Exercise and the immune system

Exercise, as we all know, is an essential part of our physical and mental well-being. And with the COVID-19 running rampant, health officials are still telling us to still exercise daily – why is that?

Many have shown the benefits of exercise to pain, cardiovascular health and our brain. Our immune system, as quoted by my biology teacher, is “magic”. It works tirelessly preventing a whole range of conditions and diseases day in, day out. We know that diet, sleep, age and genetics influence our immune system – but so does exercise.

The effect of exercise on our immune system is still being researched with many articles suggesting new mechanisms of how this occurs. We will quickly discuss what benefits and potential risks exercises pose for our immune system. Exercise has a profound impact on our bodies – almost every cell in our body is affected during and after exercise (1). Exercise works, we’re just not completely sure how!

Long-term effects of exercise

We’ve known for a while that lifelong activity and exercise is a crucial way to reduce the risk of many diseases such as cancer, heart conditions and other chronic conditions (2). However, there is increasing evidence showing that keeping an active lifestyle lowers chances of contracting a range of infectious diseases such as bacterial and viral infections (3).

This study (4) showed that adults over 60 years who were active undertaking vigorous exercise upwards of three times a week showed significantly higher immune system responses to a vaccine than a sedentary group of the same age. Suggesting that consistency of exercise, throughout our lifetime, is key in looking after our immune system.

Age related decline of our immune system is a natural process where detection of disease, clean up and protection from further disease all slow down; it’s inevitable – right? Well, it’s been shown that active individuals over 60 that have kept consistent throughout their lifetime, slow and negate some of the aging processes of our immune system (5).

Short-Term effects of exercise

Whilst long-term benefits of regular physical activity have been shown, the effect of a single session of exercise is still disputed (6).  Many say that high intensity and volume of exercise can be detrimental to your immune system in the short– term, making your body at higher risk of contracting an infectious disease (7). Perhaps this adds to the notion that too much of anything can be a bad thing?

However, others have investigated the immune systems of elite athletes and show that over the course of a year of following intense training of ultra-marathon runners, showed an average report of sickness days of 1.5 days versus the US average of 4.4 (8). This may contradict the notion that high intensity or volume of exercise is detrimental – as the highest level of athletes with the highest intensity and volume of exercise, show less risk of sickness than the average person.

Maybe the question we should be asking is does a level of exercise that we are not prepared for, have detrimental effects to our immune system?

Conclusion

We have briefly touched on the long-term effects of exercise and the surrounding debate around the short-term effects. Exercise has a profound effect on our immune systems. The benefits of exercise have clearly been highlighted, but how this happens we still don’t fully know!

In these troubling times its important to look after yourself and that means keeping active. Be kind, stay at home and wash your hands!

Thanks for Reading.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

1. Kostka T, Berthouze SE, Lacour J, Bonnefoy M. The symptomatology of upper respiratory tract infections and exercise in elderly people. Med Sci Sports Exerc (2000) 32(1):46–51. doi:10.1097/00005768-200001000-00008

2. Warburton DER, Bredin SSD. Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol (2017) 32(5):541–56. doi:10.1097/HCO.0000000000000437

3. Pape K, Ryttergaard L, Rotevatn TA, Nielsen BJ, Torp-Pedersen C, Overgaard C, et al. Leisure-time physical activity and the risk of suspected bacterial infections. Med Sci Sports Exerc (2016) 48(9):1737–44. doi:10.1249/MSS.0000000000000953

4. Kohut ML, Arntson BA, Lee W, Rozeboom K, Yoon KJ, Cunnick JE, et al. Moderate exercise improves antibody response to influenza immunization in older adults. Vaccine (2004) 22(17–18):2298–306. doi:10.1016/j.vaccine.2003.11.023

5. Campbell, John P., and James E. Turner. “Debunking The Myth Of Exercise-Induced Immune Suppression: Redefining The Impact Of Exercise On Immunological Health Across The Lifespan”. Frontiers In Immunology, vol 9, (2018). Frontiers Media SA, doi:10.3389/fimmu.2018.00648.

6. Walsh NP, Gleeson M, Shephard RJ, Gleeson M, Woods JA, Bishop NC, et al. Position statement. Part one: immune function and exercise. Exerc Immunol Rev (2011) 17:6–63.

7. Nieman DC, Johanssen LM, Lee JW, Arabatzis K. Infectious episodes in runners before and after the Los Angeles Marathon. J Sports Med Phys Fitness (1990) 30(3):316–28.

