High carb. or not?

A good diet filled with the right nutrients is an essential part of any exercise routine, but it’s especially important for endurance events like marathons or triathlons. Our ability to run, bicycle, swim and ski builds on the capacity of the body to extract energy from ingested food.

A nutrition plan better to start at least a few weeks before the event. Low GI carbohydrates such as wholegrain rice and pasta are good to introduce into a general diet at this stage, as they release energy slowly and will build up body’s carbohydrate resources. Carbohydrate is considered the body’s most efficient fuel source because it requires less oxygen to burn in comparison with protein or fat during high-intensity exercise, when the body cannot process enough oxygen to meet its needs.

However, recently some experts have suggested a low-carbohydrate diet is better than a high-carb, arguing when runners maintain a low-carb diet their muscles become better fat burners, an adaptation that spare muscle glycogen in marathons. Studies have shown that low-carb diets do indeed increase fat burning during running[1]. Yet, this effect has not been linked to improved endurance performance. Meanwhile, new research has reconfirmed that runners aren’t able to train as hard on a low-carb diet because it produces chronically low glycogen stores[2].

In addition to the diet, complicating matters for runners is something called the compensation effect. The more we train, the more our appetite increases and the more we eat. Simply ignoring the increased appetite is not a viable solution, but neither is an extra-large, double-cheese pizza. Instead, runners must increase the quality of their diets. High-quality foods such as vegetables are less calorically dense than low-quality foods, satisfying the appetite with fewer calories. The six high-quality food types are vegetables, fruits, nuts and seeds, whole grains, lean meats and fish, and dairy.

The final week before an event is the time for real carb-loading like pasta and porridge. A few hours before any long run, eat a meal high in low GI carbohydrates, moderate in protein and low in fat, to give a body all the nutrients it needs for the next few hours. Porridge with fruits, a chicken sandwich and fruit or a bagel and peanut butter are good options. Be wary of gas-inducing carbs, though, such as cabbage, broccoli, beans or too much fruit, or it could make for an uncomfortable run!

During long runs is important to refill body’s carbohydrate stores after 90 minutes or more. The body can only store around 2,000 kcals of glycogen and after a few hours of running, you can ‘hit the wall’ when the body’s carbohydrate reserve gets low and the brain and muscles show signs of fatigue. Take some high GI carbohydrate food every 45-60 minutes during a long run (around 30-60 grams of per hour). Choose specially designed sport gels and isotonic drinks, or try bananas, oranges, honey, dried fruit or gummy sweets such as jelly beans and don’t forget to stay hydrated with plenty of fluids and electrolytes.

The amount of carbohydrate a runner needs to handle his or her training is tied to the amount of training he or she does. Use this table to determine how much carbohydrate to include in your diet.

Average Daily Training Time (Running and Other Activities) Daily Carbohydrate Target
30-45 minutes 3-4 g/kg
46-60 minutes 4-5 g/kg
61-75 minutes 5-6 g/kg
76-90 minutes 6-7 g/kg
90 minutes 7-8 g/kg
>120 minutes 8-10 g/kg

Source: http://running.competitor.com/2013/

After long runs are two optimal windows of recovery following a hard workout that play crucial roles in helping your body recover as quickly as possible. The best nutrients to consume during the 30 minute window soon after prolonged exercise, is a mix of carbohydrates and protein. You should aim to consume 100-300 calories. The ratio of carbohydrates to protein should be 3:1 or 4:1 (carbohydrates: protein). This combination of carbohydrates to protein helps the body re-synthesis muscle glycogen more efficiently than carbohydrates alone[3].

The second window for optimal recovery is from one hour to three hours post workout. In this window of recovery, a meal or snack that is higher in protein, but also includes a healthy fat and carbohydrate is best. This can consist of 150 calories and up. The goal with eating in these two windows is not to consume more calories than you actually need; rather, the purpose is to give your body the right combination of nutrients at the right time, decrease inflammation, increase muscle glycogen stores, and rebuild damaged muscle tissue.


[1]     Jeukendrup A. The new carbohydrate intake recommendations. Nestle Nutr Inst Workshop Ser 2013;75:63 -71; Burke LM, Hawley JA, Wong SH, et al Carbohydrates for training and competition.J Sports Sci  2011;No29,17-27; Erlenbusch M, Haub M, Munoz K, et al. Effect of high-fat or high-carbohydrate diets on endurance exercise: a meta-analysis. Int J Sport Nutr ExercMetab 2005;15:1-14.

Brukner P. Challenging beliefs in sports nutrition: are two core principles’ proving to be myths ripe for busting? Br J Sports Med 2013;47: 663 –4.


[2] T. Noakes,  J. Volek, S. Phinney Low-carbohydrate diets for athletes: what evidence?: British Journal of Sports Medicine, 2014.


The Goals of Deep-Tissue and Sports Massage

Massage therapy is a treatment modality that involves the manual stimulation and manipulation of the soft tissues of the body.  However, there are several massage types available depending upon a person’s health and goals for massage.  Two common massage types that have some similarities are deep tissue and sports massage.  Knowing the difference between these two massage types can help to determine the best option for you.

