Running is a popular activity for many people. Whether they are training for a race, trying to stay fit, or cross training for other events, running is a common activity around the world. With running also comes injuries which will likely impact every runner at some point. In physical therapy, we often treat patients who are trying to return to running and are at various stages of rehab. When to start running again and how to do this safely are the two most common questions seen in rehab.
Before discussing a return to running, it will be helpful to review common injuries since this will directly inform how one goes about rehab and distance progression. In general, running injuries can be divided into chronic (or overuse) and acute categories. For chronic injuries, these will often be related to tendinopathies such as in the achilles or patella. Another common condition is ITB syndrome (iliotibial band) which is usually felt in runners as sharp pain on the lateral side of the knee. With all of these injuries is a component of over use, often as runners increase their mileage too quickly.
In contrast, acute injuries are less predictable and occur by accident. A classic example of this is a lateral ankle sprain or a hamstring strain. While training can help with prevention of these injuries, they can still occur and are very common for people engaged in athletic activity. With an acute injury, short term rest can be important but is usually kept to a week or less unless a more serious injury occurs. The most common site of an injury from running is the knee and a history of prev injury does increase risk for future injuries.
For most runners who want to return to action, I will often advocate reducing stress on the tissues in question which involves lower mileage. For a chronic issue this usually involves lowering the distance until pain is not a factor such as keeping runs below a certain mileage. Regardless of the type of injury, during this initial phase, I will have patients focus on retraining of the area involved such as strengthening the load a tendon can bear or accounting for imbalances in the kinetic chain.
For nearly all runners, their biggest question is what distance should I start with when returning to running? Instead of focusing on total distance, I nearly always think in terms of run to walk ratios when running is initiated. For instance I may have a patient start with runs of ½ mile followed by a ¼ mile walk. In this case their run to walk ratio is 2:1. They may end up covering several miles of distance, but they are doing this in a specific manner. From this start I will change the ratio to increasingly favor running over walking until my patients are running several miles without stopping. The total distances will obviously be based on patient desires since someone who wants to run a 5k will have very different rehab from someone who wants to run marathons.
The biggest takeaway for running, whether one is just starting or returning from injury, is utilizing a weekly progression. A good rule of thumb is to increase distance by, at most, 10% each week. This is usually what I advocate for runners and will help guide runners on safely increasing their distance. It is important to remember that injuries are common with all athletic endeavors and does not indicate that running cannot be done safely.
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