Return to Running

Running is a complicated and intense (force on your stance leg is 2.5x your body weight!) activity. Millions of people do this every year, and unfortunately injuries are bound to occur. What is most people’s solution when they get injured? Yep, you guessed it, put a little ice on it and take some Ibuprofen. This strategy sets people up for future and more serious injuries. Every injured runner should seek care from a rehab professional to guide them through the recovery process. Here are a few guidelines to use for making a safe return to running.

1. There are no signs or symptoms of inflammation present.

Running while there is inflammation will result in further injury and prolong your recovery. Signs of inflammation include pain, swelling, warmth, and redness. Using anti-inflammatory medications is alright initially, but avoid masking the pain after the initial 5-7 days. If you mask the pain now, it will only return in even greater intensity at a later time. Finally, just because you are no longer in pain does not mean that you are ready to run again. The issue that caused the injury in the first place is more than likely still present. Find a rehab professional to assist you with correcting your issues.

2. You can correctly complete functional movement patterns.

You have to possess the appropriate flexibility, strength and stability in order to load your body properly while running. Four patterns that must be normal include:

Toe touch: can you touch your toes with a symmetrical curve of your spine? This is an excellent way to see if you have the ability to fully take your forward step. Lack of mobility here can lead to excessive trunk/hip rotation to compensation.

Extension: can you lean backwards with the front of your hips crossing your toes and your shoulder blades past your heels? This is a great way to see if you can fully extend your hips and have an appropriate stride length. Lack of mobility here can lead to excessive trunk/hip rotation to compensation.

Single leg stance: can you balance on each leg for 10+ seconds with eyes open and eyes closed? Running is predominantly a single leg stance activity. If you are not able to maintain your balance in a static position, how do you expect to do it while running?

Deep squat: can you complete a squat (buttocks below knees) with your trunk and shins parallel, no inwards/outwards collapse of your knees, and your heels on the ground?

3. Appropriate running mechanics have been restored.

The previous point measures the minimum requirements needed for appropriate movement. They were all static tests; however, running is not a static activity. You may be able to have correct alignment in a static position but can you do it when running? Or do your hips rotate inwards, knees collapse, and toe off occur on a toe other than the great toe?

4. Can you tolerate a walk to run progression?

No normal person would ever decide they were going to run a marathon the week before and then go out and do it would they?! Of course not! No, there is a progression over time that is followed. Maybe it is 3 miles for 2 weeks, then 4 miles the next week, etc until the final distance is achieved. This is the same for a return to running after an injury. An injury changes the way you run and hopefully the rehab that you went through changed it for the better. The fact is though, that you need to get used to this. You should start walking first gradually increasing the distance and speed. If you are able to walk for 45 minutes at a moderate speed (4mph) then you can begin running. Start running at a comfortable speed for 1 mile, then slowly increase distance and speed as able.

Josiah Thunshelle, PT