We run to stay strong, fit and healthy. We run to protect our mental wellbeing. We run because we know it’s good for us. It builds self-discipline, strengthens determination, and nurtures a willingness to defy idleness and stay motivated. So much of running depends on willpower and pushing through discomfort, but what happens when the obstacles shift from mental to physical? One of the core challenges in running is that when the body is in pain, a defiant mindset can’t always be applied. Instead, we’re often asked to practise two virtues that don’t always sit comfortably alongside a runner’s natural dynamism and enthusiasm: patience and rest.
In this blog, we’ll be revisiting a real case from our clinic where one client’s passion for running dangerously outpaced their body’s development. We’ll be exploring their approach, the guidance we provided, and the sacrifices it required for their body heal properly and to prevent any lasting damage.
When life was carefree and easy
There’s a particular thrill about being up during the early hours of the morning for a run, a quiet satisfaction in simply having the drive to rise so early. When the rest of the world is still half asleep, the immense calm seems to magnify the benefits of progress and self-belief. It becomes a kind of meditation, putting the runner in good stead for the rest of the day.
For our client, the honeymoon period was like any other for those who remember being newly committed to running. Battling against post-Christmas blues during the bleak winter months, they sought to lift their spirits by getting active. Bursting with motivation and setting modest goals, they started with gentle, sensible runs. But progress came quickly – almost too quickly – and the client soon became hooked on improvement, pushing themself to limits they had once thought impossible. They wanted more, breaking the double-digit mark in kilometres sooner than their body was prepared for. Behind the scenes, a troubling picture was beginning to emerge.
Reality bites
The first instance of something going wrong came during a 10k run, when the client felt a sudden tweak. It started as a dull ache deep in the right hip, easy to shrug off for being a mere discomfort. But the ache soon spread to the inside of the left knee, and by the finish line, their lower back was feeling unstable too.
So, here we collide firsthand with a flaw in the runner’s otherwise admirable instinct to push through adversity – the very instinct our client relied on. They soldiered on, hoping the discomfort would fade on its own. But the body rarely responds well to being ignored. It’s message was clear: it was time for our client to rein in the exercise. Instead, our client kept running until they had no choice but to visit our clinic, worried about the severity of their injury.
We explained that although they may have believed they could simply push through, this is what was actually happening inside their body as they continued trying to run…
A mismatch in development
An important thing to remember when first starting out running is that your cardiovascular system is an overachiever. Your heart and lungs can adapt to running within weeks, sometimes creating the illusion that the body is more capable than it truly is. Meanwhile, the muscles, tendons, ligaments, and joints are still in training, developing the resilience they need at a far more measured pace. Some parts of the body can keep up; others simply can’t.
The problem is that when the training load rises too quickly, the body rarely confines the fallout to one isolated area. Instead, it triggers a domino effect whereby one struggling area forces another to compensate, and the strain ripples through the chain until the whole system eventually starts to buckle.
The first line of defence: the hip
When we run, each stride is essentially a controlled fall onto one leg. The muscles around the hip like the glutes are responsible for catching us and keeping the pelvis steady. On short runs, they will typically manage this without too much difficulty. But when the distance increases, and there isn’t adequate strength or recovery, these muscles will begin to fatigue. Pelvic control might start to falter, the hip may drop slightly with each stride, and other tissues absorb forces they weren’t designed to handle.
The first sign of this happening is often a subtle discomfort around the side or back of the hip that lingers after running – much like what our client experienced. It’s easy to ignore, but an early indication that a crack may be developing in the foundations.
The knee: the silent compensator
With hip stability compromised, the knees are then conscripted into action. As the pelvis dips, the knees can track slightly inward, placing repetitive stress on the medial collateral ligament and surrounding structures on the inner side of the joint, as well as the tissue just below the kneecap (infra-patellar overload). These tissues were never designed to absorb this kind of chronic, compensatory overload – certainly not during this stage in a runner’s development.
The result is often a tender, aching sensation along the inside of the knee during runs, stair climbs or walking downhill. Not a tear – it isn’t incapacitating – but a clear warning of what might lie ahead. Ignore these signals for long enough, and they can develop into far more serious injuries.
The lower back: the body’s last stand
Once the hip and knee start to struggle, fatigue spreads and control deteriorates further down the chain until it reaches the body’s final line of defence: the lower back. With every stride, the muscles and spine are asked to work overtime and keep the body upright and moving forward. They become the last-resort of stabilisers, a role they can’t sustain for long.
Dull aches after running, stiffness settling in later in the day, and a reduced tolerance for sitting or bending are all classic signs of a lower back under siege. Not because of spinal damage, but because of compensation and overload.
Patience is a virtue
Returning to our client, once they began experiencing all the above, it became a critical lesson to learn early in their running journey. When pain enforces setback, it can easily be misinterpreted as failure. But moments like this teach us that resting is an essential part of the physical training process paramount to exercise. Strategic rest allows inflamed tissues to settle, overloaded structures to recover, and the body to rebuild so it can return stronger and more resilient.
For our client, resting duties included:
- Temporarily stepping back from running.
- Maintaining fitness through exercises that are lighter on the joints, such as swimming, cycling or walking.
- Allowing everyday movements to feel comfortable again before stepping back into their running shoes.
Rehabilitation and recovery
During rest, the body enters a rehabilitation phase in which it begins to address what recent training has revealed to be missing. In the case of running, this includes:
- Strengthening the glutes and hip stabilisers.
- Developing trunk endurance.
- Improving single-leg balance and control.
- Creating a smarter, more gradual progression back to running.
Crossing the real finish line
With proper guidance on recovery, our client made a full recovery and soon returned to running. Theirs was far from being a unique case, and in fact, it’s remarkably common in the clinic. These are the quiet injuries that accumulate over time until the dull aches and stiff joints grow so severe that they knock a runner out of action for a long time.
This is why it’s always worth checking with a therapist if you have concerns over any small niggles, just like our client did. Here at Marsden Health, we are welcome to hear about any such queries and offer our support. Running is meant to enrich lives, not derail them. Many major injuries can be avoided simply through building good habits early on. Recovery is key, and ultimately, the time or distance of any single run matters far less than your ability to keep running in the long term.
Written by Hardik Nimla, Senior Physiotherapist
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