Advising Patients on Beginning or Returning To Running

Most sporting activities require some running. Running can be an excellent return-to-activity conditioning tool. After recovering from an injury, I find that the athlete finds great physical and emotional strength from a gradual buildup of running. In my practice, I convey that when the athlete is back to walking 30 minutes, without pain, and without a limp, they may begin a walk/run program.
 
The walk/run program that I have used for many years uses a 30-minute time period, based on the more classic 30-minute hard walk test that qualifies the athlete to begin jogging. However, you can start the program based on a 20, 30, 40, or even 50-minute period. It all depends on what you want to get to. I have used this 30-minute program personally twice in my life; once after a back injury, and the other after a knee injury. I found the program difficult since I was out of shape for running, yet safe with its low start and gradual progression. It is not as easy as it looks when one has not run for a while.
 
There are 10 levels:
 
• Level 1     Walk 9 min Run 1 min Repeat 3 times for 30 mins
• Level 2     Walk 8 min Run 2 min Repeat 3 times for 30 mins
• Level 3     Walk 7 min Run 3 min Repeat 3 times for 30 mins
• Level 4     Walk 6 min Run 4 min Repeat 3 times for 30 mins
• Level 5     Walk 5 min Run 5 min Repeat 3 times for 30 mins
• Level 6     Walk 4 min Run 6 min Repeat 3 times for 30 mins
• Level 7     Walk 3 min Run 7 min Repeat 3 times for 30 mins
• Level 8     Walk 2 min Run 8 min Repeat 3 times for 30 mins
• Level 9     Walk 1 min Run 9 min Repeat 3 times for 30 mins
• Level 10   30 min straight running
 
I recommend the patient complete each level 3 times minimum, depending on how they feel. Each session should be followed by a rest day. Therefore, completing Level 1 should take a minimum of six days. For example, start walk/run on Monday, rest Tuesday, second session Wednesday, rest Thursday, third session Friday, rest Saturday, and ready to start Level 2 on Sunday as long as Level 1 was fine (level 0 - 2 pain on a visual analog scale).
 
One should gradually work through all 10 levels. Ideally one should stay pain-free when passing to the next level, but if pain starts to come back, I recommend resting 3 days, and going back to the previously comfortable level for 3 more sessions. If the patient again has trouble moving up a level, I tell them to stay for 6 sessions at the comfortable level, continuing to run every other day. Most patients gradually go through the 10 levels in two months (60 days), but some take a lot longer to progress.
 
In my experience, the walk/run program also works well with even minor injuries where there are questions of when to start running. If a patient has only been off running for a short time, but there is anxiety about starting running, try this program. In its quickest form, Level 1 the first day, then a rest day, then Level 2, then another rest day, and so on. As long as symptoms are fine, and one does not push through pain, one can get through the 10 levels in 20 days. This is normally better than running three miles the first day, having a flare-up of symptoms, then stopping running for two more weeks. It allows you and your patient to test the waters of running more safely.
 
It is important to remember that it is better to run 1 second than not at all. Patients ask me all the time if they can start running. If they can walk 30 minutes at a good pace, without pain, and without limping, I believe they can start running. Any running for most athletes is better than not running. If a patient cannot do the 1 minute for Level 1 walk/run, have them try 10 to 30 seconds, running telephone pole to telephone pole in the neighborhood. Getting back into running shape can be safe with a walk/run program. It may require some individualization, but they will go either at the speed they were meant to, or slightly slower. You will help your patients get there!!
 
This was an excerpt from my book "Secrets To Keep Moving: A Guide from a Podiatrist."

Dr. Blake is in practice at the Center for Sports Medicine, which is affiliated with St. Francis Memorial Hospital in San Francisco. He is a past president of the American Academy of Podiatric Sports Medicine. Dr. Blake is the author of the recently published book, “The Inverted Orthotic Technique: A Process Of Foot Stabilization For Pronated Feet,” which is available at www.bookbaby.com.

Editor’s note: This blog originally appeared at www.drblakeshealingsole.com. It is adapted with permission from the author.

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