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Interview with Nick Knight - Sports Podiatrist
85 Plays5 years ago
In this episode we speak with Nick Knight, Sports Podiatrist from the Southampton area.
Nick has a clinic in Romsey and specialises in helping people return from injury and keep them active.
In this episode we talk about (amongst other things):
Biomechanics
Forefoot vs heel striking
Insoles
Gate analysis
Blisters
Shin splints and much more!
Have a listen and let us know what you think on our social channels. Feel free to ask Nick any questions through Social media as well.
Please see links below that are mentioned during the interview.
https://nkactive.co.uk/acute-chronic-workload-ratio/
https://nkactive.co.uk/product/zero2forty-running-programme/
https://nkactive.co.uk/product/exercise-box-zero2forty/
https://nkactive.co.uk/product/tone-loops-complete-set/
link to youtube video
Links to blogs
Link to youtube channel
https://www.youtube.com/channel/UCyJ1cBp1Z2bdNqLP49injBg
Recommended
Transcript
Introduction and Guest Background
00:00:00
Speaker
Welcome to this week's UK sports chat podcast. I'm Joe Williams. Our guest today is Nick Knight. Nick is a sports podiatrist from the Southampton area. He has his own clinic in in Romsey and he specializes in helping people return from injury and keeping you active.
00:00:20
Speaker
In-house they have a 3D gate analysis, they have their own gym and they have a team of podiatrists and exercise rehab instructors. As with any medical advice, please do see somebody locally if you have any injuries which are similar to what I talked about today on the podcast, during which we speak about biomechanics, forefoot and rearfoot.
00:00:49
Speaker
Running, does it matter? We speak about barefoot running. We speak about orthotic insoles, gait analysis. Have a listen. There's loads of interesting stuff on here. Please comment on our social channels. And yeah, we look forward to hearing what you think.
Nick's Athletic Journey
00:01:09
Speaker
Welcome, Nick. Morning. How are you? I'm not too bad. Not too bad. Sort of trying to recover from a cold at the moment, but
00:01:19
Speaker
Yeah. There's lots of it going around. There is. It has meant that. So I suffer with exercise induced asthma as well. So it does mean that I haven't been able to run or play hockey or do any exercise this week. So I get a little grumpy when I can't do that, but hey, hey. Yeah, don't we all. So is hockey your, is that your chosen sport? Hockey is my main sport. I used to run, I used to run competitively. I'm an X hundred meter runner.
00:01:51
Speaker
Yeah, it was, I'm not the most skillful hockey player, but even at the age of 31, not many people still keep up with me. So I've got the pace. So I actually,
00:02:06
Speaker
Now I run more now for fitness. I don't, I do your park run every now and then, but I do have issues with pacing myself because I've got that sprint mentality. It's like go hard or go home. So I'm like going home and I have absolutely everything. So, but I started off saying I'll never run like
00:02:28
Speaker
a half marathon or anything like that and then I go for like a 15k run and think if I only run five more k that's a half marathon then once I do that I'm like well actually I can double that and do a marathon so I went not doing a marathon at some point in my life. When I worked in a big corporate we had a group who did the local half marathon and one of the guys who took part was exactly like that he was a sprinter
00:02:57
Speaker
he was really quick actually and he did the whole half marathon. He'd sprint literally as fast as he could for as long as he could and then he'd just walk a bit until he caught his breath and then he'd sprint again and he was a naturally fit guy but he needed it in under 140 if I remember. Wow, it's not bad. I remember when I started doing parkrun I'd done a little experiment. I'd done one just running
00:03:21
Speaker
And then I'd done one where I just almost like an interval session. And the session I'd done, the interval session, I actually got around quicker. That's just me, I'm just a sprinter. I remember when I was at school, there was a video from sports day that I won my 100 meter race by 50 meters. So, you know. We're speedy then. Yeah, it's, yeah, it is. And I just fell out of that because I, the reason I got into hockey is I had a sprint coach down in Portsmouth
00:03:52
Speaker
And I had an argument one evening and being a typical teenager, I went to school the next day, moaned to my PE teacher about it and he put a hockey stick in my hand and I never went back,
Balancing Life and Education
00:04:08
Speaker
never went back. And a similar experience of cycling, so I cycle as well. And I used to do a lot of downhill racing when I was younger.
00:04:14
Speaker
And I remember when I was at the bike show years ago when it was at the NEC, British Cycling were there and they set up a turbo, a bike on a turbo, and they had a simulator track.
00:04:27
Speaker
And I think I was about 13, 14 at the time, but I set the fastest time of the day. And British cycling were like, oh, do you want to come to Manchester and do some of the stuff? And me being like, I could, again, tell a Latino, I was like, oh no, I'd rather throw myself off a mountain on my bike than cycle around a track. Some decisions I made early on, I sat thinking, did I make the right decisions then? Or will I just finish a shroppy teenager? So yeah, I've just got that natural gift for speed. I'm just born with it. Just fortunate.
