Marathon

Running Services

Optimise your performance…

Physiotherapy

Keeping you going is our number 1 goal…

As a London Marathon Injury Clinic for many years our expert team of Physiotherapists have developed the specific skills required to manage those injuries common to distance running. Using specialised tests and assessment methods your Physiotherapist will quickly identify the structure at fault and give you an in depth explanation of the pathophysiology. They will not stop there, a series of biomechanical tests looking at alignment, posture, running technique, muscle balance and neuromuscular control are also performed to identify the root cause of your pathology. From here your Physiotherapist will use manual techniques and individualised exercise prescription to treat the cause of your problem as well as the symptoms.

Together you will discuss your goals for the Marathon including training regimen and finishing time, then negotiate a program that keeps you on the road but also allows the problem to be treated as fast as possible. The overall aim is to help get you back to unrestricted running with minimal impact on your training.

Running Technique Analysis

Optimise your running efficiency…

Running efficiency and technique is vitally important in order to prevent injury and maximise performance. Common technique errors include over-striding, asymmetry, cadence, foot landing and posture but there are many others. As part of our dedication to provide a comprehensive service as a Marathon Injury Clinic we are lucky to have an expert Running Coach on hand. Running technique analysis not only provides assistance with those injuries where technique is the major factor, but also optimises the performance of those runners looking to achieve a PB.

The sessions include a detailed analysis of your current running form followed by exercises, joint mobilisations, drills and technique adjustment. You will be provided with ‘before and after’ videos as well as advice on footwear and training to facilitate the transition to better running.

Barefoot Running Coaching

Run like the Kenyans…

The foot evolved over thousands of years and is perfectly engineered for long-distance running in bare feet. However, excessive heel cushioning in the last 40 years has changed the running technique of those in the developed world to encourage a heel strike pattern. With the growing body of evidence, large shoe manufacturers are now producing many varieties of minimalist shoe and many runners are switching to the more ‘barefoot’ design. Simply taking off your shoes or replacing them with a minimalist pair will not remove the skill patterns you have acquired for heel running. If you want to switch to a more natural barefoot style, you will need to adapt your technique right through the kinetic chain. Your cadence and running style need significant alteration if you wish to avoid new problems and optimise efficiency.

Our fully certified VivoBarefoot Running Coach was personally trained by Lee Saxby, one of the biggest names in international Running Coaching, and will work with you to alter your technique from toes to head. Again, sessions will include video analysis with ‘before and after’ videos provided. Specific drills and mobilisations are used to alter your running technique to accommodate a barefoot strike pattern. Advice on transitional training will also be provided to ensure a gradual alteration in running technique, minimising the risk of injury. Read more about Barefoot Running

Sports Massage

Release those tight areas and recover quickly…

Maintenance
Specific release of the muscles that are commonly over-burdened by marathon training. Maintenance massages run periodically through your training to help you recover quicker from the long runs at the weekend, keeping you on your training schedule. You will likely already be feeling the strain in the calves and quads, there will also be excessive trigger points in the gluts,  lower back muscles and possibly the neck. Our Massage Therapist’s specific experience with runners mean they will focus the session to the areas most in need.

Pre-Event
Applying both to training runs in which you intend to push yourself, and the performance itself on race day, pre-event sports massage is designed to increase circulation and flexibility. This will optimise performance, prevent injury and reduce recovery time.

Post-Event
Again, this also applies to the longer training runs in which you burden your muscles more intensely to encourage their physiological adaptation. Micro-tearing of muscles as well as acid and lactate generation are inevitable with intense training. Our therapists will ease the aches and pains and release any specific tightness before it develops into a problem that could impede your training.

Common running injuries

Knee – ITB Syndrome


Pain is felt on the outside (lateral aspect) of the knee, it commonly comes on after a little while when running. Usually niggly for a while but will gradually get worse if not addressed and eventually will stop the individual running. It is caused by irritation of the fat pad or bursa just under the ITB on the outside of the knee.

Treatment is primarily focussed on identifying the biomechanical cause of the irritation. That is to say; kinetic chain, muscle balance and running form analysis. Foam rollers, stretches and ice are the usual ‘internet’ recommendations but these only address the symptoms not the cause, they also  have a very poor evidence base and ignore the individuality of the problem.

Knee – Patellofemoral Pain Syndrome (Runner’s Knee)

Pain is usually felt underneath the kneecap or in the front of the knee but can be felt more generally anywhere around the knee. Like ITB syndrome the symptoms come on gradually with more running but, unlike ITBS, pain is often experienced with other activities such as going up and down stairs. Maltracking of the kneecap (patella) allows the back of the kneecap to rub on the thigh bone (femur) causing pain.

