Building Stronger Runners

For many runners, seeking professional help only happens when pain becomes impossible to ignore. That persistent ache in the knee, the sharp pull in the calf, or the dreaded foot pain that flares up after every long run—these are often the triggers that send runners into the clinic. But what if there was a better approach? What if runners could identify underlying weaknesses and inefficiencies before they led to injury?

This is where collaborative testing and assessment come in.
By combining exercise physiology testing with orthopaedic and manual therapy evaluations, a comprehensive picture of a runner’s biomechanics can be built. Together, this data can assist in keeping runners healthy, strong, and performing at their best.

Why Testing and Assessment Matter
Running may seem simple—just put one foot in front of the other—but it’s a complex interplay of strength, stability, and biomechanics. Small imbalances can lead to inefficiencies that compound over time, eventually resulting in pain or injury. Testing provides objective data that goes beyond subjective pain descriptions or visual assessments. “If you’re not testing, you’re guessing” as the saying goes.
Key benefits of proactive assessment include:

• Identifying asymmetries and deficits before they result in decreased performance or injury.
• Providing clear benchmarks to track progress individually while comparing to normal values.
• Guiding tailored strength, mobility, and rehabilitation while maintaining a scheduled running program.
• Integrating manual therapy insights to help optimize the musculoskeletal system (muscles, joints and nervous system).

The Collaborative Approach
Step 1: Orthopaedic and Manual Therapy Assessment led by manual therapists. This starts with a hands-on orthopaedic evaluation:

• Detailed injury and performance history – understanding a runner’s past injuries and training habits provides context.
• Special orthopaedic tests – sensitive evaluations identify specific joint or soft tissue dysfunction.
• Joint mobility assessment – reveals stiffness or hypermobility that could affect stride efficiency.
• Soft tissue palpation – detects muscle tension, adhesions, or restrictions impacting movement quality.
• Neuro-muscular screening – evaluates nerve tension, motor control (coordination), and proprioception (balance).
• Provision of a plan – providing a proposed plan of management integrating different forms of manual therapy (massage therapy, chiropractic care and physiotherapy).
  
  Step 2: Exercise Physiology Testing led by exercise professionals. With the manual therapy notes in hand, the goal is now to quantify a runner’s strength, power, and movement efficiency:
• Power and jump testing (force plates) – measures ground reaction forces, landing asymmetries, and energy output. This helps us understand how a runner generates and absorbs force.
• Maximal isometric strength – evaluates key muscle groups critical for running efficiency and injury resilience like the calves, hip flexors, glutes, hamstrings and groin.
• Movement patterns – assesses running mechanics, single-leg stability and running-specific biomechanics to pinpoint deficiencies.

Putting It All Together
Data without context is just numbers. Hands-on therapy without objective measures can miss critical details. Once testing
is complete, a customized plan can be developed:

1. Data-Driven Decision Making
   Analyze test results to prioritize interventions. For example, a runner might need more single-leg stability work or require more hamstring strength, based on normative data. Findings may include muscle imbalances contributing to that achy left hip or hitch in the stride.
2. Targeted Treatment and Strength Programming
   Merge insights from both assessments. A runner with limited ankle mobility, for instance, may receive joint mobilizations alongside specific calf strengthening to maximize force absorption while increasing tissue capacity.
3. Ongoing Communication
   Collaborate closely with the runner, their coach, and other healthcare providers. Adjustments can be made as needed based on feedback and follow-up testing.
4. Reassessment and Progression
   Testing isn’t a one-time event. Periodically reassess to ensure progress is being made and refine the plan accordingly.

Case in Point
Consider a runner training for a marathon who begins to experience left hip discomfort during long runs. Traditional rest-and-ice advice might provide temporary relief, but the root cause remains unresolved. Through our collaborative assessment, one might discover that their ability to decelerate (eccentric force) as their foot hits the ground is limited on the left side. Manual testing could reveal restricted quad mobility on that side. Armed with this information, program design may focus on eccentric strength of the quads, manual release of the quads and hip flexors with massage and dry needling.

The goal can remain simple: keep runners training, not sidelined by recurring pain. Testing and assessment serve as the foundation, allowing us to treat the individual, not just the injury. Runners deserve more than generic advice or quick fixes. They need a full-spectrum approach that integrates performance data, manual therapy, and ongoing support.

So, before you push through that nagging pain or reach for another round of ice and ibuprofen, consider this: investing in a proactive assessment could be the key to unlocking your best performance yet.

Because smart runners don’t just run—they test, assess, and progress. 

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Photography: Andrea Cruz

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