If you wear a modern running watch, chances are you’ve checked your estimated VO2 max score. It’s increasingly seen as the parameter runners need to improve—a single number that promises to tell you how fit you are.
When runners look to invest in professional performance testing, their first thought is often a VO2 max test. But here is the industry secret that top coaches and elite athletes know: while VO2 max measures your potential, lactate testing measures your performance.
If you want to train smarter, avoid injury, and set personal bests, lactate testing isn’t just an alternative to VO2 max testing—it is significantly more useful. Here is why.
The Limitations of VO2 Max: Your “Engine Size” Isn’t Everything
VO2 max measures the maximum amount of oxygen your body can utilize during intense exercise. Think of it as the size of your car’s engine.
While having a high VO2 max is great, it has major limitations when used as a day-to-day training tool:
It Plateaus Quickly: For trained runners, VO2 max reaches a genetic ceiling relatively early. You can continue to get significantly faster for years without your VO2 max ever changing. In fact, Paula Radcliffe’s VO2 max was at its lowest during the years she was breaking world marathon records.
It Doesn’t Dictate Training Zones: Knowing your VO2 max doesn’t tell you how fast you should run your Tuesday tempo or your Sunday long run. Estimating zones from it can be inherently inaccurate.
It Measures Potential, Not Efficiency: Two runners can have the exact same VO2 max, but the one with better metabolic efficiency will outperform the other every time.
What Makes Lactate Testing So Effective?
Lactate testing measures how your body processes energy at increasing speeds. During a lactate profile test, small blood samples (via a quick finger pinprick) are taken as you run at progressively faster paces.Instead of measuring oxygen intake, lactate testing measures blood lactate concentration—the byproduct of anaerobic metabolism.
This test identifies two critical physiological markers: LT1 (Aerobic Threshold): The point where lactate begins to rise above baseline levels. This defines the upper boundary of your easy and recovery runs.
LT2 (Lactate / Anaerobic Threshold): The point where lactate accumulates faster than your body can clear it. This is the maximum pace you can sustain for approximately 45 to 60 minutes.
4 Reasons Lactate Testing Wins for Everyday Training
1. Training Zone Accuracy
Formula-derived heart rate zones (like “220 minus your age”) or smartwatch estimates can be off by as much as 10–15 beats per minute. Lactate testing removes the guesswork, revealing your exact individual heart rate training zones. You will know precisely how slow your easy runs need to be to build a true aerobic base, the ideal heart rate to target for marathon-pace efforts, and the exact levels for threshold intervals to maximize physiological adaptation without burning out.
2. It Tracks Real Progress Over Time
Because VO2 max plateaus (or even declines), re-testing it every few months yields diminishing returns. Lactate curves, however, shift as you adapt. As you get fitter, your body learns to clear lactate more efficiently. A follow-up lactate test will show your curve shifting to the right—meaning you can run faster at a lower heart rate and lower physiological cost. In time, that improved efficiency translates directly into better race times.
3. Essential for Threshold Volume Development
Modern training approaches, such as the widely popularized “Norwegian Method,” focus heavily on building tolerance and efficiency through controlled threshold volume. Training just below LT2 (anaerobic threshold) allows you to accumulate high-effort running volume without undue fatigue, preventing the excess strain that slows progress or leads to injury.
4. It Prevents the “Gray Zone” Trap and Overtraining
The most common mistake runners make is running easy runs too fast and hard runs too slow (the dreaded “gray zone”). By identifying your exact LT1, lactate testing clearly defines where easy running ends and moderate exertion begins. Staying below LT1 on easy days ensures proper recovery, faster adaptation, and a drastically lower risk of overtraining.
Take the Guesswork Out of Your Running
Lactate testing is the true gold standard for training guidance. It’s time to stop relying on estimated watch algorithms or generic formulas. (Did you know the classic “220 minus age” formula was never intended for athletic performance, originating instead from early observational health studies?)
From ultra-marathons down to cutting time off your 5K personal best, knowing your accurate training levels is the fastest route to progress.
Ready to find your true training zones?
