Why Does My Knee Hurt When I Run?

Does your knee sometimes hurt when you run, while other times it feels fine?

Knee pain is one of the most common problems experienced by runners. It can develop gradually, appear after increasing your training, or sometimes come on without an obvious injury.

The good news is that knee pain doesn't always mean you need to stop running completely. Understanding what may be contributing to your symptoms is an important first step.

Common causes of knee pain when running

Patellofemoral pain

Pain around or behind the kneecap is commonly associated with patellofemoral pain. It can be aggravated by running, stairs, squatting or prolonged sitting.

Changes in training load, strength, running tolerance and the way the knee is being loaded can all contribute.

Patellar tendon pain

Pain at the front of the knee, particularly just below the kneecap, can be related to the patellar tendon. It is often aggravated by activities involving repeated jumping, running or high levels of force through the knee.

ITB-related pain

Pain on the outside of the knee that develops during running can sometimes be associated with irritation of tissues around the iliotibial band. It is often related to changes in running volume, hills, speed or other training factors.

Muscle or training-load related pain

Sometimes the cause isn't a specific injury. A sudden increase in running distance, speed, hills or frequency can exceed the capacity of the muscles and joints to handle the load.

This is particularly common when returning to running after a break or injury.

Do you need to stop running?

Not necessarily.

For many running-related injuries, completely stopping activity isn't required. Instead, temporarily modifying your running volume, speed or frequency may allow symptoms to settle while maintaining fitness and gradually building your capacity.

A physiotherapist can help determine what level of activity is appropriate and develop a progressive return-to-running plan.

When should you see a physiotherapist?

Consider getting assessed if your knee pain:

• Is getting progressively worse

• Persists despite reducing your training

• Causes swelling or significant stiffness

• Changes the way you run

• Prevents you from completing normal activities

• Keeps returning whenever you increase your running

A thorough assessment can help identify the likely contributors to your pain and guide an appropriate rehabilitation program.

If this sounds like you, feel free to book in with one of our physios today at Heathmont Physio and Sports Medicine

Back Pain in Athletes, and the benefits of Physiotherapy

Whether you're a footballer, runner, CrossFit enthusiast, golfer or weekend warrior, acute back pain can be frustrating and disruptive. One awkward lift in the gym, an awkward tackle, or even repetitive training loads can leave you struggling to train, compete, or even get comfortable at work.

The good news is that most episodes of acute low back pain improve significantly within the first few weeks, especially when managed appropriately. Early assessment by a physiotherapist can help identify the source of your pain, rule out more serious injuries, and guide a safe return to sport.

Why Does Back Pain Occur in Athletes?

Athletes place significant demands on their spine. While the back is incredibly strong and resilient, rapid increases in training load, fatigue, poor recovery, or unexpected movements can overload muscles, joints, ligaments or discs.

Common causes of acute back pain include:

• Muscle or ligament strains

• Facet joint irritation

• Lumbar disc irritation

• Poor movement control under fatigue

• Rapid increases in training or competition load

• Repetitive twisting or extension movements

In younger athletes, stress injuries to the spine (such as pars stress fractures) may also need to be considered, particularly if pain develops gradually and worsens with extension activities.

Should You Rest?

Years ago, complete bed rest was commonly recommended for back pain. We now know this isn't the best approach.

Current evidence suggests that remaining as active as symptoms allow leads to better recovery than prolonged rest. This doesn't mean pushing through severe pain, but rather modifying activities while gradually returning to normal movement. Remaining active can reduce pain, improve function and help athletes return to sport sooner.

How Physiotherapy Can Help

Every episode of back pain is different, which is why an accurate assessment is essential.

At our clinic, treatment is tailored to the individual and may include:

Manual Therapy

Hands-on techniques such as joint mobilisation and soft tissue massage can help reduce pain, improve movement and decrease muscle guarding, allowing athletes to move more comfortably.

Sports Massage & Soft Tissue Therapy

Muscles surrounding the spine often become tight and protective after injury. Targeted soft tissue techniques can reduce muscle tension and improve mobility while rehabilitation progresses.

Cupping Therapy

Cupping has become increasingly popular among athletes, with many reporting temporary relief of muscle tightness and pain.

