How to Return to Running After an Injury

For avid runners, returning to running after an injury can be a bit tricky. It’s frustrating, and a significant test of your patience. However, returning to running after an injury can also be a way to prolong your injury, set you back, or create a new injury if done too quickly.

The following information is taken from two experts in running analysis and runner rehabilitation - Bryan Heiderscheit PT, PhD at the university of Madison, and Jeff Gaudette, Founder and CEO of RunnersConnect. Bryan is the head of the UW runner’s clinic and the Badger Athletic Performance Research Lab. He is on the cutting edge of runner rehab and is a great source for anyone interested in running mechanics.

There currently is no evidence or research that is available to indicate a “best approach” to returning to running, and the information we do have is based off Physical Therapist recommendations in regards to consideration of tissue readiness and strength.

The main factors to think about before running after an injury are:

  1. Don’t get frustrated with missed training,
  2. Don’t worry about lost fitness, and most importantly,
  3. DO NOT attempt to make up for missed training.

Attempting to make up for missed training can lead to increased risk of overtraining and injury. This may take the form of adding additional miles to workouts, increasing your training pace, or increasing the frequency of workouts.

Rate of Deconditioning

When we are forced to stop working out due to injury, atrophy and deconditioning can happen quickly. According to research by Jeff Guadette, if you are not able to run for 1-7 days, there is a negligible reduction in VO2 max and muscle power. This means that a 20 min 5k runner would now be running at about 20:10.

  • After 10-14 days, there is a 6% reduction which translates to a 21:05 5k.
  • After 14-30 days there is a 12% decrease equaling a 23:00 5k.
  • After 30-63 days equals a 19% decrease and a 24:00 5k.
  • After 63 or more days of not running equals roughly a 26% decrease in VO2 max and significant decrease in muscle power and approximately a 25:30 5k.

Before we get to the recommendations for return to running, be sure that during your break from running, you are building as much strength as possible. Runners need to be working on their core, glutes, hamstrings, and calf muscles. Plyometric exercises should also be performed such as hopping (double leg progressing to single leg), jumping rope, cariocas, A and B skips, etc. Consult a physical therapist to get the most out of your time off from running and help you with your rehab.

Below are 5 scenarios that will help you get back to regular training depending on how long you’ve been out.

Running After an Injury of 5 days or less

As noted before, there should be no loss of fitness and strength, so your legs should respond quickly. A 1-2 week progression is recommended. 1st run at about 70-75%. This run should be an easy run. Following that do 3-4 runs at 80-90% of normal. During the second week add some tempo and strides of 60-100 meters pickups. After your second week you should be able to return to normal training.

Time from Running: 6-10 days

When running after an injury of 6 - 10 days, there will be a slight loss of fitness and leg strength. This should be a 2-3 week progression. Start with 1-3 runs at usual easy effort.Start at 60-70% of easy mileage and increase 10-15% each day. Add some tempo and strides of 60-100 meter pickups during 2nd and 3rd weeks. After that you are ok to resume your normal training.

Time from Running: 10-14 days

At this stage there should be a noticeable loss of fitness and leg strength. This should be a 3 week or more progression. 1-3 runs at easy run effort. Start at 50-60% of easy mileage and increase 10% each day. Add tempo and strides 60-100 meter pickups during weeks 2-3. After at least 3 weeks you are ok to return to normal training.

Time from Running: 2-4 weeks

This should be a 6 week progression starting with easy run effort. Begin at 30% of pre-injury mileage and increase 10% each week. When you have returned to your pre-injury mileage, gradually increase your speed. You can also begin adding tempo and strides when you have returned to pre-injury mileage. After 6 weeks you are ok to resume normal training.

One note here about running downhill.

A 6 degree downhill increases the force on your joints and muscles by 30%. A 9 degree downhill increases the force by 50%. It is recommended that you are running 30-45 minutes of normal speed for 2-3 weeks before beginning to run downhills.

Find some flat routes for a while and if you have to go downhill, shorten your stride and slow your speed. In general you should avoid hills and speed work until you are back to 75-80% of pre-injury mileage WITHOUT pain. Typically you should not begin incorporating any speed work until you have a consistent 20 miles/week base.

Running After an Injury of 6 weeks or more

If you’ve been away from running for six weeks or more, there is a substantial reduction in VO2 max and strength with this amount of time removed from running. Remember to be patient! Don’t risk re-injury by going back too fast. Begin this stage with a walk run progression as noted below.

WeekDay 1Day 2Day 3
16x: walk 4.5 min, run .5 min6x: walk 4.0 mi, run 1.0 min6x: walk 3.5 min, run 1.5 min
26x: walk 3.0 min, run 2.0 min6x: walk 2.5 min, run 2.5 min6x: walk 2.0 min, run 3.0 min
36x: walk 1.5 min, run 3.5 min6x: walk 1.0 min, run 4.0 min6x: walk .5 min, run 4.5 min
4Run 30 minRun 30 minRun 30 min

Once you are back to running 30 min, 3x/week, begin a 6 week progression that is the same as the previous section. Begin at 30% of your pre-injury mileage and add 10% each week. Once you are back to your pre-injury mileage, gradually increase your speed and add tempo and strides. After 6 weeks you can resume normal training.

This is merely a guideline for you to follow to hopefully avoid injury. As a physical therapist, the less I have to see you, the better. Be patient and remember that your body needs time to heal. I hope this is a helpful guideline for you to follow.

Ross Vannatta

Ross Vannatta

I have been a practicing Physical Therapist in an orthopedic outpatient setting for the past 11 years in Minnesota. My wife and I recently moved to the state of Rhode Island where I continue to practice in a clinic focused on sports medicine and orthopedics. I have recently returned to running thanks to Physical Therapy! If it worked for me, it can work for you.
Ross Vannatta

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