Returning to running after injury, a staged plan
After an injury, the first run back can feel like a big moment. Some people rush it and end up sore again within a week. Others wait so long that they lose fitness and confidence.
A staged plan sits between these two. You build up step by step, and each step depends on how your body handled the last one.
Why a staged return helps
Running puts a lot of repeated load through your legs. Muscles, tendons and bones all adapt to the load you give them, but they need time. After an injury, and after time off, your tissues can handle less than before.
Sports medicine experts agree that big, sudden jumps in training load are linked to a higher chance of injury.1 A slow, steady build up gives your body the chance to catch up.
What the research can and cannot tell you
There is good agreement among experts on the general approach. There is much less research on the exact steps.
An international group of sports physiotherapists described return to sport as a gradual process that runs alongside rehab, instead of a single decision at the end.2 They also noted that research to guide these decisions is scarce. A guideline on rehab after knee ligament surgery listed return to running as a key milestone, but found no research to say which tests should decide when to start.3 An expert panel on hamstring injuries agreed that running should be built back up based on how you respond, and that sprinting should be pain free.4
So the stages below are based on expert agreement and clinical experience. They are a guide that your physiotherapist adjusts for you.
The stages
Stage one, getting ready to run
Before running, you need to walk comfortably for a good length of time without a limp. Your physiotherapist checks that you have the strength, balance and control to handle running. This often includes single leg exercises such as calf raises, squats, step-downs and hops. Strength in the injured leg should be close to the other side.
Stage two, walk and run
Your first runs mix short bouts of easy running with walking breaks. The pace is slow and the ground is flat and even. Days off between runs give your body time to recover and show you how it responded.
Stage three, building time on your feet
As walk and run sessions feel easy, the running parts get longer and the walking breaks get shorter. Over time you build up to continuous easy running. Only one thing is increased at a time. Distance goes up first, before speed or hills.
Stage four, adding variety
Once easy running is comfortable, you can bring back faster running, hills and different surfaces. For field and court sports, this is when changes of direction, acceleration and sprinting are slowly added.
Stage five, back to your usual running
You return to your normal training or sport. Keeping up a short, regular strength routine helps lower the chance of the injury coming back.
How to tell if a stage is working
A simple rule of thumb is to check how you feel during the run, later that day, and the next morning.
- Good signs. Any discomfort is mild, does not change how you run, and has settled by the next morning.
- Hold steady. Mild soreness that lingers into the next day. Repeat the same stage before moving on.
- Step back. Pain that makes you limp or change how you run, swelling, or pain that is worse the next morning. Drop back a stage and talk to your physiotherapist.
After surgery
If you have had surgery, follow your surgeon’s advice on when you can start running and what to avoid. Timelines vary a lot between operations and between people. Your physiotherapist works within your surgeon’s guidance and helps you progress safely once you are cleared.
How SOS Clinic can help
The physiotherapists at SOS Clinic in East Melbourne help runners and sports players return after all kinds of injuries, and they rehabilitate people after knee ligament surgery by any surgeon. Your plan is built around your injury, your fitness and the running you want to get back to.
A biomechanical profile assessment can help decide when you are ready for each stage. VALD ForceDecks force plates show how each leg pushes off and lands in hopping and jumping tests. The ForceFrame strength frame measures hip and leg strength on each side. The HumanTrak 3D motion camera records how you move in squats and lunges. Repeat tests show your progress.
Myotherapy can work alongside your program to ease tight, sore muscles as your running load builds.
When to get help sooner
Stop running and get checked if you have pain in one spot on a bone that gets worse with each run, or pain at night or at rest. These can be signs of a bone stress injury. The same applies if a joint swells, locks or gives way, or if you notice calf pain and swelling after surgery or a long period of rest. Seek urgent help for chest pain, severe shortness of breath or feeling faint while running. During opening hours, contact the clinic. After hours and on weekends, go to your nearest emergency department.
Book a physiotherapy assessment at SOS Clinic
Frequently asked questions
Is some pain okay when I start running again?
Mild discomfort that settles by the next morning is common and usually fine. Pain that makes you limp, or is worse the next day, means you have done too much and should step back.
Should I run on a treadmill or outside?
Either can work. A treadmill gives you an even surface and easy control of pace, which can help in the early stages. Flat, even paths outside are also a good choice.
How long will it take to get back to my normal running?
It depends on your injury, how long you were off and how your body responds. Moving through the stages based on how you feel, not just the calendar, is the safest approach.
Can I cross train while I build up my running?
Yes. Cycling, swimming and other low impact exercise keep your fitness up without adding running load. They are a good way to fill the days between runs.
Do I need new shoes?
Not always. Comfortable shoes that suit you are best. If you do change shoes, bring them in slowly instead of switching all at once.
References
- Soligard T, Schwellnus M, Alonso JM, Bahr R, Clarsen B, Dijkstra HP, Gabbett T, Gleeson M, Hägglund M, Hutchinson MR, Janse van Rensburg C, Khan KM, Meeusen R, Orchard JW, Pluim BM, Raftery M, Budgett R, Engebretsen L. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. Br J Sports Med. 2016;50(17):1030-41.
- Ardern CL, Glasgow P, Schneiders A, Witvrouw E, Clarsen B, Cools A, Gojanovic B, Griffin S, Khan KM, Moksnes H, Mutch SA, Phillips N, Reurink G, Sadler R, Silbernagel KG, Thorborg K, Wangensteen A, Wilk KE, Bizzini M. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. Br J Sports Med. 2016;50(14):853-64.
- Kotsifaki R, Korakakis V, King E, Barbosa O, Maree D, Pantouveris M, Bjerregaard A, Luomajoki J, Wilhelmsen J, Whiteley R. Aspetar clinical practice guideline on rehabilitation after anterior cruciate ligament reconstruction. Br J Sports Med. 2023;57(9):500-14.
- Paton BM, Read P, van Dyk N, Wilson MG, Pollock N, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Stirling B, Tulloch L, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 3: rehabilitation, running and return to sport. Br J Sports Med. 2023;57(5):278-91.
