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Couch to 5k is a great way to start out running or even to get back into running after some time off. It is a program that is designed to get you from doing no running at all to being able to complete a 5km run within approximately 9 weeks. This is done with a graded training plan requiring 3 sessions per week of 30 minutes. It is based around a basic return to run program of intervals of walking and running. It starts off with lots of walking and little bits of running and progresses you up to being able to run for 5km or 30 minutes without walking. It was started as an initiative to get people more active and to make running more accessible to non-runners. Lots of different people have taken on the idea and written a couch to 5k program so there are now lots of variations available. Some are in the form of a document you can print out and others come in an app you can take running on your phone. This makes them very accessible, but it does also mean you need to exercise caution when choosing which to use. Not all programs are the same and not all programs will suit you or your training level.

We will use this as an opportunity to go through some of the things you need to consider when selecting your running program.

– Check ahead through the whole program before you start. Don’t get caught out by a program that seems to start gently. To get you running within the promised time scale there may be a sudden big step up in training in the middle of the program. This is a recipe for disaster if it is too sudden.

– The couch to 5k program only focuses on the running training, there is no time built in for any other strength and conditioning. Many programs barely even include a thorough warm up or cool down. You may need to jazz up your program to make it personal to your needs and to include some much needed flexibility or strengthening.

– Couch to 5k is for people who are not currently running to get into running. It assumes that you are already of a level of fitness that is able to tolerate running. It is too literal to think that you can go from couch potato to 5k runner just by following the program. To be able to stick to a running program and not get injured it is essential for your body to have some level of strength and fitness prior to starting. If you feel you may potentially fall in or near the couch potato category it is best to spend 6-8 weeks prior to starting your couch to 5k program doing some basic strength and fitness work.

– For this same reason it is not well suited to the very unfit or the very overweight. Again, a specific fitness / weight loss program of graded low impact exercise will be necessary to get you to a level that is safe to start any running program. Activities such as walking, cycling, or swimming would be a better choice of activity to start with.

– For many people it will be necessary to adapt the couch to 5k program to make it more gradual and over a more drawn out period of time. This will give you more time for recovery and for your body to adapt to the new stresses, and it will give you a better chance at achieving your goals. This can be done by simply repeating some weeks before progressing onto harder sessions; or by adding in extra rest days to accommodate recovery or other required strength and conditioning sessions.

– It is normal and common to get soreness when starting out running and after hard sessions. Doing some simple stretches and maybe using a foam roller can help you to manage this. This will be something that you have to accommodate for within your program. If you are still sore from a previous session it is not wise to keep going. Take time to recover and stretch before continuing to progress. This may be a good time to repeat some easier sessions in stead of progressing.

– Its ok to miss a day. Don’t let it throw you off course. And don’t try to just miss it out completely. If you start to struggle doing 3 runs per week then put more rest days in between and make sure to work on some basic strengthening and stretches on your off days. If you miss a day then pick up where you left off. It is better to set it back and prolong the program than it is to skip sections and not give your body enough time to adapt.

– being able to run 5k isn’t everybody’s goal. Some people start running as they have signed themselves up for an event and need to achieve a different distance. Others just want to be able to run and a specific distance isn’t a necessary goal. There are other companies out there that have similar plans and programs to get you running. Do some homework and pick something that is best suited to you and your goals. Some examples to check out would be ‘Jeffing’, or the ‘None to Run’ program.

Everybody is different. We all adapt and change at different rates. There is no one size fits all. Do what feels right for you and progress at your own rate. You will get there.

People get given crutches for a number of different reasons. Depending on what you need them for can determine how to use them correctly.

It is also important to realise that crutches are hard work and will cause more damage than good if used unnecessarily or incorrectly. However, if you have been advised to use them by a healthcare professional, it is better to walk well by using crutches than it is to walk badly without them. If you have been given crutches by a healthcare professional they should have guided you whether they are being provided for full support to ensure you do not put weight through your leg OR that they are there just to support your normal walking. This is important to determine how much weight you should be putting through your leg and how much you should be putting through the crutches. If you are not sure then get in touch to arrange an appointment with one of our Physiotherapists, as this information is important.

In the UK the majority of people are supplied with elbow crutches.

These have a handle to put pressure through your hands and a cuff that goes around your forearm. These are most commonly measured to fit by adjusting the length so that the handle is the height of the crease of your wrist when standing with your arms relaxed down by your side. It is important to have your crutch at the correct height for you. If the crutch is too high it can cause excess stress your shoulder and neck, or worse can put you off balance. If the crutch height is too low it causes you to stoop forward and have poor posture, this can increase the stress on your wrist and hand and will negatively impact your walking pattern.

If your crutches have been provided to allow you to walk without putting any pressure on your injured leg then you will either be non-weight bearing (NWB) or will be touch weight-bearing (TWB). With NWB you do not let the injured leg touch the floor at all and all of the support comes from your arms through the crutches. If you are TWB then you can allow the toe of your injured leg to touch the floor but are not to put any weight through that leg. The weight still goes through your arms. Both of these techniques are used following some fractures or surgeries. It can be hard work to get around like this but it is necessary to protect your injury for a short period. It is not recommended to use this technique if it has not been prescribed as it greatly impacts your walking pattern.

