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A 4-Step Guide to Beating Injury
This guide and plan aims to provide you with a logical, safe progression to significantly reduce
the turnaround from injury. I want you to reduce your chance of long term injury so that you
can train more consistently.

Without consistency, you can’t improve; you can’t get faster. The purpose of this guide is to
supplement the 30-minute video seminar (available at RunSmartOnline.com).

You’ll find the “ladder test,” as described in the link below, along with a more detailed
explanation of key concepts.

The protocol, outlined in this guide has been developed across thousands of treatments
sessions with my patients who love to run.

I hope you find the same success that my patients and I have found by executing this protocol.

Best of luck,

Steve Gonser PT DPT

Physical Therapist
RunSmartOnline.com

Steve Gonser PT DPT

Physical Therapist
RunSmartOnline.com
 *
KEY ARTICLES TO
READ, KNOW, AND
PRACTICE
 STEP ONE: Admit You’re
* Injured

It’s the age-old question, “When should I just tell my some pain is only
body to be quiet and when should I listen?” If only the present while running
answer was clear cut, distinct, and easy. I’m a firm while others suffer
believer that most runners lack the discipline and during daily activities
patience to avoid long term injury. We feel things pull, (stairs, squatting, etc.).
tweak, (and) or ache. While most are unable to Your pain may oddly
conclude if the feeling is ‘a usual ache and pain’ or improve as you run
something more serious, there are some rules that can while others can
help you determine if you should keep running or not. pinpoint to the mileage
of symptom onset. This
The verge and inspiration for this article is founded not article is intended to be
only by multiple user requests, but my own experiences a blueprint to identifying
wheeling and dealing with injuries. Remember, every the difference between
runner experiences some wear and tear, some just a warning shot and a
more than others. The slope to the bottom is slippery. typical everyday ache.
Runners underestimate the seriousness of a gradual
ache or pull. That ache or pull could be nothing, sure, Most runners are
but it could also be a warning shot. Your body may be delusional, literally
telling you there’s worse on the horizon. Navigating the running on a prayer
storm is confusing and rarely the same. I plan to link (Whoaaaa, oh! We’re
my patients and my past experiences with injuries. For half way there. –couldn’t
resist.) A mixed bag of emotions circles the run. You’ll
convince !
yourself it’s all in your head or ‘not that bad,’ but
knowing when to circle back for home or call for a ride Seek
is extremely important. The structural damage that can
accumulate within a few minutes is horrifying. Most of Shelter!
my patients have heard me say, “When you have that
‘should I still be running?’ thought, STOP. Rounding out On the flipside, any
a mile or finishing the last few driveways can offset a sharp, stabbing, or
weeks’ worth of rehab.” burning pain is generally
a sign of inflammation

Deciphering Between or damaging of tissue.

Every step will create
further damage and
Pushing Through or Pulling more intense symptoms.

Up Finishing or bagging
your run quickly is
important. Every step
Even in the most stubborn of individuals, I believe all can and will create
runners know when it’s time to bag a workout. further damage.
Deciphering between every day ache and impending
doom can be tough, yes, but it’s not impossible. It really For some their lucky
comes down to proceed with caution or a stop ASAP. enough to be at the tail
Here are few things to think about when you start to end of their run, for
translate the old tongue of injury prevention: other’s you may be
miles from home. If

Proceed with Caution catching a ride isn’t an

option you’ll want to
make sure you keep
You know your body best, but don’t let that be a loop running. Stopping for
hole in protecting yourself. General aches and soreness, water, to walk, or for a
especially new ones, should draw your attention, but bathroom break will
feel free to keep running. Most minor aches, pulls, and cause your symptoms to
pains resolve mid run and you certainly don’t want to magnify. You even
overreact every time you feel a tweak. Heck, if that might end up walking
were the case most of us would never run again. home. As soon as you
Discomfort that you feel during any run should 100% can, douse your injury
resolve when you stop or shortly thereafter. The pain with ice. AVOID HEAT!
shouldn’t be sharp, stabbing, or burning. Dull ache is Ice will help manage
generally a caution sign. The symptoms shouldn’t tissue breakdown and
persist across multiple runs, either. You’ll feel it one run inflammation.
and then it’s gone the next.
If you failed to bail on the run for whatever reason (stubbornness, denial, or you’re too
far from home), you’ll still need to apply ice and quickly. An injury is usually marked
with symptoms that intensify post run. You’ll notice trouble squatting, walking, or
negotiating stairs. The pain may present as being sharp, burning, or overly tight. If you
experience tightness, burning, or sharp pain with daily activities you likely sustained an
injury. (Note: I did not mention a dull ache.) Feeling symptoms at rest or with daily
activities will be a red flag for you.