Real Runner Results
Gary (V40): Completed his first lactate test running a 1:33 half marathon. After refocusing his training zones, he ran a sub-40-minute 10K and a 1:28 half marathon. Minor injuries dropped away, and his training became both more consistent and far more enjoyable.
Taylor: Used results from two lactate tests to fine-tune his threshold training. He dropped 4 minutes to run a 70-minute half marathon, and more recently set a massive 14:30 5K personal best.
Claire: As a new mom with limited training time, Claire could only fit in three runs per week. Using lactate testing to maximize every session, she executed a perfectly paced 4:30 marathon with consistent speed and a completely flat heart rate graph.
Both Sports Massage (Soft Tissue Therapy) and Myofascial Release appointments are offered at the Accelerate Physio and Coaching Centre. These appointments are offered by our highly experienced team led by Taylor Hill and Stuart Hale.
Timing is everything when using soft tissue therapy (sports massage) to optimise running performance. Scheduling a session a few days before and after a race provides distinct physiological advantages that can really help you to get the most out of your body.
Scheduling these sessions into your training plan can help you to avoid injury by removing muscular restrictions and tightness. Often we see runners when the damage has already been done, and they are looking for a cure to an injury or something that is painfully tight. Ideally it is better to be seen when muscle soreness or tightness first strikes.
So how can massage, coupled with fascia release work help in the days before and
immediately after racing?
Two to Three Days Before: Tapering and Alignment
A massage three days before a race acts as a final physical tune-up. It focuses on gentle stretching and mild myofascial release, strictly avoiding heavy deep-tissue work that could leave muscles sore on race day.
Elongates tight fibres: It releases structural tension built up during high-mileage training weeks.
Restores muscle balance: It corrects minor biomechanical asymmetries before you hit the starting line.
Promotes deep sleep: It lowers cortisol levels to ensure high-quality rest before the big event.
Enhances body awareness: It connects your mind to tight areas needing final, light mobility work.
Two to Three Days After: Cellular and Muscular Repair
While a light flush is fine immediately after finishing, the real restorative massage should happen 48 to 72 hours later. By this time, acute muscle inflammation has subsided, allowing a therapist to safely perform deeper work. Sometimes, especially after longer distance races, waiting an extra day can reduce that soreness before your therapist starts the treatment.
Alleviates DOMS: It dramatically reduces lingering Delayed Onset Muscle Soreness.
Breaks up adhesion’s: It prevents scar tissue from forming in micro-torn muscle fibers.
Restores flexibility: It unlocks tight hamstrings, calves, and glutes bound by intense exertion.
Boosts lymphatic drainage: It clears stagnant metabolic waste from deep tissue layers.
Accelerates healing: It triggers circulatory repair mechanisms to mend micro-tears.
One Hour Before the Race
If you are lucky enough to be able to grab a pre race ‘rub down’ then there are also distinct benefits that can help you. Using light, quick strokes across the muscle to help prepare you for maximum effort. The benefits can be both calming and relaxing at a key time before racing.
Boosts circulation: It increases blood flow to deliver fresh oxygen to muscles.
Warms up tissue: It raises muscle temperature to improve elasticity.
Enhances flexibility: It expands the joints’ range of motion for a more efficient stride.
Calms nerves: It grounds the nervous system to sharpen mental focus.
Summary
Spacing your massages a few days apart from race day protects your tissues while maximising athletic benefits. It ensures you stand at the starting line loose and finish ready to recover rapidly.
A decreased recovery time also ensures you return to training more quickly, and perhaps most importantly can often iron out those muscles and so guard against injury.
Taylor is our lead Soft Tissue Therapist. Both Stuart and Taylor have also completed CPD Courses for MyoFascial Release work.
Find out more HERE
Or to book an appointment go HERE
Running in the heat can be challenging, but adjusting your routine makes a huge difference. Higher temperatures put extra stress on your body, so it’s important to slow your pace, stay hydrated, and pay attention to how you’re feeling during your run. Choosing lighter clothing, running earlier or later in the day, and taking recovery seriously can help you perform better while reducing the risk of overheating. With the right preparation, summer running can still be enjoyable, productive, and a great way to build both physical and mental endurance!
