Return to Run

PT Mentor Circle may provide programs with exercises related to your condition that you can perform at home. As there is a risk of injury with any activity, use caution when performing such exercises. If you experience pain or discomfort, immediately discontinue the exercises and contact your clinician or physician. By voluntarily undertaking any exercise in a program provided by PT Mentor Circle, you agree that you assume the risk of any resulting injury. PT Mentor Circle will not be liable for any direct, indirect, consequential, special, exemplary, or other damages or losses that may result.

 The information and content provided in this course are for informational purposes only. PT Mentor Circle makes no warranties regarding, and bears no liability for, your use of the information and content. Neither PT Mentor Circle nor the instructor assumes any responsibility for any loss or injury and/or damage to persons or property arising out of the use of the material contained in or related to the online course. It is the responsibility of the treating practitioner, relying on independent expertise and knowledge of the patient, to determine the best treatment and method of application for the patient.

Print Friendly, PDF & Email

63968 _PTMentorCircleReturn to Running Guideline

By: Douglas Adams PT,DPT, SCS, OCS, CSCS

Goals:

The current return to running guidelines is based on the following three factors:

  1. Ensure the safe return to running for the patient
  2. Decrease the risk of re-injury to the patient
  3. Ensure consistency among the athlete’s sports medicine team (PT, ATC, Physician, coach, etc).

The guideline consists of two progressions. Part I, the acute phase, is aimed at returning all levels of runners from a period of inactivity in regards to running up to jogging for 30 minutes without pain. Part II, for high distance runners, is a guideline that may be initiated in therapy or given as a handout for a home exercise program. High volume runners often have physiological adaptations which allow them to participate in higher volumes of running, but their tissue healing time frames are the same as any level runner. Part II is a guideline which will allow runners to return to higher levels with respect to appropriate rest and recovery.

Special Considerations

Phase II of this protocol is aimed toward the high mileage athlete (>25 miles/wk) but may be modified for shorter distance athletes.1 However, this is not applicable for sprinters or other ballistic athletes. When addressing any lower extremity injury, it is important to consider etiology before full return to running.

Although this guideline outlines a return to jogging, it is important to remember to treat each patient individually and address the specific impairments. There is no universal recipe and good clinical judgment should be employed.

It is important to differentiate running versus jogging as it relates to this protocol. Jogging is to be done at a conversational pace, and should not be at an athlete’s limits of their running speed. Running is done at a higher pace and is to be incorporated once a patient has developed a base level of fitness. Faster pace running can be started after completing phase II of the running protocol.

63968 _PTMentorCircleRehabilitation Guidelines:

The current guideline is based on the patient having completed the following criteria:

  • Single leg hop in place without pain
  • Full range of motion
  • Pain-free ADL’s
  • 15 min of fast walking without pain (optional)
  • Strength within 20%7 of contralateral side (primary muscle groups involved)
  • Trace or less knee effusion using modified stroke effusion test6, or < 0.5 cm difference on ankle figure 8 girth

PHASE I

  • Start each workout with a 5 minute warm-up of the Therapist’s choice
  • Mandatory 48 hr rest between workouts for the first two weeks
  • Must complete 1 sessions at each level without an increase in symptoms prior to advancing
  • Do not advance more than 2 levels per week
  • Once the patient is able to progress to 30 minutes using a timed progression, the athlete may progress to Phase II

Level

Jogging

Walking

Repetitions

Total Time

1

1 min

1 min

6

12 min

2

2 min

1 min

5

15 min

3

3 min

1 min

4

16 min

4

4 min

1 min

3

15 min

5

5 min

1 min

3

18 min

6

15 min

-

1

15 min

 

Continue to progress up to 30 min of jogging with no more than a 10% increase between sessions

PHASE II

  • Athlete must be able to jog 30 min consecutively without pain or increases in swelling
  • Start each workout with a 5 minute warm-up of the Therapist’s choice
  • If the jogging hurts the injured area (not muscle soreness), stop, apply ice and return to the previous stage the next day. If pain/discomfort remains or increases, continue to return to a previous level until discomfort stabilizes or decreases.
  • If you have no pain when doing this activity level or afterwards, and you have no discomfort or tightness that limits your normal movements the next morning, proceed to the next stage.
  • Golden Rule of Running: “You can always do more next time, but you can’t do less once it’s done” (meaning start slow to avoid overdoing it)
  • 3 weeks of progression are followed by a fourth week of relative rest with a decreased total time of running in line with periodization principles

 

Week

Day

Total

minutes

 

1

2

3

4

5

6

7

Minutes

1

-

30

-

30

-

35

-

95

2

35

-

40

-

30

-

-

105

3

25

-

35

-

20

-

40

115

4

-

35

-

35

-

35

-

105

5

30

-

35

-

25

-

40

130

6

-

40

-

45

-

40

-

125

7

30

-

45

-

30

-

35

140

8

-

35

-

30

-

40

20

125

 

Week

Day

Total

minutes

 

1

2

3

4

5

6

7

Minutes

9

-

45

35

-

45

35

-

160

10

45

30

-

45

30

30

-

180

11

45

30

30

-

45

30

30

210

12

-

45

30

30

-

40

30

175

References:

  1. Cook, SD, Kester, MA & Brunet, ME.Shock absorption characteristics of running shoes.AmJSportsMed.1985;13(4):248-253.
  2. Heidercheit,BC et al. Hamstring Strain Injuries: Recommendations for Diagnosis, Rehabilitation, and Injury Prevention.JOSPT.2012;40(2):67-81.
  3. James,S.Running Injuries to the Knee.JAmAcadOrthopSurg.1995;3(6):309-318.
  4. Kvist,Joanna.Rehabilitation Following Anterior Cruciate Ligament Injury.Sports Medicine.2004;34(4):269-280.
  5. Paluska,SA.An Overview of Hip Injuries in Running.Sports Medicine.2005;35(11):991-1014.
  6. Sturgill LP, Snyder-Mackler L, Manal T, Axe MJ. Interrater reliability of a clinical scale to assess knee joint effusion. J Orhtop Sports Phy Ther. 2009; 39: 845-849
  7. Wilk KE, Romaniello WT, Soscia SM, Arrigo CA, Andrew JR. The relationship between subjective knee scores, isokinetic testing, and functional testing in the ACL-reconstructed knee. J Orthop Sports Phys Ther. 1994; 20: 60-73