00:04:57
Speaker
But you'll have to test that out over a longer distance run then. Oh yeah, yeah. And that's my issue because I was really quick. I didn't lose many races. So that does mean when I do my triathlon, I don't come near the top at all. And when I'll go and do half marathon, I know I won't be, and that's half me to accept. I've got to get over that myself really.
00:05:21
Speaker
Well, I think that competitive nature drives you in more aspects of your life, you know, transfers, people who are motivated in sport, I find, you know, look at my friends, they're motivated in other areas of their life as well. Yes. I was just looking at your Twitter, I believe that congratulations are in order. You've completed your Master of Science in Podiatry with Clinical Biomechanics.
00:05:46
Speaker
I have indeed, that was a long slog and it was a really eye-opening journey. Though I did realise that when I started the journey, I was working in the NHS and when I finished the journey, I've left the NHS, set up my own clinic and got two children now as well. So it was like a lot changed over that time.
00:06:11
Speaker
But I'm dyslexic as well. So that whole process I found really difficult, but it was the research we've done in it and the dissertation projects.
00:06:24
Speaker
um was really opening and it's a really really good experience tough but i'm glad i'll push myself just to get through that yeah so that's that same characteristic isn't it that competitive driven self so because that's that's amazing how long have you been studying then how long does it took i think it took me about five years actually part time to do was that the start of your journey to become a podiatrist then or was that just the mass
00:06:51
Speaker
No, just the Masters. So I've done my Bachelors, my BSc. I finished that in 2009. And then from that, I was going to start the Masters in late, mid 2012. But I'm really fortunate and lucky to get part of the Paralympic Medical Team at the London 2012 Olympic Games.
00:07:21
Speaker
So I postponed the year, so I started my master's, I think it was around 2013, 2014-ish. And then the big thing I'd done wrong with the master's process, I took a year out from it. So then the motivation, and once you took a year out, the motivation of trying to get back into it was hard, but I am. Luckily, good, massively good support from my wife and family to help me just push through the process. So it's nice that it's all over and done with now.
00:07:49
Speaker
Yeah, that's great. How old are your children? Two and a bit and 13 weeks. Oh, right. Littlens, very young. Yeah, very, very small at the moment. Wow. You are a busy boy. Yeah. Tell us about 2012.
Insights from the Paralympics
00:08:10
Speaker
What was that that you were involved in the Paralympics? Yeah, so I was based as part of the Podiatric Medical Team. So I was based in the Polyclinic.
00:08:18
Speaker
Within the games, so it was in the clinic we had, the clinic had its own A and E, its own GP surgery on site. We had the sports doctors, we had the physios, we had all the blood doping team, we had some orthotists there as well, who had opticians, were their dentists.
00:08:41
Speaker
We had a couple of MRI scanners, a CT, we had an ultrasound scanner in every room. It was just amazing. So what would happen, an athlete would come in with a problem and describe that problem and then they'd get triaged to the right specialty. And it was just an absolutely amazing experience. It's something that,
00:09:07
Speaker
It's just one of those experiences that I will never get an experience like that again in my lifetime because the odds of the Olympics being back in London in my lifetime are slim to none, I think. So it was amazing. But the one thing I did learn, athletes are really poor timekeepers. So I got, the only frustrating, there's two frustrating things about it. One was I got some tickets to go and watch Ellie Simmons.
00:09:36
Speaker
in one of our races where she won a gold medal. But I had an athlete due to come and see me. So I gave the tickets away and the athlete actually turned up an hour and a half late. So I could have actually gone. I could have gone. And then the other thing is the polyclinic. I could see the Olympic stadium from my treatment window.
00:10:00
Speaker
And at times I felt so close but so far because I can hear the atmosphere from the stadium. I can physically see it but I can't get in there. Who was it? Who made you miss the race? He was a Turkish athlete so I won't name him Jess. She's amazing as well, Ali Simons, isn't she? Yeah, yeah, absolutely amazing. And do you know what? The great thing about the 2012 games were
00:10:30
Speaker
Everyone was saying that Britain won't do it because everyone didn't think the British just messed things up. But actually it's one of those that are speaking to people that were like, who couldn't get tickets to the Olympics, then went to watch the Paralympics. And it is, I think it was the only Olympics in Paralympics in history to sell out. And I think then what it's done then for Paralympic, sort of disability sports,
00:10:55
Speaker
afterwards is absolutely amazing. You look at the amount of clubs have now come out and access for people with disabilities to sport now is so much easier and so much better. And I think that was one amazing thing that come out of it. Yeah, it's a great legacy of it. Yes. Cool. Okay.
00:11:22
Speaker
Great. So you master of science in podiatry with clinical biomechanics.
Running Techniques and Injury Prevention
00:11:28
Speaker
Obviously that comes in handy. Yeah. So what's your, give us your take on some running topics then. So what about four foot versus mid foot versus rear foot? They used to be really topical. Does it matter? The short answer, no, it doesn't.
00:11:50
Speaker
And the long answer is, for me, I'm not so there is no evidence to support that running forth that will reduce your risk of injuries or running on the hill will increase your injuries. The evidence shows that the injury rate is the same. You just get different injuries. So the amount of load going through the body is a constant. You just put different loads in different places.