Deep-Tissue massage and Sports massage are both highly effective in releasing muscular tension, breaking up fibrous tissue to reduce pain, and relaxing the body.  The muscular tension and imbalance can lead to further stresses on joints, ligaments and tendons in addition to the muscles themselves.  Muscle imbalance can develop over time, gradually building up, and finally start causing pain when yet another factor puts further demand on the body – be it sport, work or injury related.  A skilled massage therapist will be able to detect differences in the soft tissue and use a variety of appropriate techniques, such as active release, trigger point therapy and muscle energy techniques to help address the associated muscular pain and tension.

Sports Massage identifies and deals with problem areas before they develop into injuries, increases range of motion, boosts

image showing Elena Long massage a calf

Sports massage and massage can be of tremendous benefit.

and restores agility and elasticity, eliminates muscle adhesions.  The main purpose of sports massage therapy is to help alleviate the stress and tension which builds up in the body’s soft tissues during physical activity.  Where minor injuries and lesions occur, due to overexertion and/or overuse, massage can break them down quickly and effectively.

Deep tissue massage is a type of massage therapy that targets on realigning deep tissue structure of the fascia and muscles, focusing on the release of muscle tension and adhesions.   When there is chronic muscle tension or injury, there are usually adhesions (bands of painful, rigid tissue) in muscles, tendons, and ligaments.  Adhesions can block circulation and cause pain, limited movement, and inflammation.  The inflammation and toxins contribute to pain and stress.  Deep tissue massage works by physically breaking down these adhesions to relieve pain and restore normal movement.  To do this, the massage therapist often uses direct deep pressure or friction applied across the grain of the muscles.

The benefits of deep tissue massage are similar to those of sports massage.  In addition to make you feeling good, they reduce muscle tension, improve flexibility, lowers the heart rate and blood pressure, increase blood circulation and lymph flow, and relieves pain.  Sports Massage can also include maintenance techniques that promote greater athletic endurance and performance, minimize chances of injury and speed up recovery time.  A pure deep tissue treatment, however, is a slower and more relaxing experience than the more vigorous sports massage, and it’s great for those who want a relaxing massage but prefer firm pressure.

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What is Tabata?

Tabata training is a High Intensity Interval Training (HIIT) workout that lasts four minutes.  It is an improved form of interval training, an exercise approach alternating periods of short intense anaerobic exercise with less-intense recovery periods. HIIT is a form of cardiovascular exercise.

Tabata was discovered by Japanese scientist Dr. Izumi Tabata and a team of researchers from the National Institute of Fitness and Sports in Tokyo.  He conducted tests on two groups of athletes; comparing moderate high intensity training with high intensity interval training.  The results were that the athletes working out in high intensity interval training (four days a week for six weeks; each workout lasted 4 minutes and 20 seconds with 10 seconds of rest in between each set) improved their cardiovascular systems as well as their anaerobic system (muscles).  The athletes who did the moderate high intensity training (five days a week for a six weeks; one hour workouts) only improved their aerobic system and had little to no increase in their anaerobic system (cardiovascular).

The Tabata training lasts only four minutes, however the main objective is to push yourself as hard as you can for each of 20 seconds workouts, and rest for 10 seconds between them until you complete eight sets. You can do virtually any exercise you wish. You can do squats, pushups, rows, etc… Any exercise that works your large muscle groups is strongly recommended.  Tabata protocol burns an extra 150 calories in the 12 hours after exercise, even at rest, due to the effect of excess post-exercise oxygen consumption.  So while it is used by most people to get fit – or by fit people to get even fitter – it also burns fat.

Tabata is useful to get a quick workout in if you are short on time, wish to change your routine, or need to improve endurance speed. Incorporate this type of workout into your fitness routine and produce results.  However, the Tabata training could be a little bit risky for those other than experienced athletes, so beginners better to start at a low intensity, and stay within their comfort zone.  Once they feel they are getting stronger, they can then increase the intensity little by little.

Please view the Tabata video below:

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Iliotibial Band Syndrome (Runners Knee) Knee pain treatment at Plymouth Sports Injury Clinic

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I’m often asked what are the commonest Sports Injuries I treat.  Knee injuries are the most frequent injuries that pass through our clinic doors.  Medial collateral ligament injuries and Iliotibial Band syndrome.

What is Iliotibial Band Syndrome?

Iliotibial band syndrome causes lateral knee pain.  It is regarded as a friction syndrome where the ITBrubs against (and

img showing the anatomy of the iliotibial band

Iliotibial band Syndrome - one of the commonest running injuries

‘rolls over’) the lateral femoral epicondyle.  When the leg is in a straight (in the extended position) the band fibers are anterior to, or in front of, the condyle (a bony projection on the femur, or thigh bone). As the knee flexes, the fibers move across the condyle and are positioned behind or posterior to it.  A bursa or sac in this area allows the iliotibial band to glide over the end of the femur.

It is normally an overuse injury which results in damage to the insertion of the Iliotibial band, this is the long fibrous band that runs from the Gluteal muscles down the outside of the leg attaching to the area of the lateral knee.

