Show me the running!

Following Bone injury: Part 3 of 3, we thought we would provide our runners an easy to follow “return to running guide” that can be used once you have been cleared by your physiotherapist.

The program slowly progresses runners over a number of weeks. Initially the emphasis is placed on building distance, with intensity of normal jogging/running speed coming to the forefront in the later stages of the program.

In clinic there are certainly times when we take a more conservative approach and utilise specialist equipment such as alter-g.  When taking this approach, the patients training history, confidence, goals, the nature and severity of injury are all considered.

By utilising an alter-g it can allow the patient to run sooner without disrupting the healing process. This means they also maintain their soft tissue structures and cardiovascular fitness, so when returning to running the load transition is not as steep (and the pool can be avoided!).

Now to say we only use this program (as below) and never modify its structure would be untrue. When considering loading programs it is known individuals physiological response to load will always differ. Therefore the program is used more a guide rather than an exact science. When returning runners a close eye should be kept on how they’re handling the transition.

Tips on whether your athlete is managing:

– Return of symptoms
– Ache or night pain in previous injury area
– Increase fatigue from a day to day perspective
– Difficulty completing the desired outcomes with good form  

The program does allow enough time for bone to recover along the way, with the aim at the end of the program being that runners can return to full training. However, it should be said that even though by the end of this program the intention is to return to full training, the program is subject to change depending on how the athlete is managing the loads and whether or not other rehabilitation outcome measures have been met.

Return to running program (Warden, 2014)

Phase one: 50% of normal pace with focus being on increasing duration

1. Brisk walk 30min
2. Day off (allows remodelling)
3. 1 minute jog followed by 9 minutes walking x 3 sets
4. Day off (allows remodelling)
5. 2 minutes jog followed by 8 minutes walking x 3 sets
6. Day off (allows remodelling)
7. 3 minutes on followed by 7 minutes walking x 3 sets
8. Day off (allows remodelling)
9. 4 minutes on followed by 6 minutes walking x 3 sets
10. Day off (allows remodelling)
11. 6 minutes on followed by 4 minutes walking x 3 sets
12. Day off (allows remodelling)
13. 8 minutes on followed by 4 minutes walking x 3 sets
14. Day off (allows remodelling)
15. Jog for 30minutes

Phase two: increasing the intensity back to normal running speeds

16. Day off (allows remodelling)
17. 30 minutes of running at 60% of normal speed
18. Day off (allows remodelling)
19. 30 minutes of running at 70% of normal speed
20. Day off (allows remodelling)
21. 30 minutes of running at 80 % of normal speed
22. Day off (allows remodelling)
23. 30 minutes of running at 90% of normal speed
24. Day off
25. 30 minutes of running at normal speed
26. Day off

Phase three: run on consecutive days

27. Run 30 minutes at normal speed
28. Run 30 minutes at normal speed
29. Day off (allows remodelling)
30. Run 30 minutes at normal speed
31. Run 30 minutes at normal speed
32. Day off (allows remodelling)
33. Run 30 minutes at normal speed

Phase four: Return to running training

Nicholas Cross
Physiotherapist, Exercise Physiologist

#STRIDEON(tealandblack)

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