How well does the NHS look after runners?

Hi,
I'm a Physio in the NHS and privately. I'm also a runner. Being on the forum a while has me wondering, does the NHS do enough to look after runners? I'm trying to persuade my NHS team that we need to develop a service for runners and so would appreciate any views, stories and feedback of your experience in the NHS and particularly relating to physiotherapy.
Did you get seen quickly enough? Was the GP reluctant to refer you to Physio?
Did the doctor or Physio seem knowledgeable when it came to running?
Overall did it help?
Do you feel the most likely thing the NHS will do is just say "stop running" and offer little alternative?
Did they advise you on techniques you could use? Stretches, taping self massage etc.
Did they help you plan a graded return to running or advice on strategies to reduce pain when running?

Any views very gratefully received, positive or negative.

Many thanks

Tom
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Comments

  • Do you feel the most likely thing the NHS will do is just say "stop running" and offer little alternative?

    Is my gut reaction, which is why I've never tried the NHS for sport related injuries.

    Stuff like this on their websites doesn't help though image

    You should always land on your heels and push through on to your toes

    http://www.nhs.uk/Livewell/c25k/Pages/C25K-tips-for-new-runners.aspx
  • JimineyJiminey ✭✭✭
    I know my boyfriend recently booked an appointment with his GP when he saw her she looked kind of perplexed that he had gone in because he was suffering knee pain, couldn't offer any help then said she would refer him to a physio. He hasn't yet heard anything and that was over three weeks ago. My Dad also found the same thing, there was over a months waiting list to see an NHS referred physio but when he went privately he had an appointment the next week.
  • This is something I've also thought about.

    As I understand it, there is a huge financial incentive for the government to emphasise preventing illness and disease by promoting healthy lifestyle choices. But I personally feel that the apparent implication of this -- that there should be tailored support for people who are pursuing healthy activities such as running -- is being ignored.

    People shouldn't have to pay to see specialist physios to deal with running-related injuries/problems.

    When I've been to my GP with running-related pains (2 occasions) her attitude has been pretty much: "Well if you will go running around like some loony you're going to end up hurting yourself". I have to say though that the "physio direct" phone service she's referred me to has been very good for a phone-based service, and their advice on stretches has been very helpful.

    I do wonder, though, whether if I had something more serious than a bit of bursitis or shin splints I'd get any proper help with rehabilitation/prevention from the NHS.

  • Hi Tom. I've spent two years trying to persuade doctors that the pain I get in my upper thigh isn't simply a pulled muscle. A lot of visits, signings off and two MRI scans later, they've finally told me it's ischial tuberosity bursits, i've had a cortisone injection and have been put on antiinflammatories. I love the NHS and deplore private medicine, but I all too often get the feeling that any sports-related injuries are seen as somehow not worthy of spending resources on. If you ever do get physio, and you may have to wait a while, it's of necessity (they have lots and lots of people to deal with) not the most personal service. I would also say, however, that I saw three different private physios in that time and not one had any clue what it was either. I've eventually found a very good musculo-skeletal specialist in a hospital round the corner from me - this after being sent to a clinic much further away who seemed convinced it was a hip problem (it isn't). I DID get advice from all quarters on stretching, and that did help. I have never been offered advice by anyone on graded returns to running or on strategies to reduce pain when running.
  • I saw a doctor at my GPs surgery when I had a reccurance of a thigh strain that initially took months to recover. Luckily, this guy also had a degree in sports science so was sympathetic, examined me, sent me for x-rays and referred me for physio which was local. I had 4 or 5 sessions where they assessed me and get me stretches and exercises some of which I still do and I have had a re-reoccurance. From referral to seeing the physio was probably a month so not too bad really.

    The centre I went we're treating all sorts. I saw babes in arms and Octogenarians in the waiting room. I'm obviously lucky to have access to a decent PCT and I hope that this service can continue.
  • I live in Oxford

    My GP, who runs a bit and pirates a bit, refered me to the sports clinic at the Nuffield, They were fab and understand about running.
    If the service you're getting is no good, move to Oxford.  image

  • i recently had 3 month course of chemotherapy. both my surgeon and oncologist were runners and we often spent more of my appointments discussing races we had done than actually talking about my illness! however the only advice relating to my running during treatment was 'not to' and once they were happy for me to return to running the advice consisted of 'take things easy' and 'you'll be back to full fitness 6 months from now'. I'm not a great one for listening to advice anyway but my fitness was often given as a reason why my recovery would be expected to be full and speedy. My desire to get back running asap and wish to get my fitness back to marathon & half marathon levels was also known to everyone, it would have been great if this could have been incorporated into a recovery plan.
  • JoolskaJoolska ✭✭✭
    I've never bothered with NHS treatment for injuries because anecdotally the response is slow (when I'm injured I want to be fixed NOW!) and because I'm in the fortunate position of being able to self-fund private treatment.  I guess the difficulty is that the financially-stretched NHS has to focus on life-threatening conditions and, frustrating as ITBS/shin-splints can be, they're simply never going to be the priority.  But it does make running a rather middle-income occupation the minute you get injured, which seems unfair.
  • In my experience, I've never come across a GP with sufficient knowledge to be able advise appropriately.  My main complaints would be:

