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Running Free of Injuries

Episode 30 -Running Free of Injuries with Paul Hobrough

Episode highlights

0:01:53 – Paul overcame dyslexia to achieve a plethora of qualifications 

0:04:39 – He opened his practice in 2003 and has become an expert in Shockwave therapy

0:11:37 – Physiotherapist, chiropractor, osteopath–what’s the difference?

0:16:54 – Sometimes it comes down to the individual practitioner’s level of experience 

0:20:00 – A good approach to preventing injuries if you’ve been inactive for a while

0:25:06 – Don’t let your ego write a cheque your body can’t cash

0:30:20 – The people that first seek a bit of help will get the best results

0:37:02 – Before you start running, you should prepare your body 

0:42:39 – Running free of injuries and the Runner’s guide to 

0:46:07 – Should you warm up before exercising? 

0:53:40 – Five key actions to help you avoid injuries 

0:59:18 – Try this test before doing a plank

Links

Transcript

Welcome to the Fitter Healthier Dad podcast where you can learn how to improve your diet, lose fat and get fitter in a sustainable and fun way, without spending hours in the gym. Here is your host, Darren Kirby. 

Darren: This is Episode 30 of the Fitter Healthier Dad podcast. In today’s show, we’re going to be understanding how to stay injury-free and what to do if we do get injured. Joining me on the show today is Paul Hobrough. 

Following a successful 16-year international kayaking career, Paul decided to bring his sporting expertise into the world of sports rehabilitation. In 2003, Paul launched Physio&Therapy UK, and he has helped Olympic athletes such as Paula Radcliffe and Steve Cram. Paul also speaks all over the world and has written a number of books on running and injuries. Hi, Paul, thanks for coming on the podcast today. How are you? 

Paul: Very good, and it’s my pleasure to come and join this podcast, so thank you for inviting me. 

Darren: It’s a great pleasure to have you on and I think, as we’ve just been talking about off air, injuries and physiotherapy is very topical, unfortunately, for guys in their 40s or coming towards their 40s, when they decide that they’re going to go all guns blazing and start to get fitter and healthier. Unfortunately, this is the side that we don’t necessarily think about when we’re thinking about getting fitter and healthier, but sadly, it’s a reality. Equally, I think there’s a lot of stuff that we can do upfront to help us avoid that in the first place, so hopefully we’ll dig into that today. But before we do, Paul, it would be really good if we could get some information and background on yourself and how you got to where you are today.

Paul: Yeah, sure. It’s always one of those funny things, isn’t it? Talking about yourself and very often I do have to write these profiles on myself and I find it sometimes a bit awkward. I’ve had quite an interesting route into the job that I do. I’m quite dyslexic and I was, I would say, struggling at school because my mom was a deputy head of the school and I perhaps opted for the role of the class clown. I struggled through school and was very fortunate–this will date me a little bit. I was very fortunate; I was the first year that ever took GCSEs and that gave me a bit of a leg up in life and it wasn’t lost on me. I was also by this stage a very accomplished kayak paddler, canoeist, racing canoeist, and I liked rowing. You’d be in between two sets of red boys, you go as fast as you can from point to point. So I was very, very committed in one part of my life but academically, I was a bright kid but wasn’t really applying myself. It was only when I started working with the human body… My first degree was Sports Science–which in many ways I was probably gifted a place at university because I’d done very, very well at the major world championships that summer and the university went into studying sport. I think they saw that as a bit of an extra qualification, really.

Once I was qualified and working with some high end athletes, trying to give them their top half or quarter of a percent of benefits through blood lactate analysis, training, all sorts of stuff, I realised I was totally useless once they got injured, and I’d be sending them off to these people who were walking on water, who were these physiotherapists who are incredible. I’d been quite injured as an athlete and I’d always seen these people as being incredible individuals. Being the sort of person, I went, “right, I’m going to become one,” and so I ended up doing a couple of more degrees and ended up being a chartered physiotherapist and I didn’t really gel. My sporting background… I mean, I’d been in the British Kayak team for 16 years, I’d really enjoyed being a lottery-funded full time athlete. I didn’t enjoy as much as perhaps people wanted me to, working in the NHS. I felt like I was doing everything a little bit one hand tied behind my back and often coming to theprocess a bit late with 16-week waiting lists and some of those.

2003, I set up my own practice which was a combination of doing all of the physiological testing from my sports science background and the physiotherapy. And what I realised very, very quickly is in a business model, pain is a much bigger crowbar in somebody else’s wallet than the desire to have that 3 or 4% improvement maybe. It’s changed slightly but I’m now absolutely 100% a physiotherapist with a strong strength conditioning and exercise prescription and sort of medical healthcare practitioner background. I study with the Society of Musculoskeletal Medicine, I inject where necessary and so I’ve got a plethora of qualifications and I now run a very busy practice in Northumberland, a place called Hexham near Newcastle. 

I also travel to Harley Street typically once a week, and I travel around the world lecturing on something called Shockwave therapy which many people have now heard of but seven years ago, when I started, nobody had. Probably the best thing that’s happened to speed up recovery from injury. It isn’t cheap but if people really need to get better quickly from an athletic point of view… And you’ll find all of the Premiership clubs, UK athletics, all of the major Olympic sports, will all be using this regularly and I’m very, very fortunate to be–putting modesty to one side–possibly the most qualified and experienced person in the UK for this right now, which is why I lecture abroad. I guess a potted history as part athlete part healthcare professional and I also present professionally as well. So, does that help?

Darren: It does. That helps a lot and just to pick out there what you were talking about the human body and the human performance. As I’ve progressed as what I loosely call an athlete, what I’ve found is that the human body is such a fascinating piece of kit that we have and is in many ways, I believe, limitless providing you treat it right. And all too often, like I just said, we neglect it and we don’t maintain it enough as we should. 

I feel like, I guess as a potential client of your industry, that that is now changing slightly in so much as people are becoming a lot more aware about their body and about the tightness, and all the rest of it that goes on, and they’re kind of switching to a little bit more maintenance as opposed to reactive and when there’s an issue. Would you say you’re seeing that?

