I know from first-hand experience the huge benefits to running and performance from having a physio as part of your team. I was fortunate to find one of the best early on. I’ve seen Mark Buckingham throughout my running career (for over 20 years now and counting!).

His knowledge and expertise with runners, as well as his treatment and support, has been invaluable. Now as a coach, I apply much of his understanding, techniques, and exercises to my coaching too.

More than just treating injuries

There’s a common misperception that the physios’ only role is to treat injuries. Like most, I also started by only seeing Mark each time I had an injury. I’ve often joked that if he was any good, I wouldn’t have seen him for 20 years. That is, I laughed until he wiped the smile off my face by sticking his elbow in my tight piriformis.

In truth I’m doing him a great disservice. It is because he’s such a great physio that I have seen him for that long. His standard retort that “he wouldn’t have to keep seeing me, if I didn’t keep running” really goes to heart of the matter.

Studies show the vast majority of endurance injuries are over-use injuries. The more you want to improve, the harder you push yourself, the closer you get to your limits, and the greater the risk of injury. Things rarely just go pop. There are almost always early warning signs. It’s easy to ignore these, either through ignorance or wilful denial. We are notoriously bad at prioritising rehab, rest and recovery over a few extra miles.

How many runners complain about their sore achilles/calf/hamstring* in one breath (*delete as applicable). Then in the next, say it’ll be fine as soon as they have “run it off”. If the injury has been caused by too much running, common sense alone tells you that yet more running is unlikely to resolve it.

Prehab & Rehab

Working with a physio doesn’t guarantee you’ll be injury-free. But it does help you spot the warning signs sooner and respond more effectively. A physio with a good understanding of runners will identify any underlying weaknesses and how these may contribute to potential future injuries.

It’s not just about treatment in the physio room or short term resolutions. They’ll set a programme of preventative and rehabilitative exercises to lengthen, strengthen, mobilise and restore functional balance in the running motion. Often in association with an adjusted running programme.

After years of working with Mark I have a far better understanding of my own bio-mechanics. Consequently, I can more knowledgeably assess when to ease back and when to push on. I know that if my foot develops a blister in the arch then it’s probably a sign that my foot is starting to collapse and most likely that my glutes are getting weak too. Then I can address these issues before I get injured again. And most importantly, I can keep running.

Relationship is key

Developing a long-term relationship with a physio means that you can build trust, openness, and honesty. There was no need to recount my running and injury history to Mark each visit. It also meant I could not pull the wool over his eyes. He knew what running I was doing and could tell if I had been working on my preventative programme.

All too often runners enthusiastically tackle their strengthening exercises only until they can get back to running. Then it’s consigned to low priority. Leading back to that boom-bust cycle of training. Regular follow up with your physio, coupled with support from your coach, ensures more sustained benefits. And ultimately, less time of enforced rest.

A long-term relationship works two ways. Rest does help most injuries in the short term. Unfortunately, it can be the default setting of some physios, without addressing the underlying causes. However, Mark knew you can find a balance and would always aim to keep me running, albeit with modifications to my training.

Especially in the build up to a major event when rest is a luxury that I couldn’t always afford. We could negotiate the best strategy from a position of shared knowledge, understanding and goals. That negotiation invariably starting with me suggesting 10 miles, and him, 10 minutes….

Mark at work via Zoom

Lockdown benefits

Fast Running Coach Tom Craggs agrees

“I have worked closely with Mark for many years and his knowledge and experience has provided a foundation for many of the UK’s best athletes. Lockdown has been tough, but one of the benefits has been the ability to jump onto Zoom calls with Mark and athletes I coach.

It’s been an education for me in how with the right words, deep knowledge and a trusting relationship you don’t always have to be with an athlete to make a big impact. Mark’s skill with observation and description is a lesson for many coaches I’d say”

So if you are one of the many runners who find themselves in that boom-bust pattern of injury then maybe it’s time to break the cycle. Physios who understand the athlete are not just for the elite runners. You too can benefit from their knowledge, expertise and input to improve your running.

Remember a physio should be for life not just for injury. You might find that by seeing them more, you end up needing to see them less.

Jo is a former GB marathon runner and now fully qualified British Athletics coach. To find out more about her coaching or see what running she’s still doing you can visit her Running Jo website or follow her on Instagram, Twitter or Facebook.

