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When an injury affects your training plan….

I have recently been fortunate enough to have participated in the Marathon Des Sables (MdS), a 250km 6 day ultramarathon in the Sahara desert.  This has been a dream of mine for a while, I’m delighted to say I completed it at the end of April 2023.

Any multi-day event requires a huge amount of resources and focus to even get to the start line. The MdS as it is known, usually has a completion rate of 95% with the greatest amount of “drop-outs” before even travelling to Morocco. Typically 20% of those who sign up don’t make it out there.  This is often due to a change in circumstances or more typically due to injury. Balancing the training load for any event is a fine line between over-training and being able to tolerate the distance required to not only complete the event, but in my case enjoy it too. 

I focused my training on being able to complete the distances required as well as being able to go again each day for 6 days. For me, this included 5 days of 30km each day, a 85km long day and a 3 day event covering 85 miles sleeping in a sports hall overnight.  As well as consistently completing a minimum of 50km each week over time and incorporating cross training to consider strength and general health. I wasn’t able to do any training camps in hot climates but did have some sessions in a heat chamber (Loughborough University) as well as a bit running in sand whenever I could, with family and friends visits to Croyde!

Its important to gradually build up with any fitness, the body likes consistency and a balance. I aimed for a maximum of a 10% increase on distance each week and was careful to include rest days. Either complete rest or walking / swimming / yoga. Another component I considered with my training was the other factors in my life. This is something that’s hard to control,  being busy at work, sleep hygiene, other occasions, eating and drinking, or fuel and hydration. There’s a lot to balance, as well as keeping everything in context, not wanting to miss out on family special occasions or socialising / spending time with friends.

My typical week involved a couple of 10km runs during the week then a longer run / two at the weekend. Also a session of two with weights and some yoga. Nearer the event I also started increasing my tolerance carrying a weighted backpack, as a self-sufficient race, you carry everything for the week.  This includes food (which weights approx.. 3.5kg at the start of the event) and mandatory kit. The pack weights a minimum of 6.5kg at the start and combined with the 1.5kg of water at each check point typically weights a minimum of 8kg on day 1. The route is all on tracks / sand / and surprisingly a minimum of 500m elevation each day so it was also good to get to the peaks to get some hills in and on varying terrain.

swollen ankle

A few months before the event I was enjoying a solo trip on the Edale circuit, and was just coming off Kinder Scout when I went over on my ankle.  I felt an immediate sharp pain which made me stop. After a few moments I checked I could weight bear and hobbled to a sheltered spot to catch my breath. As it didn’t swell immediately and I could put my weight through it I managed to walk back to the car with poles. When I took my trainer off there was a localised swelling around the outside of the ankle, pretty consistent with a lateral ankle sprain. The next morning the ankle had ballooned and I struggled to walk. I therefore followed the principles of PEACE and LOVE conscious I was 10 weeks away from the start line and had hoped to build the mileage.

What’s changed in the management of soft tissue injuries?

We used to use the acronym RICE or PRICE/R or POLICE which advocated the use of ICE and anti-inflammatories.  However this has been updated in the last few years to shift the focus on early mobilisation once the initial phase has passed and the avoidance of anti-inflammatories and ice, which may delay healing.

Along with having to change my training expectations I also had to re-consider a training plan to maintain fitness and maximise conditions to optimise healing. I was assessed to determine what the injury was and get a rehabilitation timescale / plan to manage my expectations.

The first 10 days of a grade 1 strain pretty much focused around reducing the swelling and regaining range of movement and strength / proprioception in the area. I combined some open water swims and bike riding along with strength training to keep myself in a good place.  Its really important if you pick up an injury to consider what you can do as opposed to just what you can’t.

I was fortunate enough to make a good recovery over a couple of weeks following a regime of active rest and elevation initially, followed by regular exercises to regain range, strength and reaction in the ankle. I also used the static bike and rower to keep a cardio-vascular challenge and worked on general strength with weights, Yoga and Pilates.

It’s important if you do pick up an injury, whether it from falling over or something starts to hurt or niggle that you get it assessed properly so you know the best way to manage it. Sometimes we need to protect an area from all movements, at other times its important to keep loading the area so knowing what will facilitate the best healing times is essential. Depending on the structure or part of the structure can make a big difference to how to rehabilitate the area.  A muscle responds differently to a ligament or tendon for example. Its also important to consider what else needs to be considered in reducing the risk of re-injury such as strength in other areas of the body.

If you’re planning something special then get in touch, if you want to work with us to make sure you’re robust enough for the challenge, or add something into your training schedule such as Yoga or Pilates. Or if you do pick up an injury then get it assessed so you can set realistic goals. We will work with you with the aim of optimising your recovery so you can achieve and enjoy your goal.

For further info on the management of acute soft tissue injuries;

https://www.physio-pedia.com/Peace_and_Love_Principle

https://bjsm.bmj.com/content/54/2/72

Special thanks to Finn who assessed my various injuries (hamstring and knee rehab blog to follow!) Mariangela for the awesome Yoga instruction and the whole Pilates team for keeping me strong and flexible. And of course the rest of the team for working hard in my absence and cheering me along the way. 

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Karen Cotton
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I've been impressed with every aspect of this service. When I've needed to change an appointment the people I've spoken to have been helpful and understanding. The physio, Jack Clayton, was polite, friendly and knowledgeable. He listened to my feedback and worked with me to find a programme I could follow. I wouldn't hesitate to use again in the future. Thank you!

