Your rehab worked. So why did your injury flare up again?
- Emma O'Toole
- Mar 8
- 5 min read
Updated: Mar 22
Many runners and cyclists successfully complete rehabilitation for overuse injuries, only to see symptoms return once training load increases. This isn’t usually because rehab failed. It’s because baseline capacity was restored, but strength and tissue tolerance did not continue progressing alongside training demand. In this article, Emma O’Toole explains the concept of capacity-demand mismatch, why injuries flare when strength work stays at “rehab level,” and how progressive strength training builds resilience before injury rather than only responding after it.
Strength training for runners and cyclists over 30 is a game-changer for performance, resilience, and long-term health.
If you want the full breakdown, check out my Strength Training Over 30 Guides:
TRAINING BREAKDOWN
"The principles that rebuild tissue after injury are the same principles that build resilience before injury."
By Emma O'Toole
Hi there!
Last December, I was on a Run Fitter, Ride Stronger call with one of you. She had been reading this newsletter for a while.
For the past three years she’s had what she described as an “on-off” relationship with her running. The pattern was very familiar:
Her running mileage builds steadily, she starts to feel strong running again. She begins to introduce some quality work back into her training through speedwork and hills… and in a few weeks her left Achilles flares up.
Not a full-blown stop-running completely injury, but enough to warrant taking a step back, stall her progress and book another physio appointment.
She is prescribed structured calf loading and stability on her left glute med. She commits to this, the pain settles and she begins to build her running mileage again.
Importantly, she keeps the physio exercises in- this matters. She was not a runner who stopped her rehab exercises the moment that her symptoms eased.
However, as her mileage increased, she began to slowly layer in some hills and progressively add short speedwork to her runs…
… Her pain returned and the cycle restarted.
The rehab exercises that were enough to reduce pain were no longer enough to support the new training demand of more mileage, hills, speedwork.
This didn’t happen because she was doing anything wrong, or that her physio plan was poor. Rather it was what I call a “capacity and demand mismatch”.
Basically, her rehab restored her baseline capacity, her training demand moved on and she simply wasn’t strong enough to handle that demand.
When she was injured, her rehab work was structured and progressive to get her back running comfortably again. When she hit that milestone, her rehab work stayed the same despite her running load increasing, and that is the key.
And so, over the past 3 years, the cycle repeated: On, off, on again…
Until three months ago.
She was back running pain-free and approaching that familiar point, ready to layer quality back in, ready for the hills, ready for the intervals… and close to going full circle again.
But this time, she did something different.
Instead of keeping her strength work at “rehab level”, together we introduced structured and progressive strength training to support the increasing demands of her running.
Since then, she’s been able to repeat hill sessions, reintroduce interval work and gradually build her mileage, all without the Achilles flare-ups that had defined the previous three years.
She broke the cycle.
Why we wait until something hurts
When something hurts, we (rightly) go to a physio to get checked over and more often than not we’re prescribed strength exercises to help get us back to doing what we love. This is even more common in runners and cyclists over 30 where we see overuse injuries spike.
Strength training becomes a non negotiable for us.
We make time.
We follow the progression.
We accept that load builds tissue capacity.
However, when nothing hurts, we have no niggles, strength training becomes optional… something we will add in if there is time.
Yet the principles that rebuild tissue after injury are the same principles that build resilience before injury. Load builds capacity, capacity improves tolerance, tolerance helps protect consistency.
It is simple, but it requires intent, planning and a commitment to strength training in your training week.
The injured runner and cyclist
When you are injured, your goal is not just getting you back to running and cycling, the goal is to build your capacity to do these sports.
Capacity is built through:
Controlled loading.
Appropriate resistance.
Specific exercise selection.
Gradual progression.
Structured strength training.
No physio says, “Go and add more hills while your Achilles is flaring.” They reduce aggravating load and introduce controlled strength work. This is because endurance work alone does not meaningfully increase maximal force capacity.
Running and cycling give you thousands of ground contacts or pedal strokes each session. That’s great from an endurance perspective but if you’re asking the same tissues to tolerate more demand without increasing their strength, your risk of something breaking down greatly increases.
The PB hunting runner and cyclist
Strength training is not just about avoiding injury, it is about performance.
When you increase the amount of force your body can produce, each stride or pedal stroke uses a smaller percentage of that capacity.
That means:
Less fatigue per repetition.
Better control late in races.
Improved running economy.
Improved cycling efficiency.
Greater resilience as volume increases.
This is what I mean when I say that strength training is your endurance enabler!
Why this matters more for us runners and cyclists over 30
Our recovery is slower, our tendons adapt more gradually. We’re often more stressed now than we were 20 years ago and that reduces our margin for error.
We’re also naturally losing muscle mass unless we do something about it.
This doesn’t mean you cannot improve. What it means is that your capacity must grow alongside your training demand, not only when (or if) something starts to hurt.
We've got to get in there before it does.
Here’s a question for you to think whilst reading this article:
If you picked up a niggle tomorrow and saw a physio, would those strength training rehab exercises become non-negotiable?
If the answer is yes, (which I am highly suspecting it to be!) Then why wait to be in pain to make it a priority?
The exercises that get you out of pain are often the starting point, not the end point.
As your mileage increases, the quality of your sessions increases and your sessions become more demanding, your strength work must progress too. Otherwise the train > injury > rebuild cycle repeats.
Think of it like this: Rehab gets you back to baseline. Progressive strength moves your baseline forward.
If you want help bridging the gap between rehab exercises and strength progression, you can start with my free strength workouts for runners and cyclists inside my free community for runners and cyclists over 30.
Happy running and riding!
Emma x
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I always used to think that getting injured was part of running, until I stuck to strength training and then it changed for me.