Can I Run During an Injury and if not, When can I Return to Running After Injury or Surgery?
These are million-dollar questions! My answer is, "It depends."
A patient with patellar tendonitis, whom I instructed not to run, came into his appointment and said, "I feel great, and I ran seven miles two times last week." I lifted my head from my laptop, peered at him through my glasses, and gave him a grin and head nod of understanding while at the same time resisting the urge to roll my eyes back in my head.
As a runner who has experienced many injuries and surgeries, I empathized personally, but as a physical therapist, it is cringeworthy when a patient goes rogue.
Why rest from running or manage your return to running after an injury or surgery?
The musculoskeletal system, which includes bone, takes time to heal and strengthen progressively. When running, the structures must tolerate repetitively loading at least three times your body weight.
Several factors determine whether you can run during an injury or when you can return to running after an injury or surgery.
When and whether or not you should run depends on an injury's nature, severity, and chronicity. Does the injury involve bone or soft tissue like a tendon? Is the injury mild or severe? How long has it been present? Six months, three years, or two weeks?
Nature of the injury or Surgery.
If the injury involves tendons and ligaments, it can sometimes take longer than a fracture to heal. The rule of thumb for tissue repair is at least six weeks if you do all the right things! Some surgeries require six weeks of rest from running and high-impact sports, and others require six months or more. Runners undergoing surgery should always have post-operative physical therapy if they want to return to sport.
Severity of an Injury.
The more severe the injury, the longer it will take to return to running. For example, a grade III calf injury may need months of rest, while a grade I calf injury may only require a week of rest from running. Check out my article on Calf Strain and Pain.
Chronicity of an injury.
The longer an injury has festered, the longer it will take to return to running. This is a rule of thumb, and I find it is usually accurate. And why all runners should seek professional help if an injury does not subside within a week of rest and modification.
Signs, symptoms, and issues that indicate you need to rest from running or wait to return to running after an injury or surgery.
Poor biomechanics due to lack of stability, strength, or range of motion
Swelling/inflammation
Pain greater than a 3/10 during or after running
Poor Biomechanics
Many runners can feel when their run gait is “off” or when weakness or lack of mobility is present. Weakness and/or loss of range of motion is your body’s way of telling you that something is off - they are protective mechanisms. Pushing through a run in these circumstances will delay healing, worsen the injury, or even cause another injury!
Swelling and Inflammation
Swelling is a sign that the body is not okay. It is a red flag, a warning to stop running. Intermittent, mild swelling may be permitted with a return to run, but it means that you’ve done too much. Ensure you are working with a physical therapist to help you manage your back to run the program. Check out my article on Aiding and Controlling Inflammation.
Pain
Once again, it is a warning sign that something is not right. If unmedicated, your pain is greater than a 3/10 on a pain scale where 0 is no pain, and 10 is emergency room pain, then you should not run. Do not take pain medication to run. Pain is a fascinating and multi-faceted topic, and your physical therapist can help you navigate when it is okay to have some pain. Check out my article: Pain and Injury Doesn’t Mean You Have to Quit.
Resting from running impacts our mental health. Acknowledging and addressing our mental headspace is just as important.
Following my patient’s admission to running, an explanation ensued, "I don't drink, I don't smoke, and I don't do drugs. I run." Running releases serotonin, which makes us feel good, and it is a mental escape, a muse. Taking it away from us for too long can mess with us physically, emotionally, and mentally. Fear of losing fitness comes at a close second to the effect on our headspace.
Acknowledge this aspect and work with your physical therapist to manage it with modifications and alternatives for running.
Modifications in running during injury and returning to running programs after injury are not one size fits all! It is personal and individual.
With mild injuries, sometimes running can continue, albeit modified in volume, intensity, and perhaps surface, while you heal. When it comes to a back-to-run program or continuing to run while managing an injury, finding the right recipe can be complicated: it takes practice, finesse, and patience. It's an art as much as a science, and an experienced physical therapist specializing in running can help.
Your physical therapist will continually test you to ensure you meet benchmarks for return to run and, when you meet them, will set you up with a back-to-run protocol. That protocol will consider how much time you’ve rested from running, your specific injury or surgery, your running experience, and your tolerance.
Invest in your running future.
My patellar tendonitis patient was lucky. Most runners that do this rouge testing don't fare as well and end up setting back their healing and their return to run. Pay attention to the signs and symptoms that should stop your run, and seek professional help for managing your rest, modification from, and return to run; it is an investment in your running future!
Stop injuries before they occur!
Learn the top five training errors that lead to injuries in runners in this blog post.
