Category Archives: Triathlon

Knee of little faith #01

It’s happened. After merely a few days of setting my (annual) New Year’s resolution of ‘don’t get injured’, I appear to have fallen at the first hurdle. Not literally thankfully – that could be messy – but I’m certainly not in one happy piece. 2015 is set to be my biggest athletic year to date with, at the very least, 2 marathons, a half Ironman and full Ironman, so, naturally, I panicked that the Ironman dream was over.

I am suffering with, what felt like, a twisted left knee; discomfort around the inside base of the knee, but only whilst I am running. The initial cause is unknown, although it may have had something to do with my last pre-Christmas 35 mile run. Weeks of no running and rest, since then, have yet to alleviate the problem, or my bad mood. However, a miracle, in the form of a friend’s advice, saw me booking an appointment with local physio, John Stephenson.

After performing a few one leg squats on both sides, John identified that there was indeed a difference between my two legs; notably that my hip was dropping on my left, but not my right. He explained that this was due to the nerve paths on my left side, specifically the four lumber spine nerves that innervate muscles in my leg and foot. John individually tested each lumber spin nerve path (L1-4) on both my left and right sides, at various points on the leg, via the application of force manipulations (i.e. pushing against my knee in a particular orientation and telling me to push back), and then assess the corresponding strength of my response. Of course, the strength of my right side passed with flying colours, but John identified that my L2 and L4 responses (namely my knee and toe extension) were very weak on my left hand side, including a very unresponsive duff big toe.

Although the anatomical explanations involved are rather confusing, one target of John’s fix is to remove the tightness in the muscles at the base of my back, where these nerve paths originate. This will then hopefully begin to remove the tendency of my knee to bend in during my runs. For now, my homework is a simple exercise (split squats), as well as booking up a few follow-up physio treatments.

Safe to say, I am feeling much more confident, after hearing John’s diagnosis and expertise, that the future won’t be limited to deep heat and ‘rest’. More importantly, Operation Ironman is still very much go-go-go. Consider my resolution reaffirmed.

Knee of Little Faith #04

Surprisingly, after four weeks of sound running advice, postural adjustments and gentle manipulation, my knee of little faith has defied all odds and become, in comparison, an irrepressible preacher. In other words, I’ve made good progress with John and no longer require ‘fixing’ in the immediate sense as before. Its now down to me to take on board what’s been discussed and advised, and maintain accordingly. That meant today’s session was really a wrap it altogether, check everything is improving sort of session.

A key focus was some renewed gait analysis to assess whether my newly-adopted mid strike running technique was as I imagine in my head, and not in fact worse than my technique before. I have been out for two hour-long, fairly pacey outdoors runs in the last week to act as the crucial ‘can I run yet?’ tests, as well as testing out the new pose. Thankfully, I (and my knee) passed with flying colours, with no aches, pains or Kelloggs crunchy-nut noises present during or the days following. I did notice that the transition between my old technique to new was an odd feeling, mainly in that, for the first 15 minutes or so, I felt very unstable and a bit wobbly – probably because I was used to the feeling of landing on something equivalent to a large bag of clouds at each heel. However, once I got going, I soon felt the difference: lighter and bouncier on the feet, taller in posture and, overall, faster! A real success in my books. Fortunately, so too was the gait analysis. A significant improvement on four weeks previous. One take-away message that John did make, with regards to the analysis, was the circles I was making with my arms and legs (discussed briefly in past posts). Like the beloved Roadrunner, I need to bring my limbs in to my body more (shortening the pivot) to ramp up the cadence, which will ultimately provide me with more speed. Consider it done.

Overall, the last four weeks have provided me with some very insightful advice and help, which will hopefully steer the outcome of my biggest athletic year away from total disaster. I am certainly a happier and more confident triathlete because of it. I will make sure to keep you all updated with my progress throughout the year’s events and the gruelling training involved. For now though, all I will say is that Operation Ironman is very much go, go, go…

Knee of Little Faith #03

The focus was very much on footwork in today’s session – a very Strictly Come Dancing-esque affair. The aim of this partial paso doble was to establish the most ideal and body-friendly running technique: weight bouncing on the balls of your feet, slight incline forward, head up, tight core .etc. This avoids the infamous heel strike that many athletes will have encountered at some point in their career. With a natural forward incline too, the runner can utilize the wonder of gravity and literally ‘fall’ in to each stride, thus conserving additional energy that otherwise would be used to drive them forward. This is all neatly analogous to the result of barefoot running, that I touched upon last post. Since then, I have completed some short 30-minute barefoot runs and certainly noticed a difference in my running posture, as well as which parts of my body were now taking up the slack (namely, some burning calves). I could also see that to run efficiently, you needn’t have long strides, but small circular ‘pushes’ at a higher cadence – very much like the pushing leg when riding a child’s (or your own, if you’re fortunate enough) scooter. So, altogether, I should gradually develop a far more efficient, not to mention less-damaging, running style over the course of the year.

