Treating bone stress injuries in runners requires expertise, patience, and a strategic approach to recovery.

Welcome to the final installment of our bone stress injury series for runners. In parts one and two, we explored the risk factors and prevention strategies. Now, we’re focusing on what happens after a BSI diagnosis and how to navigate the recovery process effectively.

Our lead physical therapist, Maria, shares her expertise on treatment approaches, rehabilitation protocols, and strategies that have helped countless Boise runners not only recover from bone stress injuries but return to running stronger than before. As Boise’s only specialized running clinic, we’ve developed evidence-based protocols that balance necessary rest with strategic activity to optimize healing.

Q: Once a runner comes in with a suspected BSI, how do you typically confirm the diagnosis?

A: When a runner comes in with a suspected BSI, there are a few things that we look for to confirm our suspicion of a bone stress injury.

The first thing is the location of pain, which gives us good insight into which structure is involved. From there, we examine the behavior of the pain. Is it painful at rest? Is it painful with weight-bearing? Is it painful at night when sleeping? Is it painful to press on? These questions help us understand the behavior and location of the pain. Usually, through conversation and questioning, we can form a good idea that it may be a bone stress injury before even beginning the physical exam.

If I’m seeing a runner for the first time, I automatically ask many questions about when they started running, their consistency with running, and how they feel—not just on race day, but in everyday life on a week-to-week and month-to-month basis. I look at how they ebb and flow throughout the seasons, what their training schedule has been like, and if there were any spikes in training prior to the onset of injury.

I also ask about bone mineral density, history of osteoporosis or osteopenia, history of relative energy deficiency in sport (RED-S), disordered eating, and how they cope with injury and recovery. All these factors can lead to tissue overload. It basically comes down to whether there’s an imbalance between recovery and the stimulus of running, cross-training, or whatever activity they’re doing.

Once I have these pieces of the puzzle, I examine the exact tissue that’s painful to determine whether it’s pain with muscular contraction, pain over a tendon, or if it’s in a bony area. Pressing on bones should not be painful.

Q: What does the recovery process look like—what’s the balance between rest and keeping active?

A: The recovery process can look different for many people. First and foremost, the foundational elements for any runner include consistency with sleep, adequate fueling, and sufficient time between loading sessions, runs, and exercise.

The specifics may vary depending on the caliber of runner, their expertise, and experience, but certain elements remain consistent across the board. If you’re not sleeping enough or consuming enough calories to sustain and help your body recover from running, there will be an imbalance that leads to injury.

I often talk with runners about managing stress and using tools like RPE (rate of perceived exertion) to stay attuned to their fatigue level. This awareness helps them determine when it’s safe to engage in their training schedule or when they should consider modifications to allow their body grace and recovery, rather than just following what’s written on their calendar.

Q: Why isn’t complete rest always the best answer for healing a bone stress injury?

A: Complete rest isn’t always the best answer for recovering from a bone stress injury because when that individual is allowed to start loading again, you want them to be as strong and fit as possible for that process.

We know runners are at increased risk for a subsequent bone stress injury during the recovery phase from their prior injury, particularly during that first year. This is partly due to the reasons why they got a bone stress injury in the first place—insufficiency with fueling and recovery, etc. It’s also because they likely went through a phase of non-weight bearing (for a high-risk bone stress injury) or some type of de-loading (for a low-risk bone stress injury).

Q: What types of cross-training do you usually recommend to runners during their recovery?

A: The cross-training recommendations differ based on whether someone has a high-risk or low-risk bone stress injury. High-risk sites usually require some form of non-weight bearing for many weeks to a couple of months, depending on the severity or grade of the bone stress injury following imaging.

For a low-risk bone stress injury that tolerates weight bearing without pain, individuals can do much more. They can often participate in activities like cycling, walking, and strength training to keep their bodies as healthy as possible. The caveat is that they must remain pain-free during these activities without irritating or exacerbating their condition.

Q: When can strength training safely be added back in, and why is it so important during recovery?

A: Strength training can be safely reintroduced following a bone stress injury when an individual can comfortably spend time on their feet throughout daily activities at home and work without increasing pain. When they can safely load their limb, hip, pelvis, or wherever the injury is located without exacerbating pain and feel confident doing so, strength training becomes important.

It’s crucial to maintain as much strength training in a pain-free manner as possible to stimulate the muscles. This approach prevents prolonged time off from strength training because the body quickly loses muscle mass with sedentary behavior and lack of strength training stimulus.

Q: What does a safe, gradual return-to-running plan typically involve after a BSI?

A: A gradual return-to-running plan typically involves some form of run/walk programming. We like to think of these sessions as “bone loading sessions” rather than runs, which gives runners a good mindset about the strategy and purpose of the programming.

It usually starts with something like a 60-second jog followed by three to seven minutes of walking, especially for higher-risk bone stress injuries. This is done on non-consecutive days while monitoring for symptom exacerbation during the activity and within the next 24 hours. We also offset these sessions from cross-training days to maintain balance and avoid doing too much on the same day when initiating the return to running.

Q: How do you help runners mentally deal with the frustration and fear of being sidelined?

A: There is definitely a mental component to dealing with the frustration and fear around bone stress injuries. They’re not well known or understood by most people until you’ve experienced one—it’s not something that’s on most runners’ radar.

I find that sharing statistics and being honest about the severity of the situation is the best approach. Giving information about healing and recovery time gives individuals something to anchor their focus on. I emphasize that their body is the boss—not the orthopedic surgeon, not the runner, not myself as the rehab specialist. It truly comes down to their body’s recovery and healing process.

I use a stair-step approach and give them the mental construct of plateaus in their programming. This allows their body to demonstrate that they’re handling the load well, which builds their confidence.

Q: For runners who’ve recovered, what habits or practices should they stick with long-term to stay healthy?

A: The best habits and practices for runners to stay healthy and avoid future bone stress injuries start with listening to their body. Pay attention to the niggles that inevitably pop up with running and notice patterns that may be emerging. Get these assessed sooner rather than later if something becomes repetitively problematic.

Consistent sleep habits are crucial—going to bed at the same time and getting adequate rest. Develop the habit of fueling within 30 minutes after exercise, which is a good guideline for most individuals. Prepare and plan for fueling as a foundational piece of training. This preparation should happen before exercise so you’re ready to complete the task at hand—which is not just to provide the stimulus of running but to actually recover from that stimulus. That’s where you make your gains.

Another good habit is incorporating a deload week every three to four weeks when building or progressing through a training season. This prevents perfectly linear training throughout a season and gives your body some reprieve. Also, plan for off-seasons throughout the year.

Finding goals for the year and planning ahead is a good practice. Building and strategizing recovery practices throughout the year, just as you would plan for races, is crucial to staying as healthy as possible.

Your Path to Running Again Starts Here

Bone stress injuries require specialized care and a methodical approach to recovery. With the right guidance, you can heal properly and develop habits that will help prevent future injuries.

Living in the Boise area and concerned you might be dealing with a bone stress injury? Our specialized team understands the unique challenges runners face and provides customized treatment plans that address both the injury and its underlying causes.

Don’t let uncertainty or fear of a long recovery keep you from getting the help you need. If you’re in the Boise area, learn more about our bone stress injury treatment for Boise runners. The sooner you address a potential bone stress injury, the more efficient your recovery can be.

At our Boise clinic, we’re committed to helping runners of all levels return to the trails and roads safely. Connect with us today to begin your journey back to pain-free running.

The post Treating Bone Stress Injuries in Runners | Heal and Return Stronger (Part 3) appeared first on Fit & Function Therapy Solutions.

Preventing bone stress injuries in runners is all about understanding the risk factors you can control.

In our ongoing series on bone stress injuries, we’re diving deep into the critical factors that can make or break a runner’s health and performance. Our lead physical therapist, Maria, shares her expert insights on preventing these challenging injuries.

Q: What are the most common training mistakes that increase a runner’s risk for bone stress injuries?

The number one culprit I see is under-fueling, and it’s a problem that goes far beyond simply not eating enough. When runners don’t provide their bodies with adequate nutrition, they’re essentially setting themselves up for a cascade of physiological challenges. The body needs sufficient energy and nutrients to support bone health, muscle recovery, and overall athletic performance.

When you’re not taking in enough calories and nutrients, your body enters a survival mode. The brain actually begins to shut down signals to osteoblasts—the cells responsible for bone formation—as a way to conserve energy. This means your bones aren’t just struggling to recover; they’re actively being compromised by your training approach.

Another critical mistake is poor recovery management. Many runners push themselves continuously, believing that more training always equals better performance. In reality, they’re creating a cumulative stress that slowly breaks down their body’s resilience. Without proper rest between high-intensity training sessions, athletes gradually dig themselves into a hole of potential injury.

Lastly, many runners neglect comprehensive health assessments. Simple blood work can reveal crucial information about hormonal balance, iron levels, and overall physiological health. Don’t wait until something goes wrong—proactive monitoring is key to preventing bone stress injuries.

Q: How does poor recovery—or skipping rest days—set someone up for trouble?

Rest days are not a luxury—they’re an absolute necessity. Think of your training like a construction project. The intense workouts are your building materials, but recovery is when the actual construction happens. When you skip rest days, you’re essentially trying to build without allowing the cement to set.

Your body needs time to adapt to the stress of running. During recovery, your muscles repair, your bones remodel, and your entire system rebuilds itself stronger than before. Without adequate rest, you’re constantly breaking down tissue without giving it a chance to rebuild. This leads to progressive fatigue, decreased performance, and increased injury risk.

