Run and become……injured?

It’s that time again! Marathon feaver is upon us. The clinic is quite busy with injuries related to the first time marathon runner at present.

I am always interested in finding out what it is that has caused a previous recreational runner (5K once or twice a week) to up the ante and start knocking back the miles. During my initial interview, the first thing I quickly screen for is date of birth. Is there a significant birthday looming/just passed?

So the bad news is that because you are demanding more from your body, sometimes having given it quite a healthy period of time out, it’s highly likely that at some point you will exceed your capacity to cope, i.e. you will get some aches and pains. The good news is that you are not a washing machine – you are self-repairing given the right circumstances. Hooray!

So here is some unusual advice for you first time marathoners. Boosting recovery and avoiding injury can be boiled down to 3 simple facts. Be fit, happy and healthy. So as you drag your tired, aching body around the streets of this beautiful city, don’t forget to lift your eyes from the grey road in front and marvel at this rich tapestry of life that is London. Perhaps even smile. After all, it’s good for the sole(s)!

Pimlico Physiotherapy – thoughtful therapy for the SW1, Westminster and Victoria area

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Snow and strictly

I thought it was quite insightful of one of the judges of
strictly come dancing to compare the laborings of Ann Widdecombe to
our current weather conditions. ‘Like snow, its fun in the
beginning in the end you want it go away.’ quoth Len Goodman. He’s
right. The initial excitement that I felt over the weekend as snow
fell heavily and prettily has been tempered by the grey slush of
it’s present incarnation. In this business we are exposed to
seasonal injuries, and today I received my first snow injury. A
simple slip leading to a sprained wrist. Very soon I expect my
first skiing injury, and soon after the new year exercisers and
people upping their training for the London marathon will start to
limp through. It’s a calendar of pain and injury. Personally, as i
write this on the midwinter solstice, I can’t wait for the back
injuries of the first spring lawn mowing and the Wimbledon inspired
shoulder injuries of the summer! Happy Xmas to one and all Best
wishes Pimlico physiotherapy SW1 physio

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Chelsea’s John Terry – oh dear…

So it seems like Pimlico physiotherapy got it wrong. There I was waxing lyrical about the great management strategy Chelsea had for John Terry, based around a good biological understanding of the mechanisms contributing to poor old John’s leg pain, and no sooner is my electronic ink dry than I hear he is being whisked away to consult an ‘over-seas’ expert that I had previously derided! Apparently an Italian Chiropractor is the way forwards after all. If only I had known.

This puts me in mind of a time when I was working at QPR FC, where one of the players had some on-going hip issues, that were well known and ultimately manageable not curable. It turns out that someone higher up in the club had met an ‘expert’ that claimed to be able to cure this problem.

Next thing I know I am accompanying this player to see said expert where we endure a full 30-45 minutes hokum therapy, and leave, both of us, feeling slightly dazed and confused about what had just occurred, and equally, pretty much the same, if slightly tireder, than when we had entered.

That’s the trouble with experts. Everybody knows one, especially in a world like football. And when that someone is high up in the hierarchical foodchain, off the player goes whether everyone likes it or not.

By the way, if you want to spot a real expert, it’s easy. They are the ones you’ve never heard of and who don’t think they are.

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Chelsea’s John Terry

As a physiotherapist based in the Chelsea/Belgravia/SW1 area, I like to keep my eye on what my footballing neighbours up the street are up to. This morning I learnt that John Terry has a nerve injury that is causing him pain and may keep him away from football for many weeks or months.

Not good news for Terry certainly, but there are a couple of interesting points that this raises. First, lets consider the length of time it will take to get better. Now I don’t know exactly what the problem here is, but I do happen to know that Chelsea have an excellent medical team that know what they are doing. So even with the best medical care available, this problem is still going to take a long period of time to get better. This is important. No miracle cures, no ‘specialists’ on foreign shores, just a sound understanding of the biology involved in healing and the need to be patient.

Consider this example. Say you injure a nerve in your leg. Now normal healing of some injuries involve a dying back of the nerve to its cell body located in your spinal cord, a process known as wallerian degeneration. Once this process is complete, the nerve then has to grow back out to reach its target tissue which it does at the rate of between 1.5-1.9 mm (!) a day. This would be the best case scenario. Imagine then that this target tissue is in the foot. Given that some people, John Terry being one,  are over 6ft tall and that nerves are arranged in a spiral fashion as a means of protection, then we could be looking at a distance of up to 1.5m that a nerve has to grow. At a rate of less than 2mm a day we would be looking at a time frame of over 2 years for complete re-growth of the nerve! Even if the problem occurred nearer to the spine we would still be looking at considerable amounts of time.

The good news is that certain treatments do exist to help treat the pain that can result from nerve injury and repair. Great. But lets have a quick think about what else nerves do. Sensory nerves, are one part of a body system that ‘looks after’ you. So the tissue the nerve innervates can be thought of as a structure the nerve ‘looks after’. So what happens to the tissue in the absence of an intact nerve supply? Well there is research to show it becomes less healthy and may be at increased risk of injury. For example, we know that people who undergo achilles tendon rupture have a higher incidence of sciatica – a symptom that may suggest a problem with the nerve supply that ‘looks after’ the leg.

Interesting isn’t it? In football we frequently hear of footballers with a history of back pain and sciatica whose career then goes on to become blighted by recurrent muscular/ligamentous injuries. Could this be due to subtle nerve injury and the absence of a regulatory nerve supply for prolonged periods of time? It is interesting to speculate, not least if you are Owen Hargreaves or Michael Owen.

Can we get better at predicting injury and managing it more realistically? The answer is almost certainly yes. The problem is that many powerful individuals still make their living from more and more detailed assessments of’core stability’ and biomechanics, and although this is often a necessary component in their rehabilitation, it won’t all of a sudden speed up many of the physiologic processes required to make you better.

So what would the enlightened therapist do? In the case of John Terry it’s hard to say without knowing an exact diagnosis. But we know what sort of things can delay recovery (stress, worry, concerns, fears, beliefs, over ambitious therapy etc etc). So John Terry, if you are reading this, get better soon and I hope you are lying on your back in the sun with your loved ones around you.


Pimlico Physiotherapy: Thoughtful physiotherapy for the SW1 area

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Physiotherapy in Westminster

As the long winter evening draw in I have decided to hibernate in the comfy confines of Calmer Clinics.

Starting from November I will be increasing my hours at the clinic in Tuesdays and Fridays. I hope this will make things more convenient for all my clients.

Best wishes

Pimlico Physiotherapy.

Providing thoughtful therapy to the Sw1, Victoria and Westminster areas

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Thoughts from the courts

A friend recently pointed out to me that Barristers spend the majority of their time studying and preparing for court, and a relatively small period of time in court. Shouldn’t the same apply to physiotherapy? Shouldn’t I spend more time learning and thinking rather than doing?

The problem is that I don’t think the world is quite ready to start paying for the time a therapsit spends preparing for his ‘case’. Which brings me to the point of this blog. If I promote myself well, provide a good service and increase revenue, then I may be able to buy myself the time I need to study and be better at the things I do.

So if you see me in one of the many coffee houses dotted around the Westminster area, perhaps stop and encourage a refill and a continuation of my contemplations. For who knows, perhaps oneday I might learn something that will be of use to you or someone you care about.

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