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Running Injuries: A Physiotherapist’s Complete Guide to Treatment, Recovery and Prevention

Expert guidance from Janine Enoch Founder of Vitality Physiotherapy — passionately working with runners across Surrey, Esher KT10, Cobham, Claygate, Weybridge, Woking and London SE1

Running is one of the most accessible, effective and rewarding forms of exercise — and around Esher and the wider Surrey area, it’s everywhere. From the wooded trails around Claygate and Oxshott to the towpath along the Thames near Weybridge, from Saturday morning parkruns to the Esher 10K, our community runs. And when injury strikes, it can feel devastating.

At Vitality Physiotherapy, with clinics in Esher (KT10) and Southwark (SE1), we work with runners at every level — from those lacing up for the first time to experienced athletes managing complex, recurring problems. This guide draws on over 25 years of clinical experience to help you understand the most common running injuries, why they happen, and what you can do about them.

Whether you’re dealing with knee pain that won’t shift, Achilles trouble that flares every time you build mileage, or you’re simply trying to stay injury-free as you train for your next event — this is written for you.

Who this guide is for: Recreational runners, parkrunners, half and full marathon trainers, returning runners after injury or a break, and anyone who wants to understand their body better.

Why Running Injuries Are So Common

Running is a high-load, repetitive activity. With every stride, your body absorbs force equivalent to two to three times your body weight — multiplied thousands of times over the course of a run. Most of the time, your body adapts beautifully to this. But when load exceeds your body’s capacity to absorb it, tissue becomes stressed and injury follows.

Research consistently shows that around 50–80% of runners experience at least one injury per year. The good news is that the vast majority of running injuries are not serious, are not caused by running itself, and respond well to physiotherapy — often without needing to stop running entirely.

The most common causes of running injury

Too much, too soon — increasing mileage or intensity faster than the body can adapt
Muscle weakness — particularly in the hips, glutes and core, which stabilise every stride
Previous injury — undertreated or incompletely rehabilitated injuries are a major risk factor
Training error — ignoring recovery, skipping rest days, or ramping up before a race
Footwear — worn-out shoes, or shoes that don’t suit your gait pattern
Biomechanical factors — how you run influences where load accumulates

A note from our clinic: In our experience at Vitality Physiotherapy, most running injuries we see in Surrey and London are not caused by bad luck — they are caused by identifiable, addressable factors. Understanding yours is the starting point for getting better.

The Most Common Running Injuries — and What to Do About Them

Below are the injuries we most frequently assess and treat at our Esher and Southwark clinics. Click the links to read our full articles on each condition.

Runner’s Knee (Patellofemoral Pain Syndrome)

A dull ache at the front of the knee, often worse going downstairs or after sitting for long periods. Runner’s knee is one of the most common presentations we see, particularly in recreational runners who have recently increased their mileage.

It is frequently associated with hip weakness — when the glutes and hip abductors are not working effectively, the knee is forced to compensate, increasing load on the patellofemoral joint. Treatment focuses on load management, hip and quadriceps strengthening, and gradual return to full training.

Key message: Runner’s knee is not a reason to stop running permanently. With the right rehabilitation, most people return to full training.

IT Band Syndrome

Sharp or burning pain on the outside of the knee, typically coming on at a predictable point in the run — often around the 2–3 mile mark. IT band syndrome is notoriously frustrating because it tends to recur when runners return too quickly or rely solely on foam rolling and stretching.

The IT band itself is not the problem — it is a symptom of a loading issue elsewhere, most commonly weakness in the hip abductors and poor pelvic control. Addressing these root causes, combined with a structured return-to-run programme, produces lasting results.

Achilles Tendinopathy

Stiffness and pain at the back of the ankle, typically worst first thing in the morning or at the start of a run. Achilles tendinopathy is an overuse condition that requires careful load management — complete rest often makes things worse, not better.

Tendon rehabilitation is a speciality area at Vitality Physiotherapy. Evidence-based eccentric and progressive loading programmes, delivered consistently over time, are the most effective treatment. Most cases resolve fully with appropriate physiotherapy.

Important: If you have sharp pain or sudden onset swelling at the Achilles, seek assessment promptly — a tendon rupture requires different management entirely.

Shin Splints (Medial Tibial Stress Syndrome)

Pain along the inner edge of the shin, usually diffuse and aching during and after runs. Shin splints are extremely common in newer runners and those returning after a break, and typically respond well to relative rest, load management and strength work.

Ignored or pushed through repeatedly, medial tibial stress syndrome can progress to a stress fracture — which requires a significantly longer recovery. Early assessment is important.

Plantar Fasciitis

Stabbing pain in the heel, classically worst with the first steps in the morning. Plantar fasciitis is a loading issue affecting the connective tissue of the sole of the foot, and is influenced by calf tightness, foot biomechanics, and training load.

Treatment is effective but requires patience — this is an injury that responds to progressive loading rather than rest alone. Physiotherapy including calf and foot strengthening, load management advice, and where appropriate orthotic assessment produces excellent long-term outcomes.

Hip and Glute Pain

Pain in the hip, buttock or outer thigh is increasingly common in recreational runners, particularly as we age or increase training demands. Presentations we see regularly include greater trochanteric pain syndrome (outer hip pain), hip flexor tendinopathy, and piriformis-related gluteal pain.

Many of these respond well to targeted strengthening and load management. If you have hip pain that radiates down the leg, a physiotherapy assessment is particularly important to identify the source accurately.

Should I Run Through an Injury?

This is the question we’re asked most often — and the honest answer is: it depends.

Some injuries can be managed while continuing to run at a reduced level. Others require a period of relative rest to allow the tissue to recover before loading resumes. The key factors are the type of injury, the severity of symptoms, and whether running is causing lasting damage or simply discomfort.

