Hit the Ground Running! Getting back to running after an injury
Running injuries are unfortunately quite common among both season athletes and novice runners.
Take Alex who started training for a marathon but was unable to continue due to various aches and pains. Injuries are frustrating! You try taking some time off, things feel a bit better; but as you start ramping up the mileage, the same injury flares up… AGAIN!
We see this all the time! While injuries can disrupt training routines and hinder progress, they can often be prevented or managed with training modifications, stretching, strength training, and seeking medical advice when necessary. In Alex’s case, they were able to reach a turning point when they embraced physical therapy leading to a path of recovery and eventually triumph as they crossed the marathon finish line!
Through this post, we hope that you are able to apply some of the same concepts we utilize in the clinic with our runners. To determine your readiness to return to run, recognize weak links, and get back on a running program.
Readiness Self Assessment:
This self assessment is to help determine how ready your body is to return to running! The selected assessment tasks will look at your range of motion, core and hip stability, leg strength, and power. The goal of this assessment is to be able to perform each activity pain-less, with good control/form, full range of motion, and adequate strength.
The assessment tasks and normative goals for each task are listed below:
Full pain-free range of motion
The joint or area of pain that limits your ability to perform pain-free running should have full motion that is pain-less with stretching into all motions (bending, straightening, twisting, etc.).
Anterior step down (https://youtube.com/shorts/76uq0V-dnRs?si=qnFRTmnekOaolP2d)
Perform this assessment on the stairs. While standing on one leg, step down to tap the other heel on the step in front of you. Attempt to only TAP the heel rather than put weight through it. While still maintaining weight in the original standing leg, push through this leg to return to the original step. Complete as many pain-free and full range of motion repetitions as you can counting the number of repetitions performed on the individual leg. Next perform the same assessment while standing on the opposite leg. The goal is to complete up to 20 repetitions on each leg that is painless and under control – not letting the pelvis drop or the standing leg’s knee collapse inward.
Side plank
Perform a traditional side plank and time the duration you can hold on each side. The goal is to complete a 1.5 minute hold on each side.
Single Leg Heel Raises (https://youtube.com/shorts/ECmwt5Xi0lI?si=1-2w3PrERZUjD7jr)
While supporting your hands on a wall in front of you, raise up onto both toes performing a double leg heel raise. Get an idea as to the height you are able to achieve when performing a heel raise with both legs. You can mark this height as this will be your height goal to achieve during a single leg heel raise. Next, stand on one leg. During the duration of this assessment try to keep the knee and hip straight. Attempt to minimize hand assistance as well. Perform the single leg heel raise counting the number of completed repetitions. Perform on each leg. The goal is to complete 25 repetitions achieving the same height on each repetition as you marked during the double leg heel raise. Attempt to perform as 1 second up and 1 second down during the heel raises.
Single Leg Broad Jump x 3 (https://youtube.com/shorts/T95ag-yayjA?si=i9P99viqAl75PPPU)
To perform this assessment, find a large open space. Mark a starting position. While standing on one leg you are to jump as far out in front of you performing 3 repetitive jumps in a row for distance. Attempt to STICK the final landing. Mark the ending distance. Next, perform the same 3 repetitive jumps for distance on the other leg. Stick and mark the final landing. Measure the total distance from start to finish on each leg. The goal of this assessment is that the total distance achieved should not be more than 10% different between legs and the task should be performed without symptoms. For this assessment a warm up and practice jumps is appropriate.
Warm-up
As you get back into running and/or intervals, make sure to complete a warm-up to prime the muscles and prevent further injuries.
Warmup tasks include:
Heart rate elevation x 5 min
Walking, jump rope, or bike
Foam Roll as needed x 5 min
Gentle dynamic stretching x 5-10 min
Hip flexors x 6 each leg
Quadriceps x 6 each leg
Hamstring/calf x 6 each leg
Adductor/groin x 6 each leg
Spiderman x 6 each leg
Muscle activation as needed x5-10min
Hips/Glutes
Wall stork 2x1min each leg (https://youtube.com/shorts/GcoQo6ly7iU?si=_mwnayLRdjdTnTsr)
Banded single leg fire hydrant 2x1min each leg
Skipping (https://youtube.com/shorts/X-7qx0KPUwI?si=AQ68ry7H2pQ7OsS9)
50% effort for height and distance x 10
75% effort for height and distance x 10
Max effort for height and distance x 10
Run Progression
The return to run we will break up into three phases of recovery and progressions. The phases will be in correspondence to where you are at in the stages of injury recovery. These phases will include a maintaining fitness phase during periods of high irritability. Once symptoms of pain resolve and you are able to complete and pass the running readiness assessment, begin run/walk intervals. The final phase after completion of run/walk intervals is continuous running. By this stage, symptoms should have resolved and you should have been slowly making progressions in running and rehabilitation to build tissue resilience in preparation for clearance.
Maintaining Fitness
During this phase consider a form of cross-training to maintain fitness while managing painful running. Avoid running until symptoms reside and you are able to complete the running readiness assessment without pain. Consider activities such as walking, biking, elliptical, swimming, or light hiking. Perform these activities 2-3x/week to tolerance. Avoid running for now to allow your body to adjust.
Run/Walk Intervals
During this phase we will begin to run again! We will make progressions utilizing a set duration of running followed by a set duration of walking. These durations will progress from a weekly basis or depend on body tolerance and symptoms.
Week 1-2:
Run/walk interval: 1 minute of running with 2 minutes of walking for a total of 20 minutes, 3x/week.
Week 3-4:
Run/walk interval: 2 minutes of running with 2 minutes of walking for a total of 30 minutes, 3x/week.
Week 5-6:
Run/walk interval: 10 minutes of running with 2 minutes of walking for a total of 30-45 minutes, 2-3x/week.
Week 7-8:
Continuous running: 20 minutes of running, 3-4x/week
Run Week 8+
Continuous running: 30+ minutes of running
Duration: Continue to scale the duration of running to meet personal goals. Attempt to increase duration by 5-10 minutes per week. Be cautious of scaling up too quickly.
Frequency: Continue to scale the frequency of running (how many times per week you run) to meet personal goals. Consider allowing 48-72 hours of rest between running sessions to allow recovery.
Setbacks
Setbacks and flare-ups can occur with injuries and in some cases will be “normal” to experience. Listed below are some ideas to modify your progressions and training plan to accommodate setbacks.
Listen to your body
If you experience any pain or discomfort beyond normal muscle soreness, reassess your training plan and consider how you can modify the plan.
Modify intensity
If you encounter a setback, decrease running duration or intensity. Consider cross-training activities like cycling, elliptical, or swimming to maintain fitness.
Review your training plan
Adjust your training program as needed based on your body’s response and progress. Scale back if necessary to prevent flare-ups.
Stay patient
Returning to run after a break or injury takes time. Be patient with yourself and focus on gradual progress rather than rushing back to previous fitness levels
Seek professional advice
If you’ve been trying to get back into a running routine and keep running into the same road block of repetitive injuries that are stopping you from running consistently or upping your mileage. This is where we can help. We work with runners all around the Pasadena area to help them overcome injuries and improve their running efficiency!
If you want a return to running guide that is more structured and guided by an expert physical therapist we would love to help you with this. The first step would be to book your free discovery visit to speak with one of our PT’s. On this call we will take a deep dive into any injuries you’ve been dealing with and how we can help resolve them.