Q: Can you break down how under-fueling or poor nutrition affects bone health for runners?

Bones are dynamic, living tissues—not the static structures many people imagine. They’re constantly being broken down and rebuilt, a process that requires precise nutritional support. When you’re under-fueled, you’re disrupting this delicate balance.

Carbohydrates are particularly crucial for endurance athletes. Some runners mistakenly believe they can thrive on low-carb diets, but carbohydrates are your primary fuel source. Without adequate carbs, your body will start pulling nutrients directly from your bones—essentially cannibalizing your own skeletal structure to keep you moving.

A well-balanced diet provides the right signals and nutrients to support bone health. This means consuming enough calories to match your energy expenditure, with a proper balance of proteins, carbohydrates, and essential minerals like calcium and vitamin D.

Q: For female runners, how do hormonal factors like irregular cycles tie into bone stress injury risk?

Hormonal health is a critical yet often overlooked aspect of athletic performance. An irregular menstrual cycle is not just an inconvenience—it’s a significant warning sign. While some athletes believe losing their period during intense training is normal, it’s actually a clear indicator of hormonal imbalance.

The age of first menstruation can also play a crucial role. Women who start their period later (around 17-19 or older) may have disrupted bone development patterns. This delay can create long-term vulnerabilities in bone health that persist well beyond their athletic careers.

Q: Are there specific biomechanical issues or muscle weaknesses you look out for?

Biomechanics are incredibly complex, and no two runners are exactly alike. While we look for certain structural indicators—like foot positioning or chronic lower limb issues—we approach each runner as a unique individual.

Structural variations like forefoot or rearfoot positioning can alter how your body absorbs impact during running. These variations might cause longer pronation periods or change how lower leg muscles accept load during each foot strike. However, these aren’t automatic red flags—they’re simply factors to consider in a comprehensive assessment.

Q: How much does footwear really matter?

Footwear is important, but it’s not a magical solution to injury prevention. While the right shoe can provide temporary support or address specific short-term needs, it’s not a substitute for proper training, recovery, and nutrition.

Runners often expect immediate adaptation to new shoes, but tissue changes are a slow process. It can take weeks or even months for your body to fully adjust to a new shoe design or support structure.

Q: If someone’s had a bone stress injury before, are they more likely to get another one?

Unfortunately, yes. The first two years following a bone stress injury carry the highest re-injury risk. This is because the factors that contributed to the initial injury—such as under-fueling, hormonal imbalances, or poor recovery strategies—typically affect the entire body, not just the injured bone.

Q: What’s one simple thing every runner can evaluate today to lower their risk?

Focus on holistic recovery. This means prioritizing sleep, matching your nutrition to your energy expenditure, and timing your fuel intake correctly. Most importantly, learn to listen to your body. If a persistent pain isn’t improving—especially as you increase training intensity—it’s time to reassess your approach.

Stay tuned for the final installment in our bone stress injury series, where we’ll discuss comprehensive recovery and rehabilitation strategies.

Think you might be dealing with a bone stress injury and live in the Boise area? Learn more about our bone stress injury rehab for Boise runners. We’d love to see you and get you on the path to recovery.

The post Bone Stress Injuries in Runners | Preventing Bone Stress Injuries (Part 2) appeared first on Fit & Function Therapy Solutions.

Bone stress injuries in runners are frustrating, misunderstood, and all too common.

They can creep up slowly, masked as harmless soreness… or strike suddenly when you’re in peak training. Either way, they’re responsible for sidelining countless runners every year.

In order to shine some light on this murky subject, I sat down with one of our physical therapists, Dr. Maria, to break down everything runners need to know about bone stress injuries. Instead of cramming it all into one overwhelming article, we’re splitting it into a 3-part series.

What to Expect in This 3-Part Series

Part 1: What Runners Need to Know About Bone Stress Injuries (You’re Here!)
In this post, we cover the basics: what bone stress injuries are (and how they differ from stress fractures), the key warning signs, and why simply resting isn’t enough to fix the problem.

Part 2: 5 Risk Factors You Can Actually Control to Prevent Bone Stress Injuries
No, you can’t change your bone structure—but you can control a lot of the risk factors that lead to these injuries. We dive into the training, nutrition, and biomechanical mistakes that set runners up for trouble (and how to avoid them).

Part 3: How to Treat Bone Stress Injuries—and Get Back to Running Stronger
This is where most runners go wrong. Recovery isn’t just about taking time off. In Part 3, we’ll walk you through the key steps to heal properly, maintain your fitness, and return to running without fear of re-injury.

If you’ve ever dealt with bone pain while running—or want to make sure you never do—this series is for you!

Let’s dive into Part 1 — What Runners Need to Know About Bone Stress Injuries:

What Exactly Is a Bone Stress Injury, and How Does It Differ From a Stress Fracture?

A bone stress injury encompasses both stress fractures and stress reactions. A stress reaction is a lower-grade bone stress injury than a stress fracture—it’s essentially the early stages before progressing toward a fracture.

On imaging, you would see swelling or edema in the bone. With a stress fracture, there’s an actual fracture line visible, but it’s not a complete fracture that splits the bone into two pieces. The most serious cases involve fractures that go through the cortical bone (the outer shell), which is much more concerning.

Where Do Runners Usually Develop Bone Stress Injuries?

Runners typically develop these injuries in the lower leg. We see a lot of metatarsal bone stress injuries in the long bones of the foot. They also occur in the hip at the femur and sometimes in the pelvis. The most common location would be the lower end of the tibia (the lower leg bone).

How Can a Runner Tell If They’re Just Sore From Training Versus Dealing With an Early-Stage Bone Stress Injury?

If a runner starts out on a run and finds that their symptoms improve after they’ve warmed up, this is typically a sign that it’s probably not a bone stress injury. While technically bones could “warm up,” I rarely see this clinically.

Tendon involvement, on the other hand, is notorious for warming up and feeling better with movement. Bone pain tends to persist or worsen with continued activity rather than improving.

What Are a Few Red Flags or Warning Signs That Runners Should Not Ignore?

Runners should be concerned about:

• Night pain associated with their injury
  
• Pain that persists and worsens despite rest
  
• Pain that only comes on with weight-bearing or when pressing on the bone itself
  
• Pain that doesn’t occur with gentle stretching or moving your foot or leg when seated
  
• Pain that worsens the longer you run
  
• Pain that causes you to limp
  

Are Bone Stress Injuries Really Just “Overuse Injuries”?

The majority of bone stress injuries in the running and endurance community are what we consider “bone stress injuries of insufficiency.” This means the body is experiencing an imbalance between how fast the bones are able to repair and rebuild relative to how quickly they’re breaking down.

These injuries occur when runners aren’t getting enough recovery or enough nutrients to support bone health. If you’re not consuming enough calories, the body will draw nutrients from somewhere else, and the bones often can’t keep up with this pattern.

Other contributing factors include stress, lack of sleep, and hormonal imbalances. Hormones are a significant piece of the puzzle and can provide important clues about energy expenditure problems. For example, when a female runner loses her menstrual cycle, this is her body’s warning sign that she’s not adequately fueling or maintaining hormonal balance.

What Happens If Someone Tries to Run Through a Bone Stress Injury Instead of Addressing It?

Running through a bone stress injury will only worsen it. It will not heal on its own if you continue to run on it. Bones should not be painful during physical activity. They need to be at zero out of 10 on a pain scale to safely perform any physical activity, especially running.

What Would You Say to a Runner Who’s Had Persistent Bone Pain but Keeps Putting Off Seeking Help?

Not addressing a bone stress injury, especially at a high-risk site, is extremely dangerous. High-risk sites tend to have a harder time healing and often progress to more serious injuries if not properly managed.

If you don’t unload them enough and continue to run while worsening your pain, a high-risk bone stress injury could lead to surgery and/or permanently end your running career. Early intervention is crucial for the best outcomes.

What Are The High-Risk Sites For A Bone Stress Injury, and What Makes Them High Risk?

Some bone stress injuries happen in areas that heal well with proper rest and care. Others are much more serious—these are called high-risk sites.

For runners, the most common high-risk locations include:

• The hip (femoral neck)
• The midfoot (navicular bone)
• The front of the shin (anterior tibia)
• The outer edge of the foot (base of the 5th metatarsal)
• The inner ankle (medial malleolus)

These areas are considered high risk for a few key reasons:

-Poor blood supply.
Without good circulation, bones in these areas take longer to heal—and sometimes don’t heal properly at all.

-High repetitive stress.
These bones absorb a lot of impact during running, making them more likely to worsen if not treated correctly.

-Risk of serious complications.
Because of their location, injuries in these locations can turn into complete fractures, require surgery, or cause long-term problems if ignored.

Low-risk sites, by contrast, usually heal faster and have fewer long-term consequences when managed early.

What’s One Myth About Bone Stress Injuries You Wish More Runners Understood?

One major misconception is that running alone is great for bone health. In reality, running does not do a particularly good job of stimulating bone formation. Runners can easily get into situations of under-fueling because of how much energy they expend while running, and many find it difficult to match their caloric intake to their expenditure.

