Most people spend a lot of time building capacity – very few train expression.

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Like many runners who have pain, Sam’s first angle of attack was to look at his running form. In fact, almost every runner who comes to see me starts by asking for a gait analysis as they believe it must be their ‘poor’ running form that’s resulting in their pain or lack of performance. While on the surface it may look like their running form is the cause of it all, but believe it or not, it’s rarely the case – and Sam’s case highlights this perfectly.

Your running form is simply an output – it’s a set of movements produced by your ability to control and coordinate your muscles, joints and other tissue. You can think of it a bit like the final product of a cake-baking process. If your ingredients, method or process are substandard in any way, the resulting cake will not be what you want. The best way to get a good cake is to ensure that the ingredients, method and process are exactly what’s needed to produce the cake you want.

This is exactly the same with your running form. In the case of human movement, the ingredients are the sensory input signals from all over your body; the method and processes are what your brain does with that sensory input and how it integrates it; your running form is the eventual output.

Given that Sam’s shin and calf pain only came on beyond 10k tells us that something about the quality of his inputs or processing and integration wasn’t quite right. And yes, this probably was being displayed somewhere in his running form and I could have gone down the route of measuring angles, looking for muscle weakness and all the traditional stuff – but I chose a much more direct route first.

I started by testing what he could feel from his right calf and shin. Sam had his eyes closed and was to tell me what he experienced. I applied hot and cold touch. I followed this with pressing a sharp point or a dull point at various points. I tested light tough, heavy tough and vibration. In all areas we tested, except one, Sam could feel all these sensations so I knew that his brain was getting a pretty clear map of where his calf and shin were: but not a totally complete map. There was a very small area, no bigger than 2cm round, where Sam couldn’t feel any sensation at all. It was a tiny paler area of skin from a very old scar that Sam didn’t even know was there. Could that be the issue? 

I then did some skin stretch testing on that specific area and found there were some barriers, indicating further that this tiny area was messing with Sam’s braid-body map. I did a bit of work to release the barriers and we retested Sam’s movement quality: in this case we were testing ankle range of movement and calf tightness. We immediately saw an improvement so I knew we were onto something. Then came the really weird bit!

I wanted Sam to get more in touch with the sensory information that was coming in from that area of his skin. To do this, I wanted to dull down two of his primary sensory inputs – vision and hearing. Sam then stood up tall, put on a blindfold and a pair of ear defenders. His drill was to find his way down to the ground, roll over on the outside of his calf where the target area of skin was, and then come back up to standing. He was to do this five times.

The retest after doing this exercise was outstanding! Sam’s calf tightness had all but disappeared and his right-side ankle range of movement increased dramatically.

Sam’s homework for the next few days was to repeat this exercise at home once or twice per day, and just five reps.

Within five days Sam’s shin and calf pain had gone completely! Totally vanished! When he came in for his first proper session with me a couple of weeks later, he had already increased his long run to 14km and was completely pain-free. That was a couple of months ago (June 2025) and Sam has had a couple more sessions with me, and this time we were able to go straight to improving his technique – which he did in a single session – because the stability of his right side was now not an issue and we could look at optimisation. But just from that first exercise, Sam’s pain resolved and it has never come back even though he is now a good way through his half marathon training.

Why was this area causing Sam pain? Because his brain-body map was incomplete, Sam wasn’t able to effectively stabilise his knee and ankle joints reactively (unconsciously) as he was running. When he increased his distance, the skill requirement for stability also increased, especially as fatigue creeps in. The incomplete brain-body map was stopping this from happening so his brain produced the pain experience to get him to stop – it was red-flagging him that something wasn’t right.

As soon as we completed the brain-body map, he was suddenly able to stabilise his joints again and his brain was perfectly happy and safe with him increasing his distance.

Your brain and nervous system are amazing, and by working at their level and communicating with them directly, you really can make life-altering transformations – just like Sam did.

My Runner By Design membership takes everything I do with my clients on a one to one basis, and makes it available online as a set of assessments, courses, education and live coaching calls. It’s designed to take you on your next steps of your running journey, including helping you get out of pain and enjoying your running again.

