What Every Run Coach Should Know

Takeaways from Our 2025 PT-Led Coaching Clinic by Ryan Matisko, PT, DPT, FAFS

Each year, our team of Physical Therapists hosts a Run Coaching Clinic designed to educate and empower run coaches in the NYC community. This event brings together experts in the field to discuss best practices for injury prevention, performance enhancement, and the integration of physical therapy into training programs. Below, we highlight key takeaways from this year's clinic.

The Role of a Physical Therapist in Injury Prevention and Recovery

Physical therapists play a crucial role in keeping runners healthy and addressing injuries before they become major setbacks. Here’s how we contribute:

• Develop personalized Home Exercise Programs to address asymmetries and weaknesses.

• Assist in modifying training plans when needed.

• Implement Return-To-Running Protocols post-injury or surgery, especially after bone stress injuries.

• Recommend appropriate running shoes based on individual biomechanics and needs.

Gait Analysis and Running Mechanics: What Matters Most

Understanding running mechanics is essential to reducing injury risk and improving efficiency. Some key insights include:

• Foot Strike: We don’t recommend changing foot strike; rather, the focus should be on where the foot lands relative to the body.

• Toe Runners: More prone to calf injuries.

• Heel Strikers: More susceptible to knee injuries.

• Arm Swing: Excessive movement may indicate a lack of pelvic stability.

• Stride Length: Overstriding increases injury risk; correction should focus on bringing foot strike back rather than altering foot position.

• Cadence: No universal “magic number,” but generally falls between 165-180 steps per minute, depending on height and femur length.

• Hip Drop: Often linked to poor pelvic stability rather than just weak glutes.

Recognizing When to Stop Running

Early recognition of injury signs can prevent long-term damage. Runners should take a break if they experience:

• Worsening pain during running.

• Altered running mechanics due to discomfort.

• Pain migrating to other areas.

• Inability to hop on one leg.

• Pain persisting during daily activities like walking or climbing stairs.

• Poor sleep or diet contributing to injury risk.

• Pain levels exceeding 5 on a 10-point scale.

Recognizing RED-S (Relative Energy Deficiency in Sport)

RED-S is a serious condition that affects many runners, particularly those with high training loads and insufficient nutrition. Warning signs include:

• Unusual fatigue beyond typical training-related tiredness.

• Poor sleep quality and reduced recovery.

• Amenorrhea in female athletes, significantly increasing bone stress injury risk.

• Low energy availability affecting overall performance and bone health.

When Does a Runner Need Physical Therapy?

Being proactive rather than reactive can save an athlete from prolonged setbacks. Runners should consider PT if:

• Soreness lasts more than two days or feels abnormal.

• Pain interferes with training, even if just mild discomfort.

• They have significant training goals and need a comprehensive team approach.

• They find themselves saying, “I wish I had come to PT sooner.”

What Should Physical Therapy Look Like for a Runner?

A runner-focused PT session should include:

• A detailed discussion covering training goals, injury history, strength training, and nutrition.

• Soft tissue treatment to address restrictions.

• Home exercises to enhance performance and prevent injuries.

• Education on modifying training when necessary.

• Strength and motor control exercises that mimic running mechanics to build long-term resilience.

How Physical Therapy Can Boost Performance

Beyond injury prevention, PT plays a key role in optimizing performance. Our top recommendations include:

• Keeping hard days hard and easy days easy (2-3 hard efforts per week depending on experience level).

• Prioritizing recovery through proper nutrition, self-treatment, and sufficient sleep.

• Incorporating strength training (1-2x per week) with a focus on squats, hinges, lunges, and calf raises.

• Strategically timing strength work with running (e.g., lifting on the same day as intense runs).

• Ensuring adequate nutrition and hydration to fuel performance and recovery.

Common Trends in Running-Related Injuries

Some of the most common causes of running injuries include:

• Overtraining due to excessive volume and inadequate recovery.

• Skipping down weeks, which are essential for bone adaptation.

• Weakness in key muscle groups like the glutes and calves.

• Neglecting warm-ups, cooldowns, and strength training.

• Wearing the wrong shoes for different types of workouts.

• Increasing prevalence of bone stress injuries linked to the above factors.

Mythbusting Popular Recovery Modalities

We took time to debunk some common misconceptions about injury prevention and recovery:

• Stretching: Dynamic warm-ups are beneficial, while passive stretching has little effect on injury prevention.

• KT Tape: Helps with proprioception but does not realign muscles or joints.

• Ice Baths: Can reduce inflammation but may blunt training adaptations if used immediately post-workout.

• Orthotics: Useful for temporary pain relief but not a lifelong solution.

• Foam Rolling/Massage Guns: Temporarily decrease muscle tension but do not “break up” fascia or muscle knots.

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Our annual Run Coaching Clinic continues to serve as a valuable resource for NYC’s running community, helping coaches better support their athletes in preventing injuries, optimizing performance, and knowing when to seek professional guidance. As movement specialists, we emphasize that running mechanics and injury prevention are complex and require a personalized approach. By applying evidence-based strategies, we can help runners stay strong, healthy, and fast for years to come.