Running injuries are common in both experienced runners and those returning to activity after a period of time away.

At ADAPT. PERFORM., I focus on identifying the underlying cause of injury and guiding structured rehabilitation to help you return to running with confidence.

Rehabilitation combines hands-on physiotherapy, strength training and load management to restore your body’s ability to tolerate running. Whether your goal is to return to pain-free running, build consistency or improve performance, treatment is tailored to your individual needs.

Based in St Paul's, Bristol BS2, I work with runners across the city including Montpelier, Stokes Croft, Cotham, Redland, Bishopston, Easton, Clifton and surrounding areas — from first-time 5k runners to ultra athletes and everyone in between.

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Common Running Injuries

Running injuries are often related to training load, strength deficits, movement patterns or recovery factors. Many injuries develop gradually rather than from a single event.

Common running injuries include:

• Achilles tendinopathy

• Patellofemoral pain (runner’s knee)

• Calf muscle strains

• Hamstring injuries

• Bone stress injuries and stress fractures

• Plantar heel pain / Plantar fasciitis or fasciopathy

• Iliotibial band (ITB) pain

Early assessment and appropriate rehabilitation can help prevent injuries from becoming persistent and support a quicker return to running.

Why Running Injuries Occur — And Why Rest Usually Isn't the Answer

Most running injuries aren't random events. They're load management failures.

Running places repetitive, predictable load on the body — each mile asks muscles, tendons and bones to absorb and transmit force thousands of times. Injury typically occurs when that load exceeds what the tissue is currently prepared to handle. The imbalance is usually one of four things:

• Training load increased too quickly — higher weekly mileage, faster pace, more intense sessions, or all three simultaneously

• Recovery between sessions insufficient for adaptation — either not enough sleep, not enough rest days, or both

• Tissue capacity lower than the load demands — often from insufficient strength work, or returning from a prior injury before capacity was fully rebuilt

• External factors — new shoes, harder surfaces, major training structure changes, or life stress affecting recovery
  

Why "Rest" Usually Isn't the Answer

The traditional advice for running injuries is rest. Sometimes that's right — acute stress fractures need protected loading, acute tendon ruptures need surgery, certain injuries do require a period of offloading.

But for the majority of running injuries — tendon pain, overuse knee pain, ITB symptoms, recurrent niggles — rest alone doesn't fix the problem. It often masks it. Symptoms settle when you stop running, then return when you start again, because the underlying tissue capacity hasn't changed.

What works better is load modification combined with targeted strengthening. Reducing the specific load that's provoking symptoms while building capacity in the tissues that need it. Running-specific fitness can often be maintained through cross-training and adjusted running during this period.

This is why assessment is important — knowing which injuries genuinely need rest and which need load management is what separates effective rehabilitation from cycles of rest and return that never fully resolve.

How Running Injuries Are Assessed

Running injuries are rarely caused by a single factor. Assessment focuses on understanding both the injury and the factors contributing to it.

This may include:

• Training history, running load and goals

• Recent changes in running routine

• Previous injuries

• Strength training history

• Footwear and running surfaces

• Rest and recovery habits

Where appropriate, objective measures such as strength testing, dynamometry, force plates and performance-based testing may be used to better understand your current capacity and guide rehabilitation.

Rest, Recovery and the Bigger Picture

Training adaptation doesn't happen during training. It happens during recovery.

When rest and recovery don't match the training load being applied, the body doesn't have the chance to adapt — and eventually, something breaks down. For runners this most commonly shows up as persistent injury, repeated niggles, declining performance, or bone stress injuries.

The Sleep, Nutrition and Stress Axis

Three factors dominate recovery quality:

• Sleep — the single most important recovery tool. Most athletes underestimate how much their training requires; many runners training at meaningful volumes need 8+ hours

• Nutrition — not just total calories, but adequate carbohydrate to fuel training and adequate protein to support tissue adaptation. Many endurance runners under-fuel, sometimes unintentionally

• Life stress — work, relationships, family, finances — all share the same recovery "bucket" as training. High life stress reduces the training load the body can adapt to

I factor all of these into assessment and rehabilitation planning. Someone training through significant life stress needs a different programme to someone with recovery capacity to spare — even if their physical presentation looks identical.