 Paul: Absolutely. So let’s go back to 2003 when I opened my doors. I spent the first five minutes of every session explaining to people what a physiotherapist was. People didn’t know, they had no idea. And still today, you’ll find people that don’t know the difference between physio, chiropractic, osteopathy, all that sort of stuff. People just didn’t have a clue; they went to A&E or they went to their doctor and, frankly, we were all witch doctors. Nowadays, not only do people know what a physiotherapist is; they have their guy or their girl. People almost own their physiotherapist as well and there’s a reason for that. It is partly because I think we’ve been very good at being a results-based sort of practice–I’m talking about physiotherapists generally. 

When you look at how people have started to move through and understand, people like Dave Brailsford–you know, marginal gains–people look at themselves and go “You know what? I want to be more professional with my approach.” And you find age group level triathletes, let’s say, who are doing very, very well, training at incredibly high standards. Sometimes I think, my god, they’re doing more than when I was in the full international team as a youngster. And they are seeking out any slight gain to get them past their closest rival. And so they start to understand the benefit of looking after their body, their sports psychology. 

Sports psychologist: that’s what I wanted to be when I was at university but I thought nobody’s ever going to Google sports psychologist and go and pay money for it, and now of course they are. So it’s not just the physio: it’s the sports psych, it’s the nutritionist or dietitian, it’s the technical support, it’s the biomechanical support. Everything I studied in 1990 in my first degree, was all really very, very kind of out there in the very beginning and now it’s commonplace in people. Not only those that are at international level, but people who are a good club standard are using all these services. And like you say, maintenance and being proactive, rather than being reactive. Which is exactly how I started my business and why in the first year it looked like it might fail spectacularly, because the only reason people came to see me is they’d tried everything else and they were in pain and they said, “You know what? I’m going to invest a bit in this.”

Darren: Yeah, I think when you’re talking about age group athletes now, you’re absolutely right. I’ve been even looking myself personally at sports psychology because I listened to a podcast the other day where one guy had knocked five minutes off his marathon time just by going and seeing a sports psychologist. I believe we’re in such a fortunate time in terms of the information out there but I think that the massive danger that’s out there now is this whole self-medication and self-treatment, which I think probably you as a practitioner would grimace at because you think that’s the last thing we need. Someone going and watching a YouTube video and they think they can fix themselves!

Just to pick up on the other point you said there around the differences between physios and chiropractors, can you in layman’s terms, lay out the differences between them?

Paul: It’s always difficult because I am a physiotherapist, so the trick is not to overload that and to be genuinely impartial, which I will try to be. I think that the first point is that a physiotherapist is governed by the HCPC, The Health and Care Professions Council and that is the same council that will look after most of the medics that you’d think of in a hospital situation. So if you go and see a podiatrist, a dietitian, an occupational therapist, the doctors are under the GMC, the General Medical Council.

When you move into osteopathy, they’ve their own singular Osteopathic Council and the Chiropractic Council again. They’re slightly more self-governed. I can be struck off for blinking the wrong way; it’s very, very highly governed and we get audited all the time and I’m not saying these other guys are not. Physio therefore becomes, in its purest form, possibly a form of like general practitioner for the musculoskeletal system because we have to study neurology, that encompasses stroke, Parkinson’s disease, all sorts. As a physio, you can extend your scope to become a prescribing physio, where fairly straightforward medications you can actually write a prescription for. It should be that we’re a kind of entrance to a funnel and most things outside what your docs do, we can do. 

I have very clearly specialised in musculoskeletal sports physiotherapy so that makes me far more aligned to your osteopath or perhaps your chiropractor. Whereas another physio could be working with children, with older persons, in a burns unit, palliative care. I’ve chosen one stream of that but I had to learn it all in order to get here. So there’s a vast amount of medical knowledge. 

If you compare that to the physical therapist that you might hear about in the States: when I’m teaching over there, people are like, “Why are we listening to a physical therapist?” They are consultants, treated a bit more like a gym instructor or something. They don’t have the same level of medical training, is my experience has been to the consultants: I might be under-selling that.

When you look at an osteopath or a chiropractor, those two tend to be a little bit more interchangeable. They would perhaps argue differently but essentially, they’re working around joint manipulation. The crackling sound you get if you were to crack your knuckle or your back or whatever. I would argue that an osteopath works probably more closely to a musculoskeletal physio–soft tissue and joint manipulation and strength conditioning. The chiropractor is much more about the adjustment and the overall general health; they can, become quite alternative and I know one chiropractor that told someone to take all their metal fillings out. But again, I don’t think it’s about the training; I think it’s about the individual and their experience, the people they’ve worked with, and the referral that you get. 

I would say the chiropractors are the richest of all the three. They might see you three times a week as sort of an ongoing process. The difference between an osteopath and a physio would be much, much more difficult to drive a wedge through, once you get down to the musculoskeletal level. But personally, I would choose to go and see the person that worked well for me, that had the best referral, so it almost comes to “does it matter?” Who’s the person the rest of your triathlon club or running club fixed? Let’s go and see them. 

Darren: Yeah, it’s funny, isn’t it? How you were saying there before about people align themselves–it’s my physio, it’s my chiro–and people very much go and see practitioners based on other people’s experiences and results, isn’t it? It’s a very personal thing. The way that I approach it now is that I’m going to see a chiropractor. If I’ve been out running and I feel like I’ve tweaked something, in loose terms, I’ll go and see a chiropractor to get myself sorted out because it feels very much to me, for the people that I’ve seen, the chiropractor will give me almost instant relief but then a physio is more long term with the muscular side of things. So if I’ve tweaked myself running, then it’s because I’ve maybe got some tightness somewhere or whatever and I know the chiro can come and sort me out from almost like a pain relief perspective. But longer term I need to go and see a physio because there’s obviously some imbalance there or some tightness there. Is that a fair way to use different practitioners?

