Running injuries can be unfortunately abundant, but it's hard to keep a runner down for very long. Unsurprisingly, one of the most common questions I hear is: "How do I return to running after an injury?"
This post originally appeared on Strength Running
But it's also an exceptionally complex question and there are always followups:
What type of injury do you have?
Is it chronic or your first time?
Did you run through pain (and make it worse)?
How much time did you take off from running?
So my answers aren't usually the most helpful because I don't know your training background or your level of running experience . Runners that I work with personally will get more specific advice because I know more of their variables and can offer specific solutions.
Recently I wrote about my Achilles tendon injury and how I was back to my pre-injury training volume within a week of being healthy, roughly.
Many were curious how I was able to return to running so soon after my Achilles injury. This post is a case study on how I modified my post-injury training, what worked for me, and how you can apply the same lessons to your running.
Before we get into the exact steps I took, let's be clear that this is a more aggressive approach for two important reasons:
- My training age is 15+ years (which means I can be more aggressive because of my experience level — I really know my body).
- I'm training to run a very competitive marathon in about ten weeks, so it's now or never. I'm willing take risks, though I wouldn't recommend it for everyone.
My comeback will be different than your comeback. My approach is riskier so I don't recommend this same method unless you're experienced and willing to take risks before a major race.
What Affects Your Return to Running After an Injury?
A running "injury" is a nebulous concept and I've written before about how we need to redefine what we actually call an injury. The very nature of your injury dictates whether you need a cautious or aggressive return to running.
It typically depends on four variables:
- The type of injury
- The severity of the injury
- How long you took off from regular running
- The consistency and quality of your treatment approach
These four issues work together to influence whether you're back to running within a week or a month.
Example 1: In 2008 I had severe ITBS and didn't run for six months. Not only was the injury serious, but I delayed my IT Band Syndrome treatment while I wallowed in self-pity. Once I took a more structured approach I finally got healthy, but my return to running took another six months of struggle. It was a long process.
Example 2: My recent Achilles injury was not severe and I caught it early, only running through pain for one short run. It wasn't chronic, my treatment approach was much more aggressive, and my comeback was relatively fast.
That's the type of injury I like to see: one that's resolved quickly!
Runners want to start running as soon as possible, so when I built my injury prevention program, the focus was on preventing injuries in the first place. But if you do suffer an injury, the treatment approaches (for ITBS, Achilles tendinopathy, runner's knee, and plantar fasciitis) are aggressive and designed to get you back to running quickly.
Post-Injury Training: Mileage
Since I'm training for the Boston Marathon, it's more beneficial for me to prioritise mileage than fast workouts. Thankfully, it's also easier to run for mileage after an injury than faster workouts.
Coming back from any injury (or extended period of time off) requires a gradual approach. The first few days of running are simply to establish consistency, evaluate any existing soreness or pain, and get your legs used to running again.
Knowing your "baseline mileage" is helpful here. Increasing your mileage up to your baseline can be done more quickly than the 10% Rule would suggest. Any increases after your baseline must be done more conservatively.
Here's a look at my daily mileage after my injury:
The first few days had low mileage totals — these days were simply to establish consistency. On the first day I ran three miles on the treadmill to test my Achilles. The treadmill provided two benefits: no hills to place extra stress on the tendon and the ability to stop at once if pain occurred.
The daily mileage doesn't always increase though: after seven miles, I cut the next day to five. After my first ten miler, I cut the next day to eight. For the next four days, I tested the Achilles to see if it could handle a normal workload of about ten miles. This is my "baseline" so it's relatively comfortable for me to run this amount.
There's no perfect way to structure a comeback, but my approach includes a few strategies:
- A short test run to see if any pain presented
- 3-4 days of low mileage to establish consistency
- 3-4 days of normal mileage to further establish consistency
- Like Matt Fitzgerald mentions in his book Brain Training, I have a zero-tolerance policy for sharp pain
My goal at first is to simply run every day — the effort on those days is secondary. Once consistency has been established, you can gradually add more advanced training like workouts, long runs, and double sessions.
Just like progression is used to increase training stresses, it should also be used with your return to running.
Faster workouts are even less important than overall consistency and mileage when coming back from an injury. My first workout was on the 28th after I had been running slow (except strides) for nearly a week.
I ran four miles of fast work with none of it faster than tempo pace — and three of those miles were at "Goal Marathon" pace or slower. So, not a very taxing workout. Instead, the goal was to simply run fast and see how the Achilles responded.
I followed that workout with a fartlek of 8x30 seconds at about 10k pace. The purpose of this workout was to establish the routine of running faster, twice per week instead of just once. Again, not a very taxing workout.
The pattern of testing each variable is what helps make the process of returning to running more effective.
Run a little bit less than you should. Run a little slower than you normally would. Introduce another training stress (mileage, workouts, frequency of workouts, long runs, etc.) gradually and with a "test" first.
So far, I've run four workouts in the two weeks since my Achilles healed:
- 4 x mile in 6:02, 5:56, 5:54, 5:38, 1' jog recovery
- 8 x 30" at 10k pace, 90" jog recovery
- 4 x 2k in 7:28, 7:23, 7:20, 6:58, 1' jog recovery
- 10' Progression near the end of a 10 mile run
And so far so good! Patience plays a big part of recovery and returning to your normal workload.
Prevention is Easier than Treatment
After an injury, the treatment steps often become means of prevention. Wisely invest 15 minutes a day in injury prevention and I would put cash money on you reducing your injury risk this year by more than half.
A common mistake I see runners make is that they stop all treatment steps after their injury heals. So if the ITB Rehab Routine is instrumental in the healing process, they stop using it while healthy. Big mistake!
Keep integrating treatment steps into your training even after you're healthy. You don't need as much, but a 5k of prevention is worth a marathon of cure. See what I did there?
And of course, if you're like this guy, I offer this coaching advice:
If you think you have no time for prevention work, you'll sooner or later have to find time for injuries.
How to Return to Running After an Injury [Strength Running]