When the body isn’t getting enough fuel, not only is the brain not getting enough glucose, but it also signals for the cessation of bone formation or osteoblastic activity within bone cells. For optimal bone health, runners need other interventions beyond just running, such as:

• Specific, purposeful plyometric training
  
• Regular strength training
  
• Adequate recovery
  
• Proper nutrition to support bone health
  

These additional activities, combined with proper fueling and recovery, are essential for maintaining healthy bones and preventing bone stress injuries.

Message To Boise Runners

Here in Boise, with access to everything from flat Greenbelt paths to steep foothill trails, runners face a wide variety of training stresses. Understanding bone stress injuries is key to keeping you healthy and ready for events like Race to Robie Creek—or simply enjoying your next long run pain-free.

If You Need Our Help

If you live in Boise, and you’re dealing with persistent bone pain and aren’t sure what steps to take, learn more about our bone stress injury rehab for Boise runners.

The post Bone Stress Injuries in Runners: The Boise Runner’s Guide (Part 1) appeared first on Fit & Function Therapy Solutions.

This week, we’re talking about calf strains. Similar to the last few posts, I (Jason) interviewed my wife (Dr. Maria Leibler, PT, DPT, MTC), who specializes in working with runners. Calf strains are a very common injury that she sees. In fact, she said she’s got a bunch of them right now that she’s treating.

I tried to put myself in the shoes of someone dealing with calf pain and ask all the questions that might be on their mind. Without further ado, here’s the interview:

What’s the difference between calf tightness and a calf strain?

Maria: The word “tightness” doesn’t really tell a clinician anything specific. You can have adaptively shortened calves, a sensation of tightness, or a strain. They all mean different things.

A strain is technically a tear. People don’t really like to hear that term, but that’s what it is. It’s basically going beyond the threshold of what the fibers were capable of holding onto, and they got injured. You can interchange the word strain and tear. They mean the same thing, but the severity is graded according to how extensive it is.

A sensation of tightness can come on for many reasons. It can be neural, muscular, or related to the tendon where the muscle attaches. But it doesn’t always give us the big picture. A sensation of tightness needs to be explored further.

Can you talk about calf injuries in general? What do people need to know about calf injuries?

Maria: If you have a calf injury in the muscle belly of the calf—the meaty part of the lower leg that most people think of—and it’s persisting, there’s a great chance that the more you continue to train without addressing it, the more likely it will worsen, especially for runners. It’s not something you should ignore.

Sometimes scaling back training and allowing time for recovery is all it takes. Other times there are different structures involved besides just the muscle fibers, such as the tendon or nerves in the lower leg, or sometimes even issues originating from the low back.

Males who are older, typically over 50, are a common population complaining of calf pain. But I see it in all populations. Right now I’m treating a young female, a middle-aged man, and an older gentleman.

What causes calf strains and how do they happen?

Maria: You can think of it as an overloading issue. If the demands you’re putting on your body are greater than what your tissue can recover from before you load it again, it’s not going to be able to keep up without adequate recovery time.

Are certain runners more prone to calf strains or tightness?

Maria: Men, generally older, as it relates to the entire calf muscle complex (CMC). The same is true of Achilles tendon issues—the older you are, the more it affects you, with males being most commonly affected.

Can running form contribute to calf tightness or strain risk?

Maria: Yes. There are times when people try to change their gait because they think they need to run on their forefoot or be a non-heel striker. When they adapt their running form, they shift more load to the calf muscle complex. If this adaptive period isn’t progressive and spread out enough for the body to handle that demand, it can be too much too fast and the tissues get angry.

What should a runner do if they feel calf tightness during or after a run?

Maria: It depends on the severity and behavior of the tightness. If they’re post-run, they can gently stretch their calf to see if it gives them relief. They should walk for a cool down to continue pumping blood rather than just stopping cold. They should sleep well and make sure they have adequate time between that session and their next session—ideally 24 hours.

If that’s not possible, they should ensure a thorough warm-up before their next session, which should be at least six to eight hours later if they’re having symptoms they’re unsure about.

Should runners stop running if they have calf tightness or a strain?

Maria: Generally, most runners can continue to run to some degree with considerations for decreasing intensity, which means reducing either speed or elevation. Often, going uphill is something they may need to scale back on, and definitely speed because it greatly increases the demand on the calf muscle complex.

If the area warms up the longer they run, they can generally keep going. But if the severity of their pain is causing them to change their gait mechanics or limp, then no, they shouldn’t run through a limp.

What are the biggest myths about calf tightness, strains, or calf injuries in general?

Maria: That runners should stretch their calf before a run. Or that they should stretch regardless of what’s going on, which isn’t true in the case of tendon issues, specifically insertional tendinopathy—meaning the fibers at the end of the tendon where they insert onto the heel bone. Often stretching just makes that problem worse.

People also assume that calf strains happen because they didn’t roll their calves on a foam roller enough, and that’s never the case. It’s usually an imbalance between recovery and the amount of load they’re putting on their bodies.

What home treatments actually work for calf strains and tightness other than rest? Is there something people can do at home for minor issues?

Maria: A strain to the muscle belly will generally tolerate gentle stretching. A strain happens when the muscle gets pulled too quickly or too far at a rapid rate, and the body’s reaction is to bind it down for protection because it knows injury could potentially happen again.

You can gently stretch the muscle fibers back out and massage them to help increase blood flow and relax the muscle. You can walk. Sometimes strength training is part of the remedy, but it depends on what exacerbates symptoms and what alleviates them.

How can runners tell if they need professional help for a calf strain?

Maria: If it’s worsening despite what you’ve done or attempted to do, if there’s no relief or change when you unload your training or cross-train, or if there are neural symptoms like burning, zinging, numbness, or tingling.

What are the risks of a runner trying to push through a calf injury without treatment?

Maria: Further strain, meaning a greater degree or grade of tear. There’s always a consideration for deep vein thrombosis when we’re thinking of the big calf muscles of the lower leg. That’s something we would screen for during an evaluation of muscle pain, because the calf is a common area for DVT.

Also, pushing through can cause compensations up and down the kinetic chain. Avoidance movements trying to avoid pain can cause the body to start moving differently, which isn’t good.

Could you talk briefly about the connection between the calf and the Achilles? Is one a red flag for the other?

Maria: Yes, you always want to consider them together because they form a complex of tissues that make up the calf muscle complex. They can be separate injuries if the tendon isn’t involved or the muscle belly isn’t involved, but they’re directly connected. The Achilles is how the calf muscle attaches to the bone at the heel, so you always want to consider them together.

As a physical therapist, can you talk about your approach to treating calf injuries? What do PTs do or know that people can’t do on their own?

Maria: PTs have the ability to get a lens into somebody’s situation involving their training, recovery, fueling, stress, and how they approach any given training session. We can look at their overall thought process behind cross-training, strength training, and running training, and identify where the imbalance of overloading is occurring that’s manifesting as a strain.

What does treatment typically look like? Are you working on strength in the calf or supporting muscles?

Maria: First and foremost, it’s a matter of looking at whether this calf complex is overloaded. Adding calf strengthening to somebody who’s already overloaded with physical exercise and activities could be counterproductive. You need to peel back the things that are contributing to recovery imbalance.

There may be strength deficits up and down the kinetic chain, not just in the calf. The whole posterior chain as a unit working together—meaning the glutes, hamstrings, and calves—is important.

I’m looking at how overall movement patterns play into somebody’s life. For example, can the runner perform a hip hinge? Are they always just flexing their spine and falling forward, which puts their center of mass more in front? This shifts weight to the forefoot or toes, making the calf work harder to counteract that weight distribution. So I’m examining things up and down the entire kinetic chain.

Are calf strains one of those injuries that needs load to recover?

Maria: It’s different from tendon in that sense, where you want to be loading the tendon tissue to help it heal. But the same general concept applies—you don’t want to make an individual immobilized or sedentary. You want to keep them as active as possible, and with muscular pain, we can do that by keeping their symptoms low through appropriate modifications. You want them to work through as much beneficial activity without pushing over their threshold for exacerbating symptoms.

Are there any exercises that can prevent calf issues or that you would recommend most runners have in their strength training routine?

Maria: Strengthening the calves is important for overall fitness and health because the calf muscle complex deals with a lot of load during running. If you’re consistently targeting the four main muscle groups of the legs, you should have good balance and variability in movement, which is important.

Can you be a little more specific? Should they do calf raises? Plyometrics? Lifting to failure? What should a healthy runner do to keep their calves strong?

Maria: Yes to strength exercises, yes to plyometric exercises, and no to lifting until failure. Having one or two reps in reserve when you’re lifting for muscular strength is a good general approach for runners.

For strength exercises, runners should incorporate different variations of calf raises to target both the gastrocnemius and soleus muscles. This includes straight-leg calf raises for the gastrocnemius and bent-knee calf raises for the soleus. Start with bodyweight exercises, then progress to single-leg variations, and eventually add resistance with dumbbells or a calf raise machine.

For plyometrics, include exercises like skipping, hopping, and jumping rope to develop elastic strength and power in the calves. These exercises train the stretch-shortening cycle that’s crucial for running efficiency. Start with low volume—maybe 2-3 sets of 8-10 reps twice weekly—and gradually increase as tolerance builds.

Progressive overload is important, but runners should avoid training to complete failure, as this can impair recovery between running sessions. Focus on quality movements with good form, gradually increasing weight or repetitions over time. For most runners, 2-3 calf-strengthening sessions per week is sufficient, with at least 48 hours between intense sessions to allow for recovery.

Any closing advice on calf injuries in runners?

