How to get back to running after an injury

How to get back to running after an injury

Getting injured is the reality of an athlete. The repetitive movements put a lot of stress on muscles, joints, tendons, and ligaments. The human body is designed to adapt to stress, however training stress should be gradually increased in small doses. When you apply more stress than your body can handle, things go wrong and that can lead to the most common overuse running injuries: lower back pain, shin splints, plantar fasciitis, Achilles tendonitis, patella tendonitis, gluteal tendinopathy, iliotibial band syndrome, runners knee to mention a few. The type and severity of the injury, as well as recovery time and quality of treatment, define how soon you are going to return to previous training loads. It is important to highlight that returning to training after an injury requires a cautious approach, not to worsen an already existing problem or create a new one.

What happens to your body when you stop running?

Injured runners often have to deal with the most terrifying condition after a break from running: decrease of fitness. However, deconditioning is highly dependent on pre-existing training and fitness level. Therefore the longer you have been training the quicker you will be able to get back to it again. 

During the rest period,  blood volume and mitochondria (the powerhouse of the cell) decrease,  lowering VO2 max and cardio-respiratory fitness and also oxygen supply to muscles. Furthermore, there is also a decrease of conditioning in muscles, tendons, ligaments and connective tissues, weakening the musculoskeletal system. However, the longer  you have been running the bigger the foundation and efficiency of your aerobic capacity and muscle strength. You maintain higher levels of mitochondria to produce energy and more blood cells to deliver oxygen to the muscles than someone who just started running. Even though the overall fitness decreases, it will not fall as low as if you just began training.

Following a structured running program specially designed for runners returning after injury is imperative to lower as much as possible the chances of getting injured again and have a great return to full running fitness level. Here are some tips that can help recovering runners successfully get back to training and avoid injuries. 

1. Wait until it's time 

The most obvious sign that the rehabilitation has worked is the absence of pain. If you still experience pain, discomfort or limitation, it is not time to return to running. The recovery period is an opportunity to fully understand the injury and dedicate as much time as needed to physiotherapy sessions and rehab exercises. By comprehending the whole spectrum of injury and the factors that could have caused it, you will be able to run more effectively when coming back to training and reduce the risk of getting injured in the future. 

2. Start slow

One of the most common mistakes runners make when coming back to training after an injury is doing too much too soon. The most important thing to keep in mind after a long rehabilitation is that it is crucial to go slow and be extremely conservative in the post-recovery period. After an injury, muscles, ligaments, and tendons are much more sensitive to stress. It is very important to apply the load and stress to the body in a graded and systematic manner to give soft tissues time to re-adapt to physical demands.

The first few days of running should be all about examining the injured parts of your body, noticing whether there is soreness or pain and letting legs get used to running again. Running at a slower pace and much less mileage than usual is required to progressively impose stress on the musculoskeletal system and, consequently, adapting to the impact again. Patience is gold here so there is no need to rush things.

3. Get a training plan

Periodization is an organized training program during a specific time. Divided by cycles, it allows your body to adapt to different types of stress and is considered the best strategy to promote the training effect, in other words, changes in the cardiovascular and musculoskeletal system that result in greater performance. 

Periodization involves hard training sessions and some periods of adequate rest which provides the tissues a chance to repair and therefore reduces the risk of injuries. Runners also feel more motivated to train as a periodization program provides measurable progress that helps them to work consistently to reach their goals.

Nevertheless, it is important not to push too hard when the body says "no", even when there is a hard training session scheduled for that particular day. Stress accumulates, so you should be aware of how much your body is prepared for a big training session. If you are not feeling it, perhaps it’s better to do an easier workout or simply take a day off.

4. Prevention is better than treatment

Investing some minutes of weekly training in injury prevention exercises such as strength and mobility will minimize the chances of getting injured. Many runners are reluctant to strength training, however lifting weights is not always about getting big and heavy. Weight training prevents injuries by strengthening muscles and connective tissues, improving neuromuscular coordination and power, running economy and stride efficiency. 

Stretching and mobility exercises are equally important to relax and improve elasticity in tight muscles and increase joint flexibility. They also reduce muscular fatigue and enhance muscle efficiency by improving the ability of muscles to contract.

Core exercises are your best friends as they do their job when it comes to strengthening all muscles from shoulders down to the hips. Core muscles are responsible for stabilizing the trunk and developing running form. Underdeveloped core muscles decrease forward propulsion as the body makes unnecessary movements to stabilize the trunk to compensate those weak muscles, compromising running technique and performance. On the other hand, strong core muscles ensure an efficient transfer of forces to the ground providing energy economy and protecting the body against the impacts associated with running.

Runners that have been through physical therapy (or even those who never got injured) should not abandon rehab exercises as soon as they recover. It has been proven to be a good idea to incorporate those exercises in runner's daily routine due to their effectiveness in working on very specific and critical areas of the body.

Yoga can be very beneficial for runners as the practice promotes both stretching and strengthening, bringing the body into balance and moreover promotes the sense of relaxation that is very important during the recovery period.

Foam roller is something that all runners have heard about. Some of them often use it after running, some never tried it, but the truth is, foam roller is a valuable tool to recover tired and tight muscles and avoid injury. Using a foam roller is a light form of myofascial release which reduces pain and muscle tightness by easing the tension in trigger points (or muscle "knots") and enhances blood flow, being best performed after training as a recovery method and to prepare muscles for stretching. Foam rolling is a post-running recovery activity that you should incorporate into your weekly routine because it helps to prevent the previous injury from returning and reduces the risks of getting injured with the benefit of using inexpensive equipment.

Unfortunately, getting injured is not uncommon for runners, whether they are training for an ultramarathon or a 5k. Being away from running for a while can be emotionally hard to deal with. Nevertheless, running is about being both physically and mentally healthy, is about having fun. If you are struggling with an injury, taking as much time as necessary to get fully recovered and working seriously on preventive exercises and physical therapy can help you to go on with your passion and make running more enjoyable than ever.