Rehabilitation Rules for Runners

How long should you wait before seeking professional help for a running injury?

The first consideration is the duration of the pain, says Dr Jim Bovard:

• If pain occurs during a workout and lasts until the next day, take a few days off until it settles down. Resume running at a slightly lower level than before, building back up, he advises.
• If pain persists for more than 4-5 days, see a health care professional, such as a family doctor or physiotherapist, with sports medicine expertise (See the SportMed Directory of Practitioners).

Bovard often sees people 2 or 3 weeks following an injury who have tried to continue their running program. "That's a mistake. If the pain is increasing from workout to workout, they absolutely must stop the program," and seek appropriate medical help. He examines runners for training errors, muscle and tendon imbalances, anatomical misalignment, footwear, running surfaces, nutrition, and associated diseases such as diabetes or arthritis.

How should runners modify their training?

Non-weight bearing workouts are key: these can include pool running, cycling and swimming. "Pool running has the best physiological crossover to running," says Bovard (Pool running articles are also available under the Walking and Running for Fitness section of the SportMedBC Library).

Teri-Lynn Fraser says that runners should work out with about the same increase in heart rate as when they were running because "deconditioning happens quite quickly when people stop running." However, Bovard cautions that injured runners should not overdo the crossover activities: "The highest risk people for cross-training injuries are very fit athletes: if you put a very fit runner on a bike, they will go like mad and end up with an overuse bike injury. So I tell them to start easy the first time – perhaps half an hour if they are used to running for an hour."

Bovard recommends the following principles:

• Keep the modified workouts simple. Pool running techniques for elite runners can be quite sophisticated; however, recreational runners just need to go to the local recreational centre, put on a floatation belt and start running.
• Work out for about the same time and intensity as when you were running. The frequency of your workouts should stay the same too. Keep in mind that the workout will feel different with the substituted activities and listen for how your body responds.

Increase your workout load by 10% at a time. This is also the underlying principle behind progressions in the InTraining program.

How do you know when you are ready to return to running?

Bovard's rules are the following:

• Be pain-free day to day.
• Full range of motion and strength of the injured area.

When that has been achieved, he recommends trying running again at 10% of your previous level i.e. If you were running for 30 minutes when you were injured, start at 3 minutes the first time back. Then wait 48 hours and try 6 minutes, continuing to gradually increase the duration in 3 minute intervals.

Heather Kent is a Vancouver freelance medical writer. She is a regular contributor to the Canadian Medical Association Journal and numerous other North American health and medical publications.

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