    • lack of appropriate knowledge (but fair enough, sports injuries are quite specialised and GPs are generalists rather than specialists)
                               hence
    • lack of appropriate referral (the only NHS physio I saw didn't know what to do)
    • slow response for appropriate treatment
    • lack of understanding of psychological impact of not being able to run

    But as Joolska says, emphasis in the NHS is on chronic / life-threatening illness, not "minor running injuries" so with the cutbacks, I can't see how they could afford it.

    Maybe in an ideal world. . .

  • i delayed going to the GP when i had my Achilles problem because people would say there was a very long waiting list.....delayed it for a month whilst i rested and say a sports guy who wanted me to get orthotics......

    finally went to the gp and although he knew nothing of running referred me to a physio straight away and i was seen locally within 3 weeks....was seen every few weeks for a few months and after 3/4 months off finally returned to running and cycling and fitness did return quickly.....

    went again a year or so later with knee problems.....had a quick appointment and was given advice and exercises and as they knew i would do them i was left to go away with them and just return if it didn't improve

    so no complaints here.....
  • MuttleyMuttley ✭✭✭

    My GP is a runner and on the rare occasions I go to see him we spend more time nattering about events than my ailment. But I've never gone to him with a running injury, pretty much for the reasons that Joolska gives. I too am fortunate in that I can afford to see a private sports physio if needed.

    Yes, it does irk me that the NHS seems to be more attentive to chips-munching diabetes-ridden morbidly obese chain-smoking porkers than to those who take some responsibility for their health and wellbeing (I probably exaggerate a bit here for effect), but the diseases the porker sofa potatoes suffer are more dangerous than those I am likely to present with. In an ideal world it would be different but hey ho.

    All in all, I won't complain about the NHS. I think it's a truly wonderful invention.

  • PipesPipes ✭✭✭
    I second Postie Postie about the NHS sports clinic at Nuffield.

    I'd had hip pain for 2 months and had seen a private physio/ backed off training. I went to my local doctor, expecting him to tell me to keep doing those things, but he took my problem seriously straight away. I had an x-ray the same day and appointment in the Nuffield within a month. My MRI was a month after that and, although I moaned and groaned about delays, I was happy enough to get surgery (for hip impingement) a year after I first went to the doctor. I also had physio sessions while waiting for surgery and have now been put straight back into the system for the other hip, without needing to go back to the doctor.

    So no complaints here...although I know that not everyone with my problem has been treated as well as I have (bit of a postcode lottery - some PCTs aren't offering the surgery on NHS).

  • I don't really expect my doctor to be an expert on running injuries. He is a GP after all.

    His job is to deal with medicine in well a general way, and then refer me to a specialist if they cant help.

    Thats as true of  running injuries, a broken foot or cancer

    I would go to a sports injuries specialist if I felt everything was going pearshaped.

    If I went to my doctor and he knew about taping muscles to aid blood flow  during races, I would think he was wasting his time.

  • SlowkoalaSlowkoala ✭✭✭
    Had to see a GP twice last year before getting referred to physio last year with knee problems. The first time I was just given a leaflet with knee exercises which was a standard one that they give to elderly patients (I am 40!) Luckily I didn't have to wait 3 months for the physio as have insurance through work. Otherwise something that could have been sorted by a physio in 6 weeks or so would have taken more like 7 months (from seeing the GP twice and resting each time for 3 weeks as instructed to waiting and getting physio).

    Does annoy me that there are obese people out there being prescribed free swimming, free exercise classes, etc. The NHS should offer more to people who want to stay fit and healthy.
  • Thank you for your messages, really good to hear people's views.

    It seems a mixed experience for people, some positive and some negative.
    I agree too that it is frustrating that runners, who as a group take great care of themselves, seem to be offered less support than others who maybe don't.

    I see a huge variety of patients, some who need help to walk, others who get pain 18 miles into a marathon. Both are surely equally entitled to treatment even though their needs are very different. Unfortunately the NHS budget is such that at the mo, if you're healthy enough to run your needs are rarely seen as a priority.

  • I've never tried going to my GP with running-related problems, I've assumed that the advice will be "stop running".

    As others have said, I'm in a position to pay for the (fortunately rare) treatment that I've needed, but maybe I will try my GP next time!

  • I've given up with my GP for anything more complex than asking for the pill.