As a general guide:

Pain above a 3 or 4 out of 10 during a run is a signal to reduce load or stop
Pain that worsens significantly during a run, or that you are unable to run through, needs assessment
Pain that is present at rest, especially at night, should always be assessed
Swelling, giving way, locking, or sudden-onset sharp pain are red flags — seek assessment promptly

At Vitality Physiotherapy, we aim to keep you running wherever it is safe to do so. We work with you to find a manageable training level, modify your programme, and build back gradually — rather than telling you to stop until everything is perfect.

Running Injury Prevention: What the Evidence Says

The single most effective thing you can do to reduce your injury risk as a runner is strength training. A growing body of research demonstrates that runners who include regular strength work — particularly targeting the hips, glutes and single-leg stability — sustain fewer injuries and recover faster when they do.

Beyond strength work, the evidence supports:

Gradual load progression — the commonly cited ‘10% rule’ is a useful starting point
Adequate recovery — rest days are not optional; they are when adaptation happens
Sleep — consistently underrated as an injury risk factor
Appropriate footwear — not necessarily the most expensive, but suited to your foot type and gait
Addressing previous injuries properly — incomplete rehabilitation is one of the strongest predictors of future injury

From our clinic: We often see runners who have been managing a ‘niggle’ for months before seeking help. Early physiotherapy assessment — before a minor issue becomes a significant injury — is almost always the better approach.

When to See a Physiotherapist

You do not need to wait until you cannot run to seek physiotherapy. The following are all good reasons to book an assessment:

A pain or ache that has persisted for more than 2 weeks
An injury that keeps coming back in the same location
Pain that is changing how you run — altering your gait or causing you to compensate
You are training for an event and want to manage a problem before it escalates
You want a running assessment to identify any biomechanical factors that may be increasing your injury risk

At Vitality Physiotherapy, our running assessments are carried out by experienced chartered physiotherapists who understand both the clinical and training demands of running. We do not offer one-size-fits-all advice — every runner is different, and every treatment plan is individual.

Running Physiotherapy in Surrey and London — Our Clinics

Vitality Physiotherapy has two clinic locations:

From the treatment room to the finish line — congratulations to Jessica on completing the London Marathon

Esher, Surrey (KT10)

Our Surrey clinic is conveniently located for runners across Esher, Claygate, Cobham, Oxshott, Hersham, Hinchley Wood, Thames Ditton and Weybridge. We are a short walk from Esher station on the South Western Main Line.

We regularly see runners preparing for local events including the Esher 10K, the Claygate 5K, and a range of half and full marathons across Surrey and London.

Southwark, London (SE1)

Our London clinic is located in Southwark SE1, close to London Bridge station. We see runners from across South and Central London, including those training for the London Marathon, the Big Half, and the many parkruns across the capital.

Both clinics offer the full range of physiotherapy services including running assessments, injury rehabilitation, and women’s health physiotherapy — our specialist area of practice for over 25 years.

Book a Running Assessment

If you are dealing with a running injury, managing a recurring problem, or simply want an expert assessment of your running health, we would love to help.

Book online at vitality-physio.co.uk or call us to speak with a member of the team.

Esher KT10 | Southwark SE1 | vitality-physio.co.uk

Pelvic floor issues when you run? Read this

POST-PREGNANCY RECOVERY Your Complete Guide from a Women’s Health Physiotherapist

Everything you need to know about recovering well after having a baby – backed by clinical evidence, written in plain English.

Having a baby is one of the most significant physical events a woman’s body will ever go through. Yet postnatal recovery is often under-discussed, under-resourced, and misunderstood. This guide answers the questions we hear most often in clinic — honestly, practically, and with your long-term health in mind.

Written by Tamara Figaji, Associate Women’s Health Sports Physiotherapist at Vitality Physiotherapy.

Q1 When should I start pelvic floor exercises after birth?

This is one of the most common questions we’re asked — and the short answer is: sooner than most people think.

The first 24 hours

Provided you feel comfortable and there are no complications, gentle pelvic floor contractions can begin within the first day after birth — whether you’ve had a vaginal delivery or a caesarean section. In the early days, these aren’t about ‘getting your pelvic floor back’; they’re about encouraging circulation, reducing swelling, and beginning the healing process.

Even if you can’t feel much at first — especially after a difficult delivery or if you’ve had stitches — that’s normal. The nerve supply to the pelvic floor can be temporarily affected by birth, so reduced sensation doesn’t mean nothing is happening.

The first 6 weeks

During this period, focus on low-intensity exercises. These include:

Slow, held contractions: gently lift and squeeze, hold for up to 10 seconds, then fully release
Quick contractions: short squeeze and releases to activate fast-twitch muscle fibres
Deep breathing with diaphragmatic engagement: your pelvic floor and diaphragm work together

Equally important is the release. Many women are so focused on ‘tightening up’ that they forget the pelvic floor must also fully relax. A pelvic floor that cannot let go is just as problematic as one that is weak.

⚠️ Important: Not all pelvic floor problems mean weakness

Some women experience pelvic floor tension or overactivity after birth, where muscles are tight and unable to relax. Doing more squeezing exercises in this case can make symptoms worse. If you’re experiencing pain, pressure, difficulty with bowel movements, or pain during sex, please seek assessment before continuing with generic pelvic floor programmes.

When to progress

From 6–12 weeks, as your body heals and you receive clearance at your postnatal check, you can begin building intensity and duration. This is also the time to start thinking about returning to more demanding activity — we’ll cover running specifically in Q5.

✅ Clinical recommendation

Every woman who has given birth — regardless of delivery type, age, or symptom status — would benefit from a pelvic floor assessment with a specialist physiotherapist at or after 6-8 weeks postnatal. This is standard practice in France and many other countries, and something we advocate strongly for in the UK.

