Return from Injury: Cross-Training

We’ve talked plenty about preventing injury, and hopefully, if you’re following all of the lessons, you won’t get injured. The reality is, though, that in sport, injuries happen.

Most injured runners’ biggest fear is losing the fitness they’ve worked so hard to build up, so they immediately look for an alternative to running. Cross-training is a great way to stay fit and speed up recovery via improved blood flow and greater mental engagement. However, not all cross-training is equal, and it’s especially important to choose a modality that works with your current stage of injury.

Phase 1: Early Stages of Injury—Avoid Pain

As any physical therapist will tell you, in the early stages of your recovery, you must choose a cross-training option where you can exercise pain-free and let the injured area heal. The logic is pretty straightforward: Why would you do something to aggravate the injured area and delay healing? In most cases, your pain-free options will not closely match running. Swimming and cycling, both of which are non-weight-bearing, are often good choices.

Phase 2: Recovery Has Begun—Non-Weight-Bearing

As your injury heals and you move toward your return to running, it’s time to start introducing cross-training activities that replicate the same movements as running. If you still need to avoid weight-bearing exercise during this time, aqua jogging (running in water and replicating the running motion) is a great choice.

Phase 3: Recovery Is Progressing—Weight-Bearing

Once you can tolerate some weight-bearing, then the best running-specific cross-training activity is the AlterG treadmill. This is a treadmill that allows you to run, supported, at varying percentages of your body weight. For example, you can set the machine so that you are running at 80% of your body weight, thus reducing stress on the injured tissue while still running. You would start at a level where you can run pain-free and, as you heal, gradually increase the percentage of body weight you’re using so that by the time you are fully healed, you are already running at or near 100% body weight.

If you don’t have access to an AlterG, then the elliptical machine (or any elliptical-like machine) is your next best option. It is weight-bearing, and your legs move in a (sort of) running motion, yet there is no pounding. Plus, you can get your heart rate pretty high on the elliptical machine, which helps maintain some intensity among all the easy exercise you’re doing while healing (which is good for the body and the mind!).

All Stages of Injury

As demoralizing as injuries can be, they do offer a great opportunity to do cross-training that doesn’t just build aerobic fitness but also helps loosen the body, relax the mind, and strengthen weak areas. Examples include yoga, Pilates, strength training (never stressing the injured area), and core training.

A Runner Example

Megan provides a great example of how to cross-train back from injury. She was an elite runner I coached and was prone to foot problems. One season, she got a stress fracture in her foot. Here is how we progressed back to full training, after which she went on to help our team win the National Cross-Country Championships.

Phase 1:

At first, Megan couldn’t put any weight on the foot. All cross-training was in the pool, including aqua jogging. Because there is no musculoskeletal stress, Megan could aqua jog every day, and because aqua jogging can be very boring, I had her do fartlek-style workouts to try to get her heart rate up and feel like she would in a running workout. We kept the workouts simple, like 30 x 30 seconds fast with a 1-minute recovery.

Phase 2:

Once Megan was cleared to begin weight-bearing activities, we moved to the elliptical and bike. Both exercises were gentle on the foot, and the elliptical was great because it allowed her to practice more running-like movements without landing/pounding, so there was less stress on the foot.

Phase 3:

After two weeks on the elliptical and bike, we began to incorporate low-body-weight running on the AlterG treadmill. We started at 75% of her body weight and, over a few weeks, slowly ramped up until she was running at 95–97% body weight on the AlterG in addition to adding short runs outside.

As you can see, Megan made a gradual yet progressive return to running that allowed her body to heal but also kept her training. Even after she was healed, we kept the AlterG as part of her weekly running just as a precaution, and Megan went on to help our team with the National Championship in Cross-Country that season.

The moral of the story is: Be patient! Recovery is not always linear, and cross-training is not a perfect substitute for running; however, if done smartly and with a gradual progression, it can help you get back to the running that you love.