Paul: I think the problem there is if I could imagine a single physio and a single chiropractor where that would exactly work. An adjustment to the spine or whatever, is usually a transitory bit of, like you say, sometimes immediate relief. Not for everyone. Scientifically, I could disprove the theory that you’ve just said, but I think in practise there’s a great deal of instant relief to be had. I do, do adjustments exactly like that so I would immediately sort of defend the physio role and say, well, if you came to me, I’d do that and the other stuff, and you pay once and you get both. But not every physio might be trained to do that. 

If you break it down to its most basic thing, if we were looking at someone that was the first couple of years out of university, then that would probably ring true. When you get a very experienced individual, I would have thought that either of those would have been able to do all of the job themselves.

Darren: Okay. That makes sense. It’s very much practitioner based and their experience and their knowledge, then, I guess.

Paul: Because there’s terrible physios, there’s terrible chiropractors, there’s terrible osteopaths. There’s brilliant ones of each. What you’re looking for is a brilliant person who has a title rather than just going, “all chiropractors are the same.” Otherwise, we’d all go to the same hair salon because it was cheap, we’d all drive the same car because it was the cheapest one. We look for the thing that’s going to give us the best value for money and the best quality, based upon our needs. Really, in a healthcare scenario, I’d want someone that had a great deal of experience, expertise, and I had a little bit of information from someone that perhaps wasn’t trying to sell me their services. Someone that has actually been there, seen it, done it, and is now telling me that that worked for me. I think that is the biggest litmus test, is someone who has no interest, nothing to gain by telling you they had a good experience with that person.

Darren: Yeah, that makes sense. So if we try to kind of dial it back to the people who perhaps started off 2020, they’re going to do some HIIT training, they’re going to go to the gym, or they’re just going to generally start exercising. What would you say is the best way to approach it from an injury prevention perspective? To give you an example, let’s say it’s a 40-year-old male, probably not exercised in 10 years, he’s now going to do a load of exercise. From a mobility perspective, they’re not going to be mobile, agile as they think they are, and all too often I see people kind of having these injuries. My assumption is that a lot of these are preventable, so what would you say would be a good approach? 

Paul: First of all, science tells us about how we should increase our training, so we’re talking about increasing from zero here. I could show you a graph but it’s not possible. If let’s say your exercise level, you’re doing 20 minutes running twice a week, for example. If you leave it at 20 minutes twice a week or if you increase it by 10%, so you go to 22 minutes twice a week, or you actually reduce it by 5%, you have the same injury risk across all three of those. 

If you increase it by 15%, your injury risk trebles two and a half times, actually. You really do need to–when you’re getting into starting an exercise plan–really, truly need to understand where your level is and be honest with yourself. Because anything greater than a 10% increment, you are significantly increasing your level of injury. 

Going back to your person who’s basically done nothing, they’re 40 and they want to get back into it, let’s just think really simply here. What’s your goal? Maybe their goal is they would like to just be fitter, lose a bit of weight. I’m sure that you will agree with me, one of the fastest ways to get fit and lose weight is to go running. It could be, depending upon your biomechanics, one of the quickest ways for you to find an injury. So if that’s your goal, to begin with, 5% of your exercise time would actually involve running and 95% would involve things like swimming, exercise bike or going out on your bike, a cross trainer, doing some basic strength conditioning, and some stretching exercises. And over the weeks, that five to 95% would start to change so that maybe six to eight weeks from now, you might be on a 50/50 curve with that. So 50% of your time is now running. But it really must be that slow and you must be only going up by 10% of overall activity on each given week. If a week ago, my long run was 10 miles so I did 11 miles next week, but they’ve increased their interval running in the middle of the week, so they’ve already eaten up their 10%. It’s the full week. 

I tend to suggest to people, if someone comes to me and they’re totally deconditioned, then what we’re looking at is how do we get some basic conditioning? Like can we start doing some quarter squats, literally, feet shoulder width apart and then down quarter of the way, come back up again, do 10 of those and do those four times staged out throughout the day. Start doing some very, very simple five sit-ups at a time maybe, spread that out during the day. Have a couple of days’ rest. Your body takes 36 hours before it will bite you for what you did. You’ve heard of delayed onset muscle soreness? Most people think it’s going to be the next day, everyone now really knows it’s two days later. That’s because it takes 36 hours for your body to truly respond. 

So where people go wrong is they’re get excited. They exercise on day one, they do far too much but they cope with it. They wake up in the morning, “Phew, got away with that!” They exercise the second day because they’re motivated and they want to do it. They wake up the third day, and they can’t move and they blame the second session. That’s the first session catching up with you so by day four, you’ve now got two sessions in your system, and you’ve probably maybe exercised again. So understand the body has a latent response to exercise that you should only go up by 10% at a time. And if that’s from a zero position start, then tread very, very carefully and mix it up but it starts by doing some very, very simple body weight exercises, just to prepare your body. 

So walking, you probably put one and a half times your body weight through your muscles and joints. Running, maybe two and a half/ three plus times your body weight. We can prove this on pressure maps and scans. So if you’re really not used to doing much more than just your activities of daily living, don’t suddenly go putting three times your body weight through; start preparing for that onslaught, if you like. And then do very little, then wait two days and do very little again, then wait two days and very, very gradually build that up. You will end up at your goal faster than you will do by trying to rush it in the early stages.

Darren: I think that’s so valuable because it’s exactly like you say. It’s almost like a bit of an ego thing from a perspective of, “Wow, I knew I could do this anyway. I knew I could go out running, I could just get fit. This whole exercise stuff is quite easy.” And like you say, then you don’t actually feel it until a few days later. 

Paul: On that point, from a famous film: Don’t let your ego write a cheque your body can’t cash.

Darren: I’ve not heard that one before; what film is that from? 

Paul: Top Gun.

Darren: Top Gun? Okay. Yeah, but that is so true and the older we become and the sedentary lives that we lead now–sitting behind the desk eight hours a day and all the rest of it–just compounds the immobile aspect of how we are now, doesn’t it?

