How to Get Back Into Running After Injury

Most runners will experience a running-related injury at some point. Most of these injured runners will take the necessary time off from running, whether it’s two weeks, two months, or more. Unfortunately, rest during the injury can be the easy part – while the return to run approach can be trickier to navigate. Your injury risk is heightened when running after injury, due to the time off of running.

As a running coach with over 10 years of experience, I have guided runners successful back into running after injury. This article draws from both experience and research to guide you through how to run after injury, including minor injuries and significant injuries alike.

20% Loss of Fitness

The renowned exercise physiologist and coach Jack Daniels outlined the principle of ease of maintenance in Daniels’ Running Formula. According to this principle, “it is easier to maintain a level of fitness than it was to achieve the fitness.”

Even if you take a couple months off due to injury, you do not have to start from scratch again. Your body is smart and will retain some adaptations in your heart and muscles. You will get back to where you were quicker than it took you to originally get there.

However, you cannot start back where you were before injury. You will decondition relative to how much time you take off. Even as you maintain some training adaptations. you do not remain at the exact level of fitness you were before the injury.

The exact rate of deconditioning corresponds to your time off of running. Two weeks off loses less fitness than two months off. However, even for long layoffs, Daniels estimates no more than a 20% loss of fitness.

Related: How Quickly is Fitness Lost?

How Long Does It Take to Return to Running after an Injury?

The duration of your time off dictates the rate at which you return to running. 

Essentially, anticipate spending an equal amount of time rebuilding your mileage as you spent off running. Layoffs lasting several months may only take a few months to build back up, but it’s best nonetheless to build back up slowly. 

Injury Level Considerations

Minor Injuries

For shorter layoffs – a couple weeks due to a minor muscle strain – you can return to running with two weeks of easy running at reduced volume (one week easy at ~50%, one week easy at ~75%).

For More Serious Sprains, Strains, or Fractures…

After an injury that requires six to eight weeks off, such as a low-risk stress fracture, the rebuild is more gradual, starting at a couple weeks of approximately one-third of your previous training load before gradually increasing over the course of six to eight weeks total.

Major Injuries

For injuries that required several months off, you will have to spend longer at reduced volume. These injuries include high-risk stress fractures (those in the pelvis, femoral neck, and sacrum), full bone breaks, and muscle tears.

Injury Type and Expected Effects

The type of injury also affects your return rate. A stress reaction and muscle strain often involve quicker healing timelines than stress fractures and severe strains or tears.

Bone Stress Injuries

Bone stress injuries are overuse injuries that include stress reactions, stress fractures, and full fractures. Stress reactions are the least severe and require the least amount of time off, often 2-4 weeks. Stress fractures may require six to twelve weeks off of running, based on the location and severity.

Bone stress injuries are commonly related to intentional or unintentional low-energy availability. Especially if your stress fracture occurred in trabecular bones (pelvis, sacrum, or femur), you may want to consult a registered dietitian.

Related: Understanding Bone Stress Injuries in Runners

Soft-Tissue Running Injuries

Soft tissue injuries heal at varying rates, depending upon the severity of the injury. A minor strain will typically heal within one to three weeks off. A more severe strain will require longer time off. Muscle and other soft tissue tears (such as a hip labral tear) will require several weeks to months off of running.

One unique injury is tendinopathy (an injury to the tendons). Sometimes, you can train at a reduced level through tendinopathy. Other times, tendinopathy requires extensive physical therapy before you can resume running.

If you have a soft-tissue injury beyond a minor strain (lasting 1-2 weeks), it is recommended to consult a PT. Rest alone will not resolve tendinopathy or muscle tears; you will need physical therapy before you can start running after injury.

Related: How to Rehab Tendinopathy with Dr. Alex Nelson

Tips for Getting Back Into Running

The mind is ready for more mileage after injury than the body is. Your stress fracture won’t heal faster just because you are supposed to start training for the Boston Marathon, nor will a race on the calendar make your IT band stop hurting sooner. No event on the calendar will expedite the recovery process. Rather, it is important to gradually resume running after an injury, even if it means skipping a race.

Gradual Reloading

Depending upon the duration of your injury, your bones, tendons, and muscles will need to readapt. If you were to jump back to your normal training volume after eight weeks off, your musculoskeletal system would not be ready for such stress. You would have a high risk of getting injured – again.

Run-walk intervals are an incredibly beneficial tool as you return to running after an injury. They allow you to achieve a higher volume of work while gradually reloading your musculoskeletal system. Additionally, the frequent walk breaks can help your cardiovascular system re-adapt to the demands of running.

Dial it Back a Notch

Even if you have maintained your aerobic fitness with cross-training, do not jump back into your original training load. Cross-training does not maintain the same musculoskeletal strength of running because cross-training is lower-impact. Your body needs to adapt to the impact of running again.

