How to Fix Heel Pain with Running

So you have heel pain and you can’t run at all. You head over to your doctor who sends you to Physical Therapy. They do some manual therapy, maybe some shockwave and give you stretches and strengthening exercises to do. Maybe they even review your shoes and help you improve your technique. Great.

After a few weeks it’s feeling much better. It doesn’t hurt with the first few steps out of bed in the morning anymore and you’ve even managed to get back to running! Your PT is happy with your progress and discharges you.

The trouble is, you want to run ultra marathons and at the minute you’re only running 20k a week. You want to get back to running 50k or even 100k weeks but you don’t know exactly how to do it. 

There’s this gap in the running world. Runners who can’t run because of an injury go to Physical Therapy. They get help and get running again. At the other end of the spectrum, runners who aren’t injured can follow a training plan or hire a coach.

But what about the runners in between? Those who can run a bit, but not as much as they want? They aren’t fully injured but they’re not fully healthy either. They aren’t bad enough for PT, but they’re not good enough for full training. 

They’re in this No-Man’s-Land. The phase in between rehabilitation and performance. I call this Recovery Phase and that’s exactly where Jessie found herself.

Fix Heel Pain with Running

I met Jessie in February. She’d booked a free call because she was having trouble with heel pain. She’s an Ultra Runner and her big goal was to do her first 100 mile race. However, she’d just had to pull out of a 50k race because the heel pain was too bad to train properly.

She’d seen her local doc and Physical Therapist and it was diagnosed as Plantar Fasciitis. Working with her local PT she’d made a lot of progress. She was back to running 20k a week but she was finding that if she tried to do more the heel would start to complain again.

She was unsure how to bridge the gap between 20k and 50k training weeks and she was worried that she’d just end up back where she started.

This really sucked for Jessie. She shouldn’t have to try and bridge this gap on her own. It’s really difficult and she deserves expert guidance.

The Rehab Phase

During her free call, Jessie and I spent about half an hour walking through her experience with the heel pain. She described her anxiety about increasing her training volume. She was worried that if she returned to high-volume training the heel pain would just flare up again. 

She knew basically what to do (increase her training volume), she just wasn’t sure exactly how to do it without getting hurt and she didn’t know where to turn for guidance.

I knew exactly how she felt. When I got into running, I tried to train for a marathon and got injured every year for 5 years. The injuries were rarely so bad that I couldn’t run at all, but if I tried to get over 50k a week, the wheels would fall off.

I didn’t know who to turn to either. Running Coaches (quite rightly) refer injured runners to physical therapy. But, I was a physio myself. So I knew that we don’t receive education on how to build runners up to high-volume training. 

A Plan to Fix Heel Pain when Running

I explained to Jessie that we would need to gradually increase the training while monitoring the plantar fasciitis symptoms. We would progress the training volume and intensity based on how well the plantar fascia was adapting to the increased demand. This is how to fix heel pain when running.

For this to work, I’d need Jessie to give me feedback on the heel pain after every run. If she got any red-light pain, we’d reduce the training volume and intensity for the following week. If she only experienced orange-light pain, we’d continue with the plan as written. If she had green-light pain, we could increase the planned training volume or intensity for the following week.

In this way, we would progress the training volume and intensity at a rate that the plantar fascia could adapt to. No faster, but no slower. How long it would take to get up to the 50k training weeks would depend entirely on how quickly the plantar fascia adapted.

So we didn’t set any specific goals to hit a certain amount of training in a certain amount of time. It drives me nuts when health professionals say “it will take 3 months to recover from this injury”. How could they possibly know that?

If you want to know how long it will take to get from point A to point B you need to know two things. How far apart A and B are and how fast are you going? 

You can only know how long it will take to “recover” from an injury when you know:

• A = How much running can you do now?
• B = How much running do you want to be able to do?
• C = What is the rate of change?

In Jessie’s case, she wanted to get to 50k training weeks. She was currently at 20k. To know how long it would take we’d have to work with her for a few weeks and see how many kilometers we were able to add each week without producing red-light pain.

In my experience, that is pretty much NEVER how health professionals determine a recovery timeline. Usually, they will tell you “It takes 3 months for plantar fasciitis to heal” at your first appointment!

Anyway, rant over.

The Recovery Phase

Jessie was stuck in No Man’s Land. Too good for PT, too bad for full training. We’d use the system I described to bridge the gap between rehabilitation and performance. To take Jessie from “able to run a bit” to “able to run as much as I want”.

This is what I call The Recovery Phase.

She would need to be diligent with her training and report back to us on how the heel pain responded after every run. We’d use that information to gradually build up her training load until she was ready to go run some ultras.

The Performance Phase

It’s 7 months since Jessie started with us and she’s been running over 50k a week for a couple of months now. I’m happy to report that she has forgotten all about her heel pain. That’s how you fix heel pain when running.

She did experience a pretty major setback a few months ago. We pushed our luck and asked the plantar fascia to adapt to more training than it was able to. It got really painful and we had to give her a week off. Jessie took this in stride (at least, as well as any runner does when they’re told not to run) and we adjusted the plan accordingly. Within a few weeks we were back on track.

About 4 months in she was able to do a 25k trail race. Now she’s 4 weeks out from a 50k race and eyeing up a 100k for next year. 

After that, it’ll be time for the 100 miler.

Avoid No-Man’s-Land

Many runners get stuck in this no-man’s-land between rehab and performance. Unfortunately, many runners can’t bridge the gap on their own and they end up “yoyoing” between injured and some form of “limited” training. 

They can never progress all the way back to performance and end up missing races every year due to injuries.

When we met, Jessie was unsure exactly how to get back to full training and worried that she was just going to end up back where she started. She was stuck in no-man’s-land.

With a little guidance and patience she has learned how to progress her training through the Recovery Phase. 

Now she’s crushing 3 hour trail runs and dreaming about her first 100 mile race.

If you’re stuck in no-man’s land with your injury, we can help. Just click the button below to book a free call with us.