Injury Advice

What it is

Inflammation of the plantar fascia — the thick band of tissue running along the bottom of your foot connecting your heel to your toes. Acts as a shock absorber; when overloaded it becomes irritated and stiff.

Classic sign: Sharp stabbing pain in the heel with your first steps out of bed in the morning. Eases after a few minutes of walking, then worsens again after a long run or standing.

Common causes

Too much too soon — sudden increase in mileage
Tight calves and Achilles
Transitioning to minimalist shoes too fast
Running on hard surfaces (concrete)
Weak intrinsic foot muscles
High arches or flat feet

Treatment

Reduce mileage — don't stop completely
Roll the foot on a frozen water bottle morning and evening
Calf stretches — both straight and bent knee
Towel scrunches and marble pickups to strengthen foot muscles
Single-leg heel raises — slow and controlled
Avoid walking barefoot on hard floors in the morning

Coach Rak says: "PF is almost always a foot strength issue combined with a calf tightness issue. The frozen bottle trick in the morning genuinely works — do it before your first step out of bed. And slow down your minimalist shoe transition."

Rehab exercises

Frozen bottle roll

Roll the arch of your foot over a frozen water bottle with moderate pressure.

2 min each foot, morning & evening

Calf stretch (straight leg)

Hands on wall, back leg straight, heel on floor. Hold and breathe.

3 × 30 sec each side, twice daily

Calf stretch (bent knee)

Same position but with back knee slightly bent — targets the soleus deeper in the calf.

3 × 30 sec each side, twice daily

Towel scrunches

Sit on a chair, place a small towel on the floor, scrunch it toward you using only your toes.

3 × 20 reps, daily

Single leg heel raise

Stand on one foot on the edge of a step. Slowly lower heel below step, then raise to tiptoe.

3 × 12 reps each leg, every other day

Plantar fascia stretch

Sit down, cross one foot over your knee, pull toes back toward you until you feel a stretch under the foot.

3 × 30 sec each foot, before first steps AM

What it is

Medial Tibial Stress Syndrome (MTSS) — pain along the inner edge of the shinbone caused by stress on the connective tissue attaching muscles to the tibia. Accounts for up to 16% of all running injuries.

Classic sign: Diffuse, dull ache along the middle to lower inner shin during and after running. Tender to touch. Eases with rest, returns when training resumes.

Common causes

Rapid increase in mileage or intensity
Running on hard surfaces
Overpronation (feet rolling inward)
Tight or weak calf muscles
Worn-out or inappropriate footwear
Weak hips and glutes causing poor alignment

Treatment

Reduce mileage significantly — run on softer surfaces
Ice the shin for 15 min after running
Increase your cadence to reduce ground impact
Calf and shin stretches twice daily
Hip and glute strengthening
Rest completely if pain is felt at rest

⚠️ Stress fracture warning: If pain is sharp and localised to one small spot (rather than diffuse along the shin), worsens during running and doesn't ease with rest, see a doctor. This may indicate a stress fracture which requires imaging to diagnose and full rest to heal.

Coach Rak says: "The metronome is your best friend here. Increasing cadence by just 5% reduces tibial stress significantly. Use it at track on Monday nights and you'll notice the difference quickly."

Rehab exercises

Toe taps

Sit on a chair, keep heels on the floor, repeatedly tap toes up and down as fast as comfortable.

3 × 30 reps, daily

Calf raises (bilateral)

Stand with feet flat, rise onto tiptoes slowly, lower slowly. Use a wall for balance.

3 × 15 reps, daily

Shin stretch

Kneel on a soft surface, tops of feet flat on floor. Gently sit back onto your heels.

3 × 20 sec, twice daily

Glute bridge

Lie on back, knees bent, feet flat. Push hips toward ceiling, squeeze glutes at top.

3 × 15 reps, daily

Single leg balance

Stand on one leg for 30–60 seconds. Progress by closing your eyes or standing on a folded towel.

3 × 30 sec each leg, daily

Hip abduction (side-lying)

Lie on your side, keep hips stacked. Lift top leg to about 45°, lower slowly.

3 × 15 reps each side, daily

What it is

Degeneration or inflammation of the Achilles tendon — the largest tendon in the body, connecting calf muscles to the heel bone. Very common in minimalist runners due to increased calf loading.

Classic sign: Stiffness and aching at the back of the heel or lower calf first thing in the morning. Pain during the first few minutes of a run that may ease mid-run, then returns after. Tendon may feel thickened or nodular.

Common causes

Transitioning to minimalist shoes too quickly
Rapid increase in speed work or hill running
Tight calves
Inadequate warm-up
Running in cold weather without warm-up
Weak calf and ankle complex

Treatment

Eccentric heel drops — the gold standard treatment
Reduce speed work and hills temporarily
No static stretching of the Achilles when acutely painful
Ice after activity — never before
Avoid complete rest — the tendon needs load to heal
See a physio if no improvement after 4 weeks

Coach Rak says: "Eccentric heel drops are the most evidence-based treatment for Achilles tendinopathy — they work. Do them on a step, slowly lower the heel below the step level. It should feel mildly uncomfortable but not painful. 3 sets of 15, twice a day, every day."

Eccentric heel drop

Stand on the edge of a step on one foot. Rise on both feet, then lower slowly on the injured leg only, letting heel drop below step level.

3 × 15 reps, twice daily — every day

Bilateral calf raise

Two feet, slow controlled raise onto tiptoes and slow lower. Build tendon tolerance.

