Running Assessment

Understand how you run and what may be affecting your performance or symptoms

Running places repeated demands on the feet, ankles, knees, hips and trunk. Small changes in strength, mobility, training volume or running mechanics can sometimes contribute to discomfort, recurring injuries or difficulty progressing.

A running assessment looks at how you move while running and considers this alongside your strength, mobility, training history and current symptoms.

The aim is not to force every runner into one “perfect” running style. Instead, the assessment helps identify factors that may be relevant to your individual goals, whether you are returning from injury, increasing distance, improving confidence or simply trying to run more comfortably.

Who may benefit from a running assessment?

A running assessment may be useful if you are experiencing:

• Knee pain while running
• Shin pain
• Calf or Achilles discomfort
• Ankle pain
• Foot or heel pain
• Hip or groin pain
• Hamstring problems
• Recurring running injuries
• Pain that appears after a certain distance
• Difficulty increasing mileage
• Reduced confidence after an injury
• Difficulty returning to running
• A noticeable difference between your left and right side
• Fatigue that changes your running pattern
• Concerns about running technique

You can also have a running assessment without an injury if you want to better understand your current movement and training.

What happens during a running assessment?

The assessment begins with a discussion about your running history and goals.

You may be asked about:

• How long you have been running
• Weekly running distance
• Number of runs per week
• Typical running pace
• Recent changes in training
• Running surfaces
• Footwear
• Previous injuries
• Current pain or symptoms
• Strength or gym training
• Upcoming races or events
• What you would like to improve

This helps place your running mechanics in the context of your overall training rather than looking at your technique in isolation.

Physical assessment

Before watching you run, the physiotherapist may assess areas that could influence running.

This may include:

• Hip strength
• Knee strength
• Calf strength
• Ankle movement
• Foot and ankle control
• Single-leg balance
• Squatting
• Hopping
• Jumping
• Trunk control

Not every runner needs the same tests.

The assessment is selected according to your symptoms, running history and goals.

Running analysis

You may then be observed running on a treadmill or suitable running area.

The physiotherapist may look at factors such as:

• Step pattern
• Cadence
• Stride length
• Foot placement
• Knee position
• Hip movement
• Trunk position
• Arm movement
• Differences between sides
• How your movement changes with speed

Video may sometimes be used to slow the movement down and review particular aspects of your running pattern.

The purpose is to identify potentially relevant movement patterns rather than judging whether your running looks technically perfect.

There is no single perfect running style

Different runners naturally move differently.

Factors such as:

• Height
• Leg length
• Running speed
• Experience
• Strength
• Previous injury

can all influence running mechanics.

A movement that is completely comfortable for one runner may be less suitable for another.

For this reason, running assessment should focus on whether a particular movement appears relevant to your symptoms or goals rather than trying to make every runner look the same.

Running assessment for injury

If you are attending because of pain, the assessment aims to understand why the area may be struggling with your current running demands.

This can involve looking at:

• Strength
• Training volume
• Running mechanics
• Recovery
• Running speed
• Hills
• Previous injuries

Treatment may then involve a combination of rehabilitation and changes to running rather than focusing only on technique.

Knee pain while running

Knee pain is one of the most common reasons runners seek physiotherapy.

Symptoms may occur:

• During longer runs
• Going downhill
• After increasing training
• At faster speeds
• After running several days close together

Assessment may look at:

• Hip and knee strength
• Running volume
• Cadence
• Step pattern
• Single-leg control
• Recent training changes

Treatment may combine strengthening with temporary running adjustments.

Shin pain

Shin pain can develop when the lower leg is exposed to more running demand than it is currently able to tolerate.

Assessment may consider:

• Recent mileage changes
• Running frequency
• Calf strength
• Foot and ankle movement
• Running surface
• Recovery
• Running mechanics

Persistent or very localised bone pain should be assessed carefully rather than assumed to be simple muscle soreness.

Achilles and calf pain

The calf and Achilles tendon work repeatedly during running.

Problems may develop after:

• Increasing mileage
• Adding hills
• Faster running
• Returning after a break
• Sudden changes in training

A running assessment may look at:

• Calf strength
• Ankle movement
• Running pattern
• Step rate
• Training load

Rehabilitation usually needs to rebuild calf capacity alongside any relevant running changes.

