If you run in central Tokyo, sooner or later you end up on the loop around the Imperial Palace. It is about five kilometres, it is open at any hour, and there is very little to interrupt your rhythm once you start. For visitors and for people who have just moved here, it often becomes the whole training plan: the same loop, most days, at whatever pace the evening allows.
That is also why we see a particular set of running problems in palace runners. Almost none of them start with an accident. They build quietly, over a few weeks, out of the way the loop is run.
What the palace loop asks of your body
- It is entirely paved. There is no grass or dirt option, so every stride lands on a hard, unforgiving surface.
- It has one hill. The loop rises toward the Hanzomon side and gives it all back on the long descent. Downhill running loads the front of the thigh and the knee far more than flat running does.
- Everyone runs the same way. By convention the loop is run counterclockwise, so lap after lap your body turns in one direction and meets the same cambered pavement with the same leg.
- It encourages round numbers. The lap is the unit, so training tends to jump from one loop to two, which is a 100 percent increase in one step.
- It gets crowded. In the evenings and at weekends you weave, brake and surge around other runners, which turns an easy run into an unplanned interval session.
The problems palace runners bring to us
These are patterns rather than diagnoses. What matters is what is happening in your body, which is what an assessment is for.
- Pain around or under the kneecap. Often traced back to the descent, to stairs in the station, and to sitting for long periods at a desk or on a flight.
- Pain on the outside of the knee. Builds during a run and eases with rest. Repeated laps in one direction on a cambered surface are worth looking at, along with hip and trunk control.
- Achilles and calf pain. Common after a jump in pace or laps, or after switching to a lighter, lower shoe for a trip.
- Shin pain. Usually load related, but persistent pain in one small spot on the bone needs to be taken seriously.
- Heel and arch pain. Worst with the first steps in the morning. Remember that sightseeing and commuting in Tokyo add a great deal of walking on top of your running.
- Hip or groin pain. Quietly shortens your stride and changes your push off long before it stops you.
The three habits behind most of it
When we look back over the four weeks before the pain started, the same things come up.
- A sudden jump in laps. One loop to two, or three loops added at a weekend because the weather was good.
- Every run at the same effort on the same surface. No easy days, no variation, and no strength work to build the capacity the loop is asking for.
- A change you did not count as training. A long flight, a new hotel bed, a new pair of shoes bought in Tokyo, or a commute that suddenly includes 12,000 steps and a lot of stairs.
What to do in the first few days
- Stop the run that hurts. Pain that changes your stride is a reason to end the session, not to finish the lap.
- Reduce load instead of stopping everything. Walking, cycling and pool work often stay comfortable when running does not.
- Keep moving gently within a level of discomfort you can tolerate.
- Write down what makes it better and worse, and how it feels the morning after. That history is genuinely useful to us.
- Resist the test lap. It usually confirms the pain is still there and sets you back a few days.
When to be checked sooner rather than later
Please arrange a medical assessment promptly if you have any of the following:
- You cannot put weight on the leg, or it gives way.
- There is marked swelling, or the joint locks or catches.
- Pain wakes you at night, or is there at rest.
- There is numbness, pins and needles, or weakness.
- Pain in one small spot on the bone that is getting worse week by week.
- The pain followed a fall, a collision or a sudden twist.
What an assessment looks like here
A session is one to one and in English. It starts with your history: how many laps you have been running, what changed recently, what your week looks like, and what you want to get back to. We then look at how you move, including the painful area and the things that change how load reaches it, such as hip and trunk control, ankle mobility, breathing and posture.
You leave with a plan you understand. That usually combines hands on treatment for symptoms and mobility with exercise that builds the capacity running asks for. Our physical therapists are licensed in Japan and apply coursework from the Institute of Physical Art and the Postural Restoration Institute to individual care in Tokyo.
Getting back to the loop
Returning works best as a progression rather than a single decision. In practice that means rebuilding tolerance to walking and loading first, then short and easy running, then adding one thing at a time: duration, then frequency, then pace or the hill. The lap is a convenient unit for measuring your run, but it is a poor unit for rebuilding one, so we usually start with time on feet rather than distance.
It also helps to stop making every run the same run. Keeping some easy sessions on softer ground away from the palace, and adding two short strength sessions a week, does more to protect the next few months than any single treatment.
Practical notes for visitors and international residents
- Everything is handled in English, from booking to follow up.
- Sessions are private pay, and fees are explained before treatment.
- We can issue an itemised receipt in English for a travel or international insurance claim. Coverage is decided by your insurer, so check your policy before your visit.
- The clinic is a one minute walk from Akabanebashi Station on the Toei Oedo Line, in Higashi-Azabu, and easy to reach from central Tokyo.
- Bring the shoes you have been running in, and any reports or imaging you already have.