Q2 What is a Mummy MOT?

The term ‘Mummy MOT’ has become widely used, but it’s worth understanding exactly what it involves — and why it’s so valuable.

What it is

A Mummy MOT is a specialist postnatal assessment carried out by a trained women’s health physiotherapist, typically from around 6-8 weeks after birth, ideally after GP postnatal check. It’s a thorough, evidence-based review of your postnatal recovery that covers:

Pelvic floor muscle function — strength, coordination, relaxation and endurance
Abdominal muscle assessment — including checking for diastasis recti (tummy gap)
Posture, breathing and movement patterns
Scar tissue assessment (perineal or caesarean)
- - - - Return-to-activity guidance based on your individual findings

Why it matters

The standard NHS 6- 8week postnatal check is carried out by a GP, and while valuable, it typically does not include a pelvic floor examination or musculoskeletal assessment. For many women, this means problems go undetected — sometimes for years.

Research suggests that up to 1 in 3 women experience pelvic floor dysfunction after childbirth, including urinary leakage, pelvic organ prolapse, or pain. The majority never seek help, often because they believe these symptoms are ‘normal’ or ‘just part of having a baby.’

They are common — but they are not inevitable, and they are treatable.

💬 A note from Tamara

In clinic, I see many women who have been silently managing symptoms for months or years before coming to see us. A Mummy MOT gives us the full picture of how your body is recovering — and means we can create a personalised plan to get you back to doing everything you love, safely and confidently.

When to book

We recommend booking your Mummy MOT from 6 – 8 weeks postnatal for vaginal deliveries, or from 8–10 weeks following a caesarean section, or after your GP postnatal check for both. However, assessments can be carried out at any point after this time — it is never too late to be assessed, even years after giving birth.

What’s included	What you’ll receive
60-minute one-to-one assessment	Personalised exercise programme
Pelvic floor internal examination (with consent)	Scar management advice if applicable
Diastasis recti check	Graded return-to-activity plan
Full movement & posture review	Referral or onward support if needed

Q3 Why do I still look pregnant months after giving birth?

This is something many women worry about and feel embarrassed to ask. The good news is that there are clear physiological explanations — and in most cases, effective things you can do about it.

Your uterus needs time to involute

Immediately after birth, your uterus begins the process of involution — shrinking back towards its pre-pregnancy size. This takes approximately 6 weeks. During this period, a rounded lower abdomen is entirely normal and expected.

Abdominal muscles have been stretched

During pregnancy, the rectus abdominis muscles (your ‘six-pack’ muscles) are stretched apart to accommodate your growing baby. The connective tissue between them — the linea alba — widens in all pregnancies to some degree. This is called diastasis recti, which we cover in detail in Q4.

A persistent domed or coned appearance to the abdomen, particularly when sitting up or under exertion, is often a sign of diastasis recti that needs attention.

Skin and fascia laxity

The skin and deeper fascial layers of the abdomen have been under sustained stretch for nine months. Skin has limited elasticity after this level of sustained stretch, particularly with larger babies, multiple pregnancies, or when significant weight change has occurred. Some degree of laxity may remain permanently — and this is a completely normal part of having carried a baby.

Posture and muscle inhibition

Postnatal posture changes — often exacerbated by feeding positions, carrying, and sleep deprivation — can make the abdomen appear more prominent. When deep core muscles such as the transversus abdominis are not functioning optimally, the abdominal wall may have a more lax appearance.

Fluid retention

Some women retain fluid for several weeks postnatally, which can contribute to a swollen or puffy appearance across the abdomen and lower body. Staying well hydrated, moving gently, and elevating the legs when resting can help.

When to seek advice

If you are experiencing a persistent domed or asymmetric appearance to your abdomen, particularly when you cough, sneeze, or sit up, or if your abdomen feels weak or unsupported when you move, please book a postnatal physiotherapy assessment. These presentations can be assessed and treated effectively with the right guidance.

Q4 How do I close a tummy gap (diastasis recti)?

Diastasis recti — the separation of the rectus abdominis muscles — is one of the most searched postnatal topics, and also one of the most misunderstood. Here’s what you actually need to know.

First: what it is and isn’t

Diastasis recti is a widening of the inter-recti distance (IRD) — the space between the two columns of abdominal muscle. A small degree of separation is normal in all pregnancies. Clinically, we tend to consider a distance of 2cm or more, combined with impaired function of the connective tissue (poor tension and depth), as requiring intervention.

Crucially: the goal is not always to ‘close the gap.’ A narrow gap with poor tissue tension and function is more problematic than a slightly wider gap with good tension and load transfer. What matters most is how well the abdominal wall functions as a unit.

What makes it worse

Certain activities can place excessive load on the linea alba and impede recovery. In the early postnatal period, avoid:

Traditional sit-ups, crunches, or double-leg raises
Heavy lifting without breath and bracing technique
High-impact exercise before adequate healing
Planks and push-ups if you notice coning or doming of the midline

This doesn’t mean these exercises are permanently off-limits — it means timing and progression matter.

What helps

Recovery from diastasis recti is graduated and individual. A well-structured programme typically includes:

Breathing and deep core activation: learning to engage the transversus abdominis and coordinate breath with movement is the foundation of diastasis rehabilitation
Progressive loading: gradually reintroducing load through the core as tissue tension and function improve
Postural optimisation: addressing compensatory patterns that increase intra-abdominal pressure
Functional movement retraining: returning to everyday tasks — lifting, carrying, getting up from the floor — with optimal mechanics

Realistic expectations

With appropriate intervention, most women see significant functional improvement and reduction in gap width. However, some degree of laxity may remain — and this is not a failure. Many women with a measurable IRD have no functional symptoms whatsoever.

