Returning to Running After Injury

Running is a high-impact sport. It wears and tears on our bodies, even as it makes our bones stronger and muscles more resilient. While getting injured is not inevitable, if you run for years or decades, you are statistically likely to endure a running injury that requires time off of running. After years of consistent training, you may suddenly find yourself injured – and then wondering about how to return to running after injury.

Running has an inherent injury risk, as does any sport. Generally, injury is preventable with smart training practices. But over the course of five years, ten years, fifteen years, you roll that dice again and again – and the risk compounds. The only true way to avoid a running-related injury is to not run at all, and I am certainly not advising that.

The good news is this: most injuries are not permanent. You can return to running after an injury. If you are disciplined in your rest during this time frame and avoid prolonging the recovery process, even eight weeks is not very long in the grand scheme of life. However, returning to running after injury and four to eight weeks of no running does require a gradual approach.

Ease of Maintenance and Fitness Loss

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 adaptations in your heart and muscles. You will get back to where you were quicker than it took you to originally get there.

You will, however, decondition with time. 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.

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, you can 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. 

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%). After an injury that requires six to eight weeks off, such as a 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. For injuries that required several months off, you will have to spend longer at reduced volume. 

The type of injury also affects your return rate. Bone injuries require gradual reloading as the callus strengthens. Soft tissue injuries heal at varying rates, depending upon the severity of the injury, the cause, and how you are progressing in physical therapy.

Gradual Reloading

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.

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 no be ready for such stress. You’d increase your risk of injury, again.

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.

Run-walk intervals are a fantastic 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.

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.

Returning to Running After Injury: Sample Plans

So how do we put all of this physiology together into practical training applications?

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. 

For several weeks, your running should be done at an easy effort. Do not compare yourself to your pre-injury paces yet. Focus on maintaining an effort light enough that you can carry on a conversation. This will reduce the risk of injury and optimize the redevelopment of your aerobic base.

For two to four weeks off of 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 four to eight weeks off of 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 nine or more weeks off of 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.

Supplementing Running: Cross-training and Strength Training

Especially during the low-frequency and low-volume weeks of running, cross-training 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

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.