The difference between a mediocre running physio and a great one may well be the difference between a DNF and a PB.

After years of jumping around between mediocre physios, I’ve been blessed over the last year to work with two great running physios specializing in working with athletes. They helped me rebound from two serious injuries and manage many other niggles en route to several big PB’s. So let’s break down some of the key things to look for in a great running physio.

1. They’re experienced working with athletes and runners. Some physios who don’t regularly work with serious athletes may be overly conservative working with marathon runners. Marathon training produces a lot of common running-related injuries—plantar fasciitis, achilles tendonitis, IT band syndrome, etc—physios who work regularly with runners will know these well and prescribe an appropriate course of action.
2. They’re curious and analytical. Before working with more running-specialized physios, I used to see a physio who spoke little English and asked few questions…
   • I’d come in, get on the table, point to an area of soreness, and he’d zap my feet with lasers and electric shocks before sending me on my way. We almost never discussed what was going on, when my tendons or muscles were most sore, or what kinds of stretching or strength work I was doing.
   • Fast-forward to my next physio, Nick, and the experience was completely different. Nick had loads of experience with athletes and would ask me lots of questions to get to the root causes of my aches and pains.
   • When Nick moved away, I began working with a new physio named Morgan, who specializes in helping athletes build strength. In order to tailor his approach to my strengths and weaknesses, he tested my leg strength through a series of different exercises using force plates.
3. They teach you stuff. Once he had fully analyzed my situation, Nick taught me, for instance, that I needed to double my protein intake, start doing activation exercises before runs, and adopt a regular stretching routine after runs. He taught me specific stretches and exercises to work on and helped me realize how I had been undermining my muscles by immediately sitting down to look at Strava when I got home. Those small changes have enabled me to absorb a higher volume of training with fewer injuries.
   • When most runners think of physical therapy, they may picture getting massage or manual therapy. Those, indeed, are a part of the experience when you’re battling an injury. But with a great physio, you’re likely spending about 1/3 of the time talking, 1/3 of the time getting manual therapy, and 1/3 of the time with them teaching you exercises or stretches.
   • From Morgan, I learned that my right quad and hamstring were 15% stronger than my left while my left calf was 10% stronger than my right. This was both fascinating and critical to designing an optimal strength routine – one that focused more on single-leg exercises (bent-knee calf raises, squats, dead lifts, leg press, hamstring curls). An expert physical trainer in addition to being a great sports physio, Morgan also helped me figure out the right weights to use for different strength exercises and the number of reps. Even better, he lets me stick around at his gym to get through a strength workout he’s assigned after our session. That’s what I call a support  team.
4. They take a holistic approach. A great physio doesn’t just use one technique or approach in every visit. They’ll vary up the approach and respond to where your body is at. In one session, they’ll already be thinking about what you’ll need in the next session and give you homework to complete in the meantime. And they’ll likely want to understand the context of your injuries – are you sleeping enough? How’s your diet? Is work particularly stressful right now? Is the pain worse at the beginning or end of a run? When is the best time in the week to plan a strength session? Taking a holistic approach allows a physio to see and understand all the systems at play in order to achieve the best results.
5. They care about you and your goals. Top-notch physios aren’t just working your muscles and sending you the bill, they’re invested in your success. After I wrecked my back at the gym last fall, Nick (who lived close by) was kind enough to come over and do some manipulations in my home because I was basically bed-ridden for 24 hours. That helped me recover quicker and I only ended up missing a couple days of training. Months later right before the Valencia Marathon, the last email I received before heading off to run a 9-minute marathon PB was from my physio Morgan. He didn’t need to jump online to write me an email on a Saturday night, but he knew I was racing the next day and wanted to cheer me on. He always insists that I let him know how my races go, since I may not have another session with him until a while after a race.

I had much younger muscles and joints when I trained for my first marathon at age 24, so I was able to get through that season without the kinds of injuries or niggles that plague most older runners. Now, as I approach 40, I’m extremely grateful to have a great physio on my support team. It’s something every marathon runner should seek out, as it can make a huge difference in your resilience, training, and performance.