Paul: Yeah, absolutely. Listen, you’ve got every buzzword to think about. People are working longer at their desk but go back to even the 1970s and 1980s. I didn’t have a mobile phone, didn’t have a computer. I would be going out and doing stuff. Nowadays, everything that can keep you entertained is all in one little pocket thing. We hold the answer to every single human question in the palm of our hand and typically what we do is read about what other people are doing in their lives and pictures of cats or whatever. It’s crazy, isn’t it? But the fact is we’re now a much more sedentary sort of existence. 

They’d be much, much more manual labour, people were working more in their gardens, they were doing all sorts of things. Everything is kind of, you know, machines do so much more for us now. So that’s why I think there’s been a massive increase in people’s desire to exercise. It’s a natural thing for us to move; unfortunately, some of the population have been a bit left behind and they’re not choosing to do that 40 minutes of exercise in a day, so they just don’t get any. Because they’re in this sort of manual route through to doing other stuff. 

What we’ve done is we’ve created our own sort of problem and now the route out of it is it can be quite an expensive one as people try to develop this and try and get up from their chairs. And we’re also pushed for time. Part of the injury risk is, “I’m just going to finish this bit of work. I’m desperate to get my run done before I’ve got to go and pick the kids up from ballet or whatever it is.” So you jump up from your chair which had your hips flexed at 90 degrees for the last nine hours, give or take a trip to the toilet or the coffee machine, and then suddenly you want that hip to be able to flex all the way back to something in the region of 130 degrees when you go running. And lo and behold, you don’t do any preparation because you’re trying to fit it in. 

The run’s the important bit–not the walking, not the stretches, not strength conditioning–because you want to feel that your heart has been bursting out of your neck for that 40 minutes so you really feel like you’ve achieved something. What happens is you put strain on the hip flexors, the hip flexors originate from the lower back, next time you sit at a desk, your lower back’s sore, you don’t know why, you blame the desk, not the run and your lack of preparation. And the cycle keeps going until you come to see me, and people are going, “I need my desk set up looked into at work and my employer’s crap.” No, you didn’t prepare for your run!

Darren: I keep using the analogy in some of the videos that I do related to project planning in the corporate world. You wouldn’t go about a project in your business, in your life, build a house without a plan, would you? And so for me, as I’ve learned to my cost, I’ll be honest, it is about having that plan and it is not just about putting your running shoes on and going out. It’s the preventative and the pre work that you need to do ahead of that to ensure that you do have a good run. And so many of us don’t because, like you say, we have this notion that we are pushed for time. We all have the same amount of time in the day: it depends on how you plan it and how efficient you are with it. 

From my point of view, we are living, like you said, in this Amazon economy where we want to click and have the result now and that just doesn’t happen with the human body and with fitness.  

Paul: It’s a beautiful thing. My oldest is 16 and she’s grown up with everything at her fingertips. One thing that she keeps asking: how can I get this? How can I get this quickly? In a fitness term. I say it’s the one part of your life that’s teaching you everything about everything else in your life–there really are very few quick fixes and it just takes time and dedication. When you try and rush it, effectively, you just make my business busier. Don’t make the physio happy.

I’m almost being a bit negative here and I want to inspire people to exercise. I just think that, as you say, it’s all about planning. And actually, the people that seek a little bit of help first and not just go to the University of YouTube, which we talked about earlier, are going to get the best results. Because I’ve never met a human being that is identical to the one I saw before or the one I saw afterwards. And the real trick of this is we can’t have a sheet of paper that says, “Oh, you got knee pain? Just do that.” It just doesn’t work. There are so many intricate reasons why that human being is so incredibly different to the next one. 

I think that one of the practices that you’ll really struggle to automate and almost to make it a robotic fashion will be the healthcare industry because it is so personalised. I do have a desire that people who are embarking upon a journey would first set out and say, “that is my goal.” We did this when I was an athlete, right? “That’s my goal.” The goal might be the Olympics in four years’ time so where do I need to be at the World Championships the year before? Because that’s qualification. What position therefore do I need to be two years from now? What do I need to be in one year? What do I need to be in six months? What do I need to do in the next hour that’s going to facilitate that goal in four years’ time? And that way you’re really precision planning. 

And of course you write it, but it’s got to be flexible, it’s like a white label plan. But you have to know roughly what you’re doing. So then, you know, four days off ill, where you genuinely couldn’t train, what does that mean to the rest of the programme? A lot of people that, say, lack a little bit of experience training, will try and squeeze those sessions back in. We used to say… Well, my coach used to tell me, “A session missed is a session lost.” Never ever think about it again and certainly don’t try and cram it in somewhere or change that 10% rule. 

So there are lots and lots of ways in which having some decent help… It doesn’t mean you need to sign up to a big coaching programme, it doesn’t mean you need to purchase £1000 worth of physio ahead of time. You just need to genuinely think about who you are. If I asked you what a typical training week was for you, the response from most people would be to tell me their best ever week’s training. If you then base a programme off of that, they’ve sort of let their ego get in the way of that. Now, what’s an average training week? 

People forget, it’s a bit like setting a diet. What do you normally eat? “I’m very good. I have lots of fruit and veg and all the rest of it.” It’s only when someone actually makes a diary of what they actually eat, they’re shocked at how much is getting into their body. And it’s the same with exercise. You might think, well, I’ll get my four-hour bike ride done on a Sunday morning early, and then you’re satisfying your kids and your partner’s needs for maybe shopping for ages. You’re on your feet for five hours. That’s not really a recovery. Let’s go back and think about this a little bit better. 

We don’t all have to be Dave Brailsford but we do need to think about that. And like you say, planning it means that you can then go: I’ve got a four-year plan or a one-year plan or a two-month plan, and now I know what I need to do tomorrow and I now know what I need to do today. Does that befit the 10% rule or not? Is this something which I’m capable of? Is it going to push me just enough but not too hard? 

If you’re just doing this on your own, and you’re not sharing with anyone, you can be really very brutally honest with yourself about, “That’s going to be a real challenge for me. Let’s dial it down a little bit.”

