How to return to running after injury
One of the most common mistakes I see runners make when they are returning to running from injury is doing too much too soon.
This is usually due to a lack of proper understanding about their injury (the actual cause, and how long it had been brewing before becoming symptomatic).
I am going to use an example to illustrate exactly what I mean.
Let's talk about Sally. Sally is a runner who has recently experienced an ITB issue (pain around the outside of the knee). Initially this pain came on towards the end of a 20km run, she rested a couple of days and then ran again but this time the pain came on after 12km.
Does this sound familiar?
Sally then decided to rest for 3 days to "really let it settle down" but unfortunately during her next run, the pain started at 5km and became so painful that she had to stop her run early and limp home. Her knee felt like it had a "knife sticking into the side of it".
Finally, coming to terms with the fact that her knee wasn't going to improve without doing something proactive, Sally booked in for a massage and reluctantly resigned herself to three full weeks of no running. She did some swimming and some boxing classes during the break from running to try and maintain some fitness, and also to prevent her from going mad!
At this point Sally should have sought professional advice from a running specialist physiotherapist to have her injury properly diagnosed and a treatment and rehabilitation plan created to ensure she recovered properly.
BUT . . . she didn't so this is what happened instead:
After three weeks of rest, Sally's knee felt quite good again with no pain at all during the day. So, without any formal guidance, she decided to give it an "easy test" with a 5km run. The 5km run went really well, the endorphins came rushing back in, along with a sense of wellbeing and satisfaction that she was on the comeback path.
BUT - the next day she headed out for an 8km run (because the 5km was easy) and the knife came back to meet her after only 3km. She walks home feeling completely dejected.
In this example we have talked about an ITB issue, but the same mechanism of injury is true of any of the common overuse running injuries. Sally could have had any of the following injuries and experienced the same problem.
- Shin splints
- Plantar fasciitis
- Achilles tendonitis
- Patella tendonitis
- Gluteal tendinopathy
- Runners Knee
If you have had an overuse injury which was severe enough to keep you out of running for 3 weeks or more, then you have to follow a very carefully planned incremental return to running.
If not, the injury will probably come back again, and the second time, Just like Sally, it is usually worse!
[Please Note: This is information is most relevant for a gradual onset overuse injury (as listed above), although it is still a good process to follow following recovery from acute injuries such as ankle sprains or muscle tears]
So How Do You Return To Running After Injury?
After treating thousands of runners and helping them return to running after injury, I have found that you need a combined rehab and training load approach to ensure a fast and full recovery.
You need to ensure you learn to run with good technique, you need to work on your strength and flexibility and you need to gradually build your volume using progressive and frequent walk/run intervals.
(Learn more about our guided 10-Week Return To Running After Injury Training Plan)
By gradually increasing your running load you will be surprised how quickly you can safely get back to a full training volume.
Guide on How To Approach Your Return To Running
The following interval table can be used as a template from which to structure your return to running volume. We have used this approach successfully for thousands of runners.
Some people will be able to move through these levels faster than others. It will depend on the nature and severity of your injury.
You need to repeat each level of this table twice with no increase in symptoms, before you progress to the next level.
It may seem like your progress will be frustratingly slow using this method, but it works.
It has worked for thousands of runners I have treated over the last 20 years, and is the most successful way of building people back into running without re-injuring themselves.
You need to combine this with working on your running technique, strength and stability to avoid reinjuring yourself.
EXPLANATION OF THE LEVELS:
Run for 2 minutes, then walk for 1 minute, run again for 2 minutes and walk for 1 minute. Repeat a total of 5 times, so that the total running volume is 10 minutes.
Same as for level 1 except there are 7 reps (14 minutes of running)
NB: When following this program it is possible to run 7 days/week as long as your base level of pain is not increasing. Be sensible though, and listen to your body. If you feel like you need a day off, then take one.
Here is an example of how to use the interval table.
Sally might complete Level 1 on Monday and Tuesday, and her pain on Wednesday morning is still 2/10. She then does Level 2 on Wednesday, decides to take Thursday as a rest day, and she does level 2 again on Friday morning. She is still at a 2/10 on Saturday, so she can move on to level 3 - and so on until she is eventually running again with no walking breaks.
When you are working through the guided intervals, you need to be an honest and accurate judge of your symptoms.
Try and rate your pain on a 1-10 scale, where 1/10 is a very mild sensation like a tight muscle and 10/10 is an excruciating pain that you can't tolerate at all.
Let's say Sally rates her pain as 2/10 on a day-to-day basis. i.e. it is a bit stiff and niggly in the morning and also after sitting down for a couple of hours, but is otherwise ok during normal daily activities.
When she does her first run back, it would be ok if the pain got to a 3/10 or even a 4/10 during the run, as long as it is back to her "normal" level of 2/10 by the next morning. If it isn't back to a 2/10, then she needs another day off to allow it to settle down to a 2/10. If it takes more than 48 hours to settle back to a 2/10, then the run was too long and she needs to wait a few more days for the knee to settle, before then trying another, shorter, run.
For this plan to be successful, you also need to improve your running technique and build your running strength and stability to avoid repeating the same injury.
Follow The Ultimate Guide To Return To Running Injury Free
If you have been injured and you are ready to start building up your running again, improving your running technique and strength, you should start the complete 10-Week Guide To Return To Running After Injury
It is designed to get you back to the sport you love as soon as possible, injury free.
Stop bouncing from injury to injury.
The 10-Week Program includes all the techniques we use as coaches and physios to successfully return you to running. You Get:
- Running Technique Lessons To Avoid Future Injuries
- Run-Specific Stretches and Mobility Exercises To Help Run More Efficiency
- 3 x Strength and Stability Workouts Per Week to create run-specific core strength
- Foam Rolling Videos to relieve and reduce muscle tension and stiffness
- Guided daily run/walk training plan all the way back to full training load
- Weekly schedule of exactly when to run, and when to do body maintenance to keep you on track
- Access to our online running community to keep you motivated and on track