Why I changed how I treat runners

Those who’ve known me are aware that I’ve always been drawn to sport and exercise. Growing up, it was basketball and Gaelic football, and as I got older that shifted more into endurance sports. Over the last few years especially, running and Ironman events have become a huge part of my life. I just completed the Western Sydney Ironman 70.3 and now am focusing my training towards Run Melbourne and the Melbourne Marathon in October! 

At the same time,  I was always fascinated by science and the human body. Biology and P.E were the subjects I naturally gravitated toward at school, so Physiotherapy felt like the perfect combination of these two interests. 

Early in my career, I knew I was more interested in sports rehabilitation and performance rather than the traditional medical path. But after years of working with runners, I started noticing a pattern that became harder and harder to ignore. It wasn’t that runners were coming in with different injuries every time. It was the same injuries, showing up again and again and the same patients breaking down, just a few weeks or months apart.

Eventually, it clicked for me.

I wasn’t actually helping runners get better. I was helping them feel better just long enough to go back to training… and break down again. Without realising it, I was stuck treating symptoms and  the site of pain, not fixing the reason it was happening in the first place.

Once I started paying attention, it was hard to ignore how consistent it all was. It was the same injuries: shin splints, runner’s knee, IT band syndrome and calf strains. Over and over. When you consider Sports Medicine Australia's statement of “up to 70% of recreational and competitive runners sustain overuse injuries during any 12-month period”, it stops looking like bad luck and starts looking like a bigger problem. 

Nearly every injury had the same pattern. Train hard, pain returns, rest, feel better… then go straight back into the same training. Nothing had really changed, and capacity never improved. The system just kept repeating itself.

Underneath it all were the same recurring mistakes: too much, too soon, too intense, and not enough structure.

Many runners rely on apps or generalised programs that push pace and performance, without any real consideration for whether their body is ready for it. Add in: little to no strength training or the wrong type, it’s not surprising these bodies broke down. On top of that, I often saw the same mechanical issues: overstriding, narrow stride width, poor trunk control. Small things that add up over thousands of steps.

The more I worked with runners, the clearer it became, injuries weren’t random, and they weren’t just bad luck. They were a mismatch between load and capacity.

Running fitness, especially aerobic fitness, improves relatively quickly. But tendons, muscles, and bones take much longer to adapt. So you may end up in a situation where your engine is ready to go, but your chassis can’t handle the load.

That’s where injuries may happen. On top of that, previous injuries often leave behind weak links. The body compensates, shifts load elsewhere, and eventually something else becomes overloaded. That’s why the problem usually isn’t where it hurts but the part of the body that isn’t doing its job properly.

That realisation completely changed how I approach rehabilitation.

The first shift was from pain to root cause. I still address symptoms, but that’s only 20% of the process. The other 80% is figuring out why it’s happening and fixing the underlying issues causing the pain.

The second shift was from passive to active rehab. Less reliance on things like massage and needling, and much more focus on building capacity, through improving co-ordination, heavy strength training, progressive loading, and  plyometrics. It takes time to build strength, but it’s relatively easy to maintain. The problem is most runners never build it properly in the first place.

The third shift was zooming out from the injury itself to the whole system. Training structure, running mechanics, strength, recovery, nutrition, it all plays a role. You can’t just isolate one piece and expect it to hold up.

The frustrating part was that a lot of runners felt like they were doing everything right. They were consistent. They were motivated. They were trying to look after themselves. But they were being told to rest, stretch more, or just ease back into it, without ever addressing the real issue.

Rest wasn’t fixing the problem, it was just pausing it. 

There’s a lot of noise out there. Apps pushing intensity, quick fixes being sold as solutions, and not enough focus on what actually keeps someone ticking the k’s over the long term. What I’ve found works is actually pretty simple, but it takes patience and structure.

First, build capacity. That means strength training 2-3 times per week, focusing on heavy, progressive loading. Not just during rehab, but as an ongoing part of training.

Second, fix the foundations. That might involve looking at running mechanics: posture, stride, and cadence, but also identifying any obvious weak links often due to previous injury. Small changes here can make a massive difference to how load is distributed.

Third, train smarter. Volume is the main driver, not intensity. Most running should be easy, and progression should be gradual. Build the base first, then layer in speed and intensity later.

And finally, respect recovery. Sleep, nutrition, and load management aren’t optional, they’re what allow adaptation to actually happen. Without them, you’re just accumulating stress without building capacity.

The biggest shift for me is this: Most runners aren’t fragile, they’re just underprepared for the load they’re chasing. Injury-free running isn’t about luck. It’s about building a body that can handle what you’re asking it to do.

Once I stopped treating pain and started building runners, everything changed, especially how they stayed consistent and injury-free.