To find out more, click here. 

The post The Tiny Scar That Solved Two Years of a Runner’s Pain appeared first on RunTeach.

Jeff, a male runner in his 60s, contacted me about his persistent right-sided runner’s knee pain. For over three years, it had been a constant companion, sometimes completely stopping him from running.

He’d seen his local doctor, and when they couldn’t find anything definitive, he turned to a physiotherapist. Jeff had one session every week for three months! Think about that for a moment: 12 weekly sessions, a significant investment of both time and money, all hoping to get back to the sport he loved.

Sadly for Jeff, 12 sessions of physiotherapy made no difference to his knee pain at all. In fact, Jeff also had very tight hamstrings, a problem he’d lived with since his younger years, and the physiotherapy hadn’t solved that either.

Jeff told me he’d managed to get back to running himself by using a neoprene sleeve over his right knee. This allowed him to run almost pain-free, which was incredibly intriguing. He actually had three different knee sleeves: a thin neoprene one, a more robust one with a small hinge, and an even thicker one with a stronger hinge. None were solid, just varying thicknesses of neoprene. While these sleeves allowed him to run almost as far as he wanted, they were a real inconvenience to lug around and wear on every run.

Unlocking the Nervous System: The First Breakthrough

So, Jeff came in for a running and movement assessment. We went through a thorough, personalised set of tests and observations. As with all my assessments, some tests are designed to discover the effectiveness of certain drills or sensory stimulation methods. As part of this, using specific drills and sensory stimulation, we actually solved Jeff’s long-standing tight hamstring issue in about 45 seconds! No joke – 45 seconds! This immediate improvement hinted at the power of working with his nervous system.

His knee pain, however, was a different story. Satisfied that the various scans Jeff had undergone over the past three years showed no specific tissue issues, I carried out extensive sensory testing around Jeff’s right knee. We discovered he couldn’t feel the sensation of cold on a small patch of skin on the outside of his knee. This was a crucial clue, suggesting that his brain wasn’t getting clear signals from that area, almost like a ‘blurry GPS signal’ for his knee. When your brain doesn’t have a precise sense of where a body part is, it can’t control and stabilise it properly, often leading to pain. We confirmed this by doing some squats; his right knee pain was instant, and I could see his control was poor.

There was a possibility then, that when Jeff wore one of the knee sleeves, his skin was heating up, and this extra warmth was making up for the lack of cold sensation, helping to sharpen the brain’s map of his knee. I applied cold sensory therapy to Jeff’s knee for the rest of the assessment, and we retested the squats. This massively improved his squat control, and there was virtually no pain. Running on the treadmill was also much better with less pain. I sent Jeff home with some cold therapy drills and other knee-mapping exercises.

In our next session, Jeff reported he could now run a couple of kilometres pain-free without the knee sleeves, but any longer, and it became very painful. However, he could now walk completely pain-free. I felt we were on the right track with sensory input, so I did more testing and re-testing. I gave Jeff some more mapping exercises to do at home. At his next session, Jeff said he could run a bit further now, but was still lugging one of the knee sleeves around in a backpack because beyond 3 or 4 km, he was still getting terrible pain.

Decoding the Knee Sleeve: The ‘Aha!’ Moment

So, I took to my large whiteboard, and together, we reverse-engineered exactly what the knee sleeves might be doing. Now, Jeff was like a lot of runners I see in that when he has pain, he immediately associates it with some form of tissue damage. Even though I had spent considerable time explaining and demonstrating that actually, it was his nervous system reporting false alarms of threats, Jeff struggled to move away from “it must be a tissue-issue, and I might be making it worse by running on it without the sleeve.” This made it even more important to figure out what the sleeve was actually doing.

Given that the sleeves were all made of neoprene, they offered minimal muscle bracing or structural support. This was a tough concept for Jeff to grasp initially. But by demonstrating how his knee could still freely move in all directions, even with the thickest sleeve, he started to understand that it wasn’t providing the external structural support he assumed.

