Stretching the limits of evidence

‘Stretching is essential for injury prevention’

‘Stretching is a waste of time, it’s strength training that counts’

‘Stretching is useless unless you hold each stretch for 90 seconds’…

Heard them all? Me too.

The truth is that we’re all unique and what works for one person might not work for another. Large scale studies aren’t particularly helpful for looking at things like the effectiveness of stretching when it comes to injury prevention and rehab. Partly as there’s so many variables, and partly because a study could find that 20 out of 100 people get no benefit from stretching yet still conclude that it’s helpful for most people. If you’re one of those 20 the ‘evidence’ is meaningless.

Having said all this I do stretch, but I base my routine more on my personal experience and working knowledge of human anatomy than on the results of the latest studies . Dynamic stretching before intense exercise makes perfect sense, I want to warm up and stimulate blood flow to tendons that have been static and possibly held in a chronically shortened position from hours of me sitting on them (in itself restricting their blood supply). I also favour long static stretches post exercise in order to help with the bodies natural recovery phase (and hopefully minimise the post exercise soreness).

But for me the most important thing is little and often. Regardless of whether stretching is hugely beneficial, I can say with certainty being static for long periods of time is hugely damaging. When I talk about stretching I’m not aiming to stretch the muscles to the point of intense pain I just want to gently stimulate the muscles and tendons to remind my body how they are supposed to move, stimulate blood flow and move the joints to their full range of movement. For this reason I believe gentle stretching can also be really helpful during the injury recovery phase, it may sound counterintuitive to stretch a strained muscle or tendon but gentle stretching can help to stimulate blood flow, speed up recovery and strengthen the tissue.

On balance, I believe regular stretching of the muscles, tendons and joints is a completely natural thing (cat’s do it), and should be part of everyone’s daily routine but it shouldn’t be a competition (how far you can stretch or how long you can hold it) and as much as anything it’s about trying to correct the negative effects of our sedentary lifestyle rather than being a magic cure.

Fell Running on the Isle of Wight

Last weekend was one of my favourite events of the sporting calendar, the Isle of Wight Fell Running Championships. I’ve been bigging up my hill running abilities to Fabien (the fitness coach who works next door) and with a recent score of 73 on the VO2 max test (tested to help my friend with her MSc in sports medicine), expectations were high. Could I regain the title of South of England Fell Running Champion?

After six months of training with Dark Peak Fell Running club I assumed that my hill running fitness would be stronger than ever (and I already considered it strong), but I was also aware that some of Southern England’s strongest middle-aged, trail runners would be attending, so I didn’t want to get too cocky. I’ve not been doing huge mileage lately, so taking part in three races in two days was going to be a big ask.

I arrived in Ventnor on the southern tip of the island via bicycle, train, ferry, taxi and bus on the Friday. After dropping off my kit in our delightful b’n’b I had a quick recce of the main hill we’d be running over. It seemed steeper than I remembered (probably related to the shifting tectonic plates) although I would no longer consider the course technical after a few months of fell running in Yorkshire. It had been raining for the past few days but the chalky hills drain quickly and it felt fairly secure underfoot even descending the steepest hills.

On an afternoon supermarket trip into Ventnor I spied a good group of former sparring partners from Victoria Park Harriers and also several familiar faces from Serpentine, The Front Runners and Cambridge Harriers. Everyone seemed in good spirits and ready for the first race on the Saturday morning.

Race one was short, sharp and to the point. I could feel the burn growing in my calves from the off, even if the pace felt slightly slower than I recall from years gone by. I’d been suffering from a bit of plantar fasciitis over the last few weeks and both calves and achilles regularly feel tight for the first 15 minutes of the day but running tends to loosen everything off. There was a 250 metre climb from the beach, a few hundred meters of running at the summit and then straight back down to the finish line. I could see Fabien on my shoulder at the summit so had to really throw myself down the hill, all guns blazing in order to claim the victory. My quads took some serious impact from the fast downhill running and felt like they were on fire by the time I got to the finish. I spent the next 45 minutes doing some yoga stretches for my burning gastrocs, soleus and hamstrings. I did some deep thumb work on my plantar fascia and stretched my quads and hip flexors for a good 30 minutes, it seemed to do the trick and by the afternoon I was back at the start line feeling relatively ready to race again. Race number two felt fine but I was getting some serious muscle soreness when I tried to walk home from the finish line. I decided against completing the series by taking part in the third and final race on the Sunday. My partner was a bit bored of watching people run pop and down mountains and wanted to see some more of the isle of Wight but truth be told as I get older and wiser I’m getting better at listening to my body, and my body did not want to do another race that weekend.