Below is a few different things to consider when running in warmer weather:
1. Lower your body temperature before exercise:
Starting with a cooler core body temperature helps delay the onset of physical and mental fatigue due to high temperatures, allowing you to maintain a higher level of performance for increased duration. It prevents blood from being diverted to the skin for cooling too quickly, ensuring a larger volume of oxygen-rich blood remains available for your muscles. This will also result in a lower rate of perceived exertion (RPE), and hopefully lower heart rate. Examples of how to lower your body temperature before exercise include taking a cold bath/shower, using ice packs on your neck or wrists or cooling vests.
2. Find shade:
Shaded surfaces (like trails and grass) absorb less heat than concrete or asphalt. Ambient air temperatures in the shade can also be up to (10 – 15 degrees C) cooler than in direct sunlight. Running in the shade also protects you against UV. Sometimes if there is a breeze on warmer days, you may not feel the sun as much, however UV rays can still be strong and can cause painful burns.
3. Listen to your body:
Listening to your body is essential when it is hot out. This includes being more aware of what your rate of perceived exertion (RPE) is, and if you use it, ensuring heart rate is not rising too high. Heart rate is generally higher in the heat because there is less available blood flow to the working muscles. If you have a certain pace you normally run at or are doing an interval session, be aware that your heart rate and RPE will most likely be much higher than in normal conditions.
4. Stay hydrated!
An obvious one, but one that is extremely important is making sure you are staying well hydrated, not only during your run, but before and especially after. During exercise the body loses water and electrolytes through sweating to regulate its core temperature. Dehydration reduces the body’s ability to cool itself efficiently, which can increase heart rate, raise body temperature, and impair muscle function and endurance. Drinking enough fluids before, during, and after exercise helps maintain blood circulation, supports oxygen delivery to muscles, and lowers the risk of heat exhaustion or heatstroke.
TOP TIPS FROM TAYLOR – One thing that i always do if the weather is warm is freeze my water an hour or so before i head out, and start with a slightly frozen bottle. This way, the water can slowly defrost through the run, leaving you with water that stays icy cold and doesn’t get warm quickly! This can be useful as well if you want to splash some cold water on the back of your neck or on your wrists to help you cool down. If you are travelling to a location to start your run, this is also a great idea so that when you finish, you have cold refreshing water and don’t have to wait until you get home.
I also ensure that i am using electrolytes through my run but also before/after as well. Electrolytes are important in hot weather because they help regulate fluid balance, muscle contractions, and nerve function in the body. When you sweat, you lose not only water but also key electrolytes such as sodium, potassium, and magnesium. Just be wary of the amount you are consuming however. There are loads of different nutrition companies out there which all use different dosages in their products. Ensure you research what the recommended levels are for your age, and remember that salt is present in lots of the foods we eat nowadays, so it’s just about making sure we don’t have too much!
The Accelerate Performance Centre Drop In Day is open to all! Saturday 15th October. 10am until 4pm.
The Team from the Accelerate Performance Centre will be available throughout the day. Both coaching and members of the clinical team are offering 20 or so minutes of their time to talk to you and to help point you in the right direction. There will be no cost involved so what have you got to loose?
Running Development: Our running coaches, Nancy and Stuart, will be on hand so you can discuss the next step in your training and what that may involve.
Lower Limb Injuries or Niggles: Come and meet Abbie who can put you on the right path with self help or ideas on who to see if more in-depth support is needed. Achilles Tendonitis and Plantar Fasciitis are common complaints that Abbie can discuss with you.
Supporting Your Running: Nancy will be here to discuss how you can start with strength training at home, plus the benefits of mobility and running technique development.
Mental Health: Karen will be taking over the upstairs room to spend time with anyone who would like to know more how she can help with anxiety, or other head space issues. Karen, is also able to help with the challenges and goals you set to help ensure they do not become a ‘pot of pressure’.
Running Movement Analysis: Stuart, will be on hand with slow-mo video analysis to review your technique. You’ll see how you are moving and also see how you should be moving. You’ll definitely need your running shoes and kit for this one. Allow up to 30 minutes for this one.