8. Martensson S, Nordebo K, Malm C. High training volumes are associated with a low number of self-reported sick days in elite endurance athletes. J Sports Sci Med (2014) 13(4):929–33.

Patellofemoral Pain in Runners

Patellofemoral pain (PFP) is pain associated around or behind the kneecap; it is the one of the most prevalent running injuries, with 9 – 15% of the active population reporting PFP at one time or another. This pain in runners is debilitating, often varied in how it presents, and the true source of pain is very difficult to narrow down (Stefanyshyn et al. 2006; Barton et al. 2012).

“THAT’S A FACT: RUNNERS TEND TO OVERDO AND PUSH THROUGH PAIN”

Jean-Francois Esculier – The Running Clinic

Should I stop running?

When you get PFP it’s not to say you should stop running completely, but perhaps you can modify your training for the moment? Can you reduce the distance, or slow your pace down and see if this helps?

According to Esculier et al. (2017) you should experience no more pain than 2/10 (in a 0-10 model for pain with 0 being nothing and 10 being the worst possible pain) whilst running; have no pain after an hour stopping the run and have no pain the next day. They found that this simple guidance, then building this activity up gently, was found to be effective in treating PFP.

There is an agreement that the position and glide of the patella is influenced by the soft tissue and biomechanics of the general lower limb and the joints. This means that muscle imbalances can put certain stresses on the patella and can be a reason for your pain (Neal 2019).

The role of strengthening the glutes has shown to be important in runners with PFP– they need to manage 4 x your body weight whilst running (Lenhart et al. 2014).

There’s a good glute’s circuit by Tom Goom (running physio) to help get people started – this isn’t appropriate for everyone and always best to be assessed first, or consult your healthcare professional if you’re unsure.

What this all means?

The take home message is to adjust your running regime to a more manageable pain level and gradually build from there. Maybe you’ve increased your pace, distance or number of sessions recently and your body isn’t ready just yet and needs to build up slowly?

Evidence suggests that effective treatment is about modifying activity, strengthening and education tailored to the individual (Lack et al. 2015; Barton et al. 2015). Everyone is different and in injuries there’s rarely, if at all, a “one size fits all” approach.

At TA Physiotherapy we aim to incorporate this into our assessment and treatment. If you have concerns or feel you need a thorough assessment book with one of our physiotherapists or our running coach.

Aran Pemberton

Aran qualified as a Physiotherapist graduating from the University of Worcester in 2017. He has since been working within the NHS, rotating into different specialities such as the Emergency Department, Critical Care, Orthopaedics and MSK.  He has worked with people of all ages and different levels of health and fitness, encouraging exercise as an essential part of health and wellbeing and providing the best care for his patients.

Aran has a keen interest in soft tissue mobilisation and movement re-education as part of the rehabilitation process. He has an interest in sports injuries and has experience treating players and working with the strength and conditioning coaches under the physio in Worcester County Cricket Club.

References

Barton CJ, Lack S, Hemmings S, et al. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: incorporating level 1 evidence with expert clinical reasoning Br J Sports Med 2015;49:923-934.

Barton CJ, Lack S, Malliaras P, et al. Gluteal muscle activity and patellofemoral pain syndrome: a systematic review Br J Sports Med 2013;47:207-214.

Lack S, Barton C, Sohan O, et al. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis Br J Sports Med 2015;49:1365-1376.

Lenhart R, Thelen D, Heiderscheit B. Hip muscle loads during running at various step rates. J Orthop Sports Phys Ther. 2014;44(10):766–A4. doi:10.2519/jospt.2014.5575

Neal BS, Lack SD, Lankhorst NE, et al. Risk factors for patellofemoral pain: a systematic review and meta-analysis Br J Sports Med 2019;53:270-281.

Stefanyshyn DJ, Stergiou P, et al.  Knee Angular Impulse as a Predictor of Patellofemoral Pain in Runners. The American Journal of Sports Medicine 2006, 34(11), 1844–1851.

Running Analysis & Technology

We’re always keen to provide runners with the best opportunity to understand more about running and specifically how runners run. We love using technology and combined with assessment this works well for helping runners to get over injury and improve performance. As a team of techno geeks, imagine our delight when we got our hands on DorsaVi. A wearable device that AAEAAQAAAAAAAAOEAAAAJGEyYTk4ODA1LWZhMzctNGNjNy1iZTVkLTMwZTkxOWRiNDE4ZQrunners or teams can use to monitor kinetic running data & kinematic knee data to understand the loads and biomechanics of the athlete.

