How to Safely Return to Running After Injury
Many runners who've experienced an injury are familiar with the all too common rollercoaster ride of rest and re-aggravation. Clinically, I’ve seen this in soft tissue conditions like patellar tendinopathy, achilles tendinopathy, and plantar fasciitis and all too commonly in bone stress injuries. At The Movement Physio & Performance we believe that rest is rarely best but in the remainder of this post I’m going to outline some of the keys that I’ve identified throughout my personal and professional life for a safe and efficient return to running.
Understand the Tissue at Fault
Accurately identifying the tissue at fault and the stage of injury it is in form the foundation on which a solid rehabilitation and return to running plan is based. The type of tissue being managed plays directly into the decision making process throughout the physiotherapy and return to running continuum. Some of the decisions that are influenced by these factors include:
How much pain is acceptable during or after an exercise or activity (i.e. it’s generally not okay to experience pain during the rehabilitation of bone stress injuries or in acute tendon pain)
How an individual chooses to load their body (i.e. hip hinging for a proximal hamstring versus ball curls for distal hamstring)
What types exercise might be problematic (i.e. tendons play an important role in the storage of energy so plyometric activities might be limited earlier in the rehab process)
What type of running workout should be performed (i.e. proximal hamstring tendons will tend to be reactive to hill work)
Running speed during return (i.e. slower running will tend to load the foot/ankle and faster running tends to transfer that load up to the hip)
Determine Readiness to Run
Once a runner understands the tissue they are dealing with they need to decide whether running is something that will be part of the rehab plan immediately or in the future. This can be determined from understanding how an individual reacts to both activities of daily living and functional movement testing. Some of the daily activities that are worth asking about include stairs, flat walking, up/down hill walking, and accelerating across a street. If these activities are problematic it’s likely that running is not going to be the right place to start for that individual, but again, this will depend on the tissue and stage of injury as well. Functional testing is likely to include side planks, single leg stance, single leg squats, POGO hops, or depth drops to name a few.
Determine an Entry-point
This is where human nature and the personality of many of us in the running community can get in our own way. Once an individual is pain-free and they’ve passed the readiness to run tests, I see all too often a return to where an individual left off in their training program or running routine … an all or nothing approach. Instead, when a runner determine’s they are ready to run they need to find their re-entry point to running, or run tolerance. Depending on how long an individual was sidelined from running and the type of tissue they are dealing with, a runner may need to take a gradual, less-is-more approach to finding their individual tolerance level. This approach may begin as low as 5 minutes and gradually build on a session by session basis. On the other hand, if a runner has low irritability and a low-risk tissue at fault, a tolerance test where they run until the onset of pain to find their entry point may be warranted.
Utilize a Baseline Test & Monitor Response to Load
Now something that is exceptionally important to recognize is that injury recovery is not always a linear process and there are often bumps in the road. A way that an individual can minimize the bumps in the road is through using a baseline test that is specific to the tissue at fault. Once the runner has decided on a baseline test, they can perform it at the same time each day before and/or after running to gauge their response to the activity. Some examples of specific tests we might use at The Movement Physio & Performance for different tissues are:
Patellar tendon - slant board step down
Glutei tendon - crossover squat
Medial tibial bone stress injury - hopping
When it has been determined that it is okay for a runner to have some pain during/after activity, it’s important to monitor the pain response. We want the pain response to be acceptable, we want the pain to resolve to baseline within 24 hours and we want to see a reduction in the pain over time in response to a similar load.
Follow a Structured Program
A structured program is really important in the return to running process, however, it is critical to remember that as I previously mentioned recovery can be a bumpy road so we also need to be flexible with the program. This plan will look different for every runner and every injury but a few of the guidelines that we use in this process are:
Limit the changes in your training volume to 10% or less
Think about training variables like faders on a sound board and only change one at a time
Use your baseline test and response to exercise to modify your training program
Build your volume then add intensity back in … remember that a better aerobic engine is the foundation for runners
If you’re dealing with a running-related injury and you feel like you’d benefit from some support during the rehabilitation or return to running process please feel free to book a free consult with one of our physiotherapists.