Foot and heel pain

Foot or heel pain may be influenced by several factors including training, strength and load.

Assessment may consider:

• Foot and ankle movement
• Calf strength
• Running volume
• Footwear
• Running surface
• Step pattern

Not every foot problem is caused by how the foot lands.

The wider training and physical picture is important.

Hip and groin pain

Running requires repeated single-leg control through the hip and pelvis.

If symptoms occur around the hip or groin, assessment may include:

• Hip strength
• Range of movement
• Single-leg control
• Running mechanics
• Training volume
• Speed work

Persistent hip or groin pain should be properly assessed, particularly if it also affects walking or everyday activity.

Hamstring problems

Hamstring symptoms may become more noticeable during:

• Faster running
• Sprinting
• Hills
• Longer runs

Assessment may look at:

• Hamstring strength
• Hip strength
• Running speed
• Stride
• Previous injury
• Sprint exposure

If there has been a previous hamstring strain, later rehabilitation may need to include faster running rather than only slower jogging.

Returning to running after injury

A running assessment can help when you are no longer experiencing significant pain during everyday activities but are uncertain about restarting running.

The progression may begin with:

• Walking
• Short jogging intervals
• Longer jogging periods
• Continuous running
• Faster running
• Hills
• Sport-specific running

The exact progression depends on the injury and your previous running level.

Walk-run programmes

For some runners, a walk-run approach provides a useful way to reintroduce impact gradually.

A session might alternate between short periods of:

• Walking
• Jogging

Running time can then gradually increase if symptoms remain manageable.

This can be useful after:

• Injury
• Surgery
• Long periods away from running
• Significant loss of fitness

The programme should be adapted to your current capacity rather than following one standard schedule.

Cadence

Cadence refers to the number of steps taken while running over a period of time.

Some runners may benefit from a small change in cadence if it helps reduce the demand placed on a painful area.

However, there is no single cadence that every runner should aim for.

Any change should have a clear reason and be introduced gradually.

Stride length

Stride length naturally changes according to:

• Running speed
• Height
• Leg length
• Fitness
• Running style

Some runners may take relatively long steps in front of the body, while others use shorter steps.

If stride appears relevant to symptoms, it may be adjusted as part of rehabilitation.

The goal is not simply to make every runner take shorter steps.

Foot strike

Runners may naturally land:

• On the heel
• Through the midfoot
• Towards the forefoot

There is no need for every runner to deliberately change to one particular foot strike.

Changing foot strike can shift load from one area of the body to another.

It should therefore only be considered when there is a clear reason rather than because one style is assumed to be universally better.

Running posture

Running posture can vary between individuals.

Assessment may look at:

• Trunk position
• Pelvic movement
• Arm swing
• Overall body control

Small changes may occasionally improve comfort or efficiency.

However, the aim is not to hold the body rigidly upright while running.

Running should remain a dynamic movement.

Running and strength

Running itself does not always provide enough strength stimulus for every muscle involved.

Strength training can help develop physical capacity around areas such as:

• Calves
• Quadriceps
• Hamstrings
• Hips
• Gluteal muscles
• Trunk

For runners recovering from injury, strengthening is often an important part of rehabilitation.

A running assessment may therefore lead to a strength programme as well as running advice.

Single-leg strength

Running is largely a repeated single-leg activity.

Useful rehabilitation exercises may include:

• Split squats
• Lunges
• Step-ups
• Single-leg calf raises
• Single-leg deadlift variations
• Hopping

The exercise programme can become more challenging as your running demands increase.

Running and balance

Good running does not require standing perfectly still on one leg.

However, balance and single-leg control can be useful parts of rehabilitation, particularly after ankle, knee or lower-limb injuries.

Exercises may progress towards:

• Hopping
• Landing
• Dynamic stepping
• Faster movements

The goal is to prepare the body for the movement demands of running.

Training load

Running injuries are not always caused by poor technique.

A sudden increase in physical demand can also be important.

Examples include:

• Increasing weekly mileage quickly
• Adding extra running days
• Introducing hills
• Starting speed sessions
• Returning after illness
• Training for a race
• Combining running with additional sport

The assessment therefore considers how much running you are doing as well as how you move.