00:12:20
Speaker
And for me, it's not about how your foot lands, it's where your foot lands in relation to your centre of mass. And what I mean about the centre of mass is if you were to stand up and almost you had an invisible line, your centre of mass would be just in front of your pelvis and hip region. And for me, that's where I want the foot landing in my runners.
00:12:48
Speaker
And I don't mind if people heel strike, mid-foot strike, forefoot strike, because, and the big, the myth is, is that also I see some runners in clinic where their one foot does one thing, the other foot does another. And people have this conception that if you forefoot strike, you're always going to land on your center of mass. Well, I can show you data from loads of patients who overstride with a forefoot landing as well.
00:13:17
Speaker
And the other thing is with regards to all of this is that actually the majority of runners think they know how they run. However, there was some research and I can't remember. I think it was a high number. It was like 70 or 80% off the top of my head of runners thought they knew how they run. However, when they had their gait analyzed, they actually didn't run the way they thought they ran. So it just goes to show as human beings, we're not that reliable in
00:13:44
Speaker
understanding in what we actually do. They thought that they were a heel striker, for example, and they ran on their midfoot. Yes, exactly. So don't get me wrong. For me, it's all about landing closest to that centre of mass. So reducing the overstride, I think is more important than how your foot lands.
00:14:08
Speaker
Are there any sort of drills or things that people can do to help improve that then? So, yeah. So the big thing to help improve that is actually look at your cadence. So how many steps you take per minute. Okay. People talk about this Magic 180. Again, the Magic 180 is a bit of a myth because... The number of steps you take per minute. And a lot of people say everyone must strive to take 180 steps per minute. But the issue with that, your cadence is...
00:14:36
Speaker
is personal to you and how many steps you take per minute largely also depends on your height.
00:14:44
Speaker
Also, so it's not what, not everyone needs to strive to 180. So I got some patients who they, we resolved their symptoms by increasing their cadence maybe to about 170. I got some patients, we have to run them at 185. It's all personalized to them to see what they need to do to help bring that, reduce the overstrive. But as a rule of thumb, the biggest win you can have, I think, and the easiest win
00:15:13
Speaker
you can have is work on your cadence and the beauty of with modern technology now it is so easy to track. The majority of running watches will track your cadence and they're quite reliable in that and if you like running with music if you look at Spotify and I should imagine Apple Music has the same as well but I use Spotify personally. They have
00:15:39
Speaker
tracks on beats per minute. So you can download playlists that are different sort of beats per minute. So then you can then use that to your case. Or if you really want to work it, you can download something called a metronome onto your phone for free from like Google Play or the Apple Store. What's one of them then? So a metronome is basically just a tool that beats a certain amount per minute. So it's literally a few musicians use it a lot to learn how to play instruments, I believe.
00:16:09
Speaker
But what we use it included for, you basically download this measurement, you set it to say 170 beats per minute, and it will beep at you 170 times in a minute. So you can use that as well. And there's also, for the runners that use Garmin, most people don't know, but on your Garmin watch, so your Garmin running specific watches, so this doesn't include like
00:16:36
Speaker
the Vivo active watches, but these are all more of your sort of forerunner watches. They actually, you can set a cadence range, and I only found this out a few weeks ago, that you can go on there, you can go into the settings, you can set your different cadences, the cadence range you want, and the watch will either beep or vibrate when you go outside of that range.
00:17:00
Speaker
Okay, that's clever. I think this is something with lots of watches. I mean, Poland and Garmin and Sunto, and there's all these different things. Literally, I'm guilty of this. I literally press stop and start and just record my run, and that is it. And I can do so much for you guys. Well, I only found out because I was doing some testing for Garmin, and one of their reps come down, and he's showing me all this stuff the watches can do. And I'm just like, I had no idea.
00:17:30
Speaker
or your watches. And I said to them, I said, why aren't you massively shouting out about that you can monitor your canes and set yourself an upper and lower limit of what you want it to be? Because for me as a healthcare professional treating people, if I'm doing any gay re-education work, nine times out of 10 canes is the first thing I work on. And it's a really useful tool. So I have actually made a little video on my website that's on my YouTube channel.
00:18:00
Speaker
So if you look for NK Sports Podiatry on YouTube, I can give you guys the link as well. Yeah, because my company name is NK Active now.
00:18:18
Speaker
I don't think I've changed on YouTube yet because I couldn't. But I can find it for you guys. We'll add it onto the notes as well so business can find it. I think that's just a really useful now. You may be able to do it on other brands and watches I don't know. I've only tried it on Garmin so I can't comment on the others. So that's sort of a long-winded way in saying about the
00:18:42
Speaker
the midfoot versus forefoot versus rear foot. I think we get hung up on it a lot, especially when this whole barefoot running. Yeah, what about barefoot? What about that? So again, there's no evidence suggested it reduces your risk of injury. You just get different injuries. The injury rate is still the same.