If you’ve been told you have diastasis recti, or if you notice the classic signs — coning at the midline, lower back pain, pelvic instability, or difficulty generating core tension — a specialist physiotherapy assessment will give you a clear, personalised plan.

📋 What to expect at a diastasis assessment

At Vitality Physiotherapy, we assess inter-recti distance, tissue quality (tension and depth), load transfer and abdominal function through movement. From this, we create a structured rehabilitation programme that progresses at the right pace for your body and your goals — whether that’s returning to yoga, lifting your toddler, or running a 10K.

Q5 Is it safe to run after having a baby?

Running is one of the most popular forms of exercise women want to return to after having a baby. And the answer to whether it’s safe is: yes — but with the right preparation, at the right time.

Why the timing matters

Running is a high-impact activity. Every stride loads the pelvic floor with forces of 1.5–2.5 times your body weight. This is a significant demand to place on tissues that are still recovering from pregnancy and birth.

The landmark guidelines published by specialist physiotherapists Groom, Donnelly and Brockwell — widely adopted in clinical practice — recommend that women wait until at least 12 weeks postnatal before returning to running, and that this return is graduated and symptom-guided.

Signs that you may not be ready

Before returning to running, you should be free of the following symptoms during everyday activity:

Urinary leakage (stress incontinence)
Pelvic heaviness, pressure, or bulging
Pelvic girdle or lower back pain
Abdominal coning or doming
Difficulty with single-leg activities such as stairs or walking

If any of these are present, these are signals to address the underlying issue before introducing running loads.

The readiness tests

Before beginning a return-to-run programme, you should comfortably be able to:

Walk briskly for 30 minutes without symptoms
Single-leg balance for 10 seconds each side
20 single-leg calf raises without discomfort
10 single-leg bridges on each side
20 forward bounds (low-impact hopping), symptom-free

Building back up

A graduated return-to-run programme — similar in structure to Couch to 5K — is the safest approach. Alternate running and walking, begin on softer surfaces, and pay close attention to any symptoms during or after sessions.

Week	Session structure	Symptom check
1	1 min run / 2 min walk × 8	Leakage, heaviness, pain?
2	2 min run / 2 min walk × 6	Any new symptoms?
3	3 min run / 1 min walk × 6	Confidence improving?
4	5 min run / 1 min walk × 5	Continuous running felt ok?
5–6	10 min run / 1 min walk × 3	Assess for full return

If symptoms occur during or within 24 hours of a run, step back one week in the programme and reassess. Persistent symptoms should prompt a physiotherapy review before continuing.

🏃 Running with a pelvic floor that’s ready

At Vitality Physiotherapy, we offer specialist return-to-running assessments that combine pelvic floor evaluation with a movement and gait screen. This gives you a clear picture of your readiness, a tailored programme, and the confidence to run without worrying about your symptoms. Whether you’re aiming for your first 5K or returning to half-marathon training, we can help you get there safely.

Ready to start your recovery properly?

Clinics in London (SE1) and Surrey (KT10 Esher)

Book a Mummy MOT or postnatal physiotherapy assessment

vitality-physio.co.uk

About the author

Tamara Figaji is an Associate Women’s Health Sports Physiotherapist at Vitality Physiotherapy, specialising in postnatal recovery, pelvic floor rehabilitation, and return-to-sport. She works with women at both the London (SE1) and Surrey (KT10 Esher) clinics.

The information in this article is for educational purposes and does not constitute individual medical advice. If you are experiencing symptoms or have concerns about your postnatal recovery, please book an assessment with a

Can AI Replace Your Physio?

Why a Real-Life Physiotherapist Beats an AI Rehab Plan for Back Pain

I recently encountered a post from a runner who shared how they achieved a marathon PB from using ChatGPT. It seemed convenient — quick, accessible, and of course, the running plan was free. When it comes to your back, there’s no substitute for a skilled Physiotherapist who can listen, see, feel, and adapt in real time. That’s the foundation of our learning in orthopaedic medicine.

Having mentored students over many years, I’ve learned that the best Physios listen well, remain curious, and make the complexities of pain less complicated.

Here’s why a real-life Physio beats ChatGPT and all its bot-friends:

Personalised Assessment

AI tools rely on what you type into the search bar, and as we have all discovered, the better the context you give, the better the answer. The problem is that you don’t know what you don’t know.

A Physio asks the important questions, not only the obvious ones, such as what aggravates your pain, but also the less obvious ones- like your lifestyle, nutritional, work, life, and social engagements.

Not only will a good Physio ask great questions, but they will also look critically at how you move. They observe posture, gait, strength, flexibility, breathing, and how your pain changes moment to moment.
Expert human observation is not confined to a singular moment, but is an evolving assessment and reassessment process that matches your needs. This observational cohort study in outpatient Physiotherapy clinics showed that just the history-taking and physical examination performed by physiotherapists produced statistically meaningful improvements in patient pain and function before any “treatment” was applied.

The focus: helping you reach your goals and to get back to doing the things you love. We can spot subtle problems — like pelvic imbalance, poor load transfer, trick movements, and compensations- that no algorithm can detect from text, photos, or even your Garmin data. (No disrespect intended to my favourite data platform.) Furtherore, a skilled practitioner puts you and your goals in the centre and shares in making the important decisions such as when it is best to return to sport.

Correct Diagnosis

Back pain can have many causes, ranging from disc irritation, joint stiffness, muscle spasms, nerve sensitivity, to stress, lifestyle, and even hormonal factors. It’s a nuanced condition. Your pain cannot be oversimplified as a change to your disc or spinal joints. Your back pain also reflects how well your body’s tissues can handle and adapt to the loads placed on them. A great Physio can test, palpate, and clinically reason through these factors. This ensures the plan targets what actually needs fixing.

