PART 1

Written by: Alex Bell
Images by: Bradley Farley (@bradleyfarleyphoto)

Nedd Brockmann achieved something many thought was impossible, running from Perth (Cottesloe) to Bondi in 46 days. It was the most inspiring athletic feat I have ever witnessed and something that will go down in Australian history forever. Nedd has raised well over 2 million dollars for ‘We Are Mobilise’, a charity that is making a difference to homelessness in this country. When Nedd arrived in Bondi on Monday afternoon it was like nothing I have ever seen before and nothing I will see again. The energy was electric, the noise deafening and the joy was palpable. Many people have been asking what injuries Nedd was dealing with. We have been lucky enough to be working with Nedd for over 2 years and we can tell you that he is the toughest athlete we have ever seen - both physically and mentally.

Before we get into it I want to make it very clear that Nedd is happy for us to share with you all the injuries he was dealing with both in the lead up and during the run itself. We want to give you an insight into Nedd’s ability to push his body to the limit and overcome some of the most extremely painful injuries that you can sustain as a runner. I will highlight one thing though, please seek professional help early if you have any injuries. Nedd is one of a kind and would have literally crawled to Bondi if he had to. He was on a path to greatness at any cost necessary.

Okay let me set the scene. My name is Alex Bell, Physiotherapist and founder of The Running Room. We are a physio and podiatry clinic that specialises in treating runners and active individuals. We have helped thousands of runners across Sydney and London to get the most out of their bodies. I tell you this as of the thousands of runners we have worked with I have never seen anyone like Nedd. This has redefined what I thought was possible in terms of the capability of the human body and the ability for someone to run through the injuries that Nedd sustained. Something that I am still trying to grasp.

I was lucky enough to be on the road with Nedd, however, this story begins well before the run itself. Nedd was dealing with some injuries prior to running across the country and this will give you context of just how incredible this achievement really was. Just weeks out from the run Nedd was experiencing knee pain (runners knee) in both knees as well as shin pain with mild bone stress in the tibia (shin bone) detected on MRI only weeks out from the run. We had shifted the focus of training (with the help of great mate and coach Matty Abel) towards heavy strength and conditioning and reduced running volume to build capacity in Nedd’s tissues. Knowing he had the ability to run long distances with his incredible 50 marathons in 50 days a couple of years prior the strategy was to build as much tissue resilience and for Nedd to go into the run somewhat underdone from a pure running volume standpoint. There is a lesson in the fact that strength training is so important to runners, but that is a blog for another day.

Alright, I arrived on day 3. Nedd had run over 300km by this point into some ferocious head winds and constant rain. Nedd was in bed when I arrived from Perth but I was keen to get my eyes on how the body was holding up. The next morning and the first thing I noticed was his knees. There was a good amount of swelling in both of them. Something that we knew we would be dealing with given Nedd was dealing with knee pain before the ran began. As Nedd’s mantra in his home gym goes “no one has ever died from busted knees”. We treated these as best we could: managing swelling, utilising a topical anti-inflammatory, treating the surrounding musculature and mobilising the knee cap as well as a joint on the outside of leg (proximal tibiofibular joint). We trialed taping, however, this was not as effective as I had hoped and we only did this intermittently before ceasing.

Nedd’s left calf fired up pretty early into the run. Crazy to think about using the word ‘early’ given he had run over 400km by this point in time. But when you are running across the country it's all relative. Soft tissue release, compression and we opted to utilse some heel lifts in his shoes at this point to reduce the amount of dorsiflexion (bend) in his ankle to reduce the loading on the calf. Heel lifts can be a good solution to offload certain structures. Like the name suggests they are simply lifts that you put under the insole of the shoe. This gives the shoe more of a heel to toe drop and can be useful in shifting load around. I use these a lot with achilles tendinopathy patients (especially insertional - for those physios reading) and calf complaints.

It is a different type of physiotherapy being on the road and working with athletes when they are in the fight. A lot of problem solving, quick thinking and trying unconventional techniques to try and reduce pain and discomfort. To any physio’s out there reading this, communication and forward thinking matters here. I would always aim to look at Nedd running, observe his body language and predict what he might need at the next break. I would aim to reassure him that things are okay and would explain what it was we were trying to achieve with our treatment. This is where not only what you say matters but how you say it means a lot. I would always aim reassure Nedd that he was looking good and to be really honest he was usually running with a beautiful looking stride - even when his body was screaming at him. I would aim to have the treatment table and supplies out at every main stop (20km, 40km, 60km, 80km) but in between these stops I would not always suggest that we treat Nedd. A delicate dance of knowing when to suggest treatment and when to sit back and say “we will treat it at the 20, 40, 60 or 80”. I made these decisions on the fly, aiming to analyse Nedd’s movement as well as his mood, screams, tears, laughter, smiles and piercing stares. Treatment when you are in the heat of battle is very different to when you are in the four walls of the clinic.

I distinctly remember the bottom part of Nedd’s right anterior tibia or the bottom of his shin bone becoming increasingly swollen. This swelling was severe and extended into the top of the foot. So much so that his shoes no longer fit and we had to opt for the next size up and we laced his shoes in a different way to avoid compression of the tendons. This swelling was severe in nature and was extremely sore to touch - I can still recall the sounds of Nedd screaming when it was palpated, or when his foot moved unexpectedly taking off his shoes. This was the beginning of the worst injury Nedd sustained out there.

