Rushing the Return to Run: It Might Hurt You in the Long Run

When an injury prevents a runner from doing the thing they love, running, it's natural to want to get back to training as soon as possible. That first clearance from the doctor to start a return to run program feels like the best green light ever! But sometimes there is a discrepancy between injury healing timeline (ie number of weeks post operation or post fracture) and the body's readiness. While the affected tissue may be healed, the body might not be ready or strong enough to handle the load of running.

It's important to remember that, especially when an athlete has had to take an extended time off of training, the other bodily structures have lost some strength and power that need to be addressed before returning to run. This asymmetry between injury readiness and whole body readiness to run can create friction between the athlete who can't wait another day to run, and the physical therapist who is looking at the big picture. Returning to run before the body is ready is like building a house on sand - not setting you up for long term success. It can lead to other injuries or aches and pains developing during or soon after the return to run process, which ultimately leads to set backs and delays to full return to training.

When I run into this situation, I try to explain to my client that waiting one to two more weeks to initiate running will improve their outcomes in the long run (pun intended). Usually we just need to work on a little more strength or stability, or introduce plyometrics for a couple of weeks to prepare the body for the dynamic loading of running. By taking the time to do this, we set the body up for success in the rebuild, allowing for a smooth transition into running without the need to modify for injury.

When deciding if an athlete is ready to return to running, or if we need a bit more time, these are the things that I look for them to be able to do without reproduction of their symptoms:

1. Walk for 30 minutes

2. Squat with 20#, good form

3. Single leg squat for 10 reps with minimal wobbliness at the hip, knee, and ankle.

4. Single leg heel raise for 25 reps with proper form

5. Single leg balance 30 seconds with minimal to no unsteadiness

6. Single leg hopping for 30 seconds*

*the single leg hop test is a good litmus test because if you can't hop on one foot, running, which is basically hopping from one foot to the other, is not going to be successful!

Patience can be hard to harness when you've been sidelined and are yearning to get back to running - believe me I've been there! But a return to running that is full of stops and starts, cutting back volume and trying again, is also frustrating and more likely to land you with a new injury. Nailing your return to training starts with a solid foundation of strength and control; mastering the basics before reintroducing running will have you back to your next start line stronger than before.

Thanks for reading!

Dr. Elizabeth Karr PT, DPT, OCS