During treatment, suction cups are placed on the skin to create negative pressure, which may help reduce muscle tension and improve local blood flow. While current research suggests cupping may provide short-term pain relief for some people, the overall quality of evidence remains limited. For this reason, we use cupping as one component of a comprehensive rehabilitation program rather than a standalone treatment.

Exercise Rehabilitation

Exercise remains the cornerstone of recovery.

Depending on your injury, rehabilitation may include:

• Mobility exercises

• Core and trunk strengthening

• Hip and glute strengthening

• Running or lifting technique modification

• Sport-specific loading

• Return-to-sport progressions

The goal isn't simply to reduce pain—it's to restore confidence, strength and resilience so you're less likely to experience the same problem again.

When Should You Seek Assessment?

While most acute back pain settles well, you should arrange an assessment if:

• Pain persists for more than a few days without improvement.

• You're unable to train or work normally.

• Pain repeatedly returns during sport.

• Pain radiates into your leg with numbness or weakness.

• You experience significant pain following trauma.

• You have night pain, unexplained weight loss, fever, or changes to bladder or bowel function, which require urgent medical assessment.

Returning to Sport

Returning too early is one of the biggest reasons athletes experience recurring back pain.

Before returning to full training, we aim to ensure you can:

• Move through full ranges of motion comfortably.

• Restore strength and control.

• Tolerate sport-specific movements such as sprinting, jumping, lifting or twisting.

• Gradually rebuild training loads without symptom flare-ups.

A structured return-to-sport plan helps reduce the risk of reinjury while getting you back to doing what you enjoy.

The Bottom Line

Acute back pain doesn't always mean you've suffered a serious injury. In most cases, early assessment, staying active, and following an individualised rehabilitation program lead to excellent outcomes.

At our clinic, we combine thorough assessment with evidence-based rehabilitation, manual therapy, sports massage and adjunctive treatments such as cupping when appropriate. Our focus is not only getting you out of pain, but helping you return stronger, more confident and ready for your next training session or competition.

References

Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard (2022).

George SZ, Fritz JM, Silfies SP, et al. Interventions for the Management of Acute and Chronic Low Back Pain: Revision 2021 Clinical Practice Guideline. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(11).

National Center for Complementary and Integrative Health. Low-Back Pain and Complementary Health Approaches: What You Need to Know.

Acute Management of Ankle Injuries: What You Should Do in the First 72 Hours

Ankle injuries are one of the most common musculoskeletal injuries, affecting everyone from elite athletes to weekend walkers. Whether you've rolled your ankle playing sport, stepping off a curb, or hiking on uneven ground, how you manage the injury in the first few days can have a significant impact on your recovery.

The good news? Most ankle injuries recover well with the right treatment and rehabilitation.

What Happens When You Roll Your Ankle?

The majority of ankle injuries involve a lateral ankle sprain, where the foot rolls inward (inversion), overstretching or tearing the ligaments on the outside of the ankle.

Common symptoms include:

• Pain around the outside of the ankle

• Swelling

• Bruising

• Difficulty walking or bearing weight

• A feeling of instability or "giving way"

The severity can range from a mild ligament stretch (Grade I) to a complete ligament tear (Grade III).

What Should You Do Immediately After the Injury?

Current best practice recommends following the PEACE & LOVE principles:

PEACE (First 1–3 Days)

P – Protect
Reduce activities that increase pain during the first 1–3 days. You don't necessarily need complete rest, but avoid movements that significantly aggravate the injury.

E – Elevate
When possible, elevate your ankle above heart level to help reduce swelling.

A – Avoid Anti-inflammatory Medication
While anti-inflammatory medications may reduce pain, inflammation is an important part of tissue healing. They should not be used routinely in the early stages unless recommended by your healthcare provider.

C – Compress
Use a compression bandage or ankle sleeve to help manage swelling and provide support.

E – Educate
Avoid relying solely on passive treatments. Active rehabilitation is the key to achieving the best long-term outcomes.

LOVE (After the First Few Days)

As pain begins to settle, focus on gradually returning to movement.

L – Load
Begin gentle weight-bearing and movement as tolerated. Pain can be used as a guide—some discomfort is acceptable, but pain should not progressively worsen.

O – Optimism
Recovery is influenced by both physical and psychological factors. Staying positive and understanding the healing process can improve outcomes.

V – Vascularisation
Introduce low-impact cardiovascular exercise, such as cycling or swimming, as symptoms allow. This promotes circulation and supports healing.