Carbohydrates: hero or villain?
Sausage, Asparagus and Walnut Quinoa Pilaf with Cranberries
Complex Carbohydrates are essential.
Carbohydrates are blamed for many evils related to our health, causing many of us to limit or avoid them entirely. But are they really the villain they’re made out to be? Carbohydrates have an undeserved reputation. As a result, our health is at risk.
Google “no or low carbohydrate diet.” A long list of diet plans will fill the page. Your search results will include advice and books touting that eating a diet low or devoid of carbs helps us:
lose weight
tackle Type 2 diabetes
lower blood pressure, and even
perform better in endurance sports.
This is quite true when referring to simple carbohydrates, like cookies, fruit juice, and corn syrup. But believers beware: long-term diets devoid or low in all types of carbs may cause or worsen some disease processes and starve the body of key components for health and wellness.
Repair of the body—whether due to injury, illness, aging, or overworking while training—requires a tremendous amount of energy. The best source of fuel is harnessed from complex carbohydrates. Without them, the body will instead consume protein. We need that very protein to build and repair the body.
Body repair requires complex carbohydrates + protein.
These examples show the relationship between complex carbohydrates and recovery.
Example 1:
Injured Person with Chronic Back Pain and Sciatica (inflammation of the sciatic nerve)
With this condition, nerves, muscles, and fascia are inflamed and, in some cases, scarred and torn. Think of a frayed electrical cord. There are many treatments that can help, but without protein and energy from carbohydrates, the body will not have the components needed for repair. As an added bonus, complex carbohydrates decrease inflammation.
Example 2: Endurance Athlete Training for a Marathon or Triathlon
To prevent injury and enhance performance, endurance athletes require complex carbohydrates. An endurance athlete training for a race is in varying states of high volume and intense load with minimal recovery. The endurance athlete requires complex carbohydrates not only so that the body doesn’t break down muscle during activity, but also to decrease inflammation and aid in repair microtearing of skeletal muscle and tendons after and between workouts.
The key to garnering energy from carbohydrates is eating the right kind and the right amount.
Healthy carbohydrates are referred to as complex carbohydrates. They have the following characteristics:
Low or moderate in calories
High in nutrients
Devoid of refined sugars and refined grains
High in naturally-occurring fiber
Low in sodium
Low in saturated fat
Very low in, or devoid of, cholesterol and trans fats
Examples of complex carbohydrates:
quinoa
oats
buckwheat
bananas
sweet potatoes
beet root
blueberries
grapefruit
apples
kidney beans
chickpeas
How many carbohydrates do we need?
According to The Dietary Guidelines for Americans carbohydrates should make up 45 to 65 percent of your total daily calories.
When healing from injury, five servings per day is needed (1 serving = 15 grams).
Examples of one serving:
1 slice bread
1/2 cup cooked cereal
1/2 cup rice or pasta
3/4 cup dry cereal.
Whole grain sources give you more protein.
Endurance athletes should consume 0.5–0.7 grams of carbs per pound of body weight within 30 minutes after a training session that exceeds 60 minutes. For a 120 pound athlete, that is 60 - 84 grams of carbohydrates or 4 - 5.5 servings. This is in addition to consuming an adequate amount of carbohydrates during the activity.
Whether your body needs to repair as a result of aging, endurance training, illness, or injury, your body requires complex carbohydrates. Even in daily life, a healthy amount of carbohydrates, as listed above, is essential for a healthy diet.
And now we’re down to it: are carbs heroes or villains? Like many things, it’s all about balance. Just the right amount of complex carbohydrates make them a hero to your body, both for healing and prevention.
Let’s change our perception of this key component of our health so we can move better, work better and play better!
Subscribe to Roadrunners of Kansas City Running Tips Blog for upcoming articles on nutrition for athletes and more!
In the next article in our Nutrition and Healing series, we discuss what to eat to promote muscle repair. Stay tuned and subscribe to CoachAmyPT. In case you missed them, check out CoachAmyPT’s previous three articles on nutrition and healing:
In the state of Kansas, licensed health professionals including physical therapists may use nutrition tools as an adjunct to their profession. Coach Amy will not advise patients who require extensive meal planning, specific values for macro or micronutrients or patients with specific disease processes or on specific medication that are affected by dietary manipulation such as a diabetic. Patients in these circumstances should seek help from a registered dietician.
Foods to Eat When Recovering from Injury: Boost Anti-aging, Sports Performance and Recovery
Psst…I have a secret. What if I told you that we can fight aging, enhance sports performance and boost injury recovery with little effort, minimal cost, and no side effects? Would you be in? Me too!