00:19:05
Speaker
So again, I've got no issues. I'm not against barefoot running. Um, but it's one of those things and I'm not, I don't mind people trying it. Don't get me wrong. There are certain conditions. So if people come into me with an Achilles problem, plantar fascia, I don't transition them into barefoot shoes because as a rule of thumb, it tends to make those problems worse. The problems it can help is people who are running with knee pain. Um, but
00:19:34
Speaker
It is, I always advise that it should be at least a three to six months transition period, transitioning gradually into those shoes. The mistakes people make is they go from wearing their normal trainers one day and then go straight into their barefoot shoes the next day and then wonder why they get an injury. And it's not because of the shoes, it's just because you put too much change
00:19:59
Speaker
through the body in a two-click of time. It hasn't had time to adapt to the new loads it's been exposed to. Yes. Yeah, that makes sense. So what's the most common and preventable injury that you see then in your everyday hobby? So I'm not talking about, you know, when you see an elite athlete. If you've got an everyday runner or triathlete or cyclist, what's the side of things that you see that really are preventable?
00:20:30
Speaker
I think the majority of preventable injuries I would say would most probably I think be something along the lines of medial tibial stress syndrome aka shin splints or achilles telenopathy. Now it is obviously
00:20:50
Speaker
from a medical term, I don't I can't use the term preventable, I because I can't guarantee I can prevent anything. So I, from my face, I have to say, reduces the risk of injury. But the majority of injuries I see in clinic are human error. So a lot of the time is people's made an error with their training program.
00:21:14
Speaker
And people have pushed themselves too quickly. They've added too much heel work too quickly. They've increased their mileage too quickly, or they've up their pace too quickly. And I would say that I'd mostly account for a good 70% of our caseload. And that is just a human error. That's why they've got an injury in the first place.
00:21:34
Speaker
And from that I would say, for us in clinic, that medial tibial stress syndrome and the Achilles are probably the most common that we see related to that.
00:21:45
Speaker
is that people talk about this increasing your activity by 10%. As a rough rule of thumb, I have a few issues with that just because if you're just starting running, increase by 10% every week when you're doing connects to nothing like me.
Training Load Management
00:22:04
Speaker
It takes you forever. And then if you start increasing 10% when you're running lots of miles, you then make big increases. So I tend to use something called the acute chronic workload ratio.
00:22:15
Speaker
instead, which is devised by an exercise physiologist called Dr. Tim Gabbitt. Basically, that looks at basically a month's worth of activity. And it basically works at a ratio. And in a nutshell, if the ratio is above 1.2, there's an increased risk of getting an injury. If it's above 1.5, there's a significant risk of getting an injury. But what it does, it helps take a snapshot over time of a block of training.
00:22:45
Speaker
And it's a really simple tool to use. And again, I've put the tool on my website as well. So people can just go on there, type in their mileage they've done, and then use it to try and reduce the risk of then getting an injury.
00:23:02
Speaker
Go back for that for me then. I'm just starting running. Do I need a month's worth of data? Yes. You need four weeks' worth of data. When you calculate it, your fourth week is always your highest mileage. If you say you've been running for a year,
00:23:25
Speaker
and you want to look at something, you will then take your data capture set you want to look at. You would take your biggest month's data, and that'll be week number four, and then you'd backfill it the three weeks previous to that. And that's how you use that tool. So you do need to have some data, but what you can use it also for is possibly, well, why don't people use it as a tool to, well, this is the mileage I'm planning to do,
00:23:53
Speaker
Actually, is this too silly? Am I doing too much? Well, let's have a look. So I tell my patients who are returning back to injury, well, we'll give you a guided return to running program, but we'll check it all through the acute chronic workload ratio to make sure we're not going to push you too much too soon. And then once they're back to running and they then say, well, I'm going to go run a marathon. Well, there are loads of marathon programs out there, but just double check it with the acute chronic workload ratio and make sure that you're planning
00:24:23
Speaker
because doing that I think you can reduce your risk of then getting injuries.
00:24:28
Speaker
So to play devil's advocate a little bit on that, you'll see lots of people this time of year who may be training for their first, sometimes it's their first half marathon and then they go, you know, they do that in March and then in April or May they're doing their first marathon. Aren't they to expect to be over that 1.2 because they're doing something they've never done before? Or does that come into it? Or should they have just took longer to train?