Wearable devices have been used for several years in sport specifically HR monitors & GPS trackers used to monitor load, distance and intensity of players, both in training and competition situations. Even though new evidence is being published to help us understand that training loads are one factor linked to injury, this study from expert Gabbett is particularly comprehensive [Gabbett. 2007].

It’s become more complex to measure biomechanics in the field of play because we need 3D motion capture to fully assess motion in team sports, which is unpredictable in many team sports [Willy, 2017]. The assessment of biomechanics in runners within any sporting environment is extremely difficult, hence the advent of such technologies that help assess movement naturally are welcomed by us.

Running

What we we look for?

Ground Reaction Force [GRF] – The force created by contact with the ground is referred to as the ground reaction force (GRF). This is the force the ground exerts on the body as we move.  According to Newton, for every action there is an equal and opposite reaction [Newton’s 3rd Law of Motion – Law of Reaction]. As we make contact with the ground, gravity is constantly impacting the body [Young-Hoo Kwon, 1998: http://www.kwon3d.com/theory/grf/grf.html%5D.ViMOve

Initial Peak Acceleration [IPA] – Correlates the vertical acceleration and loading rate through the tibia on ground contact, measured in G’s. The IPA being increased has been linked to higher rates of stress fractures [Crowell, 2011] and changes can be noted with alterations in cadence [Rios et al, 2010]. This graph illustrates these measurements nicely [DorsaVi ViMove2, Running Module Guide].

Cadence calculates steps per minute, two steps make up one stride. Recent research indicates shortening stride length and increases in cadence can help to reduce running injuries [https://www.runresearchjunkie.com/is-the-180-cadence-a-myth-or-something-to-aim-for/].

Absolute Symmetry Index [ASI] – is the calculation of average GRF Left vs Right. An example in DorsaVi would be a negative value indicates the right side is carrying more force compared to left.  A positive values shows left side is accepting more force than the right side. A normal deviation in ASI is 5% so we would want to reduce this whilst running [Herzog et al, 1989].

Speed – Looks at average speed over the course of the running time measured, usually measured in metres per second [m/s].

 

Everybody runs differently and this is dependent on multiple factors including:

1. Activity participation [distance runners, sprinters, team sports]

2. Running surface, environment & terrain [surface type, inclination, weather]

3. Running footwear

4. Position within a team or squad [defender Vs attacker]

5. Level of activity participation [elite Vs recreational]

 

What happens when these factors change?

Sports physio Paddy volunteered to test out the DorsaVi. We looked at his existing running style and implemented changes in order to measure the differences in kinetics data.

Within 15 minutes, we were able to assess Paddy clinically and on the treadmill. We looked at Paddy running at 9km/hr, 12km/hr & 16 km/hr. At each assessment, Paddy changed something in his gait to see what changes we noted in his kinetic data. The difficult question is, does kinetic data correlate to kinematics?

As the overview graph illustrates, Paddy completed 3 runs at 9 km/hr but what we can’t see from the graph is what kinematics changed.

  1. Rep 1 at 9 km/hr Paddy was running his normal gait pattern with no problems reported.
  2. Rep 2 at 9 km/hr Paddy changed his foot strike pattern which resulted in a reduction in cadence
  3. Rep 3 at 9 km/hr paddy attempted to shorten stride length and increase cadence
  4. Rep 4 at 12 km/hr increased speed which initially he achieved by increasing his cadence
  5. Rep 5 at 12 km/hr Paddy maintained his speed and his cadence settled to 173.
  6. Rep 6 at 16 km/hr we noted a huge ASI change which correlates to a previous lower limb injury Paddy has suffered on his right side. Increased IPA & GRF despite GCT becoming more symmetrical compared to previous speeds.

Conclusions

Overall, the DorsaVi running module kit is a game changer for us. It is portable and ease of use on the iPad. I would recommend it as suitable for all types, levels and style of runners. We only explored the running module in this article but the knee and lumbar spine assessment modules are great additions to any clinical assessment. The smart therapist would with clinical information, training information along with goal setting to get results with patients and athletes. The versatility of DorsaVi means its suitable for everyone not just sports people.

I’m yet to see any normal data ranges for athletes with GRF, IPA and GCT but differences in assessment and correlation can lead us to make assumptions – if the data supports the hypothesis of injury, then it can be used to change running gait, ultimately reduce pain and improve performance.

