Returning to Running or Lifting After an Injury: A Physical Therapist’s Guide
- chrismarino8
- Jul 26
- 6 min read
Without a doubt one of the most common questions we’re asked here at Strive Performance and Mobility is: “When can I return to running/lifting again?”. There is nothing more frustrating than having to stop exercising because of a nagging injury - trust me, I’ve been there. You hear conflicting guidance from friends, family, and even healthcare providers. So, how do you truly know when it’s okay to return to running and lifting without having to worry about reinjury? Today, Strive’s Doctor of Physical Therapy breaks it down!
The Outdated Recommendation
If you’re speaking with healthcare providers who have been treating for decades, the most common answer you’ll hear is: “After (insert random timeframe) you can return to running/lifting”. Now, from a healing viewpoint, this may make sense to most people.
If a minor muscle strain takes a few days to a few weeks to heal, then you should be ready to run again pretty quickly, right? The same goes for bones, tendons, ligaments, etc. If the actual anatomical structure heals in a certain timeframe, then once it’s healed you should be good to go… right?
Not so fast! Decades ago when people still used a chisel and stone to take notes (just kidding older readers!), this was the agreed upon ideology. What ended up happening was people completely rested or were told to not do certain activities until a specific timeframe passed, then were informed they could go back to their activity.
When they returned to activity, secondary issues would arise. Strength, mobility, endurance, and many other physical capabilities would be in a deficit, leading to poor performance and possible reinjury.
Today, I’m glad to say many (but unfortunately not all) healthcare providers have moved away from the time-based model. The new “gold standard” is evidence-based, respects individual physical capabilities, and has led to improved outcomes.
The Modern Approach
So what is the current widely accepted guideline to know if someone is ready to return to activity?
The answer: Criteria-based benchmarks!
There are several reasons why a criteria-based return to activity protocol is superior:
1) Accounts for Individual Differences: Even though there are well-established healing timeframes, not everyone heals in the same amount of time.
Ex: A 15-year-old athlete is going to heal faster than a 65-year-old masters athlete.
Ex: A low severity, grade 1 quad strain is going to heal several weeks or even months faster than a more severe, grade 3 quad strain.
2) Measures True Physical Readiness OBJECTIVELY: The older time-based protocol really just relied on one measurement… time. The modern criteria-based protocol takes objective measurements into account heavily such as:
Strength symmetry between limbs
Joint range of motion
Form/biomechanics
Muscle endurance and work capacity
3) Prevents Hidden Deficits: Building off of the last point, objective testing exposes lingering deficits that would have been otherwise missed with just a time-based return criteria. A casual visual assessment isn’t perfect and can miss plenty of weaknesses as well.
4) Lowers Reinjury Rates: Research supports the idea of criteria-based protocols because there is a reduction in reinjury rates. If you feel strong enough to return to running but your injured calf is objectively only half as strong, then that’s probably going to show up when you go for longer runs again. If you think you’ve rested long enough and are ready to slap weights on the bar again but haven’t built up strength over time, pain may be waiting for you.
5) Evaluates Psychological Confidence: From working with clients over the years AND personal experience, this is one of the most important things to measure and evaluate. You can feel good in training/rehab, see yourself making progress, but when you’re staring down the bar with 225lbs on it for the first time in a while, you feel hesitant.
The same goes for returning to sports after an ACL injury. Or squatting after a hip labrum repair. Or jumping after an Achilles repair. Returning to activity without being mentally confident is a recipe for reinjury.
The Benchmarks to Hit
Here's a list of benchmarks people should hit before being cleared to return to full activity:
Runners:
No pain with walking
No sharp pain
Full, pain-free joint range of motion
No pain with runner-specific plyometrics
No visible swelling of the knee or ankle after running
Single leg calf endurance >/= 90% of the non-injured extremity
Quad, hamstring, hip and calf strength >/= 90% of the non-injured extremity
No increased pain 24 hours after running
No issues with increased weekly mileage, running speed, or inclines
Feeling fully confident and ready to return
Lifters:
No sharp pain
No numbness or tingling when lifting
No pain with daily activities
Full, pain-free joint range of motion with and without weight
No pain with bodyweight versions of the lift
Pain-free, controlled, symmetrical mechanics with weight
No increased pain 24 hours after lifting
Able to tolerate progressions in load over several weeks
Feeling fully confident and ready to return
Pain Should Be Manageable AND Predictable
In physical therapy, we have something called the 24-hour rule. Pain should not be worse in the 24-hour period following activity or rehab. Pain should also be predictable, meaning certain injuries have certain triggers and/or certain levels of discomfort are expected based on how acute the injury is.
Here’s two examples showcasing these concepts using a runner and a lifter:
A runner with Achilles pain:
Let’s say you’re doing your rehab plan with your physical therapist at Strive Performance and it includes plyometrics so you can return to running.
You are doing some band-assisted pogo hops to introduce increased stresses to your Achilles tendon and tolerate it fairly well with pain ~2/10, which is expected. The rest of the session goes well and without increased discomfort.
The following morning you wake up and your Achilles tendon discomfort is a 5/10. It’s more uncomfortable to walk, there’s a slight loss of ankle range of motion, and Tylenol is on your mind.
Because pain is worse in the 24-hour period after rehab, your physical therapist will regress the activity next session with either less volume of plyometrics, an easier version of it, or manipulating some other variable to make it more tolerable next time.
This is why you don’t just go for a long run after time off or before cleared to do so. Running puts much more strain on your Achilles tendon than light plyometrics, and would have resulted in pain >5/10.
A lifter with shoulder pain:
You’ve been experiencing shoulder pain with barbell bench pressing and are currently in physical therapy to get it under control. Rehab has been going well, and each week you can add slightly more weight to the bar and with greater range of motion.
Pain has not been worse the morning after a session for several weeks, strength has increased as expected, and your rehab sessions are looking more and more like a regular training session.
Any minor flare up you have is well managed and you no longer stress about them since you understand they’re a part of the rehab journey.
Congratulations, you’re well on your way to returning to your full prior level of function!
Earn Your Progressions, Trust the Process
We get it, rehab isn’t the most exciting thing ever. It takes time to calm symptoms down, relearn painful movements, load them up, and get you back to running fast and lifting heavy.
Which is why it can be VERY tempting to skip critical steps along the way. Your knee has been feeling slightly better with box squats? Maybe a somewhat heavy barbell back squat to full depth isn’t a bad idea to try… Well, that doesn’t feel great. Am I even getting better? Why is this taking so long? Will I ever get back to my old self?
Jumping the gun and skipping steps can lead to an incredibly frustrating negative feedback loop:
Feeling better → pushing yourself harder than you’re cleared for → pain again → confusion, fear of movement, frustration → and on and on…
TRUST THE PROCESS AND YOUR REHAB PROVIDER! Earn your progressions. Do the little things well consistently and watch them compound over time.
Ready to Run Fast and Lift Heavy Again?
Your Doctor of Physical Therapy at Strive Performance understands the rehab process. They hold you accountable, help you set goals and milestones, and know how to modify the plan depending on your symptoms. If you’re an active adult in West Ashley and Charleston, SC we’re here to help guide you.
Book a free 15-minute conversation with a Doctor of Physical Therapy at Strive Performance & Mobility.
This article is for educational purposes and is not a substitute for an individualized medical evaluation.
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