Running Injury Physiotherapy Brisbane: Load Management, Treatment and Return to Running
By Max Cuneo, Physiotherapist
Running is an excellent way to improve cardiovascular fitness, strength and overall health. However, running injuries can develop when training demands increase faster than the body can adapt.
Running injury physiotherapy aims to identify why symptoms have developed, address contributing factors and gradually rebuild your capacity to run.
Importantly, most running injuries are not caused by one bad step or a single faulty movement. Instead, they often develop when there is a mismatch between training load and tissue capacity.
This article explains common running injuries, why they occur, why symptoms sometimes persist and how physiotherapy can help you return to running safely.
What Are Common Running Injuries?
Running injuries are often related to repetitive loading rather than a single traumatic event.
Common running injuries include:
- Achilles tendinopathy
- Calf strains and calf pain
- Plantar heel pain
- Patellofemoral pain or runner’s knee
- Shin pain
- Bone stress injuries
- Hamstring pain
- Hip and gluteal pain
- Tendon-related injuries
- Foot and ankle pain
Running repeatedly loads the muscles, tendons, bones and joints of the feet, ankles, knees, hips and trunk. Fortunately, these tissues are designed to adapt to load. However, they need enough time to recover and become stronger. Problems can develop when running distance, speed, frequency or intensity increases faster than the body can adapt.
What Causes Running Injuries?
There is rarely one single cause of a running injury. Instead, several factors may contribute.
Training Load
Changes in training load are one of the key factors to consider when assessing a running injury.
For example, symptoms may develop after increasing:
- Weekly running distance
- Running frequency
- Running speed
- Interval training
- Hill running
- Long-run distance
- Trail running
- Training on different surfaces
Research has identified a relationship between training load and injury, illness and soreness in athletes (Drew & Finch, 2016). Further research has also supported an association between training load and musculoskeletal injury risk (Eckard et al., 2018).
This does not mean running is dangerous. Instead, it highlights the importance of appropriate training progression and allowing the body enough time to adapt.
Strength and Tissue Capacity
Your muscles, tendons and bones need sufficient capacity to tolerate the repetitive forces associated with running. For example, reduced calf strength may influence the ability of the calf and Achilles tendon to tolerate repeated running loads. Similarly, inadequate lower-limb strength or conditioning may become more noticeable when training volume increases.
Running Biomechanics
Running technique can influence where forces are distributed through the body. However, biomechanics should not automatically be viewed as something that is either “right” or “wrong”. Many running injuries are better understood by considering the relationship between: Running load + biomechanics + strength + tissue capacity + recovery rather than focusing on one supposedly faulty movement pattern.
Why Do Running Injuries Keep Coming Back?
One of the most common responses to running pain is to stop running completely. In some situations, temporarily reducing running may be appropriate. Rest can also help settle irritated tissues. However, rest alone does not necessarily address the reason the problem developed. During prolonged periods of rest, running-specific capacity may actually decrease. Therefore, if strength, tendon capacity or training progression are not addressed, symptoms may return when running resumes.
Achilles Tendon Pain as an Example
The calf-Achilles complex is heavily involved in running.
If calf strength and Achilles tendon capacity are not sufficient for your current running volume, symptoms may appear during:
- Hill running
- Speed sessions
- Increased weekly mileage
- Longer runs
- Increased running frequency
Simply resting until the pain settles may not rebuild this capacity. Instead, rehabilitation often needs to progressively strengthen the calf and Achilles tendon before gradually increasing running exposure. Research into running-related injuries supports a multifactorial approach that considers the relationship between running exposure and the body’s ability to tolerate that exposure (Bertelsen et al., 2017).
How Can Physiotherapy Help Running Injuries?
Physiotherapy for running injuries usually involves more than treating the painful area.
At our Tingalpa clinic, a running injury assessment may consider three main areas.
1. Review Your Running and Training Load
We first look at what has changed.
This may include:
- Weekly running distance
- Running frequency
- Long-run distance
- Speed sessions
- Hill training
- Recent races
- Changes in terrain
- Changes in footwear
- Strength training
- Recovery between sessions
Sometimes, relatively small changes across several areas can create a significant increase in total training demand.