So what was it doing for him? We knew his knee was probably heating up a bit, and therapy around the cold sensory deficit helped, but there was something else more important for his brain. Then Jeff mentioned something that made my brain go into overdrive: sometimes he would stop his run and massage the outside of his knee, and this helped reduce the pain. Bingo! It suddenly clicked.

Through a specialist technique, I tested how his brain responded to different types of touch on his skin – specifically, how it reacted to skin being stretched and skin being compressed. I discovered that by applying decent pressure directly onto his skin, compressing it in that specific spot, he could squat completely pain-free. This included single leg squats, which he could never do before due to pain and lack of control. This was it! This was the missing piece!

The Ingenious Solution: A Small Piece of Tape

But obviously, I wasn’t going to follow him around pushing on his knee! So I came up with an ingenious, simple solution: a small, 6cm strip of kinesiology tape. I applied the tape in a very specific way, creating that precise skin compression in just the right spot. Jeff tested this on the treadmill, and just like that, he was pain-free! I cut some more strips for him to take away and taught him how to apply it, sending him a supporting video of him applying it to his own knee for reference.

At his next session, he was over the moon! He could now run more than 21km completely pain-free without hauling around those bulky knee sleeves. All he needed was a small, easily portable piece of tape. He carried several pieces with him when he went for a run; they’re so easy to pop into his pocket – no more heavy backpack!

We did some other mapping work at that session, but Jeff decided that now he could run pain-free and race half marathons again, compromising by sticking a small bit of tape onto his knee was the perfect cost/benefit ratio for him.

Your Brain is the Key to Pain-Free Running

I love stories like Jeff’s because they illustrate that even when someone holds onto the ’tissue damage’ belief, their running and their life can be profoundly transformed by working with their brain and nervous system. You don’t need to be a “believer” in neuroscience for it to work!

So, if you’ve been battling pain for more than a few months, and scans show no specific injury, or perhaps a past injury has long healed, it’s time to look beyond the obvious and start exploring the incredible power of your brain and nervous system.

To help you understand this often-overlooked aspect of pain, I’ve created a completely FREE mini-course specifically for runners which you can find here.

To access the FREE course you will need to create a free account on the course platform.

Important Note:
Jeff had already seen medical professionals before he came to see me. He had also undergone several scans so was confident there was no physical injury.

It is very important that if you suspect at all that you may have a physical injury then you must go and get it checked out by a medical professional. Nothing in this article nor in anything that I teach, suggest or recommend, replaces the knowledge and experience of a trained medical professional when it comes to acute injury. Please do not ignore the fact that physical injuries do happen, so ensure you receive the care you need.

The post From Three Years of Runner’s Knee to Pain-Free Half Marathons: Jeff’s Story appeared first on RunTeach.

If you are like most of the runners I speak to, you’ll only do a warm up selectively – usually before a race. The rest of the time you just get out and run. Now, I’m not here to pass judgement, and in fact there is very little hard evidence that supports the standard type of warm up most of us would do in terms of reducing your injury risk or improving your performance. The key is personalised neural primers.

That’s not to say your standard warm up is not doing anything at all – you’ll find some runners swear by a warm up where others say it does nothing for them. Interestingly, part of the reason for this polarity in results is the effect of prediction. Your brain gets good at what you do most, and starts to expect it in certain contexts. So, if you’ve always done a warm up and then you suddenly stop, your brain may see that as a threat and is wondering why you’re not doing it. As a result, you don’t get to feel as good as normal and may be more tense, not quite feel balanced or just a little off. The same goes for those runners who don’t normally do a warm up: they suddenly do a warm up and their brain is going “what’s going on – this is strange”.

In both cases, there will be runners who benefit from not doing a warm up who used to do one, and runners who’ll benefit from doing a warm up when they never used to do them – such is the uniqueness of your nervous system. Either way though, doing something before you run can be thought of as a neural primer.

