Running After Injury: Steps for a Healthy Return

runner with injured knee

Being injured can be one of the most frustrating and disruptive aspects of the sport of running, but it’s actually quite common. Estimates vary, but according to a recent study cited in Runner’s World magazine, 46% of runners reported being injured over the course of a year. Luckily, most runners are able to get back to their normal running routine after healing when done the correct way.

The best and safest way to get back into running after injury starts with guidance from a medical professional. You’ll want to take a cautious approach to your running return so that you don’t get injured again. Starting back utilizing easy running broken up with walking intervals while giving yourself plenty of rest days (and backing off when your body tells you it’s too much) is the best way to come back strong.

This post addresses common questions about how to get back to running after you’ve been hurt and have had to take time off from the sport. How exactly do you get back to running after injury?

How Soon Can You Run Again After Injury?

This is probably your first and most pressing question.  I remember painfully hobbling into my physical therapist’s office two days after herniating a disc in my low back due to an unfortunate workout accident, and asking him this very question. He chuckled and replied, “First, you need to be able to walk normally!” 

Unfortunately, you cannot fast forward your recovery. In fact, the most common mistake injured runners make is jumping back into running too quickly!

The amount of time off from running following an injury depends upon the type of injury in the first place.  Minor soft tissue injuries generally require less time off than more severe injuries, such as stress fractures. The following document from the American Orthopaedic Society for Sports Medicine outlines more about the causes of particular common running injuries, symptoms of each and what treatment may entail, but the best way to determine how long it might be until you can run again is to consult with a medical professional.

What do medical professionals look for in order to clear someone to start running again? An absence of pain is the biggest sign.  A full range of motion and no swelling are other telltale signs that you might be ready to return.  

Try going for a brisk walk for 30 – 45 minutes and see how you feel – if you are pain-free at the end, take it as a positive sign that you might be ready to begin your return to running. Paying attention to how your body feels is going to be a crucial tool during this time.

How Do You Get Back Into Running After Injury?

Chances are that you are on your way back from an overuse injury caused by a case of the “toos” – doing too much, too often and too soon.  Repeat to yourself: I will not do too much, too soon as I return to running from injury.  Here are additional guidelines that will help you as you prepare to return to running:

Return Gradually

A gradual return is how you avoid too much, too soon.  After time off following injury, it is crucial that you do not jump right back into the same mileage or intensity of workouts that you did pre-injury.  Fail to return gradually, and you’ll likely find yourself re-injured.

Even if you’ve been cross-training  by biking or swimming during your time away from running, you still need to gradually ease back into running.  While you’ve kept your aerobic system in good shape, your musculoskeletal system needs time to adapt to the forces and impacts of running again.

Set Ego Aside and Don’t Compare Your Past Self to Your Current Self

Returning from injury is a humbling experience.  You’ve gone from running X miles a week at X pace, to zero miles and zero pace while you recovered.  Don’t compare your old self to your current self as you begin rebuilding, or you’re likely to feel discouraged by the process (and be tempted to do too much, too soon).

Don’t Impose a Deadline on Your Healing and Return Process 

In my experience, returning from injury is not a linear process.  Setbacks are normal, and to be expected.  Setbacks are not a sign of defeat!  Avoid stress and possible re-injury, and don’t sign up for a race in the near future.  Save the race sign-ups for after you’ve successfully built your mileage back up and are running completely pain-free.

Steps to Returning to Running After Injury

If you’re still in the stage of questioning whether you have an injury at all, it’s important that you seek medical care to get a proper diagnosis so that proper rehabilitation can occur BEFORE you start your return to running. In some cases you may be able to continue running alongside rehab. If you’re not sure who to see for help, reach out to your primary care doctor and they can get you connected to the right professional based on your symptoms.

As someone who has had more than her fair share of running injuries in the three years I’ve been running, the following steps are ones that I’ve taken and have worked well for me each time I’ve had to start over with running after time off:

1. Get Cleared to Run Again by a Medical Professional

Once you’ve sought professional help for your injury, make sure you have their stamp of approval to start running again.  This way, you minimize risk of re-injury and they can provide you with the best guidance for a safe return.

2. Have a Return to Run Plan that Allows You to Come Back Slowly

Sports medicine doctors and physical therapists usually have a plan or format to ease you back into running.  Work with them to find the best way to return for you and your situation.  Or, you can use any of the plethora of free “return to run” plans found online, such as this one from TMI Sports Medicine.