Maria: Even if calf pain is minimal, if it’s popping up chronically or repetitively, don’t ignore it. Have a physical therapist who knows about running look at your overall training. Consider how much energy you’re actually expending during any given day, week, month, and season, and evaluate whether you’re giving adequate recovery for your body to keep up with those demands.

If You’d Like Our Help

If you live in the Boise area, and you’d like our help, learn more about our calf pain treatment for Boise runners.

The post Calf Strains in Runners: Why They Happen, What They Mean, and What to Do appeared first on Fit & Function Therapy Solutions.

This week we continue our series of posts where I (Jason, a non-physical therapist) interview my wife (Dr. Maria Leibler, PT, DPT, MTC) to learn more about a common running injury.
This week our topic is achilles pain in runners. I tried to ask her questions that would be useful for someone suffering from this condition.

Just to give you some quick context if you’re not familiar with us – Maria is a physical therapist who has dedicated her career to working with runners. She founded Fit & Function Therapy Solutions, which is a specialty physical therapy clinic for runners in Boise, Idaho.

In addition to working with runners all day every day, Maria never stops learning about the latest and greatest research and methods in physical therapy to help runners get out of pain and stay out of pain.

Without further ado – here’s the transcript from our interview together:

What exactly is Achilles tendinitis, and why do runners seem to struggle with it so often?

Maria: What people commonly call “Achilles tendinitis” is actually a form of tendinopathy. It’s a condition caused by excessive load that leads to structural changes in the tendon.

The term “tendinitis” is technically incorrect when talking about the Achilles tendon. The “-itis” suffix implies inflammation, but the Achilles tendon doesn’t have the blood supply or cellular makeup for true inflammation. Instead, the pain and stiffness runners feel often stem from irritation of the peritendon (the thin sheath around the tendon) or degenerative changes within the tendon fibers from repeated stress.

Achilles tendinopathy is essentially a breakdown of the collagen structure within the tendon due to too much stress. Normally, tendons adapt to stress, but when they don’t get enough recovery, small micro-tears accumulate faster than the body can repair them. This leads to thickening, stiffness, and pain—particularly in the morning or at the start of a run.
Runners are especially prone to this condition because the Achilles tendon absorbs and transmits enormous forces with every stride—up to 6–8 times body weight.

How can a runner tell if their Achilles pain is tendinopathy or something else?

Maria: The key is to look at two main factors: anatomical location and pain characteristics.
In the Achilles area, multiple structures could be causing pain—the plantaris tendon, Achilles tendon, peritendon, sural nerve, and surrounding tendons and blood vessels. The type of pain matters: Is it burning? Achy? Sharp? Dull? These characteristics help determine which tissue is involved.

For example, if a nerve is compressed, movement might initially warm up the area and increase blood flow. But if the pain worsens with continued activity, that’s a different signal than a tendon problem. Tendons actually prefer movement—they don’t like being completely sedentary. An acute tendon injury has a specific pain behavior, and typically, gentle loading is part of the treatment.

As a physical therapist who treats runners, is Achilles tendinopathy the most common diagnosis in that area?

Maria: In most cases, runners come to me with pain either right where the Achilles tendon connects to the heel bone or in the middle section of the tendon. Sometimes there might be some nerve-related issues, but typically it’s the tendon itself that’s causing the problem.

What are the early warning signs of Achilles tendinopathy that runners often ignore?

Maria: Generally, runners should watch for stiffness during prolonged rest, or pain that seems to warm up and improve after the first few minutes or miles of a run.

What are the most common causes of Achilles tendinopathy in runners?

Maria: Several training mistakes can lead to Achilles tendinopathy:

-Taking on elevation gain too quickly without gradual adaptation
-Increasing mileage too rapidly
-Pushing beyond the tissue’s current capacity
-Insufficient recovery between intense training sessions

Essentially, it’s about overloading the tendon faster than it can adapt. The key is progressive, careful training that allows the body time to adjust.

Does running form contribute to Achilles tendinopathy?

Maria: Running form itself isn’t typically the primary issue. What matters more are sudden, drastic changes in running variables. For instance, switching from shoes with a high heel drop to zero-drop shoes overnight, especially during a high-mileage week, can stress the calf complex and Achilles tendon.
Generally, I don’t believe runners need to completely overhaul their running form. Instead, they should focus on gradual adaptations and understanding how changes in footwear or terrain might impact their body.

Are certain types of runners more prone to Achilles issues?

Maria: Yes. The faster you run, the more load shifts toward the forefoot, which puts additional stress on the calf complex. Sprinters and runners doing speed work are potentially at higher risk compared to those maintaining a steady, slower pace.

Can Achilles tendinopathy be treated at home or does it require professional intervention?

Maria: If addressed early and carefully, runners can often manage Achilles issues themselves. However, many people inadvertently make their condition worse by doing what seems intuitive—like stretching or complete rest.

Tendons need careful, progressive loading. Simply stretching an irritated tendon can cause more harm. Complete rest is often counterproductive. The goal is to find a sweet spot of movement and controlled loading.

Should runners completely stop running if they have Achilles tendinopathy?

Maria: Not necessarily. Many times, runners can continue training safely with some modifications. The key is managing load and pain:
-Runners with high pain might focus on level or downhill routes
-Those with low pain can incorporate gradual warm-ups
-Cross-training and a targeted rehabilitation program can help maintain fitness while supporting tendon recovery

What treatments actually work for Achilles tendinopathy?

Maria: Loading is the number one intervention. Tendons need “mechano-transduction” to heal – meaning they require movement and controlled stress. Contrary to popular belief:
-Icing doesn’t significantly help
-Stretching can often irritate the tendon
-Complete rest can make the condition worse
-Heel lifts can be helpful in specific cases, particularly for managing pain at the tendon’s insertion point. The goal is to avoid positions that overly compress the tendon while providing gentle, progressive loading.

What muscle weaknesses contribute to Achilles tendinopathy?

Maria: It’s about looking at the entire kinetic chain. Key areas include:
-Calf complex strength
-Hamstring and glute support
-Overall leg muscle balance
-Biomechanical factors like excessive foot pronation can play a role. While not a definitive predictor, I often see a correlation between excessive foot movement and medial-sided Achilles pain.

How does someone know when it’s time to go see a physical therapist of they’re suffering from achilles pain?

Maria: Consider professional help if:
-Pain is consistently worsening
-You’re unable to run without limping
-Your own management strategies aren’t improving the condition
-You’re experiencing symptoms beyond simple tendon pain

What does physical therapy for Achilles tendinopathy involve?

Maria: A comprehensive approach that includes:
-Strength and conditioning-style loading programs
-Soft tissue work on surrounding muscle groups
-Detailed analysis of running mechanics
-Personalized training program modification
-Strategies to keep training intensity below the pain threshold

Are there treatments runners should avoid?

Maria: Treatment depends on the specific tissue involvement, but generally:
-Avoid stretching the irritated tendon
-Be cautious with positions that put excessive strain on the tendon
-Avoid heel positions lower than the toes in certain cases

Are runners more likely to experience Achilles tendinopathy again once they’ve had it?

Maria: Yes. Prevention involves:
-Understanding your body’s specific weaknesses
-Recognizing early warning signs
-Learning to listen to your body
-Avoiding constant year-round progression
-Incorporating off-seasons and cross-training
-Allowing proper recovery time

What strength exercises can help prevent Achilles issues?

Maria: Focus on a well-rounded approach:
-Strength training for all major leg muscle groups
-Plyometric work
-Exercises that improve tendon energy storage and release
-Compound movements
-Upper body conditioning

Bonus question: What’s the average prognosis for achilles tendinopathy? How long does it take to get over this on average?

Maria: (gives Jason a look because she hates these types of questions where she is forced to make blanket generalizations…)

(Jason laughs). Ok, let’s say if somebody does everything you tell them to do and they don’t flare it up?

Maria: Well, first off, it’s rare for someone to go through a rehab program without at least a small flare-up. The goal is to minimize those setbacks as much as possible so they can keep making progress. But some pain along the way isn’t necessarily a bad thing—it actually helps guide us. Pain tells us if we’re pushing too hard or not enough, and that feedback is crucial for understanding where to start and how much load the Achilles can handle.

If someone catches this early and manages it well, they can usually recover within weeks to a few months. The pain itself can take time to settle, but even after it’s gone, rehab isn’t over. We still need to build strength and improve the tendon’s capacity so it doesn’t come back. That process takes a minimum of six to eight weeks beyond the pain relief phase.
For more severe cases—especially chronic tendinosis, where the tendon has degenerated—recovery can take many months to a year, sometimes longer. The more the tendon has broken down, the longer it takes to rebuild.

Any closing advice?

Maria: Mostly, listen to the warning signs—the check engine lights your body gives you along the way. When we look back at a runner’s training history before an Achilles rupture or before the pain becomes severe, we often see clear spikes in training load that could have been managed better.

The key is paying attention to your body in real time, rather than realizing months later that something was off. It’s common for injuries to show up four to six weeks after the actual overload happened. That’s why having a broader perspective on training and recovery can help prevent these issues before they turn into a bigger problem.

If You’d Like Our Help

If you live in the Boise area, we invite you learn more about our achilles tendon pain treatment for Boise runners.

The post Achilles Pain In Runners: Causes, Treatment, and How to Keep Running appeared first on Fit & Function Therapy Solutions.

