Preparing for an ultra requires planning. It is also a time to take it easy and eat.
Update on the route
I am now planning to start at the Menai Bridge.
Having looked at the path along the North Wales Coast, it became apparent that an acknowledged leg runs from the Bridge to Chester. Or vice versa, which is the way that I am travelling — East to West.
This extends the route a little to 131k.
In the meantime…
I am looking at the maps to build in my sense of the journey and to arrange the rest stops. Here I will meet Jo and Chico for fuel, fluids and any other bits and bobs that help me to keep going. Perhaps a change of socks.
Jeff is joining me for the last 30-40k.
Ffynnongroyw or Mostyn.
This week is an easy week: a few relaxed runs help to keep moving, plenty of sleep and nourishing food.
I’ll gradually be pulling my kit together. It maybe chilly running through the night. Perhaps it will rain. Must be prepared.
This month sees the return of the 100k + distance as I trot along from Bangor to Chester.
For some time I have been chatting with Jeff, an UP ambassador, about running together. So, I am delighted and excited to say that Jeff is joining me for the last leg — I will be on my last legs, that’s for sure!
Jeff is a great encourager. He is a coach, a facilitator, a writer and much more. Jeff has a book coming out soon, which I know will be superb. I am going to ask him to write a blog about it.
I also have crew for this one. Jo, my wife, has agreed to drive along the route and keep me supplied. She will be ably assisted by Chico.
Here’s the plan:
Drive up to Anglesey on Sunday. Set off around midnight, wrapped up and be-torched.
Make my way along the coast line through the night. Meet Jo and Chico at dawn with fresh supplies.
Have a beer and a pizza.
Lie on the back seat and be driven home.
To raise awareness: pain is one of the largest global health burdens affecting millions and costing billions.
There is much we can do as a society.
It starts with understanding pain. From there, people can feel educated, empowered and enabled to move on and shape a positive future.
This is the purpose of Pain Coaching, an approach I began pioneering around 10 years ago.
Recently I started using Wholy Me organic products: the drops and the balm.
The drops I use each day, morning and evening. The balm I apply, using self-massage, as needed. This is quite often as I usually have some aches and pains from training and running.
I have no other me to compare, however, my own experience is certainly one of overall calming and soothing on a day to day basis. The balm relieves my local soreness. It is a great combo.
Recently, I had a chat with Celine from Wholy Me on Instagram Live. I shared my thoughts and experiences. The Wholy Me Instagram page is here.
Here’s the blog that Wholy Me wrote about our conversation.
I will certainly be taking my drops and balm with me!
Please share so that we can give hope!
Over the past 5 years there has been a significant increase in the understanding of pain as a perception. This enables us to offer a wide range of practices, exercises and ways to help, guide and support people along their journey to improve their lives.
See the Resources tab on the site for articles and talks, and more on the Specialist Pain Physio site; podcasts and blog (Richmond’s clinic site)
My first year, what have I learned from ultra running?
I started ultrarunning at the start of 2019 as I prepared for a run around the Isle of Wight in May. My decision to take up ultra-distance came before.
In July 2018 whilst waiting for a mate, Chris, to finish Race to the Stones, I had a strong urge to give it a go. The vibe at the finish line was exciting and infectious. I loved the unconditional support for each runner as he or she finished. At the same time, I was wondering how it would be possible to run all day over that distance; 100k.
Soon enough, Race to the Stones was in my diary for 2019. How do I prepare, I wondered? That was when I came up with the idea of the Isle of Wight 106km challenge in two halves. This was to be my first experience of running an ultramarathon, trotting round the island. It was awesome and I was hooked.
In fact, I was so hooked that I quickly booked another race. This time it was a full-on 100k in one day from London to Brighton. And on it went.
At some point I decided that it should be monthly. Partly because I had a cause, #upandrun, and partly because the way to get over the last run is to organise another.
For some time I resisted calling myself a runner. I think that I now qualify. Plus Adharanand Finn told me so.
This is on the basis that I am out at least 5 days a week, covering 70-100k, and our habits form our self-identity. I also have a good collection of running books, often watch running films on YouTube, have a box of running shoes, a selection of hydration vests and running belts, headphones, and a pile of running clothes.
