Running injuries
We keep you on the road.
Full rest is our last resort, not our first prescription. Most plans keep you running at a dose your tissue can bank while we rebuild the capacity underneath it.
You rested until it stopped hurting, started running again, and it came back. That is not bad luck, it is the predictable result of treating the symptom instead of the cause. Runner's knee, IT band pain, and shin splints trace back to load outrunning capacity. We measure the gap with gait analysis, close it with strength, and keep you running while we do it.
Most running injuries allow you to keep running at a modified dose while we fix the cause. Research on painful exercise shows training with tolerable symptoms does not worsen outcomes, and often speeds them. The exceptions are suspected bone stress injuries, which we screen for at your first visit.
We know what running is to a runner. It is the hour that keeps the rest of the day working, and being told to just stop feels like being told to stop being yourself. So we do not say it unless the tissue demands it, and most of the time it does not. Between 19 and 79 percent of runners pick up an injury in any given year, and the ones who recover fastest are usually the ones whose plans kept them moving.
Suspected stress fracture, a limp you cannot correct, or pain rising run over run despite modification. Those 3, and almost nothing else. Even then, off the road does not mean off training: pool running, cycling, and strength work hold your fitness while the bone or tissue catches up.
Because descending loads the kneecap joint with 3 to 4 times your body weight while the quad works as a brake. That braking contraction squeezes the kneecap against the femur harder than climbing does. Pain on stairs, squatting, or after long sitting is the classic runner's knee pattern, and it responds well to rehab.
Runner's knee (the clinical term is patellofemoral pain) is the most common running injury we see, and the least structural. Imaging is usually normal. The problem is a joint being asked to absorb more braking load than the muscle around it can spend, run after run, until it complains. Downhills, stairs, and long sits in a truck or a pew are where it speaks up first.
The 2019 clinical practice guideline for patellofemoral pain is blunt about what works: exercise therapy targeting the quads and hips, with the strongest results when both are trained together. Taping can calm symptoms early. Rest alone earns no recommendation, because a rested, weak quad brakes no better than it did before the break.
Cadence is the running-form lever with real evidence behind it. Raising your step rate 5 to 10 percent shortens the overstride, moves your foot closer to your center of mass, and measurably drops load on the knee. It is one of the first things we test in a gait analysis.
Because the IT band is not tight in any way you can stretch. It is a tendon-like strap engineered to be stiff, and no amount of rolling meaningfully lengthens it. The driver is usually weak hip and glute muscles letting the thigh collapse inward, which loads the band's insertion at the knee. Fix the hip, and the band quiets down.
This is the most common tried-everything story runners bring us: months of foam rolling, stretching routines from YouTube, a lacrosse ball with a personal grudge, and the outside of the knee still lights up at mile 3. The frustration is fair. The tools were pointed at the wrong tissue.
The research has pointed at the hip for 25 years. A study of distance runners with IT band syndrome found marked hip abductor weakness on the injured side, and 22 of 24 runners returned to pain-free running within 6 weeks of a hip strengthening program. When your glutes cannot hold the pelvis level, the knee drifts inward with every stride, and compression at the band's attachment climbs. Roll the band all you want: the collapse that loads it happens upstream.
Runners sometimes arrive already suspecting this and calling it dead butt, which is closer to the truth than most self-diagnoses we hear. We confirm it with numbers instead of vibes: side plank hold times, single-leg bridge capacity, and a hip abduction strength test against the uninjured side. If the injured side tests 20 to 30 percent weaker, we found your driver, and we can retest the same numbers in 4 weeks to prove the plan is working.
Our IT band plan runs in 2 lanes: heavy, progressive hip and glute work in the gym, and a stride check on the treadmill, because a narrow, crossover-style gait is a known aggravator we can widen in one session. Rolling is allowed as a warm-up if you enjoy it. It is just no longer the plan.
Because rest fixed the pain, not the capacity. Weeks off let the shin calm down while your calf strength and bone tolerance quietly dropped. Then you returned to the same mileage with less capacity than you had when it first hurt. The cycle repeats until something rebuilds the tissue's tolerance faster than training spends it.
Shin splints (medial tibial stress syndrome) are an overload problem at the border of bone and muscle along the inner shin. Almost every case traces to a training error: mileage jumped too fast, hills or speed added too soon, or a return from time off treated like a resume button instead of a rebuild. The 10 percent rule is a decent guardrail, but the real number is individual, and it is trainable.
The rebuild has 2 parts. First, calf and foot capacity: your calf complex absorbs multiples of body weight every stride, and we benchmark it with simple tests like single-leg calf raise count, then load it until the numbers protect you. Second, a graded running progression that raises volume on a schedule your shin can keep up with, instead of the boom-rest-boom pattern that got you here.
Watch the warm-up pattern, because it tells you which direction you are heading. Early-stage shin splints hurt for the first mile, ease as you warm up, and ache afterward. Progressing shin splints hurt longer into the run each week. Pain that no longer warms up at all, or that lingers into normal walking, means the tissue has stopped keeping up with the schedule and the schedule has to change this week, not after the next long run.
Where mechanics contribute, a gait analysis shows us the overstride or cadence issue feeding the shin, and in select feet, orthotics help redistribute load while capacity rebuilds. We are honest about that last one: orthotics are a tool for specific presentations, not a default upsell.