RED-S — Relative Energy Deficiency in Sport

Relative Energy Deficiency in Sport (RED-S) describes the impact on health and performance when an athlete's energy intake is consistently lower than what's needed to support their training and basic physiology.

It affects both male and female athletes. Signs can include persistent fatigue, recurrent injuries (particularly bone stress injuries), loss of menstrual cycle in female athletes, reduced libido and mood changes in male athletes, declining performance despite continued training, and frequent illness.

Importantly, RED-S is not about having an eating disorder — many affected athletes are simply under-fuelling unintentionally, often because they're trying to manage weight or have progressively increased training volume without proportionally increasing intake.

Where I identify signs suggesting low energy availability or RED-S during assessment, I don't manage this alone. RED-S requires a multidisciplinary team — typically GP involvement, sports dietitian input, and sometimes psychology support. My role is to recognise it, work within the wider team, and modify rehabilitation appropriately while the underlying energy status is addressed.

I cover this in detail as part of bone stress injury management — you can read more on the bone stress injuries page.

Read more about RED-S and bone health →

Rehabilitation — The Right Strength at the Right Time

Strength training is essential in running injury rehabilitation. But "strength training" covers a wide spectrum of exercises with very different physiological effects. Getting the right type at the right time is what makes rehabilitation actually work.

Isometric Strength

Isometric exercises involve producing force against an immovable resistance — no joint movement, no changing muscle length.

• When I use them: early in rehabilitation when symptoms are reactive, or as an analgesic effect in irritable tendons

• Why: they build strength with minimal mechanical load, allowing progression without provoking symptoms. They also have research evidence of immediate pain reduction in some tendon presentations

• Examples: isometric calf holds for Achilles pain, Spanish squats for patellar tendon pain, isometric single-leg bridges

Heavy Slow Resistance (HSR)

HSR involves slow, controlled repetitions (typically 6 seconds per rep) against heavy load — usually bilateral compound lifts or machine-based resistance.

• When I use them: as the foundation of tendon rehabilitation once isometric tolerance is established, and as a base layer for all running injury strength work

• Why: HSR loads tendons and muscles through their full range under substantial resistance, building structural capacity and strength. Research strongly supports HSR for tendon pathologies

• Examples: slow squats, Romanian deadlifts, slow calf raises with heavy load

Stretch-Shortening Cycle (SSC) Work

SSC exercises use the rapid stretch-then-shorten pattern that running actually demands — plyometric hops, jumps, bounds, skips.

• When I use them: once foundational strength is built and symptoms are settled, to bridge the gap between strength and running-specific demands

• Why: running is a plyometric activity. Without SSC training, the tissues aren't prepared for the specific demands of running load. Skipping this stage is one of the most common reasons return to running fails

• Examples: double-leg hops progressing to single-leg, drop jumps, bounds, skipping drills

Running-Specific Progression

Finally, rehabilitation integrates back into running itself — graded walk-run progressions, structured return-to-running programmes, and gradual restoration of training structure.

• When: once strength, capacity and SSC tolerance are adequate, and symptoms are controlled through lower-load exercise

• Why: running is the ultimate specificity test. No gym exercise fully replaces the specific demand of running itself — it has to be progressively reintroduced
  

Periodisation — Making It All Fit Together

Running and strength work don't compete for recovery equally — they both draw on the same recovery capacity. Periodisation is about structuring strength work within your running training so that neither compromises the other.

During heavy running volume, strength work may be lower-volume, higher-intensity, focused on maintenance. During offseasons or rebuilding phases, strength work can take priority while running serves as a secondary stimulus. During injury rehabilitation, running is adjusted to support strength work being the primary driver.

The detail varies by individual, injury and goals — but the principle is that strength and running should be structured to complement each other, not compete.

Getting the right type of strength at the right time, in the right volume relative to running — this is what separates rehabilitation that works from rehabilitation that doesn't.