My Saturday night at a ‘Psoas Release Party’

There have been many firsts since I got injured, but spending over 4 hours on a late Saturday afternoon and early evening at a ‘Psoas Release Party’ is one that I thought you would all like to hear about!

The workshop was led by Jonathan FitzGordon, who started out as a yoga teacher in the USA but now works on rehabbing people in terrible pain. He freely admits that most people come across him at 3 in the morning, when they are at the end of their rope and don’t know what to do to get out of pain. This is exactly how I came across him.

What is the psoas?

Jonathan’s theory is that the illiopsoas is the most important muscle in the body. The ‘psoas is a really interesting compound muscle, as it is very difficult to reach and touch, as it starts deep in the back (up near the ribs) and loops around the inside of the hip before attaching at the front top of each of the legs in the groin area. For all its inaccessibility, it is a large muscle and is one of only 3 linking the front and back of the body, and attaches in 6 places – so pretty complex. It is often simply called a hip flexor, but it has a role in much more than this. Jonathan attributes the majority of long-term pain in the hips and back, plus the knees and feet, and even the shoulders to how the psoas is behaving.

I read Jonathan’s book ‘The Psoas Release Party’ and was struck with some of the concepts and case studies. I tried some of his stretches and releases and felt that I had started the journey. Then I saw that he was coming to the UK and was doing a workshop…

The description of the workshop said: “The psoas is the most important muscle in the body acting as the main hip flexor and the engine of walking. A free and happy psoas allows the body to move with peak efficiency and little strain. Issues with the psoas can lead to any number of problems throughout your body—both physical and emotional. Lower back pain and other joint discomfort as well as disturbances to the nervous system can be linked to the psoas. This is not a yoga class. You will spend the afternoon awakening, learning about and releasing the Iliopsoas muscle group and understanding its core function within the body.”

So that is how I ended up being one of 16 people crammed into quite a small yoga studio just near to Wimbledon studio on a late Saturday afternoon. It was mainly women, with a few men and the ages spread from early 40’s into 70’s – and every single person in the room was in pain, and wanted to do something about it.

How did the party get going?

Jonathan did an amazing job of making the anatomy really interesting and memorable, and before long we were all evaluating our dominant muscle patterns when standing still. He looked especially carefully at the balance between the front and back muscles, and the angles down the body: from head to shoulders, from shoulders to the lower thoracic spine at the bottom of the ribcage, from this point to the hips and from the hips to the ankle and into the foot.

He had a wonderful manner of wandering around and gently pointing out individual muscle patterns–for instance, the level that each of the hips were in the sockets, the level of internal/external hip rotation playing into the weight distribution in the feet, overall muscle imbalances and the level of tension in the glutes (butt) and rib-cage.

And what was interesting, was how we all had to be coached for the tell-tale cues and signs – even though almost everyone in the room (other than me) had a yoga or dance training, making them very body aware and elegant in their movement (but still in pain!)

What were the tell-tale cues?

Overall, the biggest message that I took from the workshop was that we all hold too much tension in the wrong places. Given that as soon as one muscle is tight, the opposite (antagonist) muscle simply cannot do anything until the first muscle releases. And this is important because some of these muscles (like the psoas) are large and connect with key processes like breathing, staying continent(!) and movements like sitting, walking and standing.

So stay loose and relaxed!

To do a body check yourself and see whether there are any ah-ha moments across the day:

  • Think about your butt when you are standing and walking – are the muscles tight? (if so, the psoas cannot do anything). A friend of mine tried this for a week and was stunned at how often across the day she found that all of the muscles in her butt were tensed up!
  • Think about your rib cage – if you sigh out a deep breath does the tension change? (if so your latissimus dorsi may be overworking)
  • Are your hips forward and your thighs extended when you stand? (if so, your hamstrings are constantly short and may get persistently tight)

Was there anything practical?

It was pretty much all practical! The four hours simply flew by – we did not stop for any breaks, and yet there was not a moment where I was not learning, making notes, trying different movements and learning more about the cues and signs of my muscle patterns.

The last 90 minutes was spent on 8 gentle stretching movements – most of which were held for a very long time (we did some for 15 mins, and Jonathan can recommend an hour or more at times!) in order to allow the psoas to truly let go. Whilst I had tried almost every single one of these from the book, the specific tuition on the important points of form was incredibly useful and I understood why I may have been missing out the benefits through simply trying it on my own without perfect technique. And the good news is that they are very easy to do at home (indeed one we even talked could be done in a break at the office, if you have a role that requires sitting at a desk all day – which of course is very bad for the psoas due to spending so much time in hip flexion).

