You are three weeks into a Comrades training block. The mileage is climbing, the long runs are getting longer, and then your knee starts niggling. Or your Achilles feels thick in the morning. Or your lower back aches after every run over 15km.
Most runners push through it. “It will settle.” Sometimes it does. Often it does not, and by the time you actually get it looked at, you have lost weeks of training and the problem has become harder to fix.
Here is the thing: that niggle did not appear out of nowhere. It was building for a while. And in most cases, a simple assessment a few weeks earlier could have caught it before it became a problem.
Running asks a lot of your body
Every time your foot hits the ground, you absorb two to three times your body weight in force. Over a 10km run, that is thousands of loading cycles. Over a training block for a major race, it is millions.
Your body handles this remarkably well, but only when everything is working as it should. When a joint is stiff, a muscle is not firing properly, or your movement pattern is slightly off, the load does not disappear. It gets redirected. Your knee picks up what your hip is not doing. Your plantar fascia absorbs what your calf cannot. Your lower back compensates for a thoracic spine that will not rotate.
That is why so many running injuries feel like they come out of nowhere. You did not do anything wrong. You just accumulated enough load on a structure that was already quietly taking on more than its share.
The things that matter most for runners
Research by Bramah and colleagues (2018) looked at the gait patterns of injured versus uninjured runners and found some clear differences. Injured runners tended to have more hip drop, more trunk lean, and less control through their pelvis. These are not things you feel while you are running. But they add up over time.
A few areas are worth paying attention to.
Your ankles. Your ankle needs a certain range of dorsiflexion to run efficiently. If it is restricted, and it often is, your calf, Achilles, and plantar fascia all compensate. Stiff ankles are one of the most common and most overlooked drivers of lower limb problems in runners.
Your glutes. They are the engine of your running stride. When they are weak or not switching on properly, your pelvis drops on each step, your knee collapses inward, and your lower back works overtime. If you have ever been told you have “lazy glutes,” this is what they mean.
Your mid-back. Running is not just a lower body activity. Your upper body rotates with every stride to counterbalance your legs. If your thoracic spine is stiff, your lower back and hips have to rotate more to make up for it. This is a common driver of pain in runners doing high mileage.
Single-leg control. Running is a series of single-leg hops. If you cannot control your body well on one leg, you will not do it well at speed over distance either. A simple single-leg squat or calf raise can reveal a lot about where your weaknesses are.
Getting assessed before a big race
If you are building towards Comrades, Two Oceans, or any race where the training volume is going to push your body, getting assessed early in the block is one of the most useful things you can do.
The point is not to go looking for problems. It is to identify any areas that might break down under load before they actually do. A stiff ankle or a weak glute might be completely fine during a casual 5km. Add 60 to 80km weeks over three months and it becomes a different story.
Getting on top of it early gives you time to fix it. Strengthening a weak hip over eight weeks is straightforward. Trying to manage a stress reaction four weeks before race day is not.
What treatment actually looks like
Chiropractic care for runners is not about cracking your back and hoping for the best. It is targeted treatment based on what your body actually needs.
Joint mobilisation restores normal movement in the spine, pelvis, ankles, and feet so that load distributes more evenly when you run. Soft tissue work on the calves, hip flexors, glutes, ITB, and Achilles manages the tension that builds up with training. And identifying and correcting muscle weaknesses, particularly in the glutes, core, and foot muscles, is where the long-term injury prevention happens.
A systematic review by Lauersen and colleagues (2018) in the British Journal of Sports Medicine found that strength training reduced overuse injuries in athletes by almost 50%. That is a significant number. The exercises are not complicated, but knowing which ones you actually need makes a big difference.
If you do pick up a soft tissue injury during training, understanding the PEACE & LOVE approach to recovery can help you manage it properly from day one.
The other side of it is load management. Knowing when to push and when to pull back is half the battle with running injuries. Your chiropractor can help you make those decisions based on how your body is responding, rather than just following a training plan regardless of what your body is telling you.
Building it into your training
The runners who stay healthiest are the ones who treat maintenance as part of their training, not something they do when things go wrong. It does not need to be complicated.
During base building, a monthly check-in keeps things moving well and catches any issues early. When the mileage ramps up, every two to three weeks is more appropriate. A session one to two weeks before race day makes sure there are no surprises. And after a big race, especially something like Comrades, your joints, muscles, and nervous system all benefit from treatment to kickstart recovery.
This is the same approach used by elite athletes. The difference is they have access to a support team every day. For the rest of us, a consistent schedule is the next best thing.
You do not need to wait until something hurts
This is the part most runners miss. By the time your knee is sore, your Achilles is tight, or your ITB is flaring, you have already lost training time. The injury was building long before the pain showed up.
The runners who stay on the road year after year, who line up for their fifth or tenth Comrades without a history of injury setbacks, are rarely doing anything exotic. They are staying on top of their mobility, keeping their muscles balanced, and dealing with small issues before they become big ones.
If you are training for a race, building mileage, or just want to make sure your body can handle what you are putting it through, get in touch or book an appointment. We treat runners and athletes at every level, from parkrun regulars to Comrades veterans.
References
- Videbæk S, Bueno AM, Nielsen RO, Rasmussen S. Incidence of Running-Related Injuries Per 1000 Hours of Running in Different Types of Runners: A Systematic Review and Meta-Analysis. Sports Medicine. 2015;45(7):1017-1026.
- Bramah C, Preece SJ, Gill N, Herrington L. Is There a Pathological Gait Associated with Common Soft Tissue Running Injuries? American Journal of Sports Medicine. 2018;46(12):3023-3031.
- Lauersen JB, Andersen TE, Andersen LB. Strength Training as Superior, Dose-Dependent and Safe Prevention of Acute and Overuse Sports Injuries: A Systematic Review, Qualitative Analysis and Meta-Analysis. British Journal of Sports Medicine. 2018;52(24):1557-1563.
- Nielsen RO, Bertelsen ML, Parner ET, Sørensen H, Lind M, Rasmussen S. Running More Than Three Kilometres During the First Week of a Running Regimen May Be Associated with Increased Risk of Injury in Obese Novice Runners. International Journal of Sports Physical Therapy. 2014;9(3):338-345.
- Miners AL. Chiropractic Treatment and the Enhancement of Sport Performance: A Narrative Literature Review. Journal of the Canadian Chiropractic Association. 2010;54(4):210-221.