Running Injury Rehab: The Diagnosis Is Only Part of the Story

This is a free preview of a paid episode. To hear more, visit mskmag.substack.com When I first started writing this article, I found myself writing a more traditional piece on running injury rehab. The importance of a good subjective history, accurate diagnosis, load management and progressive rehab. All of that is key and I will touch on those things throughout this article. But I also wanted to write something that felt a little more reflective and practical, based on what working with runners has taught me. Over the past 7-8 years of solely working with runners, I feel like I have gained some great insights into different training habits, running cultures, beliefs and what it means to be a healthy runner. I have been lucky enough to work with Olympic-level runners from 800m runners all the way up to the marathon. I also work with competitive club runners to those who are just starting out and looking to run their local park run. I wanted to share some insights that I have learned from working with all these runners and experiencing different running cultures and I hope you find it useful. The more runners I work with, the more I come back to a similar point: running injury rehab is rarely just about treating the painful area. Of course, we know the diagnosis matters, the tissue involved matters. Is it bone? Tendon? Muscle or neural? If we only focus on where the pain is, we often miss the bigger picture. What has this runner been prepared for? What training have they been exposed to over time? What has changed in the last few weeks or months? How do they interpret their training plan? Can they adapt when training is not going to plan or do they feel like they must complete whatever is written in their training program? What is their belief around why they got injured? These questions help us create the bigger picture. **What has this runner been prepared for?** One of the biggest things I have learned is that a runner’s background matters. It starts with the younger athlete. We have a huge influence on young athlete development and I feel it is something we need to take seriously and create more awareness on. I feel fortunate but also slightly uncomfortable at times to have treated hundreds of young athletes who have done well in the sport but also many who have had significant running related injuries (RRIs). Some of these injuries come with potential long-term consequences, particularly when relative energy deficiency in sport (REDs) is part of the picture \[1]. Bone health is a good example. We know bone mineral density continues to develop into early adulthood, so adolescence and early twenties are a significantly important window \[2].