There are other contributing factors which may help to cause this injury such as: mechanical issues with poor flexibility and decreased strength in the quadriceps muscles of the thigh lead to the inflammation.  Spasm of the Gluteal muscles causes tightness of the ITB , and factors such as leg length discrepancy, an abnormal pelvic tilt, and “bowlegs” (genu varum: genu=knee + varum=angles in) may cause iliotibial band syndrome because of excess stretching of the IT band across the femoral condyle. High or  low arches of the feet may also be a contributing factor.  As with most Sports Injuries their will be some of these predisposing factors involved.

Here is a link to a short video explaining a little about  the causes and the anatomy of Iliotibial band syndrome,  Exercises to stretch the Iliotibial band are generally pretty useless however the best two that I have found  are both shown on this video.

 Treatment for Iliotibial band syndrome

We use a multi-factorial approach to treatment of Sports injuries.  We believe that the specific primary treatment should be soft tissue therapy, this is used in conjunction with exercises/stretching and support/kinesio taping.  Quite often practitioners just give exercises and or taping, this helps but is only half the answer, the soft tissue methods we use are listed below.  We also give advice on using medication, ice and heat treatment.

Our particular soft tissue techniques involve:

General Soft Tissue Therapy

Myofascial Release

Sports Massage

Therapeutic Massage Therapy

Instrument Assisted Soft Tissue Therapy


Trigger point therapy

Kinesio-taping (This is a therapeutic treatment for soft tissues, in particular the Myofascia)



Eating before exercise

Carbohydrates are essential for peak athletic performance, as the body uses this nutrient more efficiently than fat or protein. When exercising the timing of carbohydrate intake is very important. Athletes should consume 1.0 to 4.0 g/kg of body weight one to four hours prior to exercise, focusing on longer-lasting sources of carbohydrate combined with a source of protein (e.g., peanut butter on whole grain bread).

Recommendations for carbohydrate intake are higher for endurance training and competition (7.0 to 10.0 g/kg/day) and high-intensity athletics (5.0 to 8.0 g/kg/day).

Sportsmen and women and anyone participating in exercise should ensure that they don’t exercise on an empty stomach, ie. going to the gym straight after work without a snack mid-afternoon.

Remember if you train correctly and don’t over exert yourself you are less likely to get injured.  If you are running low on fuel when playing sport you are more likely to make errors that could result in injury.


Plantar Fascitis

Plantar fascitis is a painful inflammatory process of the plantar fascia, the connective tissue on the sole (bottom surface) of the foot. It is often caused by overuse of the plantar fascia or arch tendon of the foot. It is a very common condition and can be difficult to treat if not looked after properly.

plantar fasciitis

plantar fasciitis

The plantar fascia is a broad, firm, band of ligament-type tissue that is attached to the heel bone and stretches along the bottom of your foot to the base of your toes. You can feel it if you flex your foot and press along the inside of the arch. In fact, the plantar fascia is a large part of the assembly that makes up the arch of the foot.

Longstanding cases of plantar fasciitis often demonstrate more degenerative changes than inflammatory changes, in which case they are termed plantar fasciosis. The suffix “osis” implies a pathology of chronic degeneration without inflammation. Since tendons and ligaments do not contain blood vessels, they do not actually become inflamed. Instead, injury to the tendon is usually the result of an accumulation over time of microscopic tears at the cellular level.

The plantar fascia is a thick fibrous band of connective tissue originating on the bottom surface of the calcaneus (heel bone) and extending along the sole of the foot towards the toes. It has been reported that plantar fasciitis occurs in two

English: X-ray of the heelbone with plantar fa...

Heel Spurs maybe associated with Plantar Fascitis

million Americans a year and in 10% of the U.S. population over a lifetime. It is commonly associated with long periods of weight bearing. Among non-athletic populations, it is associated with a high body mass index. The pain is usually felt on the underside of the heel and is often most intense with the first steps of the day. Another symptom is that the sufferer has difficulty bending the foot so that the toes are brought toward the shin (decreased dorsiflexion of the ankle). A symptom commonly recognized among sufferers of plantar fasciitis is an increased probability of knee pains, especially among runners.



Some of the Sports Injuries treated at Plymouth Sports Injury Clinic

Compartment Syndrome

Ow :*(

Sprained Ankles

Golfers Elbow

Achilles Tendinitis

Ankle Sprain

Back Pain

Knee Sprains

News & Articles


Patella Tendinitis


Knee injuries

Plantar Fascitis

Runners Knee


Shin Splints

Shoulder pain

Slipped Disc

Tennis Elbow

Elbow - coude

Tennis Elbow


Always warm up

Warming up

Soccer players warming up.


Warming up with a partner.

Do sports men/women warm up more when they are older because they are older or wiser? …. probably a combination of both, however warming up is paramount for optimum performance and minimizing injuries.

Never Start Exercise Without a Proper Warm Up – Warming up raises the temperature of your muscles. This makes them tender and flexible. Now they are ready to for exercise and optimum performance.

Conversely if you start exercise without warm up, your muscles are still cold and thus not ready for stress. Sudden stress may strain them leading to back pain.