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Running and osteopathy — Sydney

Quick answer (60 sec read) Most running-related musculoskeletal presentations — Achilles and patellar tendinopathy, plantar fasciopathy, patellofemoral pain — respond to a structured load-management plan. Max assesses the interaction between running load, tissue capacity, and contributing factors at all three Sydney clinics. AHPRA OST0004003860.

Running is the most common reason patients book with Max. Across the three Sydney clinics, runners come in with a mix of tendon presentations, anterior knee pain, and load-related complaints that have not settled with rest alone. The approach is the same regardless of clinic — running-specific assessment, progressive rehabilitation, and selective use of manual therapy and other modalities where clinically indicated.

What runners see Max for

The most common running presentations across all three locations:

  • Achilles tendinopathy — load-sensitive pain at the posterior heel, often morning stiffness, worse with hills and speed work. See Achilles tendinopathy →
  • Plantar fasciopathy — heel pain worst on the first steps in the morning, associated with load spikes or footwear changes. See plantar fasciopathy →
  • Patellar tendinopathy — pain at the lower pole of the patella, common in runners who also lift heavy. See patellar tendinopathy →
  • Patellofemoral pain (runner's knee) — anterior knee pain with downhill running, stairs, and prolonged sitting. See runner's knee →
  • Gluteal tendinopathy — lateral hip pain, aggravated by sitting cross-legged, lying on the affected side, or standing on one leg
  • Lower-limb stress reactions — referred to GP / imaging if suspected; co-management once diagnosed

What a running assessment involves

An initial running assessment is 60 minutes. It typically includes:

  • Load history — weekly volume, terrain, surface, shoe history, recent volume or intensity changes, sleep and stress signals, training plan
  • Movement assessment — single-leg balance, hop tests where appropriate, calf and quadriceps strength testing, hip stability work
  • Site-specific examination — palpation, joint range, tendon-loading tests as relevant to the presentation
  • Gait observation — visual gait analysis where it helps clinical reasoning (not a routine biomechanical "fix")
  • Discussion of findings — what's been found, what it likely means, and what management would look like
  • Initial treatment — hands-on management where clinically appropriate on the day

Most initial consultations end with a written-out plan: load adjustments, rehabilitation exercises, and a follow-up schedule.

How Max approaches running load

Management focuses on modifying load to the right level for the current tissue capacity — not stopping running outright unless clinically indicated. Most runners can keep doing some form of running through rehabilitation; the question is which volume, intensity, and surface to choose week to week.

The reasoning is well-supported by current tendon and load-management research:

  • Cook and Purdam's tendon continuum model for staging tendinopathy
  • Kongsgaard's heavy slow resistance protocol for tendon loading
  • Current return-to-sport frameworks for stage-based progression

Loading parameters (sets, reps, tempo, recovery) are individualised to the runner and the presentation.

Modalities used in running presentations

  • Manual osteopathy — primary hands-on tool, used to address peripheral joint and soft-tissue contributors
  • Dry needling — selective use for muscle-tension components (e.g., calf, gluteal, quadriceps)
  • Shockwave therapy (ESWT) — considered for selected tendon presentations (plantar fasciopathy with strongest evidence; some patellar presentations) where loading alone has not produced sufficient progress over 6–8 weeks
  • Exercise prescription — central to every plan; not optional

See How Max works for detail on each modality.

Book a running assessment

Initial consultation $160 (60 min) · Follow-up $130 (45 min) · HICAPS available

See also:

Max Bellaiche · AHPRA OST0004003860 · Master of Osteopathic Medicine
Educational content, not medical advice. In an emergency, call 000.