Re-Thinking Return to Running in Sports
A question of capacity and chronicity , are we rehabilitating our athletes into chronic injuries? Can we be more deliberate in the process of return to running?
Running is the foundation of many athletic pursuits. From field sports and court sports to sprinting and endurance events, it underpins performance across codes and competitive levels.
Yet despite its central role, return-to-running remains one of the least formally structured phases of sports rehabilitation. Athletes frequently regain strength, mobility, and confidence - but soon after resuming running, symptoms return. The cycle repeats.
This raises an uncomfortable but important question:
Are we rebuilding capacity… or unintentionally creating chronic rehabbers?
This article is not written as criticism. Instead, it is offered as reflection and an invitation for our profession to think more deliberately about how we reintroduce one of sport’s most demanding tasks.
1. Injury Reduces Capacity More Than We Often Appreciate
When athletes are injured, the problem extends beyond pain or tissue healing. Capacity quietly shrinks in several domains:
tendon stiffness
elastic energy storage and release
rate of force development
neuromuscular timing
tolerance to repetitive impact
bone stress resilience.
An athlete may demonstrate excellent control in the gym, appear strong on single-leg tasks, and report confidence on return to training, yet still lack the physical readiness for high-frequency impact.
Injury reduces more than strength.
It reduces the system’s ability to absorb, store, and return force rhythmically.
And this decline often becomes apparent only once running resumes…
2. Running Is Not Low-Load, It Is High-Rate Repetition
It is easy for athletes, coaches and even clinicians to underestimate the true demands of running.
A standard 5 km run involves approximately:
4,000–5,000 ground contacts per leg
occurring in milliseconds
with forces multiple times body weight passing through each limb
Approximate magnitude at each joint per step:
ankle: ~2–3× body weight
knee: ~4–6× body weight
hip: ~6–8× body weight
As speed increases, both peak force and loading rate increase substantially. Faster running does not simply “feel harder” - it changes the mechanical exposure entirely.
From a tissue perspective, running is best understood as:
A repetitive plyometric task performed thousands of times.
Framed this way, it becomes easier to understand why symptoms re-emerge, or symptoms associated with insufficient tissue capacity emerge when athletes transition too quickly back into running (regardless of volume and velocity).
3. Isometrics: Beyond Pain Relief
Isometric exercise is often framed exclusively as an analgesic tool.
However, applied strategically, it can also support:
tendon stiffness development
rapid force recruitment
force transmission capacity
limb switching control
tolerance to rapid loading
Influenced by practitioners such as Alex Natera, many performance environments now employ:
yielding isometrics
overcoming isometrics
ballistic isometrics
switching patterns
These progressions enhance qualities that running depends upon before running itself begins. This is crucial to retraining the joint loading to exceed BW without the dynamic nature of running. These can also be applied early in the rehab phase and progressed en route to return to running.
Isometrics make plyometrics safer. Plyometrics make running safer.
4. The Case for Low-Amplitude Plyometrics
Low-amplitude plyometrics such as pogo hops, ankling, skipping, line hops, and mini-bounds as well as banded variations thereof offer a controlled way to reintroduce impact:
They expose the system to:
rapid force application
elastic loading
frequent ground contact
joint stiffness demands
neuromuscular patterning
…without the volume of running itself.
If rehab develops force production but not impact tolerance, athletes transition from “controlled strength” into “uncontrolled repetition” too abruptly. This is part of where our mismatch might be occurring as rehab clinicians.
Low-amplitude plyometrics act as the mechanical bridge between clinic and field.
5. How Much Is Enough? Thinking in Contacts, Not Just Exercises
Return-to-run is often guided by time or pain alone.
But total contact volume provides valuable context.
As a guideline:
Suggested plyometric volumes as preparation:
Per session
Low-amplitude plyometrics: 300–600 contacts per leg
Moderate plyometrics: 200–400 per leg
Advanced plyometrics (when needed): 100–250 per leg
Per week
Roughly 600–1500+ total plyometric contacts per leg, depending on sport and injury history
For perspective:
A conservative return-to-run jog can exceed 2,000 contacts per leg in one session.
Plyometrics allow exposure to rise progressively instead of abruptly.
6. A More Meaningful Question of Readiness
Rather than asking “Can they jog?”,
we may benefit from asking:
Can they…
perform fast isometric contractions without apprehension?
tolerate limb switching under load?
achieve several hundred plyometric contacts with quality?
recover within 24 hours?
produce symmetric force output? or perform outputs close to baseline?
maintain technique under fatigue?
If yes — running is logical.
If not — running may be premature.
7. Conservative Early… Aggressive Late?
Many programs are careful in early rehab.
Yet the transition to running often acts as the first real mechanical challenge.
Athletes go from:
Controlled loading to uncontrolled repetition under fatigue and speed.
When symptoms return, the injury is blamed, compliance is the issue - but we need to look inwards first for the answers
But often the explanation is simpler:
The athlete wasn’t weak.
They were just under-prepared.
A framework as basic as the FITT (Frequency, Intensity, Time and Type) can guide us into the right reflections.
8. Final Reflection
Running deserves more than a checklist. It deserves intention.
If return-to-run is rushed, our athletes suffer by returning them with compromised capacity. If it is respected, outcomes follow. If return-to-run is sporadic and unplanned, we create chronic rehabbers who struggle to bridge the gap from injury to performance.
If an athlete cannot tolerate hundreds of small, controlled impacts,
they are unlikely to manage thousands of unpredictable ones across a season.
Our task is not to load harder, but to load smarter. Because return-to-play isn’t an event. It’s a process.
-NP
I enjoyed this commentary Nick, well done. Certainly an area that needs more research, but also more reflection as clinicians. There’s a common feeling amongst clients and clinicians, that once pain has disappeared, it is safe to return to run. Like anything, without the work being put in, you are bound to go nowhere. If we take it a step further, we need to be clear as to what ingredients we are providing our clients with, otherwise we are being generic and doing our clients a disservice.