If you’re disciplined enough to stay off your feet for a few days post injury and perform
the right corrective exercises your injury should heal quickly. This article will lead you
through the opening stages and a quick recovery. For most, a sensitivity accompanies
most runs after a recent injury. Generally dull aches will come and go, while a true
injury only intensifies. Don’t be fooled by a pain that improves as you run, either. Read
here why your pain may improve while you run.

Remember, most runners know they’re hurt, but conjure up ideas that it’s “not that
bad” or “all in their head.” Don’t freak out about missing training time (easier said than
done). Pushing through or being stubborn with an injury will only fail you in the long
run (pun intended). Fix the problem, whether it’s your training, run form, or anatomy.

STEP TWO: Test Your Readiness

* to Run
The injury rehab water is murky. Most runners forego seeing a doc altogether. After all,
who wants to be told to stop running? Those two words (stop running) have bred a
distrust for doctors within the running community. Runners have sought asylum in the
confines of Google searches and the forever “valuable” phone a friend option. The
obvious trouble lingers on both sides of the latter options. For one, doc’s are
stereotyped as running haters, all spewing the same “stop running” treatment option.
The flipside offers little hope too, as your friend is likely affirming what you read on
Google (which is where they found their answer).

The distrust for the medical community is real—I know that. Timid runner’s visit me
every week hoping those two austere words aren’t mumbled from my mouth. “Please
don’t tell me to stop running,” they interject. Luckily, I’ve built my brand as being
“runner friendly.” Mostly because I’m a runner and how infrequently I murmur the
forbidden words.

Whenever I’m working with an injured runner, the number one question is “when can I
start running again?” Through my work and own injury experience, I’ve developed a
protocol of sorts. The purpose of this article is to pass on a piece of my injury rehab
protocol. It precedes my “10 Minute Feeler” article that discusses the importance of
keeping a short run on your first outing. Using the repeatable and rather simple test,
I’ve built to answer to the ultimate question: “CAN I RUN?”

I’ve used the test outlined below for nearly every runner I’ve seen since its inception
two years ago. It’s worked nearly (but not always) flawlessly when determining the
burning question on every runner’s mind. The test is my own little bearer of bad (or
good) news. It’s easy for a runner to infer that they are/aren’t ready to run.

The test mentioned below is on the tail end of my return to running protocol. It’s part
of the madness that is my treatment. It won’t tell you what you need to fix, how to fix
it, or much in the details of your injury, but it will tell you if you’re ready to run.
Whether you’re dealing with a banged-up knee, sore Achilles, or a forever lingering hip
injury, this test can make the “am I ready” conversation an easy yes or no answer.
 The Ladder Test
Running through this test is simple,
requires no equipment, and is easy to
score (pass/fail). The primary goal of
the test is to determine if the body is
ready to accept impact. It will test the
injured tissue in multiple planes of
motion, insuring that some degree of
healing has occurred.
If you fail the test, it becomes
incorporated into treatment, which I
discuss in the video below. If you pass
the test, you’ll simply move on to the
next phase of my injury rehab protocol:
the 10-minute feeler. Check out the
video below to learn how to check your
body’s readiness to run:
(Click Above to Watch the Video)
Remember, there are multiple steps that
precede this test. Those steps are injury
and patient specific (me saying I really
can’t give them to you). A simple rule: if
you’re not functioning without pain in
your daily activities, then you likely have
no business attempting the test.
If you pass this test: On to running!
Learn about your first run after injury on
the next page.
If you fail this test: You should
continue lower impact and functioning
activities specific to correcting and re-
loading your injured tissue prior to
attempting the test.
 IMPORTANT: Zero to Five Scale
*

I use the scale outlined below daily with my injured runners. This scale works for nearly
every injury. The image above is a scale that is likely burned onto the whiteboard in my
office.

A professor in college drilled into our brains that: a tissue, is a tissue, is a tissue. For
those with no medical background, it equates to the underlying fact that a tendon injury
in your ankle will likely respond the same as a tendon injury in your shoulder: a tendon
is a tendon.

