How to Return to Running After an Injury
Injury is hard. Like, really hard. Mentally. Physically. Socially. It’s a tough time for any runner.
So it makes sense that we’re often so keen to get back at it that we idealize or simplify what a return to running could look like.
Speedy paces, endless vistas, and effortless miles chatting with a long lost running friend are the stuff of an injured runners daydreams.
But when the green light to return to running is finally secured, it can be a clunky, awkward process dominated by fear of re-injury. Not exactly the runner’s high you’d dreamed of.
It doesn’t have to that challenging though. There’s no fast track solution to guarantee you’ll fly, but with a few simple strategies in place, the process can be made much easier to navigate.
So, in an effort to ensure that you’re not accidentally grabbing a speed pass to the rollercoaster ride of rest and re-injure, here are a few of our top tips for a successful return to running. Because we promise, it’s going to be so, so good, even if it takes a hair more time and intention that you dreamed of.
One last thing before we dive in; if injury prevention is top of mind for you, we’ve written an Ultimate Guide to Preventing Running Injuries. It’s jam-packed with info to help you stay healthy on the run.
Get clear on the factors that contributed to the injury.
We’ve said it eleventy thousand times and we’ll continue to do so forever: running injuries are multifactorial.
What does that mean?
As runners, we’re tempted to believe that simply switching shoes or taking a week off will be enough.
As physiotherapists, chiropractors and running specialist clinicians, we too would love for solutions to be as simple as identifying and managing an isolated cause. While we see the temptation to seek a singular downfall, that just isn’t how these things work.
Instead of looking for single causes, we encourage you to consider common factors that increase your risk of injury on any given day. Those things that might make you more or less resilient to tolerating higher ask of your body without developing an injury.
Think:
Sleep and recovery habits (A single night of poor sleep has been shown to increase injury risk by 51% over a 2 week period!).
High stress levels (In a recent study, athletes reporting psychological or lifestyle stress had a 32% increase in injury risk in the week following the complaint).
Training loads that exceed our capacity
Running mechanics
Support systems
Remind yourself that your injury risk fluctuates literally every day depending on the interaction of various contributors to your overall health and wellbeing. Appreciating and paying attention to the multifactorial nature of injury risk can prevent you from catapulting back over the injury threshold moving forward.
Also of note: there’s good evidence that understanding the role of those factors gives athletes a greater sense of control, resilience and strength as they return from injury. That strong foundation to be building on is gold.
2. Know the tissue at fault and how it’s likely to respond to load
Knowing the tissue that’s been holding you back as well as the stage of injury/recovery is key to determining the best strategy to progress. It also tells us a lot about how much discomfort we’re willing to tolerate.
For example, it you’re coming off a bone stress injury, we essentially have no tolerance for pain. By comparison, when we’re talking about a recovering tendon, some discomfort is expected and appropriate.
Knowing the tissue at fault can also help us identify the best way to ease you back into running without putting excessive stress on the recovering tissue. For example, running uphill will put a big ask on the proximal hamstrings, while running downhill is typically a lot more challenging for the Runner’s Knee crowd.
Make sure that you’re clear on the tissue and connect with a healthcare provider who can help you understand what that means for your plan to return.
3. Confirm readiness to run
The demands that running places on our bodies are significant. Depending on the study, it’s a safe bet that you’re up against at least 2.5x your body weight with every step you run, times ~1,000 steps per kilometre run.
Before you even start to consider what those first few steps look like post-injury, make sure you can tolerate those kinds of loads, period.
A few favourite tasks that we like runners to be able to nail free of discomfort before lacing up:
Brisk walk x 30 minutes
Single leg hop x 60 seconds on each side
Single leg calf raise x 30 on each side
Bounding x 10 per leg (minimum!)
As a bonus, these are some great goals to be working towards as you anxiously await the green light to get running again. Here’s to process goals!
4. Make a clear game plan with an emphasis on gradual progression
The biggest mistake we see runners make is diving back in without a clear plan in place. Not creating a clear plan means you risk being on either end of a spectrum:
Way overdoing it. Aka a fast track to re-injury.
