Why I stopped focusing on pain, and what I focus on instead

One of the biggest shifts in how I work as a physio has been moving away from chasing pain relief and focusing more on performance. I view “performance” as training consistently, building resilience, and moving towards goals without being constantly interrupted by injury.

Most of us don’t just want pain relief; we want confidence in our bodies again. We want to follow a training plan without flare-ups every few weeks and to stop restarting.

Early on, most of my treatment approach focused on the painful area. With consultations consisting of: Where does it hurt? How do we calm it down? How quickly can we settle symptoms? And yes, sometimes this worked short-term. But I kept seeing the same pattern: symptoms would improve, training would resume, but the injury would inevitably return.

That’s when my thinking changed. Instead of focusing only on pain, I started focusing more on capacity and why pain was there in the first place. Can the body actually tolerate the demands being placed on it? Is there enough strength, mobility, recovery, and load management to support the training goals in the long term?

Pain is often just the final sign that something underneath isn’t coping well anymore.

Once I started treating through this lens, the outcomes became much better, not just for reducing pain, but for consistent performance. For runners especially, injuries are rarely random. 

They’re usually the result of multiple things building up over time. Sometimes it’s a training load spike. Sometimes it’s poor recovery. Sometimes it’s a strength issue that’s been sitting there quietly for months.

Pain still matters, of course it does, but on its own it’s not telling us the full story. 

When the only goal is to reduce symptoms as quickly as possible, runners often end up stuck in the boom-bust cycle.

That’s frustrating for everyone. And I think a lot of runners have been conditioned to believe that once the pain settles, the problem is fixed. Usually, it isn’t. This is where I think a lot of rehab misses the mark. The focus is heavily on symptom relief, but not enough on building resilience.

Stretching, massages and resting all might alleviate symptoms temporarily, but this relief isn’t the same thing as long-term improvement. Our real goal should be building the body to confidently tolerate our desired running load. 

I aim to build your capacity for performance not just for a week, not just this training block, but consistently over months and years.

My approach is performance-focused, and when I say performance, I don’t just mean elite athletes or chasing podiums. Performance means being able to follow your training plan consistently without being sidelined every few weeks.

This might mean running a half marathon, chasing a PB, or it could simply be training pain-free without constantly second-guessing their body. 

1. Capacity

The first thing I look at is whether the body can tolerate the demands being placed on it.

Many runners are asking their bodies to handle loads they simply haven't prepared for yet. This might mean: poor strength in isolated muscle groups, the inability to coordinate muscle groups together, reduced mobility or low tolerance to higher mileage.

You can’t outrun a capacity problem forever. Eventually, something starts absorbing more stress than it can handle.

2. Training Load

Training load is one of the biggest pieces of the puzzle; most running injuries aren’t caused by one bad run; they’re caused by accumulation.

Common mistakes take shape as: too much too soon, intense sessions stacked together without enough recovery and trying to make up for missed training.

I often tell runners that consistency beats hero sessions every time. One huge week followed by an injury doesn’t help long-term progress. What actually improves our performance is accumulating good training weeks over time.

3. Movement & Mechanics

Gait analysis and movement assessments are valuable tools to see where the stress is being directed when running. 

I’m not looking for perfection; I’m looking for patterns: How does someone absorb force? How stable is the trunk? What’s happening at the foot and ankle? Is cadence contributing to overload? Is there compensation somewhere because another area lacks strength or mobility?

Often, small targeted changes can make a massive difference here. Trying to overhaul everything at once may create more problems than it solves.

4. Strength Training

I think strength training is still massively underestimated in the running world.

Many runners still believe they only need bodyweight exercises, stretching, or pilates. But if you actually want to improve tissue resilience and performance, the body needs meaningful strength stimulus. Heavy strength work builds resilience, boosts rate of force development, improves tolerance, and importantly, gives runners a greater buffer against overload.

The goal isn’t to make runners bodybuilders, but to make you stronger and more resilient.

5. Keeping Active Where Possible

One thing I try to avoid is completely shutting runners down unless it’s genuinely necessary.

Not only do most runners not respond well physically to stopping their activity, but also mentally. If we can modify load, cross-train, reduce intensity, or temporarily adjust volume while still maintaining fitness, that’s often a far better approach.

Cycling, swimming, reduced mileage, altered sessions - there are usually ways to keep momentum going while simultaneously addressing the underlying issue.

One concept I use a lot in assessments is the idea of “elephants versus mice”. A lot of people become obsessed with the mice, small factors that aren’t driving the problem. Meanwhile, the elephants are sitting right in front of us: poor strength, training spikes, under-recovery, lack of fuel intake, inconsistent programming and low tissue capacity.

Typically, these are the primary drivers of success. Effective rehabilitation isn't about uncovering every minor flaw; rather, identifying and addressing the significant drivers that lead to overload.

I think performance has become a misunderstood word, when people hear it, they assume it only applies to elite athletes. For me, performance simply means having the physical capacity to support the goals you care about. That could be: finishing your first marathon, training without fear of flare-ups, improving pace or distance, feeling strong again or simply enjoying running without constantly managing pain.

No one wants endless treatment, so why do we set up our rehabilitation to address the symptoms and not the cause? 

We all want confidence in our bodies again, and that’s what I care about. Not just settling symptoms temporarily but helping build strength, resilience, and capacity to keep doing what they love long-term.

In the end, consistency is what drives improvement in our performance. Not quick fixes, not magic exercises, and certainly not constantly chasing pain relief.