back to running after injury runners knee causes and treatment the prehab guys

Get Back to Running After Injury Safely

Injuries are unavoidable. $HiT happens! Whether it’s your knee, ankle, or hip, you need to follow a systematic return to running protocol to ensure that you’ve built up the adequate strength to run. Returning to running after an injury without a plan is like running a marathon without building up your mileage. It puts your body at increased risk of future re-injury! Follow these easy steps and you’ll be back to running in no time!

After an injury, that tissues (tendons, muscles, ligaments, etc) that were hurt are more sensitive to stress. What this means is that “easy” 10k run you used to do might not be a cakewalk for your tissues anymore! When it comes to getting back to running, it’s all about gradually applying the load and stresses to your body in a systematic manner – a term called graded exposure. By applying load/stress in a graded way, you not only give time for your body (and brain) to adapt to the demands, but you also allow yourself to objectively determine how much running you can actually handle.

So, if the goal is to get back to running a 10k again, it’s most advisable to start with a smaller run, something like a 1k run would be perfect. Run that a few times and get used to it, and then slowly increase your mileage from there. For someone that is returning to running for the first time after surgery or big injury, it may be advisable to start with even smaller increments (see below for a more detailed set of instructions).

The University of Delaware created a Treadmill Running Program that I typically utilize in the clinic with my post-operative patients. The protocol is divided into seven distinct levels, with certain benchmarks that need to be met before moving forward to the next level.


  • LEVEL 1: 0.1 mile walk / 0.1 mile jog- repeat 10 times
  • LEVEL 2: Alternate 0.1 mile walk / 0.2 mile jog – 2 miles total
  • LEVEL 3: Alternate 0.1 mile walk / 0.3 mile jog – 2 miles total
  • LEVEL 4: Alternate 0.1 mile walk / 0.4 mile jog – 2 miles total
  • LEVEL 5: Jog 2 miles continuously
  • LEVEL 6: Increase workout to 2 1/2 miles
  • LEVEL 7: Increase workout to 3 miles
  • LEVEL 8: Alternate between running /jogging every 0.25 miles


  • Mandatory 2-day rest between workouts for the first two weeks.
  • Do not advance more than 2 levels per week
  • Two days rest mandatory between levels 1, 2, and 3 workouts
  • One day rest mandatory between levels 4-8 workouts

Soreness Rules

  • If sore during warm-up, take 2 days off and drop down 1 level.
  • If sore during workout, take 1 day off and drop down 1 level.
  • If sore after workout, stay at same level.

Again, this exact progression is just simply a layout, and does not need to be adhered to exactly. The important thing to notice is that you don’t go from 0 to 100 in 1 day, and you respect any soreness (joint, not muscular soreness) that may arise in your training. After you get back to running, of the most important things is reducing your risk for future injury, aka PREHAB. And we’ve got you covered with that below!

[P] Running

[P] Running is the ultimate program for running enthusiasts. No matter your fitness level, age, injury history, or running experience – we have a carefully thought out plan developed for you to achieve your ultimate running goals!


Strength Training For Runners

Strength training for runners is absolutely imperative for [P]Rehab to reduce the risk of injury. While almost any exercise is better than none, we’ll highlight some of our favorite strength training exercises for novice and advanced runner’s alike from our article, “Runner’s Prehab Checklist

“You must be fit to run, not run to get fit”

Dr. Christopher Powers, PhD, PT

Step Downs

Step ups and downs are amazingly simple, yet truly effective in lower extremity rehab. Adding variability to the classic step ups and downs is key to movement proficiency and developing a well-rounded athlete. Check out THIS ARTICLE for advanced step-up variations!

Calf Strengthening

This is a great drill for runners as it focuses on calf strength with the hip and knee in an extended position that also incorporates a single leg stability component. Be sure to add this exercise to your training regiment to improve your single leg strength, balance, and control.

Core Strengthening for Runners

Lets face it, there are a TON of exercises for the core. A lot of them would likely help with trunk and pelvis stability, but these three have specific implications for runners. Runners should perform core exercises that also target hip abduction and external rotation to help resist dynamic knee valgus.

Storks for Runners

Here, I’m trying my best to replicate the biomechanics at the hip for a runner. The glutes are our primary controller of frontal plane motion in running. During loading response (when you strike the ground), your glutes need to eccentrically control your femur moving into flexion. As you progress over your foot, it requires the glutes to concentrically move the femur into extension. I added a more forceful concentric phase here to again, try my best to replicate the demands on the hips during running.




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