¶ Optimizing Running Performance and Preventing Injuries
Again , I have a special treat for you . What if the secret to optimising your running performance and preventing injuries lay in understanding your current situation , setting realistic goals and managing both load and expectations ?
Today we're joined by Aaron Nicholson , a sports medicine specialist , clinical personal trainer and running expert at Move Physio in Twickenham , who illuminates us with his expert insights . As is normally the way . I have split the interview into two parts . I promise you I could have taught to Aaron for hours . Anyway , here is the first part of our interview .
I really hope you enjoy it . So you're thinking about running , but not sure how to take the first step . My name is Brian Patterson and I'm here to help . Welcome to Brian's Rompod .
And welcome to Brian's Rompod and my name is Brian Patterson , and in today's episode we have a very distinguished guest who brings a wealth of experience and expertise to the world of sports medicine and athletic performance . Joining us and welcoming Aaron Nicholson , who is a head therapist , clinical personal trainer and running specialist at Move Physio in Twickenham .
Aaron , a graduate since 2008 , both over a decade of experience in clinical settings , including a professional sports and clinical private practice . His exceptional injury and movement assessment skills have earned him a reputation of diagnosing , treating and rehabilitating patients back to peak health .
What sets Aaron apart is his commitment to patient empowerment through education and exercise based rehabilitation . But that's not all . Aaron's extensive knowledge of extends to intricate realm of running , biomechanics and endurance athletes . Beyond his clinical work , he's also a producer and presented of accredited sports massage and soft tissue therapy .
Welcome to the podcast , aaron . Thanks , brian . Hi . How have you as a student been ?
able to do this .
Thanks , brian Hi . How have you as your day today ?
Yeah , very good , I just finished the day job , which is busy as ever . Really , that intro certainly very grand .
Very good Pressures on now , oh okay what I could do with most of them . I guess I had to start right at the beginning in terms of what you like at school . Had you always been good at sport , Did you enjoy sport at school , or something like that .
Yeah , I certainly think it was more the enjoyed sport than was particularly good at it . So yeah , first kind of intro into sport really was swimming to a fairly decent level .
It wasn't going to move any big stones or anything like that , but it got to district and county level sort of swimming and I guess that sort of exposed me to regular training and I guess committing to lots of hours in the pool was what we're doing . I've always been interested in anything and everything sports-wise .
So , even around my kind of swimming years , I would still play a lot of football .
I did 10 , 12 years martial arts up to second down in Jiu Jitsu , alongside running you know , whatever I could get my hands on , basically I would be doing sport and I guess the thing that I guess got me interested in the injury side of things and potentially having this as a career was a knee injury myself in my Judo years where I had a guy who was 25
kilos heavier than me . that I was firing with , I got myself in a bad position and I ended up with A and I think the thing that I actually loved about that which sounds a bit weird now was .
I ended up at a very good consultant who decided not to operate and said look , you can have this , you will get over it as long as you do the right things and I think there was a 15 year old 16 year old at the time then . So that was quite young then , long time ago . Yeah , it was quite a new area . That was my first proper injury , but it was .
I found it fascinating that actually with a bit of physio , a bit of strength , a bit of mobility , you can get over things . And I guess that first introduced me to actually the power of movement analysis , strength and conditioning physio , and actually how adaptable your body can be if you do the right stuff to it .
really , so you could see that what he was telling you , there was a kind of like a causal effect my proof thing you know , and then you were getting stronger , so it wasn't like , oh my God , I've got this injury and that's the end of my nice career , yeah absolutely , and I think that was the beauty of it really , was that , yeah , there were times when I
stuck my head in the sand and kind of carried on and that wasn't ideal . Knee had swell up , it'd get annoyed . I'd have to have a few days off , and then we did the same thing over again and it was around that time , sort of college years and making decisions on what to do next . Just that couple with interesting biology and fairly .
So was you so when you went to university initially ?
did you go straight into kind of sports science or so I actually I studied at Samarit's , just down the road from here , so I went straight into sport rehabilitation as a degree . So the reason I picked that was partly the level of quality of lecturers they have there at the time actually the sport rehabilitation degree was was great at the time .
And also I was umming and arming between that and a physiotherapy undergraduate . And the main reason I went down the sport rehabilitation route was I wasn't . I didn't want necessarily and I wasn't overly interested in the inpatient , the neurological rehab a lot of the kind of hospital based rehab that you would get with a physiotherapy degree .
I was definitely more sports focused and that kind of made my mind up from there .