E – Exercise
Progressive rehabilitation restores:

• Strength

• Balance

• Mobility

• Coordination

• Confidence

These are essential for preventing recurrent ankle sprains.

Should You Ice Your Ankle?

Ice can help reduce pain in the short term and may make the ankle feel more comfortable. However, research suggests that icing does not speed up healing and should be used primarily for pain relief rather than as a treatment to accelerate recovery.

If using ice:

• Apply for 10–15 minutes at a time.

• Wrap the ice pack in a towel.

• Allow the skin to return to normal temperature before reapplying.

When Should You See a Physiotherapist?

Not every ankle sprain requires an X-ray, but every significant ankle injury benefits from an accurate assessment.

You should seek assessment if:

• You are unable to walk four steps immediately after the injury or the following day.

• Swelling or bruising is severe.

• Pain persists beyond a few days.

• Your ankle feels unstable.

• You continue to sprain the same ankle repeatedly.

• You're aiming to return to sport or an active lifestyle safely.

A physiotherapist can determine the severity of the injury, identify whether other structures (such as tendons or the syndesmosis) may be involved, and develop a rehabilitation program tailored to your goals.

Why Rehabilitation Matters

Many people stop treatment once the pain settles. Unfortunately, pain often improves before the ligaments, muscles, and balance systems have fully recovered.

Without proper rehabilitation, individuals are more likely to experience:

• Recurrent ankle sprains

• Chronic ankle instability

• Persistent pain

• Reduced sporting performance

• Long-term ankle problems

Research shows that structured exercise therapy significantly reduces the risk of future ankle sprains.

The Bottom Line

Most ankle sprains recover well, but the first few days are important. Protect the ankle, manage swelling, gradually return to movement, and begin a structured rehabilitation program as early as appropriate.

If you're unsure about the severity of your injury, or your recovery isn't progressing as expected, booking an assessment with a physiotherapist can help ensure you're on the right path back to work, sport, and everyday activities.

What are Shin Splints?

Shin splints are a common running and sporting injury that causes pain along the front or inside of the shin bone.

They’re especially common in runners, footballers, dancers, and people who have recently increased their training or activity levels.

The medical term is “medial tibial stress syndrome” (MTSS), which basically means the muscles and tissues attached to the shin bone become overloaded and irritated.

What it feels like:

Pain or tenderness along the inside of the shin

An ache that starts during or after exercise

Tight or sore calves

Pain when running, jumping, or sometimes even walking

Symptoms that can gradually worsen over time

Common triggers:

🏃 Increasing running distance or intensity too quickly

👟 Worn-out shoes or changes in footwear

🦵 Tight or weak calf muscles

🛣️ Running on harder surfaces

⏳ Not enough recovery between training sessions

How physiotherapy can help:

At the clinic, treatment is focused on settling symptoms while improving the strength and capacity of the lower leg to handle load again safely.

Your physio may help with:

✔️ Identifying contributing factors to the injury

✔️ Improving calf and lower limb strength

✔️ Addressing ankle mobility and movement patterns

✔️ Building running loads back up gradually

✔️ Reducing the risk of recurrence

We also guide you through an appropriate return-to-running or sport plan, so you can stay active without continually flaring things up.

Goal:
👉 Reduce pain, improve strength and loading tolerance, and help you return to running and sport with confidence.

If shin pain has been limiting your running, training, or sport, come see us at the clinic — we’ll help get you back to doing what you love as soon as possible.

References:

Moen, M. H., Tol, J. L., Weir, A., Steunebrink, M., & De Winter, T. C. (2009). Medial tibial stress syndrome: A critical review. Sports Medicine, 39(7), 523–546. https://doi.org/10.2165/00007256-200939070-00002

Newman, P., Witchalls, J., Waddington, G., & Adams, R. (2013). Risk factors associated with medial tibial stress syndrome in runners: A systematic review and meta-analysis. Open Access Journal of Sports Medicine, 4, 229–241. https://doi.org/10.2147/OAJSM.S39331

Winters, M., Moen, M. H., Zimmermann, W. O., Bakker, E. W., & Weir, A. (2018). Medial tibial stress syndrome can be diagnosed reliably using history and physical examination. British Journal of Sports Medicine, 52(19), 1267–1272. https://doi.org/10.1136/bjsports-2017-097875

Yates, B., & White, S. (2004). The incidence and risk factors in the development of medial tibial stress syndrome among naval recruits. The American Journal of Sports Medicine, 32(3), 772–780. https://doi.org/10.1177/0363546503258776

Calf Strains

Calf strains are one of the most common injuries we see in running and field sports — but they can happen to anyone.

