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Has knee pain stopped your running?

Do you experience knee pain when running?

If you have answered yes to the above question then this blog post is for you! Today we will focus on a very specific yet common issue that is the problem of knee pain whilst running. This blog post explains why this occurs and gives you the advice and tools to prevent knee pain during exercise.

I think it is fair to say that running and taking part in challenges such as Tough Mudder or Run’a’muc have seen a steady rise in participants over the past few years.

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Adventure racing in Dingle

Quest Adventure Video Series

This video series covers anything to do with running, cycling and kayaking.

1: Posture on the bike. Important to get this right in order to reduce risk of low back and neck pain.

2: Why a level pelvis is important for running and how to work on this.

3: The art of running downhill. Some do’s and don’ts worth remembering.

4: Top recommended exercise for Runners, Cyclists and Kayakers

5: Common knee pain with running

6: Hip mobility with some added humour!

7: Top 5 tips with 5 days to go before your Adventure Race

Ring of Beara Cycle Kenmare

The Ring of Beara Cycle Video Series

This 8 part video series covers a variety of topics around cycling.  From how to fix punctures to appropriate strength exercises.  Enjoy.

1:  How to change a tube after a puncture.

2: How to maintain your chain and how to use your gears more efficiently

3:  The three most appropriate strength exercises for cyclists

4:  How to change your cleats on your bike shoes

5: Clipping in and pedaling technique

6: Lance SnowArmstrong Physio Bike Fit – Special Edition

7: Bike Handling

hockey strength exercises

Three important exercises for field hockey players

Single Leg Romanian Deadlift. Very important to get the hamstring strong in a lengthened position. As this is the position the hamstring finds itself when controlling the ball in field hockey.

Lunge for strength exercise. This is such a common position in hockey, so it is wise to strengthen up the muscles that co-ordinate this movement in order to reduce risk of injury and to improve performance.

Lastly, a low back mobility exercise that ensures normal movement at the lumbar spine, since hockey players find themselves in a rigid low back posture a lot when playing, they are at a higher risk of developing a abnormal movement pattern at the low back and so increase risk of back pain. This video shows what normal movement is and how to practice it.

knee tendon pain

A lesson (at my expense!) for future adventure racers

A Physio’s Feedback.

I write this now, exactly 6 months to the day that I over-cooked my tendons on mount Brandon! Most days of my week are made up of chatting to patients about a very important topic called load management.  This basically boils down to a simple rule to follow which is “Don’t shock your system, fool it into thinking that nothing has changed”.  Did I practice what I preach? No, not at all. My body reminded my brain of my mistake for the bones of nine weeks after the DAR, and only then did my goose’s foot calm down entirely.

If after reading this first paragraph, you find yourself confused and questioning the writer’s sanity, all will be revealed in what I hope you will find to be an interesting, educational and light-hearted article on preparing “properly” for an adventure race.

I’d like to explain the goose’s foot thingy first,  just so that we can rule out any Nazi Germany connotations or animal cruelty for that matter!  The goose’s foot, or its latin name “Pes anserinus” is the attachment point for three tendons in the body.  They attach to the inside of the knee.

Tendons on medial aspect of knee    knee tendon pain

The goose’s foot (supposedly shaped like one) makes itself clearly heard when it is rightly pissed off.  I’ll get to that bit later.

This was my second attempt at the DAR, the first time was back in 2011.  This year was different in that I challenged my wife to a duel.  We were going to compare times, and Aisling had the luxury of subtracting 40 fine minutes from her total time against mine.  Although neither of us were doing much training (mistake number one), I felt overly confident in the cycling department.  Yes, the bike was going to deliver me from defeat.  I didn’t hold the same belief in my fell running skills – Ash has an innate ability to run downhill, it must be her Kerry connection.  She was born into a sheep rearing family with a mountain as their back garden.  The wager was made, the loser would have to drive both parties home to Glencar after the race.  Anyone who knows DAR, knows that there’s no shortage of Tom Crean’s beer cans flying around the finish line and how the magical Dingle vibe takes over once you’re down from the hill.

Finishers
Finish line, but you still can’t tell who won when there’s free beer!

Saturday 10th of June 2017 was a windy one to be fair, and with this came sad news.  The organisers had to cancel the kayak section for safety reasons.  I was semi-counting on the kayak section to give me an edge over my competitive other half, even though she occasionally brings up her certificate in kayaking from Cappanalea in 1999!

Recall mistake number one: not much training done.  I realise that I am not unearthing a new discovery in that not training enough is a mistake. I also realise that it is very, very common in the world of amateur endurance sports.  Sure, you’ll hear it from the punters on the morning of the race, ‘ah I haven’t trained enough for this’, much like not doing enough study for the English paper 2 in the Leaving Cert.  I want to get across what is happening to the tendons in particular when you push your body into unknown territory without sufficient gradual exposure.

Tendons are strong, in fact they are gram for gram stronger than steel.  Their role is to connect your muscles to the bone.  In order to do this role effectively, they need to be able to tolerate load/force coming in from the muscle pulling on its anchor site.  Now imagine the tendons in your legs as your ex-partner!  The same ex who wanted to go to the same restaurant, eat the same food, wear the same jacket and go to bed at the same time.   You see, tendons by nature, do not like sudden change.  They’re great at managing load once it is kept pretty consistent.  Or, you can trick them into thinking that nothing has changed by gradually increasing the load over time.  The same way you changed the time on your ex’s watch so they would stay up later to watch a movie!  In that instance, it would be wise to only bring the time back by a little in case they smell a rat.  Same story for tendons – if they smell vermin, they may react and give you a painful wake up call.