    - biomechanics knowledge is zilch
    - interest to treat or prioritise is zilch (usual 'stop what you're doing and the problem goes away' routine)
    - when I asked to be referred (once for podiatry, once for physio) - a bored response with a reply of "waiting list of 3 months plus"

    Needless to say it's near impossible to get an appointment with the GP in the first place...  You have to ring before 8am with places allocated on a first come first served basis, so it's constantly engaged from 7am onwards...

    Of course the surgery is rammed with patients with preventable chronic illnesses, and some interest in 'prevention' and 'wellbeing' wouldn't go amiss, but I guess there isn't the capacity.

    Pay private and you can often see someone the next day.

  • Nam wrote (see)

    Pay private and you can often see someone the next day.

    And when it's a referral, it's often the same person that you would have to wait months to see on the NHS.
  • My GP is pretty good but she seems fixated on the fact that I'm A 46 year old female and is always trying to link any condition I have to my age without knowing the first thing about my lifestyle - she has never even asked apart from the usual drinking/smoking questions. If I told her I was running the VLM in a couple of weeks she would fall off her chair.

    I would no more go to her with a running injury that I would my local vet.  

  • My local vet when fantastic when my dog had a running injury! image
  • I live in Devon and my doctor has been great.

    I had a knee problem which led to an ankle problem. She referred me to the NHS mobility centre to the podiatrist and I now have orthotics made by them for free. It has been trial and error with them but the podiatrist has been amazing. He even called me today to see how it was going...

    I have a low bone density so my Doc prob thinks its a long term investment and wont cost the NHS so much as I get older if she keeps me running image
  • Muttley wrote (see)

    Yes, it does irk me that the NHS seems to be more attentive to chips-munching diabetes-ridden morbidly obese chain-smoking porkers than to those who take some responsibility for their health and wellbeing (I probably exaggerate a bit here for effect), but the diseases the porker sofa potatoes suffer are more dangerous than those I am likely to present with. In an ideal world it would be different but hey ho.

    All in all, I won't complain about the NHS. I think it's a truly wonderful invention.

    I'd like to agree with your first paragraph because it's my perception...  but my experience was different. I had orthotics on the NHS and podiatrist was linked to the physio and running shop selling shoes. By linked I mean they had a working relationship. One would refer to the other and ask advice etc. No financial linkage.

    I had recurrent physio for various injuries. Physio was a same day service!

  • I've seen a physio twice in the last 10 years.

    The first time I went to see my GP as I'd developed a pain in my achilles and another in the groin area. My GP briefly examined me and then said she wanted me to see one of the other doctors who specialised in sports injuries. I wandered down to his room and was examined to the point where he identified an imbalance in my back muscles. He then told me that he wanted me to see a physio and got on the phone to try and arrange an appointment with the one that he specifically wanted me to see. She wasn't available but he got me an appointment to see another physio within 2 weeks. As I was in the middle of marathon training I didn't want to have to give up my training for too long.

    I saw the physio who examined me pretty thoroughly and then nipped out to get the one that the doctor had wanted me to see to check me over as well. In the end they identified the fact that I was using the wrong shoes and suggested that I change them for some that were more suitable. I ended up getting gait analysis when I ran at Silverstone a few weeks later and buying new running shoes then. Never had the problem reoccur.

    The second time I went to the doctor with an injury he wasn't as used to sports injuries but was happy to write to a physio that I was able to make an appointment with through the BUPA scheme that we have at work. I got to see the physio a lot quicker and she immediately identified that I had a serious imbalance in the strength in each of my legs. I think I'd damage a thigh muscle and had been compensating for it without realising I was doing it. Again with the problem identified I was given a way to sort things out.

    Overall my experiences of the NHS have been pretty positivhe odd bad experience but those are far outweighed by good ones.

  • With my bad knee It's taken years of GP, NHS physio saying "take these exercises and do them at home" x ray - "there's nothing you can do about it, you'll have to just live with it" repeat x 3. Now my other knee has joined in with the fun and after another X-ray I'm now booked in for an arthroscopy in which I'm expecting as the dr told me to, to be told "there's nothing we can do" again. I'm 24, not 80, so I feel a bit perplexed by being told I'll just have to live with something that is so constraining especially by a person who is supposed to make people better!

    So, in answer, no, I don't think the NHS do look after runners, nor anyone else limited from any other sport because of such injuries or problems.

    Cassie
  • A couple of years ago, I had an old problem flare up (I had ACL reconstruction surgery in 2004 and my knee was painful and kept swelling) and went to the doctor. The doctor said "stop running", but I pushed for a referral to a physio which I got, amid much  muttering about 6 month waiting lists. I ended up seeing a physio a week later, which I thought was not bad going, really. The physio I saw was excellent - identified a couple of imbalances, gave me some exercises to do and told me that I shouldn't stop running or doing any activities I enjoyed. While my knee is still swollen, it's not painful and I've come to the conclusion that the swelling is never going to go away completely while I'm still running.