Real-Time Feedback and Progression

AI gives static exercises, handouts, and guides- a fix-all, monochrome magic formula for everybody. A brilliant Physio provides coaching: correcting form, adjusting load, progressing safely. They lead you to prevent flare-ups and take you beyond what you think is possible. That’s the difference between just doing exercises and doing a targeted goal-oriented, effective, progressive rehab programme.

Holistic Support

Recovery isn’t just physical — it involves sleep, stress, work ergonomics, and movement habits
A real Physio connects all these dots, problem-solves their interconnectedness and helps you stay accountable.

Safety and Trust

If pain worsens or new symptoms appear, an AI can’t respond.
A Physio knows when to modify load (how heavy), mode (how far and what position), rep range and technique. Not only will they provide you with a plan, but they can also adapt it when needed, investigate further, or refer to another medical practitioner when needed.— keeping you safe.

AI can be a great tool for many things; we use it too in our clinics to help write notes and assist with administrative tasks, but it is always Physio-led. For lasting back pain recovery, nothing replaces our expert hands, eyes, clinical reasoning and yes, the trust relationship.

Ready to experience Physio-led care that truly makes a difference? Book your session today and start your path to lasting recovery.

Long Covid: Breathing pattern disorder

Without it, life cannot be sustained, it is as simple as that. Breathe in, breathe out, our simple but most important automatic reflex-controlled function. Most of the time, our brain and reflexes do all the work for us. Have you ever observed a sleeping baby, breathing gently as their chest rises and falls, effortless and without any conscious process involved?

When the demand arises, we can consciously decrease or increase our rate of breathing. Do you remember the days of “hide and seek” when the suspicious seeker was dangerously so close you’d dare not breathe, or the exhilaration associated with the rapid preparatory breathes I take before that first jump off the highboard at the local swimming pool?

What is a normal breathing pattern?

Gentle breathing through the nose
Breathing in for 1-1.5 sec
Breathing out for 1.5-2 sec
Pause between in and out breath
Take 10-14 breaths per minute in adults
Breathe about 500ml of air per breath
Breathing is quiet

The normal breath cycle

Sometimes it goes wrong and our breathing becomes dysfunctional. What is dysfunctional breathing (DB)?

This can occur with heavy exercise, strong smells, cold weather, stress or other triggers. People would breathe rapidly through the mouth, breathe using the upper chest. The accessory neck muscles work hard and you will effectively hyperventilate.

The primary symptom is often breathlessness but is usually clarified as a feeling or need for more air or “air hunger”. Additionally, DB may cause non-respiratory symptoms such as dizziness and palpitations. It has been identified across all ages. In the United Kingdom, its prevalence is approximately 9.5% among adults.

What happens when we breathe?

We breathe in air containing a mixture of oxygen (O2) and carbon dioxide (CO2) and other gases. Our bodies process and use some of the inhaled oxygen to make energy, and creates carbon dioxide as a result. When you breathe out the air contains less oxygen and more carbon dioxide. However, carbon dioxide is not just a waste product of our body’s processes, it also has a vital role in regulating the pH of the blood. During stressful situations, a higher level of CO2 in your blood, helps your body to produce adrenaline which will help you flee from danger.

How does hyperventilation affect our bodies?

Some of the most common symptoms of hyperventilation

When we hyperventiltate, and there is less CO2 and more O2 in the blood, this causes respiratory alkalosis, or decreased acidity of the blood. This causes our blood vessels to constrict and causes reduced blood supply to the brain, among other things. This causes a feeling of light-headedness and pins and needles in the fingers, muscle cramps and exhaustion.

When overbreathing becomes regular and more permanent, the brain recognizes this lower level of carbon dioxide and accepts it as being normal. Consequently, the body is constantly on alert. This cycle of hyperventilation causes a self-perpetuating cycle, that fuels back into the system making you feel more anxious, more breathless and more hungry for air.

We also alter our posture significantly when we over breathe, adopting hunched-up shoulders as a result of rapid breathing. This causes us to use our neck accessory muscles to help draw air into our lungs. Prolonged and ongoing use of these neck muscles can cause an aching neck and stiff shoulders. Typically we can overuse sternocleidomastoid and scalene muscles which are at the front of our necks to do so. Check out this helpful video to hear more about breathing pattern disorder.

What is COVID-19 and why can it make you so sick?

What is COVID-19 and why can it make you so sick blog article

Most of us know someone in our social circles who has had COVID-19, with or without becoming sick from it.

Within the last 20 months, more than 203M cases of coronavirus infections were reported worldwide. Some people recovered from SARS-CoV-2 COVID having only a sniffle or a cough. Others got COVID and became sick with unremitting fever for days or even weeks. Sadly for 4.3 million people, this terrible disease was fatal.

It begs the question – why do some people get so sick from COVID, whilst others suffer just mild symptoms? Is it a case of genetics, age, sex, or previous co-morbidities?

This article aims to answer this question.

The journal Science Immunology published a study in March 2021 found that severe COVID-19 is accompanied by elevated levels of multiple inflammatory blood markers. It became apparent that a person’s immune response to SARS-CoV-2 determines who is at the greatest risk rather than the virus itself.

HOW DOES THE IMMUNE RESPONSE BEHAVE IN COVID-19?

In COVID-19, coronavirus particles spread across the respiratory tract and infect surrounding uninfected cells. This triggers a series of immune responses. It results in some changes in immune cells, particularly lymphocytes, which then leads to immune system dysfunction.

