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.