Overall verdict – worth the money!

I have to admit that I thought about whether to attend for weeks before I committed – the hassle of a 45-minute drive to get there, no parking at the location and the £65 workshop fee. But my husband was kind enough to drive me and drop me off at the door, and benchmarked against other treatments that I have had, it was worth the money.

And like all of the best parties, with the late finish we were locked in!

I would strongly recommend Jonathan’s book – but the workshop took it to another level for me in terms of the personal insights and advice, plus the detailed coaching on the correct technique for the exercises. If you are not able to get to a workshop, Jonathan does do Skype consultations and I cannot over-emphasise the level of knowledge that he brings to your personal situation and his commitment to getting you out of pain. I am not at all surprised that he has helped and supported so many people to incredible recovery and rehabilitation.

And there is even a summer retreat in Italy…

Fascinating reading, with useful explanation and practical exercises

What I learned from going to see a nutritional therapist

I had to go back into hospital for some manipulation under anaesthetic due to the limitations on my movement from the scar tissue after my hip surgery. I had been dutifully massaging the scar tissue on the outside but came to realise just how much scar tissue there was on the inside that was reducing my range of movement and potentially one of the causes of pain. This led me into a journey to look at what I could do with nutrition to try to help my recovery.

So, for the first time ever, I went to see someone for dietary advice – with the specific question of whether I should be taking supplements to help my healing, and if so, which ones.

Layering the different aspects

I had previously thought that nutrition was mostly common sense, but I learned a lot from the way that Saffron (the nutritional therapist) layered what I needed:

  • Starting from a well balanced diet – with 7-a-day vegetables and fruit, plus a good split at each meal of complete proteins, good fats, and wholemeal carbohydrates as well as maintaining good hydration. She also specifically asked about how often we eat fish, and especially oily fish – as apparently the British are standardly very short of the long-chain omega 3 fatty acids. The ideal is apparently at least two portions of fish per week, with at least one oily fish.
  • Then looking at my age and lifestyle to get a sense of the hormonal pressures and tensions, as well as the aging factors on all of my tissues.
  • Whether I have had any blood tests to give information on nutrient shortages. These are very useful for things like anaemia (shortage of iron) and vitamin D shortages (common in Northern Europe, especially in winter or for people who stay inside a lot).
  • Checking for any food allergies or intolerances, or specific dietary requirements. I am very lucky with the robustness of my digestive system, so it means that I can draw on most foodstuffs – I just need to be organised enough to plan the right meals, shopping, and preparation! (I am sorry – I realise that some of this advice is not going to be so helpful for vegetarians, but a nutritional therapist will work with everyone’s dietary requirements).
  • Building from there to the current medications that I am taking – and talking me through the receptors that these medications block and hence what dietary changes and vitamin supplements may be needed to reflect this. For instance, the need for extra fibre for the constipation from painkillers, sulphur if taking ibuprofen, and extra B-vitamins (B6 and B12) when taking muscle-relaxants and antidepressants.
  • Then looking at the injury and the surgeries to understand what tissues are trying to heal – in my case covering bone, joints, cartilage, muscles, ligaments, and fascia, as well as scar tissue.  She talked about the importance of protein and zinc to help the muscles and ligaments repair. So a quality protein with each meal, and a wide range of pulses, grains, seeds, and nuts for the zinc. Getting nutrients to the bone and joint is more challenging – so I will come back to this theme below.
  • From the symptoms that I am still experiencing what extra may be needed. For instance, Magnesium is the mineral involved in relaxing muscles (whilst Calcium is involved in muscle contractions), so extra Magnesium can help with the muscle spasms and cramps. Magnesium-rich foods include spinach, avocado, seeds, nuts, yoghurt, banana and best of all: dark chocolate!
  • Then we talked about inflammatory foods, vs anti-inflammatory foods. Whilst inflammation is an important process in the initial weeks after the injury and surgeries, now months down the line there is a chance that swelling and inflammation is getting in the way of healing. Hence foods can help as one of the factors that can reduce inflammation. Overall, processed foods with high fat and processed sugars are inflammatory, plus fizzy drinks and nitrates, and nitrites in processed meats like smoked bacon and ham (you can buy nitrite-free versions), and of course, mild toxins like caffeine-based drinks and alcohol. The anti-inflammatory foods include tomatoes, leafy greens, olive oil, nuts, fruits, and oily fish.

