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Coming Back After Injury

Posted by: on January, 15 2015

Found on Competitor.com and written by Brian Hodge, MSPT

The key for a successful return to running is allowing the soft tissues to have the chance to adapt. 

One of the most common frustrations for any experienced runner is making a successful return to running after being sidelined with an injury. Even for a fairly efficient runner, the act of running puts considerable stress on the joints, muscles, tendons and ligaments. If the stressing demands of running are introduced at a rate and volume that the body is not ready for—especially after time off after an injury—it makes recovery difficult and makes the body vulnerable to new injuries due to compromised form. The key for a successful return is allowing the soft tissues to have the chance to adapt.

With proper periodization, the body is able to adapt to stress. But without the opportunity to adjust to demand levels, there will be tissue failure (injury). For example, runners can get blisters from running in a new pair of shoes for too long. The skin experiences a stress (in this case friction) that it is not accustomed to, so there is tissue failure. However, by gradually increasing wear time, the skin adapts by developing a callous and is able to endure the new stress without tissue failure. This same concept occurs in other areas of the body.

Even if an injured runner is continuing to swim, bike or use any other form of cardiovascular exercise as a substitute, the exact stressors of running are not being replicated and new conditioning of the soft tissue occurs. For example, common injuries that occur for a biker when trying to transition back into running are hip flexor strains and hamstring strains. This common frustration however, can commonly be avoided with the right plan, one I refer to as “The Rule of Two.”

Start with a 10-minute run at a comfortable pace. If you’ve already been using a bike or any other form of exercise during the layoff, you can offset your times. For example, if you were doing 45 minutes of biking, start with 10 minutes of running and 35 minutes of biking. Next is where the “two” comes into play. If you experienced no pain during or after the run, add two minutes to your next run. As long as your body feels sound, add two minutes per run. But, if you experience unfavorable symptoms, subtract two minutes from your next run and do not increase running times until you have at least two consecutive successful runs.

This system of starting with a 10 minute run and increasing by two-minute increments may seem slow at first, but it builds quickly if your body is truly healthy and ready for the progression.  A runner rebuilding with four runs per week will be running 42 minutes after only four weeks. If the body isn’t ready, its better find out earlier by paying attention to pain clues, otherwise potential setbacks are much larger.


Day 1 – 10-minute run  (option – 35-minute bike) — result = no pains

Day 2 – 12-minute run  (option – 33-minute bike) — result = no pains

Day 3 – 14-minute run  (option – 31-minute bike) — result = discomfort after the run

Day 4 – 12-minute run  (option – 33-minute bike) —  result = no pain

Day 5 – 12-minute run  (option – 33-minute bike) — result = no pain

Day 6 – 14-minute run  (option – 31-minute bike) — result = no pain

Day 7 – 16-minute run (option – 29-minute bike) — result = no pain

Finally, remember to always warm-up before running. A brisk 10-minute walk or 10 minutes of easy jogging followed by dynamic drills is effective. Staying well hydrated also aids soft tissue resiliency.

Most importantly, be willing to listen to your body. Our minds commonly say “go,” yet our bodies are often trying to tell us something else. Continue progressing run duration for three to four weeks before pushing speed. Don’t do both at the same time. If an injury persists, consult your doctor or physical therapist.


About The Author:

Brian Hodge is a physical therapist in Washington DC.