However, one question remains in my mind which I’ve not seen in research yet – Does kinetic data correlate to kinematics?

Thanks for reading.

Twitter: @taphysio

Instagram: @taphysio

 

References:

Gabbett & Domrow. (2007). Relationships between training load, injury, and fitness in sub-elite collision sport athletes. Journal of sports sciences. 25. 1507-19. 10.1080/02640410701215066.

Young-Hoo Kwon. (1998). Webite: http://www.kwon3d.com/theory/grf/grf.html. Accessed December 2017

Harrison Philip Crowell and Irene S. Davis. (2011). Gait Retraining to Reduce Lower Extremity Loading in Runners. Clin Biomech (Bristol, Avon). 2011 Jan; 26(1): 78–83.

Jaqueline Lourdes Rios, Mário Cesar de Andrade, Aluisio Otavio Vargas Avila. Analysis of Peak Tibial Acceleration During Gait in Different Cadences. Human Movement 2, December 1, 2010.

HerzogNiggReadOlson . (1989). Asymmetries in group reaction force patterns in normal human gait. Med Sci Sports Exerc; 21: 110114

Baggaley, Willy, Meardon. (2017). Primary and secondary effects of real‐time feedback to reduce vertical loading rate during running. Scandinavian journal of medicine & science in sports 27 (5), 501-507

Sensorimotor System – What does it mean & What’s the implication for rehab? Bec van De Scheur

IMG_2527After hitting heavy traffic, turning what should have been a swift two hour car trip into an eventful six hour journey to Birmingham, we finally reached the Therapy Expo 2017!

 

Fuelled with coffee, we sat in on a number of interesting presentations. Although there was diversity amongst the guest speakers a common theme seemed to present itself, the role of the sensorimotor system in injury rehabilitation.

 

Steven Hawking said it perfectly when he stated:

 

“Intelligence is the ability to adapt to change”

 

The human body is of no exception. Our desire to move after injury sees that we will go to great lengths to keep our bodies mobile. Often completely subconscious, we find ways to move around pain, stiffness, or imbalances. Thus, compensatory movement patterns or “muscle patterns” are born.

 

Jo Gibson [Twitter: @shouldergeek1], well renowned shoulder rehabilitation specialist, whose lecture we were lucky enough to attend at the Expo, has been quoted to explain it like this in relation to the shoulder:Jo Gibson januar 2016 (2)_edited1

 

“Muscle Patterning refers to inappropriate recruitment, commonly of the torque producing muscles of the glenohumeral joint e.g. Latissimus Dorsi, Pectoralis Major, Anterior /Posterior Deltoid. This unbalanced muscle action is involuntary and ingrained. Patients with muscle patterning essentially have a muscle recruitment sequencing problem that results in abnormal force couples, destabilising the joint.”

It is an important topic, as failure to correctly diagnose a structural instability versus a functional instability is a common factor in patients failing conventional rehabilitation or surgery.

‘Rehabilitation in this situation should be aimed at ‘normalising’ muscle recruitment patterns around the shoulder girdle and this involves appropriate facilitation throughout the kinetic chain. Balance, coordination and core control are all factors that must be addressed to optimise neuromuscular control mechanisms.’(1)

 

Our ability to adapt to change is both the human body’s greatest strength and its biggest weakness.

As a short term strategy compensation is a great tool. It is protective against further injury and it enables us to get on with our daily function. However, when these newfound motor patterns become long term and supersede our normal programming we will at some stage hit a point of failure, which usually manifests as injury or failed rehab.

 

It can be explained like this…..

 

Your weekend football team is down a player and you have no choice but to replace your star striker with the goalkeeper. Chances are he will manage to get the job done for a period of time, but because his training has not been specific to the role of striker and he is not conditioned or well rehearsed to the demands of this position, at some point in the game he will fatigue, his reaction time will diminish and his ability to generate power and keep up with the pace of the game will become apparent, leaving him vulnerable to injury.

 

Similarly, if you delegate a task to a muscle that it is not designed for, it can deal for a time, but ultimately it will not be able to withstand the extra demands that have been placed upon it.

 

For therapists this is very important to recognise as it will guide how we structure our rehabilitation. When patterns become maladaptive and cemented centrally, rehabilitation takes on a different level of complexity. We are no longer treating an isolated system.

 

It is easier to learn than to unlearn a skill. My father always says, “Practice does not make perfect, perfect practice makes perfect”. As performing something in a sub optimal way over and over again only leads you further away from skill mastery.

 

So lets break it down….

