Physical Therapy for Lower Leg Running Injuries

Achilles’ tendonitis…posterior shin splints… plantar fasciitis….

The common theme for these three injuries is that they are the most common lower leg injuries that runners experience.

As the running season starts up again at the high school level and for recreational runners getting ready to train for their late fall and early spring marathons, I will be seeing a multitude of these injuries come to my clinic.

I know there are many articles and information that you can find on the Internet with regards to these three injuries.

I’m not going to go into full detail on the injuries themselves, but I want to talk about the main reason why these injuries happen in the first place.

There are three main reasons:

1. Improper shoe wear

2. Muscular imbalances that lead to increased stress on the injured area

3. Improper training methods

[FREE Report: 6 Quick & Easy Ways To Reduce Your Risk of Injury While Running]

That’s it… There is nothing else to it.

I have researched running programs, training regimens and injuries to the nth degree.

I have dealt with a few of these issues personally, and treated hundreds of runners for these problems.

So let’s delve into this a little bit more:

Shoewear: One of the biggest problems that I see with most of my patients that come into the office, is that they are using the improper type of shoe for training.

There are four categories of shoes that are important for everyone to know:

1. Flexible: For the lightweight person,moderate to high arch. Great for races, due to the lightweight nature of the shoe.

2. Neutral: For the medium build person, with moderate to high arch. The most ideal for training, because they are fairly lightweight, and give some support… just not much.

3. Stability: I personally recommend these shoes for the lightweight person with a low arch or medium build person with a moderate arch. The roll bar on the inside of the shoe helps with controlling the foot as it rolls in… excessive movement of the foot inward..known as pronation, is common factor in the running injuries that we are talking about.

4. Motion Control: Recommend for the heavy build person with a moderate arch or lightweight to medium build person, with a significantly low arch. 

As you can tell, my personal favorites are Brooks, as I feel as though they are the best constructed running shoes. Brooks shoes have really allowed me to be able to train at a high-level, without the need for any additional devices in my shoes such as orthotics. They really have a strong grasp on the biomechanics of the foot, and have made their shoes with an emphasis on runners.

Before wearing Brooks, I would use a stability shoe or a neutral shoe, along with a custom orthotic.

Once I finally figured it out with Brooks, I now use a motion control shoe for my training without any orthotics, and I will use a lightweight flexible shoe (racers) for my races.

I have not had any lower leg injuries since doing so four years ago. I have trained up to 60 miles per week, and have never had any issues after being put in the proper shoe wear.

The problem is that most people want to base their purchase of shoewear for training on two things.


A) They want something that looks pleasing to the eye, whether or not it’s the right shoe for them to be in.

B) They want to be in the lightest shoe possible, in order to increase their speed.

These are not good reasons to pick your shoes. I recommend that you have someone look at your foot, decide what static structural level your are at, and make an educated calculation based on your weight and the structural level your foot is at.

[FREE Report: 6 Quick & Easy Ways To Reduce Your Risk of Injury While Running]

As for muscle imbalances, many times I find that people are very dominant in one part of their body based on their running mechanics. This leads to some people having overdeveloped and underdeveloped areas. This leads to a higher tendency for overuse injuries.

Seeing a health professional that is very proficient in understanding biomechanics and the proper exercises to correct those imbalances is essential if that is your reason for having these lower leg injuries.

The last issue that I think is responsible for the majority of lower leg injuries in runners is improper training methods.

Too many times, I see people that are very motivated to start a running program, and end up overdoing it with their program.

The truth of the matter is that your cardiovascular system adapts quicker to stress than your musculoskeletal system. If you are putting too much stress on your cardiovascular system, your body automatically tells you this it is too difficult, by automatically slowing down. There’s no way to trick your cardiovascular system.

Unfortunately, when you are putting too much stress on the musculoskeletal system, which are your bones, muscles, tendons and ligaments… You won’t know that it’s too much until it’s too late.

I think this is why people don’t have solid results with physical therapy in many cases. Many physical therapist that are not into running, don’t understand this area.

They know the proper treatments to do to get the problem to calm down, and they might even understand a little bit about shoewear, or if they don’t, they are able to refer you to a running store, that specializes in biomechanics of the feet.

But when it comes to implementing a proper program to return to running and to prevent injuries, many health professionals, including physical therapists, don’t understand how to implement that program properly, so that your body can safely adapt at the musculoskeletal level.

[FREE Report: 6 Quick & Easy Ways To Reduce Your Risk of Injury While Running]

Whether it’s a Physical Therapist, MD, Chiropractor or a very competent running coach that understands how to rehabilitate runners from injuries, using a proper training program, I recommend that you consult with someone that understands this.

There is nothing more frustrating than getting an injury better by doing the appropriate rest and rehabilitation, only to end up screwing it up by going back into training at too high of an intensity that your body can’t handle.

As unfair as this sounds, you have to do all three properly and in the right sequence in order to come back safely from a running injury. You can’t just rehab, but stay in the wrong footwear… or change your footwear and rehab the injured tissue, but ramp up your running program improperly.

This is the reality of properly returning from a running injury.
I hope this helps you all, and good luck with your running endeavors this upcoming fall and spring season.

P.S. If you’re experiencing pain or stiffness from running which restricts your ability to run, click here to download my free running injury report which includes actionable tips that we give to our patients at Renewal Rehab. Click here to get your free copy: 






Greg Todd, PT, 

Physical Therapist & Co-Owner

Renewal Rehabilitation Inc.




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