Perhaps one of the greatest mistakes that we can make as rehab professionals is to treat a runner, who is dealing with a pain problem, as if they have a tissue injury, when in fact they don't. Oftentimes, pain is more about sensitivity than it is true tissue injury. It is therefore critical to distinguish between the two if you hope to engender an optimal outcome. I'd also like to remind you that most runners are not chronic pain patients, but rather, highly motivated individuals, who have been mismanaged and are desperate to return to training to avoid an identity crisis.

​In certain cases, runners will present with legitimate tissue injuries. For example, if a runner strains their calf or hamstring, we must honor healing timeframes to avoid over stressing the site of repair while progressively loading them to adequately prepare them to withstand the performance demands of running. Failure to correctly identify and treat a runner presenting with a true tissue will only prolong one's recovery and perhaps worsen their condition.   

Understanding how to assess a joint is an important skill to master as a rehab professional. To highlight the importance of joint play, we need to look no further than a lateral ankle sprain, which is a common injury, that routinely goes untreated, and can lead to various sequelae. One of the residual effects of an ankle sprain is joint stiffness at the level of the talocrural joint, which can lead to a loss of ankle dorsiflexion and compensatory motion. Possessing the ability to assess and treat such an impairment is therefore critical to foster improved outcomes among runners. 

Never overlook equipment issues. Fortunately, when it comes to running there are relatively few equipment needs beyond shoes, socks, shorts, and a t-shirt or sports bra. Even then, not all of these items are necessary. In the event that you elect to wear shoes, make sure to take the time to screen them for potential defects or premature wear. As you can see from the this pic, the left shoe lacks symmetry. Imagine if a clinician did not correctly identify this defect and started blaming a runner's complaint on some other factor that had no bearing on the situation?

​If there is one thing that a recreational runner would benefit from, it's improving their comprehensive capacity. This is most easily accomplished through some basic resistance training, and taking runners out of the sagittal plane. The bottom line is that developing capacity is not only important when it comes to running, but also to get you through the day without issues. And please don't worry that you are going to bulk up from engaging in resistance training, as there is no evidence to suggest that this occurs.

​One of the first questions that I ask ALL runners seeking my services is, "What do you understand your problem to be?" I never cease to be amazed by the responses I get. In the vast majority of cases, runners have subscribed to misinformation that only serves to make their situation worse. By no means am I claiming to have all the answers, though there is a lot of credible evidence that we should apply to ensure that runners have the "least wrong" understanding of their situation. Some great examples of misinformation relate to footwear, pronation, and foot strike pattern. 

HABITS HABITS HABITS! This is the last and most important aspect to address in working with injured runners. Invariably training errors account for a large percentage of running related injuries. As the saying goes, "We live and die by our habits." The same applies to running. At day's end, adopting good decision making skills and healthy habits, particularly in the context of challenging times, lies at the heart of consistent and healthy running. 

Over the past couple days, I have performed a handful of physical therapy consultations with runners, who have "failed" conservative management, yet were desperate to get back to running. In typical fashion, I asked what they were doing as part of their home program. Invariably, it was some combination of foam rolling, stretching, and non-weightbearing progressive resistance exercises (PREs) targeting the hip. It's no wonder that they were struggling to return to healthy running, because all of these programs were not preparing the runner for the performance demands of the sport. So, I thought it was time to go back to the drawing board and review some basic characteristics and fundamentals of running. Hopefully, these will guide you the next time an injured runner walks into your facility. To accomplish this, we need need to look no further than the word R.U.N. 

Everyday, I receive an email or message from a recent physical therapy graduate, who is looking for guidance in terms of refining their approach to working with runners, or looking to establish themselves as a running rehab specialist. Although it takes time to master any craft, I thought it would be helpful to share a few pieces of advice/reminders to put you on the right path. By no means is this a comprehensive list, but rather, some simple suggestions that have helped me over the years. Lastly, it's critical to bear in mind that your ability as a runner has relatively little impact on your ability as a therapist, so never confuse the two.

"Everyone is entitled to his own opinion, but not to his own facts." -Daniel Moynihan-
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Having spent considerable time in the research lab at the University of Delaware, in addition to working as a research assistant and PT at the Nicholas Institute of Sports Medicine & Athletic Trauma (NISMAT), I had no choice but to immerse myself in the literature. Dr. Malachy McHugh, who is the current Director of Research at NISMAT, used to always remind me that clinical decisions should be driven by evidence rather than belief. So, if you want to be taken seriously, it's important to speak in denominators.

"A coach is someone who tells you what you don't want to hear, who has you see what you don't want to see, so you can be who you have always known you could be."
-Tom Landry-

There are some amazing coaches in the world of running. Chances are that there is even one in your town. Find out who they are and ask to train with their group if they are taking on new members. Otherwise, see if you can get them out for a coffee or a drink. Believe me, they could all use a good PT and will never turn down an opportunity to talk shop.

 "You can observe a lot by just watching" 
-Yogi Berra-

One of the best ways to learn more about running is to simply spend time at the local track watching runners train and race. You will see runners of all shapes, sizes, ages, and abilities while getting immersed in the running culture. And please don't be shy! Introduce yourself and tell people what you do from a professional standpoint. Considering the high incidence of running related injuries (RRIs), chances are that you will make some friends ;-) 

"If there's one thing that runners should do beyond running, it's strength train." - Gregory Lehman

When looking at the available body of research, it's become readily apparent that strength training plays an invaluable role in safeguarding against injury while improving running economy. Although the vast majority of runners are concerned that they will only put on mass or risk injury, this is a myth. So find the strongest people and the most well respected strength coaches in your area and connect with them. Remember, "you don't earn strength, you learn strength."

"Innovation is not about tricks, gimmicks, and products. It's about behavior change!"  -Al Smith-

The most brilliant clinicians I know possess an uncanny ability to weave pain science and motivational interviewing (MI) into their care. Irrespective of what approach or system you follow, it will be far more effective if you are able to help patients re-conceptualize their situation while facilitating positive behavioral change. That is where the true magic of our profession lies. So, if you are ever looking to take a con ed course, pick one related to pain science and/or MI. 

Selecting an appropriate running shoe has never been more confusing and difficult. This should come as no surprise considering the misinformation that exists related to arch height, pronation, and cushioning to name a few. We must also contend with experts from various fields and disciplines making grandiose statements regarding footwear without ever having evaluated or observed the runner, who clings to such advice as gospel. At day's end, how you run, and the decisions you make related to your running, far outweigh what's on your feet, provided that the shoe is 

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​SCREEN FOR MANUFACTURING DEFECTS

​RUN IN MORE THAN ONE PAIR OF SHOES

​ACCOMMODATE THE FOREFOOT

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​DON'T FALL PREY TO THE UPSELL OF ORTHOTICS

​STICK WITH WHAT FEELS COMFORTABLE ON YOUR FEET

I recently shared a simple return to running program for medical and fitness professionals to help injured runners return to consistent training. Before initiating such a program, however, a runner should meet certain prerequisites or milestones to ensure that it is appropriate to advance their activity level while avoiding a potential relapse in their condition. In the event a runner does not meet the items on this checklist, and prematurely attempts to return to training, they are playing with fire and will most likely prolong their recovery. So before transitioning a runner back to training, take the time to ensure that they meet the prerequisites outlined below. ​