At the end of December 2016 a team of six Podiatrists - Simon Miles, Christine McSweeney, Jack Loveday, Danielle Knox, Ben Lumley and Andy Gilmour travelled to Northern Greece, to see patients in six refugee camps. We based ourselves in Ioannina and travelled out to camps at Faneromeni, Filippiada, Konitsa, Katsikas and Doliana.

This was our first trip to Greece and was seen as a fact finding mission to assess both overall need and also how we could have maximum effect if further trips were to be planned.

All previous trips had been to the ‘Jungle’ refugee camp in Calais. This was a huge, unofficial camp of almost 10,000 people at its peak. In contrast, the camps we visited in Northern Greece were all officially regulated and much smaller - with between around 20 and 200 people living at each location. This was partly due to the fact that authorities were attempting to move most refugees into hotels or buildings, due to severe incoming winter weather. The camps at Feneromeni and Katsikas were in the final stages of being closed, so at these locations patients were brought in by bus to the clinics. 

As we had not been to these camps before, we were unsure of the patients’ needs, so travelled with a large variety of kit - instruments, dressings, strapping and off the shelf orthotics.
Patient Data 

Over five days spent in clinic, 83 refugee patients were seen. Again, in contrast to our trips to Calais, where our caseload was largely adult males, in Greece, women made up 51% of patients seen.

We had suspected from what we had been told and also from our previous trips to Calais, that there was likely to be considerable need for wound care, but this was not the case. The vast majority of issues that we encountered were musculoskeletal, with the standout population being women with anterior knee pain. 

Our first trip to Greece was considered by all a great success. By auditing patient data, on future trips we will be able to travel with the most suitable equipment and supplies to treat the refugee population most effectively, whilst minimising airline baggage costs and allowing donations made to The Foot Project to have maximum effect. With the number of musculoskeletal conditions encountered on this trip, we found having off the shelf orthotics and additions available was key to making a lasting impact. On previous trips we had relied on strapping and hands on techniques to treat musculoskeletal conditions, however with orthotics to hand, we were able to give patients something to take away, as part of a longer term load management plan. This was particularly the case in UK sizes 4-7, which we ran out of fairly quickly, whereas some of the larger sizes remained unused. 

A huge thank you everyone who has donated to The Foot Project so far - without your support these trips would not be possible. 

We would also like to thank the companies that supported us on this trip - Firefly, Cannonbury, OSGO, Cuxon Gerrard, Kinesio UK and Harmony Medical. 
We will be running further trips throughout this year and rely entirely on donations to make this happen. If you can spare anything at all, it would be hugely appreciated. Our latest donation link is  -
At the end of October we returned to Calais for another four days to run voluntary refugee clinics. This would be my second trip with The Foot Project and would turn out to be quite different to the first. 

In the weeks leading up to our trip there was the constant threat of ‘The Jungle’ camp being closed and destroyed. Around a week before we were due to travel the demolition started, with the First Aid caravans being one of the first areas to be removed. The shambolic demolition of the camp and relocation of the migrants continued through the week and with this in mind we were advised by other charities not to travel. We had already booked travel and accommodation using the generous donations from our supporters though, so did not want this to go to waste. 

We had a re-think and contacted another, smaller refugee camp at Grande-Synthe, Dunkirk. Although this was a smaller camp - intended for 300 refugees but currently housing around 1000 - it is an official camp, so more strictly controlled than ‘The Jungle’. We managed to register with the Town Hall as official volunteers just in time, and travelled as planned. 

With the last minute change of location, we were prepared to help out however we could, whether medical or not. Frustratingly, there was a large medical centre, but nobody seemed to know how to access it, commenting that there were once a couple of dentists there, but nobody had used it for some time. The boys set about chopping wood to fuel the main kitchen and smaller community kitchens, while the girls searched out the Women and Children’s centre. 

We were quite happy with chopping wood and helping out wherever we could, knowing that we were at least helping in some way. The girls however were inundated with patients in the Women and Children’s centre - treating more people than ever before, who were all very grateful to see them! 

It seems likely given recent events that this will be our last trip to Calais. We have however already planned our next Foot Project trip - we will be travelling to Greece after Christmas for ten days to run voluntary clinics at six refugee camps. 

Given the hugely increased travel and accommodation costs involved in getting us to Greece and making a worthwhile contribution to the six camps on Lesbos, we desperately need your help to raise money to make it happen. Any donations, however small, are hugely appreciated, as is liking, commenting on and sharing our posts and fundraising ideas on social media to help us spread the word. Thank you for all of your kind support so far - it wouldn’t be possible without you! 

