Why Knee Pain Happens When You Return to Running

As the weather improves, many runners start increasing their mileage again. Whether you took time off during the winter or reduced your training, spring often marks a return to consistent running.

In sports physical therapy, this is one of the most common times we see an increase in knee pain.

The pattern is predictable.

You ease back into running. Your breathing feels good. Your endurance returns quickly. Then suddenly, your knee starts to feel irritated.

So what is actually happening?

Why Knee Pain Shows Up When You Feel “In Shape”

One of the biggest misconceptions we see in sports physical therapy is equating cardiovascular fitness with readiness to handle load.

Your lungs and heart adapt quickly. Within a couple of weeks, your endurance can feel back to normal.

But your joints, tendons, and ligaments take longer to adapt.

When you increase running volume too quickly, your cardio system says you are ready, but your tissues are not. This creates a mismatch in loading capacity, often leading to knee irritation.

The Knee Is Often the Victim

In many cases, knee pain is not just a knee problem.

In sports physical therapy, we often find that the knee is taking on extra stress due to limitations elsewhere in the body.

Common contributors include:

Hip Strength and Control

The muscles around your hip control the position of your femur, which directly impacts the knee. Poor hip strength or control can increase stress at the knee with every stride.

Quadriceps Strength and Load Tolerance

The knee itself still needs to handle load effectively. If the quadriceps and surrounding tissues are not prepared, repetitive running can lead to irritation.

A simple example is a single-leg wall squat. Holding this position for 20 to 30 seconds can help build tendon and muscular capacity around the knee.

Ankle Mobility

Limited ankle mobility can change how forces are distributed through the lower body. Even small asymmetries between sides can add up over thousands of strides.

A quick way to assess this is a half-kneeling ankle test. If one side feels significantly tighter, it may be contributing to uneven loading patterns.

How Sports Physical Therapy Helps Runners Stay Pain-Free

The goal of sports physical therapy is not just to treat pain. It is to prepare your body to handle the demands of running.

For runners returning to activity, this includes:

Gradually progressing mileage and intensity
Building strength in the hips and knees
Improving ankle mobility and symmetry
Increasing overall tissue load tolerance

Small adjustments in these areas can make a big difference in preventing knee pain.

The Key Takeaway

If your knee starts to bother you when returning to running, it does not necessarily mean you are injured.

More often, it means your body is not yet prepared for the level of load you are asking it to handle.

Sports physical therapy focuses on closing that gap so your joints, muscles, and tendons can keep up with your fitness.

When to Seek Help

If knee pain persists or continues to worsen as you run, it may be time to take a closer look.

A sports physical therapy assessment can help identify:

Where the true limitation is coming from
How your movement patterns may be contributing
What specific exercises will help you progress safely

If you are getting back into running and want to stay ahead of injuries, sports physical therapy can help you build a smarter, more sustainable return.

Winter Running Tips from a Performance Physical Therapist

Running through the winter months can be a challenge, especially when cold temperatures, ice, and wind threaten to derail your training. But with the right strategy, runners can stay consistent, healthy, and injury-free all season long.

Today, we’re excited to share insights from Dr. Elizabeth Farmer, a Performance Physical Therapist at our Bethesda location and an avid runner herself. After logging miles in recent frigid DC conditions, Dr. Farmer combined her personal experience with her clinical expertise in physical therapy for runners to share practical tips that help runners safely train outdoors during the winter.

If you hate the treadmill but feel stuck indoors every time the temperature drops, these tips are for you.

1. Dress Smart with Thin, Layered Clothing

When it comes to winter running, layering is key. Instead of bulky clothing that restricts movement, opt for multiple thin layers that trap warmth while allowing sweat to escape.