Also, I often find myself talking about running. Typically to myself or on #ukrunchat.
First up, a sense that I can and will complete the task at hand. I start here and end there. By whatever human means, I will make it to the other side. That is not to say that a DNF (did not finish) is not possible, as part of the adventure is the stretch, the push and the risk. Anything is possible en route.
The unknown beckons. Uncertainty is fuel as each moment unfolds, step by step along the changing terrain: trails, roads, fields and more. Each footfall is new and feels different.
Ending up somewhere that started as a mere pin drop on a map beholds a deep sense of connection with one’s own resources. These are available to us each day of course, no matter what we are doing.
Running an ultra is decidedly uncomfortable, which is putting it mildly.
The perceived bodily pain in the form of muscle and joint noise, stomach pains, the blisters, the chaffing, the rubbing from the straps and more.
You plan what you will do in the tough moments. Visualisations, mantras, music and plain old ignoring, all have their time. What can I focus upon? Some prefer a more mindful approach.
To be mindful is to be completely aware and present. There is no judgement: good or bad? Who knows? This is the practice. Noticing all sensations, thoughts and feelings as they arise and pass on. Nothing is permanent.
What do I learn from this deep discomfort? I understand my mind under pressure: what do I think? What are my leanings? How much am I prepared to endure to reach the other end? In essence, I learn what is under the hood. We all have much more than we might think.
Day to day, it means we can deal with the inevitable ups and downs of life with a clearer perspective. This allows us to make better choices.
Out in nature for hour upon hour, you cannot help but connect. Or reconnect. You see the planet as you pass through: the changing shades, shapes, sounds and smells.
Nature bathing or forest bathing enriches our wellness. At least two hours a week is beneficial. As a trail runner, you may be out for five to ten hours or more a week, sucking it all in.
Touching nature lets you into its secret world. Paradoxically, it is protective and nourishing, yet also a source of extreme danger if you stop paying attention. Rocks, cliffs, rivers, tree roots all create a wonderful landscape. But, lose touch with your body for too long and you may come a cropper.
Wrapped up with the immersion in nature, you realise the interconnectedness of things. As well as creating the perception of nature, ‘I’ am also within and part of that very nature.
During a race I am interconnected with other runners. It is a wonderful state of interbeing. We are all in this together, sharing the experience through our own unique lenses.
Both this and a sense of loyalty towards nature means that the world takes on a new importance as our collective home. Artificial boundaries dissolve.
One of the experiences I love most is reaching the top of a hill or mountain and absorbing the view. The feeling of awe is potent.
Our significance pales. Self-importance fades if it was there in the first place. How small I really am in this world.
It would not be a blog from me without mentioning the P word. This is not the same as discomfort. I somewhat blended these above.
Western culture promotes the idea that we should be comfortable; perhaps even deserving it because …… . This is on the basis that more comfort results in more happiness. It’s an idea. It’s wrong. There has not been an increase in happiness (a fleeting emotion like all the rest) by having more comfort.
It is through discomfort and challenge that we have the opportunity to grow and learn.
Pain is different. Pain is complex. Pain is human. And, pain is far too fascinating to nail in a few words here. That is for another time.
On perceiving pain, we try to elucidate the meaning. What is my need? It can often run deep. Pain is poorly related to tissue state or injury; although slightly better perhaps in an acute scenario. Pain is about the person, their life, the context, their past experiences, their expectations, their outlook and more.
Pain is poorly understood. This is the reason why persistent pain continues to be one of the largest global health burdens.
And what of ultrarunning and pain? Yes, they come together. We have to expect it, and welcome it rather than resist. The latter only causes more suffering.
On the run, there are a number of ways to deal with pain. Again a big topic. Suffice for now and this blog to acknowledge the normalcy of pain, an experience that many of the well-known runners describe.
I have been making study of pain for some years now, both the science and the experience. Ultrarunning gives me insights that I did not have before. All of this will be explored at a later date.
There are of course plenty of other lessons learned. You will have your own to ponder upon and share.
On we go. Step by step: the run I am on, and in life.