Darren: Yeah. But I think all too often, like we said, ego gets in the way and you assume. I said at the beginning of the interview that our bodies are truly limitless, but they’re only limitless if you treat them properly. And I think you can be brutally honest with yourself, but all too often unless you have someone challenge you, you kind of think that you can do something or achieve something in a lot shorter timeframe than you actually can. And if you give yourself a longer timeframe, you’ll actually achieve it in a much easier and more sustainable way.

Paul: Absolutely. And that’s the same with diets, the same with mental health, it’s the same with your work-life balance. You can’t just make this sudden change and expect your routine to adapt to it. On a really, really positive note, the human body is very, very adaptive and if you give it the right stimulus, it will adapt, it will overcome, and it will do it safely. We live in the most fantastic personal castle that you could ever hope an engineer to come up with, it’s why they cannot create robots that are human, they just can’t. It is a fantastic set and it will pretty much develop and improve based upon the correct level of stimulus, almost without fail. 

What we’ve spoken about for the first part of this podcast is if you don’t understand what your limits are, and you go, “Well I used to run an hour, three times a week, so going for 20 minutes now after a six-year break is easy.” No, it isn’t any more. That 20 minutes, whilst it seems small to your six-years-ago self, is now massive to your 2020 self. So just rethink that. You’ve got to be realistic with yourself, but your body will adapt, given the chance, and it is a fantastic unit of cells that really will not let you down unless you let it down.

Darren: Yeah, a hundred percent. So we’re talking about this and obviously, like you said, let’s put a positive spin on it. We’ve talked about being a little bit more conscious and about planning your runs or when you’re starting to run. We’re assuming that people are going to start running; that’s probably the most accessible form of exercise that you could do. So in terms of prevention, then, Paul, what would you say are the things that the listeners could take away, and just implement before they go running?

Paul: Some of the best things that you can do in preparation is some very, very basic strength conditioning stuff. I’m a fan of the single leg squat: both my books are laden with single leg squat information. If you think about when you’re running, you’re basically doing a single leg squat standing on one leg and bending the knee, in its simplest form. And you’re doing lots and lots of those. In fact, if you run a marathon, someone sort of towards the back of the pack would be looking at doing 50,000 or more steps, so 25,000 single leg squats. So ask yourself, could you do 25,000 single leg squats today? The answer is probably not. We don’t train to be able to do that but we have to train the body to be able to accept that load. 

Before you go for a run, stand in front of a long mirror, stand on one leg and squat down in 50-60 degrees of knee bend and just watch in the mirror as you do this five or six times, and try and decide whether you are in a position there where your knee stays over the middle toe. Let’s say it does for the first one, but by the fifth one, it’s come right across to the big toe, then you have a fundamental strength issue where what you need to do is be able to strengthen up around the lateral glutes to be able to perform a number of those squats without the knee deviating. Otherwise, you’re going for a run and you could end up with shin pain, you could end up with knee pains, all sorts of things. Very, very simple and easy test. Actually, in my second book, we have this as a test. 

Then go to a wall, put your toes against the skirting board, so you’re facing the wall, just one foot, and see if your knee can touch the wall without your heel lifting off. You should be able to do that. Then move your toes about half an inch away from the wall and try again and keep going until you cannot touch your knee on the wall without your heel lifting off. If you can’t see a reasonable gap of–I’m working in inches here, which is ancient–let’s say you couldn’t get at least two inches away from the wall, then you’ve probably got quite a significant issue around your ankle and your calf muscle. You might hurt your Achilles or your calf muscles, so start doing some basic range of movement stuff around your calf and ankle. 

You then move on to doing things like stressing your glutes. So if you lay on your front, and you bend one knee to 90 degrees, and you placed your foot perpendicular to the ceiling. Now imagine you put a tray on the base of your foot and imagine you’re balancing six glasses of champagne on that tray; can you lift that tray an inch off the ground with your leg without spilling any? And could you do that five times? Because then you know whether you’re using your glute. If you’re using your hamstring, the knee will bend more, you’ll tipple the drinks all over your back. And actually you want your glute to be working, not your hamstring and hip extension. 

If someone comes into me and they say I want to start running, I’d go, right, let’s have a look at what your glute strength is like, let’s look at what your single leg squat is like, and let’s look and see what the range of movement around your foot and ankle is like. Because they’re going to give me the very, very quick picture of whether this person is okay to crack on and do a little bit of running or whether we’ve got some remedial work to do. There are loads of other tests but if people are thinking about starting out, then there’s some basic tests you could do on yourself that probably most quite accomplished runners might struggle do. They’ve built up their strength over time, they’ve probably been injured a number of times, and they’re still not paying attention to those basics, so they still find themselves perennially injured. 

And there’s much more besides which is too much to go into but they’re the easy ones to explain so people can make a mental image of it. And if you can start to think about the strength conditioning work required so that you can go for a run, then you are already 80% of the way there. It’s so vitally important.

Darren: Yeah. I think for me personally, core has always been a key part of what I’m doing because your whole body, particularly running more than anything, centres around having a strong core strength. But two of the things that you’ve mentioned there have actually kind of made me raise my eyebrows. Jeez, I can’t do many single leg squats! I can probably do, I’d say, 12 each side before I start to get fatigued. The other issue that I’ve had personally is around lazy glutes. What I used to find was that when I’ve got above 20 K’s in my run, my hamstrings would really start to tighten up because I found that I was running from my hamstrings and not from my glutes. I’ve been doing it seven years and even then, I was not aware of that. And those basic suggestions you’ve given on exercises there are very, very key.

Paul: Actually, it was one of the things… My first book was Running Free of Injuries, which some of your listeners might have read. My second one comes out next Thursday. I don’t know when this is going out, but the 23rd, two days before the National Running Show, and I’ve actually specifically put in there these tests in that book. And then there’s a table where people fill out how they did left versus right and then they kind of know which page to then go and do the right exercises. And then they come back and they can retest and they can remark it down. They can plot their progress in the book, if you like, so it becomes a small training diary of their strength conditioning work as well.