Dr. Farmer recommends:

Tucking shirts into leggings or tights
Wearing wool socks tucked into leggings
Using merino wool base layers for temperature regulation and moisture control

On a recent easy run in 7°F temperatures (with a 2°F windchill), Dr. Farmer wore two pairs of leggings (one fleece-lined), a merino wool long-sleeve shirt, a lightweight sweatshirt, a windbreaker, gloves, a beanie, and tall wool socks and was warm enough to break a sweat within the first mile.

Proper layering helps runners maintain performance while reducing the risk of muscle tightness and cold-related injury.

2. Keep Your Pace Easy on Icy Surfaces

Winter running requires flexibility. If you’re unsure whether your route is icy or clear, prioritize safety over speed.

Running at an easy pace allows you to:

Adjust to unpredictable footing
Reduce fall risk
Avoid compensations that lead to overuse injuries

For runners in Bethesda, the Maryland portion of the Capital Crescent Trail has been plowed and is often more ice-free than neighborhood roads. Regardless of location, always assess conditions before attempting speed work.

From a physical therapy for runners perspective, slips and sudden muscle guarding are common causes of winter injuries, especially to the calves, hamstrings, and low back.

3. Warm Up Indoors Before Heading Out

Cold weather works against your body’s natural ability to warm up. That’s why an indoor warm-up is even more important in winter.

Dr. Farmer recommends completing your entire warm-up inside so you’re already warm before stepping outdoors. This helps:

Improve mobility
Reduce stiffness
Lower injury risk during the first mile

A proper warm-up is one of the simplest ways runners can protect themselves during winter training and a key component of injury prevention we emphasize in performance physical therapy for runners at our Bethesda and McLean clinics.

4. Use Warm Pre- and Post-Run Nutrition

Fueling properly in winter isn’t just about performance, it’s also about staying warm.

Try these simple swaps:

Replace cold juice with warm apple cider before your run
Swap chocolate milk for hot chocolate post-run to get carbs and protein while warming up

Adequate pre- and post-run nutrition supports recovery, energy levels, and muscle health, especially during high-volume winter training blocks.

5. Consider Winter-Specific Running Shoes

Many running shoe brands offer winter models that include:

Waterproof materials
Increased warmth
Improved traction for icy conditions

Cold temperatures can also affect how shoe foam responds. If your regular running shoes feel stiffer in winter, it doesn’t necessarily mean they’re worn out, they may simply be reacting to the cold.

For runners experiencing foot, ankle, or knee discomfort, footwear choice is a frequent topic we address during physical therapy for runners sessions at our McLean and Bethesda locations.

Physical Therapy for Runners in Bethesda & McLean

Winter is one of the most common times we see runners develop nagging aches, stiffness, or overuse injuries. The combination of cold weather, altered mechanics, and reduced recovery can add up quickly.

If you have questions about winter running, are dealing with pain, or want help optimizing your training, our team specializes in physical therapy for runners. We work with runners of all levels—from recreational runners to competitive athletes, helping them stay healthy, strong, and consistent year-round.

📍 Locations: Bethesda, MD & McLean, VA
📞 Reach out to schedule an evaluation or ask a question. We’re happy to help support your running goals.

The Most Overlooked Reason Runners Keep Getting Injured

Repetitive soft tissue injuries are one of the most frustrating issues runners face. Calf strains, hamstring pulls, hip flexor pain, and lingering tendon problems often seem to appear out of nowhere, especially in runners who are otherwise consistent and motivated in their training.

One of the most overlooked causes of these injuries has nothing to do with mileage alone. Instead, it comes down to how close your body is operating to its maximum capacity during your runs.

Why Running Pace Matters More Than You Think

Imagine a car that can technically reach highway speed, but doing so requires maximum effort. Pushing it that hard, day after day, eventually causes things to break. Not because the distance is too long, but because the system is constantly operating near its limit.

The same principle applies to running.

If you are running close to your maximum sustainable speed just to hit your target training pace, your body is under significantly more strain. That strain is absorbed primarily by your soft tissues such as your calves, hamstrings, hip flexors, Achilles tendon, and connective tissue. Over time, this accumulated stress often leads to overuse injuries.

