Why Is My Physical Therapist Asking Me What I Ate Yesterday?

You made an appointment with a physical therapist because your knee hurts when you run.

Then I start asking about your sleep, what you ate yesterday, your training schedule, stress at work, previous injuries, shoes, menstrual cycle, and whether you've ever had anemia.

You may be thinking:

Are we eventually going to talk about my knee?

Yes. But first, I need to know more about you.

When I evaluate a running injury, the conversation we have before I start testing strength, mobility or running mechanics often gives me some of the most useful information. I develop several possible explanations for the runner's symptoms from their history and then use the physical examination to narrow that list.

I Want to Know What Changed

One of my first questions is usually some version of:

What was different before this started?

Maybe your weekly mileage didn't change, but you added speed work. Maybe you started running trails. Maybe you changed shoes. Maybe you haven't taken a rest day in three weeks.

Or maybe your running hasn't changed at all.

That's when I start looking beyond the training plan.

Has work been crazy? Are you sleeping five hours a night? Are you traveling? Have you been sick? Are you eating enough to support your training?

Running injuries are complex, and research has identified associations between injury and factors extending beyond mileage alone. Sleep, for example, is increasingly considered as part of the overall picture when evaluating injured runners.¹

So telling me, “I'm only running 30 miles a week,” doesn't tell me how well your body is currently handling those 30 miles.

Why Am I Asking About Food?

Nutrition questions sometimes surprise runners during a PT evaluation.

I may ask what you ate in the last 24 hours, whether you avoid certain food groups, whether you've worked with a sports dietitian, whether you've been treated for anemia, and whether you've ever had a bone stress injury.

I'm not trying to be your dietitian.

As a PT, I need to recognize when nutrition or low energy availability could be contributing to the clinical picture and when another professional needs to be involved.

If a runner has recurrent bone stress injuries, poor recovery, changes in menstrual function or other signs that make me concerned about low energy availability or REDs, I'm going to ask more questions. Diagnosis and medical management are outside my role as a PT, so these are also situations where involving the appropriate physician and sports dietitian becomes an important part of the plan.

Some Questions Are Different for Female Runners

For female runners, I may ask about menstrual health, pregnancy, delivery, breastfeeding, urinary or fecal leakage, urgency or symptoms of pelvic organ prolapse.

Those aren't random questions.

Postpartum return-to-running recommendations emphasize looking beyond musculoskeletal strength alone. Training history, goals, sleep, fatigue, pain, energy availability and pelvic health symptoms can all be relevant when determining an athlete's readiness to return to running.²

Sometimes the information I need isn't going to show up during a single-leg squat.

I Also Want to Know Why You Run

This may be one of my favorite questions:

Why do you run?

For one person, running is exercise. For another, it's their social life. It may be how they manage stress, compete, travel, connect with their kids or see themselves.

Research on runner identity has described how running can become intertwined with identity and important life experiences.³

If you tell me that your Saturday morning run is the one time each week you see your closest friends, that's information I want to know.

Understanding what running represents to you helps me create a rehabilitation plan that fits your goals and your life—not just your diagnosis.

Your Injury Is More Than the Spot That Hurts

Of course I'm eventually going to examine your knee.

I'll assess strength and mobility. I may watch you squat, hop or run. I'll look at your shoes, talk through your training plan, and ask about recent changes in mileage, intensity, terrain and recovery. I want to understand the physical demands you're placing on your body and whether your current capacity matches those demands.

But by then, I already want to know the runner attached to that knee.

One of the things I'm incredibly fortunate to have in my practice is time. At Precision Performance, I have an out-of-network practice, and I also work with runners through consulting. That model gives me the time to ask these questions, listen to the answers and put the pieces together.

And I don't say that as a criticism of other physical therapists. There are a lot of really good PTs working in healthcare systems that simply don't give them enough time with each patient. No matter how skilled or experienced a clinician is, it is difficult to figure out a complicated running injury if you don't have enough time to hear the whole story.

Sometimes that story is in the runner's strength or running mechanics. Sometimes it's in their training log or shoes. Sometimes it's in their sleep, fueling, menstrual health, stress or recovery. Usually, I'm putting several of those pieces together.

So don't be surprised when your running PT asks about what you ate yesterday, how you're sleeping, what's happening at work, what shoes you're wearing, what your training looks like or why you run.

I'm not asking because I've forgotten that you came in for knee pain.

I'm asking because your knee came into the room attached to a whole person—and I need to understand that person if I'm going to help them get back to running.

__________________________

References

1. Mousavi SH, Hijmans JM, Minoonejad H, et al. Factors associated with lower limb injuries in recreational runners: a cross-sectional survey including mental aspects and sleep quality. J Sports Sci Med. 2021.

2. Christopher SM, Garcia AN, Snodgrass SJ, Cook CE. Clinical and exercise professional opinion on designing a postpartum return-to-running training programme: an international Delphi study and consensus statement. Br J Sports Med. 2024;58:183–195.

3. Ronkainen NJ, et al. “Running fever”: understanding runner identities in the context of turning points. 2018.