What Should Physio for Runners Actually Look Like?
It’s not too controversial to say that many physiotherapists or other musculoskeletal specialists can fall short when it comes to managing running injuries. Often, this isn’t about a lack of care or intent. The truth is, running injuries are rarely straightforward and successful return requires more than just pre printed exercise and some none specific massage. They are usually multifactorial in nature—meaning there isn’t one clear cause or one simple fix. Injuries can develop over time due to subtle biomechanical issues, poor recovery, inappropriate training loads, or even lifestyle stressors.
Equally, the path back to pain-free running while lowering your risk of subsequent injury often requires much more than simply waiting until it stops hurting and then picking up where you left off. That’s why we wanted to write a blog explaining what we believe good physiotherapy for runners should look like. Whether you’re training for a marathon or just enjoy clocking a few miles each week, this approach applies.
We don’t believe a physio needs to be an elite runner themselves. However a solid understanding of the following will ensure a much more comprehensive approach:
The clinical science behind pathology, pain, and rehabilitation
The biomechanics and kinetics of running
The principles of strength and conditioning
The importance of training load, recovery, and readiness
How to interpret objective data and relate it back to the person in front of them
1. A Detailed, Individualised History: The Foundation of Great Physio
This isn’t just about asking where it hurts. A good subjective history gives us an understanding of why the injury occurred, what might be keeping it going, and what it will take to get you back safely.
General history / background: including relevant health conditions, past injuries, surgeries, medications, and current symptoms.
Training history and recent changes: Have you increased mileage, intensity, terrain, or frequency? Have you added intervals, hills, or long runs too quickly? This is crucial in spotting load errors and arguably the most common contributor to running injury.
Footwear: Has there been a change in model, structure, or support? Is your footwear appropriate for your biomechanics and running style?
Running data (Garmin/Strava): Training logs help us assess changes in volume, pace, or recovery between runs, these are often details you might not remember off the top of your head.
Other physical activity: Are you doing S&C work, cross-training, or sports that may influence load and recovery.
Running goals: Are you preparing for an event, trying to build speed or distance, or simply aiming to stay active? This defines what your rehab must prepare you for post injury.
Recovery Strategies: Often Overlooked but always Important
This is a critical part of our assessment and often gets missed in traditional physio.
Sleep quality and quantity – Poor sleep reduces tissue healing, impairs neuromuscular recovery, and alters pain thresholds. Without good sleep, the risk of re-injury increases significantly.
Nutrition – Are you fuelling adequately for your training? Inadequate calorie or nutrient intake (especially protein and carbohydrates) can delay recovery and increase injury risk. RED-S (Relative Energy Deficiency in Sport) is a key concern.
Stress and life load – Chronic stress elevates cortisol levels, impairs recovery, and reduces your body’s ability to adapt to training. High life load combined with high training load is a recipe for overload.
2. Clinical Assessment: Beyond Just Local Pain
A proper assessment must include a whole-person view of the injury.
Swelling, bruising, and palpation: These basic signs help us determine where you are in the healing process and whether deeper tissue damage may be present.
Joint range of motion and mobility testing: Useful for identifying restrictions or compensations, especially if other joints are offloading the injured area.
Laxity or joint stability tests: Particularly relevant for ligamentous injuries or chronic instability issues.
Visual signs of overload: For example, bony thickening or Haglund’s deformity at the Achilles attachment can indicate repeated mechanical irritation.
Further examining of running gait (if relevant), and any habitual movement patterns that might lead to poor load distribution over time.
3. Objective Strength, Stability & Capacity Testing: Removing the Guesswork
One of the most important (yet often overlooked) aspects of treating runners is measuring the actual capacity of the body to do what we want it to do.
Why?
Pain levels are not always a good indicator of tissue health or performance readiness.
You can feel better with rest, but that doesn’t mean your body is strong enough to return to running without risk.
common assessment:
Muscle strength and control – using exercises like single-leg sit-to-stand, calf raises (gastrocnemius vs soleus bias), hamstring bridge tests, and comparing reps on each side.
Isokinetic testing (via dynamometer) – This provides accurate, quantifiable data on max force output, rate of force development (RFD), and limb asymmetries for quads, hamstrings, and hip stabilisers. RFD is especially relevant in plyometric or explosive activities like sprinting or trail running.
Force plate testing (e.g., VALD systems) – We can test single-leg stability, vertical stiffness, isometric strength, and performance in hopping, jumping, and landing tasks. These reflect how well a limb can tolerate rapid loading and decelerate forces—critical for injury prevention.
These tests help us:
Identify weak links in the kinetic chain
Track progress over time
Decide when and how to progress your rehab
Reduce the risk of re-injury
We always emphasise that findings must be clinically relevant. Slight asymmetries or "deficits" don’t always require fixing unless they clearly link to your symptoms or goals.
4. Planning Rehab & Return-to-Running: A Shared Decision
All of the above only works when it’s brought together in a clear, individualised plan—not just based on what we find clinically, but what matters to you.
Explain what has been found and why it matters
Discuss treatment options, their pros and cons
Set realistic timelines for recovery
Plan your return to running with structure, guidance, and progression
Depending on your injury and goals, a running gait analysis can be very useful.. But we treat this with caution. Common findings like “overpronation” are often over-emphasised, and changes in running mechanics must be made carefully and with purpose. We’ll only use gait findings to guide rehab if they clearly relate to your current symptoms and goals.
Your program might include:
Tissue-specific loading strategies
Strength and power development
Plyometrics, running drills, and return-to-run progressions
Recovery monitoring (HRV, soreness, fatigue)
Scheduling of training sessions and deload weeks
Final Thoughts: What Sets Great Physio for Runners Apart?
Great physio isn’t just about pain relief—it’s about preparing your body to do what you love, better and more consistently.
That means:
Understanding you, your goals, and your sport
Taking time to assess not just the injury, but the contributing factors
Using objective data to guide rehab, not guesswork
Ensuring you’re strong, stable, and ready before you return
If you’re struggling with a running injury or just want to train smarter, we’re here to help.