The other use for crutches is to support your normal walking pattern whilst taking some of the pressure off. This is commonly prescribed as weight-bearing as tolerated (WBAT). This means you use the crutches alongside your injured leg, whilst maintaining a normal walking pattern, and put as much weight through the leg as pain allows. This allows you to maintain a good heel-toe walking action and a nice even stride length, which will minimise the risks of secondary problems that come from spending time on crutches. If allowed this is a much healthier way to use them. Try to keep your hands soft and your shoulders relaxed as much as possible.

To get the correct gait with crutches you should always aim to keep your crutches alongside the injured leg. The easiest and most supportive way to use them is with a ‘step to’ gait. This technique means you place both crutches and your injured leg out in front of you then take a small step with your uninjured leg so that it is also level with your crutches. This small step allows you to put minimal weight through your leg without putting too much stress on your arms. The next progression is a ‘step through’ gait, this means you step your good foot out in front past the crutches to mimic a more natural walking pattern. This will allow you to walk a little faster and more naturally but requires more balance and ankle mobility. Progress to this gait as able and increase your stride length as able as you improve.

As you improve and your injury heals there will come a time when you need to progress off of the crutches and back to walking without them. This is best done gradually. Once you are able to walk with a good, even stride length with a step through gait you can gradually decrease the amount of weight going through your hands. Once you feel ready you can progress to using just one crutch. Keep the single crutch in the hand furthest away from your injured leg and try to keep your body upright. Avoid leaning towards the crutch, by this time it should just be there for balance and minimal support. When you feel you are not needing to put weight through the crutch and it seems to be getting in the way you can try walking without it. Initially, it is best to do this in and around the house and for short distances in familiar environments and to keep a crutch for longer walks outdoors. At the very least crutches are a good visual aid for others in public to not bump into you. You may find at first that you are only able to do short periods without the crutches. This is perfectly fine to do some time with them and some time without. This will allow for a gradual progression back to longer periods of walking unaided and will minimise discomfort and the temptation to limp. It is better to walk better with a crutch than it is to walk badly without. Walking should be a subconscious skill when uninjured and can take some practice to relearn.  Learning to walk well again requires lots of repetition of good habits and good technique.

For help with your crutches and injury rehabilitation, book an appointment with one of our experienced Physiotherapist by calling us on 01454 540066 or booking online.

Going in for surgery that is not in an emergency situation is called Elective Surgery. This is pretty much any surgery that you are on a waiting list for. In physiotherapy we commonly see people before elective musculoskeletal surgery for pain management and to ensure they are as strong as possible, this makes the recovery post op a little easier. We will then see them again post op for a period of more comprehensive rehab. For many NHS musculoskeletal scans and surgeries the waiting lists can be long and using this time to educate yourself about what to expect when you have surgery and what you can do pre op to make your recovery quicker can be very beneficial.

One common injury we see in clinic that gets put in this situation is an ACL tear. This is a tear of one of the ligaments within your knee joint. It is most commonly done during deceleration and twisting on a planted foot, such as in football or a fall when skiing. Often these can present in clinic as acute swelling and reduced range of movement when someone is struggling to recover from a knee injury, we then send them off on their journey of scans to confirm that it is the ACL, determine whether they have damaged anything else within the knee in the process, and to decide whether surgery is the best decision for them. If surgery is the management of choice they will then go on a waiting list and commonly return to physio in the meantime to get back on their feet and as fit as possible pre op. If you have private health cover this is also a good time to shop around and make sure you choose the best surgeon suited to your needs. Their profiles are usually available online or can be accessed by contacting your provider or the hospital you intend to use.

We’ll continue to use the ACL as an example of a surgery experience. The majority of elective musculoskeletal surgeries are being managed in hospitals as a day case, the ACL is no exception. This means you should be in and out on the same day. You should be required to attend a pre op health screening at the hospital a few days before your surgery to ensure you are fit and able for the anaesthetic. This is likely to include a review of your medical history and any medications. They will then check height, weight, blood pressure and may even require ECG, bloods or urine samples. These are all routine pre op procedures.

Most big surgeries will be done under general anaesthetic so this is the first bit you will go through to after you are all checked in. You will not have been allowed to eat from the night before so expect to be hungry. Once you are under general anaesthetic you are asleep, so are none the wiser, you just wake up after your surgery. Easy. You will need to achieve a post-op check-list after your surgery to be allowed home – this includes things like having something to eat, having a pee, and meeting the in house physio to make sure you can walk and get up the stairs. You are likely to still be a bit numb at this point so don’t be fooled that you’re not going to be sore. You will need to have arranged someone to take you home and keep an eye on you for the rest of the day. You should be able to get up and about at home but may be on crutches. It is common to be pretty sore and groggy for a couple of days but expect to find yourself back in the physio room to start rehab within a week or two of surgery. It is important to get stated with this early to give yourself the best chance at getting back to full fitness. It is essential to get the swelling under control and restore your range of movement as soon as possible.

