As a physiotherapist and runner, Mitch McInnes knows consistency is the biggest predictor of improvement in running — and injury is the fastest way to lose it.
This week, McInnes speaks with the Brainsport Times about the ways physiotherapists can work with runners proactively to set them up for success both physically and mentally.
When in a training cycle should a runner start working with a physiotherapist — and why not wait until something hurts?
In an ideal situation, runners would start working with a physiotherapist before starting a training cycle. That gives us an opportunity to do a thorough screen and put the runner through a battery of testing to help weed out potential deficiencies that could lead to injury down the road.
Whether you’re an experienced runner or brand new to the sport, identifying potential issues before you load the body with more miles or intensity can help prevent problems and keep you consistent. For example, if we find a stiff ankle that’s changing the stance phase of gait, we can address it before it becomes an injury. We can also objectively test strength to identify areas that may affect lower-extremity stability and keep you from staying consistent with training.
It’s much easier to prevent injuries with a structured, personally tailored program than it is to treat injuries that have already happened. If something has started to hurt, the root-cause dysfunction has often been present for a long time — and even mild strains or tendon issues can be harder to settle if you’re trying to keep the training plan moving.
There are a lot of social media “gurus” that make running more complicated than it really is. Running is simple: consistency is king. If we can keep runners on the road, track, or trails by preventing injuries, performance gains tend to follow.
What are the most common injuries or issues you see in runners training for races?
It’s not usually one single “most common injury.” The root cause is almost always the same: Injuries show up when the tissue tolerance to loading is exceeded.
Once we start loading tissues beyond what they can tolerate, we begin to break down. That breakdown can look like tendinopathies, muscle strains, runner’s knee, plantar foot pain, and more.
We typically see issues in the structures that take the most load during running — and that’s true across sport. Most of the time, this overload happens because of training errors: too much mileage, too much intensity, or both.
That doesn’t mean we remove training stress entirely. Instead, we figure out how to increase the tissue’s ability to tolerate the stress — and that’s where it gets more nuanced. A good physio can help you manage stress while increasing capacity, so you can maintain your training rather than constantly being forced to reset it.
What mistakes do runners make when trying to self-diagnose or self-treat injuries?
Most runners are actually pretty good at identifying what structure is irritated — and, if they’re being honest, they usually know the training error that contributed (ego pushed an “easy day,” ignored fatigue, skipped rest, etc.).
What’s difficult to self-diagnose is the why: What dysfunction was present that turned normal training stress into injury?
The human body is amazing — it adapts to an incredible amount of stress. It’s when something in the system isn’t working well (mobility, strength, control, mechanics, recovery, fueling, etc.) that stress starts producing injury instead of adaptation.
A physio’s job is to help get to the root cause, clear up the issue as quickly as possible, and help you make smart adjustments.
As an older runner myself, I’ve had plenty of overuse injuries from mistakes I’ve made. I can often diagnose the issue fairly well — but I’ve still struggled making the right training adjustments without guidance from a coach or another clinician. A good physio can help you (and your coach, if you have one) adjust the plan so you keep running while addressing the injury.
What does a “good relationship” between a runner and a physiotherapist look like? How often should runners check in?
The perfect relationship would be: you get screened, you get a tailored program to keep you healthy, you train consistently, and you never need a physio again.
In reality, runners like to push the body close to the line — and you usually can’t do that without crossing it occasionally.
How often you check in depends on the runner:
- Some runners only need a few check-ins during a training cycle to manage small aches, get guidance, and adjust strength work.
- Others do better with more regular visits — sometimes close to weekly — basically to prevent the dam from bursting.
If someone is in a phase where mileage and intensity are high, we often see them more frequently to help manage the increased stress, progress strength training appropriately, and prevent a “niggle” from turning into a full stop (ideally with communication with their coach when needed).
How important is honest communication — and what do runners often leave out?
Honest communication is critical. You can’t expect accurate guidance if the athlete isn’t being honest.
And to be fair — it’s hard to hide obvious physical signs of injury from an experienced clinician.