3 × 20 reps, daily

Seated calf raise

Sit on a chair, heels on floor, raise onto tiptoes and lower slowly. Targets the soleus (deeper calf muscle).

3 × 15 reps, daily

Ankle alphabet

Sitting with leg raised, trace each letter of the alphabet with your foot. Improves tendon mobility and blood flow.

Once through the alphabet, twice daily

What it is

The iliotibial (IT) band is a thick strip of connective tissue running from the hip to the outside of the knee. ITBS occurs when it becomes irritated where it passes over the lateral knee.

Classic sign: Sharp, burning pain on the outside of the knee, typically appearing after a consistent distance into a run (e.g. always at 3 miles). May force you to stop running completely mid-session.

Common causes

Weak glutes and hips — the most common cause
Excessive downhill running
Running on cambered roads
Sudden increase in mileage
Crossing feet over the midline when running
Tight TFL (tensor fasciae latae) muscle at the hip

Treatment

Reduce mileage and avoid downhill running
Foam roll the outside of the thigh (not the knee itself)
Hip and glute strengthening — clamshells, side steps
Work on running gait — avoid crossover stride
Stretching the TFL and hip flexors
Run on softer, flatter surfaces during recovery

Coach Rak says: "ITBS is almost always a glute weakness issue. Add clamshells and lateral band walks to your weekly routine permanently — not just when it hurts. Strong glutes mean the IT band never has to work overtime."

Clamshells

Lie on side, hips stacked, knees bent. Keep feet together and rotate top knee upward like a clamshell opening.

3 × 20 reps each side, daily

Lateral band walk

Resistance band around ankles, slight squat position. Step sideways 15 steps left, 15 right. Keep toes forward.

3 × 15 steps each way, daily

TFL stretch

Cross one leg behind the other, lean sideways away from the back leg. Feel stretch on the outside of the hip.

3 × 30 sec each side, twice daily

Single leg squat

Stand on one leg, slowly lower into a shallow squat. Focus on keeping the knee tracking over your toes.

3 × 10 reps each leg, every other day

Foam roll — outer thigh

Lie on side, roll from hip to just above the knee. Pause on tender spots. Never roll directly on the knee.

2 min each side, after running

What it is

Pain in the front of the knee around or behind the kneecap (patella). The kneecap tracks in a groove and when muscles are imbalanced it rubs or compresses unevenly.

Classic sign: Dull ache or grinding sensation around the kneecap, especially on downstairs, squatting, or after sitting with knees bent for a long time ("cinema sign"). Worse on downhills.

Common causes

Weak quads — especially VMO (inner quad)
Weak glutes allowing knees to cave inward
Overstriding — landing with foot too far in front
Rapid increase in downhill running
Tight quads and hip flexors

Treatment

Reduce downhill running temporarily
Quad and VMO strengthening — terminal knee extensions
Glute strengthening to stop knees caving
Shorten stride — reduce overstriding
Stretch quads and hip flexors daily
Taping (McConnell technique) can provide immediate relief

Coach Rak says: "Short your stride. Most runner's knee is caused by overstriding — when you land with your foot out in front of your body, the kneecap takes a massive braking force. Use the metronome to increase cadence and watch the knee pain disappear."

⚠️ Stop running immediately if you suspect a stress fracture. Running through a stress fracture risks turning a partial fracture into a complete break. See a doctor within 48 hours for imaging.

What it is

A small crack in a bone caused by repetitive stress, most commonly in the tibia (shin), metatarsals (foot), fibula, and navicular. Bone stress injuries exist on a spectrum — from bone stress reaction through to complete fracture.

Classic sign: Very localised, sharp pain at one specific point on a bone (unlike shin splints which are diffuse). Pain worsens during running and doesn't ease mid-run. May ache at rest and overnight.

Risk factors

Rapid increase in training load
Transitioning to minimalist shoes too quickly
Low bone density
Inadequate nutrition — especially calcium and vitamin D
Female runners with low energy availability (RED-S)
Running exclusively on hard surfaces

What to do

Stop running immediately
See a GP or sports doctor within 48 hours
Request an MRI or bone scan — X-ray often misses early fractures
Expect 6–12 weeks off running depending on location
Pool running and cycling are usually permitted
Review nutrition — vitamin D, calcium, and overall energy intake

Use this protocol for most soft tissue injuries (plantar fasciitis, shin splints, ITBS, Achilles). The golden rule: no pain during or after running before progressing to the next stage.

Stage 1

Rest

No running. Walking fine if pain-free. Cross-train — swim, cycle, or pool run to maintain fitness.

⏱ Until no pain at rest · Progress when: zero pain during normal daily activity

Stage 2

Walk

30 min brisk walks on flat surface. Continue rehab exercises daily.

⏱ 3–5 days · Progress when: no pain during or after walk

Stage 3

Walk / Run

Alternate 1 min jog / 2 min walk × 10 repeats. Every other day only.

⏱ 1 week · Progress when: no pain during run or in the 24 hrs after

Stage 4

Easy running

20 min continuous easy run. Flat surface, low effort. No hills or speed.

⏱ 1 week · Progress when: no pain during or after

Stage 5

Build up

Increase weekly mileage by no more than 10% per week. Reintroduce sessions gradually.

⏱ 2–4 weeks · Progress when: no pain at all training levels

Stage 6

Full training

Return to normal training including track, speed work, and hills.

⏱ Ongoing · Maintain rehab exercises permanently as prevention

10% rule: Never increase weekly mileage by more than 10% from one week to the next. This single rule prevents the majority of running injuries.