Running After Injury

Some physical therapists have long considered knee braces as detrimental to future knee health.  After all, why do we want to teach our patients to be dependent on knee braces when we can solve their knee pain through knee strengthening and teaching proper biomechanics? Some physical therapists may also purport knee braces causing perpetual weakness in surrounding knee muscles through dependency on external support. If there’s one thing runners know, it is that injuries happen. We do our best to train smart, cross-train, and strengthen.. and they still happen.
If there’s one thing physical therapists know, it is that runners will continue to run. And they should. People don’t come to physical therapy to be told to stop doing what you love- they often come to learn how and when they can continue to do what they love. If what you love is running, read on for some recent evidence on safe mileage increases and general guidelines I often use to answer the common
question, “when can I run again?”

 

1. DO YOUR LEGS MATCH?

The three areas we typically focus on when answering this question are strength, balance, and flexibility. There are a gauntlet of tests your physical therapist may choose in order to examine this issue including single-leg squats, heel raises, single-leg balance, and range of motion measures in the affected area. Your home exercises should feel similar when performed on either leg.
A good in-clinic test Stride Strong PTs perform to see if you are in a healthy place to start a focused/intense running program again is our Y-balance test and Return-To-Sport Screen, where a PT compares strength and flexibility of each leg in functional movements to see if they match.

 

2. DO YOU STILL REQUIRE MEDICATIONS FOR CONTROL OF PAIN OR INFLAMMATION?

A runner who pops a few ibuprofen before and after a run may not be getting the data his body is trying to share with him. Prescribing or altering medications are outside a physical therapist’s scope of practice, but I like to hear my patients say they no longer need medications before pushing themselves physically outside the clinic.

 

3. WALK BEFORE YOU RUN

One of the most straightforward rules of thumb I use is that you should be able to comfortably walk your dog (about 30 minutes) without difficulty before attempting to run.

 

4. HOP, SKIP, AND A RUN

Running is the act of hopping from one foot to the other. Assuming walking is no longer a problem, try hopping in place for 30 seconds. No issues? Try skipping in a straight line. Still good? You might be ready for a controlled return to run.

RETURN TO RUN

If your injury no longer interferes with your daily activities outside of running and you’ve worked through the above steps with your physical therapist, you may be considering a safe return to running. One conservative way to do this is starting with a walk-run program where you gradually increase the percent of running in the sessions. The following is an example of how you might do this with 30-minute workouts per week.

 

Week # Run Walk Repeat
1 1′ 4′ 6x
2 2′ 3′ 6x
3 3′ 2′ 6x
4 4′ 1′ 6x

 

SAFE MILEAGE PROGRESSION
So you’re back to running and enthusiastic about training for your race this summer, and you may be wondering how to safely add mileage so you don’t end up back in physical therapy with the same (or a different injury). The Journal of Sports and Orthopedic Physical Therapy did a neat study recently testing “The 10% Rule” we often used as a guide for runners. This rule recommends increases of 10% per week as a safe schedule. By outfitting hundreds of novice runners with GPS devices and comparing injury rates to mileage progressions, they actually found that 10% increases per TWO WEEKS was a safe bet for many common running injuries. Read on for more details athttp://www.jospt.org/doi/pdf/10.2519/jospt.2014.0506.

 

References:
Nielsen, R. Ø., Parner, E. T., Nohr, E. A., Sørensen, H., Lind, M., & Rasmussen, S. (2014). Excessive progression in weekly running distance and risk of running-related injuries: an association which varies according to type of injury. journal of orthopaedic & sports physical therapy, 44(10), 739-747.
How to Safely Increase Your Mileage. J Orthop Sports Phys Ther, 44(10), 748.
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