When can I start exercise after an injury?

You're injured. Don’t worry it happens. You are pretty much guaranteed to experience injury at some point if you live an active lifestyle. Don’t let it discourage you though.  The benefits of exercise far outweigh the detriments of being inactive. Let’s assume you played it smart and took some time off training to rest and recover. But how do you know when it’s safe to start training after an injury? There is no specific timeline for this, but there are some simple guidelines to get you back to the activities you love.  I’ll cover two points here: how to safely return to activity, and how to know if you have ‘overdone’ it.

Before we get into these, it is important to note that you want to be out of the inflammatory stage of tissue healing before beginning a progressive return to activity.  This initial stage of healing is very recognizable with its constant, unrelenting pain.  It typically lasts from 3-14 days, though this can vary.  If you are ever in doubt of your stage of tissue healing, or your body’s ability to being a progressive return to activity after an injury, consult a health care professional.

Guidelines for return to exercise

When you are ready to start training after an injury, there are three guidelines to avoid doing too much too fast. These guidelines apply to all activities, even things that you may not have considered physical activity prior to your injury, think getting groceries, mowing the lawn, or cleaning the house. They will also apply to activities you are doing as stepping stones to your usual workouts (example: biking with the goal to get back to running).

  1. Don’t add more than one new activity, or exercise at a time.  This includes everything that you have been modifying or avoiding because of your injury.  Pick one that seems gentle to start, try it, and monitor the effects. If it goes well, pick another one and repeat.

  2. Take a day off in between workouts to evaluate the effects on your body.  If you have ever pushed a muscle group to its limits, you will have felt the two day soreness known as DOMS or Delayed Onset Muscle Soreness. DOMS is felt one or two days after a hard workout. Considering this delayed effect, it is best to take it easy two days after introducing a new activity. This will allow you a chance to fully evaluate its impact on your body before you try adding another one. It’s the safest way to make sure you don’t do too much too fast, which can cause relapse or reinjury.

  3. Don’t change more than one variable at a time.  Such variables include frequency of the activity in days per week or times per day, intensity, duration of the workout session, and type of activity (including how many exercises you are doing at once).  Example: let's say you started with running 20 minutes easy, 2 times in one week.  You were happy with how it went, so you want to increase your training next week. Considering these return to sport guidelines, you have a decision to make. The next week you could: run 25 minutes 2 times, run 20 minutes a little harder, run 20 minutes at the same intensity 3 times, or run an easy 20 minutes 2 times plus an additional 15 minutes swimming as a third workout. In most cases, which scenario you pick is often up to you, and will depend largely on what is most important to you.  Would you be happier running less frequent but a bit harder because it is killing you to run super slow? Or would you be happier running a bit longer or more frequently. If your health care provider has left it up to you, you get to follow your heart. 

How to know you have “overdone it”

This part is usually pretty easy. Your body will tell you when you are overdoing it, just monitor for these signs:

  1. Pain during the activity. When you start back to an activity, don’t expect to feel no pain at your injured area. It’s OK if you do feel a bit sore. This is a sign the injury is being stressed in a good way, which promotes tissue healing.  But don’t let the pain get very high, no more than 2 out of 10  (0 being I feel nothing, 10 being very extreme pain). If the pain starts to get more than a 2/10, stop, you are done being active for the day.

  2. Pain after the activity. Let’s say you felt nothing during activity, but you started to feel the pain after. Again, that’s OK as along as it doesn’t last more than 20 to 30 minutes, and the pain doesn’t get too intense (think more like a 3 or 4/10).  If the pain settles down quickly, then we would still consider the activity a success, and you could proceed with your slow progressions back to activity as in point #3 above.  If the pain lasts longer, becomes more intense, or gets worse as the day goes on, then you overdid it. Take a couple days to recover, then decrease one of the variables from point #3 above, and try again.

  3. Stiffness the next morning.  In this instance, you may not have felt any pain during or after your activity, but the injured area is tight or stiff when you get out of bed the next morning. Morning tightness or stiffness is a sign that you stresses the injured area. This is required for strengthening the injured tissues, so some morning stiffness is acceptable up to 15 minutes. Anything longer than that is a sign you overdid it the day before, which will including your hobbies, work, and regular household tasks. Often what happens when a person starts feeling better after an injury is that they don’t just start back to their workouts, they start back to their life, and the combination can occasionally be too much. If this happens, take a couple days to rest and try again.  It could also be helpful to keep an activity log to know exactly how much you did each day so you can look back and modify as needed.

Returning to activities after an injury is often a slow process. Exercise your patience along with your body.  Remember, setbacks happen. It is seldom a linear progression. Don’t let this deter you from your goals.  Ultimately, persistence pays off and you will get back to doing what you love.