As the name suggests, a neural primer is getting you ready for what’s coming next. To take full advantage of the power of neural primers, it’s best to design them purposefully. So while any old warm up could possibly help to some extent, if it’s not designed specifically for your nervous system and for the aims of the race or session you are about to do, it could set you back before you’ve even started. How could that be the case?

The problem with ‘generic’

We live in a world of personalisation, from tailored social media feeds to glucose monitor-based diets and of course, personalised feedback and recommendations from your favourite running watch and apps.

It’s widely recognised that personalised services are more effective than their generic counterparts, if the data used and the algorithms are accurate of course. However, when it comes to warming up and preparing for a running session or race, the closest most of us get to a personalised warm up is making it run-specific rather than for a different sport. But is settling for a generic warm up setting you back?

Generic is easy; much easier than tailoring services and advice for an individual. However, there is a trade-off in that the generic solutions simply won’t be as effective for 30% to 50% of people. This is not a scientific figure I admit, but it’s a rough split based on all my clients over the years and from discussions and observations from and with other professionals in this space. 

You have most likely experienced this yourself as well. In a group fitness class there are some people who’ll love it and do really well and there will be others who just don’t get on with it at all. How about that mobility course you bought online – how did that work out for you? Maybe you’ve done some Yoga and have tried several different types of Yoga before you found one you got benefit from.

When it comes to warm ups and neural primers, personalisation is the way to go if you want to enjoy your running more, reduce pain and improve performance. But why?

Your uniqueness

Just like your fingerprints, your nervous system is unique to you. In fact, it’s even more unique than finger prints because even identical twins with identical DNA will have different nervous systems because they’ve had different variations in their experiences throughout their life, no matter how small those variations may have been.

You see, your nervous system is being shaped and moulded in every moment of every day. Every experience you have at any given moment in time results in changes in how your brain is wired. Sometimes these are very small changes and sometimes they can be large changes – but change is guaranteed and is a continuous process. This is what creates the uniqueness of your nervous system: it has been shaped and moulded like no other nervous system.

This uniqueness is what you can target to improve your performance, reduce your pain and increase your enjoyment of running.

There are, of course, some baseline similarities between your nervous system and everyone else’s. There are some generic exercises and drills that most people seem to benefit from, and there is a general process by which you can improve your nervous system’s performance. It’s a bit like lifting weights will make most people stronger and achieve bigger muscles (if that’s their goal), but if you really want to perform then you need to tailor those muscle-building exercises for you.

And just like tailoring what you do to improve your running is important, tailoring what you don’t do is just as important – perhaps more so. And this is often why generic solutions just don’t work for many of us.

Performance, Neutral, Rehab

Whenever I design a session or exercise stack for someone, whether it’s to help them get out of pain, improve their performance or to enhance their enjoyment of sport and life, I always look to categorise the exercises for them. The categories I use are:

The only way I can help categorise the drills and exercises for you is to assess them with your nervous system. A performance drill for someone else may be a rehab drill for you. For example, leg swings in a running warm up may make one runner feel loose and amazing. But when you do them they stiffen your hamstrings up, and you start your race with slightly wooden legs and feel terrible.

This is why a generic warm up may make you worse before you even start your session or race.

I’m sure you’ll agree that if most of the exercises you are currently including in your running warm up are either neutral or rehab exercises for you, then at best you’re not doing much to positively prime yourself, and at worst are negatively impacting how you move and run before you even cross the start line.

The same goes for pain. Well-meaning friends, family and even some professionals often give out advice and exercises that have worked for them or clients of theirs, but could make you worse! If they are not taking the time to assess and re-assess the impact of those exercises on your nervous system, then they don’t really know that those drills and exercises aren’t holding you back instead of helping you.

Designer warm ups

So the only way to improve your running and reduce your pain is to use solutions that work for you. And this is the power of a personalised warm up with neural primers designed to work with your nervous system and not against it.

In the next article we’ll get into some of the base neural primers that most people get a good return from. But of course, I’ll show you easy ways to assess and re-assess so you can be sure. Sometimes, just a small variation to an exercise or drill is all that’s needed to move it from one category to another. 

