Return To Running Acceleration And Deceleration Progressions

If you have progressed the athlete or patient appropriately to date and built on each of the previous pillars, our final pillar should be very straightforward.

The return to running progression is mostly the same continuation of exposure to load but obviously at higher speeds now.

The first running session aim is to get up to 70% of the max speed in both force production and force absorption.

The ‘Go-To’ Therapist will use a tempo running protocol of increasing intensity over the course of 3+ sessions, but, if done right and with medium term injuries, should not need much more than 3 running sessions, with the exception of course in scenarios where the athlete has deconditioned such as ACL injuries.

The ‘Go-To’ Therapist’s running sessions will also be including frontal and transverse plane loading for force absorption needs in particular. This again is an opportunity to screen for any ‘big elephants in the room’ that we may not have picked up previously with different loads and speeds of movement.

The directions of loading can be biased further, just like you have done the whole way through the graded exposure plan, by using the hands, for example, to further challenge the body’s base of support if needed. 

The first session’s aim is to hit 70% max speed on the final 2 tempo runs and also hit 70% deceleration in the sagittal, frontal and transverse planes. 

The nice advantage of not hitting more than 70% in the first session is that the athlete will usually be OK to run again the next day, if in the professional or semi-professional setting. You will continue to monitor closely as always for any negative reactions to your KPI’s the following day before allowing progress.

By session 2, the aim is to progress to 90% max speed by the final two tempo runs and decelerations in all three planes of motion. The same principles apply for monitoring any negative reactions or ‘elephants in the room’ throughout and the following day. 

I personally like the athlete or patient to have a rest day the following day if they have hit 90% in this session on their final few runs.

In the final running session, the aim would be to hit 100% top end speed and intent with decelerations in three planes of motion along with some unpredictability built into the session, especially during the change of direction loadings. The athlete or patient needs to be able to move with complete ‘thoughtless, fearless movement’ in all directions and planes of movement in this session before being discharged or allowed to return to training.

If the person is preparing for a contact sport then the contact integration will also be done over the three sessions in a graded exposure with a predictable to unpredictable progressive manner.

If you are in private practice, then you may not be able to work on the tempo runs in the clinic for obvious reasons. However, to do an effective deceleration programme in 3 planes of motion, this can be executed in a 10 square foot treatment room easily for the first couple of sessions and the patient can perform their tempo runs on a field independently with clear instructions to follow. You do not need to have a lot of space for effective deceleration work to really challenge the speed and load placed on the patient’s nervous system.

Another nice benefit of this progressive step-by-step manner is that your patient’s warm up for these running sessions is simply the exercises they have been performing over the past few sessions to get that graded exposure to load before the running takes place. The sets can essentially be reduced to 1-2 sets and the reps reduced to suit the athlete’s needs also.

You may also choose to integrate additional general mobility drills into the warm up if required. The patient is so familiar with the cueing of the exercises plus the ability to now decelerate efficiently, that the running sessions, from my experience, tend to go very smoothly, especially if we have not missed any ‘big elephants in the room’ in the preceding sessions.

Other therapists are not necessarily wrong in their approach to run athletes as soon as possible, but I am personally in no rush to run the athlete as I prefer to build a solid foundation and decrease the risk of developing further motor adaptations while pain or nervous system adaptations are still present. Although this may look like it will take my athletes longer to get back, I actually find the opposite as from day 1 post injury, for this groin pain patient, I am working on his/her graded exposure to change of direction and force production for acceleration and top end speed, specific to his/her needs.

Although I am no rush to run my athlete, I will spend a lot more time on pillar 7 and the hopping progressions, so when the patient returns to running, they are more than capable of managing the ground reaction forces and perturbatory forces at said rate of force development.

It is imperative, in my opinion, that the patient is exposed to the loads and speeds of movement that they will be exposed to in training or games, before returning to these. I see so many athletes returning to training when they’ve hit 80% max speed, for example, without actually hitting the top speeds and then they have protective responses when they do open up or move at a speed that they had not been exposed to previously in the rehab process. It is a risky way of working, and not one the ‘Go-To’ Therapist would utilise to ensure consistently long-lasting results.

Once the patient or athlete returns to the training environment, it is also very important that they continue with the bespoke graded exposure warm up prior to taking part in the team warm up, especially for the first 3-6 sessions.

Keeping it simple, you want to give them a graded exposure to the load and speed they will need to tolerate in the training session so ideally the first time they are exposed to these loads won’t be in the training session. While it is impossible to ensure this every session, it can give you good direction for pre-training movement prep and ‘injury prevention programmes’.

The ‘Go-To’ Therapist’s patient’s KPI’s will also be monitored pre-training, if possible in the professional setting, depending on equipment requirements. For our groin pain patient, the adductor squeeze and posterolateral hip force production may be monitored in the professional environment closely pre-training. For the weekend warrior, a simple ‘perception’ of how their adductor squeeze feels while pushing their knees into their hand may suffice in getting a gauge of how much pre-training graded exposure may be needed. For something like an ankle injury, we can teach the non-sporting patient to use a ruler to measure their knee to wall lunge test for gross ankle range of motion as a more straightforward method.

In regards to getting the ideal pre-training warm-up, I believe this is down to an athlete’s perception and personal feel but certainly, it makes sense to me to include a graded exposure to load and speed of movement to logically justify eliminating the chances of ‘perceived threats’ kicking in.

Once the patient is back successfully achieving the tasks that add value to their lives, then it is time to turn our attention to part 2 and building some resilience in these tasks, especially under times of high stress.