Did you like the fact that you would be dealing with people who were going to be performing at a kind of elite level , or was it your like ? You were just quite happy dealing with the common or garden Joe in terms of people who were running or doing sport ? Anna ?
I think , if I'm honest , yeah , looking back on it , I think initially there's the sort of glitz and glamour of elite sport and you get enticed in by that .
And then once you start to scratch under the service and this is a massive , I'm going to say my first sort of massive- stereotype and generalization , but you then start to scratch under the surface and go there's a hell of a lot of politics at play .
There's a hell of a lot of other things that you have to manage around the elite sporting environment a lot of the time Not to say that that's a bad thing all the time . But I think also what it made me realise is actually as good as that is the most beneficial and the most , the most that's the word I'm looking for the most . I'm still looking for .
Really , just the thing that I love the most about the job , really , and power on the most empowering side , is looking and seeing people who are , regardless of their background , are in a bad situation , that they want to get out of and you can help them get out of it .
And I think actually , regardless of whether that's an elite level or grassroots level , it's just the same thing , which is great for mine .
Maybe we could touch the injury that I had and I know that it was because I don't do a massive amount of mileage per week , but maybe 15 to 20 per four times a week sort of thing .
But you find that if , for whatever reason , you're and I know talking to colleagues , friends of mine , you're that has been interrupted , it can be really frustrating and quite I know anyone talks about it from a mental health point of view it can be very , quite depressing really . You know that .
You know either you go running and then suddenly it records that kind of thing , whether it be knee , hips or whatever .
And I think that's part of it , certainly from the way that I treat is you've got to ? There's always a story behind why someone does exercise . Regardless of what that is whether it be at elite level , because it's the job or as you say it may be a mental health thing , it may be a physical health thing , it may be an escape from something else .
And I think it's one of the ones that certainly in the clinic that I'm now in and certainly over my last 12 years or so in private practice , it's one of the biggest parts of any consultation .
Injury consultation is actually getting to know why that person needs to be back doing what they had previously done , and I think it's it's it really helps the rehab process if you genuinely listen to something . I think a lot of people assume that , yeah , he goes asking questions or rehabbers asking questions or whoever the practitioner is asking questions .
But it's not just about the physical form , absolutely .
There's more to it , yeah because that will give you some from a practitioner standpoint that will give me some really valuable information as to how I'm going to need to manage this patient , Certainly from a if we look at why , in the sky stuff of you mentioned , I'm a runner , I run 20 miles a week and I do it for my mental health .
So that means that actually , if I don't run 20 miles a week because of my back injury or injury . I know my mental health is going to deteriorate and that's a fear that I already have in the back of my mind . So that's .
The anxiety creeps in , absolutely yeah .
And then when you start to look at the effect that anxiety and stress and those elements have on actually increasing pain and creating apprehensions towards activity A lot , of the time you end up with a patient who will go one of two ways they will either go down and you will see their mental health deteriorate because they are not doing what they want to do ,
or they dig their head in the sand and ignore the pain that they are running through for weeks and months and I suppose just thinking about it becomes a vicious cycle .
So it can help . It may affect sleep patterns Absolutely and therefore , if you're not getting enough sleep , you're not rehabilitating and therefore the cycle continues .
Absolutely , and this is where it gets quite interesting , I think , when we get a little later on and we look at some of the sort of gait analysis and some of the ideas behind rehab . That's where sometimes we get so bogged down in the details that we miss the glaringly obvious problems in the rehab process , such as hydration nutrition . Is the person sleeping ?
Is the person ? Stressed Is the person anxious about what life looks like without their activity . And actually that then manifests itself into quite a complex kind of situation to manage as a practitioner . So I'd certainly say that's a big area is when a patient is sort of explaining their story .
Is the practitioner listening and does the patient think and know that ? Your practitioner is listening and that they're being heard . I think , that's a huge area . That communication is often not practiced .
This is really well enough . It's not considered well enough by a lot of practitioners , so it's very much a holistic .
Yeah , absolutely .
Yeah , okay , just from what you were just saying , with all these different elements , is there one that really stands out that people , for instance , aren't getting enough of ? So I'm just thinking , if I get enough sleep , I know I feel great the next day . I'm not likely to nap . The following day I'm able to .
I feel like you have more focus and that kind of thing , or rather the things like you said , the nutrition or the hydration . Is there one of those things which , really , if you said to them Mr Smith , we've looked at your knee or whatever that sort of thing , but make sure you go and do get this , because it will help your rehabilitation ?
I'm going to sit massively on the floor .
The fins are shaking .
