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Return running

Return to Running With Confidence

What do you use for your return to running criteria? When physical therapists think about return to running, oftentimes strength, ROM, and motor control are the primary components. Yet as our profession continues to advance through both research and good anecdotal evidence, we must do our best to objectively measure our return to running progressions. If we look at the mechanics of running, there are many ways to help ensure our athletes are prepared to run again.

Objective testing for return to running

Biomechanically, it can be difficult for a PT to mimic the load requirements for running. However, from a testing standpoint, there are ways we can mimic the running motions and requirements. Many PT’s are without a treadmill and have difficulty with performing a thorough return to running process. The good news is there are ways to test out different components of the run to aid in your decision making process.

Single leg step-down

  • This is the foundation of the running motion, in my opinion. In running, because we are essentially bounding from one leg to another, we need to look at single leg strength and control.
  • The single leg step-down to 45 degrees can be a good indicator of eccentric control, hip stability, varus/valgus control, trunk stability, and knee vs. hip patterning.
Clinical tip: When returning my athletes back to running, I test out each leg and ensure they can perform at least 15 repetitions on each leg with near perfect form. Why 15? Because when they are running they are performing at least that many steps per leg in the first few minutes.

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Planks with arm drivers

  • How do you measure core stability? Or do you say core strength? These terms are used interchangeably but need to be separated and defined clearly. For runners, I like to use the plank with alternating arm drivers for 1 minute.
  • The key with this test is to encourage the athlete to minimize rotation at the trunk when reaching out.
Clinical tip: By adding arm drivers to the plank we can see how the core responds, similarly to when an athlete is running with arm swing. I test for 1 minute to ensure enough reps are performed to get a good assessment.

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Reverse lunge

  • The reverse lunge is another test I look at with each athlete when determining whether they can start to return to running. The purpose of the lunge is to determine what the mobility of the trail leg is and the control of that leg. In other words, we are looking at the athlete’s ability to load through the rear leg and great toe. While this is often overlooked and not tested, the great toe is responsible for aiding in push off in running.
Clinical tip: Perform on each side and look at how far the athlete brings his/her trail leg back. Are they even? If not you may want to check hip extension mobility.
Clinical tip: For being more specific with hip extension mobility testing, check the Thomas test—but instead of the athlete holding onto the top leg, put that leg over your shoulder to see what a “full stride” looks like.

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Putting it all together

Without an Alter G, it can be difficult to slowly load the athlete back up to running following the above tests. My suggestion is you prepare the athlete back to that loading with light jumps and/or an agility ladder. The reason I say using an agility ladder is because it can be helpful to get that small bounding from one leg to another, similar to running. Lastly, remember that there is less vertical displacement running on a treadmill and that a treadmill will “pull” your leg back and put an anterior shearing force on the femoral head. This is crucial to understand if your athlete is returning from a hip injury.

Many thanks to Dr. Brian Schwabe from The Student Physical Therapist for contributing this article! Don’t forget to follow then on Facebook and Instagram!
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About Brian Schwabe

Brian Schwabe
Dr. Brian Schwabe, PT, DPT, SCS, COMT, CSCS is a USC sports residency trained board certified sports physical therapist, strength coach, author, and fitness consultant. He is one of the co-founders of The Student Physical Therapist, an educational website for clinicians & students. With his partners, TSPT has grown into a go to resource for learning from residency trained, board certified specialists in sports & orthopedic PT. www.thestudentphysicaltherapist.com

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