And the secret is … delicious food - believe it or not!
One of the primary determinants we face with aging, high intensity/volume sport, and injury is inflammation. In our second CoachAmyPT article on nutrition, we discussed that it behooves us to avoid foods that increase inflammation and instead consume those that minimize it. In this article we share a list of some of those foods.
I have good news for you: there are a variety of foods, spices, and teas that possess anti-inflammatory properties, and, much to my glee, dark chocolate is on the list!
Controlling inflammation can be tasty. Below is a list of nutritional items with anti-inflammatory properties:
extra virgin olive oil
spinach, kale
fatty fish - salmon, tuna
strawberries, blueberries, cherries, grapes, and oranges
avocado
bell peppers, tomatoes, and mushrooms
green tea
turmeric
Turmeric comes in pills and powders that can be added to smoothies or cereals. It is also a spice that can be added to some dishes. More on turmeric in future articles!
dark chocolate/cocoa (low to no added sugar)
Before you fill a mug with hot cocoa or grab a dark chocolate candy bar, remember that sugary foods increase inflammation. But don’t worry! There are some naturally-sweetened dark chocolate sources. My favorite source for sugar-free chocolate is Lily’s. Their products are sweetened with a natural sugar substitute derived from Stevia rebaudiana. I’ve found them at health food stores like Sprouts and Whole Foods as well as the natural food section of bigger box grocery stores.
As you may recall from our CoachAmyPT article on inflammation, it is our goal in physical therapy to control inflammation. In addition to EPSOM salt soaks, relative rest, PT treatments (such as needling and Active Release Technique) we can boost our rehabilitation, performance, and anti-aging efforts with the food we eat. Bon appetit!
In the next article in our Nutrition and Healing series, we discuss the impact of carbohydrates on recovery. Are they as ugly as they’ve been made out to be? Stay tuned and subscribe to CoachAmyPT. In case you missed them, check out CoachAmyPT’s previous two articles on nutrition and healing:
Foods to AVOID When Recovering from Injury or During periods of High Volume and intensity with sport
My traditional post-marathon celebratory meal consists of a juicy burger, fries, and ice cream chased with cinnamon whisky shots to numb my legs! In fact, when I “hit the wall” during a race, the promise of this feast often pulls me through.
“Give up or give in, and you can kiss that post-race treat goodbye!” Surely the protein, sugar, salt, and carbs after 26.2 miles is deserved … right?
Not so fast!
The fact is, running over fifteen miles causes micro-tearing of the muscles. Torn muscles—whether caused by aging tendons, degenerative joints, high volume or intensity with sport, or broken bones from a fall or car accident—all have one thing in common: they generate inflammation.
Inflammation isn't all bad: it is the body’s healthy reaction to injury and disease. But too much of it can delay recovery, and, if prolonged, it can cause a vicious cycle of chronic pain. Our goal in physical therapy is not to abolish the inflammatory process, but rather to control it. We can do that in a variety of ways, including evaluating our diet.
Some foods can increase inflammation, inhibiting or delaying healing. Some of these foods include:
Refined carbohydrates and starches, like white bread and pastries
Fried food, like french fries
Red meat and processed meat
Soda
Sugars
Foods with a high glycemic index
Shortening/margarine
Sunflower, corn, and soybean oils
Doctors have been telling us to avoid these foods—or eat them in moderation—for decades, so I guess it isn't shocking to discover that, along with other harmful impacts, they also cause inflammation. It may surprise you, however, to learn that some foods touted for their health benefits may make it more difficult to control inflammation. Enter the omega fatty acid debate.
As with many health-related topics, scholars and scientists don't always agree with each other. There is some controversy about omega-6 fatty acids and inflammation. If you go digging for more information on this topic, you may find yourself heading down a rabbit hole. An article posted in Harvard Health Publishing may shed some light if you feel like diving in for more information.
In a nutshell, when foods containing omega-6 are eaten in moderation and balanced with foods containing a higher ratio of omega-3 to omega-6, they may not cause inflammation.
The following lists contain omega-6 to omega-3 ratios for a few foods. I encourage you to look up the omega-6 to omega-3 ratio of foods that you regularly eat. As always, if you are working with a dietician for health reasons, follow the specific diet plan that they provide to you.
