Physiotherapist working on injured foot

Return To Running - Get Back In Shape

Running is a straightforward physical activity but there is one fly in the ointment: injury. Follow these key steps to help minimise your chances of picking up a strain

Running is an unrivalled activity for convenient cardiovascular exercise but it can be intense and if we push too hard or we have a flaw in our physical make-up our bodies soon let us know. Fortunately there is a great support network of professional services that runners have access to:

  1. keep them in good shape in the first place
  2. restore them to health when things go wrong

As the saying goes 'prevention is better than cure' - the best way to deal with injuries is to avoid them in the first place. Easier said than done as no matter how often you hear or read about the likelihood of injury, until it happens to you, it's not going to happen to you. If you see what I mean!

However if you've had injury problems before you'll recognise that the best way to work through a training programme is to extend your effort gradually, don't lose time because of injury and get to your goal in 'tortoise' rather than 'hare' fashion.

Take things gradually

A couple of key factors in staying well are gradual increase in mileage (10% maximum per week and regular periods of consolidation). Also make sure that any increase in your running effort is gradual too, aim for a steady progression in your interval sessions.

Cross training is a good way to avoid placing stress on limited muscle groups so activities like cycling, swimming and cardio sessions at the gym (not the treadmill) are a good way to develop your fitness but also to rest the parts of the body you hammer when you are running. All runners should develop a good stretching regime; even better build regular yoga, Pilates or Tai-Chi workouts into your programme.

Using a personal trainer works for lots of people as it includes fitness testing, individualised training programmes, goal setting and ongoing assessment plus technique correction. It can be a wise investment for people who've been inactive for a while or struggle with motivation and will instil good habits that hopefully stay with you long after you've stopped 'flashing the plastic'.

...regular sports massage is key to preparing for a marathon or other demanding event...

Continuing our theme of the merits of prevention, runners should be aware of the benefits of sports massage. One obvious benefit is that massage reduces muscle soreness; it also aids the decongestion of tissues and the reduction of blood viscosity. For many runners, regular sports massage is key to preparing for a marathon or other demanding event. A plus here is that the masseur will generally give you advice about the little stresses or strains that are worrying you and maybe recommend particular stretches.

Watch any 10k and you'll be amazed at just how different we all are - we come in unique shapes and sizes - and running is the activity that pinpoints our physical weaknesses. Getting the right shoe is a key starting point and all specialist running retailers will offer gait analysis to identify the category of shoe that will work for you. You are likely to be either neutral, an over pronator (support shoe) or a severe over-pronator (motion control shoe).

If however after being assessed by gait analysis and using the recommended shoe type you are still experiencing problems then you may consider seeing a podiatrist who could offer diagnosis and treatment of foot and lower limb injuries and abnormalities. A podiatrist may prescribe orthotics which are devices that are placed in a runner's shoes in an attempt to correct lower limb bio-mechanical abnormality.

Most running injuries are lower limb and related to overuse

Most running injuries are lower limb and related to overuse. Many of you will be familiar with problems such as arch of the foot pain (plantar fasciitis), Achilles tendonitis, runners knee (patella femoral tracking problems), and iliotibial band tightness to name a few.

Overuse can be described as a particular tissue of the body failing due to increased load, usually a relatively low load over time, such as a minor pull on a tendon repeated many times. This is actually how most runners start to train. One key component of running is the appropriate slow build up of strength by slowly increasing training. Slow build up actually allows the tissues to change in response to the stimulus they have: tendons become stronger, muscle bulk increases to help with power but also endurance improves as different muscle fibre types react to the stress of increased work.

Overuse then usually occurs when the body is not allowed to adapt fast enough or is not held in the correct alignment while repeating movements over and over. It is often the body part that 'gives' that becomes the injured part, though sometimes the tight bit that forces another area to 'give' may be affected. For example Achilles tendonitis can often be related to a sudden increase in running with poor footwear. This can allow the foot to excessively 'roll in' (over-pronate) which means that the calf muscle can become excessively tight which overloads the Achilles tendon this then becomes inflamed.


What physiotherapy does best is to identify for the client any areas of 'give' that are likely to cause injury before that injury happens - it can then work to give appropriate exercises to reduce the give and suggest training strategies. However, unfortunately, most of us wait for the early warning signs - minor pains or 'niggles' to become significant, which means the physiotherapist has to deal with symptom alleviation as well as the rehabilitation!

If you do pick up an injury it's best to see a physiotherapist with an interest in sports injuries, and preferably in running (better still if they are a runner). The most effective treatments will address the underlying causes of an injury not just the symptoms and it is important that any advice you get is related to the fact that you are a runner. It is also important that your physio should understand your desire to get running again, and should be able to make a sound judgment about when and how it is safe to do so.

In summary, prevention is better than cure, specialist professionals can successfully deal with problematic biomechanical issues and physiotherapy can deal with most of the injuries we encounter and help us avoid their repetition.

runABC is currently building a database of services for runners across the region and details of some of the south's physiotherapists can be found in our area focus section.

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