How to get back to running full speed after an injury

Long-distance runners are good at thinking long-term. That’s the only way to prepare for a marathon and it’s also the best the way to recover from an injury, according to Andrew Markwith, MD, an orthopedic surgeon based at Total Orthopedic Care in Falmouth, located at the Falmouth Orthopedic Center.

Whether it’s a mild ankle sprain or coming back from ACL surgery, there are overarching principles to keep in mind.

“The main thing is to focus on the intermediate and long-term goals,” he said. “I will frequently stress with my patients that if the week-to-week trend is going in the right direction, that's more important than how quickly it’s going. You’ll have good days and bad days, but making good progress is what counts.”

The recovery timetable is unpredictable, even for two people recovering from the same injury.

“A lot of it comes down to how good a shape the athlete is in before their time off and how long they have been training,” he said. “If someone's been a serious runner for 10 years, they can return to their previous level of performance much quicker than someone who is a casual runner.” 

If you’ve gone through surgery, your surgeon and physical therapist will advise you during the recovery process. But for smaller injuries that require only some ice and a bit of time off, there’s also a right way to start up again, according to Dr. Markwith, who has a particular interest in and experience with sports injuries.

“If you’ve had to take off a week or two, you want to have a gradual re-entry,” he said. First, make sure that you can walk at a brisk pace for anywhere from 30 to 45 minutes, without having pain during the walk or the next day.

“You want to avoid rebound pain,” he said.

Once you can do that for a week, then you can start running again.

“There's a lot of different programs or protocols that patients can follow, but the general concept with all of them is that you want to incorporate stretching,” he said. “You want to incorporate cross-training as well, so that's where the swimming, cycling or an antigravity treadmill can help. I'm a huge fan of the stationary bike, so you start working on the cardio without any significant impact on your joints.

“Early on, I like my patients to start small; just start with a half mile and take a day off, then they can gradually increase that over the next few weeks.”

It’s important to get physical therapy for anything beyond a minor injury, he added.

“One of the recommendations I make to my patients is that they request to work with a physical therapist who is an experienced runner or frequently works with runners,” he said.

Some physical therapists can do a video gait analysis, where they record you while you jog or run on a treadmill.

“It allows the therapist to identify improper muscle balance or improper mechanics,” Dr. Markwith said. “Then they can come up with a custom treatment program, frequently involving hip stretching, hamstring stretching and then a core strengthening program. That can frequently help athletes get back to running if they're not quite making the progress they want or they're just at a standstill.”

Patience is the key thing to keep in mind.

“It's important to stay positive and focus on what's going well,” he said. “If things aren't going well, then you reassess, reevaluate in the office with the physician, or try a different approach at physical therapy.

“Running is a very important exercise, not just physically, but for mental health and for stress relief, so we want you to be able to continue with it.”