pete
Pete
Going to run a Marathon? Reasons to start your strength work now
When you’re doing a run training program for a marathon, you will have several run sessions per week, some of which will be long and take hours out of your day, giving you less time to dedicate to strengthening. However, you need to be strong to be able to withstand the increasing demand of upping your mileage as your training progresses. Using your time wisely and getting into a strengthening program before you need to start thinking about how you are going to get the miles in, is your safest bet to build a solid base to build those miles.
The repetitive load of running and the increasing demand on your musculoskeletal system require you to be nice and strong.
It is not enough to think you can rely on gradually getting stronger as your miles rack up. A marathon program will push anyone to their limits and should be respected. Training is specifically designed to challenge your stamina and endurance, as this is what most people will need to work on to complete the marathon distance. However, distance running training programmes are generally not designed to build strength or power.
Strength is different from just tapping out the long miles and requires a different type of training. Not many peoples’ bodies, or diaries, will be able to tolerate the demand of introducing both increased mileage and strength training at the same time. That would be a prime recipe for injury! as would not doing strength training at all.
Benefits of Strength Training on running
- The stronger the muscles are the better they are able to withstand the forces the body is put under when running.
- Suboptimal strength of the muscles will lead to excess stress on the joints and other soft tissues.
- Relatively weak muscles do not tolerate new stresses well and can quickly become painful when overloaded.
- Strength training aids the speed of recovery once the mileage ramps up as your body will be more conditioned to the forces being set against it.
Getting a decent strength training program underway now will help to ensure you are up to the task of getting through your marathon training program.
It gives the body a gradual ramp-up of loading and a chance to get used to being under more physical stress. If you are a seasoned marathon runner who knows they have the miles in them then strength training will likely be the thing between you and a new PB for next season.
Running Trainers- the difference between Neutral, Stability and Motion Control Trainers. Is it important?
Shopping for running trainers is a minefield. It is hard to know where to start, let alone what you should end up with! The trends and the technology are changing all the time and on top of that many runners still want something that looks good.
First off let’s start with what all the different types mean.
Motion Control: These shoes are typically the most rigid and heavy shoes available. They have more support and cushion than other running shoes. They are typically recommended for people with flat feet, or who are heavy runners.
Stability: Stability shoes are recommended for people who overpronate. This means your foot tends to roll inward slightly when you are running. They provide a slight arch support in the sole and have firmer material along the inside edge of the shoe to help control the amount you roll inwards.
Neutral: As the name suggests, neutral shoes are designed for people with a neutral gait, who have fair foot posture and mechanics. They tend to be middle of the road for support and cushioning.
Minimalist/Barefoot: These shoes tend to have little to no cushioning or support. They are meant to mimic barefoot running as closely as possible while still providing the protection from a sole. The sole tends to be completely flat and very supple. You need to have fair mechanics and already be strong to tolerate this style of footwear. They require a very gradual approach to introduce these into your running and are best for shorter runs and sprint sessions.
If you are new to running buy something comfortable and progress yourself slowly, even if you’re finding it easy at first. 10% increases per week maximum and ensure you are niggle free before any increases in training.
If you have been running a while now and are thinking your trainers are looking like they need an upgrade you can plan this in a little more detail. Match the shoe to the type of running, distances, your body type etc. to get something that meets all your demands. If you do different types of running (trail, distance, speed, track work) you will need different types of trainers.
If you have an injury and are thinking new trainers will be helpful (due to advice or if your pain started within a few months of wearing your current trainers) then considering your foot posture and how you move may be helpful to guide you in this. If you have any doubts or are unsure on how to get this right then pop in for an assessment with one of the physios.
If you are an experienced runner and have been running well and injury free and are looking into getting some new trainers … then go and get hunting for the exact make and model you currently have! If it isn’t broke then don’t try and fix it.
Triathlon Coaching – Running Off The Bike
Anyone who has ever competed in (or trained for) a triathlon or duathlon knows the horrendous feeling of heaviness in the quads and the jelly legs as you leave the bike rack and enter the run.
Your free-flowing running gait, which was the hallmark of your style when you ran fresh, becomes nothing more than a pathetic and painful shuffle as you struggle to maintain contact with those with whom three minutes earlier you were riding shoulder-to-shoulder.
We have all been there! Take heart: there is hope. By undertaking a couple of practices and incorporating them into your normal training regimen, you can improve your running off the bike.
So what’s happening in your body? Well, it’s a clever machine. Firstly, it will automatically direct blood to where it’s needed. Unfortunately you use different muscles when you ride than when you run. In fact you experience what sports scientists call a vasodilatory effect – or shunting – to the capillaries and the blood vessels which are servicing blood to the muscles. What this means is that blood is not able to get to the running muscles (calves especially) quick enough. As a result, your legs feel heavy and weird as a consequence.
Secondly, your muscles will respond to any demands put on them. In short, an athlete who isn’t practised in the art of transitioning will be slower and less efficient to respond. When you are riding your brain is telling your body to act in a peddling motion for cycling. Quite simply, you do not give your body enough time to respond to the new command when you get off the bike and start to run.
During training, incorporate at least one “brick” session into each week’s schedule. By definition, a brick session means a ride followed immediately with a run. This will force your legs to get used to firing the appropriate neural pathways and shunting blood from previously active to previously inactive muscles a lot quicker, without the pressure of competition.
