This is a bit tricky because there isn’t a protocol that works for everyone and not much literature talking about this topic, either. I have told you many times that every runner is unique and so his/her treatment and recovery. The most important thing to be aware of is: to start to run, you have to be pain-free. If you start to run and pain is back, stop straight away and try to analyse, with your physio or other health professional, why this happened. The return to running has to be graded, to be sure that you can listen to your body telling you if you are doing the right thing or, otherwise, you are worsening the situation. It’s all about finding the balance, making sure that your healing tissue can manage the situation and progressing in a way that allows the body to adapt. Note that to stress tissues the right amount (not excessively) promotes healing. You might think “okay, but I have no idea when I should return to run”, “ I am scared of getting injured again and having wasted my time”, “ I need to ruuun, this situation is driving me crazy!!”.
Don’t freak out. Be sensible. All will depend on the nature of your injury, treatment and time you have been without running. Normally, the longer the rest period, the slower the return to running. A golden rule is that you never should do straight away as much as you were doing before the injury.
I wrote a series of articles about running injury prevention that will give you some useful extra information about the topic I am talking about today. Have a look at them.
Should you return to running?
These are the main requirements to be sure that you can start to think about returning to running:
- You have to make sure that you have full affected joint (if so) range of motion, as well as the surrounding joints. What does it mean? Well, imagine that you have a knee injury, you should have knee full range of motion and the same for the surrounding joints, ankle and hip. If the injury area is a muscle (for instance, your calf), you should have knee and ankle full range of motion.
- You should be pain-free, although sometimes it is allowed to run with a bit of discomfort, which might be normal after a period of inactivity. For example, many of my patients tell me that after a calf tear they feel “a something”, not pain, but something “funny”. It isn’t normally a problem, as long as it doesn’t become painful.
- Make sure that you have no inflammation.
- Your joints should have good stability and move smoothly: no giving way or locking of the joints.
- Don’t trust your lungs, I am sure they can take you further than your legs should go. You might feel that your breathing is great, but it doesn´t mean that you should push your legs all the way your lungs allow you to go.
How to start?
Obviously, it depends on the injury, the person, the age and so on (check out this paper). Let’s talk in general and later on I will tell you the way to proceed for every case.
I always recommend my patients to follow this:
- Go for a fairly high-speed 25 min walk for 2 days in a row to see how your legs feel.
- If everything is fine, you should start to do exercises that simulate running. You can start with 3 lots of 10 reps of single leg squats on stable surface to begin with (unstable surface, later on), heel raises, tip toe walk and hops.
Now, it would be time to start to run. How? Start with a “walk-run-walk” to look for your baseline (to find out how much your legs can handle at this stage). Your baseline is the distance you can run with no pain during the run and for the following two days. Once you know what your baseline is, make sure that you run a bit less than your baseline. This will reduce any possible risk of setbacks. Then, start from there, increasing your mileage progressively (10% week).
Another way I recommend, which is quite slow and therefore less risky (for me is all about being pain-free, even if it means that the return to your normal running will take longer), is as follow:
|Week 1||10 min walk, 2.5 min run, 10 min walk, 2.5 min run/rest day/10 min walk, 3.5 min run, 10 min walk, 3.5 min run/rest day/10 min walk, 5 min run, 10 min walk, 5 min run|
|Week 2||7.5 min run/rest day/10 min run/rest day/12.5 min run|
|Week 3||15 min run/rest day/17.5 min run/rest day/20 min run|
|Week 4||22.5 min run/rest day/25 min run/rest day/27.5 min run|
|Week 5||30 min run/rest day/32.5 min run/rest day/35 min run|
|Week 6||37.5 min run/rest day/40 min run/rest day/42.5 min run|
|Week 7||45 min run/rest day/42.5 min run/rest day/45 min run|
|Week 8||47.5 min run/rest day/50 min run/rest day/52.5 min run|
Note that if you find it too easy, you can jump steps, always being sensible. I would say that to go from 0 to almost 60 min run in 8 weeks is a good progression. I recommend you to do it in this way and from here to add the 10% weekly. Also, the ideal situation would be to visit your physio once a week for reassessment, possible treatment and feedback.
Something else you might wonder is why I talk about time and not km or miles. Well, there are many people who have just a normal watch and don’t have access to a treadmill, so this way the schedule works for everyone. Any way, if you have a very cool watch, “translate time into miles or km” and everyone happy.
The best surface to start running is on a treadmill because your body will suffer less impact and is easy to manage distance, speed and time. Find out more about treadmills in this three links: 1, 2 and 3. If you can’t access to a treadmill, run on a soft surface (for instance, grass).
Also, you might need to make some changes to your running if the way you were running is suspected to be the cause of your problem. Make sure that you change things one by one, as if you don’t do so, you won’t find out what makes you improve or worsen.
As always, comments with questions and/or suggestions are welcome.
If you have any questions, do not hesitate to contact me on The Physical Therapy, Physiotherapy Clinic based in Southampton, and I will be happy to help you.