IT band pain in runners is one of the most common and frustrating injuries that can sideline your training. That’s why I’m excited to share insights from my wife Dr. Maria Leibler. Maria is a physical therapist and running rehab specialist who has committed her career to treating runners with all types of injuries.

I’m Jason Leibler, Maria’s husband, and today we’re continuing our series of posts where I interview Maria to learn more about common running injuries. Today we’re tackling IT band pain—something that affects countless runners each year.

If you’ve ever experienced that sharp, stabbing pain on the outside of your knee during a run, you might be dealing with IT band pain. In this interview, Maria breaks down what’s really happening, why traditional approaches often fail, and how to actually fix this frustrating issue.

Where Does IT Band Pain Occur?

Before diving into Maria’s expertise, let’s clarify what we’re talking about. The IT band (iliotibial band) is a thick, fibrous band of connective tissue that runs along the outside of your leg, extending from your hip (pelvis) down to just below your knee.

When runners experience IT band pain, it typically presents as a sharp, burning sensation on the outside of the knee. Some runners describe it as a stabbing pain that appears a few miles into their run. Others might feel discomfort that extends up the outer thigh. The pain often worsens with continued running, especially during downhill sections, and might even force you to cut your run short.

What Does The IT Band Do?

The IT band (iliotibial band) is a thick band of fascia that runs along the outside of your leg from your hip to your knee. As Maria explains:

“The IT band is a structure that provides stability to your knee. Running is considered a high-impact sport—essentially hopping from one leg to another for a long period of time. The IT band will take on increased demand when other structures or regions of the body aren’t capable of providing enough stability for themselves.”

In other words, when you run, your IT band helps stabilize your knee. But when other muscles aren’t doing their job properly, the IT band takes on too much stress, leading to pain.

Why Does My IT Band Hurt When I Run?

According to Maria, IT band pain typically develops because of capacity issues:

“Typically runners don’t have enough capacity, whether that be strength or endurance, for the demand of whatever task they’re doing repetitively, usually over weeks or months.”

Muscle Weaknesses That Contribute

When I asked Maria about specific muscle weaknesses that contribute to IT band pain, she identified two main culprits:

1. Weak Quadriceps: “I often find the quadriceps don’t do a good enough job at absorbing enough force.”
2. Weak Glutes: “If somebody’s lateral glutes truly are weak and they don’t have the neuromuscular control to prevent excessive pelvic drop, that can put more stretch on the IT band as it accepts load. The lateral glutes—gluteus medius and minimus—are particularly important.”

Jason’s translation: Basically, the muscles on the outside of your hip (your lateral glutes) help keep your pelvis level when you’re running. If these muscles are weak, your pelvis can drop to one side when you’re on one leg, which stretches and stresses your IT band. Think of these muscles as the support system that keeps everything aligned when you run. When they’re weak, other structures like your IT band have to pick up the slack.

Running Form and IT Band Pain

Does your running form matter when it comes to IT band pain? Maria says yes:

“Running form can play a role, especially for runners who overstride. When overstriding, your foot lands further out from your body, resulting in your knee being more extended or straighter than what’s ideal for the muscles—specifically the quads—to absorb force. This puts more load through stabilizing structures like the IT band.

If you prevent overstriding, say by increasing your steps per minute (cadence), you’ll shorten your step length. Your knee will be slightly more flexed when you hit the ground, allowing your muscles to absorb that energy better, creating a more even distribution of force through different structures.”

The Truth About Foam Rolling and Stretching

Here’s where Maria challenges conventional wisdom. When asked about foam rolling the IT band, she explains:

“Foam rolling can help with symptom modification, but it’s not something I recommend for most runners, especially if they’re strapped for time and want the best bang-for-their-buck interventions. They’re better off addressing the underlying issues, such as the strength component, overstriding, or looking at their training load.”

And on stretching the IT band, Maria didn’t mince words:

“The biggest myth about IT band pain is that you need to stretch the IT band. You can’t stretch the IT band—it’s extremely tough tissue designed to resist load. It’s fascia, and you can’t stretch fascia, nor would you want to. You want it to be stable and strong.”

Can You Keep Running With IT Band Pain?

Good news for runners dealing with IT band pain—you probably don’t need to stop running completely:

“Most runners can continue to run with some modification to their training,” Maria says.

However, she cautions that if you’re limping or changing your running form due to pain, that’s a sign it’s time to seek professional help.

How to Prevent IT Band Pain Recurrence

If you’ve had IT band pain before, Maria confirms you’re more likely to experience it again. To prevent recurrence, she recommends:

1. “Making sure your training plan is appropriate and you’re not having major spikes in your running volume.”
2. “Maintaining a good strength program.”
3. “Preventing overstriding.”

Essential Strength Training for Runners

When asked about specific exercises for IT band health, Maria emphasizes a comprehensive approach:

“I generally make sure every runner is targeting all four major muscle groups of the legs: the calves, the quads, the hamstrings, and the glutes.”

Best Exercises For IT Band Pain

To Address Quad Weakness:

Since quad weakness is frequently associated with IT band pain, here are some effective exercises to strengthen them:

1. Progressive Step-Downs – Stand on a step, slowly lower one foot toward the ground with control, lightly tap the floor, then push through the standing leg to return to the starting position.

2. Bulgarian Split Squat – Stand a few feet in front of a bench, place one foot behind you on the bench, lower into a lunge by bending your front knee while keeping your chest upright, then push through your front foot to return to standing.

3. Weighted Squat – Hold a weight at your chest (or on your back), stand with feet hip-to-shoulder width apart, lower your hips back and down while keeping your chest upright, then push through your heels to return to standing.

To Address Lateral Glute Weakness:

For lateral glute strengthening, these exercises can be particularly helpful:

1. Monster Walks – Place a resistance band around your ankles or above your knees, take small, controlled steps forward and backward while maintaining tension in the band and keeping your knees slightly bent.

2. Side Planks (With Leg Lift if Possible) – Lie on your side, prop yourself up on your forearm with your body in a straight line, engage your core, and lift your top leg while keeping it straight—hold for time or perform slow reps.

The key with these exercises isn’t just doing them occasionally, but incorporating them consistently into a progressive strength program that gradually increases in difficulty as your muscles adapt.

Terrain Considerations

Certain running environments can aggravate IT band pain:

“Generally, running downhill is worse for individuals suffering from this type of pain. Uphill may be a little better,” Maria notes.

When to Seek Professional Help

While IT band pain can sometimes be self-treated, Maria suggests seeing a professional if:

1. “Your pain is increasing or worsening despite what you do.”
2. “You are unable to resume running due to how intense the pain is.”
3. “You don’t have any idea of how to improve it or don’t have any clues on how to modify your running.”

How To Fix IT Band Pain In Runners

As a professional running rehab specialist, Maria’s process for treating IT band pain is systematic:

“When I treat IT band pain in runners, my first step is to identify any areas in their training that may be overloading their system and affecting recovery. This could be things like sudden mileage increases, intensity changes, the terrain they’re running on, or not allowing enough recovery time.

From there, I make small tweaks to their training to reduce strain—this might mean adjusting their route, terrain, or intensity so they can keep running without making things worse. I also look at their running form to see if they’re overstriding, which can put extra stress on the IT band.

If they don’t already have a strength program, I introduce key exercises to build up the muscles that support the knee and hip. If they do, I fine-tune it to make sure it’s actually helping.

When they start feeling more confident and in control of their pain, I guide them through a structured return to normal training, making sure we change only one thing at a time—whether it’s mileage, speed, or terrain—to ensure their body tolerates it. The goal is to not just get them back to running, but to make sure they stay pain-free long-term.”

What Happens If Left Untreated?

Ignoring IT band pain can lead to more serious issues:

“More than likely your body will begin to compensate. You may start limping, and problems can start moving around the kinetic chain as your body tries to escape the pain. This causes you to run differently, which is never what you want because you’re just shifting the load to a different structure that’s not equipped for that amount of stress.”

Final Thoughts

The bottom line on IT band pain, according to Maria: “IT band pain is totally treatable as long as you ignore lots of bad advice circulating out there. The key is strengthening the right muscles, avoiding overstriding, and following a smart training plan that doesn’t overload your system.”

If you’re dealing with persistent IT band pain and want expert guidance, check out our IT Band Syndrome Pain Treatment for Boise Runners. We’ll help you identify the root causes and develop a personalized plan to get you back to pain-free running.

The post IT Band Pain in Runners: What To Do and What Not To Do appeared first on Fit & Function Therapy Solutions.

Hamstring pain in runners, like most running injuries, is more complex than it might seem at face value.

If you’re dealing with pain in the back of your thigh, you probably think you know what’s wrong – it must be a hamstring strain, right? Well, as I recently learned, it’s not that simple. In fact, what runners typically call “hamstring pain” often isn’t related to the hamstring muscle at all.

I sat down with Physical Therapist Maria (who happens to be my wife) to get to the bottom of this common running injury. What I learned surprised me, and it might change how you think about that nagging pain in the back of your thigh.

As an experienced runner and someone who regularly helps runners overcome injuries, Maria shared insights that challenged my understanding of this common running complaint.

Key Takeaways:

– What runners call “hamstring pain” often isn’t a hamstring strain, and might not even be coming from their hamstring at all

– Common causes include tendon issues, nerve pain from the back, referred pain from the hip joint, or bone pain.

