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Interview with Chris Watts, Founder of Back2Front Physiotherapy
The untold story of the prevention and recovery from an injury
Tell me a bit about yourself
My name is Chris Watts, owner of Back2front Physiotherapy Ltd, and a Physiotherapist with 12 years experience in treating sporting injuries. My specialist interest is all things running-related, spanning from both the physical and mental side of the treatment and rehabilitation of a running injury, right the way through to preventing an injury occurring in the first place.
Having completed a number of half marathons, and getting injured in the process, (yes physios get injured too) I had made the conscious decision that marathon distance was beyond my reach. That was until I signed up and completed Ironman Wales in 2019 (and may I just say wow what an experience), so I understand first hand the rigorous training of an endurance athlete.
That was quite a turnaround from not wanting to complete a marathon. I suppose you needed mental strength to complete the Ironman and you mention the mental side of a running injury, do you care to explain more?
Certainly. We are all aware of the physical effects of an injury such as swelling, bruising, limping or even being on crutches, but what we don’t see is the subconscious impact of an injury. This is the way in which we move without having to think about how we are moving. An injury causes us to consciously change the way in which we move due to pain. Long term this could manifest itself in a change in your running technique, a subconscious guarding of your injured joint, a loss of joint awareness, and all of these can all lead to you not achieving your pre-injury performance.
That’s interesting. Could you give us an example?
Let’s take an ankle sprain, a very common issue for trail runners. When you twist your ankle, generally an hour later you develop the classic physical sign of the golf ball on the side of your ankle, likely due to a ligament tear.
One of the roles of a ligament is to provide subconscious feedback to the brain, to let your brain know where your ankle is in space, known as Proprioception. Now that you’ve torn the ligament, the feedback mechanism becomes distorted and disconnected, and will only be reconnected through the process of conscious relearning. It’s like learning to drive a car. When you first step into a car you wonder how you are going to be able to cope with 3 pedals when you only have 2 feet. I’m guessing you don’t have to think about this now though as it’s become subconscious thinking.
The question for you is, after your injury have you consciously taught your foot and ankle how to move again and relearnt the subconscious feedback mechanism? If not, don’t worry, your ankle won’t fall off, and you’ll get back to running, but you may have learnt a suboptimal way of recreating the feedback, likely through a stiffening of your foot and ankle. Now for trail running, your ankle needs to be reactive so the last thing you’d want is a stiff ankle when attempting to react to uneven terrain.
Obviously trail running is different to road running so does your planning change with getting someone back to trail running compared to road running?
There’ll certainly be similarities in my overall planning, but trail running requires so much more awareness of your surroundings. The terrain, elevation, obstacles etc are all continually changing, so as a physio I put myself in your shoes to understand what we need from the rehabilitation. More balance exercises, throwing items at you to mimic obstacles etc. Once you’re on the road to recovery, we complete a video analysis of your running technique in order to recorrect any issues that lead to increased potential for injury. We also provide this for the non-injured runner, as many runners create inefficiencies within their stride pattern due to laziness, or not even knowing how to run. I suppose the question is, have you been taught how to run?
So you say we don’t want a stiff ankle? Isn’t this how taping your ankle works?
Yes, we want a reactive ankle to cope with the terrain, and the only way we can do that is by relearning. The research is pretty inconclusive regarding the physical effects of taping, but in my personal opinion, taping helps with the psychological impact of a running injury. It provides a feeling of support, a feeling of confidence, and if this helps you to get back running, then tape can be a useful adjunct to support you mentally, if not physically, as the research suggests. But this is not to supersede a well-structured progressive rehabilitation programme. Only once this has been completed would I suggest the use of taping in a return-to-running plan.
If taping doesn’t help prevent an injury, is there anything you can do to prevent an injury?
Having a previous injury is the biggest risk factor to suffering another injury, so seeing a good sports physiotherapist to work on your balance and strength will certainly reduce the risk of further injury. With regards to other ways of preventing injury, not all injuries can be prevented as some are just rotten luck i.e. falling down a pothole, but there is certainly a case for preventing/reducing over-use injuries. The majority of running injuries are associated with training error and not trainer error! Your footwear are mere spectators of your error rather than causing the error (in the majority of cases).
The 3 key elements you need to manage in your training are:
1. Frequency – How often you train?
2. Duration – For how long?
3. Intensity – How hard?
If you are able to manage all 3 components, then you can dramatically reduce your risk of injury.
So how much training is too much training?
Good question. This all depends upon where you currently are with your fitness level. Everyone has to start somewhere, it’s just managing how quickly you get to where you want to be. Olympic athletes complete a high frequency and duration of training, but they all had to start somewhere and build up to where they are now. What Olympic long distance athletes manage very well is intensity! It’s called the 80/20 principle. 80% of their runs are easy runs and 20% are hard runs. That’s how they manage their intensity, but this is where the novice/recreational runner falls down, sometimes literally. Running too quickly is the main reason a novice/recreational runner gets injured.
Do you have a particular method you utilise when rehabilitating athletes?
Our method at the clinic is to look at an injury in 3 phases. The Prevention, The Recovery and The Strengthening. Generally an athlete will only seek a physio in the Recovery stage. Within this stage we are looking to help our patients get back up on their feet, regain range of motion, become pain free. Generally this is where the NHS tend to stop, but we also like to look at whether there are ways to prevent further injuries. That’s where we use our gait analysis service. We slow down your running technique, using 3D video analysis software, to assess inefficiencies within your stride which could be a precursor to injury. It provides a huge amount of valuable information for us to make a change in your running technique, to firstly reduce injury risk, but secondly to improve your running efficiency. The other pillar is strengthening. The evidence suggests the stronger you are, the less injuries occur. So this is what we do. We make you a better, stronger athlete.
You seem to be building quite a service there. Is this the end goal or is there more to come?
We want to build upon our 3 stage method and look at further services that we can provide, to firstly prevent injury occurrences and secondly to further strengthen athletes. I have huge ambitions for Back2front and we want to be the most recognised place for improving health, fitness and performance in South Wales. We are in a much stronger position than we were pre-Covid, and we see that the only way is up. So I suppose it’s watch this space as there are big things to come.
Do you have any tips for the people reading this?
My 5 top tips to reduce your chances of injury:
1. The 80/20 principle. Run slow for 80% of your runs and hard for 20% – Most people run too fast on their slow runs and too slow on their fast runs
2. Go slow for the first 3-5 minutes of a race to allow your body to acclimatise to an increase in intensity
3. Incorporate 10-30 minutes of strength and balance exercises 2-3 days a week into your weekly schedule
4. You don’t have to aim for a Personal Best on every run – manage your intensity
5. Take a rest day – You deserve it.
Many thanks Chris, you’ve given us some valuable advice here, and we hope our runners find it as useful as we have.
For anyone looking for further information from Chris or his team, you can contact them at: https://www.back2frontphysio.com/ .