All of this is free and open to all. It is very much about pointing you in the right direction and giving you some self help ideas. We will also point you in the right direction for you to see the right expert who can really help you, should this be required.
Pre-booked will be given priority, appointments are also available so please get in touch via our Contact Page or by calling 0114 242 2569. Alternatively just drop in…
There are often many reasons to talk to an expert. So why not?
Our team of experts will be on hand all day.
The APC Team comprises running coaches, including strength and mobility specialties, plus movement and technique. Clinically, podiatrists and physiotherapists can help with injury diagnosis and treatment. With Soft tissue specialists dealing with niggles and injury prevention.
The Team at APC can help keep you moving, improve your running and treat injuries. No matter your ability or the distances you run, we are here to help. We can address how you move, how you plan and use your available training time to best effect. From effective mental processes through to your technique, to injury prevention and where needed diagnosis and treatment.
So why not come along and say ‘Hi’!
Running Made Easy: Workshops and Coached Sessions.
In addition the APC coaches will be running (ha, ha!) a new series of workshops that are very much based on the success of Trail School from the BIG Running Weekend. ‘Running Made Easy’ will run across two parts. This November and then to finish off in January, with each part comprising three sessions. You can book for individual sessions or for both Part 1 and Part 2.
Running Made Easy is suitable for runners at all levels, competitors or those looking for a healthy approach to their running. The sessions will also closely follow the guidelines from provided by England Athletics LiRF and CiRF qualifications. This makes Running Made Easy ideal for both aspiring and qualified coaches.
Plus, did you know that APC now offers ‘Mindset Coaching and Mental Health’ support? This is something we are really proud to offer and the feedback received so far has been incredible.
As the dust settles on another fabulous BIG Running Weekend it is clear that those that love to run and or are involved in other running sports are often a little baffled by the idea that what you do needs to be supported. ‘Support Your Running’ or any other sport or activity, is not a new concept. It is for example championed by England Athletics and the NHS, not just for elite athletes, also the general population and everyday athlete of any age!
To support your running can require less time that many realise, can be done in your own home and requires little extra effort. In fact it is not unrealistic to substitute actual running running time with ‘Supportive Sessions’. Yes it is realistic to seek out help for this, to have something tailored to you and what you actually need.
So often as part of injury rehab athletes are given exercises for strength by the physio, yet, only for that injury. Only for it to reoccur once the exercises stop. Or for something else to cause pain and potentially stop you running.
Often the cause of injury is often blamed on overuse. Yes, because a structure became overloaded. It’s the cause of that over load that is actually the issue. Sometimes it is just building ‘time on feet’, too soon and too far. This is easy to say and with hindsight we can see that overloaded areas of the body are compensation for poor movement or a lack of strength.
Most injuries in running are caused by poor movement patterns or a lack of strength-stability
Supporting Your Running
So what do we mean by supporting your running? Here’s some of the best examples that every runner should be doing.
Strength and Stability Work
Mobility
Running Technique
Recovery strategies and easy low volume training
Massage (key as part of a recovery strategy)
Head Coaching
We have to remember we are all human beings. We are not machines. If we break (injure) new equipment is unlikely to fix things, only re leave some of the pressure. A physio can help get things working quicker, release tight muscles or ensure improved movement patterns. Yet to avoid this scenario repeating ‘Prevention is definitely better than Cure’.
Supporting Your Running is very much about Injury-Prevention and Improved Running
Benefits of Supporting Your Running
Injury prevention
Improved running economy
Free speed
Better stability
Improved strength
Improved power
Reduce risk of over-training
Better more focused planning and reduced anxiety.
Finding The Time
OK, here’s a question for you: What is the benefit of a recovery training run? Too far and you are not really recovering, you are just adding to the fatigue. If it is at a really low intensity then there is actual little gain in terms of aerobic development – endurance, ability to utilise oxygen etc. Science has proven this many times.
So why not substitute part of that run for a mobility session? Or hey lets be really radical and add in an easy technique session that both mobilises and gets everything in the right position for better movement during your training runs.
If you already do a gentle warm up before a run, then 10 minutes of technique work could be perfect. As to strength and stability just replace that run with some quality muscle activation work and strength-stability. The benefits of all of this far outweighs that recovery run.