It was very important to me because you write a book called The Runner’s Expert Guide to Stretching, and really what people are going to do is go and read and go, I need to do all of these.  So at the beginning of the book, it’s a case of streamlining that and saying, well, have a little test, see what ones you actually need to do, then go and be selective. Choose those ones, do a six week programme for yourself, then come back and retest. And those ones that you’ve kind of covered off and you’re now quite good, you’ve got good range of movement, you’ve got good strength, you can maybe just do a maintenance programme on those and then go look for other areas where you perhaps need a bit of work. Over the course of the first year of owning that book, you could really restructure yourself and actually bulletproof your body to a point where maybe I put myself out of business. Who knows?

Darren: I doubt that very much, Paul! Unfortunately, we’re dealing with humans and as much as you would like to think that that would be the case, I think sadly–for you anyway–that won’t be the case. 

Paul: I will give you a statistic as to why I won’t be out of business. Only 7% of patients that see healthcare professionals do all of the exercises they need to do: the number per day and for the required duration of weeks. Only 7% follow that. So if you only give out exercises, you’ve only got a (7%) chance of success. What I try and do, both in my clinic and in my books, is to explain to people and prove to them why they need to do it, and then give them a follow up test. Because the statistic moves to close to 70% of people doing it, which means you’ve only got a 30% failure rate over a 93% failure rate, which is massive. So it’s all about education.

Darren: Yeah, definitely. I completely agree and I know myself. Once I understand the reasons why I’ve got to do something, it just makes it that much easier for me and I know everybody’s different. And it’s not necessarily going into the science; it’s do X and then Y won’t happen. It just makes it much simpler. 

One of the things that I’ve recently come across, Paul, and I heard a lot of practitioners talking about and that is warming up and cooling down. There was a programme on in the UK between Christmas and New Year and there were a lot of practitioners on there talking about warming up and they were saying don’t bother warming up because your muscles are already cold and the chances are that you could pull something or do some damage before you’ve even started. What’s your take on that?

Paul: Listen, this is a bit like “a glass of red wine a day is good for you,” so let’s just delve into why that statement, unfortunately for many people, will be false. That scientific paper showed that people that didn’t drink any wine at all, were more likely to be someone that A) had a previous issue with alcohol or B) because they weren’t drinking alcohol, they were more likely to eat chocolate and crisps and other things to reward themselves differently. The people that drank more than a glass of wine a day tended to be chronic drinkers and therefore they had various other health problems associated with that. So those that had a moderation of just one glass a day, tended to be the healthiest person all round. 

So what we have to look into is what is meant by these statements: don’t bother warming up; don’t bother doing this; don’t bother doing that. There are some scientific studies that show that if you static stretch the body–so stand in a static stretch–you are reducing the power output of that muscle. In effect, extrapolating that to the fact that you’re going to be weaker and you’re therefore going to perform at a lower level. Now let’s think about someone going for a 20-minute run who lacks mobility and all the rest of it. Is their prime concern how much power their calf muscle can produce, when really, they’re only probably producing 20 to 30% of their maximum power anyway? Or is their main concern, “I don’t have an adequate range of movement around my calf and my foot and ankle, and so every single stride, I could be on the brink of my end of range of movement and therefore an injury?”

So don’t warm up and don’t stretch is actually potentially an evil thing to say to someone who has less conditioning and who isn’t doing strength conditioning, i.e., stretches at another time in the day when they’re in the gym or whatever or at the end of a session. But it could be a very, very relevant thing to someone that was going to do a 100 metre sprint or a one repetition max effort. So you have to put it into context and you also have to relate that to where you are in your fitness journey. If you know you’re tight as a guitar string and you’ve had, very, very regular calf muscle strains or pulls or they just feel tight, don’t go out without doing some preparatory stuff. 

There is however, some really good science to show that range of movement, more dynamic stretching–so a bit of walking, going up and down the stairs, doing some gentle calf raises–that sort of stuff actually helps prepare the muscle and is sometimes good because you’re taking it through the range of movement. Building up your walking lunges is great. You get knee interaction, you get hip extension, you get ankle dorsiflexion and plantar flexion. So you’re doing something. You’re not holding for 45 to 60 seconds, but you are preparing yourself for running and that’s where most people are now accepting that the warm ups should be more of a dynamic building up gradually. 

Take a leg swing: you’re doing a pendulum swing with your leg, add a little bit of knee movement, a little bit of hip movement, and gradually, as you warm up, that gets bigger and bigger and bigger. And it goes probably beyond what you need for your running. You don’t need to go there, but you’ve warmed up. You’ve taken it through that range of movement and beyond; you’re now good to go. You don’t need to sit in 14 different static stretches to cover off everything that hit might do but you do it gradually, you do it a bit more dynamically. 

Afterwards, there’s a good argument for doing some more kind of yoga poses, a bit more static stretching because of the mere fact that your muscles have been contract-relax, contract-relax, contract-relax. Muscles are like lots and lots of different cells and the analogy I use is imagine two brushes with the prongs facing each other and you push them in, so the prongs overlap, and then you pull them back out again so they come back apart. Muscles contract and relax in a concertina fashion, lots and lots of those hair brushes in a line, so when they all contract together, all the brush bristles overlap; and when they all relax, all the brush bristles come back apart. At the end of a really hard session, you’ve got more overlap with those brush bristles and you need to do some gentle static stretching just to bring those back out to their full length. 

Understand what’s behind these big statements in magazines and newspapers that are designed to work to your confirmation bias. You can’t be bothered to warm up, so if someone says warming up is bad, you don’t even read, you go, “Great. I don’t need to do that.” Don’t allow that to happen. Read what it actually means and then follow it with caution.

Darren: Yeah, I think that’s fantastic advice. And, actually, that’s something that I’ve not done–the active warm up, I think, might be what you call it. But doing those lunges, it would be perfect, especially around ankle mobility and your hip flexors and stuff like that.

