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A couple of thoughts about function and injury

So I read a couple of blogs last week, one really inspirational and one that I found a bit annoying. That is what blogging is all about I suppose. The first one (inspirational) was by @challengesophie and about how hard it is sometimes to get going in the New Year. Loads of pressure to set up and plan new challenges, build on last year, do better, go faster, run longer, etc, etc and sometimes it is just difficult to get going / where to start? The advice (or discussion) from Sophie was summed up with ‘baby steps’ and do not always do what everyone wants you to do but say ‘No’ if that is the best thing for you. Good advice. And last week at APC we managed to make a start on a list of things we need to sort out. We put together some details regarding our Spring courses and workshops we want to offer you. We split up the jobs and all came away with a good plan of action. A very positive step and some excellent offerings that we shall let you know about as soon as we finalised the details.

Now the other one! A good runner goes into a physio / podiatry treatment clinic and seems to get (not really bad advice from the podiatrist about their function but) what seems to be half the story and not really a good explanation of what is going on. Let me try and explain. As you may or may not know, I like to work in a really functional way. This means that I always try to link the way you are moving to the problems you tell me about. So if your hamstrings are always tightening up during a run then I aim to find out which bit of your function is the problem. What are you doing in your movements that is causing your hamstrings to tighten and be an issue? That is what I want to know and I am sure you do to. Now we have an excellent physio and sports massage therapist who can tell you how to stretch them out and massage them for you but they also do not want you to keep coming back in with your tight hamstrings. My point being that a podiatrist should be aiming to put this little lot together. Podiatrists working with sports people should not be just focusing on the obvious like a pronating foot but building up the bigger picture and explaining why THIS is happening and it is because of THAT and so you need to address THIS and THAT. If that makes sense.

(A quick aside – Pronation is not a bad movement, let’s get this straight. It is an essential movement to allow you to continue to move over your foot. Too much (whatever that means) could be an issue but there are various ways around that. How is the pronation linked to your injury? What is it about the pronating foot that is causing you the trouble – that is what you want to know. A blog for another day perhaps.)

What is important is understanding why you move as you do and the effect this is having on your whole body. For example your tight hamstrings will be stopping you from pushing off the ground efficiently, this will cause you to pull your leg forward with your hip flexors (so creating tight and sore hip flexors) and resulting in an over stride, a lean forward at your hips and arms crossing over in front of your body. Or are your arms crossing over your body causing you to lean forward and so you contact the ground in front of you which will then stop you from pushing off with your foot and therefore not stretching out your hamstrings leaving them tight! The fact is you have tight hamstrings but what is the movement that is causing them to be tight and how do you address this movement pattern?

The annoying part of this is that as a podiatrist we should be offering so much more than seeing a pronating foot and responding in the first instance with orthoses as the cure. We have to link the way the body is functioning to the injury and then treat the whole picture. As a runner going to see anyone about an injury you have try to make sure what they (the therapist) says makes sense and it relates to what you are doing. If you have a gait analysis work out what you want from it before you go in and make sure the person doing the analysis is aware of what you are looking for. You ‘runners’ have to put pressure on us ‘therapists’ to do a good job and treat you correctly. If what we say does not make sense then question us more until you get to the root of the problem.

One last point, be aware of the point that we often feel we get the best treatment if the person doing the treatment tells us what we want to hear!

Hmm so many questions but glad to have got that little lot of my chest. Happy running.

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