Reducing scar tissue

As I said, reducing the scar tissue internally is a big goal for me, as I think that it will improve my mobility and potentially reduce the pain.  Saffron recommended proteolytic enzymes which are supposed to help minimise and reduce scar tissue after the surgeries.  These need to be taken away from food for best impact (either 30 mins before a meal, or an hour after a meal). Natural enzymatic foods include pineapple and papaya (yum!)

Rebuilding the bone

Of all of the injury and surgical aspects, we spent a lot of time talking about how to get blood flow and nutrients to all of the damaged tissues. Obviously, the bones are one of the most difficult to reach and the only access in the joint is via the synovial fluid. This points to the importance of movement in healing, as this only happens with movement that increases both blood flow to carry the nutrients around the body, and synovial fluid movement and regeneration.

The nutritional advice is to bring bone broths into my diet – using them instead of stock.  She counselled that it might seem weird to begin with but that you can get bones from butchers – they just give them away (I think that they normally assume they’re for a dog…) https://wholefully.com/bone-broth/

Normally your body will synthesise the necessary building blocks itself for bone synthesis and (to a certain extent) repair but it does get more difficult as we get older and we have less of the ‘whole’ ingredients in our diet such as animal skin (like on chicken etc), marrow, offal etc.  So this is where a supplement may be easier. 

Dealing with continued inflammation

Turmeric has become one of the anti-inflammatory supplements of choice for athletes. There is a lot of discussion about the format, and whether it is needed to be activated with black pepper or not. There is not a clear answer. The focus is probably best on getting one with sufficient amounts of the curcuminoids that create the reduction in inflammation. It needs to be taken with omega-3s for impact, which given the frequency really means using a good quality supplement.

More that we could have talked about

I have to admit that there was so much more that we could have talked about – and maybe I should go back in a few weeks once I see the impact of a few changes.

For instance, many people say that having had 7 general anaesthetics, rebuilding the gut fauna with a good probiotic is a priority to ensure good absorption of nutrients.

In summary

I came away with a much clearer view of what I should be doing in my base diet and the things that I should be eating more of and the things to avoid. I also finally answered the debate that I had been having with myself about supplements – and decided that the extra demands of this recovery phase meant that a few specific supplements would really help me.

But more than this, it was a real wake-up on the complexity of nutrition and how everything works together. It has been a great insight at this stage of injury, medication etc. But when life changes again, I think that there is a real value from getting expert insight on the body’s nutritional needs and how to meet them effectively. I really hope to be back to sport and when I start training would definitely go back again, plus at different physical lifestages as hormones change, or lifestyle changes. I had not previously realised the benefit that one can get and I would recommend it to others.

Affirmations and Mantras for healing

Self-talk is known to be one of the most important parts of mental strength. Athletes consistently use it (often together with visualisation) to help with performance under pressure. My suggestion is that it is just as important when you are injured and facing the challenges of recovery and rehabilitation.

Are you wondering what is self-talk? I define it as the voice in your head that chatters constantly, about all kinds of things and at times can escalate to a full-on internal debate. But there is good evidence that the mind takes these messages and images very seriously, driving changes in the hormonal system and the nervous system which in turn have very significant physical impacts (as well as changing your thought patterns going forward).

Affirmations or mantras are usually short, pithy phrases to insert positive messages into the mind. I would also be remiss not to mention that in the Hindu faith and yoga mantras are chanted, with specific mantras to generate powerful sound waves that promote healing, and the relaxation from the ancient practice of gong therapy or ‘sound bathing’.

This is something that many people write about. I especially enjoyed Carole’s blog from 2014 where she talked about Dr Coue’s mantra (or autosuggestion as he called it) where in conjunction with their medical treatment, they would say over and over to themselves 20 times in the morning and 20 times in the evening ‘Every day, in every way, I am getting better and better’. Read more on this inspiring story from over 100 years ago, plus some great tips and book recommendations in Carole’s blog:

What kind of mantras help?