Being so hesitant to load that you don’t create an environment for your body to adapt and progress.
Both those options are big limiters to your post-injury dreams, and both could be solved with a clear plan in place.
As you create that plan, a few things to consider include:
Whether or not discomfort is ok, and if so, how much. Talk to a run focused clinician if you’re unsure!
Clear targets so that you know what you’re building towards. I.e:
Increase frequency of runs to 4-5x per week at 30 minutes, then consider an increase in duration.
All runs are easy effort until you reach X minutes of continuous running. Then we introduce strides and hills (variance in loading patterns and impact forces to prepare the body for harder work, with a bonus of aerobic development). After Y successful runs, we look to introduce speed and/or tempo workouts.
Be prepared to adapt as needed. Every individual is different. Every injury is different. There’s no formula for any of this, but the better you plan and give yourself permission to adapt the plan as you go, the more likely you are to have long term success.
You are the absolute #1 expert in the world when it comes to your body, so be sure to pay attention to the cues it offers.
Returning from injury can feel like a daily dance between your body and your brain. Talk to your healthcare team, engage a coach in the process, learn as much as you can, and get an outside perspective if that feels helpful. But most of all, learn to trust your brain and body again. They form a pretty incredible team, if you let them!
5. Remind yourself that early runs are about building the musculoskeletal system, not the aerobic system.
Aka even if you feel ready to fly, keep it light! If you’re working so hard that the aerobic system is maxing out, you’re probably taking on a ton of risk to any lingering injury or weakness.
Just like when you’re training hard for a big race, every run has a goal. The goal in the early return to running phase is to train the musculoskeletal system so that it can absorb and adapt to tougher training later on. If you’re craving a seriously sweaty elevated heartbeat workout (and we feel you!), use cross training to your advantage.
6. Remember that setbacks are not failure
There is no one-size-fits-all approach to training, and there definitely isn’t a one-size-fits-all approach to recovering from injury.
Each run, workout, race or training block is an opportunity to add to our database of knowledge about what does or doesn’t work for us. Same thing for setbacks with injuries.
It’s frustrating, yes. But look at it as an opportunity to refine.
Your goal right now is to create an environment for your body to adapt. You’ve got multiple systems that need to be on board with that plan: musculoskeletal, neuromuscular, aerobic. On top of that, different elements within each system may have different capacities to tolerate running. That means that it might take a few tries to get it right. That’s ok.
But the good news is, with a little refinement, you will absolutely find your sweet spot. And once you do, you’ll adapt rapidly!
7. Celebrate the wins!
Two key facts about runners:
We’re typically a rather impatient crew.
We spend far more time longing to be further along in the process and dissecting every imperfection than we ever spend celebrating our progress!
A gut check reminder of how far we’ve come can be a huge mental boost in what can feel like a long haul process.
Of course, there may be days where you just need to wallow in an injury-fuelled pity party and that’s ok. Just be sure to eventually put a hard stop to it and celebrate progress, however fast or slow it may be!
And as a final reminder: you are an incredible human who has so much to offer beyond running! Injury can be a huge blow to our mental game, social lives, overall wellbeing and so much more. But the runners who are most successful in returning with next level resilience, strength and performance are those who are able to tap into life beyond running.
So consider reaching out to a non-runner friend, stay out past 9 on the night before your usual long run and tap into a hobby that usually gets tossed aside when running is keeping you busy. We promise you’ll be stronger for it.
We’re rooting for you!
If you’re uncertain of how to proceed, know that we would love to help you get the most out of your run.
More resources for managing running injuries:
The Ultimate Guide to Preventing Running Injuries - An all-inclusive guide written by physiotherapists specializing in supporting runners.
Returning to running after injury? Start here!
Should I run? A guide to help you navigate pain, and make educated decisions around running, racing and resting when pain strikes.
Our favourite strategy to kickstart recovery and prevent injury post-run is Active Isolated Stretching. Here’s why we love it and here’s the full series.