If it's not broken...

I've spent the last 10 years working with a variety of athletes in east London. Everyone from runners from Hackney to triathletes from Tower Hamlets. Cyclists from Stratford and footballers from Walthamstow have come through our doors with the aim of recovering from sport related injuries and getting advice to help reduce the chances of them being re-injured.  Results have been second to none but many's the time I've been accused me of doing strength routines which are not very creative or unchanging (or both).

There's a good reason for this. The 'boring' old exercises work and if they work why change them? To be honest I've never found weightlifting particularly exciting or adrenaline inducing, I don't get the rush I get from a competition or team sport, lifting weights, for me, is simply a means to an end. I don't do strength training for any other reason than to give my body the best possible chance of working well into old age. I want to be able to continue doing the cardio based stuff I love, fingers crossed I'll still be climbing and doing parkrun for a few more years yet.

Any exercise is good and most of it will have some level of benefit, but as a rule of thumb the more complicated an exercise is the less I like it. Complex machines with whistles and springs very rarely replicate the bodies natural way of moving and they often take pressure away from the joints and bones, this can be helpful when rehabbing from acute trauma, for example leg press is good for working the quads if you can't weight bear due to a broken ankle from a nasty fall from the mile end climbing wall or while running around hackney marshes. But if you're not injured then you should be putting pressure on the joints and the bones. The body needs this pressure to stimulate repair and minimise degenerative change.

Exercises using elastic bands for shoulders and wrists can be helpful for the early stages of rehab, but for preventative exercise nothing beats putting heavy weights through the joints in a controlled manner. Back squats and deadlifts, bench press, split squats and overhead squats cover most of the main muscle groups and weight bearing joints such as the ankles, knees, hips and sacroiliac joints. Pull-ups, push-ups and box jumps add some traction and explosive action using just your bodyweight, working through muscles such as the lats which many atheletes just don't engage enough, if you play tennis or paddle it's easy to not switch on some of these core muscles and instead overuse the rotator cuff muscles, and we all know how that ends.

These few 'classic' exercises done well and regularly will strengthen the main muscle groups and improve bone density as well as strengthening the joints and therefore making arthritis less likely to cut your sporting career short. 

Strength training should be simple and enjoyable and I would far rather stick to the same few proven exercises and focus on good form and increasing the weight, reps and range of movement rather than trying to master complex new machines and moves every few weeks. 

If you're an athlete based in East London and want to know know more about how strength training can help you to recover from strained ligament or tendon injuries or simply deal with the issues around chronic osteoarthritis just book a session today.

Mile End Miles...(a celebration of running in east London)

Desperate for an escape from the corrupt charade that football has become (Thanks FIFA) I leapt at the opportunity to attend an old school, grass roots sporting event in the heart of East London. So last Saturday I jumped on my bicycle with a pair of brand-new running spikes and cycled through East London to the Mile End stadium.

The Mile End Miles (a 1-mile race organised by Victoria Park Harriers) entered its 2nd year and true to form it was a great day of running, fun and general athleticism.

The mile is (almost) exactly 4 laps of a running track and with a large crowd, commentator, pacers and electronic timing it can be an intimidating event, even for seasoned athletes. I was pacing on the day and so didn't feel the pressure to win a race or get a personal best, but it's very different from what I'm used to these days and I found the different stresses on the body quite intriguing.  

Running round a track sounds like it should be far kinder on the body than running in the mountains but the truth is that in many ways the stresses placed on the body are far harsher on a running track. As a pacer I was told I had to wear spikes, I never understand why but wearing spikes on track does make me feel like a serious runner.

I rarely wear spikes these days apart from my anual attempt at cross country running and every time I forget how different running in spikes is to trainers, every year I wake up with crippling doms (delayed onset muscle soreness) in my calfs the next day. Some people claim that the link between running spikes and calf pain is due to the lack of cushioning under the heel but it's actually far more to do with the spikes being at the front of the shoe and forcing you to effectively run on your toes (thus placing the calfs under constant strain).

The short, fast explosive nature of the mile distance also places the body at much greater risk of injuries such as graded calf strains (gastrocnemius and soleus), in a longer race people will generally start slower and so gradually warm up the muscles. Having said that, most of the athletes I encountered at Mile End did seem to take their warm up seriously. Sensible warm-ups definitely seem more ingrained in the track running community of East London than in the world of northern Fell running.