Treatment focus is the same as ITBS as sub-optimal biomechanics cause the maltracking. Taping can be particularly effective to relieve symptoms and allow you to keep training, however, the underlying cause always needs to be addressed to give long-term relief.

Foot – Plantar Fasciopathy (Plantar Fasciitis)

Pain is felt under the heel and in the sole of the foot, it is aggravated by prolonged periods of walking or running and tends to be worse first thing in the morning. The Plantar Fascia is a band of connective tissue that connects the heel to the toes. The pathology is not well understood but many factors combine to result in degeneration of the plantar fascia. Initially reducing the symptoms is most important as when aggravated this is a very painful condition that will almost certainly stop you running. Your Therapist will use a variety of manual techniques to help settle the symptoms as well as identify and help you manage aggravating activities.

Again, addressing sub-optimal biomechanics, form and training errors is vital. Night-splints, orthotics and injections are often recommended on the internet but again this problem is different for everyone, there is no miracle cure and individualised assessment and management is essential.

Achilles Tendinopathy (Achilles Tendonitis)

Pain is felt in the Achilles Tendon or its insertion at the heel. It usually comes on gradually but can be asymptomatic until irritated by something quite specific. Like Plantar Fasciopathy, the pathology is not well understood but tendon degeneration appears to be related to loading.

Again, like Plantar Fasciopathy, this is a complex condition. Initially symptom management is the most important thing and your Physiotherapist has a range of tricks to reduce the pain. Eccentric loading exercises are often part of the treatment combined with biomechanical optimisation and running analysis. However, the internet will usually recommend ‘eccentric heel drops’, calf stretches and heel wedges – please do not do any of these before being reviewed by a Physiotherapist, this is not a prescriptive treatment and you are likely to make it worse.

Shin Splints (Medial Tibial Stress Syndrome)

Pain in the front or front/inside of shins. Usually comes on with the introduction of new exercise or increase in training. Can settle sometimes during the run but it will often be worse for the next run and painful the next day. The calf muscles (Soleus) and other muscles of the foot (EDL, Tib Post, FDL) attach to the shin bone (Tibia). An increase in loading of these muscles causes the attachment to the outer part of the bone (Periosteum) to become irritated and sometimes inflamed and/or degenerated (Periostitis, Periostaglia).

When you have shin splints on both sides and are new to running, treatment is usually correction of training errors and/or running technique in order to reduce the workload of the calf muscles (Our Running Coach may be a better first port of call than our Physios). When you are an experienced runner and/or the symptoms are only in one shin, the treatment needs to be more geared towards establishing the cause of over-recruitment of the calf muscles, and for this detailed biomechanical analysis is required. Ice can be helpful for short term relief, but calf stretches and arch supports as often recommended on the internet are an over-simplified approach and unlikely to work in isolation.

Foot Pain

Pain in the foot or heel when running is a common complaint and can be the result of a variety of pathologies; Tib Post Tendinopathy, Cuboid Syndrome, Peroneal Tendinopathy, Metatarsalgia, Morton’s Neuroma, Joint Synovitis, Stress Fractures, Talar Dome Lesion, Anterior or Posterior Ankle impingement. These are not all of them!
Treatment depends on the pathology and the cause. It’s different for every person and every condition but manual therapy, exercise prescription and technique/training adjustments are likely to be part of management.

Low Back Pain & ‘sciatica’

Another common complaint, low back with associated leg pain can often be exacerbated by running. However, ironically, it usually has little to do with the Sciatic Nerve. Pain can be felt as a band across the lower back or more specifically to one side. When aggravated it can spread into the hip, thigh, knee, lower leg and even the foot! It is usually referred pain from the back rather than nerve irritation but not always. Occasionally it can involve pins and needles, numbness or weakness.

Any structure in the spine can cause the pain (disc, joint, ligament etc.) and Physiotherapy will be aimed at establishing the cause of the pain and treating accordingly. Training errors are usually not part of the problem although running posture/form may be. Usually there are underlying biomechanical problems that need addressing.

Hip Pain

Hip pain is usually felt on the front of the hip itself, in the groin or on the outside of the hip, each of which is likely due to a different pathology (Femoroacetabular Impingement, Adductor Tendinopathy, Bursitis etc.). Not as common in running as in other sports but it does happen.

Much the same as back pain, Physiotherapy is aimed at finding the structure causing the pain and the biomechanical reason behind the problem. Treatment is very much based on the individual assessment findings.

All the above ailments can also be treated by Osteopathy.