Since becoming a physiotherapist, I knew I wanted to work in oncology. This decision was shaped by various experiences in my teenage years, including watching my Granny go through ten years of cancer treatment before she died when I was 16. I sometimes think about the sliding doors that led me to the job I’m in now – and how close I was to choosing an entirely different career path. I know somehow my Granny led me into my dream job and I’m grateful every day for it.
Working in oncology is different every day; cancer can affect any part of the body, so for every patient I work with, I may see any combination of cardiovascular, orthopaedic, respiratory, neurological, musculoskeletal and holistic problems. For this reason, I must be flexible, creative and patient-centred, in order to provide my patients with the best possible care.
I am a huge advocate for the NHS, and extremely proud of the work I have done and continue to do within our incredible national treasure. I am currently working full-time in a hospice, while also doing bank shifts in an oncology intensive care unit. It is such rewarding work but, as someone who is made up of both a scientific and creative mind, I found the strict structure of the NHS curbed my visions for better ways of providing care.
The current situation in oncology rehabilitation
Currently, physiotherapy and other allied health professions are hugely under-utilised in oncology. With only 30% of the people needing cancer rehabilitation receiving it, it’s clear we have a long way to go.
Thanks to incredible research and trials, we are seeing better outcomes in cancer; there is now an average ten-year survival rate of around 50 % across all cancer types. The flip side of the coin is that we are seeing more long term side-effects resulting from more advanced cancer treatments. I have met people who are in remission, but have
accepted living with a compromised quality of life because they believed this was the cost of being cancer-free. This is not true!
Physiotherapists and allied health professionals can work with people to manage the side effects of cancer and treatment, allowing them to live fulfilling, active lives. My vision is to use physiotherapy to help as many people as possible to enjoy a meaningful life after cancer. Is this not why we go through the treatment in the first place? We must get more people talking about cancer and rehabilitation.
In the face of our uncertain future in healthcare, I feel passionate about providing those going through cancer with the highest quality support. When seeing outpatients in the hospital, I found there were patients travelling from outside of London to see a specialised oncology physiotherapist. Since a majority of these people were experiencing fatigue and pain, this felt so backwards to me and I knew there must be a better way to deliver high-quality advice – without the financial, time and physical implications of a hospital round-trip!
I knew the solution was to take my expertise online, to reach as many people as possible, regardless of geographical location and local services. I spent most of 2019 thinking about my idea, unsure of where to begin. Then, on New Year’s Day, while on a flight home from New York, I decided I had to just go for it (I always do my best thinking on planes and trains – anyone else?).
The very next morning, I set up my website and STRONGERTHAN was founded!
What do I offer?
I offer 1:1 online physiotherapy appointments to those living with and beyond cancer., to help them stay strong in body and in mind. I love to work with a diverse range of people of all ages, backgrounds, cultures and abilities. There are countless reasons that someone may seek physiotherapy; from exercise and lifestyle advice, to managing peripheral neuropathy or breathlessness. My role is extremely versatile and I am constantly learning from my patients, about the realities of life with cancer.
Some examples of the people I may meet and work with are:
● A young athlete, recently diagnosed with cancer, who is aiming to complete treatment and return to competing as soon and as safely as possible.
● A busy mother, who wants to improve her shoulder function following a mastectomy, so she can play with her children comfortably again.
● An older person having chemotherapy, who wishes to maintain their strength and manage their fatigue, to continue living independently at home.
● A business-professional, who would like to be able to return to their cycling commute to work, following abdominal surgery and radiotherapy.
● A person receiving palliative care, who wishes to improve their exercise tolerance in order to comfortably attend an important wedding.
● A young person in their 20s, who has poor body image following extensive treatment and wishes to maintain their weight and muscle mass.
The patient is the centre of my work – I wouldn’t have a job without them! I listen very closely to what they have to say and I want to know their story. This is something that can be done very easily by video consultation. Research has found that more people feel comfortable opening up to health-care professionals during video appointments, compared with face-to-face. This is likely due to the security that being in the comfort and privacy of their own homes brings.