That's right , that's great . The main reason for that , typically , is sometimes the most glaringly obvious thing that needs changing is the hardest thing to change . And so actually again , we've got to start and look at what position is patient in and are they willing to , motivated to able to change all these individual little parts ?
And so for me , again , it's that thing of talk to the person , get a good detailed history of what has gone on and why they are now in the situation that they're in . It's very easy to go well , your nutrition needs to be better .
And then when you find out that they are working a 70-hour-a-week job with three kids and loads of stress and looking after elderly parents and whatever , and you go . Yeah , that's why they're grabbing food on the go and eating whatever they can get hold of . Is it going to help me going ? You need to eat better ?
Potentially not , so there might be other factors that we start to change and then actually , as the ball gets rolling and we start to see this kind of snowballing for the better , then we can start to look at maybe some of these more complex or some of these more difficult things to address . And I think that's all patient-specific .
That is all completely dependent on who's turned up to the clinic and sat in front of me when we're discussing all of that .
Right , so let's move on to the running clinic , because obviously that's the audience , that kind of thing . So what do you do ? What's the process in terms of your assessment ?
So our assessment is mainly based around a detailed history . There's this . We just talked about there . And a lot of it is really to do with where they currently are and where they want to be .
So before they stepped on the treadmill , Before they've even stepped on
¶ Setting Realistic Goals for Marathon Training
a treadmill .
Because I think one of the things that can be quite empowering but also can be quite frustrating is when you potentially have someone who doesn't have realistic goals on how long this is going to take .
Now , it may be , and I would say and we'll get into that a bit later as well is that I'd argue that a lot of injuries are typically driven by doing too much too quick or too much too fast , or too heavy too quickly . It's load management that typically drives injury , and that's over and above technique , that's over above previous injury .
There's a lot of other factors that may have a bit of a bearing on it , but typically those injuries are load management problems , and so what we've got to set up straight away is , if I've got someone who currently can't run 5K without pain and wants to do a marathon in Six weeks , eight weeks , 10 weeks , 12 weeks , then we might already be on shaky ground
at the stone , and so then the worst thing to do is to go yeah , that'll be great , and then get four or five weeks in and realize they're going to be managing expectations . Expectation management is huge .
Because , again , if a patient can see where they are , where they've got to get to and actually the process of how we're going to get there , then they can start to actually picture in their mind what this process looks like . And actually whether that be a quick two week recovery and turnaround or whether that be a longer term three , six , nine month turnaround .
I think if we set the stall out at the beginning and we give some good short , medium and long term goals , motivation is there motivation instantly is there , whereas there's nothing more frustrating than thinking you're going to hit a target and missing it by a country mile .
Do you get people that , okay , they don't have an injury , but they just say , well , I come to you , I don't have an injury , and I just say I just want to run better , want to get better , I just want to get better , I just want to enjoy running , because the first 10 minutes of my running is I'm willing myself to enjoy it .
Everything's poking . Yeah , exactly .
Or I look at other people and they just seem to run effortlessly . I want to run , like do you get people ?
Absolutely , yeah , absolutely , and again that's probably . I would say it's almost a 50-50 split . There are those people that just go ? I want to run better . I've got this time in mind , or ? Yeah this down the road that runs like that . I want to run like him .
I want to be a Kenyan athlete , exactly , yeah , yeah .
And again , that's another thing about setting out those goals and those expectations at the start of going . Do you need to run like that to be better , or do you need to run like that to achieve what you want to achieve ?
Yeah .
And so that's where the analysis comes in is going actually , what's your current training look like ? Is it in the rough ballpark of what you should be doing ? I would say certainly .
In my experience with endurance athletes in particular , you will typically find , if we use marathon runners as an example you'll typically find that people fall into this really common trap of their easy stuff being too hard and their hard stuff being too easy .
And you end up in this kind of gray zone in the middle of You're wearing yourself out because you're running too hard for too long , but then you're never quite Getting the the speed and the real kind of power of that top end into the left that's because , actually you haven't got enough in the tank to hit those kind of peaks if that makes sense .
So people end up going okay , I want to run a , let's say , a Three and a half hour marathon . Only using that because I know the kind of the splits off . Oh , yeah , okay , Okay so I'm gonna run a three and a half hour marathon . That's basically 456 per K that you've got to run for three and a half out .
So a lot of them will go cool , go out and run 456 and five minutes okay , and I'll just increase the mileage and that will end up with a 330 marathon . And it's not always quite as easy as that it's or as hard as that it's . One of those areas are going okay . Look as a rough guide .
If we're looking at a roughly five minute per K for a marathon , your long , slow , easy stuff should really be 530 540 yeah , potentially it per K . Your hard stuff should potentially be 4405 410 minute per K , but only for short periods .