Are Drugs Cheats Ruining Sport?

Another world record, another drugs bust…

Ruth Chepngetich has been caught for smashing drugs, and although not directly related to her insanely quick, 2:09:56 run at the 2024 Chicago Marathon, in my opinion a cheat is a cheat and if someone is going to take drugs to get an unfair advantage then any performance of theirs is meaningless.

I know many people who get absolutely enraged by the use of drugs in sport but more than anything else, I actually feel pity for them. I don’t care that much about world records (just numbers/see previous blog) but I feel sad for anyone who genuinely believes they need to take drugs that can threaten their life and health in the name of running around a track slightly quicker.

I get that for some people athletic success is a way out of poverty and some are pushed into it by unscrupulous coaches BUT we all have the ability to make decisions for ourselves and say no. I’m very sceptical that anyone has ever genuinely not known they were taking illegals (Mo).

So apart from the shame it can bring on you as an athlete what other harm can drugs do? Steroids can put tendons at severe risks, for example the achilles, hamstrings and quadriceps tendons. In essence, the muscle and associated strength develop too quickly for the tendons to keep up and when tendons get torn, it can be a long, frustrating rehab process. Steroid use can also put athletes at increased risk of stress fractures as it reduces bone mineral density. Cyclists’ favourite, EPO, can cause artery blockage leading to stroke and heart attack.

Worth it? Probably not, but if you do insist on taking drugs and suffer the associated tendon injuries VPSM are still here to help you and we won’t judge.

Strength in numbers???

It seems that numbers are all the rage these days! In fairness they’ve been fairly important since the early days of human civilisation. Pretty much everything from architecture to farming relies on numbers. But what does this have to do with Sports Medicine?

Science and modern medicine wouldn’t have got very far without the decimal number system, without numbers it wouldn’t be possible to conduct large scale studies and find statistically significant evidence for anything from the causes of injury to the effectiveness of treatments and preventions.

BUT numbers seem to be the basis of everything I hear in clinic, it’s all the podcast ‘experts’ base their arguments on and all quantitative research papers have numbers at their core. But is basing everything around numbers always as good as it sounds? I’ve had healthy clients told they’re obese due to their BMI, then been advised to monitor the number of calories they are consuming each day and contrast them with the number of calories they burn through exercise.

I understand on one level why that makes sense when dealing with huge population groups, but on an individual level it’s at best useless and can be quite harmful. It’s true that without evidence (which requires numbers) what do you have, just opinion, but sometimes common sense, intuition and expert opinion (as provided at VPSM) can be far more helpful than relying on pure data.

Telling someone to reduce their food intake by 1,000 calories a day is pretty meaningless. If the calories come from extra virgin olive oil and wild sardines it’s doing hugely different things to the body than a slice of chocolate gateau, they just aren’t comparable. In my opinion it’s virtually meaningless to talk about calories or BMI purely in numerical terms.

Slave to strava?The same can apply to training regimes, including running. I know many friends and clients who will run through the pain so they can make their 100 km week or run at 7 min miles pace for their recovery run, because that’s what they have read is recovery pace (even when everything in them tells them they should be running slower). Watches, training plans and weekly mileage have their place and all the elite athletes I’ve worked with follow them religiously but if long term health and love of running is your aim then it may be better to ditch the watch and run to feel. Just a thought….

Tibial Plateau Fracture!!!

I’ve been trying more outdoor sport climbing this year and finally plucked up the courage to try some lead climbing in the UK.

A couple of weeks ago I packed my tent and climbing gear, jumped in the car and found a mountain guide to show us the best spots to lead climb in North Wales. The weather was great and I was surprised by how many bolted sport climbing routes there are around the old quarries. It also surprised me how attractive some of the old quarries are.

We were climbing some really fun routes and generally enjoying the day but just before lunch time disaster struck. As my partner was lead climbing she fell backwards from the rock, her foot got caught behind the rope and so she was flipped upside down. Although it looked awkward there was no obvious collision with the wall and it didn’t look too serious. Her pain levels weren’t that high when we lowered her off the rock face, so it initially appeared like she may have sprained a ligament in the knee or possibly damaged the meniscus.

The pain didn’t ease off and is appeared slightly swollen and was made much worse by weight bearing so we decided to go to the nearest A+E in Bangor.