When considering bricks in your programme, think about the aim of your session. If you’re just trying to get your legs used to running after a heavy bike ride, then this can be done weekly by a short run off a longer bike ride. If you want to maintain or develop race pace through the run, then higher intensity bike/run repeats could be the order of the day. In this case you may wish to use it as one of your high-intensity sessions of the week and provide suitable rest and recovery both before and after the session.
Brick sessions
The following sessions are designed for athletes looking to improve their bike-run performance at their goal race distance…
Sprint triathlete
Target: To deliver a good-paced run from the start.
Duration: 1:15hrs (including a 10min warm-up and 10min cool-down).
Focus: 4 x [5min bike at race pace, 3min race-pace run, 5min easy spin]. Get into your race pace on the run quickly. When running hard off the bike, drive relaxed arms to get legs moving quickly.
Olympic triathlete
Target: To run strongly despite having a tiring body.
Duration: 2:15hrs including 15min warm-up and 10min cool-down.
Focus: 20min run (steady)/30min bike (hard)/15min run (moderate)/30min bike (hard)/10min run (hard).
Middle distance
Target: Develop and improve running off the bike at race pace.
Duration: 2:10hrs including 15min warm-up and 15min cool-down.
Focus: 2 x [30min bike (15mins easy, 15mins race pace), 20min run
(3mins quick feet, 14mins race pace, 3mins just above race pace)].
Long-distance
Target Practise running when tired. Possibly a little out of left field for some but running when tired is an important skill for long-distance races. Adding a swim before the run not only helps the body shift blood from arms to legs but increases the session duration by adding an hour of low-impact exercise.
Duration: 3hrs.
Session: 1hr swim to 2hr run.
Recording Your Mindset
If you’re like most athletes, I’d guess you’re keen to experience regular improvement in your endurance, speed and enjoyment of training.
So I was wondering…do you keep a training log? 
It’s a widely accepted fact that keeping an ongoing summary of your workouts can shine valuable light on recurring themes and patterns that are either supporting your improvement, or preventing it.
So if you don’t, start now.
(Obviously I use Triblogs to track everything.)
And when you do store the info, what do you include?
The most common areas are distance, time, pace, heart rate and description of the workout.
Smart athletes also record how they felt, for example, things like ‘sluggish’ ‘heavy legs, avoid the curry the night before…’ or ‘really good and light on my feet’.
But those that make the most steady improvements, that overcome ‘plateaus’ and shake bad habits quickly, also track their mindset from each session.
I would encourage you to do the same, starting now.
Here are 3 ways to build awareness of the pattern of your mindset and its impact on your experience.
1. Nature of your thoughts – were they more positive, more neutral or more negative?
Triathlon training is often a time to escape other parts of life and our mind uses this time away to think things through. But if you bring stress, worries, a massive to-do list into the pool or road, that is like wearing ankle weights. Without realizing it your posture, effort and technique is likely to be suboptimal and you end up feeling extra drained at the end of the session.
Even if you do have challenges in your life, you always have the choice to be fully present in your workout and focused on making it a positive session.
2. Direction of your thoughts – was your mind going to distractions or performance cues? What were you focusing on?
It’s ok to let your mind wander somewhat but if you never direct your attention to how you’re executing, do you think you will improve as much as you can?
Stay engaged in your workout, set goals for each workout and have a plan to make it a great one! Obviously sometimes it’s really worth going out to escape life – we all do it. But make sure that the majority of sessions are done with an aim in mind, training toward a particular goal.
3. Number of thoughts – was your mind racing or was it fairly calm? How much mental energy were you expending in that workout?
When you catch yourself rushing in your mind or becoming overloaded with thoughts, gently bring your focus back to the purpose of the session and keep a nice steady breathing rhythm. Avoid the habit of checking your watch every minute and instead use your training to clear your mind, to release tension and enjoy the time you have.
The Performance Matrix – You clean your teeth but do you do retraining?
Look after your body like you look after your teeth.
Most of us regularly visit the dentist for a check up. We take advice on oral hygiene and even have a scale and polish. We then try to maintain things with regular brushing, flossing and use of mouth wash and then revisit the dentist 6 months later to get checked out again.
So why don’t we treat the rest of our body with the same respect and do retraining exercises to improve our musculoskeltal health? In part it is because it’s new and not the norm, we don’t know how to look after ourselves and also because bad breath and missing teeth are socially more noticeable and less acceptable than a few aches and poor posture .
The Performance Matrix is an effective screening tool to help identify movement faults within the body. We can then prescribe simple exercises (retraining) to correct these faults that can be done for 2 minutes twice a day to help improve our physical well being. Find. Analyse. Fix.
The philosophy is simple. We just need the dedication to help ourselves lead a healthier lifestyle.
https://www.thephysioclinicbristol.co.uk/the-performance-matrix/
Pad/Tablet User?
Recently I am seeing more neck, thoracic and arm pain related to the use of tablets/iPads etc.
Patients need to be more aware of the position and posture they adopt when using phones and tablets as unlike desk tops they are not designed to be used for extended periods.
Pete Tang BSc MSCP
Chartered Physiotherapist
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