You are likely to experience considerable swelling and bruising post op. The bruising should settle within the first couple of weeks but the swelling may take longer. Immediately following surgery you will be pretty stiff and sore for a few days to a few weeks and will likely experience limited mobility of your knee. This is all normal and your physio will be able to guide you with how you are progressing. Physiotherapy will initially focus on swelling management, returning your range of movement, getting you walking well, and getting your leg muscles active again. Any pain or swelling in the knee joint will cause the muscles around the knee to turn off, without the correct exercises this can slow down your progress in the early stages. Your physiotherapist will be able to guide you in which ones get the best results for you, and how to progress them when you’re ready. Just remember, you have had surgery, it is normal to be a bit sore during exercises, but this should get easier with regular daily practice. Monitoring your swelling and pain at rest can be a good indicator on whether you are pushing yourself too hard. A puffy knee is normal for a while, but if it balloons after exercise or spending prolonged time on your feet then you are overdoing it. Work within its limits.

Foam Roller

It’s all in the name really, it is a cylinder of dense foam that you roll around on to massage out any muscle tightness. You place the roller on the floor and the offending body part with the tight muscle on top of the roller, then using your body weight to apply pressure and the limbs not being rolled out to help move you over the roller you roll up and down. It can be pretty uncomfo

rtable to start off with but if it is used with a manageable amount of pressure, and regularly, you can really start to feel it working and it becomes less torturous. If you are new to exercise you can build some pretty good upper body and core strength just from trying to move yourself around over the roller.

Massage Ball

These come in all different sizes and textures. They can be used in a similar way to a foam roller or even used up against the wall or on a hard chair. They are great at getting into smaller, more specific areas than the foam roller such as glutes and around shoulder blades. You can also use a ball for some areas with just the pressure of your hand – such as rolling it over forearms. It can be great for massaging the soles of your feet too, just place it on the floor and roll a bare foot over it.

Tip: using them up against the wall is nicer and easier to manipulate than on the floor. Place the ball in a long sock or pair of tights and throw it over your shoulder – that way you have a good handle on it to keep better control and stop it from falling.

Another tip: any firm ball will do – tennis ball, lacrosse ball, squash ball, golf ball, even a decent dog ball – they all have their uses when it comes to self-massage.

Compex

This is an electrical device that you can rent or buy for home use. It can also be used to compliment your gym sessions. It is an electrical muscle stim machine that uses low level electrical currents to simulate your muscles. The Compex machine has many different settings and can be used for strengthening, improving circulation, post exercise recovery, and pain management. We have got several machines available to rent on a monthly basis from The Physio Clinic and you are able to purchase a Compex machine from us. For more information call 01454 854466.

Massage Gun

Not as scary as it sounds. Massage guns come in a variety of sizes now from more industrial heavy duty (we have 1 in clinic, come and have a try!) to lighter more compact travel options. A firm massage head, usually in the shape of a ball about golf ball size, moves in and out of the massage gun at high speed, providing targeted massage to areas of tension or soreness. This targeted approach allows you

to have complete control as to how much pressure you use, working to increase blood flow, improve range of movement and reduce soreness.

Peanut Ball

This is a peanut shaped ball, again they come in varying sizes. Some people find these easier to use as they are less inclined to roll away and can be easier to keep control of. They are also great to get down either side of your spine without putting too much pressure on the bony bits in the center of your back. They are used in the same way as a foam roller or massage ball.

Tip: taping 2 tennis balls together can be a great homemade version to trial.

Massage Stick

If rolling around on the floor isn’t really your style then a massage stick is a great alternative.

They can be great to apply pressure to areas that you can’t quite get to with a ball or foam roller, or that needs a bit more precision to pin down the right muscle. They require you to use your hands on either end of the stick to apply pressure and direction and work similar to a rolling pin. Tip: you can actually just use a rolling pin

All of the above gadgets vary in size and material. They range from smooth and fairly soft for a more gentle approach to knobbly, spikey hard plastic for a more intense experience.

They all work on the idea that the smaller the surface area you are working with the deeper you will get into the tissue. If you choose a small hard ball to roll on you will be able to work deeper into the tissue, but done too soon this may be too uncomfortable. It takes time and repetition to loosen of muscle tension and needs to be done gradually. Many people who find this kind of self-treatment beneficial will start with what’s manageable and progress to something more intense as their muscles get looser.

Trigger Point Stick

This is a specially designed stick to help you apply pressure on those hard to reach trigger points around the backs of your shoulders. It can also be used on other areas too. It is a big long S shaped stick with nodules on and the specially designed shape makes it easy to apply pressure to those hard to reach areas with minimal effort.

Tip: A homemade version of this can be to use the top of a hooked walking stick or a curved umbrella handle.

 

If there is any area of your body that you think would benefit from some regular self-massage but are finding that the above gadgets are not hitting the spot then have a shop around online – someone will have invented something. These are just an example of the most mainstream and versatile gadgets that we commonly find ourselves recommending to patients.