It may sound radical, it’s not. I know some excellent coaches that say the difference between the elite runner and those that run good times is in what they do to support their running. It is a light and day difference.
The opportunity to support your running is a great idea and one we would whole heartily recommend.
So How Can We Help You to ‘Support Your Running?’
– or any other sport for that matter.
Injury Supportaside there is much that we can help you with. For those wishing to discover more about how they currently move, where they are strong and not so strong could seek out help in the form of a‘Move Better, Run Better Session’with either Nancy or Stuart. This will combine a review with a look at how to improve your running technique and a strength plan. There will be much, here, that you can do at home.
For those that have experienced a series of injuries would be well advised to come and see Colin for a one to one ‘Running and Movement Analysis’. This will involve video analysis, movement and strength review. Colin, will also ask about your training. His analysis is key to then working out a plan on what you should do next. It may be that you need to seek out a Strength Plan with Nancy, perhaps mobilisation is needed too. Technique could be the pointer and a coached session organised with you. You will leave with quite a few pointers to get you started.
When it comes to ‘Head Coaching’ there can be real benefits. Untangled your thoughts going into a race or being better to focus in the right way on your training can bring very tangible benefits. Karyn will be the person yo see for a one to one to help sort through techniques for focusing on the important things and the things you can control.
There is so much we can can help you with. So over the coming weeks we are going to bring you more information and ideas.
This Blog has been written by Stuart. He is an experienced Coach with over 30 years experience working at a high performance level through those taking their first steps in running. He also works when required for England Athletics and Sheffield United Football Club.
Run Your Mind, OK we are talking Mindset Coaching. This is the latest addition to the offering from the Accelerate Performance Centre and is already proving to be popular and judging by the comments we are receiving, very successful.
Sessions are led by Karyn, an experienced Mindset Coach who has studied and practiced a variety of approaches to changing minds and mindsets for over 30 years. Unlike Counseling Mindset Coaching is finding ways and process to deal and understanding mental issues. Take race day anxiety or pressure to perform as examples from running. Mindset Coaching is for more than just running it is also utilised greatly and successful for helping with issues arising from everyday life.
“Changing your mind is easy,” says Karyn, “We do it all the time. But sometimes ideas that don’t serve us well can get stuck in our brains. That’s where mindset coaching can help.”
This all came about following the pandemic when the coaches looking after the younger members of Team Accelerate identified a growing anxiety and pressure in returning to racing. Not everyone, just some. So in came Karyn to help. Karyn began with group sessions and workshops before moving onto individual 1-1 sessions where it was deemed helpful. Success, definitely.
Stuart noted, “A very definite change occurred across the group. Individual happiness was the most marked, along with a more relaxed approach to training. Suddenly, success and failure from a single session seemed to be less of a driver as the whole was now being looked at. A renewed energy towards training has occurred. In addition, the Team are definitely happier in accepting steps to progress as more positive, something that is good as it can be improved. Definitely, less about the negative, more about ‘What can I change?’. Even better has been a change in approach from the youngsters, more ‘Oh that was good, but if I change this it will be even better’.
The ongoing results speak for themselves. As racing returned this year, the effect has been a series of new personal bests and achievements including Inter-county Wins and Podium finishes.
Team Accelerate Runner, Harvey, 2nd place at the Wombwell 5 with a new PB. Hugh and Chris also made the top 5, again with new improved times.
We caught up with Karyn and asked her for some of her top things to look at when it comes to our ‘Mindset’, her top tips are:
Tip 1: In any situation, people make the best choice they can.
Of course they do, why wouldn’t they? But there may be other choices which a person has forgotten about or not yet discovered – that’s where a coach can be really valuable.
Tip 2: Your brain doesn’t process ‘not’ or ‘don’t.
Don’t think of a pink flamingo right now. I’m guessing what’s in your brain is a pink flamingo. If you are trying really hard, you might have managed a white one instead. This is why so many New Year’s resolutions fail, people tell themselves to do very thing they want to stop doing. So trying not to worry about an old injury or a bad race is the worst thing you can tell yourself (or anyone else). Focus your mind on what you would like to do instead.