00:24:57
Speaker
Yeah, so if you say if you're doing your first half marathon, say middle of March, and then you then want to do a full marathon at the beginning of April, you could argue that the odds are that's going to be a two, two quickly step increase. So you are going to be an increased risk of getting an injury. Now, just because you've got an increased risk of an injury doesn't mean everyone is going to get an injury. You get some people who can do that and won't pick up an injury. And that's just
00:25:25
Speaker
um sort of playing just luck of the draw um really so with those it is important that you sit down and and for me it's just an odds game and the way i like to practice is well let's try and stack the odds in your favor as best as we can yeah um so don't get me wrong people will do it and people will not get injured from it and they're just lucky at the end of the day and eventually they're like well you know people are more you know disposed to them
00:25:56
Speaker
Yeah, exactly. And there's loads of other things to take into consideration that you keep from a workload, doesn't it? It doesn't take into the experience of the runner your previous running history. So I think if you've got a complete novice runner, compared to someone who's done 20 marathons in their life, their body is accustomed to different types of loads. So
00:26:20
Speaker
So yeah, that is the issue of the acute chronic workload ratio. It doesn't take that into consideration. But as a simple clinical tool, I think it's better than 10% rule. Are there better things that we could use most probably? Yes, but I think it's a nice simple tool to use. It's quick and easy. Cool. So if anyone jumps on your website and has a look at that now and they come up with a 1.6 or something, are you on hand on social to answer any questions? Yes, I am indeed, yes.
00:26:50
Speaker
OK, so what about going off onto products at the moment? What's your opinion on in souls? Because there seems to be at the moment, there's off the shelf varieties, there's made to measure. Yep. So there's no evidence to suggest that one's better than the other. It's all about getting the right tool for the right job.
00:27:18
Speaker
So, for some people, an off-the-shelf set of insoles or to give them their proper name orthosis will work perfectly for that individual. What do they do? Ah, now, how long have we got? Because we've been completely honest, we're not entirely sure as healthcare professionals in what they do. The thing they
00:27:41
Speaker
don't have to do that a lot of people think do people get fixated on alignment so think okay I've got a pronated foot so foot that rolls in I must wear an insole to straighten my foot up now that is just utter garbage there is no evidence to support that whatsoever and I'm on a big campaign to try with other colleagues to try and just
00:28:01
Speaker
eradicate this thought process because insoles don't straighten your body. And there are, yeah, it's and I see it on social, I see different companies always flagging up on my Facebook feed on like, will you wear our inner thought and everything will be straight and everything will be all wonderful and will cure everything just by straightening your foot up. It's just utter rubbish.
00:28:27
Speaker
So the way I think we need to think about insoles, it's a tool to help manage your load. So for example, what we use them in clinic for is, say if you've got a plantar fascia issue or you've got an issue with one of the tendons on the inside of your ankle, we'll use an insole to help offload that structure.
00:28:49
Speaker
Now, the big thing is, is that you don't know whether you need that long term or whether you need it short term. So actually, for us in clinic, the majority of insoles we give people are short term, whilst they're then doing exercises to make themselves stronger. And this is another thing we need to get ahead around the insoles can be removed. It's not a life sentence. And a lot of people think I've got insoles, I can't run without them.
00:29:15
Speaker
Well, the majority of our patients, we actually wean them out of their insoles eventually. Don't get me wrong, there are certain types of patients that just need an insole permanently to be able to do what they want to do activity wise. But I think as I say, I do believe they are overused and they're often sold as this holy grail and magical tool when they're not
00:29:39
Speaker
The reason I laughed when you said that is I had I had orthotic insults and I can remember I wore them and wore them and I literally I'd wear them to running I'd swap them over into my everyday trainers because they did help at first I felt I did feel a lot a lot better wearing them.
00:30:00
Speaker
And then, and I warm, warm, warm to the point where like they were in tatters, they were literally in half. And I'd be swapping half an insult from one shoe to another, because I completely believed that, you know, that I had to have it, which is, you know, even saying it out loud seems ridiculous.
00:30:21
Speaker
But this is stuff I see on a day to day basis. And the thing I will say about insoles is that if anyone's given you an insult, you need to ask why.
Orthotics and Individual Variability
00:30:32
Speaker
So this is why you can get an insult from a running shop or things like that. But I'm not overly keen on that because a lot of the time they'll give you an insult for the sake of giving you an insult.
00:30:45
Speaker
I think when anyone gives you an insult, you have to ask them, okay, why am I having this? What's the reason behind it? If it's just because your foot likes it, it rolls in too much when you're running, well, putting the insult in may not actually change that. So it doesn't really matter. So I would encourage runners to ask the question, okay, what's your reasoning behind giving an insult? So every time I prescribe an insult to a patient and a runner,
00:31:15
Speaker
I will explain my thought process too and say, this is what we use in the insole, this is why we're going to do it, this is what I aim to try and achieve with it. The only snag is that every person will react differently to an insole. So that's why we don't really understand fully how they work because if you were to compare them to a drug and you were to do a scientific experiment, you would have to give, if you're doing the drug trial, is you would give all your patients
00:31:43
Speaker
different doses of that drug to get the same effect. So then it makes your trial useless because not one person has taken the same dose of drug. So it's the same with the insults that we don't know how everyone's going to react. So I can get 10 patients all come in with plantar fasciitis. They're all a similar age, bill, size, running pace, but all 10 of them will have a different experience than insults.
00:32:08
Speaker
And that's the bit we can't predict. And that's why it gets confusing within the research, is because as humans, we're reliably unreliable. If we didn't have the brain in the equation, we could use the physics and work out.