Despite my best efforts at warming up and warming down I woke up the next morning with crippling calf pain. Initially terrified I had an injury I started texting my favourite osteopaths and physios to see who was free that afternoon but after a brief walk and stretch I realised it was nothing more than a bit of muscular strain and a great excuse for a sports massage. I managed to get a sports massage that afternoon and low and behold woke up the next morning with all calf pain gone. 

I had a great time at the mile event and will certainly return next year. Hopefully next time I'll remember to do a bit of training in spikes during the build up as well as allocating some time to work on my explosive speed work, maybe even some sprint training.

Calf tear on the hills = real tears on the hills

Apparently it's good training for a manual therapist to experience the injuries they treat. If that's the case, then I'm a slightly better therapist after my latest injury at the English Fell running championship in the lake district last weekend..

After a 3-hour drive to the Lake District, my legs were feeling a bit tight but I managed a couple of km warming up gently on the hillside. I felt pretty good at the start line and although the height and angle of the first climb were out of my comfort zone, in my mind I felt confident that the adrenaline of race day supersedes inadequate training. In reality, that may have been the case 20 years ago, but I'm now officially a v45, and it turns out appropriate training, warm-up and race morning routine really are important these days.

The race was just over 12km with 1000m of elevation, and we set off straight onto a steep climb. I was feeling pretty strong and was sticking to the heels of an old training buddy from London. I was just thinking that maybe training is overrated and I was going to have a good race but then I felt a sudden, sharp pain in the back of the calf. Literally felt like I'd been shot in the calf with an air rifle. The pain was intense, maybe an 8 out of 10, but it was so sudden it really shocked me. I stopped for a second, rubbed it and tried to carry on, but the pain wasn't easing and there was no way I could run through it. I limped for a few metres, rubbed it again, tried to jog again and realised that it was not happening. It was so obviously a calf tear that even if I could carry on (which I couldn't have done if my life depended on it), it would have been a terrible idea. I felt sick and teary with a combination of the pain in my calf and the knowledge that I was going to be unable to run for a while. But I also had to get down from the mountain; the last of the runners had passed me, and I couldn't justify calling mountain rescue, so I embarked on a horrible shuffle back down the mountain to the start of the race.

The pain was getting slightly worse, and even limping along was causing quite intense pain. There was a bit of swelling around the calf, and putting any form of pressure on it was utterly excruciating. I sat on my arse in the mud waiting for the lead runners to finish, luckily it was warm and the course was quite short so it was only a few minutes before Finlay Grant came through having broken the course record. I sat around feeling slightly awkward as everyone else finished the race, congratulated one another and asked me what was up. It was actually a real eye-opener to experience the shame of being injured. It's something I discuss with clients a lot but there's nothing like living it to make you really appreciate how it feels. 

Recovery has been really good and after a couple of gentle sports massages I'm going for gentle jogs now, just a week later. The lessons I've learned? I'm making more of an effort to focus on very runner specific strength training for the gastrocs and the soleus. I'm being more sensible about warming up (especially if I've just been sitting in a car for 3 hours) and I'm planning to make my training more reflective of the races I'm aiming to compete in, so for me this means some fast, hard hill sessions.  Now the pain has gone and I'm running again I'm grateful to be back running again and feel I've learned a useful lesson about looking after my own body.

All the best,

Joe

Does Strength Training Reduce the Risk of Running Injuries?

Running is one of the most popular forms of exercise, certianly in this clinic, but it also comes with a frustratingly high rate of injuries. From shin splints and bone stress injuries to tendon overload, many runners find themselves sidelined at some point in their training.

Because strength training is known to improve bone density, muscle resilience and overallperformance, many runners are told it can also help prevent injuries (often by me).

But is there any good research to support that? I recently carried out a literature review atQueen Mary’s University to try to answer what I had assumed was a simple question.

 What my review looked at:

 I searched three major medical databases (PubMed, Embase and Scopus) for high-qualitystudies that looked at:

Studies focusing on adult runners, used strength or resistance training as the intervention,

compared injury rates between runners who did strength training and those who didn’t, reported running-related injuries (not general fitness or performance outcomes). I did this using areplicable academic method (so any other researcher should come up with the exact same studies).

Only eight studies met the criteria:

5 Randomised Controlled Trials (RCT’s), 2 Cross-sectional surveys, 1 Cohort study.

These studies varied widely. Things such as type of Strength Training (some just looked at generic strength training, some at runner specific training), duration of the study, follow-up period and number of participants. All these variables influenced how confidently the results could be interpreted.