Tip 3: The best time to solve a problem is now.
Our brains love patterns. And once a pattern is established, your brain will repeat it over and over. This is really useful. It’s how you learned to walk – life would be pretty tough if you had to think about how to move every muscle and how to keep your balance every time you want to move. Repeating a brain pattern over and over creates an automatic loop in your brain (this is called an Engram if you want to get technical here).
The trouble comes when your brain picks up a pattern that is unhelpful you you. The more times the pattern is repeated, the more automatic your nerves or worries become. So getting help to break the pattern as soon as possible is the best way to change it.
Karyn is available for 1:1 Sessions or can booked for small group sessions here at the Accelerate Performance Centre. You can read more about the options and one to one sessions Here >>
To find out more you can get in touch Here >> or alternatively please call 0114 242 2569
The BIG Running Weekend – 18th to the 20th March 2022.
APC will once again be at this years BIG Running Weekend – we wouldn’t miss it for the World, it’s such good fun.
Abbie, Nancy, Izzy, Karyn, Stu and Colin will all be on hand, involved with workshops, coaching and Question and Answer Sessions.
Nancy and Karyn are relative newcomers to the Team here at APC and bring with them a wealth of experience in working with everyday athletes through to those looking for a little more performance.
Nancy, will be hosting the Strength and stability sessions and also the New Mobility sessions. She has already helped many runners through APC and also members of Team Accelerate Running. Something new to the BIGRW and has definitely helped those she has worked with has been with her Mobility Work, helping the runners to recover better from racing or harder sessions and also as part of a warm up. So if you like the idea of an end of day loosener or morning wake up call then the mobility sessions should not be missed.
Karyn, will also be on hand throughout the weekend and will be hosting a Workshop on the Saturday. Karyn’s specialty is Mindset Coaching and will be looking at how we can all effectively change our mindsets for more positive outcomes and what this can mean. This could include ways of dealing with pre race anxiety or looking at how we can become more positive. Judging on her success already working at APC we think this will be more than a successful workshop with many asking for a follow up meeting. Feedback has been amazing already.
Both Colin and Stuart will be taking plenty of workshops and coaching sessions throughout the weekend. Colin, is one of the podiatrists and also specialising in running movement and technique. His approach offers a unique blend of session coaching with medical input. Stuart, offers specific Technique from a coaching perspective, looking at how we can integrate the various aspects of movement into everyday training. Both will be also be involved in Workshops throughout the weekend.
Throughout the weekend APC clinic staff will be on hand for drop in sessions. Ideal those for looking for a little advice on an injury or niggle. Izzy, Abbie and Colin will be available at various times in Hectors House, at the Discovery Centre (event HQ). So feel free to pop along for some help and support.
To finish the weekend members of the Team will be hosting a Workshop and Question and Answer session on Running Injuries, dealing with them and more importantly prevention. Nancy, Abbie, and Colin will be your panel, following a presentation from Colin.
So as you can see there is plenty going on at this years BIG Running Weekend and as always the team from the clinic will be leading a hand with their knowledge and experience. You can find out more from www.bigrunningweekend.co.uk or
The full 2022 Timetable is now available for download Here
Today we take a look at one of the most common injuries we see here at APC. Podiatrist Colin explains what’s going on in your ankle and what you should do to help it heal as soon as possible. Grab a cuppa and a biscuit and settle in for a read!
Ankle sprains are a pretty common occurrence here in clinic and we see them at an early stage but also many weeks or months later when the runner thinks that full function has not fully returned.
So what is an ankle sprain?
An ankle sprain is usually referred to as an inversion injury and this is when you ‘go over’ on your ankle. Usually on landing and you tip sideways with your foot planted on the ground. So there is a big stretch on all the structures on the outside of your ankle, foot and even leg. This can range from a big stretch and everything thinks that is just far enough and it settles down quickly and you can often carry on running and it eases off and could just feel a bit sore for a couple of days. At the other end of the scale is a major injury that could involve all the supporting ligaments and soft tissues in the ankle, foot and leg. The next level up from this is a break, usually of the bone down the outside of the leg – fibula – but that is another issue and will involve hospital care. So I am going to talk about ankle sprains – not breaks.