Cells of the immune system communicate with each other through a process known as signaling. Cells respond to viruses by secreting proteins called cytokines. However, in the presence of excessive inflammation, sometimes there is an uncontrolled release of cytokines. This triggers a ‘cytokine storm.’ The cytokines released by the SARS-COV2 infection lower white blood cells (such as lymphocytes) and suppress the immune response.

Some cytokines cause lung cells to die. As those lung cells break down and die, the alveoli (air sacs in your lungs) fill with fluid. This causes pneumonia and prevents the exchange of air in the lungs. The body becomes deprived of oxygen (hypoxia) and respiratory distress occurs.

Are you starting to understand why COVID makes some people so sick?

WHY IS COVID-19 SO MUCH MORE DANGEROUS IN OBESE AND OLDER AND VULNERABLE POPULATIONS?

1.OBESITY:

A recent study published in The Lancet Diabetes and Endocrinology analyzed COVID-19 severity in 6.9 million people in England. It demonstrated that a BMI over 23 kg/m2 was associated with an increased risk of severe COVID-19.

It has been suggested that obesity is associated with an inflammatory state. WE see a surplus of macronutrients in obesity fat tissues. The macronutrients cause increased production of inflammatory mediators (tumor necrosis factor* and interleukin-6) and reduce adiponectin. Adiponectin is a hormone that plays a crucial role in protecting against insulin resistance/diabetes. The result is oxidative stress and pro-inflammatory reaction. During oxidative stress, the body is overloaded with free radicals and not enough antioxidants

During normal metabolic processes, the body’s cells produce free radicals. The cells also produce antioxidants that neutralize these free radicals. In general, the body can maintain a balance between antioxidants and free radicals. An imbalance favoring free radicals causes oxidative stress.

Clinical manifestations and mechanisms for COVID-19 risk in individuals with obesity

Individuals with obesity and COVID-19: A global perspective on the epidemiology and biological relationships. Obesity Reviews November 2020 e13128

Individuals with obesity are more likely to develop diabetes type 2. Hyperglycemia (excessive blood sugar), and uncontrolled blood glucose, have been shown to significantly impair immune cell function and was associated with a higher mortality rate.

A high-fat diet also triggers an inflammatory response in the body. The fatty acid, Cholesterol is an essential ingredient in the spread of SARS COV-2. This virus enters the cell in the presence of cholesterol in the form of lipid rafts, The virus attaches and enters the cell by being engulfed by the cell (endocytosis). An exciting discovery was recently discovered by the University of Birmingham, Keele University, and the San Raffaele Scientific Institute in Italy, where fenofibrate, a blood cholesterol-lowering drug, decreased sARS-COV-2 significantly in laboratory testing.

2. OLDER PEOPLE

Over 65-year-olds represent 80% of hospitalizations and have a 23-fold greater risk of death. Cardiovascular disease, diabetes, and obesity increase the risk of fatal disease, but they do not explain why age is an independent risk factor.
By 29 May, the Office for National Statistics reported that more than 46,000 people had died from Coronavirus in England and Wales, and that more than 4 in 5 of those people were over the age of 70. When we examine the number of deaths caused by Coronavirus per thousand people, the correlation is even starker.

In age groups up to and including 60-69, fewer than 1 in 1,000 people have died from coronavirus.

Age 70-79, is 2 in every 1,000 people.

Age 80-89, is 7 in every 1,000 people.

Age 90 and over, is 18 people in every 1,000 people.

By Colin D. Funk, Craig Laferrière, and Ali Ardakani – Funk CD, Laferrière C y Ardakani A (2020) A (2020) A Snapshot of the Global Race for Vaccines Targeting SARS-CoV-2 and the COVID-19 Pandemic.

The virus typically enters an individual’s airways and enters a cell by attaching its spike protein to the ACE-receptors found on the surface of many organs in the body. The virus becomes engulfed by the the cell (endocytosis), and then begins to replicate, taking over and replicating itself using the body’s own protein making mechanism.

Two major changes occur in the immune system as we age. There is a gradual decline in immune function known as immunosenescence, which hampers pathogen recognition, alert signaling, and clearance of pathogens. Other classic immune system changes during aging are chronic inflammation and inflamaging, which result from an overactive, but ineffective alert system.

The virus continues replicating and spreading in the body, causing chaos and damage as it does.

The aging immune system

A patient’s ability to control viral load is one of the best predictors of whether they will become mildly or severely sick from COVID-19. The immune system requires four main functions: (1) recognise, (2) alert, (3) destroy, and (4) clear to destroy any virus. In older adults, each of these mechanisms is dysfunctional and increasingly variable. The immune system’s response is usually two-fold. Our first reaction relates to the innate immune response which is characterised by the cytokine and interleukin response, which serves to slow down the replication of the virus, and to allow the body to launch it is personal bespoke acquired immune response which seeks to destroy the virus. However, in older people where the immune workings are less than optimal and variable, the virus is by default is more opportunistic.

image showing the immune response such as in covid-19

Image: The mechanism of the human immune response Source Cell Signaling Technology

OTHER HEALTH CONDITIONS:

Several health conditions, such as diabetes, can increase the risk of becoming severely sick from COVID-19 by suppressing the immune system; whilst COPD, increases the risk due to the weakened state of the lungs. This is largely due to poor underlying lung reserve (The amount of extra air inhaled — above normal shallow breathing when taking a forceful breath) as well and increased expression of angiotensin-converting enzyme 2 (ACE-2) receptor in the small airways

Increased risk has also been seen in people with high blood pressure (hypertension) and coronary artery disease. Fever and infection cause the heart rate to speed up, increasing the work of the heart in COVID-19 patients who develop pneumonia. Blood pressure may drop or spike, causing further stress on the heart, and the resulting increase in oxygen demand can lead to heart damage. This is especially so, if the heart arteries or muscle were unhealthy, to begin with. Heart damage is most often caused by heart attacks, which result from the formation of a blood clot in a vulnerable heart artery, blocking the delivery of oxygen to the heart muscle. COVID-19-related inflammation raises the risk of this type of heart attack by activating the body’s clotting system and disrupting the blood vessel lining. This lining loses its ability to resist clot formation when inflamed. Clots in the large and small arteries of the heart cut off the heart’s oxygen supply. The increased clotting tendency can also cause blood clots in the lungs, which can cause the oxygen level in the blood to drop. A severe case of pneumonia further reduces blood oxygen levels.

