Progressing Running Mileage Post Injury

Many runners are familiar with the ‘10% rule’ as a framework for progressing mileage over the course of a week. For example, if you are currently running 50km/week, you could reasonably push to 55km the following week.

But how does this apply to increasing mileage coming off an injury?

There are obvious injury-specific factors that will come into play here and I’m not going to discuss the merits of the ‘10% rule’ but instead dive into a recent case of mine and the intricacies of programming mileage progressions.

I want to start by introducing a question; Is 50km a week, simply 50km a week?

Hypothetically, you are in a busy practice with short treatment slots and you have a runner as a current patient. As your session ends they ask if they are able to increase their mileage for the week. If you know something about running, you may ask what their current distance is and loosely float them the 10% rule, or you may simply say “I think so, but be careful.”

Best case, you’ve offered them a simple framework but minimal direction or worst case you’ve left the ball in their court and they are quite literally going to run with it… perhaps right back to the clinic.

Keeping that 50km in mind, here’s the case.

‘C’, my patient, is a Master’s runner who has been a competitive marathoner for years (likely longer than I’ve been alive). She came in with a very very angry achilles tendon (AT) that she had tried to push through a bit and ended up limping around, in pain and quite defeated. She had never experienced anything like this in the many many years of running predating this injury.

Fast forward a couple months, C is back to running and we are in consistent communication about how the AT is responding to her running and S&C program.

C is currently at 50km/week and feeling relatively good. Some small twinges at certain times but all in all, progressing well.

Her current program looks like this:

Mon: S&C. Tues: Run. Weds: Run. Thurs: S&C. Fri: OFF. Sat: Long Run. Sun: Run.

Coming into the session she had a weekly mileage cap of 50km, with the caveat of not running more than 2 days in a row. This is dramatically different than her pre-injury routine of 3-4days in a row and 5-6 days/week of running.

She had a single day distance max of 18km (which she does on sat) and a 2 day distance max of 30km. She tolerates Tuesday and Wednesday runs well and generally feels quite good after her long run on sat (no-minimal AT pain/stiffness). However, it is the Sunday after the long run on Saturday where things start to show up in the AT. She is able to complete ~10km, but she feels the AT during and then a bit more awareness than usual after the run and the next morning. Not to a point where it is breaking rules we have on what to push through and what not to push through. We established a framework early on for what is okay and not okay to be feeling while running.

It is ~30km over 2 days that we reach the current capacity limits of her AT.

This is where the fun begins and your clinical judgement can really help your runner progress forward.

If I were to simply tell her to add 5km next week (following the generic 10% rule) she could add it anywhere.

Let’s play this out.

She could increase her single day max by 5km, this would take her to 23km, a 22% increase in distance.

She could increase her Sunday, the second day of a back to back, by 5k, a 33% increase and the most symptomatic day due to the back to back.

Or perhaps she could add in another run day, creating 3 days in a row, if she wasn’t told not to. 5km is just a short run right?

At the end of the day she is a runner, and runners want to run.

If I told her she was good to run 42km again, she would. So having a very firm and detailed plan is critical.

What I’m trying to get at here is that distance is not just distance when coming off an injury. It is part of a complex weekly schedule and where you progress that distance matters based on how the injury is responding.

For C, we are juggling:

• single day max distance

• 2 day max distance

• weekly max distance

Where those miles get added in could be the difference between a significant flare up or the successful application of gradual progressive load with the appropriate rest that a tendon needs to adapt, reorganize, and heal.

With out presenting a complete case history, you won’t fully get to understand C and her story but this is what I did. [There are always many ways to do something, so this isn’t to suggest you need do it like this].

Her single day max got bumped up to 21km (She was incredibly happy for the green light to hit that distance again).

Her 2 day max remains at 30km. She will actually have to drop some mileage on the second day until we get a sense of how her AT responds during the 21km and then again on the back to back.

Her weekly max distance was boosted to 55km (which coincidently is 10% haha). So she gets to add some mileage to one of her runs in the middle of the week with minimal concern as they tend to both be ~10km with no issues for the AT during or after.

We will likely stay at this mileage for a few weeks to make sure everything passes the test before looking to modify again. She has no current races planned thanks to the pandemic which means that we can do a very good job of not rushing this along to meet a deadline. We don’t need to increase mileage weekly, so we wont.

Here’s the kicker, this has only been about mileage! We haven’t touched on pacing, elevation, surfaces and all the other factors that make up the ecosystem of a run. You can only increase so many variables at a time before the system crashes again from an overload of stress. Those weren’t the goal of today’s discussion but know that they do need to be considered along with everything else.

C’s goal after our most recent session was to run 3 days in a row again. So we will figure out the best way to make it happen!

I hope this case shed some light on the intricacies of increasing mileage for a runner coming off an injury and as always thanks for reading!