 

What does sensorimotor mean?

 

The term sensorimotor system describes, ‘the sensory, motor, and central integration and processing components involved in maintaining functional joint stability’. This encompasses neuromuscular control and proprioception. (2)

 

Sensorimotor Diagram
Neural Basis of sensorimotor learning: modifying internal [Lalazar & Vaadia, 2008] https://www.sciencedirect.com/science/article/pii/S0959438808001578
 

Lets look at this in relation to a common injury such as an inversion injury of the ankle….

 

It is generally known that the primary risk factor for an ankle sprain remains a history of a previous sprain (5). It is thought that the initial damage to the lateral ankle ligaments alters the function of mechanoreceptors of these ligaments disrupting the ability to sense motion at the joint (4) and can lead to functional instability of the ankle. It is often described as frequent episodes of “giving way” or feelings of instability at the ankle joint.

 

A number of authors support the idea that some patients with functional ankle instability have deficits in neuromuscular preparatory or anticipatory control, which increases the risk of injury to the ankle, as it is less protected in an inadequate ankle joint position. Add to this a sub optimal rehabilitation program and paving the way towards a chronic ankle issue.

 

So what does this mean in terms of exercise prescription?

 

Benoy Mathew [Twitter: @function2fitnes] from Harley Street Physiotherapy during his talk regarding “the problem ankle” discussed the benefits of dynamic exercises such as sport specific plyometrics, which utilises sensorimotor training to promote anticipatory postural adjustments as well as optimise agility, landing technique and reaction time.

 

When it comes to overall running efficiency Mike Antoniades [Twitter: @runningschool], Performance & Rehabilitation Director of The Running School agrees:

 

“To change running technique, theoretical information and tips will not do the trick. The body needs to learn movement through movement – mostly while running but also through other re-patterning exercises”

(1)

 

During his workshop at the Therapy Expo, Mike gave us great examples during a live running assessment of particular movement dysfunctions that result from motor patterning, which often lead to muscle imbalances, poor technique and may be a factor in the recurrence of injury.

 

A common example is poor gluteal activation, which leads to compensatory hamstring dominance. Recognising this as the main offender of a patients running pain is a great start but strength training alone will only get you so far if it is a neuromuscular issue and ‘sensory motor amnesia’ is the primary reason why certain muscles fail to activate during movement.

 

There is a lot to think about during clinical diagnosis to ensure we are not ‘band-aiding’ a sensorimotor issue with strength exercises and manual therapy.

 

It is our responsibility as physiotherapists to ensure that we are continuously looking for opportunities to enhance our clinical skills. By optimising our assessments we are giving each person that seeks our advice the best opportunity to reach their full potential.

 

  1. Antoniades, M (2016), Mikes view on therapy expo 2016. Retrieved December 10, 2017, from http://runningschool.co.uk/blogs/mikes-view-on-therapy-expo-2016/
  2. Foundation of Sports Medicine Education and Research (1997). The role of proprioception and neuromuscular control in the management of knee and shoulder conditions.; August 22–24; Pittsburgh, PA.
  3. Gibson, J (n.d), Advances in rehabilitation of the shoulder. Retrieved December 10 2017, from http://www.physioroom.com/experts/expertupdate/interview_gibson_20041031_1.php
  4. Hertel J. (2002). Functional anatomy, pathomechanics, and pathophysiology of lateral ankle instability. Journal of Athletic Training. 37(4) 364–75.
  5. Milgrom C, et al. (1991). Risk factors for lateral ankle sprain: a pro- 
spective study among military recruits. Foot Ankle. 12(1), 
26–30.
  6. Lalazar & Vaadia, (2008). Neural Basis of sensorimotor learning: modifying internal models.  https://www.sciencedirect.com/science/article/pii/S0959438808001578

 

Bec van De Scheurcropped-logo-resize-21.png

Marathon Tips – Roger Kerry

Going the distance

Marathon season has begun and this weekend it’s the iconic London Marathon. Well done to everyone who is competing on getting this far, and the very best of luck – particularly if you’re beach runningplanning to attempt it dressed in a hot, heavy and generally unsuitable fancy dress costume!