So you are running along and go over on your ankle. Even a big stretch often feels very painful. There is often a crack heard and a sharp shooting pain that feels hot and ‘white’. Often people say they can feel a bit sick at this point too. I often find swearing loudly at this point is really helpful. You may have fallen at the same time and so you are probably going to be feeling a bit shaken and not that great. If you have tripped off a kerb and fallen into the road your body will know what to do and you will instinctively get yourself off the road and back onto the path. But most of the time you are going to be able to take a minute to see how everything feels. If you have fallen check the rest of you to see if any other damage you need to know about. But this time everything else is ok and you can just concentrate on your ankle. It is going to be hurting – no matter how bad the damage. First thing is that you have to get from where you are back home or to A&E. I always carry a cohesive bandage as I remember a time before mobile phones and you had to take some responsibility for yourself up in the hills. These are great things to have with you (bandage not phone) as they will cover a whole range of body parts, easy to apply and will allow you get back to safety in most cases. So strap it up tight and get yourself back home so you can see what is going on.
Once you are back home and you have decided hospital is not needed (at the moment) you need to do something. First things first, a bit of anatomy and physiology information required. There are not only ligaments, tendons and bones around the ankle joint. There is a whole host of soft tissues that will be affected by an ankle sprain. So even if there is no ligament tear there will be damage to these other tissues and a big stretch can also be quite damaging. Also the body is going into overdrive to protect and repair the damage. So swelling is very useful at splinting, heat is great for speeding up the all the many chemical reactions that are going to be taking place and pain is great for keeping you sat on your bum and not wanting to stand on it. So think carefully about whacking on loads of ice, taking loads of Ibuprofen and trying to do too much too soon. All of these will have a negative effect on healing and will generally slow down the healing. But if you are in a lot of pain then take some painkillers but try and stick to paracetamol and be mindful that you will not be getting full feedback from the injury – but sleep is also important.
Ideally up to the first 72 hours you should be aiming to do as little as possible to let your body get on with doing what it is extremely good at – i.e. fixing what is damaged. Strapping, compression, taping can be really useful at this stage as the protection bit is really important. The less damage you continue to inflict on yourself at this stage the quicker this whole process is going to take. But life goes on and sitting around for 3 days being waited upon is not likely to happen to the majority of us. So be aware of what you have to do and do just that. Keep all non-essential activity down to a minimum and use ice and painkillers sparingly. If things are not feeling like they are improving quickly during these first 3 days then consider a trip to A&E to check for breaks.
Once the initial inflammatory response is starting to settle (this may be 36 hrs – you do not necessarily have to wait three days) then we need to get things moving again. Bodies get very good at being overly protective. They are also very good at making things feel as if they hurt more than they do to protect you from being silly again and going out for a run. The other important thing to be aware of is that bodies will only do just enough healing to do what it thinks you need. This is a response to the load you are putting on your body. So your body will only heal to the level of force you put on it. So if you do nothing a weak repair will occur, if you continually load it then the repair will be stronger as you are keeping your bodies repair process ticking over. This way does involve having pain for longer as you are going to be niggling away at the injury, but your activity should be going up and the pain should be manageable.
To start with try a single leg stance (cleaning teeth time), some double leg squats – holding onto work surface whilst making a cup of tea – feet shoulder width apart and bending forward from ankle and knees, not sitting down through hips, and walking. Walking is important as it is an easy exercise you can do anywhere and should not be overlooked. But walk properly, heel-toe, extend your leg out behind you, try not to hold ankle too stiff, let your upper body help drive your feet and legs. Also specific exercises for the individual muscles using a TheraBand to ensure you are working the specific muscle through its whole range of movement are useful. So at this stage it is not about strength but getting the muscles used to working again. They will have been in protection mode and we need them to start letting go and working correctly again – not over tightening. This is what happens if you push too hard too soon – muscles become stiff and tight as they need to protect the area and then they do not work correctly and a re-sprain is a common occurrence as the body has no tolerance to excessive movements. You have to use pain as a guide to how much you should be doing. Aim for a pain scale level of about 4-5 during and immediately after exercises that very quickly drops back to where you were prior to exercise, if not below. So you aggravate the injury, create a bit of an inflammatory response, let it settle as the body heals the new bit of damage, and then go again once it has settled back down. Start running with a gentle walk / run program. Do not overload the muscles too soon as they will fatigue quickly. Try to always come back thinking you could have done more, not continually thinking you have done too much. If you do too much and it is sore then let it settle down again and start with the gentle mobilisations exercises as soon as it can take it. It is important to keep moving but below the level of damage that your body can deal with. This process should take no longer than 6 weeks. By then you should be easily back to where you were before the injury and progressing well again.