When I was running ultramarathons and doing Ironman triathlons, I used mantras a lot and found:

  • It needs to be positive. I had a spin teacher who used ‘mine is the power and the glory’ as a mantra, and I know that many people find these universally positive exhortations very useful– hence the Ironman slogan of ‘Impossible is Nothing’.
  • It needs to be realistic at that moment! For instance, telling myself ‘I love to run’ is true, but in the final stages of ultra-marathons or long-distance triathlons the voice on my shoulder would scream back ‘I don’t right now – I want to stop!’ so I would use simple exhortations like ‘run for home’ or ‘nice and steady’.
  • It is better when it is process-based.  There are times in a long race where the final finish line seems too far away to engage with, and so process-based mantras worked better for me. This seems a strong parallel with the uncertainty on outcomes in recovery and rehabilitation. So just as I would focus on technique points in races like ‘keep my rhythm’, ‘nice and light’, which brings the benefits to keeping good technique at a time when tiredness can reduce form. In the same way in the tough part of recovery focus on the exercises, release work, nutrition, hydration and sleep patterns can reinforce the positive habits that will make a difference.
  • It is not helpful to set specific goals that you then miss. Whilst I have spent many races setting myself a challenge for the next split time, or the person that I would overtake, these are only useful when you hit the goal and then set the next goal. Missing them really can really drag you down, as it allows the internal critic to keep saying that today is not your day and you may as well just give up.

How do I apply that to my recovery?

It is really useful to reaffirm your strengths and the resilience that you bring to this situation: from the factual such as ‘we have a good plan and next steps with the medical team’ or ‘we are focused & determined and will get to the bottom of this’, ‘I have what I need to get through this’, ‘all of this strength and conditioning will make me a better athlete’ to the more aspirational ‘we will beat this’, ‘I’ll be back’, ‘my body is amazing’ and ‘I’ve come through tough times before and I will again’.

Also to recognise all of the people on your side and rooting for you: ‘I am in great hands’, ‘I am surrounded by love and support’, ‘I stand shoulder-to-shoulder with my team’, ‘I am enveloping my body in love and kindness’.

Reaffirming the sense of progress – even when it is too small to see: ‘every day of careful nutrition and good sleep helps my body to rebuild’, ‘little by little my body is healing itself’ and ‘every step towards recovery helps me’, ‘cell by cell my body is rebuilding itself’.

Some people find perspective very useful – for example: ‘whilst this is tough, people are facing much worse than this and getting through it’.

Some inspiring quotes

This link includes some inspiring quotes for injured athletes that could be used as mantras:

https://www.theodysseyonline.com/25-quotes-inspire-injured-athletes

So why not try it?

How about choosing a favourite mantra and use it every day for a week – repeat it under your breath over and over at key points in the day, write it on a post-it and put it on the bathroom mirror or under your pillow, close your eyes and smile gently as you visualise it… the mind is a powerful thing.

Your body and mind are amazing – ‘Every day, in every way, you are getting better and better’

Victoria Cairns’ book: ‘Dealing with Disability’

Victoria Cairns worked as a statistician for large pharmaceutical companies, including working in the area of cardiovascular drug development. In 1998 she was bitten by a tick in her garden and caught Lyme disease. She remained ill for 5 years and had to stop working full-time. In 2001 she first started having an irregular heartbeat and these palpitations went on for many years until in January 2017 she decided to have a fairly routine keyhole operation to solve the atrial fibrillation. Unfortunately, she suffered a complication that occurs in 1% of cases, and the prolonged resuscitation led to a T8 incomplete spinal cord injury and some brain damage.

Her book is a well-researched and referenced account of her best advice for dealing with disability and gaining acceptance of what cannot be changed. It focuses on developing the right mental attitude towards handicap in order to maintain a good life. It discusses avoiding negative thoughts, developing perseverance and how to move on from trauma and let go of anger, blame and regret. The book offers a mix of psychological information and practical advice, and provides the scientific background for the information given and the sources of evidence.

I would suggest that this is tremendously useful for anyone with spinal or nerve damage, and indeed a good read for anyone injured and their relatives.  Her calm, stoic and hardworking approach to everything gives real perspective.

Is your body cheating on you?

I have been reading a lot about some of the latest advances in understanding the brain and Alzheimer’s Disease. One of the concepts that interests me seems to explain why dementia seems to be so much faster and more brutal in the people who developed and used their minds the most. Research says that this concept is ‘cognitive compensation’ – that when the brain is used to working hard and solving difficult challenges, it finds work-arounds that disguise a lot of the early symptoms and copes for so much longer. And it struck me that the body does the same – that muscles and compensating movements and loading kick-in to get us over the line physically too.