Two runners may complete the same 5-mile run at the same pace, but if one runner is operating at 80% of their maximum effort while the other is closer to 60%, the internal load on their bodies is very different.

This difference matters.

Why Faster Runners Often Stay Healthier

Elite and highly trained runners are fast, but more importantly, their speed ceiling is high. Because of this, moderate and long-distance paces require less relative effort. Their muscles and tendons are conditioned to tolerate higher forces, which makes everyday training less stressful on their bodies.

For recreational runners, this is where many training programs fall short.

A common assumption is that preparing for longer races simply means running more miles. While mileage is important, it is only one part of the equation. One of the most underutilized tools in injury prevention is strategic speed training.

How Speed Training Reduces Injury Risk

Speed training isn’t just about racing faster, it’s about raising the maximum speed your body can safely handle.

Incorporating interval-style workouts helps:

Improve force tolerance in muscles and tendons
Reduce strain during slower, longer runs
Improve running efficiency and resilience

A simple and effective example includes:

400-meter intervals on a track or measured flat surface
Running at a high effort (roughly 80–90%)
Taking longer rest periods to ensure quality movement and speed

The goal is not exhaustion. The goal is adaptation, teaching your body to handle higher forces so that everyday running feels easier and places less stress on vulnerable tissues.

Even runners training for half marathons or marathons benefit from this approach, particularly during the off-season or early build-up phases. As race day approaches, speed work often becomes less frequent while mileage increases, but having already raised your speed ceiling can dramatically reduce injury risk.

How Physical Therapy for Runners Helps

This is where physical therapy for runners becomes especially valuable.

At Cohen Health & Performance, we work with runners to:

Identify strength, mobility, and load-management limitations
Assess running mechanics and tissue tolerance
Design training strategies that reduce injury risk
Integrate speed work safely and progressively
Treat recurring soft tissue injuries at the root cause

Rather than simply addressing pain after it appears, our approach focuses on helping runners train smarter so injuries are less likely to occur in the first place.

Serving Runners in McLean and Bethesda

We provide specialized physical therapy for runners at our clinics in McLean, VA and Bethesda, MD, working with runners of all levels, from recreational athletes to competitive endurance runners.

If you’ve been dealing with recurring calf strains, hamstring tightness, hip flexor pain, or feel like your body breaks down whenever you increase training intensity, it may be time to take a closer look at how you’re training, not just how far you’re running.

Our team helps runners stay healthy, improve performance, and continue progressing toward their goals without constantly being set back by injury.

If you’re looking for expert physical therapy for runners in McLean or Bethesda, we’re here to help.

Why Strength Training is the Missing Piece in Your Running Program

Today we have a special guest post from Dr. Elizabeth Farmer, our newest Performance Physical Therapist at Cohen Health and Performance Bethesda!

As a performance physical therapist and avid long-distance runner, I’m no stranger to the aches and pains that can threaten to derail a training plan or race goal. Over the years, both in my own training and while working with runners at Cohen Health and Performance, a leading provider of physical therapy in Bethesda, I’ve noticed something important: most “overuse injuries” are really under-preparedness injuries.

When aches or pains arise during training, it’s often because the body isn’t fully prepared for the stress of increased mileage or intensity. The good news? With the right guidance, you can build the strength and resilience needed to handle those demands, helping you run stronger and stay injury-free.

The Role of Strength Training in Preventing Running Injuries

Even the best running programs can fall short if they don’t include one key ingredient: strength training.

At Cohen Health and Performance, our Bethesda physical therapy team help runners develop strong, balanced, and durable bodies that can handle the demands of training. Strength training improves muscular endurance, running economy, and speed while significantly lowering the risk of injury.

