Strength and load management, prescribed to your training and injury history.
Jessica Coombe (AEP) works with athletes across all sports; running injuries are a particular focus given the volume of runners she sees.
We commonly see runners whose injury keeps returning — shin pain, a grumbling Achilles, or knee pain that settles with rest and comes back as soon as mileage builds. Rest, ice and stretching have usually been tried. They help briefly, but the problem recurs on return to training.
We also see runners building toward a goal race who can feel a problem developing and want it addressed before it forces a break, and runners coming back after time off who need to rebuild load safely.
Others present after being told to stop running altogether, and want an assessment of whether the underlying cause can be corrected instead.
Typical diagnoses include patellofemoral pain, Achilles or patellar tendinopathy, medial tibial stress syndrome, ITB syndrome, plantar fasciopathy, and bone stress injuries.
Most running injuries are load errors rather than a single traumatic event. Rest and stretching settle the symptom but don’t change the tissue’s capacity to absorb load, which is why the injury returns when mileage climbs. Treatment targets the two factors with the strongest evidence behind them: training load, and strength.
Load management. Most overuse injuries follow a spike in a single session or a rapid rise in weekly volume, applied to tissue that hasn’t been built to tolerate it. Jessica Coombe (AEP) maps your current load, identifies the spikes, and builds a graded progression. Where you are injured, relative rest — reduced volume or pace with targeted work — is usually more effective than stopping completely.
Progressive strength training. Strength training roughly halves overuse injury rates, while stretching shows no protective effect (Lauersen et al., 2014). The effective dose is two sessions a week built around single-leg movements — split squats, single-leg deadlifts, and heavy-slow or eccentric calf raises — which load the calf, quad and glute along the same pathways running uses. Hip weakness is a consistent finding in injured runners and is correctable.
Gait retraining where indicated. We don’t overhaul running form; wholesale changes rarely help and can introduce new problems. Two adjustments have consistent evidence: increasing step rate by 5–10% reduces peak knee loading without changing pace, and reducing forward trunk lean shifts load off the knee. Cadence is measured, and changed only where the data supports it.
Bone density and energy availability. Bone stress injuries are often driven by low energy availability — under-fuelling relative to training load — which lowers bone density and raises injury risk (Relative Energy Deficiency in Sport, RED-S). Where the history suggests this, Dr Isobelle Smith can assess bone density and the hormonal drivers, and our dietitian Isabelle (Bell) Smith can address energy availability. Jess is also ONERO trained in bone-loading exercise.
Rest and stretching have a place — rest offloads an irritated tissue, and mobility work belongs in a warm-up. Neither changes the load capacity that allowed the injury, which is why symptoms return when mileage is rebuilt. Stretching in particular has not been shown to prevent overuse running injuries. Where a runner is caught in a rest–return–reinjure cycle, the missing element is usually progressive loading and a training-load plan.
No referral is required to book. If you have a chronic condition, your GP may be able to refer you under a chronic disease management plan for a Medicare rebate — ask us and we can explain how it works.
Usually not. Most running injuries are managed by modifying volume and pace while strength is built and the load error corrected. Complete rest is reserved for the injuries that need it, such as some bone stress injuries.
No. Stretching has a role in warm-up and general mobility, but it has not been shown to prevent overuse running injuries. Strength training and load management have the strongest evidence.
Recurrence usually means the underlying load capacity was never rebuilt. The symptom settled with rest, but the tissue still could not tolerate the training, so it broke down again on return. The fix is progressive loading, not another round of rest.
No. Jessica Coombe works with athletes across all sports. Running is a particular focus given the number of runners she sees.
The Endocrine & Wellbeing Clinic
Phone: (02) 9870 3256
Locations: Balmain (inner west Sydney) and Telehealth Australia-wide
Affiliated with: ESSA (Exercise and Sports Science Australia), ANZBMS, Endocrine Society of Australia
This page is not a substitute for individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