This is called tenosynovitis. Okay, quick anatomy review for those playing along at home. Down the front of your shin bone you have a number of muscles and tendons. Now these muscles down the front part of your shin are responsible for you being able to lift your foot up as well as your toes - they have other roles around the foot and ankle but let's just keep it simple for now. This is very important for running and walking for obvious reasons. These tendons are encapsulated in a tendon sheath. When you overload these tissues (running 100km per day and there were a lot of hills in the first few days out of Perth which means these tissues work even harder) you may get swelling and inflammation inside and of these tendon sheaths - tenosynovitis.

It then becomes extremely painful with movements that involve these muscles and tendons eg. running, impact, moving your foot up and down. Initially we tried to settle this down & it was somewhat effective for around a week with the use of a topical anti-inflammatory gel which we then wrapped the site with glad wrap to slow down the absorption. We would do this every night in an attempt to settle the inflamed tissue. I wanted to tape the ankle joint to limit movement but compressing the tissue caused extreme pain for Nedd. We strapped the foot and ankle with tape that had some level of stretch which although did not stabilise the ankle as much, it provided minor relief, temporarily.

Day 12 - The phone call from hell.

I had flown back from Perth to Sydney after day 11 as I had a pretty wild couple of weeks leading into Nedd’s run. My father had passed away a week prior to Nedd starting and I flew out 2 days after his funeral to be with Nedd. It was important I go back to Sydney for multiple reasons but as soon as I returned I only wanted to be back on that road with the team and with Nedd. I would wake at 3am and think about him, how his body was going and would speak with Jemma and Kylie and run them through treatment techniques and taping over the phone.

Day 12 I got the call. Nedd can’t run. He can’t pick up his foot anymore. His plan was to walk the 100km until 1am in the morning. I called Nedd - a strange sense of calm even as he was dealing with the potentiality of what could lie ahead. I distinctly remember him saying “I am just going to keep walking until the wheels fall off.” And he would have unless we convinced him otherwise. I still think about that moment. How far would he have gone if we didn’t convince him to pull up stumps at 42.2km that day? It’s scary to think about really.
Okay, drop everything in Sydney now. It is time to get on the phone. I must have been on the phone for 4 hours that day. Why do these things happen in the middle of our great country? No MRI’s at the Nullarbor RoadHouse. I called Esperance, Ceduna, Port Augusta, Port Lincoln and Whyalla - we needed an MRI as we needed to rule out significant bone stress in Nedd’s tibia. This type of injury is not uncommon amongst runners and especially when you have run over 1100km in just over a week.

It was a funny conversation ordering that MRI at Whyalla. I called and they said they could get Nedd in for a scan in 2 weeks time. I explained what he was doing and although they were in disbelief they came to the party and the 13 hour one way trip began. To think that Nedd and Jemma drove the Nullabor effectively twice is a crazy thought. The MRI revealed no bone stress - a relief came over me like you wouldn’t believe. Having said that we were dealing with what we knew had been occurring since about day 3 or 4 - this highlighted the extent.

“Quite marked oedema surrounding the tendons of the tibialis anterior, extensor hallucis and extensor digitorum with tenosynovitis, maximal affecting the tibialis anterior where there is tibialis anterior sheath effusion. There is also oedema at the anterolateral margin of the distal tibia at the crural fascial insertion”

I must give a shout out here to Sports Doctor Dr David Samra. He played a pivotal role in assisting what followed with regards to the cortisone injection and his communication with Nedd was incredible. I remember Nedd telling me it really helped to hear Dr Samra acknowledge his frustrations and he laid out the options very clearly. We put you in a boot and let it settle or we trial an injection into the tendon sheath. He knew the answer he was going to get.

An ultrasound guided injection followed - one injection into the tibialis anterior tendon sheath and one into the extensor digitorum tendon sheath.  If you ever have to have this done, it’s not pleasant.  Here is Nedd’s description. 

“The cortisone didn’t really inject very well as there was so much swelling, it felt like expanda foam going into a tiny little nerve, but we got it in.”

We opted for the use of a dictus band (great suggestion from the doc). Now this band is a type of neurological brace - essentially we use them in people with foot drop. It is a brace that attaches around the ankle joint with a small rubber band that attaches to your laces. When the toes point when you push off it assists in pulling the ankle upwards. Nedd had lost his ability to lift his foot up by this point and in fact he couldn’t really move his foot and ankle at all without severe pain.

Let me run you through what typical management looks like after a cortisone injection and then we will run you through the Nedd Brockmann protocol. I will say that this is the most insane thing I have ever seen in my career. So post cortisone injection you are recommended to take 3 days off to let things settle. What Nedd did was slightly different to that. He drove back from Whyalla - a 13 hour drive to get back at 3am. He had a 2 hour sleep and then proceeded to knock out a 100km run. Yes, you read that right. 100km run after having a cortisone injection some 13 hours prior and driving through the night to just start hammering. Just let that sink in for a minute and then prepare for your mind to be blown again. In the week following Nedd’s scan and cortisone injection he went on to run 675km in the 7 days following - that is an average of 96.42 kms per day after being in crippling pain and not being able to lift his foot.

I want to leave it here for today as there are so many more injuries to uncover and stories of Nedd’s resilience to tell. I will release part two of this series next week.

Until then I will leave you with this quote from Nedd immediately following his day 15 100km run:

Got the the scans and thankfully I have some incredible people in my corner so when push came to shove we got what we needed to get done. We were out of there at 3:30 in the arvo yesterday. Drove all night and hopped on the track at ten to five and got hammerin.
No complaining here, frothed it. Ankles scat but we get TF on with IT!
We don’t quit, I never have and I never will.
Quote of the day - again “FIND A WAY”

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