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The N60  Challenge  –  A Physio’s Perspective by Mark Reid

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Thanks to a late social media recruitment drive courtesy of Claire Robertson and Jonathan Bell at Wimbledon Clinics, I recently had the honour of a trip to Norway to provide Physiotherapy for IGO Adventure’s inaugural N60 Challenge. It was an amazing experience, a welcome change to my usual clinic environment and one from which I have learned a lot. I wanted to share with you some thoughts of my experiences on the trip from my own physio’s perspective.

Preparation

The N60 Challenge is not your normal challenge. It is designed to test you physically and mentally in one of the most beautiful but unforgiving environments in the world. The event itself is a four-day race from Hemsedal to Geilo using touring ski, fat-bike, cross-country ski and finally running a marathon. All of this while camping in Lavvu tents in freezing cold temperatures in the mountains. It is safe to say that this is a very tough event and to complete it you’re going to have to be tough too. And that is exactly what the participants were – tough; tougher than most of them realised.

Preparation had started a long time before the trip. Participants had trained in various amounts and were ready to go. There were only a couple of niggling injuries reported by the group which we managed to get calmed down before the race even began. The first two days were spent familiarising with equipment and I actually didn’t have too much to do. A busy physio is not necessarily a good thing leading up to an event such as this. People should be prepared both physically and mentally for what they are about to do and everyone seemed to be in good shape – I was the least busy man in camp.

In fact, people were still in good shape at the end of the first day of racing, which was a difficult touring ski stage which included a 1km ascent up Mt Toten. People crossed the line and reported feeling pretty good. I was both slightly surprised and extremely happy, these athletes had obviously prepared well. The only thing we did have to deal with were some sinister looking blisters on the feet, luckily the Norwegian medical team were on hand to drain and patch up any major ones.

Realisation

It was at the end of Day 2 that most people had begun to ache and my work really started. That day was a punishing 40km fat-bike bike ride over mountains and across country. Fat-biking on snow is tough, if you drive too hard the wheels will spin; if you turn too sharp the bike will slide; if you go too fast you cannot stop; and if you reach an incline you’re often better off dismounting and pushing the bike up with you. To top it off the sun was high in the sky, the snow was getting ever slushier by the minute and the course included no less than twenty brutal hill climbs. Everyone made it through safely, although some were out there for over 7 hours!

The general consensus in camp that evening was that this had been a very tough stage and people were feeling pretty sore. I made sure to have a chat with everyone to see how they were feeling and only two competitors seemed to be carrying what I would deem to be ‘injuries’ – one with acute back pain which had gradually worsened over the stage and the other a seemingly irritated hip joint. A mixture of reassurance and bit of manual therapy seemed to do the trick in calming things back down. Everyone else seemed to be reporting the same thing – all-over soreness. The exact same all-over soreness you would expect after a particularly gruelling trek through the mountains but not everyone was expecting this. This was the first night I had a queue at the camp ‘clinic’. One-by-one people came through complaining of the same thing and the conversations went something like this:

Me: Right, what’s up and how can I help?

Competitor: I’m sore.

Me: Where?

Competitor: Everywhere.

Me: So what do you want me to about it?

Competitor: Can you make it go away?

Me: Probably not, why do you think you’re sore?

Competitor: Because I’ve just spent 5 hours on a fat-bike.

Me: That makes sense. In fact, in the last two days you’ve managed to ski or fat-bike nearly 70km, over mountains, in the snow, and now you’re sore… Of course you’re sore! You’re meant to be sore! It’s good to be sore! It tells me that you’re human! AND you’ve managed to get through today after only a few hours’ sleep in a literally freezing cold tent, using rehydrated food as fuel. So if you can manage that, in as impressive of a time as you’ve just managed today, do you really think being sore is going to stop you carrying on?

Competitor: I suppose it isn’t. My hips do feel a bit tight though; could you help me with that? I’ve gotta ski tomorrow.

And that was that. Some tough love was what was mainly needed to help people realise that soreness is not all that bad in an event such as this. Once people recognised that they had just completed an arduous 40km bike ride and a minor bit of muscle aching was their only real complaint, they started to feel a little more prepared for the next day, as opposed to feeling worn out by the previous day. I suspect any ‘hands-on’ therapy I used that evening had only a tiny part to play in this.

