From “I Just Want to Run Again” to the Completing the Leadville 100 Run

Aaron C. Castonguay PT, DPT, OCS, CSCS | October 2026

When this athlete, Madeline first walked into Summit Sports Lab, running the Leadville 100 wasn't on her radar. She simply wanted to run in the mountains again.

Running had been part of Madeline’s life for as long as she could remember. She grew up in rural Pennsylvania, where running was something to do and a way to explore. As Madeline got older, it followed her through her travels and eventually into the mountains she now calls home. Running is only one piece of how she lives, though. Madeline is an avid mountaineer, mountain biker, and skier, and she teaches others to move safely in the backcountry as an avalanche instructor and outdoor leadership instructor. Movement isn't just a hobby, it's how she works, teaches, and shows up for her students.

After years of big adventures and not much attention to maintenance, Madeline developed chronic IT band syndrome, which led to a string of other running-related problems. By the time we met, she had already spent about two years in physical therapy and was feeling defeated.

“I told Aaron that all I wanted was to run in the mountains again and that even just a few miles would be a tremendous win.”

I was confident we could get her there. We started gradually with strength training, mobility work, and a running analysis so I could understand how she was moving and where we could make improvements. Eventually she started running again, at first for only a few minutes at a time.

Over the following months, those few minutes turned into consistent running. By fall, Madeline felt good enough to tell me about a much bigger goal she'd been quietly thinking about: running the Leadville 100 the following summer.

When Rehab Becomes Training

For many athletes, there's an awkward gap between physical therapy and getting back to the sport they love. Traditional rehab may address the injury or the pain, but returning to running, skiing, cycling, or competition usually takes a lot more than being cleared from PT.

At Summit Sports Lab, that transition happens as part of the same process. With Madeline, strength training, physical therapy, running analysis, VO2/physiology testing, nutrition, and endurance coaching weren't separate stops along the way. They were different tools my team and I could reach for depending on what her body and her training needed at the time.

That became especially important when she was diagnosed with a torn hip labrum in the middle of her Leadville training.

After dealing with injuries for so long, the diagnosis was understandably discouraging. She was convinced surgery was going to be her only option.

A Labral Tear Doesn't Automatically Mean Surgery

This is one of the most common conversations I have with patients. Most people hear "torn labrum" and assume the next step is an operating room. In many cases, that simply isn't true.

A labral tear on MRI is surprisingly common in people who have no hip pain at all. In a 2012, a study out of the Steadman Philippon Research Institute in Vail, researchers gave hip MRIs to 45 volunteers with no history of hip pain, injury, or surgery. Labral tears showed up in 69% of those hips (Register et al., Am J Sports Med). 

A larger 2018 review of 29 studies found labral tears in roughly 54% of people without any hip pain (Heerey et al., Br J Sports Med).

In other words, plenty of people are walking, running, and skiing around with a "torn" labrum and never know it. The tear on the image isn't always the thing causing the pain. That's why the clinical picture (how someone moves, what aggravates their symptoms, how they respond to loading) matters more than the MRI report alone.

Conservative care also holds up well when it's compared directly with surgery. In a randomized trial of 80 patients with hip impingement who were eligible for arthroscopic surgery, the surgery group and the physical therapy group both improved, with no significant difference in pain or function at two years (Mansell et al., Am J Sports Med). Surgery has its place, and some people do need it. But for many active people, a well-structured rehab plan is the right first move.

There's another reason I'm careful about rushing to imaging. Research suggests that getting an MRI can itself make surgery more likely, even when the findings may not explain the pain. A study of more than 400,000 Veterans Affairs patients with uncomplicated low back pain found that those who had an MRI within six weeks of their first visit went on to have back surgery about 12 times as often as similar patients who didn't (1.48% vs. 0.12%), and they also reported worse pain a year later (Jacobs et al., J Gen Intern Med, 2020). An earlier Medicare analysis found that regions of the U.S. with higher MRI rates also had higher spine surgery rates (Lurie et al., Spine, 2003).

