Running Nightmares: Performance notes on how to run with ease



Training for the London Marathon with plantar fasciatis? Doing the Couch to 5k programme with sore knees? Cross Country runner with lower back pain?



Whilst this blog offers an extensive list of pain symptoms which can be incurred when running, it is NOT exhaustive, and it is NOT a list for self diagnosis - it is VERY IMPORTANT to seek diagnosis from a reputable physiotherapist as it is very complicated. 


Therefore, this blog focuses on prevention and performance notes regarding how to avoid and rehab such pain symptoms. It is pretty easy too - it's just a case of having an understanding and being aware.

Pain does not have to be scary or stressful!


How to prevent running injuries and pains


There are a few things to understand first:

- Fascia: A connective tissue that provides cling film like properties to everything in the human body (albeit it can be found in all living things in various forms). Fascia has 2 main properties, 1) as it surrounds everything in the body, it reduces friction and keeps your body together through tensegrity, and 2) it's a big proprioceptive organ, meaning it absorbs pressure and provides feedback on this pressure to enable the muscles to react more efficiently. If you have ever prepared chicken, the white tissue which upon being peeled off the chicken becomes clear - that is fascia! There are different types of fascia for different purposes, such as the superficial fascia near the skin, to deep subcantaneous fascia in the gut. Plantar fasciatis is tension held in the fascia of the foot but the fascia does not stop there - it goes right up to the head. It is important to keep fascia hydrated and balanced functionally to reduce fascial tension so no matter what you do, for your fascia, the important part is HOW you do it!

If you're interested in learning more about this connective tissue, there is the British Fascia Symposium and the International Fascia Congress, as well as a plethora of research and literature. I recommend looking up Leon Chaitow, Gil Hedley, John Sharkey, Carla Stecco, Julian Baker, Susan Findlay and Caroline Barrow to name just a few.

- Your soft tissue is built like a matrix: thus running in all directions to enable your body to absorb pressures from any direction. Through postural and biomechanical dysfunctions/imbalances, the matrix begins to align to the strain as demonstrated through the Young's Modulus. As the tissue aligns to the strain, the body compensates by depositing more collagen to help stabilise and balance the area which reduces elastin capacity and therefore, reduces flexibility. A prime example of soft tissue matrix composition is trigger points!

- You have more than 1 diaphragm: Recent research has found that there is more than 1 diaphragm in the human body ranging from 4 to 12!!! A diaphragm is a transverse structure that separates an area into 2 compartments, and has a pumping mechanism which allows the diaphragm to move creating changing pressures within the compartments. The Dallas Osteopathy Study Group chaired by Dr. C. Speece discovered a potential 12 diaphragms in the body ranging from the arch of the foot, 2 in the knee, the pelvic floor, thoracic outlet and in the brain there is the tentorium cerebelli, and diaphragm sellae. Whilst there still needs to be much more research conducted to support these findings, it seems understandable that the human body would evolve to create such structures, particularly when we evolved to move vertically. Consider how the human body functions within gravity. These diaphragm mechanisms enable hydrostatic flow, improved balance due to increased proprioception, and rhythm which supports homeostasis. The function in one diaphragm could easily impact the other diaphragms which would be both advantageous in stressful situations, but disadvantageous with chronic stress and poor posture.

- Leg length differences: Leg length differences are much more common than you think, about 75% of my clients and athletes have a leg length difference. Whether someone experiences pain or injury caused or influenced by the difference is purely subjective, and therefore, it is important to see a professional who knows how to correctly measure leg length. 


So having an understanding of those areas...


Supination/Pronation: As you move, your big toe should absorb 2-3 times your body weight. If you don't absorb it through the big toe, the foot absorbs it through the plantar plate (balls of the feet) and the instep (bones of the feet). This dysfunction can augment any supination or pronation depending on subjective elements.

Big toe: Scientific name, the hallux (halluces: plural). Using the images above, it is easy to comprehend HOW you use your feet determines the structure of your feet. Bunions for example mean the big toe cannot absorb the pressure of movement as functionally as a straight big toe, which can increase pressure on the outside of the foot, and reduces function of the arch. 