I always ask myself: if it were me, ‘would I follow that advice?’. If I felt my health-care professional heard and understood what I had told them and felt excited about my goals with me – I would feel more confident to make adjustments to my lifestyle and change my habits, to better my quality of life.
Investing in physiotherapy, your health and your future is an important decision for anybody. Working with a health-care professional will provide someone with support, encouragement and accountability to ensure they are able to make the changes they need, to live their life the way they want to.
With cancer treatments advancing, it is essential that we provide innovative after-care to match. To reach as many people as possible living with and beyond cancer, we must continue to re-think how we provide specialist physiotherapy advice.
I will continue to shout about online physiotherapy, because I strongly believe that having expert rehabilitation a few clicks away, is the path to a brighter future for those
living with and beyond cancer. So, to anyone reading this post now, who thinks you or a loved one might benefit from this support – book your appointment now and thank yourself later!
We started the tour in Johannesburg, then on to Durban and finally to Cape Town. It was a whirlwind. Each event drew local physiotherapists, kinesiologists and other healthcare professionals together for a burst of education, socialising and presentation of the product range.
The organisers and sales teams created a positive vibe, which made the delivery of the pain talks a pleasure. I also had the opportunity to gain an insight into the pain problems that exist in South Africa by talking to the therapists.
We can be optimistic. Our knowledge of pain is expanding at a fast rate directly via pain science but largely from related fields. This was a message I tried to get across.
Therapists can choose to see people’s potential and strengths. Through this lens, the possibilities open up and we can help and encourage patients to shape their own positive futures.
The three days of talks in three cities was energising. It did not prepare me for a mountain though. Or the heat.
For the first 10k I was guided up to Lion’s Head by Nicola from Energy in Abundance. We set off on the trail chatting about life, running and philosophy. The photos tell the story.
Nicola hooked me up with South African ultrarunner Linda Doke for the Table Mountain part of the adventure. Incidentally, Nicola made all the arrangements by email beforehand so I just had to turn up. I would recommend this if you are a runner wanting to explore the area. You’ll be taken safely on the best routes and experience the awesome views.
We set off along the bottom of the mountain to reach the point of ascent. Apparently the weather was to be the best of the season today. It was. The flip side was the heat, which I was not prepared for having come from the English winter. This together with the steep climb took some effort. The reward was the magnificent view and a tin of coke. I love coke on long hot runs. And coffee.
Leaving the cable station and heading off along the stony trail, we also left contact with humanity except for a few lone souls we met. Three in total over the coming hours. It was a rugged and jagged terrain, yet covered with green resilient flora. We stopped to look at some of the plants that thrive on the mountain top.
There was little shelter from the sun. We knew the temperature would be rising so I had plenty of water on board. Of course this warmed up against my body.
When Linda mentioned stopping at the dam for a dip, I couldn’t wait to get my feet in and refresh. What a moment it was, to step into the reddish water, tanned by the fynbos plants beneath the surface.
The five dams are entwined in the history of Cape Town. They feel remote, sitting above in stillness like a meditating hermit. Some say that they have been forgotten (read here). A small dedicated museum at northern end of the Hely-Hutchinson Reservoir houses the original steam train. It was closed and did not look like it would open any time soon.
Recharged, dripping and grateful for the simplicity of fresh, cold water, on we went. To the right appeared the sea. As the reservoir had, it looked so tempting. There was the feeling that I could dive off the mountain into the blue. Later and warming up, I thought of icy drinks on the beach that I could see. The sounds from the people on the sand wafted up on the wind, yet we were a long way from any form of significant rest. Linda kept me going. Plodding along. The initial climb had taken a lot out of me.
We made a descent down a gorge towards Hout Bay and Llandudno. We chatted about the latter and how it bears no resemblance to the North Wales version. Both have their charms.
This was a bit of a scramble over loose scree before reaching a more defined path around the peak we were navigating. I had to navigate a few tricky points, expertly advised and encouraged by Linda. To many they would be easily traversed, but with a fear of heights I had some extra sweat to manage.
I realised that I had taken something from the Snowden experience in September. Looking back now, I know that these experiences have pushed the balance towards a greater confidence.