Paul: And take it another natural stage further. So as you’re working towards, let’s say you’re going to run a marathon. I see a lot of marathon runners: let’s say you’re going to run a marathon and all of your training has been unimpeded. No one’s left a plastic bottle on the ground, you haven’t got to get round a rhino in the central street in Middlesbrough or wherever. But then you go and run the marathon and you’re dodging left to right. Your body hasn’t been trained in lateral that movement. You might have run 21 miles in training, but none of that was lateral, so it makes you wonder why people have abductor issues by Tower Bridge on the London Marathon; because they’re doing things that they weren’t used to. Think about the event and do some preparatory work for that lateral movement as well. Don’t become a one trick pony.

Darren: No, and that’s why I think trail running and things like that in the winter is very, very good because the ground is relatively uneven and, like you say, you are doing that lateral movement from side to side on uneven ground and getting used to that. And that’s very tough to actually deal with when you’re running as well.  

Paul: Yeah, and it works your proprioception much more as well, which is your body’s understanding of where it is in time and space, mixed in with your balance. So proprioception is a big long word: part of is balance, part of it is your brain understanding where your foot is in the recovery phase and all that sort of stuff. So it really works your proprioceptive forces: no one step is the same. It gives your nervous system a lot more to deal with and actually, you become stronger as a result. But likewise, a terrible piece of advice to the person just starting out. They need a repeatable surface they can rely on whilst their body gets used to the actual simple act of running.

Darren: Yeah. Okay. Paul, before we finish, then, what would you sum up as the five key actions that listeners can take away today to really help them avoid the injuries that we’ve been talking about?

Paul: Okay. This is simple and I’ve given this advice in lots of different places. Concentrate on your core. Your arms and legs are going to have to work twice as hard if they’re not coming from a decent foundation. The foundation of body movement sits with the core. Being able to do a plank does not mean that you have a wonderful core. There are people with six packs who have terrible cores and there are people that have got a big old, protruding beer belly that can have a fantastic core. The core are the tiny little muscles that sit around the spine and its natural corset that extends around your lumbar spine. 

Now, some good Pilates moves are very good. Just to describe one very, very quickly. If you lay on the ground like you’re about to do an old fashioned sit-up: your knees are bent and your feet are flat on the floor and, by and large, together. Your knees can’t be squeezed together. And you imagine that you’re about to go to the toilet and the process of stopping the flow of going to the toilet would engage a muscle called transverse abdominus. The key, if you like, to unlocking your core or locking your core. Once that is activated and you can feel it if you put two fingers on those little bony points on the front of your pelvis, go in a bit and down a bit and you cough; those muscles will bounce. So when you sit in that position, imagine you’re going to go for a wee and then stop the flow. Those are the muscles that will do it. You’ll feel under your fingertips, they’re doing it and you know they’re contracted, keep that contracted. 

The second stage, whilst that is contracted, is draw your belly button in towards your spine. Not by holding your breath, but by using muscle. And the last thing is to ever so slightly flatten your lower back towards the floor. You have just engaged all of those core muscles that make up that natural corset and by holding that locked together for 10 seconds at a time, 10 times whilst you’re watching the TV or listening to this interesting podcast, 10 times a day of 10-second holds, you will start to develop your core and then you can repeat those stages. You won’t have the floor to flatten your back towards but you can repeat those stages whilst doing a basic sit-up, whilst doing a plank or a kneeling plank and that will mean your core is activated all the time. That can shave minutes, not seconds, of your half marathon or marathon time, just by having a better core, because your legs and your arms and the rest of your body will have less work to do, because you will have a stronger base. 

When you think you’ve got that done, single leg squat. Everyone that’s listened to the whole thing knows I was going to say that. That is so functional. You’ve got foot ankle, you’ve got balance and proprioception, you’ve got knee, you’ve got hip, you’ve got glutes, you’ve got core, you’ve got lower back all being worked. You should be able to do 25 without very much knee deviation to the midline, over your middle toe each side. You should be able to do that a number of times a day, every day. 

The glute activation. So you can do things like bridges, which is like the start position for the core activation, but you actually lift your hips up so your knees, hips and shoulders are in a line. Or you can do the champagne balancing exercise which I prefer, which I mentioned earlier in the podcast. 

Then you start to get on to making sure that you don’t end up with common injuries so let’s start with two of the most common ones. Shin splints: walk around without your toes touching the floor a number of times a day. So you build up the strength in those muscles that support the foot as it slowly lowers down to touch the ground when you run, and you will avoid that. And the single leg squat looks after your knee. 

And then the other thing that I would really recommend is to stop friction from the dreaded iliotibial band, IT band friction. If you wear a pair of jeans, in the right pocket, there’ll be a small coin pocket. You know the one? If you put two fingers into there, your fingers are now over a muscle called TFL: Tensor fascia latae. Think transport for London–TFL. That is the contractile component of the IT band so that is the only bit you can really make a difference to, to stop ITB friction syndrome. The iliotibial band has a tensile strength of steel and you can roll it, ball it, punch it, shoot it, do whatever you want, and it will not and cannot change length. So the only way to change it is to work on that TFL muscle, and there are stretches or you can get a little tennis ball or golf ball, you can roll around it and then do the stretches. It’s not one for a podcast or radio. It’s very difficult to describe, it’s a bit like line dancing. A shameless plug, it is in both of my books mentioned earlier, or if you put in TFL stretch or even ITB stretch which is slightly inaccurate, you will find it on Google. So there you have my top five.

Darren: That’s perfect. I think they are really simple but seriously effective basic exercises. What I’ve written down here, the wee control one, that’s really simple, but very effective. I wonder how many people who listened to the podcast standing up were actually doing that. I was. 

Paul: I’ll tell you what. A little test for you. If you get into that position and you think you’ve got your core sorted, and you still put two fingers on each side of that muscle, try very slowly lifting one leg off the floor and then putting it back down again, just as that touches, lift the other one up. And if both pelvic muscles aren’t staying completely contracted, and there’s no pelvic rock, you do not have suitable core control. You should be able to hold that absolutely still, your pelvis absolutely still, and they should both remain taught and contracted, whilst you lift your leg up. And the points at which it will change is the change of direction at the top of the movement and as you change your feet. And you’ll notice one side can’t control it. Make sure you can do that 25 times, three sets of, before you even consider doing a plank.