An important note: Even though the rehab exercises and drills can make you worse, these are often the ones you need to do in a controlled environment and at an appropriate time if you really want to improve. But you need to make sure the timing of these matches your goals. The last thing you want to do is a rehab exercise and then go and race. But you might sandwich a rehab exercise between two performance exercises on a rest day, after a run or even a couple of hours before an easy run. 

This is such an exciting area where you can make real gains in performance and enjoyment as well as pain modulation. I’ve been blown away by some of the results I’ve personally experienced and seen from my clients from well-designed routines and exercise stacks including tailored versions of base neural primers.

To find out more about pain and how individualised it really is, click here.

The post Is Your Warm Up Slowing You Down? appeared first on RunTeach.

Introduction

In the first article we looked at some common running injuries and also started to delve into the definitions of injury and whether there needs to be any physical tissue issue for you to experience physical pain. In this article we are going to dive in deeper to get a good understanding of what pain is and how it works.

Because pain is such a complicated topic and often very hard to explain without going into a load of science you probably don’t want to read right now, I’ve put together a short story to help you understand pain a bit better. We can then pull apart individual areas of this story in future articles to tease out a deeper understanding – something I regard as critical if you are going to manage and modulate your own pain.

The Whisper of Pain

It began as a whisper, a fleeting discomfort in Emily’s ankle as she ran along the embankment on a crisp, bright morning. At first, she dismissed it – she had felt her foot slip off a root, but it was a tiny movement; maybe she had banged it as she was loading up the kids’ bags as they rushed into the car for the school run. But over the weeks, the whisper grew louder, becoming a persistent throb that forced her to question: What exactly is pain?

This is Emily’s story, but it could be anyone’s. Pain is universal, yet deeply personal, shaped by biology, psychology, and even society. To understand pain, we must journey into the intricate world of neuroscience, where signals, chemicals, and perceptions weave a complex tapestry.

The Signal of Alarm

Pain begins its journey as a threat signal in the body, often as a response to potential harm. When Emily’s foot slipped off that root, specialised nerve endings called nociceptors sprang into action.

These nociceptors, which reside in her skin, muscles, and organs, are like tiny watchtowers. They detect extreme temperatures, pressure, or chemical changes and send electrical signals racing along her nerves to her spinal cord and brain.

In milliseconds, her body reacted – returning her ankle to its previous position before she was even consciously aware of what had happened. This is the power of the reflex arc, a rapid protective mechanism that bypasses the brain for speed.

The Brain’s Role in Pain

The signals from Emily’s ankle didn’t stop at her spinal cord. They continued their journey to the thalamus, a central relay station in her brain. From there, they were dispatched to various regions:

• The somatosensory cortex, which identified the potential threat’s location and intensity.
• The limbic system, which processed the emotional distress of her rolled ankle.
• The prefrontal cortex, which helped her brain assess the situation and decide what to do next.

Interestingly, Emily’s pain wasn’t just a physical sensation. It was shaped by her thoughts, past experiences, and expectations. This is why neuroscientists say pain lives in the brain.

Chronic Pain – When the Alarm Stays On

Weeks later, Emily’s ankle had long ago healed, but the dull ache persisted. She wondered: Why does it still hurt when there’s no injury?

This is the enigma of chronic pain, where the nervous system continues to send threat signals long after the initial damage has healed. Scientists have discovered that in chronic pain, the nervous system undergoes a process called central sensitisation, making it hypersensitive.

For Emily, this meant that her brain and spinal cord were amplifying normal sensations, interpreting even gentle touches as a threat and creating the experience of them being painful. This phenomenon explains why chronic pain feels so real, even when doctors can’t find a clear cause.

Pain and Emotion – The Brain’s Feedback Loop

Pain and emotion are intricately linked. On stressful days, Emily noticed her pain felt worse. On relaxing weekends, it seemed more bearable.

This is no coincidence. The brain’s pain and emotional centers are deeply intertwined. Neurotransmitters like serotonin and dopamine, which regulate mood, also influence pain perception. Stress can amplify pain by flooding the body with cortisol, a stress hormone that heightens sensitivity.