There is much to love about mountains: their strength, enormity, resilience, their danger and unpredictable bedfellow in the weather to name a few. I continue to be attracted to the challenge of ultra trails in mountainous regions. The mystery they offer and the contrast to my local running spots draw me in.
The final push up a long jeep track to us to the edge of the park. Across from the parking lot was a smart looking restaurant and bar. Linda assured me they would serve a smelly, dusty runner, and they did. I sat outside amongst the casually dressed Cape Town diners, mostly families, and enjoyed a pint of icy coca-cola reflecting on a tremendous day of trails.
Big thanks to Nicola for organising the tour and to Linda for guiding me and running at the slowest pace that she has had to endure for a long time!
Contact Nicola here for information about guided runs around Cape Town
Read about Linda’s running here. She also coaches runners.
Considering the need for social distancing, I chose a 5k circuit that I could run twenty times. For variety, I changed direction with each lap.
It was still dark when I set off at 5:08am. I love this time of day. It was so quiet, the sky is just starting to lighten and there were just a few people on their way to work or out walking their dogs. Soon enough the first kilometre was indicated by the familiar sound from my watch. 99 to go. I set my mind to the task, resigned to the fact that there were twelve or thirteen hours to go. There is always some comfort in that.
The day was perfect: a warm sun and a cool breeze. There was no need to carry anything as I could simply grab fuel and drinks on each lap, and even stop for lunch at home. My wife prepared a delicious bowl of plain pasta.
Each time I ran down my street, someone would cheer and clap, shouting out words of encouragement. This gave me energy. There was a purpose behind this run, as there is with each upandrun. Usually I am running to raise awareness of the problem of pain, but this time I was using my legs to show support for the NHS heroes.
No matter what discomfort I was experiencing, I knew that it would ease and that I would be in the bath at the end of the day. However, for our NHS and other essential workers (carers, teachers, delivery people, personnel running the public transport, supermarket staff and more), this goes on for now. The run was about them and showing appreciation for what they are doing to positively contribute to our society.
And so the day proceeded: round and round, legs heavier, strides shorter, but onwards I went. The toughest period was 60 to 80k. I had covered a good distance, but there was still a long way to go.
At 1245 I was interviewed on BBC Radio Surrey by Sarah Gorrell. This was a chance to tell listeners about the run and the cause. It was also a break in the monotony.
A friend who runs jokingly called this the Kingston Hospital Self-Transcendence race after the Sri Chinmoy 3100 that takes place in New York. Runners complete a 3100 mile course around a single block in New York. There is a film about it now: Run and Become. This was my version. A much shorter version.
My sense of time was distorted. I find that this always happens on an ultramarathon. I lose track of time, which is wonderful. I simply focus on the next step. The day begins to blur and soon enough, the end is near.
The final lap approached. For some reason, I was a few hundred metres short and had to take the lower road to loop round and make the 100k total. The neighbours were waiting, and as soon as they saw me coming the cheering and clapping began. It was a super way to end the day.
upandrun 14 is a special one. 100k round the block to raise money for the #NHSHeroes at Kingston Hospital. This shall be the Kingston Hospital Self-Transcendence Race*, my much shorter version of the 3100!
Each month I run an ultramarathon. That is a distance beyond a marathon, typically 45 kilometers plus. This will be the 14th since I started ultras last May.
There are several purposes of upandrun. One is to raise the awareness of the problem of pain that affects millions and costs billions. Another is to help people understand how they can improve their lives. But, upandrun 14 (April) is different.
This month upandrun will be dedicated to raising money for NHS staff at Kingston Hospital, my local one. I am pleased to link up with the Kingston Hospital Charity to steer donations to the people who are caring for the sick and vulnerable. It is vital that the NHS Heroes remain well, and our support will help them and their families.
upandrun 14 for the NHS ~ Kingston Hospital: donate here
With upandrun 14 due, it made me wonder how I could use my legs to make a contribution to the NHS. I thought, why not run around the block?. I stay local, the streets are quiet (easy to keep distance from others) and I could clock up a decent mileage. Initially I decided on 50k but then it seemed like a better idea to round it up to 100. A 5k route times 20. Round and round I will go, grabbing refreshments from my crew (mainly my wife, but she does not know yet).