– Most runners can continue running if pain improves during the run and stays mild

– Stop running and seek help if pain is severe (5-6/10) or spreads down the leg

– Recovery time varies greatly depending on the actual cause

– Professional evaluation is crucial for proper diagnosis and treatment

Common Misconceptions About Hamstring Pain

Jason: What’s the biggest misconception runners have about hamstring pain?

Maria: The main misconception is assuming it’s a muscle strain. For endurance runners especially, it’s rarely a true hamstring strain unless you were doing high-intensity sprinting. The pain in the back of your thigh could be coming from several other structures – tendons, nerves, the hip joint, or even bone.

This misunderstanding often leads runners down the wrong treatment path. Many will try to treat what they think is a muscle strain with stretching and rest, when in fact they might need a completely different approach.

Understanding Different Types of “Hamstring” Pain

Jason: Where do runners typically feel this pain, and what might it mean?

Maria: The pain can occur in different locations, but I see it most commonly near the “sit bone” (where your hamstring attaches at the bottom of your pelvis) and around the knee. The location can tell us a lot about what’s actually causing the pain.

For example, if you’re feeling pain right at the sit bone, it’s often related to the proximal hamstring tendon. Pain closer to the knee might involve the distal hamstring tendons. But here’s where it gets tricky – sometimes pain in these same areas can actually be coming from your lower back or sciatic nerve, even though it feels like it’s in your hamstring.

Jason: Why is this type of pain so tricky to diagnose and treat?

Maria: It’s complicated because many different problems can cause similar symptoms. Think about it – we sit all day, which can compress both tendons and nerves in that area. Activities like bending over, going uphill, or climbing stairs can all cause discomfort, but the same activities might hurt whether it’s a tendon problem, nerve issue, or something else entirely.

That’s why we have to look carefully at the type of pain, when it occurs, and how it responds to different movements. For instance, nerve pain often feels different from tendon pain – it might feel more like tingling or burning, and it’s more likely to travel down the leg. Tendon pain, on the other hand, is usually more localized and might feel better once you’re warmed up.

Recovery Timeline and Treatment

Jason: What can runners expect in terms of recovery time?

Maria: It really depends on the underlying cause:

– For a true muscle strain: Usually a matter of weeks

– For tendon issues: Can take up to a year, but most runners can continue running while doing rehab

– For nerve pain from the back: Typically 3-6 months, but it varies widely

The key thing to understand is that recovery isn’t just about waiting for time to pass – it’s about following the right treatment approach for your specific condition. For example, with tendon problems, you might need to modify your running but not stop completely. The focus would be on gradually building the tendon’s capacity to handle load through specific exercises and careful progression.

When to Keep Running vs When to Stop

Jason: How do runners know if they can keep running through the pain?

Maria: Here are the general guidelines:

– OK to continue if: The pain warms up during your run and stays mild

– Stop running if: Pain is severe (5-6 out of 10) or gets worse the longer you run

– Red flag: If pain starts traveling down your leg during the run

It’s also important to pay attention to how you feel the day after running. If your symptoms are significantly worse the next day, that’s a sign you might need to modify your running or take a break. Remember, running through pain isn’t always being tough – sometimes it’s just making the problem worse.

Prevention and Strengthening

Jason: What can runners do to prevent these issues?

Maria: The key is gradual progression. Build your running foundation first – consistent easy runs before adding intensity or hills. Also, strength training is crucial. The top exercises I recommend are:

1. Romanian deadlifts (RDLs)
2. Bridge exercises
3. Hip thrust movements

These exercises help build tissue capacity and resilience, which is essential for preventing both muscle and tendon problems. But it’s not just about doing the exercises – it’s about progressing them appropriately and integrating them into your overall training plan.

Jason: Is stretching and massage helpful?

Maria: It depends on the actual problem. Irritated tendons and nerves don’t like to be stretched. I usually prefer strengthening exercises that provide a gentle stretch while building capacity. This approach is more effective than stretching alone.

Many runners immediately reach for stretching when they feel tightness or pain, but this isn’t always the best approach. If you have a tendon problem, for instance, aggressive stretching might actually make things worse. Instead, focus on controlled strengthening exercises that work through a full range of motion.

When to Seek Professional Help

Jason: When should runners stop trying to manage this on their own?

Maria: See a professional if:

– Pain persists longer than two weeks without improvement

– Pain is severe even after scaling back activity

– Pain starts spreading to new areas

– You can’t hop on one leg without pain

– Your symptoms don’t change no matter what you try

The earlier you seek help, the better your chances of a quick recovery. Many runners wait too long, trying various self-treatment approaches before getting professional help. This often leads to a longer recovery time and more complicated treatment process.

Jason: What can a physical therapist do that runners can’t do on their own?

Maria: The biggest value is getting an accurate diagnosis. What feels like hamstring pain could be coming from various structures – muscle, tendon, nerve, bone, or even the hip joint. Each requires a different treatment approach. A PT can identify the actual problem and create a specific program that either loads or unloads the affected tissues appropriately.

We also look at the bigger picture – your running form, training history, and other factors that might be contributing to the problem. Sometimes what seems like a simple hamstring issue is actually related to hip mobility, running mechanics, or training load management.

Jason: What’s the risk of not getting professional help?

Maria: Two main risks: First, the longer you wait, the longer recovery typically takes. Second, if you’re compensating for the pain by moving differently, you’re likely becoming a less efficient runner and could develop other problems.

This compensation pattern is particularly concerning because it can lead to a cascade of issues. You might start favoring one side, which can affect your hip, knee, or even your lower back. These compensations can persist even after the original pain is gone if they’re not properly addressed.

Final Thoughts

Remember, pain in the back of your thigh might not be a simple hamstring strain. Understanding that “hamstring pain” in runners can have multiple causes is the first step toward proper treatment. While some cases might resolve with self-care, persistent or severe pain deserves professional attention. The key is getting an accurate diagnosis and following a targeted treatment plan that addresses your specific condition.

Don’t let misconceptions about hamstring pain keep you from getting the right treatment. With proper diagnosis and management, most runners can return to pain-free running and prevent future problems. The journey back to healthy running might take time, but with the right approach, you can make steady progress toward your running goals.

Need Help?

Not sure what’s causing your hamstring pain? Don’t guess—get answers. Learn more about our hamstring pain treatment for Boise runners.

The post Hamstring Pain in Runners: Why It’s More Complicated Than You Think appeared first on Fit & Function Therapy Solutions.

Most people aren’t thinking too much about training for the Race to Robie Creek quite yet.

And I get it.

It’s early February right now, there’s snow on the ground, and it’s cold. The weather forecast shows we might even hit the single digits for a low this week. 

Not exactly ideal running conditions. 

But that doesn’t change the fact that the Race to Robie Creek is just a little over two months away! If you’re planning to run it, now is the time to start training. 

Let me briefly introduce myself: I am NOT Dr. Maria Leibler, physical therapist and running rehab specialist. I’m Jason Leibler, her husband.

Maria normally writes these blog posts, but she was short on time this week, so we did something a little different.

I played the role of a reporter and “interviewed” her. I tried to extract as much useful info as I could for us non PT’s about how to train for the Race to Robie Creek.

Here’s what I learned:

TL;DR: How to Train for the Race to Robie Creek

The Race to Robie Creek is no ordinary half marathon—it’s a brutal uphill grind followed by a steep descent. To survive (and maybe even enjoy) it, focus on:

• Hill training. Your calves, quads, and lungs will thank you.
• Strength work. Especially for your calves, glutes, and quads.
• Fueling properly. Robie takes a lot more energy than a normal half.
• Downhill technique. Bombing the descent = knee pain. Control your form.
• Strategic tapering. Strength training should back off as mileage peaks.
• Smart recovery. Eat, sleep, and move well post-race.

Now, let’s get to the 10 questions.

10 Essential Questions About Training for the Race to Robie Creek

1. What makes Robie Creek different from a regular half marathon?

Maria: “Running uphill for such an extended period requires significantly more energy than covering the same distance on flat or rolling terrain. You need to adjust your fueling strategy accordingly and make sure you’ve trained on similar elevation profiles beforehand. My advice is to give it your all on the uphill portion because you can use the backside descent to your advantage.”

2. Are there any unique considerations about the Robie Creek course?

Maria: “The sun exposure is primarily on your right side during the climb, so plan your sun protection accordingly. If it’s been a snowy winter, be prepared for varying footing conditions on the backside of the mountain. Also, don’t neglect your upper body strength training – a strong upper body and core help maintain efficient form while climbing and provide better control during the descent.”

3. How do steep climbs affect our legs and joints?

Maria: “Steep climbs primarily put increased demands on your calf muscles. While running uphill engages multiple muscle groups, the calves take on a significantly larger workload compared to running on flat terrain. This is why specific hill training and calf strengthening become crucial when preparing for races with substantial elevation gain.”

4. How should runners prepare their muscles for the long uphill?

Maria: “The key to preparing for long uphill sections is consistent, progressive training. You should incorporate hill workouts at least once a week, starting with easier runs and gradually increasing the intensity. Additionally, complementing your hill training with targeted strength work in the gym is essential for building the muscular endurance needed for sustained climbs.”

5. What are the best strength exercises for hill running?

Maria: “The most effective exercises for hill running include step-ups, Romanian deadlifts, calf raises, squats, and Bulgarian split squats. When it comes to programming these exercises, focus on building true strength rather than endurance. This means using heavier weights with sets of 8-10 repetitions, leaving only 1-2 reps in reserve. You’re aiming to build muscular strength, not muscular endurance.”

