Every year, up to 80% of runners sustain an injury that keeps them off the roads for at least one week.
EIGHTY PERCENT. EIGHT-ZERO. Which means, pretty much every one of you runners reading this right now has had to take some significant amount of time off due to pain during or after running. That’s a lot!
There’s a lot of debate as to whether running injuries, and sports injuries in general, can be prevented. I believe there are just too many variables that are out of our control, so injuries might not be PREVENTABLE, but I really believe that a runner can greatly reduce their RISK of injury! But that’s a story for another day. The fact of the matter is, most runners are going to get injured. If you’re a student or a clinician, most of your patients aren’t coming to you to prevent injuries (but damn I wish they would, right?) – they’re coming in because they’re hurt and can’t run.
There are a lot of different running bodies out there, a lot of different injuries, and thus…an infinite number of ways to rehabilitate an injured runner. That’s also a story for another day. But what about that moment when you or your patient is pretty much symptom free, and you’re thinking it’s time to start running again?
THAT’s where the “absolutes” come in. There are standards that a runner SHOULD meet before they take their first post-injury steps; there has to be an objective way to ensure that the runner is strong enough, powerful enough, has enough muscular endurance, and adequate motor control to run their distance and volume of choice WITHOUT GETTING INJURED AGAIN. I’ve compiled a list of some such standards from various clinicians and books, as well as articles to back these ideas up when appropriate.
If you are getting ready to return to running, or are thinking about that transition for one of your patients, ask these questions first!
1 Can you perform a single leg squat?
This is what running is, over and over and over and over and over. If you can’t do one with good body mechanics, that says a lot about your hip strength and motor control in the frontal plane, and these deficits will come back to bite you in the a$$ (probably literally) around mile 8 when you start getting fatigued. If you can’t do one…how are you supposed to do them over and over and over?
2 Can you squat your body weight?
According to the National Strength and Conditioning Association (ya girl is a CSCS now!), this is a prerequisite for #3. See below.
3 Can you perform basic plyometrics?
Running is basically a series of single leg squats. You should be able to perform lunge jumps, bounds, single leg bounds, and ideally box jumps before you start running. This ensures that 1) you are able to LAND with good body mechanics, 2) you have enough muscular POWER for running and 3) your bones are strong enough to withstand the repetitive impact of running (better bone strength helps you avoid stress fractures!)
3 Can you hop on one leg for two minutes straight?
This is something random that I heard on an episode of The PT Pintcast, but it makes a lot of sense, and builds off of #1 and #3. You can describe running as a series of single leg squats, or single leg hops. This again is a test of landing mechanics, power output, and muscular endurance. If you can jump and land with good mechanics over and over again, that shows you have the motor control, power, and endurance to run for miles without your form breaking down.
4 Can you hold a plank for 2 minutes and side plank for 1 minute?
This came straight from my physical therapist. It’s really just basic core muscle endurance, which again relates back to whether, or how soon, your form breaks down due to fatigue during your run.
When you think about risk factors for injury, STRENGTH is really the one with the most evidence behind it. If you’re not strong enough for what you’re trying to do…you’re at a higher risk for injury! If you don’t have enough muscular endurance (different than cardiovascular endurance!) then you will fatigue sooner into your run; fatigue leads to form breakdown, which basically means your body can’t support the load you’re putting on it….and that leads to joint and/or soft tissue compromise. Running requires a lot of frontal plane stability, sagittal plane power, and all around muscular endurance – of both the prime movers and the postural stability muscles! There are a lot of different ways to test for this, BUT YOU MUST TEST! These are some objective measures (can you do it or not?) you can use to track your (or your patient’s) progress, and they can help you answer the question EVERY injured runner wants to know:
“when can I run again?”
Most of dis stuff came from this excellent book:
And these people: