Running physio in Brunswick: most running injuries are load problems

Somewhere between a third and a half of regular runners pick up an injury that interrupts training each year. The overwhelming majority are overuse injuries rather than accidents, and the overwhelming majority of those trace back to the same thing: a change in load the tissue was not ready for.

That is a more useful frame than looking for a defect to correct, because load is something you can control this week.

The load story

Every tissue, tendon, bone, muscle, cartilage, has a capacity, and that capacity adapts to what you ask of it. Injuries happen when demand exceeds capacity, which can be because demand went up quickly or because capacity dropped.

Common ways demand goes up faster than capacity:

• Adding distance too quickly. The ten-percent-a-week guideline is crude, and it is directionally right
• Adding hills or speed work, which load tissue very differently from steady mileage, on top of existing volume
• Returning after a layoff at the level you left at. Capacity falls faster than fitness feels like it does
• Changing surface or footwear
• Sleeping badly, under-eating, or training through illness, all of which reduce the rate at which tissue recovers and adapts

What running form actually contributes

Less than the internet suggests, and not nothing.

Two changes have reasonable support:

Step rate. Increasing cadence by 5–10% reduces load at the knee and hip meaningfully. It is one of the few adjustments with decent evidence and it is easy to implement.

Step width. Running with the feet landing very close to or across the midline increases load on the outside of the knee and hip, and is associated with ITB syndrome in particular.

What has less support than commonly claimed: forefoot versus heel striking as a general prescription. Changing strike pattern changes where the load goes, from knee to calf and Achilles, rather than reducing it. Someone with knee pain may benefit; someone with Achilles pain will not.

Pronation, likewise, is a much weaker predictor of injury than the shoe marketing of the last thirty years implied.

The five most common running injuries

• Patellofemoral pain, front of the knee, worse downhill and on stairs
• Medial tibial stress syndrome, pain along the inner shin
• Achilles tendinopathy, stiff and sore at the start of a run, aching after
• Plantar fasciopathy, heel pain worst in the first steps of the morning
• ITB syndrome, sharp outer knee pain at a predictable point in a run

Each has its own detail, and all five share the same underlying story.

What actually reduces injury risk

Strength training. The intervention with the best evidence, and the one runners skip most. Two sessions a week of loaded lower-limb work, squats, deadlifts, calf raises, single-leg work, raises tissue capacity. Studies of strength training in runners show meaningful reductions in overuse injury.

Sensible progression. Boring, effective. Build volume before intensity, and only change one variable at a time.

Sleep and fuelling. Under-recovering and under-eating both reduce adaptation. Low energy availability in particular is a well-established risk factor for bone stress injuries, and it is not confined to elite athletes.

Not running through pain that is getting worse. Mild discomfort that settles within 24 hours and does not worsen week to week is usually acceptable. Pain increasing over successive runs is not.

When to get it assessed rather than manage it

• Pain that is focal, particularly on bone, a possible stress fracture
• Pain that wakes you at night or hurts when walking
• Pain that has not improved after two to three weeks of reduced load
• Numbness, pins and needles or weakness
• Swelling, locking or giving way in a joint
• A sudden onset with a pop or a sharp tear

Running physio and running assessments in Brunswick

Running is a particular interest of Andrew Macdonald, the physiotherapist at Brunswick Health, and Achilles tendinitis is the injury he most enjoys treating. He runs running assessments for anyone whose training keeps breaking down, whether you’re injured now or want to stop it happening again.

A running assessment covers your training and injury history, watching you run, and a strength and mobility screen through the hips, knees and ankles. It ends with a plan for the injury or the training block, built around how much you’re running and what you’re running for.

Assessment covers the injured tissue and the training history that produced it, what you were doing, what changed, and when the pain started relative to that. Most of the answer is in the history.

Treatment usually combines hands-on work to settle symptoms with a loading programme to rebuild capacity, plus specific changes to the running itself. Where a tendon problem has become stubborn, shockwave therapy is available on site. Where the foot is a genuine contributor, the podiatrist is in the same building and a gait assessment is a conversation away rather than a referral.