Whether it’s during sprinting, pushing off quickly, jumping, or even a long walk after doing “too much too soon,” a calf strain can stop you in your tracks.

Your calf is made up of two main muscles (the gastrocnemius and soleus) that help you push off, run, jump, and absorb force through the leg. When these muscles are overloaded or stretched too far, small muscle fibres can tear.

What it feels like:

A sudden sharp pain or “pull” in the back of the calf

Tightness or cramping

Pain when walking, pushing off, or going up stairs

Tenderness when touching the muscle

Sometimes swelling or bruising

When it’s worse:

Running or sprinting

Pushing off quickly

Jumping or changing direction

Walking fast uphill or stairs

Why it happens:

Sudden increases in running or sport load

Poor calf strength or endurance

Tight or fatigued muscles

Previous calf injuries

Reduced ankle mobility

How can our Physios help?

Physiotherapists help by reducing pain, restoring strength, and guiding you safely back to sport or activity.

Assessment & diagnosis:
Identify the severity of the strain and what structures are involved

Load management:
Help modify activity so the calf can recover without losing too much fitness

Exercises:
Early movement and strength work

Progressive calf strengthening

Balance and control exercises

Running and return-to-sport progressions

Manual therapy:
Techniques to improve muscle flexibility, ankle mobility, and reduce stiffness

Return-to-sport planning:
Gradually reload the calf safely to reduce the risk of re-injury

Goal:
👉 Reduce pain, rebuild confidence and strength, and get you back to doing what you love as soon as possible.

If you’ve recently injured your calf or keep getting recurring tightness and strains, come see us at the clinic — we’ll help guide your recovery and get you moving again.

Should I see a Physio, Osteo or Chiro?

Physio, Osteo or Chiro? Whats the Difference:

Physiotherapists, Chiropractors, and Osteopaths all treat muscle and joint pain — but they use different approaches.

PHYSIO (What we do well!):

Assessment and diagnosis of injuries and pain

Exercise-based rehab and strengthening

Improving movement, function, and performance

Hands-on treatment including massage, dry needling, cupping and other techniques

Helping you recover and stay active long-term

CHIRO:

Spinal alignment and joint manipulation

Hands-on treatment of the spine and nervous system

Treatment often centres around “adjustments” or manipulations

OSTEO:

Whole-body movement and alignment

Hands-on manual therapy

Joint mobility, muscles, posture, and movement patterns

SO WHAT MAKES PHYSIOTHERAPY DIFFERENT?

Physiotherapists combine hands-on treatment with exercise rehabilitation and education to help treat the cause of pain — not just the symptoms.

At our clinic, treatment may include:

Exercise programs tailored to your injury and goals

Strength and stability training

Manual therapy and joint mobilisation

Sports rehab and return-to-play planning

Dry needling

Taping and bracing advice

Load management and recovery advice

Post-operative rehabilitation

Education to help prevent flare-ups and future injuries

Physiotherapy is about more than just treating pain — it’s about helping you move better, recover properly, and get back to doing what you enjoy.

Whether you’re dealing with a sports injury, back or neck pain, workplace aches, post-surgery rehab, or ongoing stiffness, our team focuses on finding the cause of the issue and creating a treatment plan tailored to you.

At Heathmont Physio and Sports Medicine, we combine hands-on treatment, exercise rehabilitation, and education to help reduce pain, improve strength and mobility, and prevent injuries from coming back.

👉 If pain or injury is stopping you from performing at your best, come see our team in clinic!

Compartment syndrome

Compartment syndrome is a condition characterised by an increase in pressure within a limited space, this in turn compromises both the circulation and function of the tissues within that space. The space or the compartment consisting of the muscles, blood vessels, arteries and nerves is surrounded by a layer called the fascia. This fascia is a tough connective tissue, hence why it is unable to adapt to increased pressure. Compartment syndrome can be acute onset, or more chronic.