After getting in touch with The Foot Project earlier this year, I was given the opportunity to join them running clinics in 'The Jungle' refugee camp in Calais, for four days over the August bank holiday weekend.

As the year has gone on, media coverage of the migrant situation in general and 'The Jungle' has gradually disappeared. Part of the camp was bulldozed, leading many to think that the camp was no longer there. In reality, the camp is growing by the day, with almost 10,000 inhabitants squeezed into a smaller space than ever. 

I got onto the coach in Bristol and then on to the ferry at Dover, with little idea of what to expect ahead. I had recently read Patrick Kingsley's 'The New Odyssey' which had given me a better idea of the hell that people have to endure to leave their homes and flee across the Mediterranean on expensive, overcrowded boats controlled by smugglers, but still had almost no idea what I would find in 'The Jungle'. 

On the first day we picked up a car pass from the distribution centre and headed onto the camp - the police stopped us, checked our documents and the contents of the car and were happy to let us through. This was apparently the easiest it had ever been to get onto the site. 

The first aid area was a triangle made up of 3 caravans. As we arrived, there was already a queue of people waiting to be seen. On this trip there were more volunteer doctors (mostly medical students) than there had been previously, so we ended up working outside the caravans, setting up on a large concrete block. 

On the first day, the majority of what we saw was ankle sprains - a lot of which had come from playing football on the sandy pitch next to the camp! At first we thought this was a bit strange, having walked hundreds or thousands of miles and then spraining your ankle playing football - but many of the refugees have been stuck here for months, and once you're in 'The Jungle', there is very little to do. 

After the first ten minutes or so of feeling completely overwhelmed, I settled into a rhythm - helping those that I could and directing others towards the doctors. It seemed that even with the warmer, dryer weather almost all of those coming in were complaining of a cough or sore throat. Taking any kind of history was a challenge, but with the support of a couple of the migrants who worked as interpreters around the first aid area every day, we usually worked it out. 

I was completely blown away by how friendly and seemingly positive most people had managed to stay, despite the unrelenting adversity that they have faced and are facing. A few who spoke English shared some of their story with me, which was heartbreaking, but others preferred to joke and laugh. I had no idea of what the atmosphere would be like in the camp, but I felt completely comfortable and certainly at no point whatsoever felt threatened.  

We returned on the second day to find the police in a less 'easy going' mood than before. They checked our passports as usual, but decided not to let us on the site in the car. As a result, we had to be dropped off outside the perimeter, walking across the dunes and into the camp from the side. The police simply don't want anybody there to help and make the situation more comfortable for the refugees. 

After a flurry of ankle sprains on the first day, the second day was filled with various knee injuries. Unfortunately it became apparent that most of the injuries were traumatic, caused by being hit from the side with metal bars or clubs. While examining one Eritrean man, we realised that he had no medial collateral ligament at all in his knee, not a recent injury, but meant that his knee was able to bend sideways - I think we were more surprised by it than he was! 

Leaving 'The Jungle' was a very strange feeling. Knowing that the camp is still there, getting bigger and bigger, more and more cramped, while we just headed off home left me feeling quite empty. Before we had even got home though, we were already planning the next trip and will be returning in October. The weather will be getting colder and wetter by then, so the need will be even greater. We will be focussing on taking out shoes and socks as well as our usual medical supplies, in particular to help the women and children in the camp. 

Thank you so much to everybody who has donated and supported the cause - without you it wouldn't be possible.
A couple of years ago I was asked to answer a question on acupuncture as part of my role in 220 Triathlon Magazine's TriClinic Expert Panel. Acupuncture is something that I use a lot in practice and always raises a few questions, so I thought I would share it with you again here - 

Q / "What exactly is acupuncture, and what are its benefits in terms of rehabilitation and performance?"

A / Acupuncture is the practice of inserting fine needles into the body for therapeutic benefit.  The two most common forms of this are the acupuncture used in Traditional Chinese Medicine (TCM) and Western Medical Acupuncture (WMA). Both types explain how acupuncture works in very different ways, despite often being very similar in how they are practiced. TCM explains the effect of acupuncture as the balancing of Qi (pronounced 'chi') - an invisible life force that some believe runs within us. WMA on the other hand explains its effects in terms of physiological and biochemical changes within the body, in line with modern scientific knowledge.
Acupuncture is useful in the treatment of a wide range of injuries that are common amongst multisport athletes, including muscular overuse injuries, tendinopathies, joint and ligament sprains as well as conditions such as osteoarthritis. Because of its wide ranging effects it can be useful for both acute and chronic injuries.