Being an athlete can actually work against us

This issue of compensating is clearly a battle at every stage – other muscles and body systems stepping in and getting us through. It can stop us from spotting the issue early and dealing with it.

It can also be a big challenge in rehabilitation.

We have to stay so focused on the process

When the challenge from the physio is to build up to a certain number of reps and sets, this can become an all-consuming challenge.  And having been so pathetic for so long during the injury, every fibre of our mind and body wants to achieve this and start to return to the person we used to be.

But compensation can kick in so easily! And quietly…

So we really need to ensure that we totally understand the correct form and ways to check that the right muscles and movement are activating. We need to check every rep and be really honest on when the compensation is setting in. And this is why it is really useful to have regular checks from a physio, or starting to work with a Personal Trainer with a Corrective Exercise qualification and focus.

Quality not quantity

Compensated reps are empty reps. So whilst we need to ‘control the inner chimp’ (Dr Steve Peter’s book and philosophy of the Chimp Paradox) about not hitting the headline goal – we need quality reps, followed in such a way that they are pattern forming for our nervous system, muscles (helping ‘muscle memory’) and movement patterns. And if we cannot do it, this is really useful medical information that we can develop a plan to address. But only if we surface the issue and work with it.

Good luck!

Is it time to learn from a flea?

Fleas are amazing athletes – with the ability to jump 50 times their body length!

But the inspiration for injured athletes comes from the oft-quoted experiment with fleas in a jar. It is said that if you put fleas in a jar, then they jump out. But if you put a lid on the top to stop them jumping out, you can remove it a short period later and for all that they could jump out they do not. And this lasts for the life of those fleas – they have learned their new limits and do not exceed them.

The path to rehabilitation involves false starts

The really hard part of rehabilitation is that we need to keep trying things and pushing the body to learn and adapt. Sometimes this can hurt a lot, and rekindle the kind of pain that has been so hard to cope with before.

But somehow we have got to find the discipline and strength of mind to keep doing the activities recommended by the Doctors or Physios. Even if previously this led to pain or set-backs. Because this time ‘the lid to the jar’ may have been removed. And we can only find it out by trying.

This is especially hard for athletes

Every single injured athlete that I have met has pushed themselves too hard in the early stages of recovery. We love to believe that we can always be in the top 5 or 10% of people, and always beat the timings and goals through sheer willpower and determination. Sadly that cannot always be true for our bodies.

So as time goes on, the people around us get used to warning us and holding us back. And we too often start to look on the more pessimistic side, in order to avoid slipping backwards and to protect ourselves. But when is the time to move on from this important protection and guarding behaviour? How can we know?

Keeping a diary of activity and pain is very useful

Just like a good training log, a diary of activity and pain levels really helps to show the trends and ensure a gentle progression, together with the right nutrition, hydration, sleep and rest. It can also help to look at the potential reasons for times when the pain is bad, or you slip backward.

So we need to learn from the fleas as we progress down the rehabilitation path and need to spot the moments where we are being too conservative and could be holding ourselves back. Our loved ones and closest friends can also be really useful advisers, and we should ask them to look out for signs of when we need to step up and leave our injured past behind in order to get to the recovering future that we want so much.

Gaining the lift to recover after a difficult injury can be very hard, and takes work both mentally as well as physically.

Would a chiropractor be able to help me?

If you have been lucky enough not to have injuries in the past, you may not have any clue of who may be able to help you with your injury. One of the most common questions is what is the difference between a physiotherapist, chiropractor and osteopath? I also cover this in my previous blog www.injuredathlete.co.uk/how-do-i-know-that-i-am-going-to-a-good-physiotherapist/ 

Chiropractors generally focus on the integrity of your nervous system

The British Chiropractic Association www.chiropractic-uk.co.uk  says that chiropractors specialise in back pain, neck pain and sports aches & pains:

“Chiropractors specialise in assessing, diagnosing and managing conditions of the spine. They are highly-trained in finding the cause of pain in the spine. In the UK they undergo a minimum of four years’ full-time training. Importantly, chiropractors are regulated by law and must work within strict professional and ethical boundaries.  Before starting treatment, a chiropractor will do a full assessment. This will involve taking details about your condition, current health and medical history, and performing a physical examination. Sometimes it may be necessary to refer you for other tests, such as X-rays, MRI scans or blood tests. It is important for your chiropractor to gather as much information about your back pain as possible so that the most precise diagnosis can be made.

