Category Archives: Running injuries

London Marathon 2013

London Marathon 2013 | Dealing with the aches and pains

Most runners will have put in the hard yards by now and are set to go. Undoubtedly there have been quite a few aches and pains along the road so far. Sadly this will prevent some people from participating, say in the case of a stress fracture – click here.

It is entirely normal to experience pain as a result of exercising. We expect it after new or unaccustomed activity and recover quickly, often independently and sometimes with assistance (e.g./ physiotherapy, massage). The marathon will be no different as limbs and bodies will be sore on Sunday afternoon and evening, most likely building into Monday and Tuesday before starting to settle. This kind of sensitivity is an adaptive response to the demands placed upon the tissues and physiological systems. In essence it is the body asking for a rest, motivated by the unpleasant sensations.

If there have been more significant niggles during the training period, these may flare-up and require professional attention. For example an issue with a tendon. A diagnosis followed by a comprehensive treatment and rehabilitation programme will be needed to address such a problem or an injusy sustained on the day of the race.

For further information about post-marathon treatment and recovery please contact us on 07932 689081

Clinics in Chelsea – Harley Street – Temple – New Malden

Common running injuries include: shin splints, anterior knee pain, ITB syndrome, iliotibial band syndrome, hip pain, hamstring pain, calf strain, ankle sprain. We see the more persisting and recurring running injuries at our London clinics, delivering comprehensive treatment and rehabilitation programmes that are based on the latest neuroscience.

London Marathon

All stressed out – stress fractures in marathon runners | Guest blog

Dr Cath Spencer-Smith writes…

Marathon season is upon us, and thousands of runners throughout the land are in the final stages of training for their big day. For some, this is also the time when they find themselves experiencing new aches and pains. Whilst we may all expect to feel discomfort and stiffness from time to time, some marathoners may literally find themselves running into trouble, when they fail to heed the warning signs of a serious injury.

Stress fractures and responses are common, and may be overlooked because of the misconception that they only occur in skinny females. Any runner is susceptible to a stress fracture, particularly if they are relatively new to the sport, have gone through a rapid increase in mileage, or have poor biomechanics or muscular conditioning. If a person with a high level of CV fitness (e.g. from road cycling or football), then decides to switch to running, they can be at increased risk as they are able to push themselves hard. A stress fracture is a literally that- a kind of fracture in the bone, which arises when the bone literally weakens when it is overstressed. It is created either through impact forces (which focally overload an area of bone – a metatarsal), or through the forces created when muscles pull against bone (e.g. the fibula). This overload brings about an abnormal bony remodelling. A stress ‘response’ then ensues, and eventually the bone actually breaks. During this break down process, a runner will often experience increasing symptoms of pain – maybe at first at the end of a long training run, and then earlier and earlier into each successive run. Some stress responses can occur in the worst possible places, e.g. the neck of the femur. If these progress to a full facture, it can herald disaster for the hip, sadly sometimes ending in a total hip replacement in a person who may only be in their 30’s…

In additional problem we have to consider around Marathon time, is the impact of a stress fracture or stress response on the ability of a runner to be able to participate in the event, when race day comes round. This is probably the hardest part to deal with, for both the runner and the person looking after them. Sometimes, the injury is mild, and there is sufficient time to get runner recovered and robust enough to be able to race. This is sadly not often the case, and for many runners, the discussion of their diagnosis involves a conversation about pulling out of the race. The risks of participating with a high grade stress response should not be underestimated, and on the day of the London Marathon, several runners will literally try to push on through pain, and during the run, will succumb to a fracture.

When we think about the time and effort invested in training for a marathon, it’s no surprise that many runners are desperate to try to participate, particularly if they are running for a charity, or are running as part of a group. Wherever possible, we try to help runners get to the beginning of a race, provided it can be done safely. Each year I meet a runner who is determined to run, no matter what the risks, or potential fall out for him or her in the future. Some runners are cognisant of their symptoms, and yet choose to either disregard them or somehow justify that all is well. Worse still, others around them, including clinicians, can become embroiled in the process of this potentially disastrous decision making. How could, a sensible or experience coach or clinician allow this to happen?. Sometimes, the runner and his support group fall prey of two other ‘conditions’, know is ‘Groupthink’ and ‘Captainitis’.

‘Groupthink’, a term coined by a psychologist, Irving Janis, describes the process by which we can collectively, as a group, make a really, really bad decision. In essence, if we feel loyalty to our group (which might e.g. consist of the runner, their coach, a training partner, and sometimes a therapist), we want to achieve or maintain harmony. Let’s image that the runner finds him or herself in a situation, which brings about doubt – (e.g. ‘is this pain I’m experiencing a ‘tweak’ or a’ big problemo?’), or requires that an awkward decision be made (e.g. ‘is wise for me to keep training, and should I considering pulling out of the marathon?’). Imagine then, that the runner mentions his leg pain to his training partner, who is quick to dismiss it as ‘the kind of pain it’s OK to run through- just ice it’. The coach, who has seen his young prodigy blossom from couch potato to racing machine, is keen to reassure – ‘you’ll get round on the day’, and the massage therapist is quick to declare ‘look how it eases off with treatment – we’ll get you to the start line’. Outside views are purposely avoided by the group, and its members, keen to avoid upset or express concern, develop an inflated (and misguided) certainty that the right decision has been made. And then a leg breaks…

Sometimes the runner’s coach or clinician has their own malady to deal with, known as ‘captainitis’. Some of the individuals were interact with in our lives, may be very capable, and we may hold them in great esteem, or even put them up on a pedestal. We may sometimes believe that the wealth of their knowledge or experience dwarfs our own, which can bring about a strange hierarchy of opinions. When bowing to our ‘senior’ or ‘wiser’ Captain, we may literally choose suppress our own doubts and keep shtum, however personable or humble our ‘Captain’ may be. We feel we don’t want to speak out because our Captain is so capable. Surely Captain knows best? But what if the Captain has got it wrong?