Acupuncture close to the injury site releases hormones that increase blood flow. This improves the rate of healing in chronic and sub-acute injuries by increasing the amount of oxygen and other nutrients getting to the area. Various other substances such as  adrenaline are also released which provide a pain relieving effect. This may mean that you can avoid taking pain killers such as ibuprofen, which commonly cause unwanted side effects. It is often surprising to people that acupuncture is actually safer than taking medications like ibuprofen.

A common after effect of acupuncture treatment is a feeling of wellbeing and relaxation which is generally beneficial to the often negative outlook of the injured athlete.

Beyond injury rehabilitation, acupuncture is now recognized in Western Medicine as an evidence based treatment for conditions such as migraine (meaning that its use has a solid medical research backing). This is something that can clearly affect performance, consistency, recovery and the overall mental state of sufferers. Again a benefit of acupuncture here is the potential to avoid the associated side effects of strong pain killers and anti-depressant drugs that are often prescribed.

Some research even shows that pre-exercise stimulation of acupuncture points can have a direct performance enhancing effect, with one study showing an improvement of over 4 seconds in a 1km road running time trial. Research has also shown improved recovery rates between training sessions - although the reasons why are not entirely understood. With regard to this, WADA do not consider acupuncture as performance enhancing as such but their guidelines are fairly vague on pre-competition use.


What you'll need - 

- A smartphone or MP3 player

- Earphones to run with

- A metronome app

- Someone to count your baseline number of strides per minute  (ideally!) 

First of all you need to work out a start point - your natural baseline cadence in strides per minute (spm). The easiest way to do this is to get somebody to count for you so that you can run as naturally as possible. Count for 15 seconds and multiply by 4 rather than counting for a whole minute. You can also just count one foot and multiply by two if you find this simpler. A treadmill is the easiest place to do this but can be done outdoors too. 

With this data, work out what a 5% increase from your baseline number is and program this in to the metronome app. 

For example - if you count your natural baseline cadence as 160spm then you will be running at 168spm when increased by 5%.  

Again a treadmill is the best place to start with this as you can make sure that you are running at the same speed but a higher cadence - the biggest and most common mistake that people make at first is increasing their spm by running faster! 

Start with small intervals eg. 30secs with the metronome set at 5% increase, 30secs rest or run with no metronome. This will allow you to get used to the change slowly. Gradually increase the time with the metronome with each run and use this as a warm-up or part of your warm-up protocol before your main session. There is really no need to do longer than 10 minutes with the metronome to make a lasting change. 

During your main sessions try to focus on keeping a high stride rate without following the beep. 

Once the 5% increase feels comfortable then build from there. It's normal at first to feel a bit less efficient when running at the same speed but a higher cadence - don't worry, this will pass and you should end up with better form and eventually be a more efficient, less injury prone runner.

This blog post was originally written for Altra Running

Running cadence or how many steps per minute (spm) you take is a hot topic in medical research at the moment - often looking at gait changes as rehab for specific injuries. The running form improvements that running at a higher cadence encourages are just as important, or even more important, in avoiding injury in the first place though. Retrospective research looking at injury prevention however, is strewn with issues, so most of the work taking place looks at changes post injury. Obviously as athletes we would rather avoid the injury in the first place though if possible! 

So what should we be aiming for? You will often hear people say that 180spm or above is the ideal cadence, but we are talking about a highly individual thing here with a whole range of contributing biomechanical and environmental factors, so no number will ever fit everyone. 

An interesting study on how changing cadence affects uninjured runners was carried out by Bryan Heiderscheit and his team in 2011. They looked at both increasing and decreasing cadence and found that a cadence increase of 5% decreased energy absorption at the knee and that a 10% increase decreased energy absorption at the hip and knee. 

Looking at the data in this study, the mean baseline cadence was 172spm. Compared to most recreational and club runners that I see in clinic this is quite a high start point - so I would assume the sample was made up of experienced, decent level runners. This could mean that increasing the cadence of an average recreational runner may have an even larger effect. 

Many of the benefits found from running at a higher cadence come from preventing over-striding - you simply don't have time to reach too far in front of yourself with each step. This results in landing with a softer knee, allowing you to absorb shock more efficiently, amongst other things. 

If you are a health professional wanting to learn more about gait retraining then check out Kinetic Revolution, who run a fantastic weekend course on the subject. 

Pt. 2 will cover how to practically and sustainably increase your cadence and integrate it into your running.