How to Get to the Root Cause of an Injury

injuryInjury can quickly sideline any runner by causing pain, frustration, and disappointment over lost training days and unmet goals.

Injuries can be classified as accidental or as a result of overuse.

Some injuries occur due to accidents (such as tripping or falling). Accidents are unfortunate, but mostly random. Using common sense can help you to avoid repeating similar injuries.

Overuse and overload type injuries are preventable if you reduce your risks. Let me explain . . .

Overload Injuries

I tend to classify overload type injuries as more of a onetime occurrence that leads to injury. Examples include:

  • Sprinting, and then suffering a hamstring tear.
  • Quickly (and unexpectedly) changing directions and jumping over an obstacle during a trail run which then causes a hip flexor strain.
  • A quick cutting motion during a soccer game that results in tearing an ACL.

In each one of these examples, the quick and powerful force that was generated overloaded the capacity of the tissues to handle the load and resulted in an injury.

Overuse Injuries

Also called repetitive motion injuries, these tend to occur when the same tissue is stressed over and over again without adequate time to recover and adapt. This may occur over the course of several weeks or months, but it could also occur over the course of a single run or race.

  • For example, imagine running a half marathon that is primarily downhill without training for the downhill component. You would develop shin splints as the anterior tibialis muscle is stressed repeatedly throughout the race over and above its capacity to handle the workload and recover.

In a typical recovery adaptation cycle, the body experiences a stress (a training workout), then you rest and recover. Your body adapts and is ready for the next stimulus. Ideally, the progression of your abilities is linear.

Biomechanical Imbalances

However, different tissues will adapt at different rates. As training volumes and intensities increase, some tissues cannot adapt as fast as others. Biomechanical imbalances throughout your body can impart asymmetric forces through your body’s tissues. Thereby, overloading the tissues and leading to injury.

These biomechanical imbalances and subtle asymmetries led to altered forces and body mechanics. This means that the actual reason for the injury may or may not be located at the actual site of injury.

Often, the root cause of the injury is somewhere above or below in the kinetic chain and may even be on the opposite side of your body. By understanding the common patterns that are found in most overuse injuries, you can not only recover from an injury more quickly, but more importantly, avoid it in the first place!

In order to recover more quickly and completely after suffering an injury, it’s critical to get to the root cause of the injury. Follow these steps in order to determine the root cause of any injury.

How to get to the Root Cause of an Injury


Questions to Ask . . .

  • What tissue is injured?
  • Evaluate how the injury occurred. Did you trip and fall or did someone trip you?
  • What were the environmental conditions that were present that lead to the accident? Was it rainy?
  • Was the road slick? Was it too hot or cold outside?
  • Was there some sort of sports equipment failure that led to the accident?
  • What steps could you have taken to avoid the accident?

In the case of accidental injuries, were there common sense steps or lessons learned that can help you to avoid similar injuries in the future? If yes, then don’t forget to implement those steps in the future.

Overuse/Overload Injuries

Questions to Ask . . .

  • Evaluate what tissue is painful or injured. Was there any type of direct trauma or a specific incident that occurred which led to the injury?
  • Have you experienced this pain before? If so, can you trace back to when it started?
    What makes the pain better? What makes it worse?
  • If the injury or pain is only on one side of your body, what is different from one side of your body to the other?
  • What patterns can you identify that led to the pain?
  • Have you noticed or has someone ever commented about an unusual movement pattern or posture that you tend to stand, walk or run in? For example, has anyone ever said that you tend to limp or sway when you walk or run? Do you have one foot that rolls out or turns different than another?
  • Are the wear patterns in your shoes symmetrical within the shoe and between shoes?

If there isn’t a known cause to the pain or injury, can you identify other areas above and below the injury site that may have contributed to the injury?

  • For instance, your knee starts to hurt after a ten mile run. There isn’t any known reason for the pain. You didn’t fall or have a pre-existing injury or a prior history of knee pain. Upon evaluation, you recall that the hip on the same side had been feeling tighter than the other hip for several days. Potentially this asymmetry in motion led to altered mechanics which caused abnormal stress through the knee and resulted in pain.

Many overuse injuries are caused by issues above and/or below the injury site due to biomechanical imbalances. Are there structures above and/or below the site of injury that have you experienced issues with previously or intuitively feel may be involved?

Leave No Stone Unturned

These questions are not exhaustive. When I first meet a new client for physical therapy, we spend nearly half of our time discussing questions like these and general medical history and running history. Medical professionals are always taught that a thorough history is the most important part of an examination.

So when thinking through your particular overuse injury, leave no stone unturned. The more unusual or chronic the pain, the more you need to dive down into patterns and altered mechanics elsewhere in the body.

The problem with most running related injuries is that they are caused by overuse (repetitive motion). This is why it’s so important for runners like you to learn how to identity the root cause that led to an injury. Then you can identify the common risk factors for that particular injury and evaluate if any of those risk factors pertain to your particular situation. Use that as a starting point for identifying possible causative factors.


In order to be successful in meeting your running and training goals, injury must be avoided. Other than lack of time, injury is the number one reason why people report not completing their exercise and training goals. With the right training advice and preventative maintenance, most injuries can be avoided! If you are already injured, then getting the right treatment the first time is the best way to accelerate recovery and insure that you are back running as quickly as possible.

That is why Trevor, Angie and I have created the Resilient Runner program. This program gives you all the tools needed to become a lifelong resilient runner. We explain injury prevention strategies to keep running, plus we provide detailed videos and rehabilitation guides on each problem area of the body including:

  • Lower Back Pain and Piriformis
  • Upper Leg: Iliotibial Band and Hamstring Injury
  • Knee Pain: Patellar Femoral Pain Syndrome (Runner’s Knee); Patellar Tendinitis; and Meniscus Injury
  • Lower Leg and Foot: Achilles Tendinitis; Plantar Fasciitis; Shin Splints; and Stress Fractures

It’s a virtual library of self-treatment protocols including downloadable podcasts, videos, and .pdf files of rehabilitation guides. It also includes a 277 page eBook, The Resilient Runner, Prevention and Self-Treatment Guide to Common Running Related Injuries.

In addition, Angie offers in-depth advice on preventing the most common running mistakes and mishaps from side stitches to blisters; how to cope with the mental and physical aspects of injury; tips on avoiding overtraining; tips on cross training including a special 27 minutes Yoga for Runners Video.

More written content and videos are in the works, but if you sign up now you will get access to everything at one special introductory price!


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