The same rationale can be said for joints, ligaments, and the like. In my work with
running injury rehab, I’ve developed a protocol/system that is based on the “a tissue is
a tissue” method. My patients have likely heard this at one point or another. Although
rather simplistic, the rule applies to nearly all running injuries and is rooted on a
foundation of tissue resilience and the ability to accept load, which are two very
important principles if you’re looking to successfully run after an injury.

Load acceptance and loading until failure reaches far beyond injury rehab. Engineers
know this well. For example, a bridge can accept a certain load before buckling. An
elevator cable can withstand a specific weight limit before straining (or breaking). The
same can be said for your (insert your running injury here). It can withstand so much
load until re-injury.

My simple scale can help you better understand the threshold breakdown for your
injury. I’ve used this thousands of times in practice and developed it when dealing with
my own injuries (yes, I too get injured).

The Scale: 0 to 5, How Much Does It Hurt?

Zero (0): “I don’t feel anything.”
Zero is easy. This is typically the point you’re thinking yourself, “hey, maybe this is the
time it won’t hurt?” It’s usually a subconscious Hail Mary that your (insert injury here) is
finally gone for good.

One (1): “I think I feel it?”

A one rating is that “is this all in my head” question. You’re running and you think you
feel it, but are typically unsure. This isn’t anything to fret, keep going (not that you
were going to stop anyways).

Two (2): “It doesn’t hurt, but I definitely feel

it.”
Ok, so at this point you’re positive you’re not crazy. You feel it. A “two” on the scale can
go either way. It can loosen itself up and retreat to a “one” or “zero” or can progress.
This is where you ideally stay close to home. You can keep running, but the street signs
now read “proceed with caution.”

Take home from zero to two:

As you can see, I’m not telling you to stop running. I equate the sensation of “feeling”
your injury or “being aware” to loading tissue that is simply not fully healed. News
flash, it can take up to six months for tissue to fully remodel (heal back to normal).

The zero to two stage can (but not usually) last months. Just proceed with caution and
patience.

Three (3): “It hurts a little, but I can run

through it.”
There’s no doubt that this thought has crossed your mind when attempting to return
running. Crossing over from a two to three on my running scale equates to the
beginning stages of breakdown.

The “slight pain” you feel may be manageable, but it’s a sign that your injury is failing.
The bridge is beginning to buckle.

Four (4): Pre-Limp – “I probably shouldn’t be

doing this.”
Although you shouldn’t be running, you’re likely still putting one foot in front of the
other. At this point every foot strike is shredding, tearing, and destroying your injury. It
doesn’t matter than you only have a few minutes left of your run.

Think of it this way: the average runner hovers around 80 steps a minute. An additional
10 minutes of running exposes your injury to 800 additional repetitions when it’s
already sending signals to stop. If you had a sore arm, would you lift a weight 800
more times? (Please say no)

Five (5): Limping

So by now the pain is fairly strong. You can’t hide your limp and it’s clear you

shouldn’t be running. You’ve gone overboard at this point. Plan on resetting your injury
clock a few weeks or even back to day one.

Progressing Through the Scale

Most runners will progress from a 0 (“I feel nothing”) to a 3 (“It hurts just a little”). The
progression of symptoms is a clear indication that your injury is failing to withstand the
barrage of foot strikes. If you start at “three” within 30 seconds you’re not ready to run
(sorry).

Don’t run on denial. It either hurts or you feel it. Black and white. Once you’re at the
“it’s about to start to hurt” pull the plug. Walk. It doesn’t matter that you’re only a block
away from home. Every foot strike is damage.

With time, you’ll slowly watch your time to symptoms or pain onset increase. What
started at five to 10 minutes is now 30. If you continue to run with patience, you’ll
avoid becoming a patient.
 STEP THREE: Perform a
* Trial Run

The first run after injury is crucial but often butchered by most runners. Your first run
sets the table for a full recovery or destroying what you thought was healed injury. The
internal dialogue starts to weigh the fact that you can walk and negotiate stairs without
pain. Essentially every aspect of your life is pain free and seems to have resolved within
a week (or two) of rest. Most of you have lived the story, some of us hear it every day
(me!). You think you’re healed–you’re fine. You lace up and head for the door.
Confidence shortly begins to fill with self-doubt. Symptoms go from nonexistent to
negligible climbing to ‘not that bad’. Continuing that trajectory, your pain worsens until
you’re at a perfect, yet damaging, distance from your car. You refuse to walk back and
decide that running is your only option. Sound familiar?