In fact the more capable the Captain, the greater the risk of this. This may seem strange until we consider that the Captain in his capable, confident bubble may be unlikely to solicit the opinions and advice of others. He or she may make the decision for the group alone, not in an arrogant manner, but in a manner based upon the belief that the Captain is deemed to have the best skills to be able to make that decision.

So what advice should we give to a runner in pain, who is not sure of the cause or what to do? Firstly, it is important to own up to that there is a problem and not try to deny it. Seek help, and seek the help of experienced clinicians who are used to dealing with runners. Declare that you have a problem to your friends and family, and charge one of them with the responsibility of ensuring you do this, rather than entering into a collusion group-think situation. And how to avoid the sinking Birds Eye ship? …The answer here is to get your word in edgeways first. This means declaring that you are concerned that you might have a stress fracture, and that you believe you need to undergo some investigations. Do this rather than pausing for a response from the Captain at the point when you’ve finished discussing your symptoms. This will often be enough to trigger the Captain to reflect, and consider that you may indeed have a significant clinical problem… Never be too afraid to speak up, and remember that even if you have to sit this particular Marathon out, you only have 365 days to wait till the next one…


A big thanks to Cath for writing this piece. For further information please see the Sport Doc website here

Why do my knees hurt? Running injuries

Why does my knee hurt when I run?

The success of the London 2012 Olympics has had a huge impact upon society including the greater participation in sporting activities. This is a truly vital legacy and we must seek to pervade this healthy mindset to all corners of the country and across all the age ranges to optimise the benefits.

Those seeking immediate gratification will have pulled out the old trainers, dusted off the bike in the shed or grabbed the shorts (or briefs) and visited the local pool – see Get Active London. This is indeed a welcome shift towards more active lifestyles at a time when we have increasing understanding of the benefits of regular exercise for both body and brain.

Turning our attention to a consequence of either taking up running for the first time or re-starting having had a break, inspired by the mighty achievements of our athletes, there can be a few aches and pains in the knees. Sometimes the onset will be quick and at other times gradual. I will look briefly at why this can happen, remembering that when you increase your level of exercising it is usually quite normal for there to be some pain afterward. If you are unsure it is advisable that you seek the opinion of your local health professional as soon as possible so that the correct treatment and management is started.

Training methods

A sudden change in the demands upon our joints, particularly the knees in running due to the impact, can trigger local sensitivity in the joint and surrounding tissues. We should think carefully about the baseline, or start point from where the programme can be progressed. Too much too soon will hurt and especially if there is not adequate time between exercising bouts for a good level of recovery in the early stages. It may not be the first time out but the second or third that the pain begins.

The shoes that are used are vital. You do not have to spend a small fortune on the latest running kit but it is sensible to have a good trainer that is suitable for your foot type and provides the right kind of support. If you have pulled out an old, smelly pair of runners from under the stairs, you may have problems. Make a visit to a good quality running shop, for example Run & Become.

Where you decide to go running will determine the loading upon the joints. Start easily and gradually build up the time and speed, thinking about where you are training. Up and down hills and uneven grouns will pose more of a challenge of course.

Old injuries

If you have had a problem with your knees before, re-starting running could re-ignite the pain. It is not totally out of the question to take up running again, but you should ensure that the motor control, movement and proprioception is adequate and then gradually build the intensity. It will be best to seek advice in this case as there maybe some essential rehabilitation training that is required before starting the running programme.


There will be many people enthusiastically exercising as a result of the Olympics and this is to be commended. It is important to really consider how to start training, the baseline and progressions and using the right equipment.

If you have any questions please contact us here or call 07518 445493

London Marathon - Tower Bridge

Training for the marathon – developing pain & injury

London Marathon - Tower Bridge

At this time of year, as the London Marathon nears, runners reaching new levels of training can start to develop aches and pains. Usually the pains are in the legs or feet and often begin as an annoyance but develop into a problem that means training has to stop.

The tissues are constantly breaking down and rebuilding. This is a carefully orchestrated process that is impacted upon by exercise. This is how we develop muscle bulk. However, we do need a period of adaptation that can be disrupted if there is inadequate rest. The balance tips towards tissue breakdown and inflammation triggers the development of sensitivity that if ignored can progress and become amplified. A good training programme should account for both rest periods and gradual progression of intensity.

A second issue is that of control of movement. On a day to day basis we can walk around, undertake normal activities, play sports and even run for certain distances with minor motor control issues. Motor control refers to the way in which our body is controlled by the brain with a feedback-feedforward system. The tissues send information to the brain so that there is a sense of position and awareness, allowing for the next movement to be made and corrected if necessary. The problem lies in the increasing distances, often never reached before, that can highlight these usually minor issues. Compensation and extra strain upon muscles and tendons that are trying to do the job of another can lead to tissue breakdown as explained previously. The sensitivity builds and training becomes difficult.

A full assessment of the affected area, body sense and the way in which movement is controlled will reveal factors that need addressing with treatment and specific exercises. This fits alongside a likely modification in the training programme that allows for the sensitivity to reduce before progressing once more. In some cases a scan or other investigations are recommend to determine the tissue nature of the problem.

If you are starting to develop consistent twinges that are worsening, pain that is affecting training or you are concerned, you should seek advice.

For appointments at one of the clinics please call 07518 445493

  • 9 Harley Street
  • The Chelsea Consulting Rooms
  • Temple
  • New Malden Diagnostic Centre