An X-ray in A+E showed a potential fracture at the top of the tibia which seemed strange as she hadn’t banged into the rocks, but a follow up CT (3D X-ray) showed a big dent in the top of the tibial plateau (the top of the shin bone where it forms the knee joint). It’s quite a rare injury but basically involves the femur (thigh bone)smashing hard into the tibia (shin bone) with such force that it makes a large crater at the point of impact (in this case the lateral side of the tibial plateau). If left untreated this would effect the way the knee joint moves, and more than likely lead to early onset arthritis in the knee.

Based on the research and advice of knee surgeons we know it seemed to be a no brainer and so a couple of days after the accident she went under general anaesthetic and had surgery to rebuild the tibial plateau (basically using screws and plates to push the bone up and level off the surface of the tibia). The suregery seemed to go well and the bone seems to be healing well. Now it’s just 6 months of rehab before we’re back out climbing again.

Incidents like this are tough and make you question everything, but it’s never possible to eliminate all risks. Cycling to work, running in the hills, indoor climbing, swimming in a reservoir all have the potential to cause serious injury or even death, all we can do is accept the risks and take them seriously.

Ultimately the most serious risk to our long term health is inactivity. So, painful as this episode has been I think it’s important to remember that not exercising is the biggest risk to a host of health conditions from heart disease to arthritis. There will always be risk in any form of activity but it’s important not to let that stop us doing the things we love.

Should I push through the pain

A question I get asked a lot in clinic, especially by athletes, is whether it's OK to keep going if you feel pain.

Conventional wisdom stated that you should rest at the first sign of any pain/injury although research over the last few years has demonstrated consistently that that’s rarely the best course of action. By continuing to use muscles/joints/tendons you are stimulating blood flow and allowing the bodies own healing mechanisms to operate effectively. Of course there’s a limit to this and pushing a damaged tendon too hard may well lead to further damage and longer recovery time.

A classic example is tennis elbow (or lateral epicondylitis), the tendon is damaged and it can be really irritated when you engage the muscle by gripping, I see it a lot in climbers. The temptation is to completely rest the wrist and forearm but in my clinical experience even if it causes short term pain, people who carry on using the muscles tend to heal quicker in the long run. A degree of common sense is helpful and it’s best to use lighter weights than normal until it’s completely recovered.

When I get minor running injuries my rule of thumb is that I will carry on running as long as the pain doesn’t get significantly worse while I run, the pain doesn’t effect the way that I run (eg landing on the outside of the foot as the inside hurts to land on) and I don’t need to take painkillers to keep going (honestly, you’d be surprised ;)

There are always exceptions, such as stress fractures where it’s vital to take pressure off the bone to allow it to heal. But even in this instance it’s important to keep some pressure on the effecteted area.

So in conclusion, rest is very rarely best but it’s a fine line between stimulating repair and doing too much.

Climbing as a competitive sport?

As someone who’s dabbled in climbing over the last few years (initially to complement running but more recently because I’ve come to really enjoy sport climbing) I thought it was great to see climbing at the Paris Olympics last year. Initially I was surprised such a primal sport has only recently been accepted into the Olympics. I’m not a massive fan of watching sport on TV but I thought it worked quite well as a spectator sport, even if it was unrecognisable from the climbing I see when running through the Peak District on a Sunday.

However, when I mentioned it to a much more experienced friend, who identifies as a ‘proper climber’ they dismissed it as ‘grabbing bits of plastic’ which has more in common with gymnastics* than the pure climbing which originated from mountaineering and is more a way of life than a spectator sport.

I’ve since chatted to lots of climbers (especially trad and/or mountaineers) who agree with this. I’ve also chatted to a lot who think that the Olympic version of climbing is fantastic as it makes climbing seem less daunting and so opens its up to a whole new generation of people who may be more inclined to try indoor sport climbing, bouldering or top roping.

On balance, I think that anything that encourages people to climb is a good thing. The health benefits are too many to list here and it compliments running incredibly well. It may be an oversimplification to say that running compresses the joints of the lower half of the body whilst climbing stretches the upper half, but we all like simple so I’ll say it anyway.

After hearing all the opinions I’m inclined to agree that indoor climbing (the Olympic variety) has little to do with the outdoor mountaineering lifestyle which spawned climbing, but that doesn’t stop me enjoying indoor climbing, doesn’t make it any less watchable and doesn’t stop it being a great way of staying fit and healthy.

*nothing wrong with gymnastics