Running Injury Recovery: Helping Athletes Return to Sport

When planning a return to running, psychological readiness is equally as important as physical readiness.

Returning to sport after a running injury requires a cautious and systematic approach to ensure the athlete's full recovery and prevent further injuries. Although each athlete’s injury and recovery are different, a general step-by-step approach can help to develop and implement a plan for running injury recovery.

Recommended course: Return to Sport: Running Injuries in Student-Athletes

Step 1 for running injury treatment: Medical assessment

After injury and before a rehabilitation plan with the intent to return to sport, the athlete must undergo a thorough medical assessment by a healthcare professional with expertise in sports medicine, preferably orthopedics. This assessment should evaluate the etiology and extent of the injury and provide general participation guidelines for the athlete.

Once the site and severity of the injury is known and the athlete has recovered and is ready to return to sport, the athlete should undergo a readiness assessment (Harrison, 2021). These assessments vary in what they measure and can be customized. However, whichever scale an athletic trainer chooses to use the scale should evaluate physical and psychological readiness, along with pain.

While the specific aspects of a readiness scale can vary, scales should include:

• Perception of pain. Start with asking the athlete if there is any pain in or around the affected area. If pain is present, the athlete cannot return to sports. For an athlete to return to sports, (s)he should report that during daily activities and targeted exercises, there is no pain. Pain indicates that the athlete must continue rehabilitation activities until pain subsides.
• Physical readiness. Physical readiness includes assessments that determine the affected joint range of motion, muscle strength, and flexibility. These tests also include an examination of cardiovascular preparedness and overall functional fitness.
• Range of Motion (ROM). Assess the athlete's joint range of motion at the injured area. Achieve a full range of motion prior to returning to sport.
• Muscle strength. Evaluate muscle strength of the muscles around the injured area using submaximal strength test.
• Flexibility. Measure the flexibility of the primary muscles involved in running, such as quadriceps, hamstrings, and hip flexors.
• Functional movement tests. Administer functional movement tests relevant to running like single-leg squats and hops.
• Cardiovascular fitness. Evaluate the athlete's cardiovascular fitness using aerobic capacity tests. Make sure endurance is adequate prior to a return to training and sports.

Step 2 for running injury treatment: Biomechanical analysis

Once basic measurements have been collected and the athlete has been approved to return to training that includes running, the athletic trainer should consider gait and running biomechanics.

• Gait analysis. Conduct a gait analysis looking for any abnormal biomechanics. The trainer should also be looking carefully for compensatory movement patterns that reflect either a physical and/or psychological disruption that will impact running mechanics. Before the athlete can resume training, gait abnormalities must be corrected. This includes gym and training activities or might require a resumption of rehabilitation until further improvement.

• Running analysis. If there is no deviation in gait present, it is appropriate to move on and evaluate the athlete's running form. The trainer should look for any mechanical deviations.

Recommended course: Running Injuries

Psychological readiness for running rehabilitation

When planning a return to running, psychological readiness is equally as important as physical readiness. Before an athletic trainer begins a post injury running program, (s)he wants to ensure that the athlete is mentally prepared to do so. To determine psychological readiness, discuss the athlete's fear of re-injury, confidence in return to sport and his or her motivation for doing so.

Designing a return-to-running plan

Based on the assessments above, provide specific recommendations for the athlete's return-to-sports plan. A good plan includes gradual progression, continuation of rehabilitation exercises in addition to gradual return to preinjury training routines, ongoing monitoring, and reassessment.

• Progression. Implement a gradual and progressive program. Start with low-impact activities, such as walking or cycling, before introducing short duration running at a low to moderate pace. Set realistic and attainable short-term and long-term goals to measure progress.
• Exercise selection. Incorporate a variety of cardiovascular activities like swimming, cycling, and elliptical training. Include strength and stability exercises that target the core, hips, and lower extremities and address muscle imbalances or weaknesses that may have contributed to the initial injury, grown in severity during recovery and can offset the likelihood of future injury. Emphasize flexibility and mobility exercises to improve the range of motion in joints and muscles. Finally, integrate sport-specific exercises that mimic the demands of sports specific movements.

Reassessing running injuries treatment and prevention plans

Encourage athletes to pay close attention to their bodies during the return-to-sport process. Look for any pain or discomfort. If there are lingering symptoms, end training and consult with a healthcare professional.

In addition to addressing ongoing concerns, the athletic trainer should plan scheduled reassessments to track progress and make any necessary adjustments to the return-to-sport plan. Maintain open communication with healthcare professionals throughout the process and use regular check-ins to adjust the plan.

After returning to a full training and competition program, continue to monitor the athlete for any signs of overuse or recurrent injuries. Remember, each athlete's recovery process is unique, and the return-to-sports plan following a running injury should be tailored to their specific injury, fitness level, and goals.