Dr. Nevin Saju
Doctor of Physical Therapy
You love running. But your body doesn't seem to agree.
Maybe it's your knee. Or your IT band. Or plantar fasciitis. Or shin splints. You rest, you ice, you stretch. The pain goes away. You start running again. The pain comes back.
Rinse and repeat.
Here's what's frustrating: You're doing everything "right." You're not overtraining. You have good shoes. You warm up. You stretch. But you keep getting injured.
Want to know why? Because the problem isn't your training volume or your shoes or your stretching routine.
The problem is how you move.
Running doesn't cause injuries. Running with poor mechanics causes injuries. Fix the mechanics, and you can run as much as you want.
— Dr. Nevin Saju, DPT
The Real Reason Runners Get Injured
Most running injuries aren't from running too much. They're from running poorly too much. Your body can handle a lot of volume—IF your mechanics are sound. But if you're running with poor biomechanics, every step is a micro-trauma. Do that enough times, and something breaks down.
The Weak Link Theory
Your body is only as strong as its weakest link. When you run, forces travel up through your foot, ankle, knee, hip, and spine.
If any link in this chain is weak or not functioning properly, the other links compensate. Eventually, one of them breaks down.
Example: You have weak glutes (common in runners). Your IT band and TFL have to work overtime to stabilize your hip. Over time, this leads to IT band syndrome.
You can foam roll and stretch your IT band all day. But if you don't strengthen your glutes, the problem will keep coming back.
The Mobility-Stability Trade-Off
Joints need either mobility or stability, in an alternating pattern:
• Ankle: Mobility • Knee: Stability • Hip: Mobility • Lumbar spine: Stability • Thoracic spine: Mobility
When a joint that needs mobility is stiff, the joint above or below (which needs stability) becomes mobile to compensate.
Example: Stiff ankles lead to excessive knee motion. Stiff hips lead to excessive low back motion.
This is why ankle mobility issues can cause knee pain, and hip mobility issues can cause back pain.
Common Running Injuries and Their Root Causes
Let's look at the most common running injuries and what actually causes them:
Runner's Knee (Patellofemoral Pain)
What people think causes it: Running too much, bad shoes, weak quads.
What actually causes it: Poor hip control. When your hip drops or rotates inward during the stance phase of running, it changes the angle of your knee. This puts abnormal stress on your kneecap.
The fix: Strengthen your glutes (especially glute medius) and improve single-leg stability. Your knee pain will often disappear without ever directly treating the knee.
IT Band Syndrome
What people think causes it: Tight IT band.
What actually causes it: Weak hip abductors (glute medius) and poor running mechanics. Your IT band gets overworked trying to stabilize your hip.
The fix: Stop foam rolling your IT band (it doesn't actually stretch). Instead, strengthen your glutes and improve your running form. Focus on preventing hip drop during stance phase.
Plantar Fasciitis
What people think causes it: Tight calves, bad arch support.
What actually causes it: Poor foot and ankle mechanics, often combined with weak intrinsic foot muscles and limited ankle mobility.
The fix: Improve ankle mobility, strengthen your foot muscles (yes, you can strengthen your feet), and address any hip or core weakness that's causing compensatory foot mechanics.
Shin Splints
What people think causes it: Running on hard surfaces, increasing mileage too fast.
What actually causes it: Overactive anterior tibialis (shin muscle) compensating for weak calves or poor foot control.
The fix: Strengthen your calves, improve ankle mobility, and work on foot mechanics. Also, check your cadence—overstriding puts extra stress on your shins.
The Bulletproof Runner Protocol
Want to run injury-free? Here's what you need to do:
1. Build Single-Leg Strength
Running is a series of single-leg hops. If you can't control your body on one leg, you can't run efficiently.
Essential exercises: • Single-leg deadlifts • Single-leg squats • Step-ups • Single-leg calf raises
Do these 2-3 times per week. They're more important than your running mileage.
2. Fix Your Cadence
Most runners overstride, landing with their foot too far in front of their body. This creates a braking force with every step and increases injury risk.
Optimal cadence: 170-180 steps per minute.
If you're below this, you're likely overstriding. Increase your cadence by 5-10% and watch your injury risk drop.
3. Don't Skip Strength Training
"I don't have time for strength training" is the most common excuse I hear from injured runners.
Here's the truth: If you have time to run 30-40 miles per week, you have time for 2-3 hours of strength training.
And if you don't make time for strength training, you'll be forced to make time for injury rehab. Your choice.
4. Address Mobility Restrictions
The three most important mobility areas for runners:
Ankle dorsiflexion: You need at least 10cm of forward knee travel over your toes. If you don't have this, you'll compensate elsewhere.
Hip extension: You need full hip extension to push off efficiently. Tight hip flexors limit this.
Thoracic rotation: Running requires counter-rotation between your upper and lower body. A stiff thoracic spine limits this and increases stress on your low back.
Test these areas. If you're limited, fix it before it becomes a problem.
What to Do If You're Already Injured
If you're currently dealing with a running injury, here's the smart approach:
Don't Just Rest
Rest might reduce pain, but it doesn't fix the underlying problem. As soon as you start running again, the pain will return.
Instead, use the time off from running to: • Identify and fix movement dysfunctions • Build strength in weak areas • Improve mobility restrictions • Cross-train to maintain fitness
When you return to running, you'll be stronger and more resilient than before the injury.
Get a Proper Assessment
You can't fix what you can't see. A proper running assessment includes: • Video gait analysis • Strength testing (especially single-leg) • Mobility screening • Movement pattern assessment
This tells you exactly what's wrong and what needs to be fixed. No guessing, no generic protocols.
Follow a Progressive Return-to-Run Plan
Don't go from zero to your previous mileage. That's how you get re-injured.
Instead, follow a structured progression: • Start with walk-run intervals • Gradually increase running time • Monitor pain and adjust accordingly • Build back to full mileage over 6-8 weeks
Patience now prevents setbacks later.
The Bottom Line
Running injuries aren't inevitable. They're predictable consequences of poor mechanics, inadequate strength, and mobility restrictions.
Fix these issues, and you can run as much as you want without constantly breaking down.
But you need to be proactive. Don't wait until you're injured to address these things. Build a strong, mobile, resilient body now, and you'll be running pain-free for years to come.
If you're dealing with a running injury that won't go away, or you want to prevent injuries before they happen, book a free discovery call. We'll assess your movement, identify your weak links, and create a plan to keep you running strong.
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Book a free 15-minute discovery call and let's discuss your specific situation.
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