A Return to Run Process

Getting Back on the Road

The final step of the return to run process, actually getting back on the road, should come after plyometric progression, after return to run assessment testing, and after your athlete already feels like they’re fine to start running again. The return to run process is essential for ensuring a safe and effective transition back to running after an injury, but it’s slow. As a physical therapist, gaining athlete buy-in is crucial, as this process often unfolds more slowly than athletes anticipate. Educating them about the rationale behind a progressive approach can help to align their expectations with the necessary recovery steps. Emphasizing that rushing back may lead to setbacks can foster a shared commitment to a structured plan. Building trust and understanding enables athletes to invest in their rehabilitation, ultimately leading to a more successful return to the road or trail.

Inadequate time taken in the return to run process significantly increases the likelihood of injury recurrence among athletes. When athletes rush back into running without properly adhering to your guidelines, they risk exacerbating existing injuries or developing new ones. This is particularly true for soft tissue injuries, where insufficient healing time can lead to ongoing issues that may sideline the athlete for even longer periods. Ensuring that athletes buy into your recommendations is crucial for a successful recovery. Open communication, education about the risks of returning too soon, and setting realistic expectations can help facilitate this buy-in. If the athlete has a coach working collaboratively with them could be effective. Overall, creating a clear plan that integrates gradual progression and specific milestones, while also celebrating small victories along the way is key to the process.

With that all said, let’s dive in to what an actual process can look like. This is going to vary relative to the athlete’s running and injury history, the plan below is very generic. Do not apply this directly to any athlete, use it as part of your clinical decision-making process to build your own plan.

Return to run plan

The initial process should be a walk:run protocol to slowly reintroduce the concept of running. The athlete should be able to complete each step without pain, symptoms, or edema before moving to the next step. Athletes should stop if they experience pain or swelling or need to alter their gait pattern at any point. All of these phases should be completed on flat ground before attempting any hill work.

Step 1

• Warmup for 5-10 minutes, walking

• Run 3 minutes, Walk 1 minute

  • Repeat 3-5 times

• Cool down 5-10 minutes, walking

• Gently stretch hamstrings, calves, lateral hips, adductors, and quads after exercise

• Repeat twice with one day off in between without pain, swelling, or gait pattern alterations before moving to next step

Step 2

• Warmup for 5-10 minutes, walking

• Run 5 minutes, Walk 1 minute

  • Repeat 3-5 times

• Cool down 5-10 minutes, walking

• Gently stretch hamstrings, calves, lateral hips, adductors, and quads after exercise

• Repeat twice with one day off in between without pain, swelling, or gait pattern alterations before moving to next step

Step 3

• Warmup for 5-10 minutes, walking

• Run 8 minutes, Walk 1 minute

  • Repeat 3-5 times

• Cool down 5-10 minutes, walking

• Gently stretch hamstrings, calves, lateral hips, adductors, and quads after exercise

• Repeat twice with one day off in between without pain, swelling, or gait pattern alterations before moving to next step

Step 4

• Warmup for 5-10 minutes, walking

  • Walk uphill for 3-5 minutes, if possible

• Run uphill 3-5 minutes, walk down

  • Repeat 3-5x

• Run on flat ground 5-10 minutes

• Cool down 5-10 minutes, walking

• Repeat twice with one day off in between without pain, swelling, or gait pattern alterations before moving to next step