Leaving the NHS and life as a "phlegmy physio" for the world of musculoskeletal is a significant change in tack on the career path for a physiotherapist. 

With the first week of my new job completed, I am pretty excited about becoming a skilled MSK physio. To begin this transition, I thought it would be a good idea to attend the "Running Repairs" course last weekend. 

As both a runner and physio, running injuries have always been of interest to me. Led by "The Running Physio" (@TomGoom) at the Circle Hospital in Reading, it was a no-brainer to sign myself up.


Why "Running Repairs" is essential for your physio toolbox 

With 2.2 million people participating in Athletics on a weekly basis, it's England's second most popular sport (Sport England, 2016). It's also an essential element of the majority of sports and quite frankly, life as a human being. Let's face it, we are a designed to run (even if you choose not to). 

Unfortunately, with running comes injuries. Elite marathoners, Premier League Footballers, Army officers, seasoned parkrunner, couch to 5k'er. It's inevitable for most when training load exceeds tissue load capacity, pain and injury can occur (Tom Goom, 2015)

Where is the potentially injured runner's first point of call? 

The physio! 

For us, that "broken" runner (even if they don't call themselves a runner) is a common complaint we see hobbling (often kicking and screaming) through our door. 

Running injuries, kind of a big deal. We need to know how to deal with them. Take it from me, the actual injury tends to not be that complicated but it's managing the athlete what's most tricky (and after all, we treat the person, not just the injury) 

"80% of running injuries are caused by training error" - Tom Goom 

The 2 days cover a variety of key areas including assessment, common injuries, and gait assessment. With case studies, video analysis, gadgets, exercise prescription brainstorms and plenty of discussions (some over beer), it's awesome for anyone working with runners. 

Key points that will change my practice 

Without any spoilers, here are my take-home points, but really this is only a snippet of what I learnt over the weekend. 

Nail your subjective assessment - Get to know your athlete!

Unpicking the athletes training regime, lifestyle and beliefs will often make the cause of the injury obvious. 

Training diary, stress, sleep, work/life balance, diet and attitude/misconceptions e.g. "Joe can run 100 miles a week, why can't I?"

It's also really important to gain an understanding of the importance running holds to the athlete and their goals 

What are they working towards? When is their "A" race? 

Running is a way of life and often a coping strategy for many. Not being able to run may have a huge impact on their wellbeing, which brings me onto the next key point....

Keep your athlete running (where possible) 

Obviously, if they have a bony injury or an incredibly irritable problem this wouldn't be appropriate. Generally, it's important to keep them running by adapting their training and perhaps utilizing cross training. Don't forget, running is rehab!  

Education, Education, Education! 

The cornerstone of our role as a physiotherapist. Reassurance/information about their injury, advice about returning to play and training tips for further injury prevention are a few areas we should cover 

Check out the Running Physio's "Top 8 Tips on Avoiding Injury Through Training Error"

Gait Re-education - If it ain't broke, don't fix it? 

Even if they run like Phoebe if it's working for them and they're not getting injured, would you change it? 

Forefoot striking and having that magic 180 cadence isn't optimal for everyone. If drastic changes are made, the load will be significantly changed and guess what might follow? 

If poor running style is contributing to an athletes injury or tweaks are being made for performance, it's important that these are done gradually. 

From a personal note, I drastically changed my foot strike from heel to forefoot a few years ago after reading "Running with the Kenyans. 

It switched the load and my niggles from my hips to my calves. With analysis from Run 3D, this became very obvious with my lack of dorsiflexion on footstrike. This change in load contributed to a tibialis posterior tendinopathy and the fibula stress fracture (I mean, who fractures a non-weight bearing bone?!) Throughout my rehab, Run 3D gave me some strength work to help manage this extra load onto the posterior chain. Now back running, this strength work combined with running drills has helped my tissues tolerate this load. So far, I've not been having any issues! 

S&C and exercise prescription are core to rehab and injury prevention (BUT, treatment adjuncts can ASSIST injury management)

Exercise prescription and education is always my number one priority as a physio. It generally has better evidence in the literature (however, science changes pretty much on a daily basis) Although, short-lived, treatment adjuncts like manual therapy, soft tissue work, taping etc, etc can be used when needed. It should never be used in isolation, but it can be helpful for getting patient "buy-in", reducing pain and helping the movement to facilitate rehab - however, alongside the explanation that hands-on treatment WILL NOT fix their tendinopathy on its own.  

Huge thanks to Tom for such a great course. 

I'm looking forward to putting my new knowledge and skills into practice.