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Getting back to running after injury.

Getting back to running after injury.

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Returning to running after an injury can be daunting. Research suggests that 28% of novice runners who get injured do not return to running again. Is the experience so terrible that they choose to give up on running forever? That being said, I am yet to meet an injured trail runner who isn’t already planning their return up the mountain.

Successful return to running is not an exact science; your progress will depend on the type and severity of your injury, how long you had to be off from running and whether you followed the appropriate rehab principles during recovery.

To guide you through the process, I put together a few principles to help you transition back to running:

1. Pass the test:

Before you start running again, make sure you regain pain free joint range of motion, adequate muscle strength and normal balance. Also re-evaluate your readiness to run by performing running specific tests. These tests should replicate (trail) running motions: landing, pushing, jumping, climbing, etc. infographics-main-v8

  • Balance on the injured side for 30 seconds.
  • Perform 10 single leg squats, heel raises, step up’s and step down’s.
  • Perform 20 single leg hops.
  • Bound and side-bound.
  • Perform box jumps and split jumps.
  • Run on the spot – the best way to test if running is pain free, is to run.

The sequence is available on video here. Always compare the injured limb to the non-injured side. Once the tests are normal and pain free, you are ready to run.

2. Get your head in the game: #positivethinkinginfographics-main-v82

Poor motivation, lack of confidence and fear of re-injury are your biggest enemies when it comes to successful return to running and pre-injury performance level. How do we overcome these psychological barriers?

Get motivated by setting (realistic) goals:

  • Enter a race; it will motivate you to start training.
  • Improve your 5k PB; it will motivate you to run faster.
  • Plan your own mountain summit / trail challenge.

Consistency builds confidence: Try not to skip training sessions. With each training session you successfully complete, you build confidence in your ability to run. Take a moment at the end of each week to look back at what you’ve accomplished.

Face your Fear: Fear of re-injury is normal but can become a barrier that prevents you from reaching your pre-injury performance potential. I often see runners still “nursing” and “protecting” an injured area long after the injury healed. You might be missing out on carefree running and peak performance. So trust your body and repeat after me:

I am not made of papier-mâché,

I am tough and resilient,

my body is adaptable and quick to heal.

based on quote by Sano

3. Learn from your mistakes:

enhanced-3632-1431454816-7Before you return to running, make sure you sort out the training errors that lead to the injury in the first place. Addressing the cause of the injury is key in preventing re-injury. Possible training errors to consider:

  • Poor running form.
  • Overtraining: sudden changes in training intensity, distance and surfaces.
  • Under recovery: lack of sleep and rest.
  • Poor nutrition: not getting the required nutrients for tissue repair.
  • Inadequate running shoes.
  • Mobility and/or strength deficits.

When I work with an injured runner, we aim to pinpoint the training errors during the first evaluation. The biggest mistake I see runners make is overtraining. Overtraining can easily be avoided by sticking to a goal centred training program.

4. Use the Traffic light guide to monitor pain and progress:

Aches and pains during training is normal, even non-injured runners experience this. So, how do I recognise the difference between injury and normal exercise soreness? Use the traffic light guide:three-things-infog-v22

 5. How far? How fast? How much?

Running is not the end goal but forms part of the recovery process. Throughout rehabilitation we load the injured tissues, allow them to recover and get stronger, before increasing the load again. Running is just another progression of load. How to approach running progressions:infographics-main-v83

  • Run fast and short, not long and slow. There is a misperception that we need to “go slow” or “take it easy” when we return to running. Long slow distance (LSD) is often what lead to overtraining and injury in the first place. Running at tempo pace for shorter distances with recovery walks/hikes in between, produce better improvements in running ability. Running faster encourages better running form and prevents poor movement patterns. Not only is the run/walk interval approach more specific to trail running but interval training also leads to greater gains in fitness. So instead of shuffling at 7min/km for 30min, run 1min at goal race pace (4-6min/km) then walk/hike for 1min.
  • Not all injuries will keep us from running. Often we only need to temporarily reduce the training load/volume to give the tissues time to adapt and recover, before gradually increasing distance again. This is a yellow traffic light scenario: decrease training volume and increase recovery time to stay below the injury threshold.
  • If you’ve been off running for less than 3 weeks and distance was not the cause of the injury, resume your normal training program, but don’t attempt to make up the lost kilometers.
  • If the injury kept you from running for an extended period of time, start with walk/run intervals: 1min walk/1min run. Gradually build up to 30 minutes then increase the run interval. Once you are able to run 30min without provoking pain, you can resume a normal training program. 30 minutes will be your baseline time/distance. Depending on pace, 30min can be 4km for some runners and closer to 8km for faster runners.
  • Use the traffic light guide and keep a training diary/logbook to monitor pain and progress.
  • Never run more than 2 days before you take 1 day off for rest and recovery.
  • Follow a goal specific training program that includes running, strength training, plyometric drills and mobility maintenance. Don’t neglect your final rehab exercises once you get back to running.

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That’s what a comeback is. You have a starting point and you build strength and momentum from there. Stay the course…remain patient. Focus on small steps that are constantly forward. –Kara Goucher

Note: The guidelines above are general principles and should not replace specific protocols or advice prescribed by your Doctor, Surgeon or Physio. When in doubt about readiness to run, book an assessment. Consult you health care provider should you experience recurring symptoms.

Happy Running

Tarrin

Tarrin van Niekerk

Physiotherapist and Blogger at Running Clinic & UltraRunner ZA
I am a Physiotherapist with a special interest in running injury prevention.I enjoy running in all its forms; but I am happiest in the mountains.I believe in empowering runners by teaching them self-management and injury-prevention strategies. You have all the answers as to why you have pain, I just know how to ask the right questions.I am a fan of common sense and the best current available evidence.

You can find me at:
tarrin@runningclinic.co.za
071 685 2235
Practice: Lifestyle Management Park
Unit 4, Second Floor, Suite 224
Clifton Ave, Lyttelton, Centurion
012 664 6128

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About The Author

I am a Physiotherapist with a special interest in running injury prevention. I enjoy running in all its forms; but I am happiest in the mountains. I believe in empowering runners by teaching them self-management and injury-prevention strategies. You have all the answers as to why you have pain, I just know how to ask the right questions. I am a fan of common sense and the best current available evidence. You can find me at: tarrin@runningclinic.co.za 071 685 2235 Practice: Lifestyle Management Park Unit 4, Second Floor, Suite 224 Clifton Ave, Lyttelton, Centurion 012 664 6128

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