When a runner comes to physical therapy looking for help returning to running we take them through a few first steps. First, my team of physical therapists will ask about their history with running, any injuries they are experiencing now or have experienced due to running in the past and what their goals are for future running. We will gather any injury- or surgery-related protocols from their doctors to guide their rehab and return to running. We will then perform a physical examination to assess the injured area and also to assess other components of the body that are important for running like hip strength, core stability, ankle mobility and so forth. With all of this information we will create a plan to address any injuries while also building the necessary strength, motor control, endurance and mobility needed throughout the body to return successfully to running. Once cleared to begin a return to running protocol they will be taken through a progressive series of activities that usually starts with strength training and walking and progresses eventually to a full return to running. As they go we will be assessing their response to running, looking out for any symptom exacerbation or new issues and helping them make modifications and decisions along the way.

HOW LONG DOES A RETURN TO RUNNING PROGRAM TAKE?

If you decide to work with a physical therapist to help with Return to Running related issues, your entire treatment plan could consist of around 8-20+ different return to running physical therapy sessions that will each last 60-90 minutes. Once you complete your customized physical therapy treatment plan, you will be able to continue to do the prescribed stretches and exercises utilized during your PT sessions yet in the comfort of your own home.

Looking for the cause of an injury

You might be wondering why therapists put you through such a rigorous and gradual program when returning to running. Running is an activity that is both higher impact and also repetitive. These types of activities place a higher degree of stress throughout the joints, bones, tendons, muscles and ligaments. When you begin to run you typically start with shorter, easier runs and over time, as you become more fit, build up in speed, duration and frequency of runs. This gradual increase in volume and intensity promotes physiologic adaptations in body tissues so that they are able to gradually withstand the increasing load you place through it as you progress. So while the body can positively adapt to the increasing volume of running, the opposite is also true. When you take time off, especially more than 4 weeks, these adaptations begin to reverse. Your tissues are no longer capable of withstanding the forces placed on it by your earlier run volume and intensity. The longer the break, the more those adaptations decrease and eventually returning to running too quickly or at too high of an intensity will overload the deacclimatized tissues in a way that will likely cause injury. Add to this mix a running injury, where tissues are not as healthy as they normally are, and you have a recipe for ongoing or new injuries if you don’t approach returning to running the right way. A return to run protocol aims to combat these concerns and with the help of your physical therapist you can feel confident you are progressing in a safe and effective manner.

WHAT DOES A RETURN TO RUN PROTOCOL LOOK LIKE?

• Rehab is needed to address the injury and ensure the injured tissues are ready to begin loading more aggressively
• It is important to initiate higher impact activities like progressive plyometrics before running
• A runner is able to walk longer distances without pain or changes in their gait before initiating running
• Running begins in short bouts with at least 24 hours rest in between
• Running volume increases about 10% each week
• Specific criteria exists to evaluate any onset of pain, i.e. when it is ok to push through and when a runner needs to stop progressing or regress
• Guidelines are provided on when it is ok to begin speed work or hill workouts
• A complementary strength program continues throughout the program