Don’t Stop Running

Don’t Stop Running

“Adversity is preparation for greatness.” ~ Andy Andrews

If you are a runner and anything like the thousands of runners I have treated over the years, you have probably never heard a physician to tell you to “keep running”. For most runners, running is as much a core vital part of who they are as their own DNA. Runners must run. Period. It is what they love. Telling a runner they need to stop running is akin to taking away vital oxygen from them. But for many who have had serious injury, running through injury equates to pain. Maybe you have been plagued by chronic ITB syndrome, Runner’s knee, AKA Patellofemoral Pain Syndrome, Shin Splints, Plantar Fasciitis, meniscal tear of the knee, hip or low back pain. Perhaps you even have some degenerative arthritis in your knee, hip or lower back.

If you have sought medical attention for pain related to running, then you likely have been told by your primary care physician or even an orthopedist to ” stop running” because your body can’t handle it. It’s like a dealth sentence for the runner.

What should you do? Get a second opinion.

Runner’s make up a substantial part of my clinical practice. I wish I had a dollar for every patient who comes to me and tells me they were told to ” Stop Running”! Well I am here to tell you something different. 100 % of all running injuries and all musculoskeletal injuries are due to load exceeding capacity. All tissues will fail under a certain load or after a certain number of repetitive motions. Factors like poor mobility, lack of joint stability, scar tissue buildup from soft tissue injuries can lead to pain and even premature degenerative arthritis. Of course there are many running injury scenarios where it is appropriate for patients to take an active rest from running to let the body repair and recover from injury.

For example, in the case of an acute tendonitis condition like ITB syndrome or patellar tendonitis, it is often necessary that you give the body some short term active rest from repetitive motion, like running which is likely causing and perpetuating the injury. But rest is just a ” temporary inconvenience” and only one part of an effective strategy to recover from injury and get back to running. Even in extreme cases of advanced arthritis, many runners can restore function and get back to running. It is important to note that in extreme cases, the weekly mileage your body can safely handle may be lower than what you have been accustomed to in the past. The big key is to not take a “Stop Running” order lying down. Get a second opinion. In sports medicine and rehabilitation we often leave a ton of stuff on the table. That is to say that in the past healthcare and sports medicine professionals have not done an adequate job of looking for and detecting all the key dysfunctions that have led to injury and caused the decline in performance in the first place. It is important to note that there is always a price to pay. If you continue to run through injury without allowing the body adequate rest and recovery and without proper treatment you will eventually run out of road. The price is pain and decreased capacity for running. The key is to detect and resolve muscle imbalances, improve mobility of the soft tissues and joints, and learn strategies to move better. Following this paradigm can help you recover from and prevent reoccurence of pain and dysfunction from repetitive motion injuries to the soft tissues and joints. The big key is to evaluate where you are in real time. X-Rays and MRI are helpful to assess structural integrity to the joints and soft tissues. Imaging can quantify the presence of arthritis. Bone scans and MRI can assist to detect stress fractures. What I look for in my athletes during exam is the overall picture. Orthopedic and neurological testing are important to assess for problems with the joints and electrical wiring to the joints and surrounding muscles and fascia. I also look for muscle imbalances and assess movement patterns. By clearing up bad movement, we can better manage load across the joints during sports like running. Our bodies are constructed of rods and suspension slings, better known as bones and soft tissues like muscles, tendons, fascia and ligaments. This system is what Buckminster Fuller coined “Tensegrity “. Any tension applied across this sytem can cause stress further up or downstream from the area of tension. Therefore you can develop pain in an area remote from where the actual restriction in movement is. Muscle imbalance and prior injury can cause compensatory movement which can overload these tissues overtime, leading to pain, tendonitis, and even arthritis.

After an examination, here is what I typically recommend based on examination findings:

1. The number one priority is to restore mobility. Active Release treatments combined with joint manipulation to the foot, ankle, knee, hip, pelvis and lower back are vital to the successful resolution of pain and to restoring functional movement.

2. Daily ice treatments done at least 2-4 times per day to reduce inflammation. If the injured area is constantly inflammed, the body cannot proceed to the next two stages of healing- Repair and Remodeling.

3. Supplements can play a vital role in optimizing your nutrition to give the body what it needs. Glycosamine helps to support the natural structural scaffolding of the cartilage of the body including spinal discs. Other supplements like Phytoprofen, an enzyme that eats up inflammation and kills pain can also be helpful in recovery.

4. REST that foot/ankle, knee, hip, lower back (so sorry to say that) or injured body region meaning no running or jumping or hiking or pushing off the wall while swimming for at least ONE week. The timeline depends on nature and severity of the injury. For example, a stress fracture can take 6-12 weeks to completely recover. Rest is often a key ingredient in the recipe for successful treatment.

5. Return to running after one or more weeks of REST as prescribed and frequent ART and manipulation during a gradual return to run program. There needs to be a progression and treatment needs to accompany this progression. It is vital not to overload the tissues as you ramp up your running again. So I typically recommend the runner start with 10-15 minute tempo runs which gives us a good test to determine how the body responds.

There are a few things that can speed up healing.  One is deep tissue laser therapy.



I understand many runners are on a time budget, I totally get it, but I have to shut that out of my mind to be honest, objective and realistic in setting the runner’s expectations. These injuries will take a few weeks to heal, typically 4-8 weeks. It is important to respect the process and nobody should run through injury. The tendonitis can quickly worsen. You can OPTIMIZE your physiology, but you cannot OUTRUN your physiology.