What today’s edition covers
We’re trying something new today! If you’ve been around for a few weeks you’ll know Sundays are for reader questions. However, today we’re doing it a little different.
I’ve sourced one of the most interesting cases from real people on Reddit. And now we’ll try to understand it, solve it, and move forward from their situation.
Written by your favorite UESCA certified coach, Jonathan Fors
Let me lay the foundation for the situation we’re tackling today. I think you’ll find it relatable.
The person and the problem
The person we’re talking about is a 21-year-old man who started running eight weeks ago.
Two days ago he suddenly started feeling pain on the outer side of his left ankle. It came on fast, though he could tell something was off in the days leading up to it.
Understanding the problem
Normally when an athlete comes to me with an issue like this, I want to know a couple more things first, the keys being:
Is the pain in one spot or spread across the whole foot area, and does it feel sharp or dull?
Is there swelling of the foot?
Does it hurt only during activity, or at rest as well?
These three questions will massively help me determine where the pain is coming from.
For the sake of this conversation, let’s say that the pain is sharp and localised, no swelling, and it hurts mostly during activity.
So now that we’ve locked down the situation, let’s move on to the diagnosis.
A great illustration of some key tendons and muscles in the foot.
The diagnosis
One of the most common causes of running-related pain is various forms of “-itis”, meaning inflammation.
There are plenty of other things that can cause pain in the ankle — partial tendon tears, accidental hyperextension, a lateral ankle sprain, and the list goes on.
But because the pain is sharp and localised, shows up mostly during exercise, and there’s no swelling, the most likely cause is inflammation of the tendon running down the outer side of your ankle.
Also known as the peroneal tendon.
One caveat before we go further. I can’t diagnose anyone from a Reddit post, and you can’t diagnose yourself from an email.
Sharp pain on the outside of the ankle in someone eight weeks into running can also be a bone stress injury, which is a different problem with a different fix. If it isn’t settling once you take the load off, get it looked at by a physio.
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The fix & how to avoid it in the future
While it is the peroneal tendon that’s inflamed here, the real problem is likely further up the chain.
This is generally the case for most knee and ankle issues, as one niggle, poor form, or compensating muscle quickly escalates into bigger issues.
For peroneal tendonitis (inflammation of the peroneal tendon), there are a couple of common causes:
Pelvis and femur: Compromised movement patterns of the pelvis (think hip) and femur (the thigh bone).
Foot strike: Over-supination or over-pronation leading to worsened form.
An old injury: A prior ankle injury leaves the area weakened — or stops you using it normally, out of fear of getting hurt again.
You might think that all three of these are just running mechanics and form issues, and you’d be right.
The truth is that almost every running injury can be traced back to a form problem.
Running is a repetitive movement
When you run, you’re basically jumping on one leg at a time, over and over, repeated tens of thousands of times.
When that’s the case you can quickly damage muscles, tendons, or ligaments from just a slightly less than perfect movement pattern.
This is why quality running form should be every runner’s top priority.
A niggle in the hip is not just a little niggle. It’s a feeling your body will try to avoid by compensating somewhere else, which creates an imbalance, which turns into pain or damage further down the line.
It’s all a chain.
How to fix peroneal tendonitis
So, it’s a form problem in the pelvis and/or femur. When that’s the case, there are a couple of things I’d want you to focus on:
Strengthen your glutes: Strong glutes are great for many reasons (not just the gym selfies) and will help with posture, push-off while running, and a more stable step overall.
Improve hip flexor range of motion: Weak or tight hip flexors will shorten your stride and compromise your running form.
Strengthen calves: The calves play a crucial role not only for pushing you forward but also for balance and stability of the ankle.
I’m tempted to say the most important area here is the calves, but as we know by now, the body is a chain — and a chain is only as strong as its weakest link.
So here’s the step by step plan to fix peroneal tendonitis:
Stop running: Take a break from running for 4–6 weeks. That also includes other activities that put a lot of pressure on the calves, like hiking and long walks.
Strength training: During these weeks the primary focus should be on improving the functional range of motion and strengthening glutes, hip flexors, and calves.
Be consistent: Plan 2–3 strength sessions per week focused on the areas mentioned above. Some example exercises are single-leg calf raises, ATG split squats, regular squats, and hip flexor raises/holds.
So that’s the cure. Or at least as close to a cure as one can get.
We’ve already established that our bodies are one big chain, but it’s worth repeating.
Because one weak area will force another area to compensate, which in turn shifts something else in your body, and boom, suddenly you’ve got pain in all kinds of places.
And if you ever need a hand, more structured training, or are ready to take your running to the next level, I offer 1:1 and group coaching.