In this article I am going to teach you how to safely and effectively return to exercise following injury.
Returning to exercise following injury is one of the main areas that I see people go wrong and sadly end up taking a backwards step in their rehabilitation. The problem is that people believe that when they are pain free that they are ready to return to exercise. Sadly, this is not quite the case. Becoming pain free is just one part of the rehabilitation process and ultimately it all comes down to why you experienced pain or became injured in the first place.
The principle of load has a huge impact on pain and injury. Load describes the amount of stress placed on your body during your given activities. People have a problem when the volume and intensity of the load increase too much & too quickly to a point beyond which their body is able to tolerate. And this is vital to consider during rehabilitation…
Research has shown that increases in load greater than 10% per week places you at an increased risk of injury. So why as soon as you become pain free would it be appropriate for you to return to the same exercise levels you were at before becoming injured?
It’s simple, a gradual exposure back to exercise is ultimately what is going to allow you to safely and effective return to exercise. Top athlete’s follow the same process and you are no different.
Lets take an example of a recreational runner, who normally runs 3x per week on average 10km and they have not ran for 3 weeks due to right ankle pain. After 3 weeks they are pain free, have a full range of movement and strength. They will now begin the following gradual exposure back to exercise to build the resilience and capacity to enable them to return to exercise safely (each step must be pain free in order to progress to the next).
Hop & Land from 2 feet to 1 (on to right foot)
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Hop & Land from left-to-right
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Hop & Land from right-to-right
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Multiple Forward Hop & Land from right-to-right-to-right
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Run 1km on flat ground at recovery run pace (half speed/light jog)
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Run 1km over hills at recovery run pace (half speed/light jog)
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Run 3km on flat ground
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Run 3km over hills
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Run 6-7km
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Run 9-10km
Now this isn’t a scientific or evidence based approach to returning to exercise but it gives a simple but more importantly actionable guide to gradually return to exercise following an injury. This programme will take on average 2-3 weeks to progress through but it ensures you limit your chances of re-injury and pain. It is important that you leave at least 24 hours between each stage to allow you to recovery but also to note how your body reacts to the slowly increasing load.
You may perform some of the hopping progressions together but it is important you work on these for at least 3-4 days before running to ensure you are ready to absorb and produce the increased forces associated with running.
The key thing is DON’T SKIP STEPS!
Also, don’t focus on your injury whilst your return to exercise. I’ve seen this hold people back because they search to feel the pain, remember why you exercise and enjoy it!
Your physio should be making this plan with you as your rehabilitation has not finished until you are comfortable at (or above ideally!) your pre-injury condition.
About the Author
Alex Morrell (MSc, BSc (Hons), MCSP) is a Sports Physiotherapist working in international and professional rugby alongside private practice. He has a keen interest in all things training & performance from his sports science/S&C background. (@theonlinephysiocoach)