Acute compartment Syndrome:

Acute compartment syndrome is a medical emergency and often presents after a traumatic injury. The most common location for acute compartment syndrome is the anterior or front compartment of the leg that contains the tibialis anterior muscle, extensor muscles of the toes, tibial artery and peroneal nerve. Common conditions that can lead to acute compartment syndrome include:

• Fractures (Tibial fractures being the most common)

• Burns

• Crush injuries

• Vascular injuries

• Thrombosis (clots)

• Bleeding disorders

• Casts or splints worn incorrectly

• Tight bandages

• Intense athletic activity

Symptoms of acute compartment syndrome:

• Limb pain that is severe

• Pain not reduced with medication

• Pain that increases with movement of the limb

• Burning or tingling

• Reduced limb strength

• Temperature reduction

• Discolouration and swelling (whiteness/ blueness)

• Reduced mobility of toes and fingers.

Treatment for acute compartment syndrome: A surgery called fasciotomy if often performed, where a cut is made in the skin down to the fascia to release the pressure inside the compartment. This cut remains open to ensure the pressure does not build up again. This surgery aims to decrease the chance of permanent damage to internal structures.

Chronic compartment syndrome:

Chronic or exertional compartment syndrome, unlike acute compartment syndrome is not an emergency. This condition develops over days or weeks and is often an outcome of intense exercise, especially intense activity that is repetitive. The pain usually disappears once the strenuous activity ends.

Symptoms of chronic compartment syndrome:

• Numbness in the area

• Tightness in the relevant limb

• Tingling in the affected area

• Weakness in the limb

• Bulge in the muscles

Common causes of chronic compartment syndrome:

• Enlarged muscles

• Venous hypertension (increased pressure in veins)

• Abnormal lack of flexibility in fascia

General treatment of chronic compartment syndrome:

• Anti-inflammatory Medication

• Elevation of the affected limb

• Orthotic shoe inserts

• Ice post exercise

How can my Physiotherapist help?

Chronic Compartment Syndrome:

• Diagnosis

• Adjusting load appropriately

• Modifying loading biomechanics

• Addressing muscles imbalances

• Education on pacing activity

Acute Compartment Syndrome:

• Diagnosis and acute management including specialist referral

• Post surgery rehab

• Preventing stiffness

• Restoring normal range

• Muscle training to prevent muscle atrophy

• Retraining of gait if relevant

• Retraining for relevant activities (e.g. sports, stairs, occupation)

Compartment syndrome may present similarly to other conditions, hence why it is important to rule out other possibilities.

• Cellulitis- This condition is a bacterial infection that usually occurs when the skin that acts as a barrier to bacteria is wounded or broken. The swelling, tenderness and tightness of the skin are features that are similar between cellulitis and compartment syndrome, hence why these conditions can be mistaken for each other.

• Deep Vein Thrombosis- This occurs when a blot clot forms inside a vein, interfering with normal blood flow. Swelling, pain and discoloration are cardinal signs of deep vein thrombosis, and these symptoms as mentioned earlier are also common in compartment syndrome.

• Gas Gangrene- This is a life-threatening condition caused by a bacterial infection in the muscle leading to rapid tissue destruction and the production of gas. The gas build-up often results in noticeable swelling, hence why gas gangrene can also be mistaken for compartment syndrome.

Take home messages: Compartment syndrome is rare but can have severe complications if diagnosis is late or missed and treatment delayed. If you have had a recent injury and develop severe pain it is important to be seen by your healthcare practitioner as soon as possible for evaluation. If you have been having persistent chronic pain and can’t get to the bottom of its cause, see your physiotherapist for an evaluation and consider chronic compartment syndrome.

References:

McQueen, M. M., & Court-Brown, C. M. (2003). Compartment monitoring in tibial fractures. The pressure threshold for decompression. The Journal of Bone and Joint Surgery. British Volume, 85(5), 693–697. https://doi.org/10.1302/0301-620X.85B5.14352

Agency for Clinical Innovation. (2021). Acute compartment syndrome: Recognition and management of patients with musculoskeletal conditions. NSW Government. https://aci.health.nsw.gov.au/__data/assets/pdf_file/0007/458188/ACI-MSK- Acute-compartment-syndrome.pdf

Kanj, W. W., & Gunderson, M. A. (2022). Acute compartment syndrome. In StatPearls. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK448124/

Orthopedic + Sports Medicine Institute of Fort Worth. (n.d.). Compartment syndrome. https://www.osmifw.com/orthopedic-diseases-disorders/compartment-syndrome/