How to Incorporate Strength Training Into Your Running Plan

Whether you’re a beginner or a seasoned marathoner, here are a few guidelines our performance physical therapists recommend:

1. Start Strength Training in the Off-Season

If you’ve never lifted before, the off-season is the perfect time to begin. It gives your body time to adjust (and recover from that initial soreness!). Studies show that it takes roughly 6–8 weeks to see true strength improvements, so the earlier you start, the better prepared you’ll be when race training ramps up.

Building the habit in your off-season also makes it easier to maintain strength workouts once your running mileage increases, a key principle we teach at Cohen Health and Performance through our Bethesda physical therapy and performance programs.

2. Keep Hard Days Hard, and Easy Days Easy

Your goal should be to complement your running, not compete with it. We recommend stacking your strength workouts after your harder running days (like hills, intervals, or long runs). This allows your easier runs or rest days to stay truly easy and promotes recovery.

A good rule of thumb: always lift after running, not before, so you can perform your key running workouts with fresh legs.

3. Intensity Matters: Choose the Right Rep Range

If you’re short on time, focus on higher-intensity, lower-rep movements. Aim for 2–3 sets of 6–12 reps at a difficulty level that feels like a 6–9 out of 10 on the effort scale. You should only feel capable of 2–3 more reps with good form at the end of each set.

This approach helps you get the most benefit from your workouts without spending hours in the gym, a philosophy we emphasize with our runners seeking sports physical therapy in Bethesda.

4. Essential Strength Exercises for Runners

Here are four lower-body exercises we often prescribe at Cohen Health and Performance to help runners build strength, stability, and resilience:

1️⃣ Single-Leg Depth Drop – Builds resilience when absorbing landing forces.

2️⃣ Bulgarian Split Squat (Front Heel Float) – Improves unilateral quad, glute, and hamstring strength while also challenging calf stability.

3️⃣ Copenhagen Plank – Strengthens the adductors and core to support pelvic control.

4️⃣ Side Plank with Leg Lift – Targets hip stabilizers, crucial for preventing “under-preparedness” injuries.

Looking for Physical Therapy Near You in Bethesda?

If you’re a runner dealing with nagging aches or simply want to improve performance, our team at Cohen Health and Performance in Bethesda can help. We specialize in sports physical therapy, strength training for runners, and performance optimization, all under one roof.

Our Doctors of Physical Therapy provide one-on-one, 60-minute sessions designed to help you move better, recover faster, and perform your best.

Ready to take your training to the next level?

Contact us to schedule your session today and experience why so many athletes searching for physical therapy near them in Bethesda trust us to keep them healthy and strong.

Struggling With A Calf or Achilles Injury? What You Need to Know

I’m now at that age where I have to start being more mindful of the nagging calf and Achilles injuries that seem to pop up for so many of us in our 30s, 40s, and beyond. Whether it’s rec league basketball, tennis, pickleball, or just hitting the gym hard, many active adults still love to move with intensity—but we may not have the same resiliency we had in our 20s.

At Cohen Health and Performance, we see it all the time in our physical therapy clinics: a fit, active individual suddenly sidelined by a calf strain. These types of injuries tend to be the first warning sign of lower leg issues that can creep up when we push our bodies beyond what they’re currently prepared to handle.

Why Calf Injuries Happen

A calf strain typically occurs when the loading tolerance of the muscle—its ability to handle force—is exceeded. It’s not always about being out of shape; in fact, many of our patients are in great cardiovascular condition. But if the calf and Achilles haven’t been progressively trained to handle specific types of force—like running, jumping, or quick direction changes—they’re vulnerable.

One of my patients recently told me they went on vacation and, without access to a gym, decided to start running more than usual. They felt fit, so why not? But shortly after, they messaged me with a calf strain. Their cardiovascular system may have been ready—but their calf muscles weren’t conditioned for that repetitive impact. That mismatch between perceived fitness and actual tissue readiness is a common reason we see these injuries in our physical therapy practice.

Physical Therapy for Calf and Achilles Recovery

So what do we do when a calf injury strikes? Or better yet—how can we prevent it?

