The four changes that precede most running injuries
- A jump in weekly volume, often after a race entry or a good week
- Adding intensity — hills, tempo, intervals — without removing volume
- A surface or footwear change made abruptly
- Life load: less sleep, more standing hours, a stressful stretch
When someone tells us their heel or Achilles "came out of nowhere," one of those four is almost always in the previous three weeks.
Bone stress is the exception that changes urgency
Pain that has progressed from after-running, to during-running, to walking, especially with a recent training jump and a focal tender spot on bone, needs evaluation before any treatment decision. That's a load and imaging conversation, not a shockwave conversation.
Returning to running properly
- Establish what tissue is involved and how irritable it currently is
- Find the volume you tolerate now, not the volume you had in April
- Build strength for the involved region alongside the running
- Reintroduce intensity separately from volume, one variable at a time
- Use adjuncts such as shockwave only where they're clinically indicated