Today we welcome back Mark Green from The Body Mechanic for an excellent article on returning to running after injury. Mark knows a thing or two about this having I believe, broken his ankle seven times with two operations on his ankle. This article first appeared on Mark’s website, The Locker Room, which is an excellent resource for runners wanting to get some expert advice. It’s a subscription website, but the good news is that if you’re an Ultra168 Supporter, you can grab a 20% discount off an annual subscription. Mark has very kindly allowed us to reprint this article from The Locker Room.
One of the most common mistakes I see runners make when they are returning to running from injury is doing too much too soon. This is usually due to a lack of proper understanding about their injury (the actual cause, and how long it had been brewing before becoming symptomatic).
I am going to use an example to illustrate exactly what I mean. Let’s talk about Sally. Sally is a runner who has recently experienced an ITB issue (pain around the outside of the knee). Initially this pain came on towards the end of a 20km run, she rested a couple of days and then ran again but this time the pain came on after 12km. Does this sound familiar?
Sally then decided to rest for 3 days to “really let it settle down” but unfortunately during her next run, the pain started at 5km and became so painful that she had to stop her run early and limp home. Her knee felt like it had a “knife sticking into the side of it”.
Finally, coming to terms with the fact that her knee wasn’t going to improve without doing something proactive, Sally booked in for a massage and reluctantly resigned herself to three full weeks of no running. She did some swimming and some boxing classes during the break from running to try and maintain some fitness, and also to prevent her from going mad!
At this point Sally should have sought professional advice from a running specialist physiotherapist to have her injury properly diagnosed and a treatment and rehabilitation plan created to ensure she recovered properly. BUT . . . she didn’t so this is what happened instead:
After three weeks of rest, Sally’s knee felt quite good again with no pain at all during the day. So, without any formal guidance, she decided to give it an “easy test” with a 5km run. The 5km run went really well, the endorphins came rushing back in, along with a sense of wellbeing and satisfaction that she was on the comeback path.
BUT – the next day she headed out for an 8km run (because the 5km was easy) and the knife came back to meet her after only 3km. She walks home feeling completely dejected.
In this example we have talked about an ITB issue, but the same mechanism of injury is true of any of the common overuse running injuries. Sally could have had any of the following injuries and experienced the same problem.
- Shin splints
- Plantar fasciitis
- Achilles tendonitis
- Patella tendonitis
- Gluteal tendinopathy
- Runners Knee
If you have had an overuse injury which was severe enough to keep you out of running for 3 weeks or more, then you have to follow a very carefully planned incremental return to running. If not, the injury will probably come back again, and the second time, Just like Sally, it is usually worse!
[Please Note: This is information is most relevant for a gradual onset overuse injury (as listed above), although it is still a good process to follow following recovery from acute injuries such as ankle sprains or muscle tears]
When you are working through the guided intervals outlined below, you need to be an honest and accurate judge of your symptoms. You need to try and rate your pain on a 1-10 scale, where 1/10 is a very mild sensation like a tight muscle and 10/10 is an excruciating pain that you can’t tolerate at all.
Let’s say Sally rates her pain as 2/10 on a day-to-day basis. i.e. it is a bit stiff and niggly in the morning and also after sitting down for a couple of hours, but is otherwise ok during normal daily activities.
When she does her first run back, it would be ok if the pain got to a 3/10 or even a 4/10 during the run, as long as it is back to her “normal” level of 2/10 by the next morning. If it isn’t back to a 2/10, then she needs another day off to allow it to settle down to a 2/10. If it takes more than 48 hours to settle back to a 2/10, then the run was too long and she needs to wait a few more days for the knee to settle, before then trying another, shorter, run.
The following interval table can be used as a template from which to structure your return to running. Some people will be able to move through these levels faster than others. It will depend on the nature and severity of your injury.
You need to repeat each level of this table twice with no increase in symptoms, before you progress to the next level.
For example, Sally might complete Level 1 on Monday and Tuesday, and her pain on Wednesday morning is still 2/10. She then does Level 2 on Wednesday, decides to take Thursday as a rest day, and she does level 2 again on Friday morning. She is still at a 2/10 on Saturday, so she can move on to level 3 – and so on until she is eventually running again with no walking breaks.
It may seem like your progress will be frustratingly slow using this method, but it works. It has worked for thousands of runners I have treated over the last 20 years, and is the most successful way of building people back into running without re-injuring themselves.
EXPLANATION OF THE LEVELS:
Level 1 – Run for 2 minutes, then walk for 1 minute, run again for 2 minutes and walk for 1 minute. Repeat a total of 5 times, so that the total running volume is 10 minutes.
Level 2 – Same as for level 1 except there are 7 reps (14 minutes of running)
NB: When following this program it is possible to run 7 days/week as long as your base level of pain is not increasing. Be sensible though, and listen to your body. If you feel like you need a day off, then take one.