3. Let Pain/Soreness Be Your Guide

Your body will respond uniquely the impact of running after taking time off.  Pay close attention to how it feels and adjust your running plans accordingly.  There may be times when you need to take extra days off, or repeat a day or even a week or more of your return to run plan. Additionally, don’t just pop pain medication so you can get through your run more comfortably. This can actually set you back on your recovery, which we explain more in our article, “Advil or Tylenol Before Running: Not as Harmless as You’d Think.”

4. Know What Caused Your Injury in the First Place

The goal is to not repeat the same mistakes that led to injury in the first place, otherwise you’re more likely to find yourself hurt again.  Was it a weakness or imbalance?  Strength train and keep following the exercises prescribed by your physical therapist.  Was it something like finding out you’re an overpronator and shoes you wore were for neutral runners?  Visit your local running store for guidance on the proper footwear for your body and running mechanics.

5. Use Run/Walk Intervals 

Run/walk intervals will ensure that you avoid too much, too soon, by slowly allowing your body to adapt to the impact forces of running.  There are many ways to rebuild fitness with the run/walk method, and no one way is better than another.  

6. Change One Variable at a Time

Three variables can be manipulated in running: time (measured by the amount of miles run, or total time spent on your feet per week), frequency (how many days a week you’re running), and intensity (hard efforts or easy efforts).  

Changing more than one variable at a time in your return process will put you into dangerous too much, too soon territory.  If your priority is building mileage, focus on building mileage first.  Don’t try to build mileage AND get back to running 5 days a week at the same time.

Keep the intensity of all of your runs easy during this build-back time.

7. Don’t Run on Back to Back Days

Your body needs extra time to heal and recover in between runs.  Though running back-to-back days can be beneficial for a healthy runner, it’s not advised when re-acclimating to running after being hurt. Don’t rush back into running on consecutive days…you’ll get there!

8. Include Strength Exercises

One of the major reasons that runners get injured is because the only exercise they do is running. Though running is excellent cardiovascular exercise, it’s also very hard on the body when not approached correctly. One of the best ways to offset the constant pounding that running causes is to do a strength program especially designed for runners.

First and foremost you’ll want to be doing any specific exercise routine given to you by your PT or other medical professional. Beyond that, CU Sports Medicine has outlined several maintenance exercises in this document, or you can try five of the best bodyweight exercises for runners demonstrated in this video.

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RELATED: How Yoga Can Help Your Running: Get Faster, Train Your Mind, and Stay Injury-Free

Know When to Back Off During Your Running Return

As I mentioned before, pain and soreness is your guide on your journey back to running.  There might be times when your body is telling you through its pain that it isn’t ready for what you’re doing quite yet, whether that’s running, walking or something else. 

How do you know when it’s okay to push through soreness, versus when you truly need to back off?

The physical therapists I’ve visited for my injuries all rely on a numerical pain rating scale to help guide their patients in returning to activity.  Pain rating scales range from 0, no pain, all the way up to 10, the worst pain ever.  

For soft tissue (muscle and ligament) injuries, acceptable pain typically falls between 2-5 in intensity on the pain scale.  This kind of pain is stable, does not cause a runner to alter their gait mechanics, and usually settles within 24 hours following the run.  If your pain falls within this range, you may progress in your running plan.  

Worsening pain that falls above 5 on the pain scale is unacceptable, and you should immediately stop what you’re doing and seek medical advice on what to do next.  This kind of pain often alters a runner’s mechanics and requires pain medications or NSAIDs to manage.

For bone stress injuries, the only acceptable level of pain is 0 during, immediately after, and the day after a run.

How Long Will It Take to Re-Gain Fitness After Injury?

You’re probably worried that time off from running has hurt the fitness gains you made prior to your injury.  Here’s some good news: Legendary running coach and exercise scientist Dr.  Jack Daniels has found over his years of experience and research that it is easier to maintain fitness gains than it was to acquire them in the first place.  He calls this the ease of maintenance principle.  

In other words, you have probably lost less running fitness than you think. 

The rate of deconditioning depends on the length of your running break, and also whether or not you were able to cross-train during that time.  Up to five days off has zero effect on your fitness level.  Twenty-eight days off results in only a 6.9% loss in VO2Max, according to Daniels.  And finally, a study published in the Journal of Applied Physiology in the 1980s found that after 12 weeks of stopping all physical activity, endurance athletes only lost about 16% of their VO2Max.  The bottom line is that if you are able to cross-train while you’re recovering from a running injury, your fitness losses will be reduced, and you will be able to get back in running shape fairly quickly! 

Running injuries that cause you to take time off from running are no fun, but remember that the setback is only temporary.  With patience and perseverance, you will be back on the road again very soon!

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