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Tim Gordon
8th April 2023

Chris Davenport was brilliant. Correctly diagnosed and treated mt persistent back pain in one session. I can't thank him enough. Thanks Chris

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Reggie Tailor
12th January 2023

Came here for the first time a few months ago looking for help with my lower back. I had a god sit down chat with Jack and then a number of physio sessions thereafter. Jack was incredibly helpful, informative and very passionate about his work and getting me better. Jack gave me a clear timeline and a structured plan of physio which has helped me incredibly. I would highly recommend Impact Physio to anyone that needs physio and if I ever do need to go back it will be Jack I go back to see.

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Barbara Chilton
27th September 2022

Jack was very helpful and understanding. The exercises I was given have helped a lot and I will continue with them.

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Maggie Pearson
6th September 2022

Glad to be referred here. Good exercise program built up in stages. These sent email to follow and refer to. Very effective. My physio very calm and encouraging. Best of all is I’m able to do again what had become so limiting. If I should need help again I’ll definitely go back

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Emma Cobb
9th May 2022

Impact Physio has given me a new lease of life, for the first time in 6 years I don't worry about my backache and Joe has been great. She listened about my previous experience to create a unique plan for me that was so adaptive and really work. Hard work and Joe's help has really changed my life

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22nd February 2022

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17th January 2022

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18th December 2021

My First experience was with Chris Davenport on referral for hip and spine problems by my GP. Two courses done and he recommended Hatha yoga to supplement his treatment and help me long term. However before I could implement it lockdown came in so it was delayed until Autumn this year. I signed (with Mariangela)not fully knowing or expecting much in the way of personal tailoring or yoga exercise to be relevant to my situation. I needn’t have worried as the class of six is like minded and Mariangela caters (and cares) for us all. Bonus is it seems to be working; thanks Mariangela. The covid care from all at LE clinic is first class and not uncomfortable allowing for windows open. Reception staff always friendly with a smile. All in all just the tonic Update following treatment again in 2023 Not the first time I’ve used this service, same location, same Physiotherapist (Chris Davenport) and yes the same receptionist’s. As before they provided me with the ( in my view) the best treatment they could given my arthritis coupled with a set treatment time scale provided by the NHS. Thanks to all the staff.

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23rd September 2021

Word cannot describe very good staff

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michael hickley
14th September 2021

Having pulled a hamstring at work and being unable to walk for a few days,my wife booked me in with impact Physio.I was looking at being off work for about 2-3 months.On the day of my appointment,I was met by a pretty young lady who got me to walk away from her then back again a few times.I was then asked to lie on my back on the couch where a pair of expert hands gently massaged the delicate hamstring area.A bit of manipulation got me a bit of pain,causing me to jolt slightly, but I was expecting worse anyway.I was then asked to lie face down on the couch.My lower back was then massaged and manipulated.The whole session took probably 30 minutes.The physiotherapist was always talking to me,saying what she was going to do, and wether or not I would experience any pain or discomfort.She was very good at her job, and did it professionally.Within 2 weeks, I was back at work.If you need a physiotherapist, look no further than Impact Physio.They don't come cheap, but you pay for what you get,rather than get what you pay for.Mine was worth every penny.I will definitely use Impact Physio again if i need to.

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Gerry Foran
14th September 2021

Great treatment everytime without fail I would not go anywhere else

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Steve Holland
21st July 2021

I am very happy to commend Fiona's diagnostic skills, the immediate treatment and the provision of a set of achievable and worthwhile exercises that backed up the initial treatment and mobilisation.

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A Pau
17th June 2021

Having long term back pain is  not easy and same goes for three discectomies. Initially my physiotherapist was chosen for me by a spinal surgeon and I went with his choice but after meeting Louise and going through her 1:1 sessions I ended up attending the Long Eaton clinic for the last six years. Louise has an impressive  knowledge base and will always find a way to keep you mobile even when you feel you won't ever be able to move normal . During the years we worked together on  my back  she attended many courses and conferences and her skills make it so that , somehow, we still rarely repeat an exercise and I am sure there are many more to discover.She worked her "magic" on me so many times that I now only trust her with my recovery from yet another discectomy. Due to her skills I  managed to lead a normal life, I was able to keep my job which can be quite strenuous , I travelled long distances by plane or car , basically kept active. My admiration for  Louise is endless. Not only she is an excellent physiotherapist and Pillates instructor, but she is  also a wonderful human being ,who in this day and age  has maintained empathy and compassion for the suffering of those around her. I wouldn't want to miss Laura and Sandy and the whole reception  team from this review . Thank you for your help and support over the years ladies! It is much appreciated.

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5th May 2021

My daughter was referred by her GP and we had 2 appointments with Louise. She was brilliant and really good with my 8 year old daughter. Both appointments were thorough and my daughter was shown lots of different exercises to do at home with explanations of how they would help her. We also had emails showing the exercises in videos as well. The appointments were during 'covid times' as well and we felt very safe.

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27th April 2021
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Oliver Reed
13th April 2021

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Martin Burton
16th March 2021

Sally was absolutely brilliant.

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16th March 2021

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9th March 2021
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Beryl Withey
21st January 2021

Went for covid inoculation. Extremely well organised. Very nice place.

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Sue Shearman
12th January 2021

Would totally recommend Impact Physio, and in particular Annalise. Referred here due to neck/shoulder pain during Covid, the service was safe, professional and most importantly effective. Annalise spent time to really understand the background to my issues to treat the cause, as well as the symptoms