Hey friend! My name is Dr. Matthew Klayman. I’m a runner and physical therapist living in Chicago, and today I’m excited to talk to you about one of my favorite subjects, coming back to running after injury. This shouldn’t come as a surprise, but one of the best parts about my job is clearing a runner to run after they’ve been hurt. It’s an emotional moment, and today I want to talk about the key things any runner should think about when they want to return to running after physical therapy.
Let’s start at the beginning. If you’re reading this, you or a runner you know may have just graduated from PT! Although you went there feeling injured, you’re slowly returning to your normal self. As you finish your sessions, it is important to get cleared to run and build a plan with your PT. Your therapist can help you determine a realistic running goal, so make sure the two of you are on the same page. It all starts with communication.
By the time you finish PT, you should be pain free when walking and performing lower-level activity. However, as we all know, running is a different beast. Whether you sprained your ankle or had major knee surgery, there is usually confusion and worry when getting back to your old running self. You are likely asking yourself questions like “Am I able to return to running my normal speed or mileage?” “Will I always have to keep up with my exercises?” and “Will I constantly be thinking and worrying about my injury?”
I’ll give the bad news first. You won’t feel like your normal self after that first run. Our bodies are amazing at healing, but our tissues need time to adapt to load and stress. Just like shoes take time to wear in, our lower extremities need to be exposed to the rigors of forces coming up from the ground when we strike our foot while running. There is meaningful impact associated with walking, but it is significantly greater with running. Certain parts of our body, like our knees, experience up to 4.6x more force when running than walking (study). So, we’ve got to build up slowly. This is called “graded exposure.” Graded exposure to running forces allow our muscles, connective tissue, and brain time to adapt to the demands of the motion.
Key things to remember as you return to running
As you begin to test the waters with a return to running, there are a few considerations that will keep you safe and healthy:
- Keep up with your exercises: They were given to you to stay strong and mobile. Working your glutes, lateral hips, calves, and quads goes a long way with helping you run more efficiently. Consider using the Recover App to stay on track with varied exercises for your previous injury.
- Stay on one surface: As you ramp up mileage, stay on soft and even surfaces. Running downhill increases load at the knee by as much as 70% at comparable paces, so try to avoid downhill or unstable surfaces whenever possible (study).
- Use plyometrics to increase your tolerance for load: Getting your legs used to higher amounts of steps will help you dissipate load better. Trying this routine once per week is a great place to start.
- Consider a run-walk method to build up your mileage: Here’s a free program from one of the top running scientists in the world. That old rule of thumb “the 10% rule” is useful here too.
- Keep your stride rate up: The relationship between stride rate and injury is complicated, but increasing your cadence can move load from the knee to higher capacity parts of your legs (study). Think of having a short, quick stride, and use a GPS watch or your phone to see where you’re at. Increasing your stride rate 5% from what you usually do decreases the load in your knee by 20% (study)
As you embark on your running recovery, know and accept that getting back in the swing of things will have its challenges. Keep in mind that general muscle soreness is normal within 24-48 hours of a run and stiffness should dissipate shortly after you start moving. If soreness turns painful and lasts for longer than 48 hours, chances are you overdid it a bit. Never panic, and always keep a scientists eye on your body. Be especially careful if you notice your stride start to change; this can lead to compensatory patterns which will stress the muscles in ways they’re not used. If this persists, check out Recover for exercises to decrease pain and take your training down a bit for a few days until soreness dissipates. If symptoms continue, always consult with your PT.
What injury comeback usually looks like
Coming back to running following an injury is hard. It probably won’t be a perfectly straight line, but remember, your body was designed to heal. You will come back, and if you listen to your body, you’ll be amazed how quickly you’re back to full strength. Always remember the tools you have at your disposal to help you on this journey. Use your PT exercises and/or Recover to reduce pain, improve strength, and improve mobility, and keep in mind that your PT is there for you even after you are discharged. We always have your back (and your running legs too)!
– Dr. Matthew Klayman, PT, DPT, OCS
Dr. Matthew Klayman is a Chicago based runner and physical therapist with more than 5 years experience helping runners come back from injury. You can connect with him on social media and learn how to book an appointment with him here. Get excited for more of Dr. Klayman’s favorite routines coming soon to the Recover app!