Dr. Kelsea Fishkind, PT, DPT
As a physical therapist that specializes in treating runners, I field a lot of questions from injured runners commonly centered around why did I get this injury? A lot of my clients will frequently ask if their injury is caused by their shoes, running form, muscle weakness, or mobility deficits. And usually one or some of those factors do play a part in their injury. With that being said, there is another huge reason why injuries are occurring in runners. The reason: poor training plans.
Oddly enough, I don’t often notice runners picking out issues with their training plans as a common reason for their injury. But a good training plan can make all the difference for a runner, especially an injury prone runner.
I’ve been working at Custom Performance for almost two years now and a lot of the clients that I saw when I first started were injured runners training for marathons. Then, for my second marathon season at Custom, I noticed I’m seeing the same patients that I saw last marathon season!!!! And some with the same exact injury. I’ll give them credit – many of them were still doing the strength work that we went over during their first rehab cycle. However, one thing that didn’t change – how they are training. Hence, cue injury recurrence. As spring marathon training has commenced, I’ve gently convinced many of my previous PT clients that are not currently injured to start coaching me, a certified run coach, so we can finally break the cycle.
Anytime I bring up training plans and our run coaching services to my runners I get a flood of questions. I answer all of the questions that I get for my runners and I want to answer some frequently asked questions here too. Below is a self Q&A based on the most common (and important) questions my run coaching and PT clients ask me.
Question: What is the best training plan?
Answer: The best training plan is one that is written by a certified run coach that is specifically tailored to the individual.
Question: How are run plans individualized?
Answer: No two runners bring the same body, background, or goals to a training cycle so no two coaching plans should look exactly the same. Individualization goes far beyond just setting weekly mileage. Here’s how I tailor coaching plans for each runner:
1. Training Age and Experience
A newer runner most likely will respond best to a simple and consistent structure, while an experienced runner may need more targeted workouts. I adjust not just what we do, but how quickly we progress.
2. Injury History and Current Symptoms
- Past injuries need to be taken into consideration when developing a training plan for a runner. A runner with a history of Achilles issues, stress fractures, or knee pain needs different volume progressions, intensity distribution, and strength emphasis than someone with a clean injury history. If pain shows up, the plan adapts immediately.
3. Tissue Tolerance and Biomechanics
- Bones, tendons, and muscles adapt at different rates. As a PT, I consider how well each runner’s tissues tolerate load and whether their mechanics match their current strength and mobility. This helps guide pacing, workout frequency, and terrain choices.
4. Schedule, Stress, and Lifestyle
- The “best” plan is the one a runner can actually execute. Work hours, sleep, family obligations, and overall life stress all influence how much training a runner can tolerate. I build plans that fit real life – not ideal circumstances.
5. Strength and Cross-Training Needs
- Strength training isn’t generic. Exercises, loading, and frequency are chosen based on what that runner needs to run better and stay healthy. Cross-training is used strategically when it supports increasing aerobic capacity or managing symptoms.
6. Goals and Race Demands
- Training for a 5K looks very different than training for a marathon. Training for a flat marathon can look different than training for a hilly one. Plans are built for the specific race distance and course, as well as the runner’s timeline and performance goals.
7. Ongoing Feedback and Adjustments
- Individualization doesn’t stop once the plan is written. Check-ins, performance data analyzation via our training log platform, and symptom tracking allow the plan to evolve in real time. If something isn’t working, we change it before it becomes a problem.
The bottom line: An individualized coaching plan accounts for the runner, not just the race. By combining run coaching with physical therapy principles, training becomes safer, more effective, and more sustainable long term.
Question: How do training plans change with different distances?
Answer: Each distance stresses the body differently. Coaching should reflect that – not just adjust mileage.
1. 5K Training
- Lower mileage
- Shorter long runs
- Higher emphasis on speed
- Power focused strength training
2. 10K & Half Marathon Training
- Higher mileage
- Longer tempo efforts
- Balance of speed and endurance
- Strength training supports fatigue resistance
3. Marathon Training
- Highest mileage
- Longer long runs and fueling practice
- Conservative intensity management
- Strength training may shift toward maintaining tissue tolerance and managing fatigue
Question: Why is it beneficial to have a run coach that is also a physical therapist?
Answer: As a run coach and physical therapist, I have a deep understanding in how the body handles load and responds to training. And this is different for everyone! If I don’t already know my coaching client, I am speaking to them during their intro session to get an in-depth explanation of their run history. If the runner explains that they’ve run multiple marathons, are experienced in the distance, and want to focus on a time goal this training block, their training plan is going to be more aggressive compared to someone newer to the marathon. For newer runners, especially if I’ve seen them for physical therapy before, injury risk is built into the plan; I don’t react to injuries after they happen. Additionally, strength and mobility aren’t afterthoughts; they’re integrated into your training, not added randomly. Lastly, pain doesn’t have to mean training is over; I know how to modify training without losing fitness.
Question: Do I need a run coach or a PT?
Answer: Oftentimes, both! But here are a few general rules:
Runner #1: A New or Experienced Runner with No Pain = Needs Run Coaching
- A new runner usually needs structure, appropriate progression, and accountability.
Coaching helps build smart habits early and reduces injury risk down the line. A more experienced runner usually needs help managing mileage, intensity, and progression. Coaching helps ensure those factors are done safely.
- **It would still be smart for this runner to see a physical therapist at least for a couple of sessions to get their muscle strength assessed so an appropriate strength plan can be developed!
Runner #2: A Runner with New or Recurring Injuries = Needs: PT & Run Coaching
- As I’ve said, the runner with chronic injuries usually doesn’t just need rehab – they need training changes. This is where combining PT and coaching makes the biggest difference.
At Custom, we integrate rehab and run coaching so runners don’t have to choose between the two. We have a “run coaching add-on” membership for any PT client that is interested in also getting coaching. We also have stand alone run coaching options for those not currently in PT. Have more questions? Chances are, you’re not the only one asking them. Reach out to us at
(212) 682-7860 or info@custompt.com – we’re always happy to talk running.