Some foods containing a higher ratio of omega-6 to omega-3 fatty acids to eat in moderation:
tofu
ground fresh peanut butter (no sugar added)
walnuts, almonds, cashews
pumpkin seeds
commercial eggs
avocado
Some foods containing omega-3 fatty acids or a high ratio of omega-6 to omega-3 that are recommended by health/nutrition experts:
fish, like salmon
fish and flaxseed oils
omega-3 enriched eggs
flaxseed and chia seeds
oatmeal
spinach, broccoli, and kale
kidney beans
Looks like my high post-marathon race reward needs a makeover in order to promote recovery and prevent injury. In moderation, alcohol can decrease inflammation, so maybe I will keep the promise of one cinnamon whisky shot to help me punch through the wall.
While carbohydrates, protein, and salt need to be replaced post-marathon or when recovering from injury, the source of those nutrients is key. We will further explore healthy sources for those key nutrients as we continue with our nutrition series.
Subscribe to our blog and stay tuned for the rest of the articles in our nutrition series to learn more about what we should eat to promote healing.
Follow us on Facebook for recipes, exercises, and more health and wellness tips.
In the state of Kansas, licensed health professionals including physical therapists may use nutrition tools as an adjunct to their profession. Coach Amy will not advise patients who require extensive meal planning, specific values for macro or micronutrients or patients with specific disease processes or on specific medication that are affected by dietary manipulation such as a diabetic. Patients in these circumstances should seek help from a registered dietician.
Discover the Role of Nutrition In Healing and Prevention of Injury
We’ve all heard the old saying “you are what you eat.” And we all know what we eat impacts not only our weight and shape but also how we feel. But did you know that your diet also impacts preventing and recovering from injury?
Patients often ask me for nutritional advice. They are wise to do so: nutrition has a direct impact on recovery, prevention of injury, and, ultimately, function. While I am not a dietician, it is my responsibility as a physical therapist to provide information on nutrition as it relates to the healing process and as it pertains to medical conditions that I treat.
“It is within the professional scope of physical therapists to counsel and advise on nutrition in treatment as it relates to treating chronic pain, injury, inflammation, and optimal physical function. ”
The science of nutrition and health is constantly changing, and I’m keeping tabs on what you need to know. I’m diving into the latest research to find the most up-to-date information relevant to preventing and recovering from injuries. You’ll find my most important discoveries in a series of articles that include tips on what to eat (or not eat!) to fight chronic pain and inflammation and to promote tissue repair and function.
Whether these tips include eating avocados, protein shakes, or triple-chocolate brownies (I wish!), let’s discover how what we eat impacts prevention and recovery.
I hope you will join me on this journey. To learn more, subscribe to the CoachAmyPT blog.
In the state of Kansas, licensed health professionals, including physical therapists, may use nutrition tools as an adjunct to their profession. Coach Amy will not advise patients who require extensive meal planning or specific values for macro or micronutrients or patients with specific disease processes or on specific medications that are affected by dietary manipulation, such as diabetes. Patients in these circumstances should seek help from a registered dietician.
Protein and its Role in Injury Prevention and Recovery
Athletes and patients often ask me questions about nutrition. From my experience as a coach, therapist and athlete I’ve gleaned some knowledge on the topic. As we all know proper nutrition is key for maintaining a healthy lifestyle. Our diet not only affects our athletic performance, but it also plays an important role in how quickly we recover from injuries, and helps prevent injury in the first place.
A protein rich diet is particularly critical for athletes. Everyone needs protein for rebuilding and repairing the body, but it’s especially important for patients recovering from injury and for endurance athletes. During injury rehabilitation we are trying to repair injured connective tissue (muscle, nerves, fascia, tendons and ligaments). Athletes in training are trying to build muscle at the same time their muscles and connective tissues are undergoing micro tearing. This is where protein comes in! The primary job of protein in the body is to repair tissue, including muscle cells that were damaged from exercising to the point of fatigue.
Protein is processed by the body in small quantities, so nutritionists recommend that we take in protein throughout the entire day, at every meal and with snacks. Most athletes are aware of the importance of taking in protein after a workout, especially within the first hour. But many athletes do not realize the importance of taking in protein throughout the whole day. The protein requirement for athletes is about 60% higher than non-active counterparts. If we rely solely on stuffing ourselves with a high protein meal one hour after a workout, we do not have enough protein in our systems for repair and rebuilding.
So what foods are high in protein? Here is a list of a few healthy sources that pack a lot of protein per serving: lean roasted meats and fish, red beans, cooked eggs, low-fat yogurt, skim milk, fresh nuts and nut butter with no added sugar (peanut, almond, cashew).
One of my favorite go to’s immediately after a workout is chocolate skim milk. I also like gluten free protein balls for snacks. Do you have a favorite recipe high in protein? Share with us on our CoachAmyPT Facebook page. We’d love to have you chime in!