The exercise covered today was to visualise what the components of this desired running style were, and how each felt. It went as follows: Lean forward until you feel you are on the balls of your feet and your body wants to fall forward – very much like the Winslet moment at the front of the Titanic (although neither the arms nor Leonardo are necessary). Core tight and head up, to avoid a slouch. Lightly push out and pull back each knee alternatively in a running-like manner. Power-producing arm swings should be included too (swinging forward and back, not up and down), aiming not to let the upper body rotate too much as you do the knee movements – which, again, would waste energy. Hold one knee out mid-stride and allow yourself to give in to the forward urge of your body, falling in to several steps of a run. It should feel a bouncier and lighter gait.

And it certainly did. Lots to take away from this session and apply to my next training runs. John did mention that I need to disassociate my upper body from my lower when I run (and swim), as it has a tendency to rotate, rock and generally divert much-needed energy away from my legs. However, the way things are going leg-wise, I should be on track for a Glitter Ball trophy of my own…

Knee of little faith #02

Consider this the first petrol stop on my road to recovery. On today’s body-fixing menu was a starter of tightness relief, a generous portion of gait analysis and a sprig of athletic literature.

The tightness was to be relieved from my lower and mid-back, from which the aforementioned nerve paths originate. The nerves innervating muscles in my leg and feet come very much in one, unfortunately unyielding, length only. Therefore, the most direct (and, when fit and healthy, the normal) route of nerve to leg components is the best. However, the tightness in my back is distorting the nerve path into a far-less direct and convoluted route around my knee. Being one stubborn, unchanging length, this new nerve path causes a restriction in movement of both my upper and lower left-sided limbs, in particular directions. My hip also lowers to, almost, provide ‘slack’ to accommodate the new path choice. For my left leg, the path shift is placing more emphasis on the side of my little toes rather than the ball of my feet as a collective, when I push off whilst running. This in turns twists my knee inwards, and, hey presto, an unhappy triathlete. Miraculously then, and with equal delight and despair, the conclusion is that my knee, in fact, isn’t the problem child of this whole ordeal, but a mere victim of circumstance. John even checked for any extensive knee damage to no avail. (I feel I should apologise to my knee for my terribly unsubtle disdain towards it over the past few weeks). Anyway, after a good back-clicking session (similar to the sound of fresh snow crunching under the weight of car-tyre) I vowed to adjust my tightness-inducing student posture (‘the slump’) to something a little more back friendly.

Of course, with any good theory, some physical evidence is very much welcome. In my case, this came from the gait analysis. After just a short stint on the treadmill, several aspects of my running gait were highlighted. The first was this hip drop on the left hand side. The other, rather embarrassingly, was the presence of a definite heel strike – as shown in the picture. For this, I blame the years of being lulled into the welcoming arms of running shoe companies and their unnecessarily, cloud-like foam heels – goodbye technique! The (most enjoyable) method of altering this is to run barefoot, which immediately forces you away from the joint-clattering heel strike to the bouncy balls of your feet. This was proven by the Mexican Indian tribes outlined in Christopher McDougall’s best-selling book ‘Born to Run’, and their long-distance running prowess. Safe to say, I have already replaced my trainers with a poncho and pack of plasters.

Mid-stride evidence of a very embarrassing heel strike, found during my gait analysis ...
Mid-stride evidence of a very embarrassing heel strike, found during my gait analysis …

However, there is hope for me yet. Again, a simple posture change – namely from my lumbering, swimming-shoulder hunch to the upright, proud-athlete stance – left my running gait far more eloquent. There was even evidence of the preferred ‘cycling circles’ (more circular motion of my lower legs, which ensure mid-foot landing), as well as a nice forward tilt. Phew – I was beginning to reconsider my activity choices.

The preferred running gait: small circling legs, mid-foot landing and slight forward tilt.
The preferred running gait: small circling legs, mid-foot landing and slight forward tilt.

Overall, another very helpful and informative session to get me back on the highway to hell aka. Ironman Wales.

Rehab the body – not the injury!

Picture showing - London Marathon Finishers Medal 2013
London Marathon Finishers Medal 2013

Speaking at the recent Physiotherapists in Sports conference, former Olympic USA coach Vern Gambetta called on delegates to consider the whole body and the brain when treating patients. ‘If it hurts, we look for where it hurts, and we rehab the hell out of that, and leave the rest of it,’ he said.

