What stood out to me straight away was how long he’d been putting up with this. And how many things he’d already tried. He wasn’t lazy or reckless. He was doing what most people do. Guessing. Googling. Trying one thing after another in the hope that something would click.

We started with a full biomechanical assessment. Not just a look at his feet or how he was running, but an in-depth review of his foot and ankle mechanics, gait pattern, pressure loading, and how his whole lower body was functioning as a unit.

The findings were clear. His arches were collapsing moderately during load, which was increasing stress on his lower legs. But more importantly, he had a condition called ankle equinus which means he didn’t have enough range of motion through his ankle joints. So when he ran, his ankle and shin bones were making contact earlier than they should, forcing excessive pressure through the inside of his shin.

That pressure was showing up exactly where he felt pain at 4K.

Finally, we had answers. And once you know the why, you can build a proper plan around the how.

We started with custom 3D printed orthotics to help control the arch collapse and improve shock absorption. We also made one crucial change to his running shoes. He had been running in six millimeter heel to toe drop trainers. Because of his ankle restriction, we shifted him into a ten millimeter drop which allowed more movement and reduced the stress on his shin during each stride.

But footwear and orthotics were just the beginning.

He had significant tightness in his calves and hamstrings and poor hip stability. All of which were contributing to poor running mechanics. So we implemented a tailored strength and conditioning program. We focused on calf endurance, single leg stability, hip control, and running drills designed to retrain movement patterns. Weekly soft tissue therapy helped ease tightness and improve mobility.

We didn’t rush his return to running. Instead, we gradually increased his distance over four weeks after the initial eight week rehab period. At each stage, we monitored how his body responded. And finally, when he hit five kilometers pain free and remained pain free the day after it was a huge milestone.

Today, he runs regularly again. He continues his strength and conditioning, does mobility work to maintain flexibility, and wears his orthotics part time during daily life. He doesn’t run in them. He doesn’t need to. He sticks to higher drop trainers, gets a soft tissue treatment every six weeks, and most importantly feels in control of his running again.

And that’s what so many people in his position are missing. Control.

When you’re injured, especially with something like shin pain that doesn’t show up until a certain distance in, it’s incredibly easy to feel helpless. You don’t know why it’s happening. You try things that don’t work. And eventually, you start wondering if your body just isn’t meant to do what you love.

But with the right assessment and a clear plan, you can break that cycle.

If there’s one thing I hope this story shows, it’s that persistent pain like this doesn’t just show up for no reason. There’s always a cause. And more often than not, it’s hidden in the way your body moves.

Runners often hear a lot of conflicting advice. Rest more. Run less. Stretch this. Strengthen that. But unless someone takes the time to look at your unique movement patterns, your footwear, your muscle control, and your joint function, most of it is just guesswork.

A proper biomechanical assessment doesn’t just explain the pain. It helps build a map out of it.

This runner’s story is one I see versions of every day. He didn’t need to stop running. He just needed someone to guide him back the right way.

Joe Sharp

BSc (Hons) Physiotherapy