The key lies in a progressive, personalized rehabilitation plan, and physical therapy plays a critical role in that process. Here’s how we typically approach it:

1. Start with Isometric Loading

We begin with isometric exercises, where the muscle contracts without changing length. This is a safe, low-threat way to begin reactivating the calf muscle after injury. Isometrics help reduce pain, improve blood flow, and reintroduce loading to the tissue without overstraining it. These are often the first steps in any effective physical therapy plan for a strained calf. For more information on isometric exercises, check out this article and video!

2. Progress to Full Range of Motion Drills

Next, we move into more dynamic exercises that take the muscle through a full range of motion. The calf needs to be able to both shorten and lengthen under load, especially if you want to return to activities like running or jumping. These movements are carefully progressed based on how the tissue responds.

3. Introduce Plyometric and Sport-Specific Drills

Once strength and mobility are restored, we introduce plyometric exercises to recondition the tissue for faster, more explosive movements. At this stage, we might use bands or assistance tools to reduce body weight until you’re ready to go full intensity.

Finally, we tailor the program to your sport or activity. Runners may progress to drills like A-skips and A-runs, while basketball or tennis players might focus on reactive jumping or lateral movement training.

Personalized Care is Key

No two injuries—or recoveries—are the same. That’s why every physical therapy plan at Cohen Health and Performance is built around your unique goals, limitations, and lifestyle. Whether you’re returning to a sport or just want to stay pain-free during weekend workouts, we’re here to help you move forward.

If you’ve recently dealt with a calf or Achilles injury—or you’re hoping to prevent one as you stay active into middle age—we’d love to help. Our physical therapy team specializes in helping active adults recover quickly, move better, and keep doing what they love.

Contact us to schedule your evaluation at our Bethesda or McLean location. Don’t let a nagging calf injury slow you down.

Unlock Your Best Run: Physical Therapy for Runners

Are pain and stiffness holding you back from running your best? If you’re tired of reaching for Advil like it’s candy and feeling like something is just not right with your stride, it’s time to consider a more proactive approach—physical therapy tailored specifically for runners.

Imagine a Pain-Free Run

Picture waking up with fresh legs, excited to tackle your run without nagging pain. Imagine gliding through your favorite routes, feeling strong, confident, and powerful with every stride. With the right physical therapy guidance, you can reclaim your running potential and experience these benefits every day.

Discover the Benefits of Physical Therapy for Runners

Our exclusive Running Performance Lab is designed with one goal in mind: to help you run pain-free and reach your peak performance through targeted physical therapy techniques and drills. Here’s what you can expect:

Pinpoint Your Barriers: Identify hidden physical limitations that may be sabotaging your performance. With a customized plan, you can overcome these barriers and even shave minutes off your personal record.
Reclaim Your Speed and Power: Learn simple yet effective exercises that enhance your movement efficiency. Our physical therapy and performance strategies are tailored to help you move stronger and run faster.
Ditch Temporary Fixes: Move beyond quick fixes like medication, braces, or band-aid solutions. A dedicated physical therapy approach addresses the root causes of pain, ensuring lasting results.

Who Can Benefit?

Whether you’re a weekend warrior, a seasoned marathoner chasing a personal best, or simply a casual runner who wants to feel good while staying active, the benefits of targeted physical therapy are universal. Every runner faces challenges such as nagging injuries, stiffness, or unexplained performance plateaus. Left unchecked, these issues not only persist—they often worsen. But it doesn’t have to be that way.

Join Our Running Performance Lab

I’m excited to offer 10 exclusive spots for our Running Performance Lab, and it’s absolutely FREE. This is your chance to discover how a customized physical therapy plan can help you overcome pain and stiffness and unlock your full potential.

Don’t wait!
Spots are limited. Click HERE for more information and to secure your spot in the lab. Take action now, and let targeted physical therapy help you rediscover the joy of running.

Happy Running,

-Zac