As previously described when the ‘spike’ molecule on the surface of the virus particle binds to ACE2 on the surface of a cell. This causes the virus particle to be taken into the cell. It replicates its genetic material to form new virus particles. Normally, cells in the airways, lungs, and heart, as well as those in the circulatory system, contain ACE2.

However, patients with heart failure or respiratory conditions like COPD have an increase in ACE2. A higher level of ACE2 means that there are more entry points for the virus and therefore increase the risk of severe illness. Please note that if you have been prescribed ACE inhibitors, you should continue taking them. ACE inhibitors and ARBs are safe to use.

The researchers at Kings College London found that there was no link between the use of angiotensin-converting enzyme (ACE) inhibitors, used to treat blood pressure or diabetes, and how sick you get from Covid-19.

“This study has addressed a very important clinical question since a large proportion of the UK population takes these cardiovascular drugs. Our study indicates that it is perfectly safe to continue taking these agents and that people’s concerns about them can be alleviated”

– Professor Ajay Shah, BHF Chair of Cardiology & James Black Professor of Medicine Director,

King’s BHF Centre of Excellence, King’s College London and King’s College Hospital

So, the older you are, the more health issues and underlying conditions that you may have, the more severe the risk of severe infection. However, taking the necessary steps to protect yourself and others from becoming sick with COVID-19, is possible.

Vaccination, social distancing, wearing a face covering, and practicing hand hygiene remain crucial to help reduce the spread of COVID-19.

If you would like to learn more about how physiotherapy can help you recover from Long-COVID, this article will answer all your questions!

If you are currently experiencing symptoms associated with COVID-19 or Long-COVID and would like to speak to an expert, get in touch: info@vitality-physio.co.uk

COVID-19 Rehab: Your Questions Answered (And How Physio Can Help)

COVID-19 Rehabilitation and Long-COVID Recovery

It is staggering to think that these words never existed two years ago. Now, entire market sectors are dedicated to them. In January 2020, the World Health Organisation (WHO) called the new Coronavirus outbreak a “Public Health Emergency of International Concern”.

Three months later, a global pandemic was declared, and life as we knew it changed. Early on, the WHO did not expect a vaccine in less than 18 months. Then, against all odds, the world’s institutions combined their forces and produced a vaccine within 11 months.

Hope was renewed, and a way forward pathed.

With more than half of the UK population now vaccinated, it’s tempting to assume the COVID nightmare is almost over. But, this may be short-sighted. Although we’ve made progress, there’s still much more to learn about this disease before we can move on from this pandemic.

The reality is the world is healing, and many people have a long journey ahead of them.

These are the most common questions we get from patients and carers, and we hope by the end of this article you will have found the answers you’re looking for.

1. WHAT IS CORONAVIRUS AND COVID-19?

Coronaviruses (CoV) are a large family of viruses that cause illnesses ranging from mild common colds to more severe conditions like SARS and MERS. The Coronavirus at the centre of the pandemic is a new strain called SARS-CoV-2. The virus spreads through direct contact or respiratory droplets that contact the nose, mouth, or eyes.

Data shows Black and Asian ethnic minority populations have poorer outcomes but, ongoing symptoms occur across all population groups. The WHO reports, ‘anyone can get sick with COVID-19 and become seriously ill’. Those found to be at most significant risk of severe COVID-19 illness are:

Men
People over 60
Those with an underlying health condition.

2. WHAT ARE THE MOST COMMON SYMPTOMS OF COVID-19?

COVID-19 can show up as a mild or severe disease. In some cases, it can progress quickly, so knowing the symptoms and understanding the difference between mild and severe cases helps save lives. These are the most common symptoms:

Covid-19 rehabilitation, covid-19 symptoms

COVID-19 Coronavirus Symptoms (Source: WHO )

As with any new outbreak, little is known about the condition until more studies are conducted. Time brings more information, improved knowledge, and ultimately, better management of the disease or condition.

Since COVID-19 is a new condition, the list of symptoms may change in the future. Therefore, it’s best to keep up to date with current evidence.

3. HOW LONG DOES IT TAKE TO RECOVER FROM COVID-19?

COVID-19 recovery is different for everyone. The WHO reports most people (about 80%) will recover without needing hospital treatment. Around 15% will require oxygen treatment, and 5% will need intensive care due to critical illness.

Many people get back to their normal activities within a few weeks, but most recover within 12 weeks. Unfortunately for some, symptoms can last longer than 12 weeks. New initiatives provide guidance and support for those dealing with COVID-19, either directly or indirectly.

The NHS has done a terrific job with its website, www.yourcovidrecovery.nhs.uk. It’s an incredible resource for anyone needing support through their or a loved one’s COVID-19 recovery.

4. WHAT IS ‘LONG-COVID’?

Long-COVID is the extended period of illness after initial COVID-19 infection.