Yeah , and then you combine the two we end up in the middle . Yeah , we don't run in the middle and your sort of tempo runs would be roughly that split exactly yeah , and so what that means is that the overview of that training program then goes okay .
It's not about necessarily the specific speed that we're running out to match . Mm-hmm the marathon time that we're after , we're looking at training energy systems and actually our aerobic system . Yeah , can only work efficiently when we are running within ourselves .
Yeah and our anaerobic system in basic terms can only work efficiency when we're running Hard and actually we've got to have those differences in intensity .
Yeah .
To make sure that we're training those energy systems efficiently , and then , when we put it all together , we can then start to get a bit closer to our tempo times , and our kind of race-paced .
So do you advise on lactate threshold or is that something that you would ?
We yeah we stay away from to a certain extent , mainly because , mainly because it's quite time-consuming actually in terms of kind of training , programming and also you've got to have the kit available . So yeah , if anyone wants to go down that route .
We know of places and yeah , we can refer out for that for that level of detail , but that tends to be , again , that tends to be actually a small percentage of people that will Genuinely benefit from yeah , and we're talking our kind of yeah , sub 245 marathon runners and when they're getting to that level where you're looking at trying to get those , hmm ,
individual percentages . Yeah , that's where we need the detail of that and I think that's sometimes what confuses and conflates a lot of the situations that actually good club and good Weekend runners get bogged down in .
¶ Understanding and Debating Running Techniques
Okay , I need to know my Vo2 max , I need to know my blood lactate , I need to know this , I need to know that . And you go . Actually , if we can address the elephant in the room here , yeah , you're gonna see massive benefits from actually very little .
You just gave me an idea of a question later on maybe I'll talk about . But okay , we've assessed .
So sorry yeah .
You've assessed and , again , like you said , it's managing those expectations and finding out you're going to Take a look at how they're running . Yes , and so you may be making an assessment in terms of the , the biomechanics Is that and that kind of thing . Yeah , so , are there any ? So I know it's very difficult .
It's a very individualistic thing , in terms of how people run . But are there any , let's say , takeaways that you could say ? If you're doing these things , or what were your advice , then you can improve on a very basic level . You're kind of running for .
Yeah , I would say what's oh been quite interesting over over the years I've been involved in it . There was a kind of a big push a few years ago . Now it's probably eight , maybe ten years ago . Around this whole , 180 beats a minute .
Hey , yes , yeah , I was gonna say yes , that's the holy grail of .
Running everyone needs to run at that cadence and then what you start to do , and this is where it gets quite interesting when you do look at the research that happened around that yeah was that actually You're ? In any research study , if you're looking for cause and effect , you've got to control variables . So actually a variable that you could control is cadence .
So yeah , let's go Everyone , one at run a 180 beats a minute and let's see what happens off the back of that . So yeah then they started to study back the other way of going . We found these changes happen to people's running gate . When we're at 180 beats a minute , I , what cadence does it change ?
Actually , what's the minimum cadence we need to run potentially to bring about those changes ? And I guess this is where the attitudes towards cadence covariance . You could get four or five different people sitting in this room and they'd all argue for and against those .
So it was the idea in the first place because I don't know if I'm right , was it the 84 Olympics that someone did the study on Was the idea is that you don't get injured . Is there always again , very debatable .
Yeah , debatable when we look at injury risk , and I think that's the beauty , but also the complexity of what we do is that actually ? I would argue that you are never going to prevent injury yes , so there is no way . There is no one factor that you will go . If you abide by all of these factors , you will not get an injury .
It's just , it's totally unrealistic , and the reason for that is because there are so many factors that we've just talked about . So , then , the idea was that the theory behind it was that if you run at a high cadence , you end up your initial contact happens more of a mid to four foot strike rather than a heel strike .
Typically and again this is it's quite varied , but typically that initial contact will happen a little further under your body rather than out front , and just overstride idea that you're really impacting far out in front of you , and so the theory behind that is that then you're like a spring .
basically is that if you strike the ground below you and your ground reaction force is bouncing back up in the opposite direction from the ground , then we've got this ability to cushion that with our glute strength , our quad strength , our calf strength .
So in theory , yes , the point is that it will potentially reduce impact forces seen at the ankle , at the knee , at the hip , at the back , but that force has got to go somewhere else . So then , if we're loading the calves , glutes , hamstrings , quads , does that potentially open up just different injuries or different stresses to the body ?
And it was one of those areas that got quite interesting when there was a big push on barefoot running and and then you had a whole load of the population go .