Returning to Running After Injury: The Case for Introducing High Speed Running Early in the Return to Play Progression. Part 1

By Mitch Hauschildt, MA, ATC, CSCS

Running is a bit of an interesting topic in our current sports medicine environment. It wasn’t that long ago that running for cardiovascular fitness was considered a pillar of physical fitness. As the fitness industry has changed, running has been looked upon by some as almost a dirty word stating, “steady state cardio training is dead.” Some in the corrective exercise specialty area of the sports medicine field have made the bold proclamation that no one should ever run until they can score a certain score on the FMS or some other standardized test because they are causing harm to their bodies by doing so.

While I do believe there is some merit to just about all of those arguments and I can see their thought process, the world of competitive athletics that I work in every day necessitates that athletes run, usually because it is a major part of their sport.  And coaches quite honestly don’t really care whether some scores a good score or not…they need their guys to be able to train and train often.  But the other reason people run is because they just enjoy running. And regardless of what we think as clinicians, it is our job to ensure that our patients get to do what they need to do (or enjoy doing), with as little injury risk as possible.

One thing that I have always found interesting with regards to running is the progression that athletic trainers, strength coaches, and physical therapists tend to use when returning an injured athlete to running.  The typical protocol is to start slow and stay safe, because they have damaged joints and compromised motor patterns. That makes sense, right? In most cases, yes, but with running, not really.  Let me explain…

The goals when returning athletes to running should be two fold:

1. Protect the injured body part
2. Facilitate the nervous system while it is in a plastic state to promote proper running mechanics

Protect the Injured Body Part

So, lets start with item #1: Protect the Injured Body Part. We can be talking about a number of injuries for this conversation, but most of them have to do with the lower extremity and they are usually fairly significant injuries if we are progressing them back into running. Injuries that come to mind are Grade II or better ankle sprains, ligament or cartilage injuries to the knee, soft tissue injuries to the hip and thigh, as well as low back pain. But, this principle can be adapted for just about any injury.

Understanding running mechanics and the effect that it has on our body is an important concept here. While jogging, most people tend to heel strike while in the stance phase. Conversely, the vast majority of people move forward to a midfoot running stance during running or sprinting.  Research tells us that there is a significantly greater vertical ground reaction force when heel striking versus a mid foot strike in the knees of runners.¹ Thus, most joggers tend to experience greater impact into their joints than those who run or sprint.

Thus, a slow jog actually causes greater impact forces and disruption to the already compromised joint or body part than up-tempo running due to the elastic nature of the soft tissue surrounding a joint that is designed to ultimately support and protect the injured area..

Improve Running Mechanics

The other goal on our list is to improve running mechanics while the nervous system is in a plastic state, primed and ready for input. The overall mechanics are quite a bit different between jogging and running. Most of the difference occurs at the hip joint and arms. Research demonstrates that the faster an athletes runs, the greater the demand for hip range of motion and the same holds true for the shoulder.²

So, when you begin running again for the first time and begin with a jog, the input that you are giving the brain is of limited range of motion during running, which is suboptimal for speed and power athletes.  This part of the rehab process is a great opportunity to engrain motor patterns that encourage proper mechanics, not poor ones.  So we should be doing everything that we can to improve neuromuscular efficiency, not poor mechanics.

Further, we know through research that pain changes motor output.³ We move around pain. We can all agree that if we sprain an ankle, we tend to want to stay off of it in the form of a limp. We can also agree that if we can stimulate the global stabilizers around a joint, their pain usually decreases because we restore normal joint kinematics.

Running and sprinting demonstrate a higher rate of stabilization around a joint via greater activation of the stabilizing muscles. This increased activity equates to decreased pain in an injured joint.

Lastly, when most people jog, they have a tendency to go for a fairly long distance. Due to a decreased stride length while jogging and a longer overall distance to travel, an athlete will take exponentially higher number of strides during that run than they would in a series of 40-60 yard runs at 80% of their full sprint. If they are limping or moving around their pain in some regard, there is a much higher likelihood that they will turn that limp into a permanent motor pattern.

The body loves repetition, so when it feels something over and over and over, it will become a habit. And, as Thomas Myers says, “habit becomes posture, which becomes structure.” He made that statement in a different context, but it does hold true here as well.

You may be asking yourself, “how do I introduce running at 80% of a max sprint for the first time without them getting hurt again?” It seems dangerous, right? It can be, if you don’t progress them properly. In part 2 of this blog series we will discuss how we reintroduce running in a systematic manner that is safe and effective.

1. Sol, C., et al. “Impact Forces at the Knee Joint: A Comparative Study on Running Styles.” Medicine & Science in Sports & Exercise. 2001. 33(5);S128.
2. Mann RA and Hagy J. “Biomechanics of walking, running, and sprinting.” American Journal of Sports Medicine. 1980. 8;345–350.
3. Nijs, J., et al. “Nociception Affects Motor Output.” Clinical Journal of Pain. 2012. 28;175-181.

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