Leading expert Roger Kerry, of the Division of Physiotherapy and Rehabilitation Sciences in the School of Health Sciences, believes from a physiotherapist’s view that running the marathon will be about three things: performing well; not getting injured; and most of all – having fun! Here are his top 10 tips for getting the most out of your London Marathon experience…

  1. Prepare – It’s too late now to think about more training, but you should prepare properly for the day in all other respects. Make sure you have checked all your kit at least the day before, and that all your food and drinks are organised in good time – there’ll be no time to dash to Runners Need on Sunday morning.
  1. Taper – The evidence behind tapering (progressively lowering your mileage leading up to the event) is a bit hit-and-miss. However, for a long race, basic principles of exercise suggest that it is not a great idea to be cramming in long or hard sessions the week before the race. Start to relax and do just what you need to keep you motivated and active, but not much more. At this stage, noting will change your fitness in time for Sunday.
  1. Eat – You need the right type and right amount of fuel for Sunday. Start to think about that now, but don’t do anything that your body isn’t used to. Avoid strategies with inconsistent evidence, like dramatic ‘carbo-loading’. Make sure you have wholesome, simple complex-carbohydrates the night before – plenty of brown rice or pasta, supplemented with dried fruit etc. Before an intense, prolonged effort, progress towards at least 10g of carbohydrate per kilogram of bodyweight in the days leading up to Sunday.
  1. Drink – Again, the golden rule: don’t do anything your body isn’t used to. You obviously need to be well hydrated before, during, and after the race. However, over-hydration can be just as (if not more) problematic that dehydration, so you don’t need to guzzle 3 pints of water every few hundred yards. Aim for no more than 0.8 litres of fluid/hour. You will need carbs to keep you going as well, so if you’re used to a specific sports drink or gel, than use that, but don’t start experimenting during the race though!
  1. Shoes – Don’t run in new shoes! Make sure your socks are fitted well, with no small creases or seams. A tiny crease at the start will seem like a boulder at 10 miles, and increase your chance of blistering. Make sure your heel is captured well, but remember that in a long run your forefoot will expand, so avoid ultra-tight lacing in your lower laces. Use thick, or double-layer socks, or Vaseline, to reduce chance of blistering. Use plasters is you’re used to them – again, nothing new please!  

  1. Warm-up – OK, so in 26 miles there’s plenty of time to warm-up, however, it is still absolutely sensible to make sure your muscles are ready for action and your vital organs are ready to be stressed. Do some gentle, progressive running or drills to get ready and try and keep moving on the start-line. The evidence for stretching (especially static stretching) or massage suggest that these don’t help in either performance of injury prevention, so you’re better off spending your time moving and preparing your tissues for load.
  1. Pace yourself – The crowd will most likely prevent you from sprinting off, but aim for negative splits, i.e. the first half of the race being slower paced than the last half. Use your GPS if you need to, but better still, listen to your body. Have confidence in all that fantastic training you have done, and know that you can achieve your marathon aim if you don’t stray too far from what your body is used to.
  1. Keep control – In line with the point above, consider strategies to put in place when you start to fade. Going through rough patches is normal, even if your fitness and fuel control is in order. It’s what you do during these patches that’s important. Try not to get worried about a drop in your pace. If you do, you will try and speed up at a time when your body and mind is asking you not to. Rather, try and focus on your form: work from top to bottom – recalibrate your head posture and your shoulder height, make sure your torso is not slumping and affecting your breathing, make sure your arm swing is even and synched with your leg movements, keep control around your pelvis, shorten your stride length and/or increase cadence, and think about your foot strike. You’ll soon be back in the zone!
  1. Finish strong – Let the crowd motivate you during the last few miles, but don’t blow up before the finish line! You have put in months of training, and this is where it all comes together. Make sure you save something for that last kilometre. You might get a bit of euphoria with two or three miles to go, but avoid that last burst until the finish line is in sight.
  1. Re-fuel, refresh, and reflect – You’ve done it! 26.2 miles in the bag, and an amazing london-marathon-the-mallexperience. But it doesn’t stop here. How you feel for the next few days, and whether you remain motivated to ever do this again will depend on what to do in the few hours post-race. You will need to gradually take on some replenishing carbs and protein, and get your hydration status balanced, considering electrolyte also. Again, stretching or massage won’t necessarily help the recovery process, and may in fact contribute to a delayed recovery. A sensible reduction in tissue load, whilst maintain some movement is key for that next 72 hours. That means keep your legs moving, as long as they are comfortable. You can expect to introduce steady running again after a few days. No hard sessions for a good three weeks or so though. And finally, reflect on your experience to maximise your enjoyment as well as learn from it – for next time!

We have a physiotherapy service available for injury reviews, sports massage & running related advice at Tom Astley Physiotherapy. Sessions can be bookd online HERE.