00:32:26
Speaker
But because the human brain is involved, that changes the game massively. So yeah, it's a complex topic. It's a topic I'm really passionate about because the insults will be massively useful in the right person, in the right environment. But as a rule of thumb, I think they're massively overused. Okay. So what about, and there's links to that, and then what about gate analysis then? So yeah, gate analysis. So we are,
00:32:55
Speaker
Again, that's another pet topic of mine, because I'm really fortunate to have 3D gaze analysis. If anyone that goes to was off at the running show in January, and they saw runs 3D, that's the system I have in clinic. And I've had it in clinic now for three and a half years. And I think with gaze analysis, the big thing is, is again, knowing what
00:33:24
Speaker
you want to achieve from doing it? Why are you doing it? What's the objective and what's the reason behind it? And it's, so I get a little frustrated when I see patients and they said, I've had a gaze analysis in a running shop. And I'm like, okay, no, you haven't had a gaze, you've had someone look at you running, but that's not in my opinion,
00:33:49
Speaker
a proper gaze analysis because, yes, I use 3D gaze analysis, but not everyone needs 3D gaze analysis. And I'm not saying everyone should have 3D gaze analysis. We also have access to normal 2D, which is just your normal camera phone. But for me, it's about the knowledge of the person doing that and linking it back to a problem, which is far more important.
00:34:13
Speaker
Um, so I think that's where obviously my, all my training and for me, my masters come into play because it's about knowing what to do with that information that you've got, which is key. And I think that's the bit that is missing from people that have to get in as in the running shop, because they just look at one thing. Um, and you're not looking at the overall picture. You're not looking at the running history, the running injury pattern and everything along those lines. So yes, Gates analysis can be.
00:34:40
Speaker
can be helpful and really useful if it's done by the right person who knows and understands what they're doing and why they're doing it.
00:34:52
Speaker
what seems to be the pattern is that most people, thus they might start running or triathlon as they become more informed, oh, what's this gait analysis? I need to have gait analysis to get the right shoes. Is that real, is that? Yeah, it's largely a myth, if I'm honest. The best current evidence suggests that we should be picking our shoes on basis of comfort.
00:35:18
Speaker
as long as they fit well and they're comfortable, you don't need a full-on gait analysis to pick your trainers. How do you do that as a new runner then though? Is it literally just try an area? Because you can pick a stability shoe and not get on with it and then pick a different style. My advice for a runner is when I go buy new running shoes, I can spend an hour in the running shop. I will just get a whole range of shoes down
00:35:49
Speaker
go for a run in the shop because most running shops have a treadmill in. Yes, they'll try and feel me running, but I just pay attention to that. I just pick whatever ones I feel most comfortable and go with that. That's how I select my shoes. That's what my advice would be, is to new run it. If you're just starting getting into running,
00:36:14
Speaker
You don't need to have a gaze analysis. My biggest tip would actually be, the mostly thing you do need to do is make sure you're strong enough to run in the first place.
00:36:26
Speaker
just because I think the biggest thing runners don't do enough of is strengthening exercises. So if you're a runner, I wouldn't worry about a gait analysis. I worry about picking a set of running shoes that fit well and are comfortable and make sure you're doing regular strengthening exercises at the same time and then make sure you're not progressing your mileage too quickly. I think gait analysis is useful when you start getting injuries or niggles.
00:36:53
Speaker
And that's where I think the 2D can be helpful. But for me personally, that's where I think doing the 3D gaze analysis just takes it to a whole new level for me personally. And I thought I had a really good understanding of how the lower limb functions.
00:37:11
Speaker
during running. However, when I got my 3D gaze nurses kit, I realized I actually knew nothing because... About your own running? No, about running in general. I thought as a podiatrist who's half of the room is MSE, I thought I had a good understanding of low limb biomechanics.
00:37:29
Speaker
However, then I got a 3D gait analysis system and it's a whole new learning curve because the thing I realized is that every single person runs differently. There's no correct way to run. There's no wrong way to run and everyone responds differently to every scenario.
00:37:50
Speaker
I can show you runners where they will just, everyone, you think, okay, you look at someone standing and your foot does X, Y, and Z. That has no correlation to what happens when you run. Or if you watch someone walk, that has no correlation to how you run. So in cleaning it, I've given up predicting how people are going to run because we just can't predict it until you watch someone physically
00:38:17
Speaker
physically run. The reason I use the 3D gate system is because it's actual physical data. It's not my opinion of how you're running. It is objective data. We stick a load of markers on you and this is what is happening. I think this is happening. I think that's happening. That is what is happening. But not every runner needs that. If I've got a runner coming in,
00:38:42
Speaker
who when we ask, we go through their history and they've gone from running 20 miles a week to 60 miles a week, they don't need a gate analysis, they need some education on how to train better and not over train. A gate analysis won't fix their problem, education will fix their problem. So again, gate analysis is useful, but it's using at the right time in the right scenario. And you then pick whether you do 2D or if you do
00:39:08
Speaker
3D. Obviously we do more 3D in clinic because that's what we have access to. Is that the future? Will all the stores have 3D do you think? I don't think the stores will because it took me at least 18 months to actually understand how to then interpret the data from it. So I don't think the running stores will ever get down to the point where they'll have a proper 3D
00:39:32
Speaker
a gaze analysis market system. But again, even if you had a 3D gaze analysis, but if the clinician doesn't know what they're doing with regards to interpreting results, then it's not that useful. So again, it comes down to making sure the person doing your gaze analysis, 2D or 3D, actually understands what they're seeing.