What I found

1. Overall, strength training does show a protective effect

Across the five RCTs, most intervention groups experienced fewer running injuries than the control groups, although not always at a statistically significant level. Two higher-quality studies (Letafatkar A & B) showed a strong and statistically significant reduction in injury rates with strength training.

2. The evidence is promising but not yet strong Because:

● Only a small number of high-quality studies exist

● Some studies involved very small groups

● Many looked only at men or only at women

● Training programmes varied greatly in duration and type

● …the overall level of evidence is rated as moderate, not strong.

Short-term programmes showed less benefit

Some interventions lasted only 12–21 weeks. Strength adaptations can take up to 32 weeks to fully develop, so short programmes may not capture the full protective effect.

Survey-based studies suggested a trend toward fewer injuries

But because they rely on self-reporting, they cannot prove cause and effect.

What this means for runners

Although more high-quality research is needed, the current evidence points towards a clear

message:

Strength training likely helps reduce running-related injuries — especially

when it’s lower-body focused, progressive, and performed consistently

over months rather than weeks.

This aligns with what sports physiotherapists and osteopaths see clinically every day:

● Stronger muscles help absorb impact

● Tendons adapt to load better

● Bone stress injuries become less common

● Movement control improves, especially under fatigue

Practical takeaways for runners

If you run regularly, adding strength work is one of the most effective ways to stay injury-free.

Based on the trends in the research:

✔ Aim for strength training at least 2 times per week

Consistency matters more than intensity.

✔ Focus on lower-body and core strength

Squats, deadlifts, lunges, step-ups, calf raises and hip strength work all matter.

✔ Progress gradually

Increase load over time to drive adaptation.

✔ Allow enough time

Benefits appear strongest after several months of training.

✔ Don’t rely on stretching or “core-only” routines

Only true strength training (bodyweight or weighted resistance) was linked to lower injury rates.

Bottom line

Strength training probably does reduce running injury risk — and the evidence is

growing — but more high-quality research is needed.

For now, strength training remains one of the most effective, accessible and physiologically

sound tools runners have to stay healthy and perform well.

Getting Older and Getting Healthier (Not mutually exclusive?)

You read correctly, it's not impossible to get healthier, stronger and even quicker as we get older (it does depend on how quick you were to start with, Usain Bolt probaly won't get quicker with age but I do know competitive club runners who have got pb's well into their 60's).

The truth is, a lot of us associate increasing age with declining health. Once you're over 50, creaky bones and shortness of breath become the norm right? The longer I work in sports medicine and the more involved I become in research, the more I realise that although increasing age undoubtedly does lead to decreased health for the majority of the population, that doesn't have to be the case.

Indeed, I'd go so far as to describe it as a choice. If you choose to actively make positive choices in terms of exercise, diet, rest and managing stress then there's no reason you can't still be running and lifting weights as you get into your twighlight years. I have several clients who are lifting heavier weights and running quicker 5k's in their 60's than they were in their 20's (I should add that how much you can lift and how quick you can run aren't necessarily that important, but they can be a helpful indicator).

No one's saying it's easy to make the necessary lifestyle choices and it's vital to be motivated and be aware of how life-changing this can be. I'm not saying it's simple, it's not just a case of doing parkrun or yoga once a week. I'm not even saying its guaranteed, some people will do everything right and still end up with an auto-immune condition, osteoarthritis or a premature heart attack...BUT making ghe right lifestyle choices will minimise the risk and severity of these conditions and more.

The research is clear. On balance if you make the correct lifestyle choices your body is much more likely to stay strong and healthy into old age. Correct lifestyle choices sounds simple and in many way it is but it's not just one thing. It's not just a case of doing parkrun once a week or going to an occasional yoga class. It should be a concerted effort on a variety of fronts. Exercise is number one, that can be cardio such as running whihc has dpozwens of benefits including improved heart function, strength training (such as lifting weights) which helps strengthen the muscles, bones and joints, reducing the risk of arthritis or breaking a bone when you fall. Regular stretching (such as yoga) is helpful in a number of ways but on a basic level it loosens the muscles and tendons and means you are less likely to get injured doing strength training. 

We don't have space to cover every aspect of aging with grace but recovery is just as important as the exercising, there's little point in putting all the hard work in if you then don't replenish the body with good food and rest....

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.