Return To Running From An Injury

Below is the full interview with A Sweat Life regarding how to deal with your running injury.


A Sweat Life (SW):

What’s the first thing you want to do when you feel a potential injury? Should you give it a few days to see how painful it is, or is it smart to visit a sports medicine professional right away? 

Eric Oliver (EO):  

If you feel a potential injury it's best to have it looked at by a doctor or physical therapist.  If you live in a state that allows you to see a physical therapist without a doctor's prescription then going the route of a physical therapist can be more ideal.  Working with a PT will not only allow you to get the injury assessed, but you will also be able to start a rehab program immediately without the extra run around of going through a doctor.  When going the PT route it is best to work with one who understands runners.  If the pain is severe, then a doctor's visit will be necessary especially if the symptoms may require additional testing such as an x-ray or MRI. 



Can you walk through the basic steps you should take to overcome some of these common injuries: 

  1. IT band issues?

  2. Runner's knee?

  3. Shin splints?

  4. A stress fracture or other bone injury?

  5. Sprained ankle?

  6. Tendon inflammation (achilles tendonitis, plantar fasciitis)?

  7. Any other common injuries?


Truthfully, all of the above injuries can be addressed with a common formula—

  1. Address the inflammation (ice, heat, over-the-counter anti-inflammatory medications)

  2. Identify the underlying dysfunction or issue (muscle inflexibility, muscle weakness, poor muscle recruitment patterning, poor neuromuscular coordination, poor joint mobility, poor running mechanics, poor training)

  3. Correct the dysfunction/issue

  4. Get quality sleep

  5. Give your body time to heal while finding alternate ways to continue training that doesn't exacerbate your symptoms.

Over time with the appropriate corrections and appropriate anti-inflammatory interventions your body will heal itself.  Our body is always trying to repair and heal itself.

There's no one specific device, doodad, shoe, or technique that will heal your running injury.

All of the above injuries can be attributed to any one or combination of the below listed factors.  Simply addressing these issues can take care of your injury, but identifying these issues takes a skilled eye and time to implement a treatment plan.  The most common factors that lead to injury include:

  1. Running too many miles than what your body can handle

  2. Racing beyond your training

  3. Running faster than what your body and fitness can handle

  4. Sub-optimal running mechanics such as overstepping or running with a low cadence (step count per minute)

  5. Poor running posture

  6. Weak or poor activation of gluteal muscles

  7. Weak or poor activation of diaphragm, back, and core muscles that contributes to poor running posture

  8. Inadequate single leg stability

  9. Inadequate quadricep, hip flexor, calf muscle, gluteal, or hamstring flexibility

  10. Inability to activate the above mentioned muscles in the correct sequence or at the appropriate time in the running sequence



Generally how much rest should you give yourself? Or how can you determine how much to pull back on running? Should you stop completely for awhile? 


This is dependent on the severity of your injury and the list of problems that need to be addressed.  Your healthcare practitioner will be able to give you a more specific time-frame based on your injury.  Generally speaking:

•Minor soft tissue and bone injuries can heal as soon as a week or two, but more severe injuries can take several weeks

•Once you introduce a new strength training or stretching program you typically won't see the physiological adaptation to the exercise for at least 3-4 weeks, so if strengthening a muscle(s) is part of your return to running plan don't expect to fully address the issue within 3-4 weeks.  This doesn't mean you can't run before this time period, especially if your pain has subsided, but it means that you may set yourself up for re-injury if you don't give the muscle time to adapt and learn how to support your running.

• Neuromuscular adaptation to exercises can happen within a week.  I recently changed how a runner engaged her gluteals while running in order to reduce the exertional demand on her hamstring.  The week before we did this she couldn't run more than 13 miles without having to stop and walk due to pain in her knee.  Three days after optimizing her muscle recruitment pattern to activate her gluteus maximus and medius, she ran 20 miles with zero pain.  No strength training or rest was involved in this quick turn around from having pain to no longer having pain. 

◦ Improvements in neuromotor recruitment or efficiency sometimes gives a perceived increase in strength in the short-term (within 1-2 weeks).  Rather, you are experiencing an improved efficiency in muscle recruitment and movement which can lead to increased force production during particular movements.  If your pain has an underlying issue with either poor muscle force production, motor coordination, or muscle recruitment then seeing an improvement in these issues can both help you return to running from an injury and prevent injury.

• Joint mobility can improve immediately after a joint manipulation.  Therefore if your pain is due to an immobile joint, manipulating it--as well as giving your injured tissue time to heal--may yield a relatively quicker healing time depending on the severity of the injury.



Should you try cross-training as possible?


If you have a clinician that understands the physiology of endurance training, he/she can create a training protocol that takes into account your injury and replaces  or complements your running with other cross-training activities that will prevent you from losing much fitness.  Cross-training will permit you to continue training your aerobic and anaerobic system without placing stress on your injury (depending on the injury/activity).  I tend to lean towards using an AlterG Anti-gravity treadmill and/or an elliptical because these devices most closely mimic running.  Pool running or aqua jogging is also a good option.  Other options are stationary cycling or outdoor cycling.  I was able to prepare a runner to qualify for the Olympic Trials in the Marathon by using a combination of AlterG, elliptical, and spinning (with a power meter).

If pain cannot be prevented then absolute rest is prescribed until the runner can move and cross-train without pain.  We will re-assess on a weekly or 10-day cycle depending on the injury so that we can return the runner to some level of activity as soon as possible as long as there's no significant pain involved.  All my runners who are rehabbing from an injury are given strength training exercises so as to prevent atrophy, strength loss, and motor coordination loss when they are not running as long as the exercises don't interfere with the recovery and are not painful.



How can you ease back into running? 


Once you graduate from your rehab program and your pain has subsided listen to your body, and have your clinician (if they are experience in creating running plans) or coach write up a return to running schedule.  We have samples on our website.  This is where working with a clinician who understands how to create and adapt a training program is important.  I am a certified running coach through the Road Runner’s of America and USA Track & Field and therefore have the knowledge base to not only identify and address injuries, but also carry that person over to the return-to-sport phase and performance phase. 


Eric Oliver is the owner and founder of Beyond Exercise, a physical therapy and fitness facility in Cincinnati, Ohio.  He is a physical therapist, run form specialist, and running coach.  He has participated in triathlons from sprint to 140.6 and in road running from 5k to half-marathon.