How to Return to Running After an Injury

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How to Return to Running After an Injury

Words by David and Megan Roche
Photography and videography by Matt Trappe

We’ll let you in on a secret: running is the worst. That’s a weird way to start a running article, but it’s an essential jumping-off point. You can trust us, since we’re giving up the game. Running sucks.

At least, it sucks at first. That first run can be excruciating, clearly an abomination against nature and gravity. And let’s not even get into how the stomach responds to persistent up-and-down motion. That’s why non-runners make jokes about running, because they never get beyond those first sucky runs. But give it time and patience, and running can transform into something transcendent and beautiful. You just have to wade through the annoying, painfully slow crap to get there.

That starting-out feeling from your first few runs can also be evident in the return to run process. It’s easy to idealize the sport, thinking about those beautiful mountains you’ll climb and fast paces you’ll run. But all that comes later. To start, it can feel like you’re a hippo with hemorrhoids, painfully lumbering until it’s thankfully, mercifully time to stop.

On top of the psychological strain, coming back from injury is physically risky. There’s a constant risk of aggravating the injury, going back to the beginning, dusting off the walking boot or crutches. It can almost manifest like inklings of post-traumatic stress, with mental and physical challenges that make those few weeks or months even tougher than the initial injury.

That’s where this article comes in. Tons of runners have been through that return to run process before, and 8 principles can help you be back enjoying effortless running. Just wait until your doctor gives you the green light to start this process.

Walk before you can run

The best cross training activity to prepare for running is walking. That makes sense, right? It’s similar biomechanically, or at least more similar than a stationary bike. The problem is that many athletes consider cross training about aerobic development, ignoring the essential musculoskeletal adaptations that need to happen to withstand impact. Walking is the intermediate step between injury and running that many athletes skip.

Start with walking in everyday life, progress to relaxed hiking, and then to more vigorous hiking. There’s no need to go far or long, with an hour being a good time to target, progressing from every other day to almost every day as you gain strength. Walk over hills, rocks, and other terrain that challenges you. When you can do that with no ill effects, you’re ready to start running.

Mixing walking with running is a good way to start

Don’t just hop back into full runs. Because your body is adapting to the impact, even if you can run the entire time, you probably want to make sure that you aren’t doing damage that won’t be evident until post-run. Using run:walk methods can take some of the risk away.

Start with 1 minute running periods with 1 or 2 minutes walking. Do that every other day, building up run periods based on how you feel, until you’re running straight for 20 minutes. Only then increase frequency. This stage is also a good time to use the anti-gravity treadmill at the direction of a medical professional, just be careful about not overdoing it.

The initial goal is musculoskeletal strengthening, not aerobic development

Here’s the hardest part for many runners. It might not feel like training if your heart rate doesn’t get high, working the aerobic system. But the initial goal needs to be focused on the musculoskeletal system. Doing enough output to work the aerobic system a bunch will be a big risk to any lingering injuries.

Initial runs are not about aerobic training, they are about training the musculoskeletal system now so that it can absorb and adapt to aerobic training later. You can maintain more intense biking or elliptical for cross training on the off days from running to keep the aerobic system cranking.

Running economy reductions feel like fitness reductions, but they come back much more rapidly

Runners often feel like pace corresponds to fitness, but fitness isn’t really an output metric like that. Fitness is something that happens on the cellular level, with multiple systems interacting in complex ways. On the comeback, your running economy will need work--you’ll be using a ton of energy to go a given pace. That’s not because you can’t process oxygen on the cellular and systemic levels, that’s just because your neuromuscular and musculoskeletal systems aren’t used to the specific demands of running.

Fortunately, those systems adapt rapidly. Whereas aerobic development is best thought of on the scale of years, neuromuscular adaptations can happen in just a few days, and musculoskeletal adaptations on the scale of a week or two. So don’t judge. You’ll feel like donkey crap, and that’s okay. There’s just some donkey crap covering up a beautiful diamond of fitness.

Increase frequency of runs before increasing volume of runs

The body adapts rapidly to frequency, with consistent running entailing less risk and more reward than higher volumes at first. The general rule is to increase to 3 to 5 runs a week before you increase volume above 30 or 40 minutes at a time. Once you get there, you can add a sixth day or more time.

Add hills to increase loading

Just like walking is a bridge from being injured to running, hills are a bridge from returning to running and returning to workouts. As your running economy develops, your pace will naturally pick up, and that’s okay. But before doing concerted fast workouts, do some of those normal runs over hills. The variance in loading patterns and impact forces will prepare the body for harder work while getting some bonus aerobic development in the process.

Add hill strides and strides to improve running economy and increase output

Now, it’s a choose your own adventure story where different athletes will diverge. We like athletes to return to structured intensity with hill strides, 20 to 30 second intervals up a moderate incline, which keeps impact forces low while maximizing output. By straining upper end output first, it’s almost like a form of strength work for the muscles and joints, all while maintaining good form. Plus, the rapid increase in effort will expand cardiac stroke output, which could result in relatively quick running economy improvements.

Get back to full training load based on how you feel, not based on a formula

After you’re running frequently, sometimes over hills, with hill strides, you’re ready to ease back into normal training. The comeback from here will be intensely personal. Every athlete is different, every injury is different. You may be a rapid healer ready to kick it up to full gear immediately, but most likely you’re in the center of the bell curve, needing to do a linear progression of 10-20% per week. Just remember to listen to the #1 expert in the world on your body: you.

You have access to thousands of individual variables, all being integrated with that supercomputer between your ears. Pay attention to those variables. Feel off one day? Take 3 days off. Feel good one day? Maybe add another run. Talk to experts, read articles, and get an outside perspective, but most of all, learn to trust your brain and body again. Because your brain and body form an amazing machine.

Yeah, the machine runs miles. But it also can dance and sing and write and love. All of that gets combined to create you, this creature that is enough just the way it is, even when things don’t seem amazing . . . especially when things don’t seem amazing.

As a runner, you’ll get injured. As a person, you’ll screw up. All of those little things you might not love about yourself and your journey combine to create the whole you, such a beautiful piece of semi-organized stardust. Running injuries and other life setbacks are an essential part of your full journey. So let’s embrace them as much as we can. Even though injuries can suck to go through sometimes, you are amazing and enough all the time.

David and Megan are the coaches of the Some Work, All Play adventure team. Their book, The Happy Runner, is available now.