One of the most common things patients want to know when rehabilitating an injury is when they can go back to their sport, especially runners. As a clinician my hope is once people start to return to their sport they don’t have a set back or a compensatory injury because they weren’t ready. Sometimes taking more time off is hard in the short term, but will pay off in the long term, getting you back in the game for good. Unfortunately in the presence of injury and dysfunction you need time and work to clear yourself to get back. Here are 6 things to understand before returning to running or sports which require running.
- Are there any signs of inflammation: Pushing an injury in the presence of inflammation is a recipe for failure. This includes using medications to reduce inflammation. If you are using medications to resolve inflammation, you still have inflammation. You are risking further injury and at best will prolong your recovery. Resolving inflammation is always the first step in rehabilitating an injury, if you forgo this nothing good will come of it. In this situation you should be protecting and resting the injury, icing, compressing, and elevating to reduce inflammation. Remember, this is just the first step. Just because the inflammation is gone does not mean you are ready to handle running activities.
- Do you have normal mobility: Running requires a certain amount of joint mobility and muscle flexibility. Many people lose some of this in the down time they were less active. And many repetitive stress type injuries are actually caused by lack of mobility or asymmetrical mobility. You can lose mobility in your muscles (hip flexors, glutes, tensor fascia late, hamstrings, quads, gastoc/soleus) or your joints (subtalar joint or talocrural joint in the ankle, knee, or hip). If these are restricted you need to get things evaluated and restore this through joint mobility, soft tissue work, neural mobilization, or stretching.
- Do you have strong hips: Hip strength is one of the key areas for normal lower extremity function. Along with poor mobility, hip strength can change your lower extremity mechanics for the worse. This frequently can influence knee pain, shin splints, and other lower extremity repetitive stress injuries. Frequently you can work on hip strength while you are resting from your primary injury, so this is something that you can get at aggressively. Open chain hip exercises (those with your foot off the ground) are OK to start with, especially in the resting phase, but to return to running sports you will need to do closed chain exercises (foot on the ground, weight bearing).
- Can you SOLIDLY stand on one leg: One common thing we see in repetitive or overuse type injuries is poor stability while standing on one leg. If you are unable to stabilize while standing still on solid ground, how will your body do this while moving at high speeds, with greater forces on variable surfaces? This increases stress on your system and invites compensation. Working on your single leg stance once your injury will tolerate this is key to returning.
- Can you handle walking?: This seems simple, but is often overlooked. You have to walk before you can run. Athletes are frequently impatient and want to skip steps. But if you can’t tolerate walking without pain, for at least as long as you plan to play a sport or run if not longer, you won’t succeed at the higher level. Ideally you could walk for something like an hour at a brisk pace without difficulty before trying a 20-30 minute run.
- Can you tolerate eccentric then plyometric activities: Eccentrics or negative contractions are those that your muscles control body weight and forces. In your legs think lunges, step downs, or squats. Plyometrics are those where we go from an eccentric contraction (controlled lowering) to concentric (force generation). In running this is from where our foot lands and controls our body weight (eccentric) to where we push off and propel our body forward (concentric). Many people in early rehab when protecting the injury work on concentric exercises, think leg lifts or hamstring curls, then feel better once the inflammation reduces and head right back to sport. They are missing some steps. Eccentric exercises such as step downs, single leg squats, and dead lifts should be looked at for both pain and proper form. Once these are cleared then plyometrics such as hopping and bounding should be worked on and cleared.
As you can see there are many factors to performing athletic activities safely after an injury. As physical therapists we are often the bad guy in telling you you shouldn’t play yet. I hear all the time “my friend ran after this injury in x weeks how come I can’t?” Everyone is different as a patient, and frequently people are going back to sports without meeting these criteria and frequently they are getting injured again sooner or later. It is better to take the time and get better once and for all than become a chronically injured athlete.
If you have questions about running injuries or sports injuries or don’t know if you are ready to return to sport give us a call in our Avon, CO clinic at 970-949-9966 or our Eagle, CO clinic at 970 328-5230 or check out our website at ascent-pt.com.