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Fit To Run: Why Physical Therapy WILL WORK For Your Running Injury


Early in my career, I had a patient share a story with me. Mrs. Smith (for purposes of this article) was a sweet elderly lady whom I was treating for shoulder pain. She was running out of options to manage her increasing discomfort and finally stumbled on Physical Therapy.  In interviewing her to determine the cause of her pain, she told me of a previous interaction she had had with a medical provider. She had informed him that her shoulder pain was increased with reaching over her head to put away dishes in her cabinet.  His solution?  “If it hurts to reach over your head, don’t reach over your head”.  I wish I was joking.

 Why this advice is an appropriate form of pain management is beyond me, but sadly I have heard this and other, similar stories over the course of my career. The most common scenario? Runners being told to stop running!

 First, let me define the types of injuries this article is referring to. Common running-related injuries include Runner’s knee, IT band syndrome, Plantar Fasciitis, Achilles tendinitis, Shin Splints, etc. These and other common overuse injuries are what I am referencing throughout the article. I am not telling you that rest from running is a “bad thing” if you have recently had a surgery or are dealing with a stress fracture.

 Lets talk about “rest” and why I do not use it as part of a rehabilitation plan when working with athletes and, specifically, runners. Running injuries are related to at least one or a combination of three important factors: Body type/structure, running mechanics (or “form”), and running mileage. Since body structure cannot feasibly be changed, we will focus on mechanics and mileage. If your running mechanics are “poor”, your mileage needs to be “low” in order to avoid injury. However, if your running mechanics are “good”, your body can likely tolerate increased mileage as compared to someone with “poor” mechanics.

 To take it a step further, this leaves us with two main options. First, you can accept that your weekly mileage may need to be lower than desired in order to prevent injury. Or (I like this one better), you can make changes in your running efficiency (i.e. mechanics) that will allow for a safe progression of mileage to meet your goals, whether that means recreational running or as part of a race training plan.

 These changes in running efficiency don’t happen with “rest”. Research will also support that these changes do not happen consistently with strength training, foam rolling, stretching, icing, etc. performed together or in isolation.

So what does it take? The answer lies not only with the strength of the “running muscles”, but how they are recruited by the brain according to our motor (or movement) patterns. You see, the best tool to evaluate and improve your running mechanics is a biomechanical evaluation by a Physical Therapist who specializes in working with runners. This will help to identify common problems with individual “movement patterns”, which can be addressed with running-specific exercises to activate specific muscles and train them to stabilize during the running motion.

 So whether you are resting from your running injury because you were told to or because it seems intuitive, I’m here to tell you that this is not the solution. While backing off on mileage may temporarily help, your pain will almost always come back when you start to “pick back up” the mileage. You need a comprehensive examination (including video analysis) of your running mechanics to see the whole picture!



Anthony Moss is a Physical Therapist who specializes in the treatment of athletes. As a frequent competitor at the marathon and half marathon distance, he has a special interest in the evaluation and management of runners. He frequently utilizes slow-motion video analysis for biomechanical assessment of runners to guide rehabilitation, maximize performance, and reduce injury risk. 

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