Shin splints hurt along a diffuse stretch of the inner shin, ease as you warm up, and calm with modified training. A stress fracture hurts at one precise spot on the bone, gets worse the longer you run, and can ache at night or with hopping. Pinpoint bone pain earns imaging, not a wait-and-see plan.
Here is the 3-question screen we run in clinic. Can you point to the pain with one finger, or do you sweep your hand along the shin? Sweeping suggests shin splints; one finger on bone raises the fracture question. Does hopping on the leg reproduce a sharp, localized pain? Does the pain show up earlier in each successive run, or wake you at night? Yes answers move you up the concern ladder.
This is one place where running through it is the wrong call. A tibial stress reaction caught early costs you weeks. The same spot pushed through a race build can cost a season, and certain sites can crack through. If your exam raises the flag, we refer you for imaging the same week and keep you training on the bike and in the pool while the bone heals. You do not lose your fitness. You lose the gamble.
You run on a treadmill while we film you from behind and from the side, then we measure cadence, overstride, hip drop, step width, and where your foot lands relative to your body. Worth it if you are injured or keep getting reinjured. Optional if you are healthy and just curious.
That honesty matters because gait analysis gets sold 2 bad ways: as a shoe-store gimmick that ends in whatever is on the wall, and as a mystical form fix that promises a new stride in an afternoon. Ours is neither. It is a measurement session run by a doctor of physical therapy, and it exists to answer one question: which loading pattern is feeding your specific injury?
The levers we actually pull are few and evidence-backed. Cadence up 5 to 10 percent to unload the knees. Step width adjustments for IT band compression. Reducing a hip drop the glutes cannot currently control. Occasionally a footwear or orthotic change when the foot is clearly part of the story. What we do not do is rebuild your natural stride to match a textbook, because no such textbook survives contact with the research.
You leave with your numbers, side-by-side video, and at most 1 or 2 changes to practice, because stacked form cues fall apart by mile 2. The full service is described on our biomechanical analysis page.
With a written return-to-run progression tied to your race calendar, not a vague take it easy. We map your current tolerance, rebuild volume in measured steps, keep 2 strength sessions a week under the mileage, and adjust weekly based on how each run settles. You always know what next week looks like.
Around here the calendar usually points at the FRESH 15 in March. If you are 12 weeks out with angry shins, there is often still a path to the start line, but it has to be engineered now, not hoped for in February. We reverse-plan from race day: how much volume the goal requires, how much your tissue currently tolerates, and how fast we can close the gap without reopening the injury.
A typical comeback week looks like 3 runs and 2 lifts. Runs start as walk-run intervals on flat ground (the Rose Rudman Trail is a favorite for this: paved, flat, easy to measure), then progress to continuous easy miles, then reintroduce hills, then speed, in that order. Each step holds until the next-day response is quiet. Skipping steps is how Decembers get lost.
The 2 lifts are not decoration. A runner's strength menu is short and heavy: split squats, calf raises, hip thrusts, step-downs, loaded to the point where 8 reps is work. Twice a week, 30 minutes, year round. Runners who keep that habit through a training cycle give us dramatically less to fix in the next one.
The strength work does not end when the pain does. Capacity above demand is the only durable injury insurance a runner can buy. For the full protocol, read our guide to returning to running after injury.
Treadmill gait analysis: cadence, overstride, hip drop, step width.
Explore Foot and ankleFor the specific feet that need them. We tell you honestly if yours do not.
Explore CapacityThe strength under your mileage, built in a real gym.
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Full rest is our last resort, not our first prescription. Most plans keep you running at a dose your tissue can bank while we rebuild the capacity underneath it.
Probably not wrong, just mismatched to your current capacity. There is no single correct running form. What matters is whether your cadence, stride, and strength can absorb your weekly mileage. A gait analysis measures that match instead of chasing a textbook ideal that does not exist.
Shoes matter less than the running world says. Comfort is the best-supported selection rule, and rotating 2 pairs may reduce injury risk slightly. A shoe change rarely fixes an injury by itself, because the problem usually lives in training load and strength, not in the foam.
Neither extreme. Pain up to 3 of 10 that settles within 24 hours is generally acceptable to train through. Pain above that, pain that worsens as you run, or pain that changes your stride means stop and modify. Complete rest fixes symptoms, not causes.
Because rest removed the symptom, not the cause. Weeks off lowered your tissue capacity while the pain faded, so you returned weaker to the same mileage that hurt you before. Rehab that rebuilds capacity above your training demand is what breaks the loop.
Cadence, sometimes. Raising step rate 5 to 10 percent shortens overstride and measurably lowers load on the knee and hip, which helps runner's knee in particular. Wholesale footstrike conversions trade one loading pattern for another and often just relocate the injury. We change one variable at a time.
Usually yes, at a modified dose. Running you can tolerate keeps tissue capacity, fitness, and sanity intact while we fix the cause. Most plans cut volume 30 to 50 percent, flatten the route, and rebuild from there. Full shutdown is reserved for suspected bone stress.
If you are injured or keep getting reinjured, yes: it finds the loading pattern behind the problem and gives us measurable levers. If you are healthy and chasing a marginal PR, it is optional. We will tell you which camp you are in before you pay for anything.
No. Texas direct access law (HB 4099, effective September 2025) allows up to 30 days of physical therapy care without a physician referral. Book the $99 audit directly. If your exam suggests a stress fracture or anything needing imaging, we refer you the same week.
Book the $99 audit. You leave with a diagnosis, a return-to-run progression, and a plan that respects your race calendar.