Where athletes often “fudge” the facts (intentionally or not) is around recovery and RED-S (Relative Energy Deficiency in Sport). Athletes may downplay:
- how tired they feel overall
- how much sleep they’re actually getting
- hydration
- whether rest days are truly rest days
- how much they’re eating / fueling
- menstrual cycle changes (if applicable)
- reduced libido
- mood changes
These details matter. We’re getting better at identifying RED-S, but even the best clinician still relies on honest answers to adjust training and nutrition appropriately and keep an athlete healthy.
What signs suggest an issue is more than normal training soreness and shouldn’t be ignored?
Soreness is normal — managing it before it becomes a problem is the hard part.
Three things I ask runners to watch for:
- Does pain get worse as the run goes on?
- If discomfort starts at 2/10 and stays the same or improves, I’m usually okay with continuing the plan. If it starts at 2/10 and creeps to 4/10 twenty minutes later, that’s a good sign a tissue is getting irritated beyond “normal.”
- How does it feel the next morning?
- If you can run through it, but the next morning pain is worse, that’s often a sign there’s been more tissue irritation than you think.
- Is it sharp?
- I’m usually less concerned with steady discomfort and more concerned with sharp pain. Sharp pain is often a protective response — your body telling you it isn’t tolerating something well.
How can a physiotherapist help adjust training when life stress, fatigue, or niggles accumulate?
Once stress exceeds tolerance, breakdown happens — but there are lots of ways to adjust stress while maintaining training effect.
One simple option is changing the mode of training: if we want to reduce weight-bearing load, cycling or swimming can be great.
Other times, it’s about adjusting the structure of the week. For example: you might shorten a long run and use a shorter tempo-style workout to create a similar stimulus without being on your feet for 2+ hours. There are almost always options to keep you doing what you love while preventing a small issue from progressing.
Life stress matters too. The body has a hard time distinguishing emotional stress from physical training stress. Too little stress and you don’t adapt. Too much combined stress (life + training) and you can plateau or get injured.
A physio won’t “treat life stress” directly — that’s not our scope — but we can help identify when it’s affecting training and help plan around it (exams, work presentations, travel, kids being kids, etc.).
How does a good physio relationship affect confidence and mental readiness on race day?
It’s hard for runners to feel confident going into a race — even when training has gone really well. If you read elite runners biographies, it’s common to see the best runners in the world doubting themselves right before big races.
Much like a good coach, a physio can help you “see the forest through the trees” — understand the building blocks, why the training is structured the way it is, and how peaking works.
On the objective side, some clinics can show measurable progress: force plate metrics (strength/power), repeat screening data, and sometimes VO₂max/metabolic testing. VO₂max alone doesn’t predict race time, but combined with things like running economy at specific intensities and lactate response, it can help give runners confidence that their goal pace is attainable.
What would you say to runners who avoid physio because they don’t want to be told to stop running?
Speaking from professional experience — I rarely tell someone to stop training completely. There’s almost always a way to adjust training and keep the stimulus where it needs to be while rehabbing an injury.
Most tissues heal best with controlled, safe stress — not complete shutdown.
The main caveat is bone stress injuries. That’s the one situation where we often need a true period of no running. And if a runner is at that point, it usually means earlier warning signs were missed or not adjusted for.
How does your physio background affect your own approach to training?
Unfortunately over the years my training hasn’t exactly followed what my professional advice would be. More of a ‘do what I say not what I do’ situation. As I’ve become more mature in my running I’ve learned there are three things you can’t cheat if you want to run well: Rest. Strength. Speed.
- Rest: True rest days matter. And sometimes the best decision is deviating from the plan when the body needs it.
- Strength: Early in my running career there wasn’t much emphasis on strength training. All the data now indicate strength should be a hallmark of a training plan. Strength doesn’t just prevent injury — it improves efficiency. And we don’t need to fear “getting bulky” from lifting anymore. Lift heavy to run faster.
- Speed: I took many years off after my competitive running days and when I finally came back to running I was doing lots of long slow miles. All research and what the best training plans are doing now is incorporating lots of speed work into the program. To run well you need to become an efficient runner, and speed work (in whatever form fits the runner) is a powerful way to get it back. Speed work will always be a large factor in my own training plans.
Rest. Strength. Speed.
Mitch McInnes is a former University of Saskatchewan varsity distance runner and owner of McInnes Physiotherapy.
