Start with how you move

Most runners I see with a stubborn injury don't have one injury.

They have two or three. A knee that pinches. A groin that never fully settled. An Achilles that's tender to the touch. Each one gets its own set of exercises, its own attention, and none of them clear.

That was Dan when he came to me.

Meet Dan

Dan runs about 45 miles a week. He's building toward his first 50k, with a 50 miler somewhere down the line.

He came in with a left knee that pinched unless he taped it, a left groin strain that hadn't gone back to normal, and tenderness at his right Achilles. He'd been working on all three for months. His running hadn't stopped. The niggles hadn't moved either.

He sent me his footage and his Garmin data and asked me to take a look.

Two of the three pointed at the same place

From behind, his knees cave in a little at landing. The femur rotates inward with them.

Then at push off his foot turns out, and the tibia looks a little stuck rotating the other way.

So you've got the thigh bone turning one way and the shin bone turning the other, with the knee sitting in between.

That rotational mismatch is what I'd point at for the pinching. The forces twisting through the joint are what the tissue keeps reacting to.

The groin sits close to the same story. When the hip isn't controlling that inward collapse, the muscles around it end up holding work they aren't built to hold.

His pronation, the thing a lot of people would fixate on, is downstream of all this. The hip is upstream. Settle the hip and a lot of what's happening below it settles with it.

The one that doesn't fit

The right Achilles is the odd one out.

Dan thinks it started when he switched to a wide shoe that didn't support his midfoot well. That's a reasonable read, and I'm not going to force it into the same explanation as the rest. Some things sit on their own, and this one does. Part of doing this well is knowing when to stop connecting dots.

What’s making things worse is his cadence. His cadence sits around 156. That's on the low side for his volume. He also runs very upright, without much forward lean.

Both of those put more load through each step than there needs to be.

That doesn't cause the rotation. It just makes everything the rotation is doing hurt a little more.

The plan

The plan to work on this is a combination of things, in order.

First, the hip. Banded step downs to get the knee tracking better while the glutes actually do their job. That's the one I'd start with. Then hip airplanes and 90/90 work to build the strength around it.

Alongside that, a bit of tibial mobility so the shin isn't stuck, and side lying hip adduction progressing toward a Copenhagen plank for the groin.

On the running side, cadence work with a metronome and a drill to bring some lean into his posture.

We also talked shoes. He'd moved to Altra for the wider toebox, which makes sense. I pointed him at the Saucony Guide 19 for a bit more room than his old Rides, plus some stability while he rebuilds the strength underneath.

Why I'm telling you all this

Three injuries felt like three problems. Underneath, most of it was one thing the hip wasn't controlling, with a load pattern making it louder. That's a very different job than chasing each symptom on its own.

If you've been rehabbing a couple of niggles that won't clear, it's worth asking whether they're actually separate.

Most fall marathons are 11 to 12 weeks out. If something's been nagging you, this is the window to sort out what's actually driving it, before you're deep in a build and stuck managing it week to week instead of fixing it.

That's what a gait analysis is for. Reply "gait" and I'll tell you how it works.

Thank you for reading,

Tim 👟

P.S. Dan ran his race two weeks after this analysis and took 80 minutes off last year's time on the same course, with better recovery on top of it.

He's working through the exercises now. His honest note: pairing a higher cadence with easy Zone 2 pace is awkward at first, since running slow and turning your legs over faster pull in different directions. That settles as the pattern becomes normal. The Guide is already helping his pronation.

Nothing here is instant, but the direction is right, and that's the part that matters.