The National Institute for Health and Care Excellence (NICE) develops COVID-19 care guidance based on these definitions and timelines:

Acute COVID-19: Signs and symptoms up to 4 weeks
Ongoing symptomatic COVID-19: Signs and symptoms from 4 -12 weeks
Post-COVID-19 syndrome: Signs and symptoms presenting as clusters during or after COVID-19 infection, with no alternative diagnosis and lasting longer than 12 weeks
Long-COVID includes both the ongoing symptomatic COVID-19 and post-COVID-19 syndrome stages

Image: Vitality Physiotherapy. Source: NICE

In a joint UCL 2021 study, researchers found patients hospitalised with COVID-19 still had symptoms more than seven weeks after hospital discharge.

These included:

Persistent breathlessness (53%)
Cough (34%)
Fatigue (69%)
Depression (14.6%)

They also found that 38% of Chest X-Rays remained abnormal and 9% showed worsening.

As much as we want this pandemic over, some symptoms are an ongoing reality in many people’s lives.

Long-COVID symptoms are wide-ranging and fluctuating, and these can change in nature over time.

Covid-19 rehabilitation, symptoms, Long covid — **LONG-COVID SYMPTOMS**

Image: Vitality Physiotherapy, Source: NHS

5. WHAT CAUSES LONG-COVID?

The research is scarce about the causes of Long-COVID. However, a theory about viral persistence has emerged. Certain body parts (brain, testes, eyes, spinal cord) are considered ‘safe havens’ or immune-privileged organs to our immune cells. These are ‘no-go areas’ for immune attacks.

When viruses hide out in these body sites and come out later, causing relapses, it’s called viral persistence. In these organs, damage from an immune attack is riskier than allowing an invader (a virus, for example) to infect the cells.

In June 2020, a National Geographic article called ‘How long does Coronavirus last inside the body?’ explored viral persistence and explained how it impacts your recovery.

6. WHO CAN GET LONG-COVID?

The short answer? Anyone who gets COVID-19 can get Long-COVID. Many people believe they will not experience severe symptoms if they are not at risk.

The chances of having long term symptoms does not seem to be linked to how ill you are when you first get COVID-19.
– NHS

The NHS clarifies an important aspect here – your initial and post-COVID symptoms may not be related. But why can’t we predict how unwell we’ll get with COVID-19 or tell whether we will develop long-term symptoms?

In a review into the global health strategies surrounding COVID-19, a researcher explained it like this:

‘What follows after the acute phase of SARS-CoV-2 infection depends on the extension and severity of viral attacks in different cell types and organs.’
– Aging clinical and experimental research

In other words, how sick you become after acute infection depends on how severely the virus attacked during the acute phase.

Viruses also affect our immune systems differently. Unfortunately, we cannot predict which patients will have a worse outcome from the limited clinical evidence and research data.

This NHS video discusses how post-COVID symptoms affect healthy young people. For example, a 26-year-old former marathon runner describes how ten weeks after her initial infection, she still couldn’t walk for more than 15 minutes at a time in this BBC article.

These stories, along with countless others, demonstrate that no one is safe from Long-COVID.

7. WHAT HAPPENS IN A COVID-19 PHYSIO APPOINTMENT?

Your appointment will include a thorough assessment and a concise treatment plan.

Assessment includes:

A screen for serious illness
A discussion about your case history to find out about your current and previous functional abilities and challenges
A respiratory examination
A musculoskeletal examination

Treatment includes:

A uniquely designed custom treatment plan according to your specific goals and functional requirements determined in your assessment.

8. HOW CAN PHYSIOTHERAPY HELP?

COVID-19 Rehabilitation tools, techniques and exercises help:

Reduce breathlessness
Increase your lung capacity
Pace your activities
Manage fatigue
Improve your exercise tolerance
Rehabilitate muscle and joint dysfunction

We show you a way forward and help you manage your symptoms better so you can live your life.

In any holistic Physiotherapy Rehabilitation programme, an onward referral network is essential. We work with experts to help you recover fully.

If we suspect you need further investigation, we will refer you to our trusted colleagues for extra help:

Specialist Medical Physicians
Respiratory consultants
GP’s
Psychiatrists
Sports and Exercise Medicine Consultants
Speech and Language Therapists
Occupational Therapists
Psychotherapists

There is more to COVID-19 than just a virus. You can feel the impact on every aspect of your life – physically, mentally, socially and financially.

Have you waited long enough for things to improve on their own? You are not alone on this journey – we’re on your team!

COVID-19 is a complex puzzle, and we are here to help you solve it! Don’t wait any longer to restore your quality of life and start doing the things you love again!

Get in touch with our specialist team now!

We are still open for in person consultations at our clinics as well as for video consultations

FOR THE CURRENT LOCKDOWN 2.0 PLEASE NOTE THAT WE WILL REMAIN OPEN FOR IN PERSON CONSULTATIONS AT OUR CLINICS, AS PER GOVERNMENT GUIDELINES

During the first lockdown, we made all our Physiotherapy consultations vitual. We quickly realised that our online service was a huge benefit to our patients who found the service to be both convenient and effective. It’s been so popular that we have decided to keep offering our virtual service to our patients on an ongoing basis.

How does it work?

Physiotherapy video consultations are evidence based and have proven to be clinically effective to treat musculoskeletal conditions, and at Vitality Physiotherapy this is not the first time we have used such tools.

During your consultation, your Physio will be able to establish a diagnosis and offer you treatment through a custom made exercise plan as well as manual therapy and self-mobilisation techniques, offer technical expertise, advice and week on week guidance on your condition, your exercise regime or training plan.

Book your appointment here

Our Waterloo location has reopened!

The wait is over and the clinic has now been completely refurbished.

Come and visit us at Roupell Street from Monday the 24th of February and enjoy our new comfortable setting.

Picture by Tom Reading – Creative Commons Attribution 2.0 Generic (CC BY 2.0)

Our Waterloo location has re-opened!