Running-Physio
@tomgoom
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Runner, physio at @bodyrehab & creator of Running-Physio. #RunningRepairs & #RunningRepairsOnline Course Lead. Tweets are not medical advice!
Brighton
Joined August 2011
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Pinned Tweet
Fancy a free Glutes Exercise Circuit to share with patients? Each option has an image, instructions and a link to a video demonstration. Visit to get yours now!
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I’ve been working on a graphic for differential diagnosis in anterior knee pain… have I forgotten anything?! In truth I’m not sure I can fit much more on! 😂
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Not all heel pain is Plantar Fasciitis! Find out what else it can be in today’s video ➡️
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@NoContextBrits
I can’t bring myself to type it, so I’ll just leave this here and let you work it out…
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❗️Stress fractures of the foot and ankle
Note the ‘High Risk’ sites - these require rapid investigation and careful management.
The most common stress fractures of the foot and ankle are low risk - posteromedial tibia, 2nd/ 3rd metatarsal and calcaneus.
Please like and share
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NEW VIDEO: Tendinopathy Treatment Timeline
Key points;
- Allow at least 3 months with patient education, load management and progressive rehab
- Consider alternative conservative options if unsuccessful in this time period
- Allow a year of treatment prior to considering surgery
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#Whatsonyourwhiteboard
? So important to help people see that being able to do more is always an improvement even if pain hasn’t changed.
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Posterior Hip Pain Differential Diagnosis. This was a complex one so I teamed up with
@TheHipPhysio
for his expert input. Pain locations are approximate and will vary. [PHT = Proximal Hamstring Tendinopathy]
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There are lots of potential causes of anterior knee pain! The common ones you’ll encounter in clinic are included in this graphic but there are a couple of important points to add…
Pain location alone is not sufficient to reach a diagnosis. Symptoms can vary significantly in
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Sleep fixes everything. It’s the human equivalent of ‘turn it off and back on again!’ 😴
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Sometimes we’re guilty of a ‘just load it’ approach in tendinopathy, new research suggests there may be subgroups with different presentations. Recognising this is an important step in tailoring our approach to meet individual needs.
Hanlon et al. (2021)
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New open access review paper on tendinopathy pathogenesis and management in sport via
@SPMagnuss
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The cross-over step up, a great glutes exercise from
#RunningRepairs
. Give it a go and feel your buns burn! 🍑🔥
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Good news for knees! More evidence that physical activity (including running) is not harmful for patients with knee Osteoarthritis.
We still need to ensure exercise is safe and at an appropriate level for each individual but this helps to confirm that avoidance is not the
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Common pain sites in Gluteal Tendinopathy...
Most tendinopathy in the lower limb has quite focal pain that rarely spreads. Think of the Achilles or Patellar tendons, for example. The Gluteal tendon is different! There is likely to be local pain over and around the tendon but
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It’s helpful to provide a patient with guidance about what may be an accepted & expected pain response to exercise. Consider 3 main responses; pain during, response for 24 hours after and trend in symptoms over time 1/
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A simple strenghening strategy for patellofemoral pain ‘Work down the leg’. Strengthening the hip & trunk can reduce pain to facilitate exercises to target the knee. The foot & ankle is often neglected in PFP but manages a lot of load in function & should be considered in rehab.
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Weighted Soleus Lunge; nice exercise for challenging Soleus & kinetic chain. Potential option for Achilles tendinopathy from
#RunningRepairs
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Do you see runners with persistent calf pain? Check out our infographic collection on assessment, differential diagnosis & treatment.
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Not all heel pain is Plantar Fasciitis!
Please note pain locations are approximate and will vary between individuals
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So proud of Woody, he ran his first junior park run today. 2km in 15 mins! Not bad for a boy that was 10 weeks premature and has mild cerebral palsy!!
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A new study has found many *asymptomatic* runners have knee effusions, meniscal tears and cartilage damage. Training for and completing a marathon doesn’t seem to lead to a significant change in symptoms and may even improve some MRI findings ➡️
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Soleus is an important muscle for runners, absorbing 6 to 7 times body weight! Here is a simple soleus circuit;
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Posterior hip pain differential diagnosis
This is a complex area so I teamed up with
@TheHipPhysio
to create this.
Thanks to
@TaylorAlanJ
for his feedback to improve the section on vascular symptoms.
Please note pain locations are approximately & will vary between individuals
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I’m going through a spate of people using my slides and content without referencing their source. Even going as far as removing my logo to pass it off as their own! Please just ask permission, I usually say yes, providing you cite the source.
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Treated myself to
@runnerphysio
’s ‘Science of Running’ book. Looks excellent on first flick through with brilliant graphics...
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This ‘lockdown’ is a real tripple whammy for therapists in private practice:
1) Need to make a huge change to online care
2) Lots to do but much less income
3) Time is very limited as trying to homeschool children! 🤯
Anyone else finding it hard?!
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Return to running post injury can be challenging & there’s little evidence in this area. We’ve put together a new comprehensive guide that covers key principles, assessing readiness to run & planning return to sport. Access it free here -
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Rehab of Achilles ruptures is not my speciality but I wanted to learn more some I got my geek on, read some research and summarised my findings in this video ➡️
Anything you’d change? 🤔
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For runners we need to think of the leg like a complex spring that needs sufficient stiffness...