Emily’s story highlights the importance of addressing not just the physical, but also the emotional aspects of pain.

The Gate Control Theory – A Balancing Act

Emily’s movement coach introduced her to a fascinating concept: the Gate Control Theory of pain.

Imagine a “gate” in the spinal cord that controls whether threat signals reach the brain. By engaging in activities like running and other exercise, massage, sensory stimulation such as skin stretch or vibration, and even laughter, Emily could “close the gate,” reducing her perception of pain.

This explained why certain distractions, like playing her favourite music, seemed to help. Her brain was focusing on other signals, leaving less bandwidth for pain.

Phantom Pain – The Ghost in the System

One day, Emily met Sam, a veteran who’d lost his leg in an accident. Despite the amputation, Sam often felt excruciating pain in his missing limb – a phenomenon called phantom pain.

Sam’s story illuminated the incredible adaptability of the brain, known as neuroplasticity. His brain was still mapping the missing limb, generating threat signals as if it were still there.

Through techniques like mirror therapy, Sam was retraining his brain to quiet these phantom sensations, offering hope for recovery.

Pain’s Silver Lining

Despite its unpleasantness, pain serves a critical purpose. Without it, Emily’s system might not have reacted to control her ankle, potentially leading to severe tissue issues. Conditions like congenital insensitivity to pain, where individuals cannot experience pain, highlight its importance.

However, while acute pain is protective, chronic pain often loses its usefulness, becoming a condition to manage rather than a symptom to treat.

The Future of Pain Management

Emily’s journey led her to explore cutting-edge advancements in pain science. Researchers are developing treatments that target pain at its source, such as:

• Neuromodulation therapies, like spinal cord stimulators, which block threat signals.
• Personalised movement, exercises and drills specifically designed for that individual’s nervous system.
• Personalised sensory stacks, where certain sensory receptors are stimulated in specific ways and stacked together in response to the individual’s nervous system output.
• Personalised medicine, where genetic testing helps tailor treatments.
• Mind-body approaches, like mindfulness meditation, which retrains the brain’s response to threat.

The neuroscience of pain is evolving, offering new hope for millions like Emily and Sam.

Pain as a Teacher

Emily’s experience with pain transformed her perspective. She learned that pain is not just an output signal but a story – a narrative shaped by her body, brain, and environment.

Her journey underscores the resilience of the human spirit and the incredible complexity of the mind. While pain may be inevitable, understanding its science empowers us to rewrite its story.

FAQs

1. Why does pain feel worse during stress?
Stress releases hormones like cortisol, which amplify threat sensitivity by heightening the nervous system’s response.

2. What is central sensitisation in chronic pain?
Central sensitisation is when the nervous system becomes hypersensitive, amplifying normal sensations into threatening ones that result in an experience of pain.

3. How does the Gate Control Theory of pain work?
The Gate Control Theory suggests that “gates” in the spinal cord regulate threat signals to the brain. Distractions or physical activities can close these gates, reducing pain perception.

4. What is phantom pain?
Phantom pain is a sensation of pain in a limb or body part that has been amputated. It occurs because the brain’s map of the body persists even after the loss.

5. Can emotions influence pain?
Yes, emotions and pain are closely connected. Positive emotions can reduce pain perception, while negative emotions can intensify it.

6. What are emerging treatments for chronic pain?
Emerging treatments include neuromodulation therapies, personalised movement strategies, personalised sensory strategies, personalised medicine, and mind-body approaches like mindfulness meditation.

Conclusion

Through Emily’s pain story, you can get a basic understanding of what pain is and how pain works. Effectively, pain is an experience created in the brain in response to threat signals from your body’s tissues, combined with your previous experiences and your beliefs.

In the next article we are going to look at some specific case studies where I have worked with clients to modulate their experience of pain, including avoiding surgery and continuing to be very active and performing at a high level.

In the meantime, here is a great resource from Tame The Beast to help you understand pain a bit better: https://www.tamethebeast.org/

The post Running injuries and pain – 2 appeared first on RunTeach.