Jo now works closely with Mark Buckingham and Matt Bergin at Performance Team. Performance Team provide expert online physiotherapy to assess, diagnose and prevent persistent injuries and improve running performance with packages of support including video gait analysis and strength and conditioning programme using their unrivalled experience working with all abilities from club athletes to Olympians

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Whilst this isn’t specific for running I’ve had a few runners recovering from COVID-19 that have actually found it helpful. As well as this athletes slumped around the house all day in general might benefit from thinking about their breathing too.

If you are recovering from illness or struggling with breathlessness, or even fear, anxiety or panic, learning some simple breathing techniques can really help.

It is essential to keep good lung function and breathing patterns to ventilate all the lung to reduce infection by mobilising and clearing the whole of the lung of fluids.

Your lungs sit within the protective cage of your ribs, with the diaphragm – the dome-shaped muscle, at the bottom. It is the diaphragm that plays a major role in breathing. 

Breathe it all in

As you take a breath in the diaphragm contracts and flattens, increasing the space in the chest, allowing air to rush into your lungs. The opposite then happens when you breathe out. 

Good diaphragm strength improves cough effectiveness and makes it harder for bugs to take hold – which is the difficulty people have with this virus.

When we get breathless or spend hours slumped on the sofa or over your laptop, we do not effectively use the diaphragm and we revert to breathing only with the top of the lungs, and the lower parts become stagnant. This then in turns reduces the oxygen uptake in the blood and leads to more feelings of breathlessness…..a vicious cycle.

You can get control of this as well as exercise the lungs and clear the tubes more effectively by working on your breathing pattern.

Posture can be key

To start with think about sitting back in a chair and taking pressure off your tummy. This allows space for the diaphragm to move. If you can’t sit back, then lean forwards with your elbows on your knees to let your tummy space to expand.

Breathing Exercises

The active cycle of breathing techniques (ACBT) is an effective way to help clear sputum from your chest. ACBT is simply a set of exercises that helps loosen and remove secretions from deep in your lungs and airways. 

Breathing Control

Breathing control is slow, controlled breathing, using as little effort as possible.

• Check your posture (as above).
  Relax your shoulders and think about breathing in with your tummy. 
  • Place one hand on your tummy and one on the chest, feel the movement.
• Take a slow breath in through your nose, using your tummy
• As you breathe out purse your lips – this helps to open up the airways
• Gradually make the breaths slower and deeper

Deep Breathing 

Deep breathing allows the lungs to fully expand, especially the lower parts.

• Take a long deep breath in through the nose, using your tummy to fully expand your lungs. 
  • At the end of the breath in you might feel the ribs lifting, this is good. It should NOT be the first movement though.
  • What you DON’T want is your shoulders lifting up. Doing this leads to issues elsewhere – neck/shoulder tightness predominantly.
  • It can also be helpful to hold your breath for a couple of seconds at the end of the breath in, to really allow the air to get to the depths of your lungs. 
• Breathe out gently and relaxed, as if you’re sighing. 
• Repeat 3-5x

Huffing or Coughing 

Huffing is brilliant at shifting reluctant materials from the depths of the lungs to the central tubes ready to be coughed out. Better than coughing and nicer on the throat. If when performing you hear a rattling sound, you are doing it right. 

• Perform the huff on the breath out. You should have an open mouth, and imagine you are trying to steam up a mirror, rather than coughing. Use your tummy muscles to help you squeeze the air out.
  • This can either be a gentle, long huff or shorter, sharper huff.
• Repeat 3x
• Each cycle of huffing should be followed by breathing control.

If you have found this sequence of exercises has not completely cleared the chest it may then be worth performing a couple of coughs.

• At the end of the huffing, perform 1-2 short coughs, with chin to chest.
• The temptation is often to continuously and aggressively cough in the attempt to remove fluid, avoid this. It will cause irritation in the throat and will make you more breathless.

Working on these exercises several times a day will help enormously to ventilate the lungs and prepare you to better fight the worst effects of this virus.

Matt Bergin and Mark Buckingham are both chartered physiotherapists at Witty, Pask and Buckingham. For more information on both, or the clinic as a whole, click here. They are still able to offer video consultations within the current situation. 

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