Especially if you had a stress fracture, opt for softer surfaces such as smooth dirt trails (avoid anything too technical), grass, or indoor or outdoor tracks. The treadmill provides a soft surface and the option to stop at any time, but be cautious when using it after injury. Set the pace based on effort, not based on your ego.

Supplement With Cross-Training and Strength Training

Especially during the low-frequency and low-volume weeks of running, cross-training can help you stay in shape while injured. Each builds your aerobic fitness with a lower amount of stress and impact. Means of aerobic cross-training include pool running, the elliptical or arc trainer, swimming, cycling, or cross-country skiing.

Strength training also strengthens your bones and muscles and prevents compensation injuries from occurring as you resume running. If your physical therapist prescribed specific exercise, include those regularly as you resume running.

Cross-train and/or strength train on the days you do not run. The frequency of cross-training will be higher earlier on and decrease as you add in more runs. Be mindful to include one rest day per week to allow your body to recover and adapt to the increased training load.

Try one of these cross-training and strength training workouts for runners:

• Pool Running Workouts
• Swimming Workouts for Runners
• Elliptical Workouts
• Upper Body Workouts
• Resistance Band Workout for Runners
• Injury Prevention Workouts
• Total Body Medicine Ball Workout
  

Know When to Reintroduce Speedwork

When in doubt, focus on building your aerobic base and strength back up. There is no rush to resume speedwork. If you do not feel ready, do not rush if. If you are excited to do tempo runs and intervals again, be patient. Focus first on building back up your aerobic base. Speed work stresses the body more than easy running and reintroducing it too soon can lead to reinjury. 

Ideally, you want to be close to normal training volume (50-75%) before adding in speedwork. When you do reintroduce faster running, don’t start with track workouts or long tempo runs. Utilize strides (here’s how to do them correctly) and hill repeats (such as one of these workouts) to safely add small doses of faster running back into your training. 

Read this article more information on how to safely introduce speedwork without getting injured.

Sample Return to Running Programs

So how do we put all of this physiology together into practical training applications with smart return to running programs?

Before starting any of these progressions, ensure you can walk for at least 30 minutes without pain. These plans are samples: use advice from your PT or orthopedist, guidance from your coach, and common sense regarding your own unique circumstance to modify as needed. It is always better to take a slower approach if that is appropriate for you.

For 2-4 weeks off from running

With four weeks or less off due to injury, you can resume with easy running at a reduced load. This sample is borrowed from Daniels’ Running Formula.

Week 1 (for two weeks off) or 1-2 (for four weeks off): 50% normal training volume at an easy effort. If you wish, start the first week with one day less of running than your normal training frequency.
Week 2 (for two weeks off) or 3-4 (for four weeks off): 75% normal training volume at an easy effort, at your normal training frequency.
Week 3 (two weeks off) to 5 (four weeks off): Normal training volume, reintroducing hard workouts 

For 4-8 weeks off from running

If you took more than four weeks off due to injury, your return will be more gradual. This sample plan utilizes run-walk intervals in the first two weeks to strengthen your musculoskeletal system. This is especially true if your time off was due to a stress fracture.

For your very first run, I recommend beginning with a ratio of 3-5 minutes walk, 3-5 minutes run. This may be only 10 minutes total of running (20-30 min total with running) – enough to test out your injury. If anything hurts in the hours or day after this test run, wait another week until you resume running.

Normal training frequency is the number of days you ran before your injury. If you ran five days per week, that is the number of days to run by week four or five. Do not try to add extra days of running.

Week 1: 20-30 minutes total with short run-walk intervals, every other day
Week 2: ~30 minutes total, progressing the duration of run-intervals and decreasing walk intervals, every other day
Week 3: 30-35 minute continuous easy runs, three to five times per week (one day less than normal training frequency, approximately 33% of previous mileage)
Week 4: 30-45 minute easy runs, three to six days per week (returning to normal training frequency)
Week 5:  30-60 minute easy runs, three to six days per week (approximately 50% of previous mileage)
Week 6-7: Approximately 50-75% of previous training volume, introducing strides or short hill repeats
Week 8: Return to normal training volume

For 9+ weeks off from running

Similar to the four to eight week plan, begin with run-walk intervals every other day for the first two to three weeks. After the third week, gradually increase your mileage by approximately 10-15% per week, so that you are back at your normal training mileage in approximately 12-15 weeks.

You Can Return to Running After an Injury

Returning to running after an injury requires patience and a gradual approach. While it may take time, most injuries are not permanent, and you can rebuild your fitness. Remember to listen to your body, avoid rushing the process, and prioritize injury prevention to ensure a sustainable return to running.

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