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.

Matrix Alignment with performance markers

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.