‘You can see a lot by watching’ – Gambetta said, ‘We miss what we don’t see. Sometimes it’s as simple as watching someone from all sides.’

This approach resonates and underpins everything we do in the AAA-Physio clinic at Moti – Which is why we get great results!
So if your are stuck in a loop of; injury – rest – re-injury and can’t see a way out. Book some expert help from the Therapy Team at Moti

book Physio online LOGO

Athletics and Triathlon – Physio #2 800m Champs Winner

Both myself and my daughter have had physio from John.

My daughter runs 800m track athletics and following an injury to her ankle just before the SouthWest Championships visited John before the finals at Millfield, which following a couple of sessions with John she managed to win, we will be visiting John again soon to work on some technique training before next season. She is currently running cross country for Westbury Harriers and finished 3rd in Avon at the Tri Counties Championship

J. Reed

Athletics and Triathlon – Physio #1

Having visited John with a right knee problem prior to the Portishead Traithlon, I have with his help managed to complete 3 events without any further issue. John worked on my running technique and my back to great effect.I picked up a pain in my left knee a few weeks back following a hard track interval session, having rested for a week I then aggravated it again this Tue and decided to visited John on Thursday. Later Thursday I was able to run 10k without any knee pain, which I could not believe and have had no issue with today.

J. Reed

My self diagnosed ‘pressure’ knee injury – part 2

Prior to my first ‘full’ appointment with John, I decided to check out some more of his advice and exercises on his website, especially regarding posture at a desk. I realised that I had a tendency to sit very poorly, with a curved spine for hours on end and so already started to make a conscious effort to improve that. I had also started doing some more focused core muscle exercises while at the gym. This small increase in effort over a couple of days resulted in John commenting almost right away that ‘things had improved from last time.’ The muscles in my left leg and lower back were by no means equal in movement with those on the right, but were noticeably less tight.

So John started this session by once again checking the range of movement of my legs, lower back and, a bit more surprisingly, arms. Again, my lower right side performed well, exhibiting good movement and strength, whilst my left side was less flexible and weaker. My arms, however, exhibited largely the same movement as each other, showing that my problems stemmed from my lower back. At this point, through a slightly bizarre mixture of twists, rolls and squeezes, John stretched and ‘cracked’ both my middle and lower back. The improvement in my range of movement was noticeable immediately. I gained roughly 20 degrees of forward rotation in my left leg and a significant increase in strength, I was amazed! After this ‘manipulation’, we focused on exercises and postures that I should adopt to ensure that I strengthened my core and prevented the injuries from reoccurring.

While I always felt like I knew what a good posture entailed, John showed me that I had been slightly mistaken. My ‘good’ posture involved maintaining one single slight curve through my spine, rather than the outwards curve at the top and the inwards curve at the bottom. I was shown that, by raising roughly where the tag on my shorts were, I would achieve this desired ‘S’ bend. Since the appointment I have been trying to adopt this posture whenever possible, but it certainly takes some concentration and getting used to!

John then taught me how to perform a version of a ‘roll back’, a move derived from pilates that, as I understand it, is designed to stretch out your spine and strengthen your core. This involves sitting up, slowly collapsing and rolling back along your spine, before rolling back up to sitting. I was also taught the basis for how to run without bouncing, by maintaining a constant head height – achieved by reimagining how I carried my weight on the pads of my feet.

Alongside these exercises, John provided advice about some further reading, some improvements for my cycling technique and also the kind of desk chair I should consider in the future. It also turns out that John is pro barefoot running and that some of the techniques I was learning may help me achieve this in the future.

I have been instructed to bring my trainers to the next session, so I have high hopes of being able to run again soon!

AAA-Physio Meets Olympic Gold & Bronze Medallist – Martin Cross @ RACE Blokes (Big!) Breakfast Event – Bristol

Gold Medal Olympian Rower Martin Cross Meets John Stephenson from AAA-Physio at RACE

Dougie from R.A.C.E. Organised the first “Meet an Olympian – Blokes Breakfast Event” in Bristol – This event ran smooth – Like Triathlete Dougie’s swim stoke!! See him in action at the Lido Bristol or United Reformed Church Bristol BS8!

The Q&A Session with Martin Cross was a real insight in what its like, to sustain this level of performance,  over two successful Olympic campaigns – Gold and Bronze

The next R.A.C.E. Event in the Olympic build up, will be held in March 2012
for more information contact  Douglas Burnett United Reformed Church Bristol BS8