Further resources
Returning to running after a lower limb injury
Most people, especially athletes, who have suffered a musculoskeletal injury want to return to activity as soon as possible. Typically, this basic activity is running. For athletes, the primary goal is, of course, to return to the discipline they practice, but also for them, jogging is usually a transitional stage.
Preconditions
Before starting training, the physiotherapist should assess the patient:
– balance (e.g. standing test with two legs together and one-leg standing test with eyes open and closed, one-leg standing test with an additional task, e.g. passing a ball from hand to hand);
– involved lower limb stability (e.g. one-leg ¼ squat test);
– range of motion in the joints of the lower limbs;
– the strength of the hamstrings, gluteus maximus, gluteus medius and minimus (they work as abductors, but also as pelvic stabilizers, so it is worth performing the Trendelenburg test), tensor fasciae latae, rectus femoris (as a hip flexor, but primarily as a knee extensor), adductors, internal and external rotators of the hip, back muscles and abdominal muscles (assessment of the control of the trunk and pelvis position in statics and during movement). The strength of the mentioned muscles should be assessed not only in concentric work but also in eccentric and isometric work. This is necessary to estimate the efficiency of these muscles both in the acceleration and deceleration phases of movement, which are the basic components of walking and running.
Stage I. Walking
The first step to getting back to running is walking on a treadmill. The therapist should assess the quality of gait and, if necessary, introduce re-educational exercises aimed at eliminating compensation and improving symmetry and gait pattern. It is beneficial to pay attention to the work of the entire body (from foot propulsion, through torso rotation in walking, to head movement and positioning). Training on a treadmill should be continued until the patient is able to walk properly and with a feeling of complete comfort for 30 minutes at a speed of 6.5-8.4 km/h (quite intensely, but without the impression that he/she is almost running). Then the patient can start plyometric training.
Stage II. Plyometric exercises
Plyometric training is a very important stage of preparation for running. It allows to improve the shortening-extension cycle of the muscle and increases the safety of landing on the involved leg after the flight phase. The basic plyometric exercises are jumping with both legs in place, jumping with both legs forward, back, and to the side, jumping with one leg in place and in different directions, or long jumps.
Stage III. Trotting
Initially, the patient is advised to jog every other day for 30 minutes starting with an alternation of 5 minutes of walking and 1 minute of jogging. The patient should gradually increase the duration of trotting and decrease the duration of walking until they are able to trot for 30 minutes without experiencing any discomfort (excessive fatigue, pain, feeling of stiffness, etc.).
Stage IV. Running
Timed running: The patient is recommended to start with 30 minutes of running every other day and increase the distance by 10% in the following weeks. After 8 weeks, the patient can run several days in a row, but remember to take a rest every third or fourth day. The goal for intermediate people is a 45-minute running workout 5 times a week. The goal for advanced people is a 60-minute running workout 5 times a week.
Distance running: Those running less than 6.4 km/h should start by running 0.8 km every other day and gradually increase the distance until they reach 6.4 km in the fifth week. Runners above 6.4 km/h should start with 1.6 km every other day until they reach 8 km in the fifth week. After this time, the patient can return to running pre-injury distances.
It is an absolute recommendation that before moving on to the next stage of running training, the physiotherapist conducts an interview with the patient, a clinical examination, and appropriate tests. The occurrence of pain and its pattern should be observed (does the pain occur at the beginning, does it appear during exercise, is it constant, does it increase, does it always appear in the same place, does it “wander”, maybe the pain appears after exercise or at night?). The presence of edema and compensation as well as the patient’s mental state should also be assessed. Depending on the type and severity of side effects, the patient should increase the time between subsequent workouts, reduce the intensity of training, or stop training for some time.
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