6. How should runners structure their strength training?

Maria: “If you’re lifting heavy enough, you don’t need a huge variety of exercises in each session. Pick about four key exercises and perform them with proper intensity. It’s important to vary your movement patterns from week to week rather than doing the exact same routine. Most runners benefit from strength training twice a week.”

7. Why do runners often get knee or shin pain after long downhills?

Maria: “Most downhill-related knee pain occurs when runners over-stride and ‘bomb’ down the hill with excessive step length. The key is maintaining control of your movement and keeping your step length appropriate. Strong quadriceps are crucial as they act as your primary braking force when running downhill. When properly trained, they can help absorb and manage the increased forces that come with downhill running.”

8. What are common downhill running mistakes?

Maria: “The biggest mistake is not treating downhill running as a skill that requires specific training. Many runners assume running downhill is easy and therefore don’t develop proper technique or strategy. This lack of preparation often leads to poor form and increased injury risk. Downhill running needs to be practiced progressively, starting on gentle gradients before tackling steeper descents.”

9. How should runners adjust their training as race day approaches?

Maria: “As you approach race day, recovery becomes increasingly important. You need to sleep more than you think you need and increase your fueling to match your increased mileage. It’s also important to begin tapering your strength training as your running volume increases. Remember that you can’t just keep adding training load – as one aspect increases, something else needs to give. Consistency in recovery strategies is crucial.”

10. What’s the best way to recover after finishing the race?

Maria: “The immediate post-race period is crucial for recovery. Focus on proper fueling by ingesting calories to replenish the energy you’ve expended during the race – eat soon and eat plenty. Avoid doing anything too strenuous and give your body adequate time to recover before returning to running. Light walking can help promote blood flow and aid recovery.”

Tactical Training Tips: Where to Train in Boise

If trails are muddy and off-limits, you can still get quality hill training in. Local runners recommend:

-8th Street & Rocky Canyon – Reliable year-round roads with plenty of elevation.
-Cartwright Road – Climb from either Pierce Park or Bogus Basin Rd.
-Shaw Mountain Road – Another solid option for sustained climbing.
-Blacks Creek Road & Wilson Creek (Nampa) – Good alternatives with rolling hills.
-Hill Repeats – Short, steep climbs (e.g., Phillippi Hill) can simulate the effort.
-Part of the Actual Course – Get familiar with the first few miles.
–Boise Area Runners Group – Hosts Robie training runs starting in February.

For more runner-recommended training spots, check out [this Reddit discussion].

Final Thoughts

The Race to Robie Creek is brutal, but if you train smart, you’ll show up ready to take it on.
Stay consistent, listen to your body, and train safely.
And if you have any questions—or need help with an injury—shoot us an email or message us on Instagram.

Good luck with your training!

The post How to Train for the Race to Robie Creek: 10 Questions Answered appeared first on Fit & Function Therapy Solutions.

Plantar fasciitis—just hearing the term might make your heel throb if you’re one of the many runners battling this frustrating condition. Whether the pain started as a dull ache or hit you suddenly after an intense workout, the result is the same: walking, let alone running, feels like a struggle.

For runners, plantar fasciitis is a common yet misunderstood injury. It’s often caused by a mix of overuse, poor foot mechanics, and inadequate recovery. Without the right approach, it can sideline even the most dedicated athletes.

The good news? Plantar fasciitis is treatable. In this guide, we’ll break down what plantar fasciitis is, why it happens, and how you can recover without giving up your training entirely. Let’s tackle this together so you can get back to pain-free running.

Looking for plantar fasciitis treatment in Boise? We specialize in helping runners get back on their feet—without surgery or injections.

A Quick Note on Terminology

As a physical therapist who works extensively with runners, I often get questions about plantar fasciitis. While we in the medical community might use the more technically accurate term “plantar fasciopathy” (which simply means a problem with the plantar fascia), the treatment approach remains largely the same.

The difference in terminology mainly reflects our understanding that:

• Plantar fasciitis suggests inflammation (“-itis”).
• Plantar fasciopathy describes a chronic overload issue (“-opathy”).

For this article, we’ll use both terms interchangeably, as most runners and healthcare providers commonly use “plantar fasciitis.”

Understanding Your Foot’s Support System

Let’s start with the basics: the plantar fascia is a remarkable structure in your foot. It’s not a muscle or a tendon, but rather a specialized tissue designed to provide stability. Think of it as a tough, dense band that runs along the bottom of your foot. Unlike what many believe, it’s not meant to stretch—it’s designed to be incredibly stable and sturdy, capable of handling significant forces.

The plantar fascia attaches to your heel bone (calcaneus) and extends toward your toes, playing a crucial role in maintaining your foot’s arch and providing essential stability during walking and running. Most people experience pain at this heel attachment point, which is why heel pain is often the first symptom they notice.

How Plantar Fasciopathy Develops

This condition typically develops in one of two ways:

• Sudden Onset: Picture sprinting across your yard to catch an escaping dog and suddenly feeling pain in your foot. This acute pain occurs when the fascia gets tugged on too quickly or forcefully. These cases often have a clear triggering incident that the runner can identify.
• Gradual Development: More commonly, the condition develops over months or years of gradual overload. This is particularly relevant for runners who incrementally increase their training load without adequate recovery periods. The insidious nature of this development often makes it harder to pinpoint exactly when or why the problem started.

Understanding Load Management

The key concept here is tissue loading. Whether sudden or gradual, plantar fasciopathy occurs when the load placed on the fascia exceeds its capacity to handle that load. This can happen through:

• Rapid increases in running volume.
• Sudden changes in running terrain or elevation.
• Significant increases in speed work.
• Changes in footwear or running technique.
• Inadequate recovery between training sessions.

The Classic Morning Pain

If you’ve experienced that characteristic sharp heel pain with your first steps in the morning, you’re not alone. This is one of the most common symptoms of plantar fasciopathy. The pain typically occurs after periods of inactivity—not just in the morning, but also after sitting at your desk or watching a movie.

Here’s why: contrary to what you might think, rest actually makes the tissue stiffer, not better. The plantar fascia, like many other tissues in our body, benefits from appropriate movement and loading. When we’re inactive, the tissue becomes less pliable and more sensitive to stress, leading to that characteristic pain with initial steps.

Myths About Plantar Fasciitis

When it comes to plantar fasciitis, there’s no shortage of misinformation. Let’s clear up some of the most common myths:

Myth 1: Rest is the Best Cure

While rest may temporarily reduce pain, it’s not a long-term solution for plantar fasciitis. Prolonged inactivity can actually worsen symptoms by causing stiffness in the fascia. Instead, recovery requires a combination of gradual loading exercises, mobility work, and activity modifications.

Myth 2: You Can Stretch the Plantar Fascia to Fix It

The plantar fascia isn’t like a muscle—it doesn’t stretch in the same way. In fact, trying to stretch it too aggressively can cause more irritation. Focus on improving mobility in the ankle and big toe instead, as this can reduce strain on the fascia.

Myth 3: It’s All About Your Shoes

While footwear plays a role, it’s rarely the sole cause of plantar fasciitis. Many cases stem from biomechanical issues, overtraining, or muscle imbalances. Supportive shoes can help, but they’re not a magic fix.

Myth 4: Rolling on a Tennis Ball or Frozen Water Bottle Cures It

Rolling can provide temporary relief by increasing blood flow and reducing stiffness, but it doesn’t address the root cause. Think of it as a helpful tool for managing pain, not a standalone treatment.

Myth 5: Surgery (or Cutting the Fascia) Is the Only Option for Chronic Cases

Some people believe that cutting the plantar fascia is the best way to solve persistent pain. While plantar fascia release surgery is a real procedure, it’s almost always a last-resort option. This surgery involves partially cutting the fascia to release tension, but it comes with risks, including instability in the arch.

For the vast majority of runners, conservative treatments like physical therapy, activity modifications, and strengthening exercises are highly effective. Surgery is rarely needed when the root causes are properly addressed.

Myth 6: Plantar Fasciitis Will Go Away on Its Own

Some cases do resolve over time, but persistent symptoms often need intervention. Ignoring plantar fasciitis can lead to chronic pain or compensatory injuries, so it’s best to address the problem early.

Myth 7: You Have to Stop Running Completely

For most runners, complete rest isn’t necessary. Modifying your training to reduce intensity, avoid high-impact activities, and manage symptoms can allow you to keep running safely during recovery.

When Should You Seek Help?

If you’ve been dealing with plantar fasciitis for more than a few weeks and self-care hasn’t provided relief, it’s time to seek professional help. While plantar fasciitis can sometimes resolve on its own, ongoing symptoms often indicate an underlying issue that needs to be addressed.

At Fit and Function Therapy Solutions, we specialize in helping runners recover from plantar fasciitis through a comprehensive, personalized approach. Here’s how we can help:

1. Pinpointing the Root Cause
   Not all heel pain is plantar fasciitis. Many runners experience similar symptoms caused by nerve or tendon-related issues in the same region. A thorough evaluation ensures you’re addressing the right problem from the start.
2. Gait Analysis and Biomechanical Assessment
   We carefully evaluate your running and walking mechanics to identify factors contributing to your symptoms, such as overpronation, limited ankle mobility, or poor shock absorption. These insights help guide your individualized treatment plan.
3. Customized Strength and Mobility Exercises
   Weak or tight muscles in the foot, ankle, and calf often place additional strain on the plantar fascia. Targeted exercises improve strength, flexibility, and stability, helping your body absorb impact more efficiently and distribute forces evenly.
4. Custom Orthotic Solutions
   For runners with structural imbalances or foot mechanics that contribute to their pain, custom orthotics can be transformative. At Fit and Function, we offer a unique orthotics approach:

• We create temporary custom orthotics during your first session, allowing you to test them immediately.
• If they provide relief, we partner with Tony Bare at Bare Physical Therapy in Fort Collins, Colorado, to manufacture permanent custom orthotics tailored specifically to your needs.5. Tailored Training Modifications
  We work with you to adjust your training plan so you can maintain fitness while reducing strain on the plantar fascia. This might include modifying mileage, switching to softer surfaces, or incorporating cross-training activities.