The Kingston Hospital Self-Transcendence Race is a tongue in cheek version of the Sri Chinmoy self-trancendence race. This is a 3100 race around one block in New York totalling, yep, you’ve got it, thirty one hundred miles. If you fancy that, read here. I’ll be doing a mere 60 odd miles.
The course set, the day chosen (Monday 20th April) and the charity on board, it’s all go. I have a JustGiving page set up and on the first afternoon had donations over over £1000 — great start! To get to £3000 would be fantastic, and maybe more…..
Now to take it easy for a few days.
You will be able to follow progress on Instagram (@paincoach) and Twitter (@painphysio) where I will post pics and vids. Please take part, send messages, share and donate what you can!
* The idea for the name of the run came from my old mate Chris, who actually got me into ultrarunning. Ta!
I was very pleased to be asked to speak at the Adcock Ingram Sports Science & Rehabilitation division launch roadshow — a whistle-stop tour of South Africa.
Innovative TensCare CEO Neil Wright asked me whether I would give a series of talks in South Africa (Johannesburg, Durban and Cape Town). He had heard that I bring an ‘edge’ to the topic of pain. I like to think so, but only in terms of challenging out-dated thinking that holds us back. What a great opportunity, I thought. A chance to spread important messages via Understand Pain (UP) and to learn about how chronic and complex pain is addressed in South Africa.
The new Adcock Ingram division was being launched to local physiotherapists, chiropractors and biokineticists, and the theme of the events was pain. How could I resist? Adcock Ingram are engaging with therapists and clinicians in a new way that is generating a great deal of excitement. This is based on creating great relationships and distributing high quality products that compliment rehabilitation, including the range of devices from TensCare.
Both the team putting on the roadshow and the attendees were buzzing! The feedback from the people in the audience was very positive. There was a thirst for quality pain education, and it would be great to follow up with full Pain Coach workshops.
In my experience, TENS is under-used for chronic pain. Whilst TENS will not solve the problem, it can offer relief that helps the journey forwards. As an inexpensive and simple form of self-treatment, it is a good option. The key is that the user understands how it works and how to best use the unit. This can take some time and practice, but with instruction, discovering the right parameters can be found more swiftly.
I shared the stage with Nick Martichenko from Canada. Nick spoke about the use of tape and the understood mechanisms, whilst I focused on pain and pain coaching. I entitled the session ‘The Challenge of Pain’ as a doff of the hat to Pat Wall, the founder of modern pain biology, who wrote a book of that name. It was Wall’s work that resulted in the development of the TENS machine.
Three days, three events
On the road…
The roadshow put on by Adcock Ingram was very high quality from start to finish. They really wanted to make sure that every detail was covered. This was appreciated by the attendees who were most enthusiastic about the event. There was a new precedent being set, and the beginning of a new engagement between Adcock Ingram and therapists/clinicians.
I was particularly impressed by the way that the sales team approached their work. Selected and led by Juan Schaerer and Sheila Keshav, this group has come together in a short period of time. There was a great deal of positivity within the team, supporting each other, and getting jobs done from start to finish. I was privileged to be able to hear some the individual stories about how they came to join the team.
From a pain education perspective the roadshow was a great opportunity to talk about ways in which we can help people understand their pain and move on to improve their lives. That’s the purpose of UP. I hope that everyone else enjoyed their time as much I did. This was a super start and I will be very interested to learn how this story unfolds.
The Programme is now open to anyone suffering persistent or complex pain.
Face to face or Skype ~ reaching across the globe with Pain Coaching to improve lives
As the project has proceeded, I have been making changes to better suit the needs of the participants. Now I am delighted to be able to offer the programme to a wider audience — chronic pain is one of the biggest global health burdens.
Participants will receive 6 free Pain Coaching sessions: an initial conversation to understand the person’s narrative, clarify what is important to them, what they want to achieve and outline the steps forward. The next four sessions focus on practical tools: e.g./ practices, exercises, strategies, habits of peak performance. The final session is a summary and an opportunity to look at ways to keep momentum.