The short answer
- Rehab has four phases: settle it, build capacity, reintroduce running, and rebuild the demands of your sport. Most plans cover one and four.
- Pain settles long before capacity comes back. Feeling fine is not the same as being ready.
- Rank your own activities from easiest to hardest and move up and down that list, rather than stopping and starting.
- Hills, speed and long runs come out first and go back last, because they are the three that load everything hardest.
- Finish the strength work. Stopping when the pain stops is the most common reason the same injury comes back.
Ask most runners what their comeback plan is and you get a first run. Three kilometres, easy, next Tuesday.
Ask what happens in week five and the answer goes vague. That vagueness is where the second injury lives.
Four phases
Settle it. Reduce what provokes it to a level your body can manage. Not to zero, usually. This phase ends when day-to-day life is comfortable and you have found a dose of activity that does not leave you worse the next morning.
Build capacity. Strength, range, control. This runs underneath everything else and does not stop when the next phase starts. It is the phase that determines whether you are back for good or back for six weeks.
Reintroduce running. Short, easy, frequent. Walk and run intervals if you have been out a while. Build duration before you touch intensity.
Rebuild the demands. Hills. Speed. Long runs. Whatever your sport actually asks of you. This is the phase that gets skipped, because by now you feel fine.
The international consensus on returning to running after pregnancy describes exactly this shape: relative rest, gradual increases in duration and intensity, a walk and run protocol to start, and strength training incorporated throughout1. The condition is specific, the structure is general.
Pain leaves before capacity returns
This is the thing that catches people.
Pain settles when the tissue stops being sensitised, and that can happen in a couple of weeks. Strength, tendon stiffness and bone density take months. So there is a window, often a long one, where you feel completely fine and are not yet able to do what you could before.
The secondary analysis of the runners with kneecap pain found that low knee extension strength at the start predicted a worse outcome2. Capacity matters, and it is invisible from the inside.
Moving up and down rather than on and off
Most people treat rehab as a switch. Running or not running. That throws away all the useful information in between.
For most runners the bottom of the ladder is walking and short flat easy running, the middle is longer easy runs and gentle undulation, and the top is hills, intervals and the long run. Build your own version, five rungs, and keep it somewhere you can see it.
1During the run, it stays at five out of ten or below.
2By the next morning, it is back where it started.
Reintroducing running specifically
Start below where you think you should. The first session should feel almost pointless.
Frequency before duration. Three short runs beat one long one for rebuilding tolerance, because tissue adapts to being loaded often rather than to being loaded heavily once.
Duration before intensity. Get to comfortable easy running of a reasonable length before any session has the word intervals in it.
Then intensity before volume, if you have a race. Adding speed and distance in the same week is how people find out where their limit was.
Our return to running plan has the detail on structuring this.
Do not stop the strength work
Strength training had the strongest injury prevention effect of any intervention in the meta-analysis of exercise programmes, with overuse injuries roughly halved4.
Almost everybody stops it when they get back to running. The exercises feel like injury admin rather than training, the week gets busy, and the running comes back so the strength work goes.
Then the same thing happens again eight months later and nobody connects the two.
One or two sessions a week, permanently, at a level that maintains what you built. That is the difference between a comeback and a cycle.
How long the whole thing takes
Depends entirely on what it was, and anyone giving you a number without knowing that is guessing.
What generalises is the shape. Settling takes days to weeks. Capacity takes months. The return to running is usually the fastest part once the first two are done properly, which is the opposite of how most people sequence it.
And a flare on the way up is normal. It means you found the edge, not that you have gone back to the start.
When to get someone involved
The second and third are the ones we help with most. The running is rarely the hard part. The sequencing is.