So for a functional foot to prevent such injuries and pains, use your big toe more and keep your feet straight - the big toe should be in line with your inner ankle as the muscles which rotate the leg outwards, i.e. toes pointing out,  are in the glutes which causes misalignment and dysfunction through the leg into the foot. Think of the body as a building, if the foundations are not balanced and supportive, the structures above will struggle to maintain optimum function.

Exercises to help are towel scrunches, and practice curling the big toe with pressure ensuring feet are straight. A Strassbourg Sock can be helpful to stretch the fascia of the foot, and inserts such as a big toe straightener and plantar plate supports can help return the feet back to function.

For more information on the big toe and exercises, check out another blog:

For more information on the feet, check out another blog:



Being a hinge joint, pressures received by the knee depend on the foot/ankle and the hip, to which these depend on posture and biomechanics, noting the 2 diaphragms within the knee. Your patella (knee cap) should face forward, thus not inwards our outwards, to which the position of the patella can help determine current alignment. Too much pressure at the front of the knee is usually caused by an anterior tilt of the pelvis be it posturally or biomechanically and/or tight hip flexors and quads. There are 2 common knee dysfunctions through such pressure absorption, these being knee valgus and varus.

Valgus: Reduced support from the hip stablisers (predominantly gluteus medius and minimus), allowing the femur to medially rotate and collapse inwards at the knee causing weakness of the medial knee (signified by a weak vastus medialis obliquus - VMO), tension in the adductors, and increased pressure received by the arch in the foot/feet. 

Varus: Tension in the hip causing a pull through the iliotibial band (IT Band), most commonly seen with a lateral rotation of the femur causing increased tension on the outer knee. This then can be seen with increased supination of the foot due to imbalanced pressures and alignment received by the ankle and foot. 

Noting both knees do not have to be either valgus or varus, as it can differ between legs depending on posture and biomechanics.

For more information on the knee, check out my article written in collaberation with Safety in Sport Campaign:


Hips and pelvis

A fun little exercise that requires 2 people:

Standing facing each other, one turns their toes outwards so the leg is laterally rotated, and then the other gently pushes the one with the toes facing out at the shoulders. Compare the results with turning the toes inwards and again, the other gently pushes the one with toes inwards at the shoulders.

This exercise emphasizes the importance of foot position in regards to hip and pelvis balance.

Toes outward/feet laterally rotated: the big toe cannot absorb pressure functionally, meaning the outside of the foot attempts to maintain balance albeit not as successfully. This then means the outer knee receives increased pressure and the inner knee reduced pressure, causing the lateral rotators in the pelvis to absorb most of the pressure, bypassing the hip stabilisers. This means the spine receives more pressure than it should, resulting in reduced balance by pushing the centre of gravity higher.

Toes inward/feet medially rotated: the big toe can absorb most of the pressure, allowing the arch of the foot to receive and absorb such pressure. This then activates the inner knee structures such as VMO meaning the femur can translate such pressures functionally into the hip by activating gluteous medius and minimus. Therefore, through these hip stablisers, the pelvis is able to absorb the majority of pressure, reducing tension in the sacro-iliac joints (SIJs) and allowing the spine to receive this reduced pressure, enabling a functional centre of gravity.

Noting that whilst this position is more functional, it is meaningless without the use of the big toe/s. 

Pelvic rotations: this can be both sides or just one.  There is neutral positioning which allows optimum performance and thus reduced likelihood of injury and/or pain symptoms, yet there is also anterior rotation where the pelvis tilts forward, and posterior rotation where the pelvis tilts backwards. Whether the pelvis anteriorly or posteriorly rotates however, it signifies dysfunction of the abdominal and glute muscle groups as these work together to maintain a functional netural pelvic position. To prevent this, make sure hips are in line with ears and shoulders, and also knees and ankles. Using the glute muscles in ALL movement patterns is vital to prevent overloading of the hip flexors and groin which promotes anterior rotation.

