Bone Injury: Part 3 of 3 (Return to running)

Bone symptoms are nasty and at times hard to manage. However, what can be even more difficult is returning runners to running once their symptoms have settled. This is because runners are stubborn patients and are often have great difficulty separating their pre-injury running capacity, and what their capacity is post symptoms management.

Recently there was a podcast on BJSM with Dr. Blaise Williams that discussed five objective tests (that we currently use) that can be used to determine whether a runner is at a stage to commence a reloading/return to run program. For those not familiar with the tests or podcast we thought we could share the tests and the criteria for what you can look for!


– All tests stress the muscles used whilst running
– Runners need to pass all 5 tests
– Takes emotion out of the decision making process: Pass or fail
– Tests must be completed in a particular sequence

Test one: Hop against wall, 60 seconds on both left and right at 160BPM


– Able to maintain 160BPM
– Knee does not collapse into valgus
– Pushes through ball of the foot for the 60 seconds on both left and right foot

Test two: Front plank 60 seconds



– maintains level through torso
– Hips do not shift either up into air or down toward floor
– Hips do not sway to left or right

Test three: Single leg 1/4 squats at 160BPM


– Hips remain level and do not repeatedly rotate
– Knee tracks in line with second toe

Test four: 6″ Box Step Up 30 seconds on left and right


– Keeps in time with the 160BPM
– Bends forward slightly at the waist

Test five: 90/90 (hip/knee flexion) Swiss-ball Wall Squat



– No shake in the quadriceps
– Does not start looking up and down
– Does not rotate off to either left or right

The testing sequence lasts for approximately 7-minutes (as you give the runner 30 seconds break between the tests), which is the time it would take to run approximately 1.5-1.6km at a moderate speed. Therefore we agree that this is a good objective measure not only because it stresses the muscles involved in running, but because it gives an indication on whether a runner is likely to handle a short distance, or the start of a gradual return to running program.

When working with runners, especially those who run distance, we find that it is not uncommon that non-elite runners don’t include strength training as part of their training program. Having adequate strength levels to run is imperative for many reasons, not just injury prevention.

When wanting to increase running volumes there needs to be a strong emphasis placed on resistance training methods for running, especially if the adequate strength levels are missing. No, strength training won’t make you “big and bulky”, but what it will do is increase your efficiency when working at sub and maximal efforts and lower the risk of injury associated with repetitive tasks!

If you find your runner fails the tests above we would advise:

– Prescribe cross training methods to maintain cardiovascular fitness
– Incorporate strength training (minimum of 2 x weekly) into the program
– Re-test after allowing enough time for a strength adaptation to occur

Nicholas Cross
Physiotherapist, Exercise Physiologist


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