00:39:57
Speaker
And there are certain things like if you want to work on your cadence or work out how your foot's landing or whether you're landing with a bent knee or a straight knee, you can do that with 2D very reliably. And there's evidence support that actually doing stuff like that, 2D is just as good as 3D. So I don't want, even though I
00:40:16
Speaker
we mainly use 3D. I don't want to paint the picture that 2D is bad because it's not. It's just using the right tools at the right time and for us and the patients we see, we find 3D works better for us in our hands. Cool, that makes sense.
Zero to 40 Program
00:40:32
Speaker
So what your, I was looking through your website before you came on. Yeah. And we could be talking, sorry to go back, we could be talking about that. It'd be great to have some debate and get some
00:40:42
Speaker
some people to chat with you who really believe that people should have it at the beginning of their running journey. Perhaps we should do that. Yeah, I like a nice debate.
00:40:55
Speaker
Yeah, I was having a look at your website. Tell me about your zero to 40 program. I'm really interested in this because I think there is only really the couch to 5k. There is. The reason they come about was actually one of my staff members done the couch to 5k and got injured at week six.
00:41:20
Speaker
And then we then we then started looking through our previous notes and we had about six or seven patients that had done the cache 5K that all were injured at the same time.
00:41:31
Speaker
And we're like, okay, so this is about eight or nine people in total now who have got injured all at the same time. This is, is this more than a coincidence? So we were looking at the data and we put the couch to 5K feet through the acute chronic workload ratio. And it does spike up over 1.5 at that week five or six mark. And I think that's why some people get injured. And then I was speaking to a few runners on Facebook
00:42:01
Speaker
and just doing a bit of Google search and looking at different forums and I was finding out that more and more people were getting, picking up injuries at that stage.
00:42:13
Speaker
So that's what I just thought, okay, maybe the couch of 5K is too progressive. Now, not everyone who does the couch of 5K gets injured. There are many people that do it and get through that process. But I do believe that it is slightly, it does progress you too quickly in around week five to six. And that's why we see some people pick up injuries.
00:42:35
Speaker
And then the others that don't are just lucky and just carry on okay. Because once you then get past, basically, when we look at the couch, if you get past that week to five, six, then as a rule of thumb, then you're going to be okay for the rest of the program because it doesn't push you up as quickly. And then when we were speaking to our patients in clinic who have just taken up
00:42:58
Speaker
running and for me I don't give a monkeys whether you started running at the age of 12 or for you I've got patients who only took up running once they retire to be honest to me as long as you got a
00:43:12
Speaker
As long as you've got a passion for being active and you want to do more, I don't care how old or young someone is. As long as they want to go do something, as long as they want to run, I'll have to help anyone. So then we then thought, well, actually, when we speak to these people, they don't sort of say, oh, I go run 5K, I go run 10K.
00:43:30
Speaker
They sort of say I'll go for a half-hour run. I'll go for a 20-minute run and a lot of these novice runners seem to Just type that time base time base. So then we thought well actually let it can we create a program and we only come a zero to 40 because That will then get most people around 5k in 40 minutes the
00:43:55
Speaker
and it's a 16-week program that we made sure, using acute chronic workload ratio, it doesn't progress you too quickly. Is this to get people active from who have done nothing for 40 minutes, or is it to get them running for 40 minutes? Yeah, so the aim is to get someone who, so it's two-fold, it's either you haven't run before, or the other people it's useful, if you've been off from an injury for a long period of time,
00:44:24
Speaker
or it's used to run when you're younger and then life got in the way and you had 10 years off running or something and then you got back to running. This is what this is aimed at and it's aimed at just getting people more active.
00:44:36
Speaker
because I am, as you'll see from all my branding and website stuff, I have a massive passion for promoting exercise and because I think if you're gonna talk about the best medication in the world, exercise is better than any drug for managing lots of things. So, and this program is there just to help people get from no running whatsoever to 40 minutes of running and help reduce their chance of picking up an injury.
00:45:05
Speaker
And does this encompass, so you mentioned that Dr. Tim's tool again. So this has been built with you managing load, is there strength exercises within this? Yes, then the other thing is that
00:45:21
Speaker
the couch of 5k lakhs in my opinion is an exercise program to go with it. So I'm a big believer that if we look at the research, we know that runners who do regular strength in the exercises can reduce their risk of getting an injury of up to 50%. So if you look at reducing your risk of injury, there's no better way to do it than working on just getting yourself stronger.
00:45:48
Speaker
So what we've done with the program is each week has its own little exercise program attached to it. And the aim of the exercise program is it can be done in the comfort of your own home. Each exercise takes you no longer than two minutes. So we want people to encompass doing the exercises while brushing their teeth, whilst making dinner, whilst putting the kettle on. Because I'm a
00:46:10
Speaker
I'm a big believer that in modern day life, money isn't the biggest commodity time. We're all time poor due to work. Unfortunately, I think technology makes us more time poor because we're constantly contactable on watches and phones and everything. So if I say to someone, unless you're going to the gym, if I say to someone, you need to spend a half hour at the end of the day to do some exercises, I can guarantee everyone will have the best intention, but a very small number of people will do it.
00:46:37
Speaker
However, if I could say here are three exercises to do, do them throughout your day to day routine, people do it.
00:46:46
Speaker
And then when people do it and they see the benefit, they then want to do more. Give me an example, what do you mean? Is this calf raises while you're doing the washing up? Yes, calf raises while you're doing the washing up. It's doing bridges maybe when you first get out of bed in the morning. It's doing what I call lateral band walks, maybe whilst you're waiting for the kettle to boil. It's doing anything like that, but be creative with it.
00:47:11
Speaker
And then the aim of the exercises is then as you get better at them, you then make them harder and harder and progress those forward. Um, and so yeah, so the aim of the zero to 40 is to get people active, but try and reduce how many injuries people pick up on the way.
Patient Education and Common Issues
00:47:29
Speaker
Um, because don't get me wrong. I have a private healthcare business. So we obviously make a living from seeing people that have got injuries, but all our aims of everything are.
00:47:40
Speaker
to we basically would rather not see people because they've got no injuries. So at the end of the day is always have plenty of work because the more active you are, people are going to get niggles and injuries and whatnot. But if we can reduce people's risk.
00:47:55
Speaker
of getting those, I think that's a really helpful thing. Yeah, my local physio, he's very good and he often says that a good physio and in your case podiatrist won't just fix you, they'll actually, they won't just fix the problem, they'll tell you how to stay fixed or give you
00:48:17
Speaker
100% agree with that. We aim to discharge all our patients and they can phone back anytime they want. But the aim is to manage the problem they got and then educate them how to prevent it all happening again, as best as we can. Because I love my exercise. And I know that if I'm not exercising, I get massively grumpy. And with modern day life, the amount of people that use running just to help
00:48:43
Speaker
manage their own mental health, helps to manage depression and stress around work. And if you say to a runner, you can't run, it says I reckon I could just shot them and they wouldn't have taken that as badly. It's it is it is. So if we can do things with trying to reduce the risk of them getting injuries in the first place, then they're happy because they can carry on running. So it's a win win for everyone.
00:49:14
Speaker
Okay, so final thing then for me, Nick, is that we get asked this a lot, and I think it came up as well when you were on the hour a few weeks ago. Yep. Blisters. Yep. How'd you treat them? Do we pop? Do we not? As a general rule of thumb, if they're not painful, leave them alone. The reason being is that, yes, the risks are low, but if you pop a blister, you do create a portal for possible infection.
00:49:45
Speaker
So whilst the blister is intact, it's a nice sterile field within there and the body over time will absorb that fluid and the blister will slowly shrivel up and disappear. However, if it's painful, then the advice is to pop them with a sterile needle and then stick a dressing over the top.
00:50:09
Speaker
of them, it is the best. But if you want to try and prevent blisters, in my opinion, the biggest thing is making sure your footwear fits. You'll be amazed the amount of people that don't wear the correct size shoes. Should they be half a size up? That's another... Yeah, I think that's a myth, if I'm honest.
00:50:34
Speaker
the same advice again, what's comfortable that you were saying before? Yeah, it's comfort and it's fit. So the majority of people that will come in and say, oh, I'm a half size bigger than my running shoes than my day to day shoes. Their running shoes fit perfectly. However, their day to day shoes are too small.
00:50:49
Speaker
So it is, you should be having, but when you stand up, your toes shouldn't be bulging over the side of your shoes and you should have a thumbs between your big toe and the end of your shoe. And that's the same for regards to your work shoes or whether it's your running shoes. The issue with the sizing system is flawed because every manufacturer will have their own sizing chart that they'll adhere to.
00:51:15
Speaker
So if you look at a Brooks, or if you look at a Nike, or if you look at Adidas, for example, and you buy size eight shoe, they all will be different sizes. So that's why it might. There's a definite outbreak of them, you know, the wider toe box shoes as well. So I think of ultra. Yeah. Yeah, ultra the widest. And if you want another wider fitted shoe, you're looking at your Brooks or your new balance as a whole. Adidas tend to come up slightly narrow, in my opinion.
00:51:45
Speaker
But yeah, it's just finding that shoe that fits for you. Cool. Nick's been great, thank you very much. No problem. It's been good fun and hopefully I can sort of dispel a few myths and not upset too many people on the way.
00:52:05
Speaker
Well, it'd be great to have you on again and then if we get any questions on social, we will tag you into things. Yeah, more than happy to come and do again and more than happy to come on and have a debate with certain people if they want to say. Yeah, great. Thanks very much. Perfect.