Darren: Okay. That’s very valuable advice. And yeah, the single leg squat as well. I mean, that is not easy, to be honest, to do that, but it’s interesting how you say unless you can do 25 of those… Which I’ll be honest, there’s no way I’ll be able to do 25 of those on each side without being seriously fatigued in my muscles, so that’s something that even me running seven years, I need to work on. So that’s really valuable.

Paul: And to run a marathon, you’re expecting your body to cope with 25,000 on each leg. It’s quite a big jump, isn’t it?

Darren: Yeah, it is, and that comes back to what we said about earlier around once you understand the reasons why you need to do that–you’ve got 25,000 on each leg–you’re going to be more inclined to do single leg squats when you go to the gym. Understanding the reasons why, I think is very valuable, to be honest. 

Paul, it’s been fantastic talking to you today. I really appreciate your time. Obviously, you mentioned you’ve got a new book coming out. So let’s talk about that first. When is it coming out? What’s it about? How can people get hold of it?

Paul: Thursday, the 23rd of January 2020 and it is published by Bloomsbury. My surname is Hobrough. If you put Hobrough into Amazon, then all my books will come up. This, if you like, is kind of the book, if you’re not injured, then crack on with The Runner’s Expert Guide to Stretching because this is everything you should do to try and remain injury-free. I’m very proud of it, it’s been out on pre-order for three months. For the last six weeks, it’s been on Amazon, “the book that is most anticipated” or whatever the title is they do. And it’s been 25 in the charts, and that’s on pre sales alone. 

My desire for this book is that people go and they can learn the standard they’re at now, which has been a large part of the subject of this podcast. All the stuff we’ve been talking about is contained within this book and you can actually note down what you’re doing, how your progress is. But there’s so much strength and conditioning exercise in this. There’s probably more strengthening exercise than there are stretching exercises. If you did even a quarter of the exercise in this book, and there are many, including a two day photoshoot– and the models were brilliant but knackered at the end of it–honestly, you’d be putting me and all of my colleagues out of a job. It would be nearly impossible for you to get injured outside of a rugby tackle. 

And the first book which was a best seller, I’m so proud of it, Running Free of injuries, there’s a foreword by Steve Cram. And another one of my clients, Paula Radcliffe, said it’s a much needed book for every runner’s bookshelf or so on the front. Lots of people said lovely things about it. I’ve never had a negative review from it and the thing that people say and I hope has come across in this podcast, is that I simplify something that historically they’ve read and they’ve found it quite complicated. For me, I’m a simple human being. I said right at the beginning, my academic life was (made a little bit difficult) by dyslexia. I’m not a natural author but I’ve really enjoyed the process of writing in a conversive way. 

I’m so thankful to Bloomsbury for allowing me to write in that almost magazine article way. Don’t get me wrong: there’s 70,000 words in every book, so plenty of room for some spelling mistakes! But what’s really been the best feedback I’ve ever had is people saying, “It’s just so simple. It really unlocks it for me.” And that is what I’ve really enjoyed about the process of writing it. Because they’re not a money making exercise: there’s a certain element of altruism in writing a book. I just want people to enjoy them. I just want people to get information and say, “That one point was really good.”  And that’s enough for me. I can leave that as one thing for the world.

In terms of getting in touch, I do probably a third of my day, because I spend most of my time in Northumberland, which is a long way away from a lot of people, and it’s beautiful, so keep it that way–I don’t want everyone moving there! A third of my day is probably doing Skype physio consults. It’s something that I started a few years ago and it has grown in popularity. It’s 40 minutes one on one with me, I can see you, I can get you to do these things in front of me and I can diagnose. I’ve got a Facebook group with like 3000 practitioners and so I can just go, “this is a great person, go and see them or find someone local to you.” Or possibly even solve the problem without ever touching you. If you go to PhysioAndTherapy.co.uk or PaulHobrough.com, you can get an audience with me on either one of those. 

If you’ve never ever tried Shockwave therapy, it is my absolute baby. It’s my fourth child. I use it 10 times out of 14 clinical visits, which is what we do in a day, and it is the best thing that has happened to the health and fitness industry for such a long time. It speeds up your recovery by 40% and I teach other practitioners how to use it all around the world. And seeing their lights come on when they first treat their patients, when they go, “My god, it was incredible!” I want people to start understanding what that is and seeking out clinics that not only have that, but are trained to an appropriate level so that you can get the best out of it, and I’ll help you find those clinics myself as well.

Darren: Perfect. That’s a topic which I’d love to talk about, so maybe we’ll get you back on again but it’s something that I’ve not heard of before today either.

Paul: One other thing. Obviously, Instagram’s a thing and I’d love to be ahead of my daughter, so @physioandtherapyuk.

Darren: Guys listening to the podcast, head over to Instagram, give him a few likes, a few hearts to make him feel better. But on a more serious note, I highly recommend you go and get those books, particularly Paul’s new book that’s coming out. Because you’re absolutely right, Paul. Unless you’re a medical practitioner yourself, a lot of the books that I’ve read, it’s so complicated and you need to have a PhD to understand it, so putting it in layman’s terms for the rest of us can only be a good thing. And like you say, maybe one day it will do you out of business but I don’t think you need to worry too much in the short term. 

Paul: No, that’s brilliant. Thank you very much, Darren.

Darren: All right. Thanks very much, Paul. I appreciate your time and I look forward to catching up with you again soon. 

Paul: Brilliant. Thanks, buddy. Really appreciate it.

Darren: Thanks for listening to the Fitter Healthier Dad podcast. If you enjoyed today’s episode, please hit subscribe, and I would really appreciate it if you could leave a review on iTunes. All the links mentioned in the episode will be in the show notes and a full transcription is over at FitterHealthierDad.com.

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