Increasing running distance

If you are trying to run further, increasing too many things at once can make it difficult to understand how your body is responding.

Progression may involve gradually changing:

• Distance
• Frequency
• Speed
• Hills

The right rate of progression depends on your experience, current fitness and injury history.

There is no single percentage increase that works for every runner.

Increasing running speed

Faster running places different demands on the body than easy running.

If your goal is to return to:

• Intervals
• Tempo running
• Sprinting
• Race pace

rehabilitation may need to introduce speed gradually.

Being able to run slowly without pain does not automatically mean the body is ready for repeated faster efforts.

Hill running

Uphill and downhill running change the physical demands placed on the legs.

Some runners notice symptoms mainly:

• Running uphill
• Running downhill
• After repeated hills

The assessment may consider whether hills need to be temporarily reduced and then gradually reintroduced.

Running surfaces

Roads, treadmills, trails and tracks each provide slightly different running environments.

A runner does not necessarily need to avoid a particular surface permanently.

However, a sudden change in surface combined with increased training may contribute to symptoms for some people.

Rehabilitation may gradually prepare you for the surfaces relevant to your normal running.

Treadmill and outdoor running

A treadmill provides a useful controlled environment for observing running.

However, outdoor running includes additional factors such as:

• Uneven surfaces
• Wind
• Hills
• Turns
• Changes in pace

If your symptoms only occur outdoors, the assessment should consider these differences.

The goal is to make recommendations that apply to your actual running environment.

Running footwear

There is no single shoe that is suitable for every runner.

Footwear should generally:

• Fit comfortably
• Be suitable for the type of running you do
• Allow you to run without creating new symptoms

A running assessment may consider whether a recent footwear change is relevant to your symptoms.

However, shoes are only one part of the overall picture.

Strength, training and previous injury may be equally or more important.

Changing running shoes

Changing immediately from one very different type of shoe to another may alter the way loads are distributed through the lower limb.

If you are making a significant footwear change, introducing the new shoes gradually may be more comfortable.

You do not necessarily need to replace shoes simply because they have reached an exact mileage.

Condition, comfort and how they feel during running are also relevant.

Running after a long break

Returning to running after several months away can feel surprisingly difficult.

Your cardiovascular fitness may return faster than the strength and load tolerance of the legs.

A gradual return may therefore include:

• Shorter runs
• Walk-run sessions
• Fewer running days
• Strength training
• Gradual increases in distance

The goal is to rebuild running capacity rather than immediately matching your previous mileage.

Returning after illness

Illness can reduce strength and fitness even when you have not had a running injury.

The first runs back may need to be shorter and slower.

If there has been a significant illness or ongoing symptoms such as chest pain, unusual breathlessness or severe fatigue, appropriate medical guidance should be followed before returning to demanding exercise.

Running after pregnancy

Returning to running after childbirth may require consideration of:

• Pelvic floor symptoms
• Abdominal strength
• Leg strength
• Pelvic or back pain
• Impact tolerance
• General fitness

Symptoms such as urinary leakage, pelvic heaviness or pelvic pain may indicate that additional postnatal or pelvic floor rehabilitation would be useful.

Return to running should therefore consider whole-body recovery rather than time alone.

Running with previous injuries

A previous injury does not necessarily mean that you need to stop running.

However, previous injury can sometimes influence:

• Strength
• Confidence
• Running volume
• Movement

Assessment may consider whether the previously injured area has fully regained the capacity required for your current training.

This can be particularly relevant when the same problem keeps returning.

Recurring running injuries

If an injury repeatedly settles and returns when mileage increases, the problem may not be simply that the area needs more rest.

Assessment may consider:

• Strength
• Running volume
• Speed
• Hills
• Recovery
• Previous rehabilitation
• Running mechanics

The goal is to improve the amount of running the body can tolerate rather than repeatedly stopping and restarting without changing anything.

Running fatigue

Running mechanics naturally change as the body becomes tired.

This is not automatically a problem.

However, some symptoms only appear later during a run.

