4. Coming back from an injury or illness

Most of the runners I’ve worked with who have experienced injury have been able to ease back into running after a few days off for healing. Illness presents more complex issues. Before resuming a strenuous training program after injury or illness make sure that your doctor has approved your return to running. The advice in this section and the book is from one runner to another. For medical advice, see a doctor.

By easing back into running using short segments, the legs, feet knees, etc. can gradually re-adapt naturally. Too much continuous running is the most common cause of injury. If walking is allowed during the time off from running, build the walk to 30 minutes. Whether walking or running, keep a short stride with your feet low to the ground.

Some runners will be able to progress more rapidly than others, but it is always best to start with very short segments of running. After about two weeks of very gentle running, most runners are able to add more running. Even then, a gradual increase back to the former level is recommended. Normally this is more than twice the time runners had to lay off from running due to injury, sickness, etc.

Principle: Stay below the threshold of further irritation of injury. When coming back from illness, be conservative in increasing workload. Too much, too soon can lower the immune system.

First run:

If there are no problems after the first workout, increase the number of R5sec/W55sec segments on successive workouts, every other day, until you’re running 30 minutes. Don’t do any strenuous exercise on the day off from running. Walking is usually allowed but ask your doctor.

Monitor weak links and back off if there is irritation.

Gradually increase the amount of running and decrease the amount of walking as the body adapts: R10sec/W50sec, R10sec/W40sec, R10sec/W30sec, R10sec/W20sec, R15sec/W30sec, R15sec/W30sec, R40sec/W30sec, R40sec/W20sec, etc.

If you feel that the irritation in an injured area is coming back, take 2-3 days off and come back with just a few minutes of R5sec/W55sec.

My comeback story: Returning to marathons after a hip fracture

By March 1, 2012, my wife Barbara and I had been running a marathon every month for about three years. I had just finished two days of filming a pilot for a TV show on running, and was walking up a stairway thinking about the next marathon in two weeks in Rome. As I reached the top of the stairwell, I noticed the doors opening ahead of me and shifted to the side, not looking at the top step. My left foot caught the lip, and my hip hit the stone floor hard, causing a fracture.

X-rays and an MRI disclosed three fractures. My excellent medical advisors, Dr. Ruth Parker and Dr. Paul Parker, believed that I should not jump into surgery or other procedures. I started learning how to use crutches. Barbara was so great about helping me get around. At first, almost any movement was awkward and any slight departure from a short range of motion triggered an instant jolt of pain.

Ruth told me right away that I should keep the calf muscle active and she suggested toe raises. I found that there was no pain doing these and I quickly built up to 700 per day. This was crucial in my return to running later.

I also walked around on crutches, several times a day. One day a week, I increased the distance covered on this long crutch run. This was simply a visualization—I imagined myself running along the sidewalk. Each week I went a bit farther.

Two weeks after the fracture I was scheduled to leave for Rome. My medical team was cautious but let me go. The RunItaly tour asked me to give clinics to the runners. I experienced a few moments of real pain trying to move from one mode of transportation to another and some significant swelling during and after the flights. But I crutched my way around Rome on the wonderful tours, and advised the runners on tour about how to be strong and energized during the marathon, while recovering fast enough to enjoy the tours and Italian cuisine. They seemed to believe me even if I was giving the clinics on crutches.

I continued my 700 toe raises each day for 7 weeks. During the sixth and seventh weeks, my bone seemed to be getting stronger every day, and I started supporting some of my weight on my legs when walking, while still getting some support from the crutches. Seven weeks after the day of the fracture, I felt strong enough to walk without crutches. I had many anxious moments that week. I walked around the house, up and down the hallways, then cautiously outside on the sidewalk. I was definitely wobbling as I walked through airports to my clinics. There was a lot of weakness due to the atrophy of the gluteus muscles, but the symptoms were not the pain I received from the bone damage. I talked this through with Ruth and Paul who cautioned me to monitor warnings as I increased the distance of my walk about every other day. The remaining damage seemed to be exclusively in the soft tissue in the gluteus medius and the many tendons, ligaments, nerves, and other components damaged during the fall.

During the two weeks of walking only, I increased my long walk distance to 8 miles. At that point, I felt that I could begin short running segments. I continued to feel weakness and significant soreness as I walked, but these symptoms seemed to lessen every two days or so. On my first attempt at running I was nervous and excited. I started with a 5-minute walk. Then I tried to jog for 5 seconds. I felt very awkward and unnatural, and walked for 55 seconds after each 5-second jog. On the first day, I did ten of these R5sec/W55sec segments and walked for 10 minutes. Every other day I increased the number of minutes of R5sec/W55sec until I could do 30 minutes.

Because of my toe raises, my calf muscles were ready to run. After 30 minutes of R5sec/W55sec, I moved up to R10sec/W50sec. The running felt more and more natural so I moved up to R15sec/W45sec and then to R30sec/W30sec (one week at each ratio). At this point, I was at the Med City Marathon/Half Marathon in Rochester, MN, for clinics and decided to try the half marathon. While R30sec/W30sec felt doable at first, it was too much for the soft tissue when continuing for 13.1 miles. I shifted to R20sec/W20sec and finished with R15sec/W30sec walk.

I should have used R10sec/W20sec or R15sec/W30sec from the beginning. The extra stress of the R30sec/W30sec for that distance damaged the glut muscles, nerves, and tendons requiring a very gentle recovery week. I shifted back to R15sec/W30sec on my runs and started improving again. Two weeks later I used R15sec/W45sec to cover 15.5 miles. One month after Med City, I used R15sec/W45sec to cover 18 miles during the Grandma’s Marathon, where I was giving advice about training and how to avoid tripping on stairwells.

There were no setbacks from the 18 miles, but soreness and glute weakness continued lessening every week. I planned to do 22 miles at the Missoula marathon, three weeks after Grandma’s, and walk for the last 4 miles or so. It was a beautiful morning through the scenic Montana ranchland as I walked for 2 miles with my friends Kim and Stan. At that point, we decided to try R10sec/W20sec. It worked. At 22 miles I was having so much fun that I decided to continue and finished Missoula in 6:04. It was my slowest of 169 marathons but I couldn’t have felt more proud or empowered.

For the first two days there was some of the usual glute soreness, but then it mostly disappeared. One month later I finished the Alaska Wild Life Marathon (one of my favorites) in 4:55 using R20sec/W20sec for the first half and then R15sec/W10sec for the second half.

The human body has an amazing ability to regenerate when challenged—if we let it.