...makes you wonder why the focus for so long has been stretching! 🤔
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This is a really excellent review of strength training for runners by
@rich_blagrove
so much to unpack and great recommendations to consider when planning S&C with your athletes. 🏋️♂️➡️🏃♂️
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Great article from
@rwilly2003
on strength training for runners. Concise, clear and evidence-based. Thanks to
@DrChrisBarton
for sharing ➡️
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Wow! I’m totally blown away by this! Such a pleasure and privilege to record a podcast with
@BJSM_BMJ
let alone be top of the charts! 😁🎉
Congrats to
@tomgoom
for taking the 2020 podcast crown, with just under 20,000 listens for this podcast on common mistakes clinicians make and how to avoid them 👑
#FreeCPD
#2020Charts
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What tests can we do for patients with Achilles Tendinopathy? Here are some options covering strength, endurance, plyometric ability, pain and function. What would you add? 🤔
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Thought for the day: It’s better to give 1 rehab exercise that’s effective than 10 that aren’t! 🤔
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Can’t believe Woody is 7 today! He had a tough start in life, arrived 10 weeks prematurely and weighing just 3 pounds but he’s doing brilliantly. First task as a 7 year old… test his new bike 🚲 😁
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Good news for runners - evidence suggests you have lower prevalence of arthritis and running with arthritis doesn’t seem to worsen knee health or symptoms.
References:
-
-
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Plantar Fasciopathy can be a challenge to treat and there are multiple differential diagnoses to consider. Check out our infographic series;
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You’ve probably heard of RICE or PRICE for managing acute injury? What about POLICE or PEACE & LOVE? Most still centre around protection, ice, compression & elevation. This may be right for acute traumatic injury but what about overuse injuries? I prefer to LOAD it...
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Soleus is an important muscle for runners. Here are a few simple exercise ideas from
#RunningRepairs
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Anyone else find that physio seems to be going in circles?
We’ve had it manual therapy, core stability and now ‘pain science’.
Surely there’s a better way?.. 🤔
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⚠️ Why fifth metatarsal stress fractures can be high risk…
Earlier I posted a question about a runner with lateral foot pain and swelling (see my timeline). Many of you got it right - the ‘high risk’ injury we were concerned about was a stress fracture to the base of the fifth
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Great graphic from Willwacher et al. (2022) systematic review of biomechanical risk factors for running injury.
Have a read, it’s *open access* ➡️
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Important study published today from
@alisongrimaldi
@Bill_Vicenzino
@paulwhodges
@KimBennell
et al. finds education and exercise effective in managing gluteal tendinopathy *open access* ➡️
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As much as I love running I have to admit it’s not brilliant at building bones!
Short duration exercises with high magnitude forces and a rapid loading rate are more effective for bone adaptation
#Plyometrics
#Heavyresistancetraining
#Jumpwithload
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A growing body of evidence is highlighting that psychosocial factors such as fear of damage, kinesiophobia, depression and anxiety may play key roles in tendinopathy, it’s more than just load!
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A growing body of evidence suggests sleep is vital for athlete recovery and performance and may play a role in injury development. Here are 10 top tips from recent research.
#NationalSleepDay
#nationalsleepawarenessweek
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Foot position influences muscle hypertrophy during calf exercises. New research from Nunes et al. (2020) suggests to point the foot out to target medial gastroc and in to target lateral gastroc.
#calfworkout
#calfexercises
#calfmuscles
#calfstrength
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I love a supine leg curl. Great eccentric hamstring exercise and of all the things I’ve tried it with, the skateboard is the best! 🛹
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Should runners change their foot strike pattern? Nah, probably not! 😉 Findings from a great new systematic review by
@DanielRBonanno
@DrChrisBarton
and colleagues at
@latrobe
in
@SportsMedicineJ
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There are multiple potential causes of posterior knee pain. Too many to fit everything on to this graphic!
So if you’d like to find out more read this open access paper for a nice overview:
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Really enjoyed contributing to this piece in the
@Telegraph
on avoiding gimmicks and getting more sleep to improve recovery.
#Sleeptowin
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Here’s an example rehab progression for patellofemoral pain incoporating research findings on deficits in quads & glutes, movement control & power. It’s not a recipe though, combine with education, activity modification & assessment of psychosocial factors for best results.
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Anyone else feel research is being used a little too rigidly on social media?!
I think we forget that studies aren’t great at telling us what will help each individual, yet it’s individuals we treat.
Are we dismissing things that might helps as the research says, “No”?! 🤔
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Calf training for runners: Does position matter and how heavy should you go?
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New infographic of
@rich_blagrove
et al’s great review of strength training for runners. Be sure to read the paper ➡️ and check out our review for
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These great new guidelines on Patellofemoral Pain (PFP) from
@rwilly2003
@DrChrisBarton
& co are amazingly detailed with nearly 100 pages! ➡️
What questions would you ask the authors about PFP?