“Your chiropractor will then explain what is wrong, what can be done and what you can expect from chiropractic treatment.”

How do I know that it is nerve pain?

Of course, it is really hard to work out the cause of pain. Nerve pain accounts for much of the pain that goes all of the way down the leg (sciatica is a classic of this, but there are also other nerves that take different paths down the leg). The words that people usually use for nerve pain include words like prickling, tingling, burning plus sometimes stabbing, spasming and cramping. At their worst they can literally take your breath away and leave you unable to speak, stand or so anything.

Many people fear that chiropractors will be very physical and involve lots of popping

There is a range of chiropractic techniques. Some use just their hands for manipulation and other techniques use tools that can help to rebalance the tightness of muscles, tendons, ligaments etc and enable the rebalancing and correct alignment of the spine and therefore the body, both at rest and in movement.

The short, sharp movement with popping for spinal alignment is just one technique, and if this is not what you want, then talk with your chiropractor. For more advice, this link is worth a read:

https://www.spine-health.com/treatment/chiropractic/questions-ask-about-chiropractic-techniques

When you are in pain, there is lots of compensating

The bad news about compensating behaviours is that you can start to get pain in parts of your body that were not involved in the injury. For example, most injuries are more on one side than the other. This means that you are not evenly balanced across the two sides, but the brain does not tolerate the eyes not being level at all times. So the top of the spine often takes a compensating role, and this can lead to issues in your head and neck, as well as the site of the injury.

More runners’ injuries are related to nervous system issues than you might think

Joe Uhan has written a series of very useful posts on how often ongoing injuries in runners are related to nervous system issues. You could start by reading his blog on the I Run Far website for trail running and ultra-running https://www.irunfar.com/2017/08/six-signs-that-your-running-injury-is-nerve-pain.html and then follow the related links into his related blogs on treating nerve pain in runners.

I especially liked his guide to a neuropathic approach to healing www.irunfar.com/2018/05/six-principles-of-naturopathic-running-health.html

But if you are needing help with the healing process, cranial-osteopathy may be a technique that helps reduce your pain. And chiropractic interventions may help to find that ‘reset’ button to get everything working together again to move correctly without pain. Many athletes swear by the support chiropractors have given to get them back on-track.

Best of luck with finding something that helps!

Jo Pavey’s ‘This Mum Runs’

One of the things about being injured and unable to move very much (without a lot of pain) is that I have read some great books. I wanted to share a few things that I took from reading Jo Pavey’s book that I think are really relevant for an injured athlete – but do buy the book, as it is a wonderful, human and inspiring read.

I remember really clearly the feeling of being in the crowd with my husband and two close friends and all screaming ourselves hoarse at Hampden Park stadium when Jo Pavey took bronze in the 2014 Commonwealth Games 5,000m and stopped the Kenyans taking a clean sweep of the medals. The race was incredibly exciting and inspiring – as this race report summarises https://www.bbc.co.uk/sport/commonwealth-games/28626133, but how Jo had come back to win this medal (and a Gold medal at the European Championships 2 weeks later) is even more inspiring.

Here are the top three things that I took away for injured athletes specifically:

  1. Having been British Champion in her late teens, Jo had six years in her 20’s of not being able to train and compete. She hung in through this – did not let it get her down and also qualified as a physiotherapist (which must have helped her to understand how to rehabilitate her injuries). Six years! And yet she came back to win major medals in her 40’s – to me that shows such true grit, resilience and mental strength.
  2. With her coach (and husband), Jo managed her annual, training block, weekly and daily training schedule and sessions based on what was possible and what her body responded best to. The fact that she could turn out amazing track performances in spikes, having done almost all of the training on much softer and more forgiving surfaces and in trainers says that peak performances are still possible when we do the right things for our bodies.
  3. After her stress fractures Jo threw away her orthotic supports in her shoes and concentrated on strength training to address the functional muscle, joint and bone issues.

I don’t under-estimate the incredible dedication and hard-work that lies behind the achievements. But if we could all soak up a little of the balance with which Jo has managed her way through the lows and the highs, this could help any injured athlete move forward.

Enjoy the book. It is great.