Running With Autoimmune Disease: What Physical Therapist Sammie Lewis Teaches Runners About Injury Prevention

For many runners dealing with recurring injuries, the same questions come up again and again.

Is my running form wrong?
Do I need different shoes?
Do I just need to get stronger?

According to physical therapist and endurance athlete Sammie Lewis, the real answer is often more complex.

In a recent conversation on the podcast, Sammie shared how her own running journey, shaped by three autoimmune conditions, completely changed the way she thinks about running injury prevention and runner health. Today, it is the same perspective she brings to the endurance athletes she works with every day.

Running With Autoimmune Disease

Sammie manages ankylosing spondylitis, celiac disease, and life after a thyroidectomy for Graves’ disease. Each condition affects the body differently, but together they highlight how interconnected overall health and running performance really are.

Ankylosing spondylitis is an inflammatory arthritis that affects the spine and pelvis. Movement can help manage stiffness and pain, but high training loads can increase inflammation.

At the same time, celiac disease affects nutrient absorption. Runners with celiac disease often struggle to maintain adequate levels of nutrients like iron, vitamin B12, and vitamin D. Daily carbohydrate intake can also be more challenging when many gluten free foods contain fewer carbohydrates than traditional options.

After a thyroidectomy for Graves’ disease, Sammie relies on daily hormone replacement. While these medications support normal function, they cannot fully replicate the body’s natural hormonal rhythms, which can affect recovery, energy levels, and exercise tolerance.

For Sammie, this means training is never just about workouts or mileage. It requires careful attention to fueling, recovery, inflammation management, and overall health.

Her experience highlights an important truth for runners.

The body functions as a system.
When something is off within that system, it can show up as fatigue, pain, or injury.

Why Systemic Health Matters for Running Injuries

One of the biggest misconceptions Sammie sees among runners is the belief that injuries are always caused by a mechanical problem.

While biomechanics do matter, many runners experiencing chronic fatigue or recurring injuries are actually dealing with systemic stressors, such as

• under fueling
• poor sleep
• chronic stress
• hormonal changes
• inflammatory or autoimmune conditions

A physical therapist’s role is not just to treat the painful area. It is also to recognize when something larger may be influencing the injury.

That means asking questions about nutrition, recovery, stress, and medical history rather than focusing only on how someone moves.

A Whole Athlete Approach to Physical Therapy

Sammie founded Golden Endurance, a physical therapy clinic in Golden, Colorado, that specializes in endurance athletes.

Her clinic focuses on one-on-one interaction with each athlete to gain a deeper understanding of what might actually be driving an injury.

Rather than focusing only on the site of pain, Sammie evaluates the entire kinetic chain, along with lifestyle factors that influence training and recovery.

She also uses gait analysis technology to measure things like impact loading and movement patterns. These objective measurements help distinguish between compensations caused by injury and patterns that may have existed long before symptoms began.

Rethinking Running Biomechanics

Sammie also challenges several ideas that runners often hear about biomechanics and injury prevention.

Pronation Is a Normal Movement

Many runners believe pronation is something that must be corrected.

In reality, pronation is a natural shock absorbing movement of the foot.

Research suggests that injury risk is more closely related to how quickly pronation occurs, rather than how much pronation a runner has.

Instead of trying to block pronation entirely, the goal is to build the body’s ability to control that motion through strength and neuromuscular coordination.

The Most Comfortable Running Shoe Is Often the Best Choice

Another surprise for many runners is that comfort is one of the strongest predictors of running shoe success.

Studies show runners who choose shoes based on how comfortable they feel often experience fewer injuries than those who rely solely on gait analysis at a running store.

Sammie also encourages runners to rotate different shoes, which slightly changes how forces are distributed and can help reduce repetitive stress.

Why Strength Training Alone Is Not Enough

Strength training is widely recommended for runners, and for good reason.

However, Sammie emphasizes that strength alone does not guarantee injury prevention.

For muscles to effectively absorb impact during running, they must activate before the foot hits the ground. This timing is controlled by the neuromuscular system.

If that timing is delayed, even strong muscles may not protect the body from repetitive loading.

To address this, training should gradually progress beyond slow strength exercises.

Sammie often introduces faster movements and eventually plyometric exercises that train muscles to activate automatically. These drills help bridge the gap between strength and real world running demands.

Interestingly, this type of training can feel deceptively easy because it is neurologically demanding rather than physically exhausting. Educating athletes about this difference is often key to helping them commit to the process.

Treating the Whole Runner

At the core of Sammie’s philosophy is a simple idea.

Running injuries rarely have a single cause.

More often, they result from a combination of factors including training load, recovery, biomechanics, neuromuscular control, nutrition, and overall health.

Addressing these elements together helps runners build resilience and train more consistently.

Sammie’s personal experience navigating autoimmune disease while continuing to run has shaped the way she helps endurance athletes understand and support their bodies.

Her story is a powerful reminder that running well is not just about how we move. It is also about how well we support the systems that allow our bodies to keep moving forward.

Supporting the Whole Runner

Sammie’s approach to injury prevention reflects an important principle in endurance sports. Staying healthy as a runner requires looking beyond a single workout, muscle group, or training plan.

It requires understanding the whole athlete.

That same philosophy guides the work we do at Maximum Mileage Coaching. When we coach runners, we consider more than just mileage or pace. We look at training load, recovery, fueling, life stress, and long term durability so athletes can train consistently and perform at their best.

Our goal is not simply to prepare runners for their next race. It is to help them build a sustainable and resilient relationship with the sport.

If you are looking for coaching that supports the whole runner, you can learn more about working with us by clicking Enquire Now.

You can also learn more about Sammie Lewis and her work helping endurance athletes stay healthy at Golden Endurance:
https://www.golden-endurance.com/

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