If pain consistently begins after a particular distance, assessment may consider:

• Endurance
• Muscle strength
• Running pace
• Fuel and recovery
• Training history

In some cases, observing running after a period of effort may provide more useful information than only watching the first few minutes.

Running for beginners

A running assessment is not only for experienced athletes.

Beginners may benefit from guidance on:

• Starting distance
• Running frequency
• Walk-run progression
• Strength training
• Managing normal post-exercise soreness

The aim is to build running gradually and avoid making every session more difficult than the last.

Recreational runners

You do not need to be training for a race to have a running assessment.

A recreational runner may simply want to:

• Run comfortably
• Improve fitness
• Manage recurring pain
• Increase distance
• Return after injury

Recommendations can be based on those goals rather than competition performance.

Distance runners

Longer-distance runners may need to manage high weekly running volumes.

Assessment may consider:

• Weekly mileage
• Long runs
• Speed sessions
• Hill training
• Strength training
• Recovery

A runner preparing for a marathon may need a very different rehabilitation plan from someone running twice per week.

Sprinters and faster runners

Sprinting involves much higher forces and speeds than easy distance running.

Assessment may therefore include:

• Hamstring strength
• Calf strength
• Hip strength
• Acceleration
• Running mechanics at speed

Returning to sprinting after injury should usually include progressively faster running rather than jumping directly from jogging to maximum effort.

Running assessment for team-sport athletes

Football, rugby, hockey and other sports require running alongside:

• Acceleration
• Sprinting
• Stopping
• Turning
• Changes of direction

A treadmill running assessment may be only one part of rehabilitation.

Later assessment may also need to include field-based movement and sport-specific tasks.

Changing running technique

Technique changes should usually be:

• Small
• Purposeful
• Gradual

Trying to change several aspects of running at once can make running feel unnatural and may place new stress on different tissues.

If a change is recommended, you should understand:

• Why it is being suggested
• What it aims to change
• How to practise it

The goal is not to create a completely different running style unless there is a clear reason.

Video feedback

Video can sometimes make it easier to understand what is being discussed during the assessment.

You may be shown:

• Your running pattern
• Differences between sides
• A particular movement being discussed
• How a small technique change affects running

The video should support practical recommendations rather than simply provide a list of technical faults.

A running assessment is more than watching you run

Running analysis is most useful when combined with the rest of the assessment.

A video alone cannot tell us:

• How strong you are
• Whether an area is painful
• How quickly your training increased
• How well you recover
• Whether you are returning from injury

Running mechanics therefore need to be interpreted alongside the wider physical and training picture.

What happens after the assessment?

Following the assessment, you may receive recommendations involving:

• Strengthening exercises
• Mobility exercises
• Changes to running volume
• Running technique adjustments
• A return-to-running programme
• Changes to speed or hill training
• Advice around recovery
• Further physiotherapy rehabilitation

Not every runner needs all of these.

The recommendations should focus on the factors most relevant to your individual situation.

When further assessment may be needed

Some running-related symptoms require further investigation rather than simply changing technique.

Seek appropriate assessment if you experience:

• Severe pain after an injury
• Inability to put weight through the leg
• Significant swelling
• Persistent localised bone pain
• A joint that repeatedly gives way
• New significant weakness or numbness
• Pain that regularly wakes you at night
• Unexplained pain that continues worsening
• Sudden calf swelling, heat or redness
• Chest pain, fainting or unusual breathlessness during running

Running should not be used to repeatedly test symptoms that may require medical assessment.

Assessment based on your running goals

Different runners have different reasons for attending.

Your goal may be to:

• Run without pain
• Return after injury
• Complete your first 5K
• Increase weekly mileage
• Return to half-marathon or marathon training
• Improve confidence
• Return to sprinting
• Manage recurring injuries
• Return to team sport
• Understand your running mechanics

The assessment and rehabilitation programme can be developed around these goals.

How many appointments will I need?

A running assessment may sometimes be completed in a single session when the goal is general advice or analysis.

If an injury, strength deficit or return-to-running programme is identified, further rehabilitation may be useful.

The number of appointments depends on:

• Your symptoms
• Injury history
• Current running level
• Strength
• Training goals

Follow-up assessments can also be used to review how running changes as rehabilitation progresses.