Please RT to share this excellent work 🙏
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Ever wonder if our clinic posters are a bit uninspiring? What about this instead to help give positive messages about exercise & the body?..
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Stress fractures of the foot and ankle
#StressFracture
#BoneStressInjury
#FootInjury
#AnkleInjury
#RunningInjury
#RunningPhysio
#RunningRepairs
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Calf pain in runners is really common but can be a challenge to diagnose and treat. Here’s our selection of infographics from our podcast series on it with
@davidkpope
of
@clinicaledge
. Listen to the podcasts here -
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Great running gait study from
@chrisbramah
@DrNiamhGill
@DrStevePreece
&
@leehphysio
found a number of kinematic contributors to common running injuries that we can identify through assessment and address through gait retraining ➡️
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Rate of Perceived Exertion (PRE) is a simple measure of exercise intensity that correlates with training zones & can be used to monitor load
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Heat application (e.g. heat pack) is a simple, effective option that can help pain and function. A new systematic review (Clijsen et al. 2021) suggests it may even outperform pharmacological treatment. It’s not a cure all but certainly worth considering for patients in pain.
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Nice conclusions to a great lecture from Christian Couppé on loading for tendinopathy at
#sportskongres
- load magnitude and time under tension are key
- contraction type (ISO/CON/ECC) less important
- heavy slow loading may be preferable with ~75% getting good outcome
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I’m putting together some free video and webinar content to help university students. Reply to this if you’d like this for your uni.
@UoW_Physio
@OBUPhysio
@UoBriPhysioSoc
@BrightPhysios
@thecspstudents
@thecsp
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A 'work in progress' on static lower limb alignment and running injury. All feedback welcome! Thanks!
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I’m learning that as a physio we need both empathy AND healthy boundaries.
Many of us are good with empathy but struggle to put boundaries in place. We find ourselves peppered with lengthy emails to answer, working in our spare time, struggling to say no and feeling overwhelmed
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A pain traffic light is a simple but effective way to provide guidance on staying active during injury. Surprisingly lots of patients identify such guidance as an unmet need!
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Sometimes pain is vascular in origin. This is a brilliant overview of Peripheral Artery Disease and what we need to know as physios: it includes the 6 Ps of ischemia and this amazing guide to assessment ➡️
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This is probably appropriate for anyone in lockdown at the mo that is either a) drinking too much or b) running too much! 😉
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We’ve put together this infographic on running injury prevention with
@rehabscience
. Optimising training, recovery and S&C can make a big difference although more research is needed to prove this!
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Has anyone else watched Game Changers with their other half and been told that, “we’re cutting down on meat”? I can’t help but feel it’s only telling one half of the story and in quite a biased way.
#cherrypickingtosupportcherryeating
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Is it me or is loudly dropping your weights at the end of every set REALLY annoying!? 😡
#GymEtiquette
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Compression v tension stress fractures and why it matters!… 🦴
The location of a stress fracture can have a big impact on its severity and treatment. Those that occur on the side of the bone that is exposed to tension tend to have a worse prognosis and require more careful
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‘Shin Splints’ (Medial Tibial Stress Syndrome - MTSS) is different from other running injuries. It doesn’t respond well to continuing to run with pain. It’s considered a Bone Stress Injury and optimal loading for these is pain free both during and after.
.
In conditions like
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Very excited to announce the release of our Return to Running Guide for women post-pregnancy today for
#InternationalWomansDay
. It’s aimed at clinicians & health professionals & was a team effort with
@ABSPhysio
&
@emma_physiomum
. Access it free here
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Both over-diagnosis AND under-diagnosis can lead to overuse of healthcare, increased treatment burden and worse patient outcomes.
The answer is using investigations and diagnoses appropriately and being aware of both sides of this story not just the one that suits your biases.
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Common pain sites in Gluteal Tendinopathy. It's not just the lateral hip!
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Foot position influences muscle hypertrophy during calf exercises. New research from Nunes et al. (2020) suggests to point the foot out to target medial gastroc and in to target lateral gastroc.
#calfworkout
#calfexercises
#calfmuscles
#calfstrength
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A pain traffic light is a simple but effective way to provide guidance on staying active during injury. Surprisingly lots of patients identify such guidance as an unmet need!
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This Achilles Testing Battery from our video series covers key assessments for patients with Achilles Tendinopathy. For more on reducing pain, progressing rehab and planning a successful return to sport access our free videos at
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Is inflammation a part of tendinopathy? Video of a great session at
@sportskongres
from Michael Kjær, Stephanie Dakin and
Neal Millar (AKA
@TendonGlasgow
)
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Doing lots of second opinion work I’m always amazed how many people I see who have virtually every treatment EXCEPT progressive rehab or appropriate education! Massage and injections seem to be especially popular in patients I see so I have a new slogan...
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This is a must read paper for anyone treating bone stress injuries in runners (and other athletes). Brilliant work from
@StuartJWarden
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Really important study from Premkumar et al. (2018) of 9,940 cases suggests red flags are NOT great screening tools ➡️ They have low sensitivity meaning they can’t rule things out e.g. 64% of those with spinal malignancy had NO associated red flags.
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