5 lessons from running 174 km around Mont Blanc for physiotherapists treating runners

Physiotherapist and Plus instructor Dawn Nunes recently completed the HOKA UTMB Mont-Blanc, one of the most famous trail races in the world. She shares what the experience taught her about strength, recovery, pain and mindset, and the lessons clinicians can take into their work with runners of every level.

In late August, physiotherapist and Physiopedia Plus (Plus) instructor Dawn Nunes ran into Chamonix, France, after 42 hours on her feet. The HOKA Ultra-Trail du Mont-Blanc (UTMB) covers 174 km and around 9,700 m of climbing on a loop through France, Italy and Switzerland, and Dawn was one of 1,681 runners to reach the finish this year.

The finish line is like no other. You are welcomed in as a hero all the way through Chamonix. I took my time down the finish line chute, ran in like an aeroplane because I was flying high, and grinned like there was no tomorrow.

For Dawn, getting to the start line was years in the making. Growing up in South Africa, the race was something she thought about but never imagined being able to afford. After moving to the UK it suddenly became possible, and she spent several years collecting the qualifying races and “stones” (ballot entries) needed before finally securing her place for 2026.

The race didn’t go entirely to plan. On the first climb, Dawn realised her breathing was all over the place despite a sensible start, and by the second climb she knew altitude was affecting her, as it had in high altitude races the year before. She slowed down, took breaks and kept her breathing under control on the long climbs. “It was frustrating as I had trained really hard to climb, but my body refused,” she says. On the positive side, her descents and flat running stayed strong all the way to the finish. It’s a useful reminder that even the best preparation can’t control everything, and that adapting the plan is part of the skill.

I ran the whole race with no cramps and strong legs, and my recovery has been the best I have had

Dawn’s preparation is where her clinical knowledge really shows. Her training was consistent and specific to the race, but strength work was non-negotiable. Her running mileage is relatively low, with strength as her foundation, and she prioritised sleep, good nutrition and easy days alongside heavy training.

Most of my running patients have overloaded in some form, either too much, too fast or not enough recovery time, I want to learn from that and be an example.

She practised what she preaches when a niggle appeared 6 weeks before the race. A heavy staggered Romanian deadlift at the peak of her running training pushed her a little too far. She backed off heavy hinge exercises, had dry needling to her glutes and piriformis and focused on mobility work in the final 2 weeks. By race weekend there were no problems. Spotting the warning signs early and adjusting the plan, rather than pushing through, made all the difference.

Fatigue was the other big challenge on race day. Starting just before 8pm on the Friday, after a full day awake, Dawn found this one of the most tiring races she has done. A 15-minute rest on the trail with her eyes closed, without actually sleeping, helped her reset. Switching off from all stimulation, even briefly, was enough to keep her going.

Her experience on the trail has also shaped how she thinks about pain. Dawn has seen how much a runner’s interpretation of pain depends on how badly they want to finish, with some using it to push on and others adapting their race with poles, strapping and changes to how they move. That understanding has shaped how she works with runners.

Here are her five key lessons for physiotherapists treating runners:

1. Be very specific with return to running. Rather than general advice, give clear instructions such as 5 km at an easy pace, stopping if pain goes above 3/10. Consider surface, terrain, time of day and whether they’re running on fresh legs, and tailor the plan to how experienced the runner is. Don’t be afraid to say exactly what you think their rehabilitation and return to running should look like, then back it up with a clear plan and a goal they can work towards.

2. Assess them running. Dawn sees many runners who have never been assessed on a treadmill, even when their pain is linked to running. Watching them run gives you a real feel for how they move.

3. Know their main goal. Find out what their “A” goal is and don’t be afraid to remove races that could compromise it. Trust is earned when runners realise that your goal is their goal. Dawn finds that runners also trust her advice because they know she has been through it herself, and that shared understanding helps build a rehabilitation journey you both feel passionate about.

4. Keep them running if you can. For many runners, running is their mental and social space. Unless it’s clearly contraindicated, keep them ticking over, even with a few minutes of adapted running, or use cross training to keep them focused.

5. Look beyond the mileage. Daily step count, sleep, stress, nutrition and footwear all add up, and for longer events, details such as planning and testing gear matter too. Encourage runners to adjust their training when life gets busier or more stressful, whether that’s easing off for a small niggle or prioritising an extra hour of sleep. Upskill where you can, and refer to colleagues such as podiatrists or for nutrition advice when needs go beyond your expertise.

With ultrarunning, the mental side matters just as much as the physical. Dawn believes the majority of an ultramarathon is mental, and that confidence comes from training through tough conditions and sessions you don’t necessarily enjoy. She encourages runners to prepare for when it gets hard, not if, by listing what could go wrong and planning how they’ll respond. Her own most valuable lesson came from a race that didn’t go her way. “You need to accept what you feel, just for a moment. Feel it. Then you can action it,” she says. For Dawn, that might mean letting off steam with a scream, then focusing on the next step and setting small goals to keep moving forward. That approach translates well to rehabilitation, where setbacks are part of the journey, and her own experience of chasing cut-offs has given her real empathy for the runners she treats.

Next up, Dawn has a huge 2027 planned in South Africa, with the Mountain Ultra Trail 100-mile race in George, followed just 2 weeks later by the Comrades Marathon, the 90 km road race known as the Ultimate Human Race.

If you’d like to explore Dawn’s approach in more depth, her Complete Guide to Understanding Your Runner Programme on Plus covers assessment, running analysis, footwear and rehabilitation, and her webinar recording on how to optimise and advance the ultrarunner to the next level is also available.

Dawn’s journey to Chamonix shows that strength, recovery, specificity and a resilient mindset matter just as much as the miles. Whether you treat ultrarunners or weekend parkrunners, her lessons offer practical ways to help the runners in your clinic get back better and stronger.