8 Things Every Runner Needs to Know About Physical Therapy

We all know that going to WebMD when something hurts is a terrible idea. But do we do it anyway? Of course. Let’s be honest, nothing good comes out of that. Searching “knee pain after running” will leave you with the alarming impression that you have kneecap cancer and your leg is going to fall off, or something equally dire. Let’s just say those things are highly unlikely, and there is a better way: go see a physical therapist.

As an ultrarunner, I’ve acquired a few injuries over the years. (Doing the same activity for hundreds of hours in a year sometimes causes injuries? Weird.) Every time an injury has cropped up, a physical therapist has helped me through the injury to run another day. I’m certainly not alone in this – each of my running friends has their own favorite physical therapist that they speak of in reverent tones. These therapists understand and respect our desire to run hundreds of miles, and help us heal and strengthen our bodies to make it happen.

Haven’t found your own favorite physical therapist yet? Intimidated by this facet of the healthcare system? Do you have a niggle in your XYZ, but you also have a race coming up, and you’re mildly panicking?

Have no fear! With these things in mind, I interviewed my own physical therapist, Emily Thomas of Stride Physio. As a former Division I 10,000m specialist, she has the unique perspective of dealing with injury from both sides, and can relate to running being a huge part of one’s identity. She graciously agreed to answer my burning questions about physical therapy.

1.When should people stop using Web MD as their primary source for injury treatment? (No, really, when?)

Pretty much always. Feel free to use it as a cursory look into what your aches and pains might be, but if you spend more than 5 minutes scouring the web, it might be time to consult with a healthcare professional. Reading that there is a 2% chance that you have cancer because you have ankle pain won’t make you feel better and it probably won’t help your ankle pain much. You’ll always feel better when you know what’s really going on, and typically setting up a plan of care as early as possible will be best for addressing the root cause.

2. Runners always develop niggles. When is it something to worry about and seek help?

Distance running involves the same movements from the same muscles over and over again. As such, it is common and even expected for aches to develop and general soreness to set in. Things to be on the lookout for are: sharp pain, pain that doesn’t go away after a few miles, minor aches that stick around for more than a week.  

3. Should they see a general practitioner or sports medicine doctor first, or go to a physical therapist straightaway?

Washington is a direct access state, (as are most states), meaning that you can see a physical therapist without an MD referral. Typically, with undiagnosed and non-emergent musculoskeletal problems (muscles, joints, tendons, and bones), you are better off seeing a PT first, as we are the movement specialists of the healthcare world and are trained specifically in musculoskeletal diagnoses and treatment. We are also trained to know when to refer you to your primary care doc or a sports medicine specialist. Because of this, going to a PT first typically saves you time, money, and sometimes unnecessary imaging.

4. What are the most helpful things for patients to communicate to you? (That maybe they don’t.)

• The most important thing is to be open and honest about your goals and what things are most important for you to get back to. When creating a plan of care, our first concern is tissue healing, then determining and addressing the root cause/reason for the injury, and then our attention shifts to progressing toward your goals.
• Also, questions! Ask any question that you might have about your anatomy, exercises, or treatment plan because informed patients are the most successful patients!
• Finally, recovery from injury can be a very stressful and sometimes emotional process, so depending on your level of comfort, don’t be afraid to discuss your fears and concerns about recovery.

5. What are common “mistakes” that you see with your patients? (Either with how they approach their treatment plan or something else?)

The biggest mistake that I see is when folks are not willing to put in as much effort in their own recovery as their clinician is. PT-provided manual therapy is a proven and powerful tool to assist in tissue healing, pain reduction, and tissue mobility, but it should almost always be combined with exercise for strengthening and optimal functional movement. For optimal results, patients should be firmly committed to their home exercises and addressing their biomechanics. Luckily though, this is typically not a problem with runners – runners sometimes need to be held back from “overdoing it.”

6. Are there any common misconceptions from patients about physical therapy that you wished you could alter?

So many! But here are the 3 big ones:

• Myth 1: PT is “physical torture.”

All situations are different, but very rarely does PT require incredibly painful treatment, and “no pain, no gain” isn’t always the case with exercise or treatment. You will work with your PT to find the optimal pain to return on investment ratio for your treatment plan.

• Myth 2: PTs will just give you a couple of exercises and call it a day.

Not true. A good PT will:

• Spend 40+ minutes a session one-on-one with you (I am lucky and get 1 hour sessions at my clinic.)
• Educate you about the relevant anatomy, biomechanics, and prognosis about your injury.
• Provide skilled manual therapy to address issues at the tissue level and promote healing, reduce pain, and optimize function.
• Prescribe exercises based on your specific limitations to promote optimal function, and progress them appropriately.
• Ensure that you have all of the tools necessary to return to sport or desired activities with confidence and new knowledge about your body upon discharge (graduation) from PT.

• Myth 3: PTs aren’t doctors.

In order to become a PT, a bachelor’s degree used to be all that was required. This eventually transitioned to a master’s degree, and finally a doctorate (DPT) was required. Most PTs who graduated in the last 10 years are doctors, while others with master’s and bachelor’s degrees attain their DPT through extra schooling. Some PTs with many years of experience may not have attained a doctorate degree, but these clinicians have years and years of continuing education and clinical experience under their belts.

7. What are the most common running injuries that you see? And what is the general prognosis for these?

The most common running injuries I see are:

• Achilles Tendinopathy
• Knee pain secondary to maltracking of the patella
• Forefoot pain
• Hamstring tendonitis
• Plantar Fasciitis

As you would imagine, each of these are overuse injuries, often due to some sort of muscle imbalance. The prognosis is always based on the individual and the imbalances at play. Luckily, with the exception of forefoot pain that is specifically secondary to a stress fracture, the plan of care for each of these involves a combination of both active and passive treatment, meaning we continue to load the structure in a controlled way while being sure to address the imbalance at play.

8. Lastly, what is something you wished all runners would add to their routine?

• Jumping! Running is a series of forward single limb hops, and our ankle, knee, and hips have to attenuate those forces over and over and over and over and over again! Practicing repetitive loading on one foot with optimal foot, knee, and hip biomechanics is a great way to prevent injury.
• Find your glutes! Having strong posterior glutes (glute max) provides your power while you are running that you don’t have to compensate for with your calves or hamstrings. Having strong lateral glutes (glute meds) helps to prevent the dreaded hip drop and early pronation that is often the culprit of knee pain.
• Core work! Your core is your foundation, so don’t forget this aspect of your training. A strong core also promotes optimal trunk positioning when running and reduces your risk of lumbar pain.
• Gait analysis! One of the biggest investments that you can make in your running is a skilled gait analysis. Come in and have a PT look at your form to determine breakdowns, inefficiencies, and likely causes of injury.

Emily concluded our interview by emphasizing that too often, runners believe that if they ask a PT for help, the answer is going to be “stop running!”  However, usually the appropriate action is to crosstrain while continuing with some of the regularly scheduled mileage in concert with specific exercise and manual therapy.

So, don’t be afraid of seeking help for that knee pain that WebMD says is kneecap cancer (it’s probably just weak hips anyway.) It doesn’t mean the end of the world (or even your season!) It’s about correcting weaknesses and imbalances now to make you a stronger athlete going forward.

Emily Thomas PT, DPT is a USATF Certified Running Coach and holds a doctorate of Physical Therapy from Regis University. Helping runners stay healthy is one of her biggest passions.

If you have questions or comments after reading this post, she would love to hear from you at ethomasdpt@gmail.com.