Most of this research comes from the spine, but the lesson carries to any joint: an MRI shows structure, not pain. Once a patient sees the word "tear" on a report, it's hard to un-see it, and that alone can steer decisions. MRIs absolutely have their place, especially when someone isn't progressing as expected or there are red flags. I just want the image to answer a clinical question, not create one.

Back to Madeline

That's the conversation she and I had. Instead of jumping to surgery, we talked through what she was actually feeling and built a plan around it: daily exercises, weekly dry needling, and continued strength training.

Within a few months, Madeline was running without worrying about her hip.

More importantly, she hadn't spent those months simply waiting to finish rehab before she could start training again. I was able to look at both sides of the equation at once: what needed to be addressed physically for her to recover, and what she needed to keep building toward the demands of running a long and challenging distance.

“We worked together to understand the pain I was feeling and figure out how to keep moving forward with training through all of the ups and downs.”

A Different Way to Think About Injury and Performance

That ability to adjust became a big part of the eight months leading up to Leadville. Training for an endurance event rarely goes perfectly, especially when an athlete has a history of injury. There were setbacks and changes along the way, but a setback never meant stopping everything and starting over.

Instead, we could evaluate what was happening, address the problem, adjust training when needed, and keep working toward the larger goal. Our team meets every week to discuss shared patients in clinical rounds, and she was no different.

This approach makes particular sense for active people. Most don't walk into physical therapy just wanting a knee, hip, or shoulder to stop hurting. They want the pain resolved because there's something they want to get back to doing.

For her, that started with running a few miles in the mountains. Eventually, the goal became running 100 of them.

Trusting the Process

I want to be clear about something: this result belongs to Madeline. My team and I can build the plan, but she's the one who showed up, did the work, and trusted the process when it would have been easier to doubt it.

A big part of that was staying true to the load we prescribed. For someone who lives in the mountains and is used to big days, the temptation is always to do more. Madeline did what was asked without overdoing it, and that discipline is what let her tissues adapt instead of flaring up. Progress in rehab rarely comes from one heroic session; it comes from consistent, appropriate loading week after week.

It's also completely natural to feel uneasy along the way. When you've been hurt for a long time, every new ache can feel like a step backward, and she had her share of those moments. That's where our weekly dry needling sessions became more than a treatment.

They were a regular check-in, a chance to talk through what she was feeling, separate normal training soreness from real warning signs, and leave with confidence in the next step. Sometimes the most valuable thing I offered in those visits was reassurance.

None of this happens without the rest of the Summit Sports Lab team. Our coaches, physical therapists, and performance staff each played a role, from strength sessions and running analysis to physiology testing, nutrition, and endurance coaching, and our weekly clinical rounds kept all of us on the same page. I'm proud of the work we did together for her.

From a Few Miles to Leadville

Less than a year after first coming to Summit Sports Lab, Madeline made it to the starting line of the Leadville Trail 100. She finished feeling strong and, just as importantly, without any lasting injuries.

“If you had told me on the first day I walked into SSL that I would be standing at the finish line of the Leadville 100 less than a year later, there is no way I would have believed you.”

Madeline’s story is a great example of why we don't treat rehabilitation and performance training as two separate things at Summit Sports Lab. To me, they're part of the same movement paradigm. Getting someone out of pain matters, but for an athlete, that's often only part of the job.

The bigger goal is helping people get back to what they love and preparing their bodies to handle it once they get there. Having physical therapy, strength training, performance testing, nutrition, and coaching under one roof lets us adapt as an athlete progresses, rather than handing them off from one provider to the next and hoping the communication holds up.

In her case, the original goal was simply to run in the mountains again without pain. Less than a year later, those same mountains included the Leadville 100, and plenty more mountains since.

Have Questions? Reach Out

If any part of her story sounds familiar, whether it's a hip, a knee, a shoulder, your back, or something you've been told needs surgery, I'd love to hear from you. You don't need to have a race on the calendar or a diagnosis in hand. Maybe you just want to get back to the trails, the skin track, or the bike without pain.

Email me anytime at Aaron@SummitSportsLab.com with your symptoms or questions, and my team and I will help you figure out the next step.

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