By addressing the underlying causes and creating a personalized recovery plan, we help runners not only heal but also return to running with improved strength and resilience.

Why Professional Help Matters

Plantar fasciitis can be a stubborn condition, especially for runners. Addressing it early with expert guidance can save you months of frustration, prevent compensatory injuries, and ensure a smoother recovery.

If you’re ready to tackle plantar fasciitis head-on, schedule a free discovery call with us today.

Running with Plantar Fasciopathy

Yes, you can often keep running with plantar fasciopathy if you make smart modifications:

• Reduce mileage and intensity.
• Switch to softer surfaces.
• Monitor symptoms carefully to avoid overloading the fascia.

Prevention Strategies

The best way to deal with plantar fasciitis is to prevent it. Here’s how:

• Smart Progression: Follow the 10% rule for increasing mileage.
• Deload Weeks: Plan lighter training weeks every three to four weeks.
• Strength and Mobility Work: Build strength and mobility in your calves, ankles, and feet to reduce the risk of overload.

Conclusion

If you’re currently dealing with foot pain, remember that while plantar fasciopathy can be frustrating, it’s typically manageable with the right approach. The key is getting an accurate diagnosis and understanding the specific factors contributing to your condition.

The complexity of foot and ankle biomechanics means that what works for one runner may not work for another. This is why it’s important to get a proper assessment rather than relying solely on generic advice or treatment approaches.

Remember, the goal isn’t just to get rid of pain – it’s to help you return to running confidently and prevent future issues from developing. With proper guidance and a systematic approach to treatment, most runners can overcome plantar fasciopathy and return to the activities they love.

For those dealing with persistent symptoms or uncertainty about their diagnosis, I encourage you to get it checked out. If you’re in the Boise area and would like help with plantar fasciitis or other running-related issues, feel free to book a free discovery call with us to get started. If you just have questions, you can email me or send me a DM on Instagram.

The post The Runner’s Guide to Plantar Fasciitis: Myths, Causes, and Treatment appeared first on Fit & Function Therapy Solutions.

If you’ve ever experienced shin splints, you’re not alone. It’s one of the most common complaints among runners. Studies suggest that up to 35% of runners will experience shin pain at some point.

But here’s the thing: “shin splints” isn’t actually a diagnosis. It’s a catch-all term for pain in your lower leg or shin, and the causes can vary wildly. That’s why treatment isn’t as simple as following a one-size-fits-all plan.

I wish I could tell you, “Just do A + B + C, and you’ll never have shin splints again.” But the truth is, the right treatment depends entirely on the specific cause of your shin pain. To show why, let’s first set the stage with some facts about shin splints—and then explore two very different cases of runners with this common issue.

What Does “Shin Splints” Really Mean?

The term “shin splints” is often used to describe pain along the front or inner part of the lower leg. But it’s not a diagnosis—it’s more like a nickname for a variety of underlying conditions, such as:

• Medial Tibial Stress Syndrome (MTSS): The most common cause of shin pain, involving inflammation along the shin bone (tibia).
• Stress Fractures: Early signs of bone stress injuries, which require significant rest.
• Chronic Exertional Compartment Syndrome (CECS): Cramping, burning, or numbness caused by increased pressure in the lower leg compartments.
• Muscle or Tendon Overuse: Pain from overworked stabilizing muscles, such as the tibialis anterior.
• Nerve or Vascular Issues: Rare but possible causes, involving nerve irritation or restricted blood flow.

Why Diagnosis Matters

Because “shin splints” can describe so many different issues, proper diagnosis is essential. Knowing what’s causing your shin pain helps guide appropriate management and ensures you’re addressing the root problem.

What Doesn’t Work for Shin Splints

When shin pain strikes, many runners turn to well-meaning advice that doesn’t always work. Here’s why these common approaches often fall short:

• Tibialis Raises: While these exercises can help strengthen the muscles along the shin in some cases, they’re not effective for all types of shin pain, such as MTSS or stress fractures.

  

• Complete Rest: Stopping all activity might temporarily relieve symptoms, but without addressing the underlying cause, the pain often comes back once you resume running.
• Foam Rolling: Foam rolling feels good, but it doesn’t address the structural or biomechanical issues behind shin pain.
• Ignoring Pain Until It Goes Away: Pushing through shin pain can make conditions like MTSS or stress fractures significantly worse.

The Danger of One Size Fits All Treatments: Two Case Studies

To understand why there’s no universal fix for shin splints, let’s look at two runners with very different experiences.

Case Study #1: Sarah, the Marathon Newbie

Background:
Sarah is training for her first marathon. She recently increased her mileage from 15 to 30 miles per week in just two weeks. She’s been running on pavement and noticed a dull ache along the inner border of her shin that worsens during her long runs.

Diagnosis:
Sarah has Medial Tibial Stress Syndrome (MTSS). This is an overuse injury where repeated impact has caused inflammation along the tibia.

Treatment Plan:
For Sarah, the focus is on reducing load and improving her body’s ability to tolerate the demands of running. Her plan includes:

1. Offloading:
   • Scale back her mileage to stay below her pain threshold.
   • Switch to low-impact cross-training (e.g., cycling or swimming) for a few weeks.
2. Strength Training:
   • Begin eccentric calf raises and single-leg balance drills to build resilience in her lower legs.
   • Progress to plyometric drills like pogo hops as her pain subsides.
3. Running Form Adjustments:
   • Increase her cadence to 175 steps per minute to reduce tibial loading.
   • Focus on shortening her stride to avoid overstriding.
4. Recovery Optimization:
   • Prioritize sleep, hydration, and a nutrient-rich diet to support tissue repair.

Outcome:
After 6 weeks of guided rehab, Sarah gradually returns to running pain-free, with a stronger, more resilient lower body.

Case Study #2: James, the High School Sprinter

Background:
James is a competitive sprinter who has been training on the track 5 days a week. He feels sharp, localized pain on the front of his shin and notices swelling after workouts. He also feels pain when he hops on one leg.

Diagnosis:
James is showing signs of an anterior tibial stress fracture—a more serious injury that requires strict rest to avoid progression.

Treatment Plan:
For James, the focus is on bone healing and protection. His plan looks very different from Sarah’s:

1. Complete Rest:
   • No running or high-impact activities for at least 6–8 weeks.
   • Use a walking boot if necessary to offload the tibia completely.
2. Low-Impact Strength Work:
   • Focus on non-weight-bearing exercises, like swimming or upper-body strength training, to maintain fitness without stressing the bone.
3. Gradual Return-to-Run Program:
   • After imaging confirms the fracture has healed, James begins a slow progression of running with frequent check-ins to monitor for pain.
4. Running Mechanics Assessment:
   • A physical therapist evaluates James’s biomechanics to identify factors that may have contributed to the stress fracture, such as overstriding or weak hips.

Outcome:
After 12 weeks of rest and progressive rehab, James returns to sprinting with no pain, a stronger stride, and better form.

Prevention Tips: How to Avoid Shin Splints

While not all cases of shin splints can be prevented, these general tips can help reduce your risk:

1. Wear Proper Shoes:
   • Ensure your running shoes are appropriate for your foot type and replaced regularly to maintain proper cushioning and support.
2. Gradually Increase Training:
   • Avoid sudden spikes in mileage or intensity. Aim to increase your weekly mileage by no more than 10% at a time.
3. Warm-Up Properly:
   • Incorporate dynamic warm-ups like leg swings and walking lunges to prepare your muscles for running.
4. Avoid Overstriding:
   • Keep your foot strike closer to your body to minimize stress on your shins.
5. Cross-Train:
   • Include low-impact activities like swimming or cycling to reduce cumulative stress on your lower legs.
6. Strengthen and Stabilize:
   • Work on building strength in your calves, hips, and core to improve overall running mechanics and resilience.

Why You Need a Running Specialist

As these cases show, shin splints isn’t a one-size-fits-all problem. What works for one runner might make another’s condition worse. That’s why seeing a running specialist is so important.

A running specialist can:

• Pinpoint the exact cause of your shin pain.
• Design a treatment plan tailored to your needs.
• Guide you through a safe and effective return-to-run program.

Takeaways: The Truth About Shin Splints

• “Shin splints” isn’t a diagnosis—it’s a catch-all term for lower leg pain that can have many causes.
• Getting an accurate diagnosis is the key to effective treatment and long-term recovery.
• A running specialist can help you recover safely and prevent shin pain from coming back.

Needing shin splints treatment? At Fit & Function Therapy Solutions, we specialize in helping runners recover and build resilience for pain-free miles. Schedule an evaluation today and take the first step toward lasting relief.

The post The Truth About Shin Splints — A Runner’s Guide appeared first on Fit & Function Therapy Solutions.