How to Return to Running After an Injury

by Jason Fitzgerald

Of the dozens of questions I get every week, the most common is How do I return to running after an injury?

Potomac Marathon

Because injuries are (unfortunately) so abundant – and as runners we love to run – I’m not surprised I get this so frequently.

But it’s also exceptionally complex. I always have even more questions:

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. Runners in my 1-on-1 program will get more specific advice because I know more of their personal variables and can offer specific solutions.

Recently I told you about my Achilles tendon injury and how I was (about) back to my pre-injury training volume within a week of being healthy.

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 (I can be more aggressive because of this experience level – I really know my body).
  • I’m training to run a very competitive marathon in about 10 weeks so it’s now or never. I’m willing take risks.

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 talked before about how we need to redefine what we actually call an injury. So 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 prioritize mileage than fast workouts. Thankfully, it’s also easier to run easy 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:

Post-Injury Mileage

The first few days had low mileage totals – these days were simply to establish consistency. On Day 1 I ran 3 miles on the treadmill to test my Achilles (runners in my 1-on-1 coaching program know that I use the first run after a major race as a “test run”). 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 10 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 10 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.

Post-Injury Workouts

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 4 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 8 x 30 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 (and it’s why I focus on this principle so much in Injury Prevention for Runners - to learn more about this program, sign up here for two free presentations about injury prevention).

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, it’s no longer used 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.

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{ 16 comments }

Allison

Thanks for this entry, Jason. I recently tweaked my knee somehow on my longer run this past Saturday (some medial knee pain on the run and now a littlls bit of strange discomfort on and off over the kneecap) and while I have decided to take three days off, I have been a little concerned about how I should ease back in without having to jump too far back in mileage.

Before this past Saturday, I kept my runs on a treadmill for two weeks straight because of inclement weather and fear of icy roads (I didn’t want to slip, fall and injure myself that way). I was fine until the last mile and a half of my outdoor long-ish run (8 miles). I suspect that maybe taking a run of that length outside on a harder and hillier surface rather than easing into getting back outside with one of my shorter runs may have contributed. What are your thoughts on that? Is this something that commonly happens, or at least has been shown to happen in some cases? Thanks!

Jason Fitzgerald

Hey Allison. Sure that sounds like it could happen. TM running is different than outside running (no surprise there) so when you go from doing it all outside to all inside or vice versa you’re going to experience more stress. Just like adding any new stress, keep it gradual at first.

Allison

Thanks, Jason. I guess I thought I’d be okay since I normally do much more running outside than inside, sans the last few weeks of TM runs. I didn’t think a few weeks would make much of an impact. It’s a cliche statement, but you learn something new everyday!

Lisa Whitlock

This is a very thoroughly written post, and on quite a useful topic as well.
Running injuries have always been very discouraging for me, especially when I first started running. I injured my knees, ankles and my feet very often, part of which I think was because of my choice of running shoes and partially because pushed too hard for a person who hasn’t gotten to know their body well enough yet.
All of that lead to taking breaks that got unnecessarily long, hence my discouragement – all until I decided to take it easy.
I will definitely check out Matt Fitzgerald book, looks like a read I would enjoy.

Amy

Good to know, I’ve been struggling this year with some knee and hip issues, and exactly as predicted, when I quit doing the IT Rehab exercises (due to “time constraints”) I found myself sidelined on the couch again. I thought it was my sudden increase in mileage, but more likely my negligence in keeping up with my strengthening exercises. I will also openly blame “Breaking Bad,” as I used to run through the exercises while mindlessly flipping channels. Unfortunately, I took friends’ advice and began watching the series- and dang! that show really commands your full attention… Good thing the Olympics are on :) Inspirational, especially when you hear all the injuries those elite athletes have had to overcome! Back to clamshells…

Franzi

Good case study, thanks for sharing and great on your success!

Allison

Hi Jason,

I just have one more thought/question on gradually moving my runs from a treadmill to back outside (I posted the first comment on this entry about tweaking my knee). As far as longer runs are concerned, after I’ve been able to move all of my short runs to pavement, how cautious should I be? Would it be safe to try and run the entirety of a longer run outside, or would it be smarter to be super-conservative and maybe run part of it inside and part of it outside? For example on a 10 mile run, do 4 or 5 outside and then the rest inside. Would you consider that to be a little paranoid, or smartly erring on the side of caution? I have a half-marathon on May 4th and I want to be careful, but I also want to get my body back into the routine of handling that kind of mileage on pavement so I can enjoy the race without pain. Your opinion is appreciated!

Jason Fitzgerald

Hey Allison – I wouldn’t overthink things too much. TM vs. outdoor running isn’t that much different that you need a super conservative approach. Start moving one run a week from the TM to outdoors, you’ll be entirely outside within a few weeks. Good luck!

Allison

Okay, thanks so much for the reply. That helps a lot. I did manage a short 3-mile TM run on Wednesday with nothing more than slight discomfort, so I seem to be seeing progress so far. I originally had 8 miles scheduled for tomorrow but I plan on backing off a little bit and shaving a few miles off and keeping it inside. As I said, better safe than sorry! Thanks again!

Allison

And I forgot to add this before, but good luck with Boston! Is this your first time?

Gregory

Jason! Love the step-by-step approach. It’s so well-explained! Thanks.
One question though about the short test run.

Do you wait not to feel any pain or bad sensation at all before doing it? Or do you kind of pushi it and give a try even if you still feel a little something?

As I’ve been off for 2 months now and my strategy is to wait to feel “zero discomfort” in my daily life before going to the treadmill. Good plan or bad one?

Thanks again Jason.

Jason Fitzgerald

Yes, for the most part my Achilles felt good before I started running. I tried a run a week later but only lasted 30 seconds before pain, so I rested for another 2 days while doing the treatment protocol in IP for Runners. Then after that it felt good. But the caveat here is that my return to running was more aggressive because I have Boston coming up and don’t have time to waste!

I think “zero” discomfort might be too cautious. Sometimes active recovery with some running is a good idea.

Carlos

Nice article Jason!

Prevention is something that one must take into consideration everytime you will do some training. I have just started running, but I have done Martial Arts since I was little, now I´m 36, and if I don´t take in account my prevention for running, or any kind of workouts, I will get hurt. Before, I could just start running; now, If I don´t do my warmups I will get hurt. Thanks.

chuck

I’m 45 and I just started to run again. It’s been really hard because my hips and knees seem to be a lot weaker. At my age will my hips and knees get stronger or worse? Any feedback would be greatly appreciated.

Jason Fitzgerald

If you’re not strengthening them, they’ll get weaker! Strengthening these areas is a top priority for all runners and you can see that in the training plans in Injury Prevention for Runners.

Dickson

Would you please share what your typical training week looked like pre-injury? I have a marathon in 4 ½ weeks and I’ve spent the past 8 days aggressively rehabbing a strained calf muscle. I am ready to start running again and am trying to plan my ramp back to my original training schedule.

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