Physical Therapists Using Clinical Analysis To Discuss The Art And Science Behind Running and The Stuff We Put On Our Feet

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The Healthy Runner Inventory: Assessing the Mental Health Side of Running
By Nathan Brown

If you’re reading this, you’re probably a runner right? Or you know one. Or you coach one. Or you’re related to one. Runners are everywhere. Running is one of the most popular ways to get exercise, with over 50 million Americans (15%) participating in some sort of running every year. And why not? It’s a great way to get exercise, meet friends, and step away from the business of life. Most of us want to run as a way to stay healthy.
The irony is that in the pursuit of staying healthy, between 19.4-79.3% of runners get injured every year. That’s a minimum of 9.12 million people in a given year. So what’s going on here?

The reality is that there isn’t one particular answer. That also is the point. Researchers of running injuries haven’t been able to identify a specific reason why people get hurt and are pointing to the reality that it is multi-factorial, involves multiple systems, and is very individual. In the realm of multiple systems, it is about more than how much you’re training, your running mechanics, or your strength and mobility. It also has to do with your nutrition, hydration, stress level, sleep, and social and emotional wellness. Ironically, if your goal is to be and stay healthy, running may not be your best option, truthfully - unless you’re willing to do things holistically.

Mental Health Challenges of Being a "Runner" 

Unlike most sports where identifying oneself as a “basketball player” or “wrestler” is typically reserved for those competing at the upper echelon of competitions or leagues, the ability to identify oneself as a “runner” is much more common. There is beauty in this, as the community of runners is expansive and helps provide a sense of community. On the flip side, placing running as a central identifier of who we are can have its downfalls, and possibly contribute to many of the factors associated with running injuries.

The pressure to run, exclusion/elitism, social comparison, and narrow focus can wreak havoc on your physical, emotional, social, and spiritual well-being. It can lead to physical burnout, overtraining, and putting your physical body at risk for injury. You can create exclusive social groups, create a standard for who is a “real runner” based on your own criteria and weaken social connection in your local community. Your own self-image can worsen as you compare it to other runners’ performances on their Strava accounts or how they look. You can neglect things like your family, your friends, your emotional needs, or your spiritual needs while prioritizing “getting your run in” or using running to try and avoid or solve those issues. All of these habits can lead to burnout and overtraining, which may be a big reason why running-related injuries are so prevalent.

What is Running, Anyway?

From a mechanics and physical therapist standpoint, running is a series of single-leg hops that are controlled by our neuromusculoskeletal system to help move us forward across space. But that’s not what we are talking about.

We are taking a 30,000-foot perspective though, and how running should be situated in our lives and within our identity. The issue isn’t about whether you call yourself or identify as a runner. That’s fine, and if we can broaden the definition to anyone it could be a source of inclusion. However, it’s more about our own relationship with our runner identity and whether it is a core identity or a small part of who we are that is situated in a more holistic view of how we view ourselves. If we try to make running something it isn’t meant to do, it will let us down. If we try to use a hammer to pound a screw into the wall, we will simply create a stripped hole that does no good for hanging anything beautiful onto it. We can’t make running do everything for us, because we aren’t just runners, we are people who run.

The Healthy Runner Inventory

Coming from a physical therapist who works with runners, you may expect me to say that the best way to remain healthy and well as a runner (and even perform at your best) is all about mobility, strength, and running mechanics. However, even after 7+ years of education on those topics and working with runners for 6 years, it is clear that those aspects are the tip of the iceberg. Physical wellness is not an isolated aspect of our being. It is intimately tied to our emotional, social, and spiritual health. To be steady at the tip of the iceberg, you have to have an identity and foundation in something deeper, wider, and less fickle than something as fleeting as running. 

So here is the next step. Assess where you are at. Find out if your identity as a runner is in a healthy space that is contributing to your overall wellness or if your relationship with running is actually putting you at risk for physical, emotional, social, and spiritual harm. Up to 79.3% of runners get injured, and others are struggling with eating disorders, depression, and anxiety. I tell my patients that they are the greatest PhDs. in the study of themselves, and without them understanding themselves it is hard to develop an effective plan of care. The same is true for you.

Take this Healthy Runner Inventory as a starting point on your journey to healthy (and happy) running, and be willing to take your reflections and let them change your habits and mindset. Keep in mind there aren’t necessarily correct answers to these questions. They are prompts to help you process where you are at and assess if it is where you want to be, which will vary from person to person.

This inventory is not diagnostic, but functions as a sort of spotlight on our mental wellness, feelings, beliefs, and how those affect our behaviors. Within the assessment, you'll notice questions about how your mindset varies depending on run performance, ability to get a run in, and how it affects your attitudes, behaviors, and relationships. If you're seeing patterns that you wish you didn't see, investigate why. Running in and of itself usually isn't the problem, and removing running likely wouldn't "fix" any issues you see. Instead, running is one avenue of our lives (as people who run a lot) that can be used to understand our deeper beliefs and tendencies. For example, if someone who sees a pattern of compulsive running and feelings of failure if they miss a planned run takes running away, that pattern may then show up in your work or your next hobby. Our emotions and behaviors are the fruit of our lives. This inventory helps you identify the fruit. Once you know what the fruit is in your life, work it back down to the root cause and work more on your inner being. That's when the real work begins.


1. Bertelsen, M. L., Hulme, A., Petersen, J., Brund, R. K., Sørensen, H., Finch, C. F., ... & Nielsen, R. O. (2017). A framework for the etiology of running‐related injuries. Scandinavian journal of medicine & science in sports, 27(11), 1170-1180.

2. Sophia, B., Kelly, P., Ogan, D., & Larson, A. (2022). Self Reported History of Eating Disorders, Training, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 US Olympic Marathon Trials. International Journal of Exercise Science, 15(2), 721.

3. Goesling, J., Lin, L. A., & Clauw, D. J. (2018). Psychiatry and pain management: at the intersection of chronic pain and mental health. Current psychiatry reports, 20, 1-8.

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