Sometimes, the tendons are able to adapt to a sudden increase in load, improve their structure and don’t make a peep.  Other times, they freak out and slap you across the face.  A lot depends on your habitual levels of activity and types of activity.  If you only ever go for a run at the weekends and sit at your day job for the weekdays, then the load absorbing qualities of your tendons will simply match that level of demand, putting you at high risk of tendon tantrums if you expose them to new loads.   If you do a moderate amount of flat running, a lot of cycling but no mountain running, as was the case with me, then your tendons will struggle to manage the new, unfamiliar load/force of running downhill.  As was the case with me!  I hope this way of explaining load management will better inform readers to introduce new activities gradually.  The couch to 5k programme is a prime example of this.

Back to the race, everything was going beautifully.  The bike section went well, I managed to build a nice gap between myself and herself.  Then came Mount Brandon.  No bother with the going up bit, just get the head down and lunge your way up till you see the cross.  Actually, that was almost an impossibility on the day, it was like a war-zone up there.  I can remember staggering across to a brave official at the top, who shouted in my right ear to stay close to the white stakes on the way down.  It’s very difficult to see white stakes in a white out!  I’m exaggerating a bit, but for anyone reading who was up there that day, I’m sure you’ll agree, it was a wild one!

Dingle adventure race
Sporting the hipster south-westerly comb over!

I started the descent full of beans, bouncing around like a wasp in a glasshouse.  Half way down, I noticed slight soreness to the inside of my right knee.  Noticeably, my right leg, the dominant one, was certainly taking on more of the jumps compared to the left one.  When you annoy your tendons, they don’t let you know there and then like a torn muscle would.  They tend to wait until that evening or the next morning, lulling you into a false sense of achievement and accomplishment at the finish line before bringing you back down to earth and into a physio’s clinic to find out what’s wrong with your knee.

For the next 3 or 4 weeks, I struggled to bend my knee.  This however didn’t take away from the glory of winning!  Even though Aisling didn’t take home the bacon, she arrived at the finish line battered and bloodied and proud.  Although, at the time of the photo, she didn’t know that she lost!

Dingle adventure race
Proud as punch’ed someone!

I couldn’t bend my knee fully because this stretched the tendons and that’s another thing angry tendons don’t like, to be stretched.  Next time your Achilles gives you pain, please don’t stretch it.  I was another 4-5 weeks of very gentle and low volume jogging before gradually bringing up the speed and distance.

The up and coming challenge is Quest Kenmare on the 10th of March next year.  This time there will be 6 of us all vying for top position.  I started my training last month, slowly introducing downhill running and hopping into my routine so that I don’t wake the Goose again!

 

John Phelan

MSc Physio, BSc Nutritional Science

www.lifefitphysio.ie

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ATTENTION ALL DUBLIN MARATHON RUNNERS

An insight into carbohydrate loading

Digest this blog like you do your post-run meals and you will be well informed of the science behind carbohydrate-loading in time for the big day.

Step one  –       Understand the Science.

When you run, your muscles require fuel to move.  This fuel is called Glycogen.  Glycogen is simply sugar stored with water in your muscle cells, and also your liver cells.  I can safely say that anyone reading this who has been training for months and eating well in preparation for the Dublin marathon will have bigger glycogen storing capacity in their muscles now compared to a time when you were not regularly training.  There is the potential to almost double the size of your glycogen stores with regular training and sufficient carbohydrate daily intake.  This is yet another added benefit to regular exercise, in that the more you do, the better your body becomes at doing it.

Carbohydrate loading is the topping up of these glycogen stores to the absolute max so that your muscles have a full tank of fuel on the day.  Why then is there the need for thousands and thousands of gel sachets available on the streets of Dublin come October 26th, because no human has a tank big enough to get around the 26.2miles without adding some more fuel into the furnace.  So whether you’re a glass half empty or half full person, in this instance, make sure it’s completely full.Read More

Back pain:don’t blame your bed, blame your head!

A personal story of overcoming persistent low back pain.

I hear this in clinic a lot, “I even bought a new mattress and it still hasn’t improved”.  The mattress that was minding its own business for many years, that provided many comfy nights, suddenly becomes the target of blame, and gets replaced at the drop of a hat! I am speaking from my own personal experience here also, having bought an orthopaedic mattress when I complained of back pain from 2001 until 2007 –  more on this later.  We are going to discuss the array of myths and public perceptions surrounding back pain.  An old mattress being a cause of, or contributory factor to back pain, is one such myth.

There is a brilliant article in the Irish Independent by an established Irish physiotherapist and researcher named Kieran O’Sullivan Read More

Knee pain when running. Part two. What to do.

Welcome back to Madison Square Gardens for the fight of the century.  The bell has just sounded to signal the boxers back to the ring.  I can tell you now, it will need to ring a little louder to wake up The Tendon Tornado after the pounding he took in the last round!  Ground Force Frederick is commanding this fight.  The Tendon Tornado’s corner team should listen to the following advice to have any chance back into this fight.

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