Sports physiotherapy for runners: preventing injuries before autumn training

September marks a new beginning for many runners. Temperatures become more favourable, regular training resumes, and preparation begins for autumn races, half marathons, marathons, or simply to increase mileage and pace after a summer spent with greater freedom. The problem is that motivation often grows faster than the body's ability to adapt.

Immediately returning to four or five runs per week, increasing mileage because "the legs feel good", or introducing long runs, interval sessions and hill training all at the same time can create the ideal conditions for overload.

Prevention does not mean avoiding effort. It means reaching the point when training becomes more demanding with a body that is sufficiently prepared to handle it. A programme of physiotherapy for runners can be useful precisely at this stage: not only when pain is already present, but also to identify potential weaknesses and build a more solid foundation for training.

When running, every step represents a stimulus to which muscles, tendons, bones and joints must adapt. The body has a remarkable ability to do this, but it needs time.

After a period of reduced running, increasing distance, speed and frequency at the same time can exceed the tissues' current capacity to tolerate the load. This is when discomfort may begin to develop in the Achilles tendon, knee, plantar fascia, shin or muscles.

There is no universally safe number of kilometres. A training load that is perfectly tolerable for one runner may be excessive for another. Training history, recovery, previous injuries, strength, sleep and even what has happened in the preceding weeks all matter.

The useful question, therefore, is not simply "how many kilometres can I run?", but how much load am I ready to handle today?

One of the most common mistakes is using the absence of pain as the only criterion for deciding whether to increase training.

A runner may feel perfectly fine during an easy five-kilometre run but may not yet be ready for a thirty-kilometre week that includes an interval session and a long Sunday run.

Before increasing training volume, it is useful to consider other factors:

• lower limb strength;
• ability to control movement;
• tolerance to repeated effort;
• recovery between training sessions;
• any discomfort in the hours following a run;
• previous injuries.

Physiotherapy for runners can help assess these factors as a whole, rather than focusing exclusively on the area that may be painful.

Those who love running understandably tend to prefer running. When available time is limited, strength training is often the first session to be dropped.

Yet good muscular capacity helps the body manage the demands of running more effectively. The calves, quadriceps, hamstrings and hip muscles must produce and absorb force thousands of times during a training session.

Gym training or specific exercises do not need to turn a runner into a bodybuilder. They should be tailored to the demands of running and progressively adapted to the individual's level.

Squats, lunges, single-leg exercises, calf exercises and movements requiring control and force production can all be incorporated into training, with appropriate intensity and progression.

Having experienced an injury in the past does not mean that it is destined to happen again. However, it is important information when planning a new season.

A runner who has suffered from Achilles tendinopathy, for example, should make sure that the calf has regained a good ability to produce force and tolerate repeated loads before rapidly increasing mileage and speed.

The same principle applies following problems affecting the knee, ankle or muscles.

The aim is not to protect the affected area indefinitely, but to prepare it once again for the demands of the sport. Recovered tissue needs to be progressively loaded again, not avoided.

Not all problems occur while running.

Discomfort may appear a few hours later or the following morning. Achilles tendon stiffness when getting out of bed, knee pain when walking downstairs or sensitivity in the sole of the foot after spending a day standing may indicate that the recent load was greater than what the body is normally able to tolerate.

This does not necessarily mean that an injury is present. It does, however, mean that it is worth monitoring how the symptoms develop before adding further load.

Temporarily reducing intensity, modifying a training session or allowing additional recovery may be more sensible than completing the planned programme at all costs.

When pain develops, running shoes are often immediately blamed. In reality, the relationship between footwear and injuries is more complex.

Running shoes should be appropriate and comfortable, but they are unlikely to be the sole explanation for every problem experienced by a runner. The same applies to running technique.

Changing foot strike, cadence or running style without a genuine need can introduce new loads to which the body is not accustomed. Similarly, suddenly switching from road running to trail running, adding many hills or beginning to run almost exclusively on different surfaces changes the demands placed on the muscles.

Before correcting something, it is therefore necessary to understand whether there is actually something that needs to be corrected.

Good preparation does not necessarily require complicated training programmes. Above all, it requires progression and consistency.

Before entering the more intensive phase of the season, it can be useful to:

• gradually rebuild weekly training volume;
• avoid increasing all training variables at the same time;
• maintain at least some strength training;
• alternate demanding sessions with recovery;
• monitor any symptoms during the following 24 hours;
• adapt the programme when the body responds differently than expected.

A training programme should be a tool, not an obligation. If a particularly stressful week, insufficient recovery or minor discomfort changes the starting conditions, the training can be adjusted accordingly.

At TI-FISIO in Mendrisio, the assessment of a runner is not limited to looking for a single abnormality or focusing solely on the area where pain occurs. The aim is to understand which physical capacities are already adequate and which could be improved before increasing training.

The programme may include:

• assessment of strength and mobility;
• analysis of movement control during functional exercises;
• assessment of the ability to tolerate specific loads;
• progressive exercises based on individual goals;
• management of the return to running after an injury;
• guidance on training progression.

When necessary, physiotherapy for runners combines therapeutic exercise and manual therapy within a programme tailored to the individual. The purpose of treatment is not to create a "perfect" runner, but to prepare the body for the specific demands it will face.

A successful running season is not built during the first two weeks of September. It comes from the ability to train consistently, progressively increase training stimuli and recognise when it is time to push harder and when, instead, recovery is the better choice.

Preparing in advance means having more capacity when long runs, interval sessions and higher-mileage weeks arrive. It also means not necessarily waiting for significant pain to develop before taking care of your body.

If you are planning your autumn training, have experienced an injury in recent seasons or want to understand how to approach an increase in training load more safely, contact TI-FISIO in Mendrisio. A physiotherapy assessment can help you build stronger foundations for your upcoming training and, above all, keep running consistently.

+41 91 940 10 20

info@ti-fisio.ch

Via Ceresio 42, Pregassona.

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+41 (0)91 229 69 80

mendrisio@ti-fisio.ch

Via Giuseppe Motta, 6a, Mendrisio