John Davis

Written by John Davis

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How Much Running Can You Safely Do When Returning From an Injury

It’s hard to tell how quickly you can come back from an injury.

Should you wait until all of the pain subsides completely or is it okay to do some easy running when you still have a bit of soreness?

These are difficult questions to answer because getting it wrong can prove to be a big setback.  Nevertheless, it’s very important to know!

Full recovery from some chronic injuries can take months, but often runners can get away with doing some running while their injury improves.  Exactly how much you can get away with has remained a mystery.  Fortunately, some new scientific research has investigated how much pain is acceptable during injury recovery.

The pain monitoring model

A research group led by Roland Thomeé at Götebord University in Sweden first pioneered what they termed a “pain monitoring model” for recovery from athletic injuries in a study of women with patellofemoral pain syndrome, a common overuse injury of the knee which is colloquially known as “runner’s knee.”

Though the original intent of the study was to test whether eccentric or concentric rehab exercises were superior, the recovery program for both groups of women included a guideline on acceptable levels of pain when doing activities like running during the recovery period.

Both rehab interventions turned out to work just as well, but perhaps because of the fairly high success rate of the patients in the study (85% having returned to running without pain), Thomeé continued to pursue investigations of this pain monitoring model.

Thomeé’s model permits pain during exercise up to “5/10” on a pain scale, where zero represents no pain at all and 10 represents “pain as bad as it could be.”

This “5/10” level of pain was only permitted as long as it subsided immediately after stopping exercise, and all pain should have gone away by the next morning.  If not, the subjects had to dial back their training.  But because both groups of patients followed the pain-mediated exercise model, it’s hard to say whether it directly contributed to or hindered the success of the study.

Running during injury recovery

To test the effect of exercising while experiencing mild pain while rehabbing a chronic injury, the group at Götebord University conducted another study, this time of patients with Achilles tendonitis.

The pain monitoring model was explicitly tested by Silbernagel et al. by splitting the 38 participants into two groups, one of which followed the typical protocol for injury recovery—no painful activity allowed at all for six weeks—while the other followed a slightly modified pain monitoring model.

In this study, the researchers still mandated that pain during exercise remain at “5/10” or below, but pain was permitted to persist for a while after finishing exercise, with the condition that it must be gone by the following morning.  Additionally, Achilles tendon pain was not allowed to increase from week to week during the 12-week study.  Both groups followed the same physical therapy program. The subjects were followed for 12 months.

At every check-up, there was no difference in pain levels or tendon function between the group prescribed six weeks of rest and the group which was allowed to exercise into mild tendon pain; both groups demonstrated continuous improvement, even one year after the study’s outset.

In the conclusion of their paper, the researchers contrasted their results with a previous study by a different research group which found that:

  • A rehab program was ineffective in volleyball players with tendonitis who continued to practice and compete while rehabbing their injury.
  • They highlighted the fact that the subjects in the present study were not allowed to push above 5/10 on the pain scale, while no restrictions were placed on the volleyball players.
  • Keeping pain levels at moderate levels, the researchers hypothesized, was what allowed tendon healing to take place even while the study participants continued to exercise.

Conclusion

The results of this study are good news for runners, who often suffer from stubborn, chronic overuse injuries like Achilles tendonitis and patellofemoral pain syndrome.

From the work of Thomeé and Silbernagel et al., it’s reasonably safe to predict that doing some running while you are still recovering from Achilles tendonitis or runner’s knee won’t have deleterious effects on your rehab as long as you cut back on your workouts if the pain becomes anything more than a mild to moderate irritation (5/10 on the pain scale).

Unfortunately, because different running injuries have quite a varied recovery pattern, it would be reckless to apply this to all running injuries before more research has been conducted. Trying to continue running when you have a stress fracture, for example, is a terrible idea!

By no means are we suggesting that you should always be running through pain. However, this research does help answer that question of “how much and when can I run again” when rehabbing from an injury. If you’ve taken the necessary time to recover and heal, the research suggests that as long as the pain level stays below a 5 on a scale of 0 to 10, it may be safe to run while you continue rehab.

If you have specific questions about your own recovery, you should probably ask your doctor or physical therapist.

Ultimately, though, the future looks promising for runners who are eager for recovery programs from soft-tissue injuries that are more involved than “take six weeks off and see how you feel.”

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References

1. Thomeé, R., A comprehensive treatment approach for patellofemoral pain syndrome in young women. Physical Therapy 1997, 77, 1690-1703.
2. Silbernagel, K. G.; Thomee, R.; Eriksson, B. I.; Karlsson, J., Continued Sports Activity, Using a Pain-Monitoring Model, During Rehabilitation in Patients With Achilles Tendinopathy: A Randomized Controlled Study. The American Journal of Sports Medicine 2007, 35 (6), 897-906.

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