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speed recovery and provide best practice management of running injuries


Injuries like plantar fasciitis, hip impingement, and sciatica often take several weeks to heal.  Patients eagerly await a return to running in spite of the fact that running likely created, or perpetuated, their initial problem.  What does an evidence-based chiropractor need to consider to speed recovery and provide best practice management of running injuries?

Regardless of the injury, sport, etiology, or recovery time, there is one major concern; muscular strength and size decreases as a consequence of immobilization after a sports injury. Strength loss is secondary to neurogenic inhibition (pain) and/or muscular atropy.  The sharpest decrease in strength is during the first week of disuse. (1)

Should patients stop running while recovering from an injury? 

Athletes frequently push their bodies to the limit to build strength and resilience with a goal of improving performance.   As we know, every tissue in our body has a capacity.  This capacity is dependent on several factors, but rest assured if you exceed this capacity the tissue will fail.  Tissue failures result in sprains, strains, breaks, and ruptures that we classify dependent on the orthopedic exam.  Check out this prior blog infographic to help explain tissue capacity and healing.

What do our patients need to consider before returning to running?

Too often, athletes returning to activity suffer from the “terrible too’s”- they train too much, too hard, and too fast.  If they attempt to develop their bodies too fast—injuries return.  Our phasic and postural muscles need to be re-activated slowly to build capacity and performance.

Follow the 10% RULE

The 10-percent rule is one of the most important and time-proven principles in running. It states that you should never increase your weekly mileage by more than 10 percent over the previous week.  This slow progressive increase in activity will allow your body to adapt to the changing demands placed upon it.  For example, if your patient is running 10 miles one week (5 runs @ 2 miles per run), they should only increase the distance to 11 miles the next week.

Koblbauer et al. in 2014 tested to determine what would happen if a patient increased running activity beyond the capacity of their muscles. They found that reproducible compensations occurred.

In their study, seventeen novice runners participated in a running-induced fatigue protocol and underwent core endurance assessment. Changes in pre- and post-fatigue running kinematics and their relations with core endurance measures were analyzed.  Two main compensations that may cause or exacerbate injuries where found:

“Runners displayed an overall increase in trunk inclination and increased ankle eversion peak angles when fatigued utilizing a running-induced fatigue protocol.” (2)

Can you imagine all the new problems that runners create if they exhibit increased trunk flexion and ankle eversion (pronation) during activity?  The increased pronation alone can account for many orthopedic problems ranging from foot to the lumbar spine.  Runners expecting to jump back into their same distance and time following injury may be setting themselves up for more problems.  Equipping your patients with the right information at the right time has a dramatic effect on clinical outcomes and patient satisfaction so make sure to include ChiroUp’s running advice from the Common Treatment section for pertinent patients.


  1. Appell, HJ. Muscular Atrophy Following Immobilisation. Sports Med (1990) 10: 42.
  2. Koblbauer IF, et al. Kinematic changes during running-induced fatigue and relations with core endurance in novice runners. J Sci Med Sport. 2014.


About the Author

Dr. Brandon Steele

Dr. Brandon Steele


Dr. Steele began his career at The Central Institute for Human Performance. Dr. Steele has trained with experts including Pavel Kolar, Stuart McGill, Brett Winchester, and Clayton Skaggs. He has been certified in Motion Palpation, DNS, ART, and McKenzie Therapy. Dr. Steele lectures extensively on clinical excellence and evidence-based musculoskeletal management. He currently practices in Swansea, IL and serves on the executive board of the ICS.

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