Proper Return-to-Running Protocol Following a Lower Body Injury

By Nicholas Crecco, PT, DPT 

Following a lower body injury, the process of returning to running can be a complex matter whether the injury is a sprain, strain, fracture, or surgery. Resuming running requires a thoughtful approach to ensure safety and long-term recovery. As physical therapists, we have an important role to guide runners back to their sport effectively and safely. A well-designed return-to-running protocol is important along with the benefits of the recovery process. 

Understanding the Need for a Return-to-Running Protocol 

Preventing Re-injury: The risk of re-injury is high if a runner returns to their activity too soon. This can exacerbate the initial injury or lead to new injuries due to improper movement patterns. An individualized protocol helps ensure that the injured area has healed appropriately and the body is prepared for the stresses of running. 

Restoring Function and Strength: Even after the pain subsides, the involved muscles, tendons, and joints may not have fully regained their strength, flexibility, or function. A return-to-running protocol can address these deficits, focusing on rebuilding strength, improving range of motion, and ensuring proper running form and mechanics. 

Gradual Return: Running places significant stress and demand on the body, especially on the lower limbs. An individualized approach allows the body to gradually adapt to these demands, reducing the likelihood of re-injury and stressing the newly healed tissues too soon. 

Components of an Effective Return-to-Running Protocol 

Rehabilitation Phase: Before starting a return-to-running protocol, the runner should complete a rehabilitation phase aimed at restoring function and strength. This phase includes: 

● Range of Motion Exercises: To regain any lost joint mobility and flexibility 

● Strength Training: To improve muscle strength and support the injured area ● Functional Training: To re-learn and improve movement patterns and coordination 

Gradual Reintroduction to Running: Once the rehabilitation phase is complete and the runner is cleared for activity, the protocol should focus on gradually returning to running. This phase includes: 

● Walking: Start with brisk walking to improve endurance and assess tolerance. ● Run-Walk Intervals: Alternate between running and walking, gradually increasing the running intervals as tolerated. 

● Running: Transition to running, starting with short distances and progressively increasing the time and distance. 

Analyzing Biomechanics: Throughout the return-to-running program it is important to address any issues with biomechanics. Improper running form can lead to further issues, so it is important to analyze individual biomechanics and make adjustments as needed.

Benefits of a Proper Protocol 

Improved Recovery: An individualized protocol ensures that recovery is addressing not just the injury, but also overall physical conditioning and biomechanics. 

Reduced Risk of Future Injuries: By gradually increasing running demands and focusing on proper form and technique, runners are less likely to experience new injuries or complications related to the original injury. 

Improved Confidence: Runners who follow an individualized return-to-running protocol often feel more confident to safely return to their sport. This boost in confidence can be as important as the physical recovery itself. 

The transition from injury to full recovery in running is gradual and requires careful planning and execution. As physical therapists, our role in developing and implementing a proper return-to-running protocol is important to ensuring that athletes not only return to their sport, but do so in a way that promotes long-term health and performance. By implementing an individualized approach, we can help runners avoid re-injury, build strength, and regain confidence, setting the path for a successful return-to-running and athletic activity. 

Sources of information: 

● Injury Prevention, Safe Training Techniques, Rehabilitation, and Return to Sport in Trail Runners – PMC (nih.gov) 

● Running: How to Safely Increase Your Mileage | Journal of Orthopaedic & Sports Physical Therapy (jospt.org)