2. Assess Strength and Running Capacity
The next step is assessing whether your body currently has the capacity to tolerate your running demands.
Depending on the injury, this may include assessment of:
- Calf strength
- Single-leg strength
- Hip strength and control
- Balance
- Hopping capacity
- Tendon tolerance
- Range of motion
- Running-related movement
- Functional endurance
Rather than simply identifying weakness, the aim is to determine which factors are relevant to your symptoms and running goals.
3. Gradually Rebuild Running Exposure
Once symptoms and contributing factors have been assessed, running can often be progressively reintroduced.
Your physiotherapy treatment plan may include:
- Strength training
- Tendon-loading exercises
- Running load modification
- Mobility exercises where appropriate
- Running technique or gait advice
- Recovery strategies
- A staged return-to-running program
The goal is not simply to reduce pain.
Instead, rehabilitation aims to increase your capacity so that your body can tolerate the running you want to do.
Do You Have to Stop Running When Injured?
Not always.
Whether you need to stop running depends on the type and severity of the injury.
In some cases, running can continue with adjustments to:
- Distance
- Speed
- Frequency
- Hills
- Training intensity
For other conditions, such as a suspected bone stress injury, temporarily stopping running may be necessary. Therefore, an appropriate diagnosis is important before deciding how much running is safe.
When Should You Have a Running Injury Assessed?
Consider having your running injury assessed if:
- Pain keeps returning when you run
- Symptoms are becoming progressively worse
- Pain is limiting your running distance
- You have changed your running technique because of pain
- Symptoms are affecting walking or everyday activities
- You repeatedly need to stop training
- Your symptoms return whenever you increase your training
- You are unsure how to safely return to running
Early assessment can also be useful if you are preparing for a race and want to avoid repeatedly increasing and reducing your training because of recurring symptoms.
Running Injury Physiotherapy in Tingalpa, Brisbane
At the Institute of Sports and Spines in Tingalpa, we assess running-related injuries by considering both the painful area and the demands placed on your body.
This may involve looking at your training load, strength, tissue capacity, running biomechanics and recovery.
By identifying the factors that are most relevant to your injury, we can develop a structured rehabilitation and return-to-running plan based on your current capacity and running goals.
If running pain keeps returning or is preventing you from training normally, a running injury physiotherapy assessment may help provide a clearer pathway back to running.
Frequently Asked Questions
What is the most common cause of running injuries?
Running injuries rarely have one single cause. However, a rapid increase in training load is a common contributing factor. Changes in distance, speed, hills, running frequency or recovery can increase the demands placed on muscles, tendons and bones.
Should I stop running if I have pain?
Not necessarily. Some running injuries can be managed by temporarily modifying running distance, speed or frequency. However, certain injuries require complete rest from running. An assessment can help determine what is appropriate.
Can physiotherapy help with recurring running injuries?
Yes. Physiotherapy can assess factors such as strength, tendon capacity, training load and running biomechanics. Rehabilitation can then focus on gradually increasing the body’s ability to tolerate running.
How long does it take to return to running after an injury?
Recovery time depends on the injury, its severity, how long symptoms have been present and your training goals. A minor overload problem may improve relatively quickly, whereas tendon and bone stress injuries can require a longer period of progressive rehabilitation.
Do I need a running assessment if my pain only occurs after running?
Recurring pain after running may indicate that your current training load is exceeding the capacity of a muscle, tendon, bone or joint. An assessment can help identify contributing factors and guide your training progression.
References
Bertelsen, M. L., Hulme, A., Petersen, J., et al. (2017). A framework for the etiology of running-related injuries. Scandinavian Journal of Medicine & Science in Sports, 27(11), 1170–1180. https://doi.org/10.1111/sms.12883
Drew, M. K., & Finch, C. F. (2016). The relationship between training load and injury, illness and soreness: A systematic and literature review. Sports Medicine, 46(6), 861–883. https://doi.org/10.1007/s40279-015-0459-8
Eckard, T. G., Padua, D. A., Hearn, D. W., Pexa, B. S., & Frank, B. S. (2018). The relationship between training load and injury in athletes: A systematic review. Sports Medicine, 48(8), 1929–1961. https://doi.org/10.1007/s40279-018-0951-z
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