    I ususlly now pay to see a physio privately, because I can't bear to go through the rigmarole with my doctor who makes me feel like a nuisance, whatever problem I see him with (sports related or not). She is usually about £30 a pop which isn't too bad, really - she usually sees me for the initial consultation then follows up by email or phone.

  • When the benefits of exercise are so clear you'd think the NHS would do more to support people to continue to exercise.

    If you have a spare few minutes, watch this;

    image

    Excellent video on the benefits of exercise for a host of different conditions.
  • I'm a surgeon. We're all (in the NHS, anyway) under the management cosh- we are pushing patients through clinics/ theatre quickly to try to meet targets. GP's have their targets to meet, too, and are not usually trained in sports medicine.They have a ridiculously short appointment slot per patient, no wonder they can't sort out the problem in depth, if it is at the expense of running late, and potentially being late for a house call on a sick patient.

    I wouldn't go to my GP with a sports injury, unless I thought it might reflect a serious underlying medical condition, I would expect to get the "comedy sketch " response- "doctor, doctor, it hurts when I run 26.2 miles!"- "well- don't"- boom, boom!

    Of course it's annoying that it's the obese and unfit that get sunsidised gym membership/ personal training, but their need is greater than yours!

  • E mmyE mmy ✭✭✭

    For me it depends on which GP I see at the practice. If it's the "sporty" one -he's absolutely fantastic, does a thorough examination and if I need a reference to go to a physio etc - he'll personally suggest one and has once called them up on my behalf because I wasnt getting seen quick enough. I cannot fault the service and attitude of "preventative" medicine.

    Then there's the only doctor. Mid 50's and every response i've received has been "stop doing it, take paracetamol/anti inflammatories and come back in 2weeks if it's not better". They never examine you and make you feel like a waste a space. I'm not looking for a miracle cure -i'm looking for help/advice and support in getting back on my feet.

    I agree with what other people have said - it seems that the NHS is so focused on their "diabetic/overweight smokers" that they don't put enough of their energy into resolving the "avoidable" injuries. I'd like to point out that whenever i've had a serious issue (e.g. A&E, emergency doctors appointment) I've been seen fast and with fantastic service.

    It's the hit and miss of NHS and different practices. These two doctors work at the same surgery in a small town in Surrey.... it was only pure chance that one time - I managed to get an appointment with the "sporty" one that I've never looked back. If i have an issue - I specifically request him.

    To put into comparison - I've been a user on the "normal" health treatment plan in both Germany and Belgium and I've been seen within 24hours on both occasions by masters in their fields (physio/doctors etc). It's meant to be the same as the NHS (but you pay a small surcharge with every visit) and you can get recompensated by the government for it.

  • Hi Tricialitt,

    I totally agree with you, it is tough for GPs who have very little time and have to prioritise to help those with most need. We do that too in the Physio department, prioritising into urgent or routine with most running problems being seen as routine which unfortunately means a 2-3 month wait for treatment. Sadly that would be too long for someone training for an event.

    I think that a contentious issue here is fairness. If we all pay into the NHS via taxes is it fair that some people utilise a much larger percentage of the resources and others end up having to pay for advice privately? There's been a big debate in the media about it recently, with the NHS reportedly spending £1 million per hour on treatment of diabetes, a condition that commonly happens as a result of obesity.

    I feel we all have a responsibility to look after our own health to protect the NHS in future. The NHS can't cope with people not taking care of themselves and expecting it to pick up the pieces. In my trust we lose around £10 million per year in people simply not turning up to appointments and of those low cost gym memberships we offer locally, only 55% of people took up the offer of half price gym membership (despite saying they wanted it and making us spend the time needed to arrange it for them!)

    Where people do make every attempt to look after their own health the NHS must support them. So really the NHS should support people in their sports, maybe not as a prioritiy but it could certainly do more. I appreciate there are cost implications to this, but surely they are less than £1 million per hour and treating injuries quickly would prevent more costly chronic problems.
  • My ha'penny worth - me and my hubby go straight to a private osteopath now for day to day running induced issues, after experiences (negative) similar to those listed already.  Even the private physio at work said "stop running" in response to a hip problem I had, that I now see the osteo for every three months or so - helps that he's a runner too.

    The worst experience ever was the suggested treatment for my hubby's partially healed broken leg by an NHS orthopedic specialist  -  "stout boots and painkillers". Went private, £6k and a titanium plate = 1/2 marathon finishers medal just over a year later. 

    NHS is fantastic in an emergency, but don't bother waiting for physio etc - by the time you get an appointment you can get it sorted privately and in the gym, in our experience of West Sussex NHS.


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