Reconceptualisation

Often the fear of injury can be more debilitating than the injury itself. Never has this been more apparent than at the end of Day 3, a technically tricky 30km cross-country ski, when one competitor crossed the line supported by her team-mate, in complete agony and entirely unable to move her neck. This had the potential to be a serious injury. We laid her down, took a history and checked for any concerning features of serious pathology. She’d had a pretty nasty fall a few kilometres from the finish and had jolted the neck pretty hard but there didn’t seem to be any worrying signs of fracture or otherwise. It was likely to be an extremely irritated joint from the fall and the doctor and I tentatively cleared any serious pathology. This is when the hard work began – she had a marathon to run in 16 hours’ time.

The competitor was in a lot of pain; she was completely unwilling to move the neck; and her tearful statement of “I’m not going to be able to run tomorrow” showed the first signs of catastrophisation. “Nonsense,” I replied. “You’re telling me you’ve managed nearly 100km over 3 days and you’re going to a let a bit of neck pain stop you finishing? I’m not buying it; this isn’t going to stop you.” Three hours later, after a bucket load of reassurance, careful and gradual movement, some gentle mobilisations and a tiny piece of blue tape, she had nearly full movement of the neck and pain was now only a dull background ache. Was it my hands that fixed the problem? Definitely not. But what they did do was to help reconceptualise the injury. We managed to show her that her pain was adaptable and that it could change for the better with something as simple as a little bit of ‘hands-on’ therapy. We managed to gradually change her perception of the injury and removed her fear of moving the neck. It was the reconceptualising of her injury that decreased her pain response and helped her move the neck again. My hands helped facilitate this change but it was most likely words that played the most important role. Effective reassurance is perhaps the most lethal weapon in a physio’s arsenal and it certainly worked wonders that night.

People had picked up a few injuries during the ski and she wasn’t the only one who didn’t want to run on the final day. That night, three competitors told me that they weren’t even going to start the marathon the following morning. I couldn’t let this happen, especially when all three had achieved so much already and there was no physical reason they couldn’t run. After plenty of words of encouragement, a bit of reassurance and a little bit of kitchen-sink therapy, all three had the confidence to start the marathon on the final day.

Resilience

The N60 Challenge is tough and in an event such as this we expect some injuries. In physiotherapy, we often talk about making people resilient to injury which in my opinion involves two interlinked components. The first part involves physical preparation; the body will adapt slowly but surely to the work that you make it do. It is therefore essential that we train the body to adapt to the stresses that it is going to be placed under, making the body’s tissues robust enough to cope with those stresses without failing and causing injury. The second part involves psychological preparation; if people feel robust; if they feel invincible; if they are confident in their ability to succeed; then that person also becomes more resilient against injury. Physical preparedness is something that is achieved through training in the weeks and months leading up to an event like this. Mental preparedness is developed in the same way, but it is much more adaptable in the short term. One fall, one bad night’s sleep, one dip in mood, can change that feeling of invincibility into one of vulnerability.

In any multi-day event such as this, a physio’s role is a complicated one. People are going to feel sore, injuries are almost inevitable and they need to be assessed and appropriately treated, but there is very rarely anything that can be done to change the injury itself in the short time before the next event. Perhaps a physio’s most important role then is to give people the confidence they need to continue and to remove that feeling of vulnerability if it ever comes on. Make someone feel invincible and they will do the rest.

Going into the N60 Challenge not every competitor had the same level of physical preparedness; in fact some had a worrying lack of training. But the one thing that they all shared was an incredible drive to get through to the end. It was the camaraderie and the sheer determination that ultimately got people over the finish line of the marathon on that final day. It was incredible to watch each competitor and team cross the line each having accomplished something truly remarkable. It just goes to show that if you set your mind to it, you can push your body to achieve some extraordinary things.

Mark is a Manchester-based Physiotherapist with a special interest in the management of musculoskeletal and sporting injuries. He qualified in 2012 from Manchester Metropolitan University and has worked in a variety of different settings since. Mark currently divides his time between work in private practice and the NHS whilst also completing a Master’s degree in Sports Injury Rehabilitation at the University of Salford. If you’d like to hear more on Mark’s physio-related musings you should follow him on Twitter – @markreidphysio

Photographs supplied by Johnny Fenn Photography Ltd

N60 website: IGOADVENTURES.COM