If things do not seem to be progressing quickly then seek advice as there could be other damage or activity may need to be modified to address certain areas. Also hands on treatment to muscles, joints, bones and ligaments can be required to help with promoting healing, switching off guarding mechanisms and altering nerve conduction. This can be really useful if things have been going on for a couple of months and do not seem to be improving past a certain point.
The Knee is a complex joint with a lot of muscle attachments, there is also the matter of the cartilage and ligaments around the knee joint. However, I’m not going to talk about the anatomy of the knee and how it works.
A lot of the knee pain I see at the clinic is around the front of the kneecap (patella) or under the kneecap, it is generally referred to in physio speak as anterior knee pain and can be caused by several factors which I will cover below.
When the area around the knee is swollen, red in colour or warm to the touch, there may be more serious issues and it would be best to seek professional advice (APC) can provide this.
The most common issue which causes a pain in the patella area is caused by the muscle at the front of the leg (quadricep) being tight. The pressure of this tight muscle pushing on the patella and pulling on the area it attaches to will cause pain. This can be easy to manage and a regime of stretches and soft tissue massage by a trained therapist with help resolve this. You may need some time off running to help your recovery.
The next most common issue we see at the clinic is call Chondromalacia patellae (also known as ‘runner’s knee’). It’s a condition where the cartilage on the under surface of the patella deteriorates and softens. This condition is common amongst younger sports people, it can also occur in older adults who may have increased wear to the cartilage. This is best managed by removing the pressure on the cartilage. This is best done by carrying out the following steps:
REST! Most runners don’t like this word but sometimes it’s the best option.
Stretch your quadriceps
This will help with the symptoms of this condition but to manage the cause is a more complex issue and it’s best to call and see us.
Bursitis (house maids knee) this is common with runners, or people doing a repetitive movement. Bursitis is an inflammation of the bursa in the front of the patella. It occurs when the bursa becomes irritated and sore, which causes it to swell and put pressure on the knee. The treatment of his is that word again. REST but we are going to advice ICE as well. If you can tolerate an ice pack wrapped in a cloth for 15-20 minutes this should be done regularly throughout the day. Again, this helps with the symptoms of this condition – but to manage the cause is a more complex issue and it’s best to call and see us.
Most runners and sporty people have heard of the ITB or Iliotibial band. It causes pain at the knee when it becomes tight. This pain can be on the inside or outside of the knee. The ITB is in your leg to help stabilise your knee, so needs to be somewhat tight, but the issues start when it becomes over tight. Treatments can include dry needling, soft tissue massage, stretches.
Less common Knee issues we do see, but with some testing during an assessment, can hopefully be eliminated quite quickly.
Ligament damage, this will cause your knee to feel unstable and can cause pain when going up and down stairs or hills.
Cartilage damage (or in physio speak Meniscal) symptoms include locking of your knee, pain when your leg is straight or when you are twisting and turning.
Tendonitis is inflammation of the patellar. This is an injury to the tendon that connects the patella to the shinbone. You will generally experience pain when your knee is bent.
This is a snapshot of the common issues clients bring to the clinic and a straightforward example of some treatment to help with the symptoms. Most runners also need a level of strength and conditioning to prevent their condition returning post treatment. These exercises need to be specific to the individual.
If you are having Knee pain please come and see one of the physiotherapists at APC to ensure you get the correct advice and treatment for your condition.
The BIG Running Weekend – 18th to the 20th March 2022.
