Ask any physiotherapist which patients they see on repeat and runners will come up quickly. Shin splints before a marathon. IT band syndrome that clears up, then returns six months later. Achilles tendinopathy that responds to loading protocols in the clinic, and then flares again the moment the patient returns to unsupervised training.
The injuries are familiar. The cycle is frustrating. And for most physios, the root cause is hiding in plain sight.
Recreational runners are undertreated and underserved, by the tools available to them, by the gap between clinical care and daily training, and by an industry that has historically built everything for the elite athlete and left everyone else with a generic plan and a hope.
That gap is worth examining closely. Because closing it isn't just a clinical opportunity. It's a significant one for anyone building in the sports medicine, health tech, or digital therapeutics space.
The scale of the problem
Running is one of the most accessible and widely practised forms of exercise on the planet. It requires no equipment beyond a pair of shoes, no membership, no team. And yet it carries one of the highest injury rates of any recreational sport.
Research from Kluitenberg et al. (2015) found that up to 85% of recreational runners sustain an injury in any given year. A systematic review by Kakouris et al. (2021) identified runner's knee, IT band syndrome, plantar fasciitis, shin splints, and Achilles tendinopathy as the five most common presentations, accounting for the vast majority of running-related injuries seen in clinical practice.
What unites almost all of them is not biomechanics, not footwear, not terrain. It is load. Specifically, load that increased faster than the body could adapt to.
Kluitenberg et al. (2022) found that injured runners had commonly increased their weekly mileage by 30-50% in the four weeks prior to injury. A landmark study drawing on over 140,000 sessions (Nielsen et al., 2025 - Garmin RUNSAFE) found that sessions just 10% above a runner's recent load were associated with a 64% elevated injury hazard.
The mechanism is well understood. The clinical tools to address it, for the recreational runner, largely don't exist.
The elite athlete vs. the recreational runner
Elite and semi-professional athletes have infrastructure. Performance coaches monitor load daily. Sports scientists apply validated frameworks, including Exponentially Weighted Moving Average (EWMA) load monitoring, which weights recent training more heavily than older sessions and has been validated in peer-reviewed literature including Williams et al. (2017, BJSM) and Impellizzeri et al. (2020, BJSM) to track acute and chronic load simultaneously and flag dangerous spikes before they become injuries.
The recreational runner has none of this. They have a training plan downloaded from the internet, a Garmin on their wrist recording data nobody is interpreting, and the advice to "start slow" when they return from injury or a break.
That advice is not wrong. It is simply insufficient. "Start slow" is not a protocol. It is not personalized. It does not account for what the runner was doing three weeks ago, whether they have been sick, whether last week's long run pushed them into an overreaching zone they haven't recovered from yet.
This is the gap physios know intuitively, and the one that explains why the same patients keep coming back.
What happens after discharge
The clinical episode is the part physiotherapists can control. Assessment, diagnosis, treatment, rehabilitation, return-to-run progression. Done well, this is excellent care.
But the injury doesn't happen in the clinic. It happens at 6am on a Tuesday when the patient, feeling good for the first time in weeks, decides to run a little further than planned.
There is no visibility into that moment. No alert. No flag. Nothing telling the runner, or their physio, that their acute load just spiked relative to their recent chronic load, and that the research suggests they are now in a meaningfully higher-risk zone.
This is not a failure of clinical care. It is a structural gap in the tools available. The patient leaves the clinic with good intentions and no mechanism to translate those intentions into safe behaviour once they are back training alone.
Prior injury is one of the strongest independent predictors of future injury. The research on this is consistent across sports. Rehabilitating the tissue and returning the runner to training is necessary. It is not sufficient if nothing changes about how they manage load when they are not being supervised.
The referral tool that doesn't exist yet
Physios regularly recommend apps to patients. Breathing tools, mobility programmes, pain tracking apps. The category of tools available for ongoing load management, specifically for recreational runners, built on peer-reviewed methodology, and designed to be used between clinical appointments, is essentially empty.
This is the opportunity. Not to replace physiotherapy, but to extend it. A load monitoring platform that a physio can utilize throughout care, that the patient can connect to their existing wearable, and that surfaces real-time load data in a format that is actionable for a non-expert, that is a clinical complement, not a competitor.
LODE connects to Garmin devices and uses EWMA to calculate each runner's acute and chronic training load simultaneously. Rather than applying fixed thresholds, it monitors the trend and rate of change between the two, classifying each runner's current training phase, recovering, maintaining, building, or overreaching, and building a personalized weekly plan around it. If the runner misses sessions, deviates from the plan, or has a harder week than expected, the plan adapts to what they actually did.
It also combines external load (distance, pace, duration) with internal load (heart rate response) to capture the real physiological cost of each run. Two sessions at the same pace carry very different stress depending on sleep, fatigue, hydration, and dozens of other variables. EWMA doesn't eliminate that complexity, but it is far more sensitive to it than a rolling average or a fixed weekly mileage target.
For the physio integrating it into care, the value is straightforward. Throughout treatment, LODE gives them a live, objective measure of the variable most likely to cause re-injury, data they can use to fine-tune load progressions, time return-to-run decisions, and adjust management in real time, not just at the final session. And when the patient is ready to manage independently, they leave with a tool that already knows their training history, not a fresh start with a blank plan.
Why this patient group deserves better
Recreational runners are not a niche. There are tens of millions of people globally, many of whom are using running as a primary mechanism for managing their physical and mental health. They are highly motivated. They are already instrumented, the majority wearing devices that record everything needed to calculate load accurately. And they are being failed by a tools ecosystem that was built for someone else.
The injury rate hasn't moved in years. The clinical load on physiotherapists treating overuse running injuries hasn't reduced. The gap between elite athlete infrastructure and recreational runner support remains as wide as it has ever been.
The methodology to close it exists. The wearable data to power it exists. The patient group that needs it is enormous and growing.
What the recreational runner needs, and what the physio referring them back to training deserves, is a tool built specifically for this gap. Not adapted from elite sport. Not a generic plan with a heart rate monitor bolted on. Something that actually knows who the runner is, where they are in their training, and what they can safely do next.
That is what LODE is building. And it is long overdue.
LODE is a training load management and injury prevention app for recreational runners, built on peer-reviewed sports science. Learn more at lodefitness.com.
References: Kluitenberg et al. (2015); Kluitenberg et al. (2022); Kakouris et al. (2021); Williams et al. (2017, BJSM); Impellizzeri et al. (2020, BJSM); Nielsen et al. (2025, Garmin RUNSAFE).