Breathing patterns: An easy way to help improve pelvic function and balance is to improve breathing patterns. When in rest, you should have a more diaphragmatic breathing pattern which requires the gut to move out on the inhale and back in on the exhale. Improved function of this respiratory diaphragm helps improve function and balance of the other 11 diaphragms.

For more information on the lower back and pelvis, check out another blog:


Upper torso

Whilst there is little pain symptoms in this area which can be caused from running, 'stitches' being one of the few, this area is still important for function and performance when running. 

Breathing patterns: Alike above, an easy way to help improve running performance is to improve breathing patterns. Babies commonly follow diaphragmatic patterns which can be seen in their gut moving in and out, yet by the time people reach adulthood, they rarely use the diaphragm and rather the thoracic cavity and collar bones absorb the pressure. More thoracic breathing patterns can be advantageous in short term when consideration is given to the requirements of the fight-flight-freeze response, yet long term it can be detrimental both mentally and physically. Thus, when in rest, you should have a more diaphragmatic breathing pattern which requires the gut to move out on the inhale and back in on the exhale. Improved function of this respiratory diaphragm helps improve function and balance of the other 11 diaphragms. 

I find that dysfunctional breathing patterns can help induce cramp and 'stitches', increase MSK tension, influence more headaches, increases pressure on the shoulders, neck and head. 

- For more information on the various breathing patterns, check out this other blog:

- For more information on stress and breathing patterns, check out this other blog:

Head, neck and shoulder positioning: Imagine holding a heavy bowling ball in your hands with your arms out straight in front of you, and just stand there. It won't take long for your arms to feel sore, your shoulders and back to feel sore and tired, and you'll find yourself balancing on your toes to stop you from falling forward. Now that is how your neck feels when you keep your head tilted forward so that your ears are in front of your shoulders! POSTURE IS KEY TO STOP PAIN SYMPTOMS!

Neck muscles have been compared to the likes of hip flexors, more noticeable in sprinters when they require their neck to help them propel forward. However, the more tilted forward the neck is, the less support it can provide to such hip flexion as it is already flexed! So my top tips for this area to improve running performance and reduce chances of incurring pain symptoms:

- Shoulders rotated back and down away from the ears

- Head back so ears are in line with shoulders but keeping chin level (thus, don't tilt head back) - to prevent a 'sway back' posture, use your glutes and ab muscles.

- Run with your palms facing each other or toward the sky, not palms facing down as this weakens the arm through tension lines, and try to keep elbows in at the waist as they move back and forth.

- Breathe down into your gut as much as possible to utilise the more efficient areas of the lungs. 


For more information on this area, check out another blog:


So to review the performance notes:

- use more big toe

- keep feet straight with inner ankle when pushing off big toe

- don't hyper-extend your knees

- use more glutes 

- to stop you from tilting back through increased glute activation, use your abs to help you stand upright 

- practice more belly breathing

- shoulders back and down

- ears, shoulders, hips, knees and ankles should all be aligned

- relax the jaw


Top Tip: warm up and down with resisted side walks.

What: Using a resistance band, wrap around ankles until there is a little resistance when standing square. And then walk sideways keeping both big toes aligned with both inner ankles at all times.

How: Upon increased resistance and fatigue, the feet will attempt to laterally rotate. To avoid this, focus on pushing down the big toe of the balancing leg whilst the other moves across. Do no compensate by allowing your foot to supinate. And finally, make sure knees are slightly bent and you move from the glutes and hips rather than the groin - if you feel it in the groin, you're not using enough glutes and big toes and probably have your pelvis anteriorly rotated. 

Why: In my experience in sport and clinic, I find the gluteus minimus and medius the weakest of the pelvis muscles. Without strength and function is these muscles, the more pressure is put through the lateral rotators of the leg which can cause a variety of problems, including sciatica. They also help maintain function into the IT Band through TFL, and also the knee