Overdoing it seems to be hardwired into our DNA. It hinders healing, which eventually
causes further damage to our confidence and psyche (oh yeah and body!). Remember,
we all get hurt and injured. That’s not the point of this article. It’s more important to
discuss the steps required to resume running. As stated, that first run is so crucial. Most
athletes analyze runs comparatively. “Well I’m used to running 5-8 miles so 3 miles
should be an easy gauge.” You’ll need to ditch that mindset if you want to fully recover.
Often a first run will tolerate less than 10 minutes. Ten minutes you say? Who cares
about 10 minutes? Well, for one, your injury certainly does. We’re not looking to
increase fitness with a short, simple run, but simply “feel it out.” You’ll want to grasp
how your injury bodes before jumping off the deep end.

The All Important 10 Minute Feeler

Clinically speaking, I will always begin with what I like to a call a ‘10 Minute Feeler Run’.
Ten minutes is an easy gauge that allows you to assess symptoms with minimal chance
for aggravation. It’s set in stone, too. Ten minutes doesn’t mean 10:15, or 10:45. Ten
is ten. I don’t care that you don’t feel anything or feel like you could run forever. Ten is
ten.

Ten minutes allows us to assess your tissues immediate and latent response to load.
Symptoms can be felt during the run or within minutes of stopping. For others, the
effects might not be felt for 24 hours. I’ve had patients experience zero symptoms in
their ‘10-minute feeler’ with symptoms drastically increasing the next day. Imagine if
said individuals were to keep running. The effects of stretching a run longer could cause
a setback measuring weeks to months.

Other Considerations:
Before making that crucial decision to start running, you’ll need to be able to function in
daily life without pain. That means walking, negotiating stairs, squatting, etc. If you
can’t function at lower level activities, how do you expect to fair at higher ones
(running)? If you can’t do these
activities, then unfortunately, your
answer is rest. Rest can equate to 24
hours, 7 days, or even longer depending
how much damaged occurred.
The key here is catching it early. You’ll
know something is wrong. Burning or
sharp pain is always a dead giveaway
when it comes to injury identification.
Symptoms may be experienced mid-run
or once you stop. You know your body
best. Don’t talk yourself out of an injury.
The best thing is to start the rest cycle
paired with ice immediately.
Progressing from 10
Minutes
No one wants to lace up for a 10-minute
feeler, especially in the colder months.
You’ll spend more time getting dressed
than running. Warming up on an
elliptical or bike can help get the blood
flowing and transform the experience
into a workout. Remember, motion is
lotion and may help you complete 10
minutes successfully. Once you’ve
completed 10 minutes without
symptoms, it’s time to progress. Every
other day is your best bet. I’m guessing
less than 1% will listen to what I just
wrote, so please don’t go three days in
a row. Fill the in between days with spin
classes, strengthening, and the elliptical.
These activities can serve to minimize
fitness loss, keep you sane, and not re-
injure yourself. You’re looking for small
gains early. Literally one run to the next
might yield 90 seconds of gain, but take
it. Ninety seconds turns into tens of
minutes quick. You’ll see progression
every few runs, but you’ll need to
patient.
It’s so important to avoid the mental
trap. Going out for an ‘easy 3’ is no way
to test an injury. Does it make sense to
throw 20-30 minutes at a recently
injured tissue? It shouldn’t. Ten minutes
has served me well and quickly grows to
tens of minutes. It allows a safe gauge
and shows improvement in a short time.
Work the process, remain patient, and
stay in control. You will run again… why
not make it sooner rather than later?
 STEP FOUR: Progressing to
* 40 Minutes and Beyond
As you begin to gain confidence with your ability to run, it’s easy to rush the process.
This is a huge (and common mistake). Below you will find an example schedule of how
to progress your runs. The process is not the same of everyone and every injury.

What about speed work?

As you build your mileage you should be avoiding excessive hills (up and down) and
speed work. Plan on getting 1-2 weeks of solid running under your belt before adding
harder running.

EX
Example Return to Run Schedule:
XT = Cross Train, Bike / Elliptical. Rest Days are interchangeable
ST = Strength Train (BaseSix Bootcamp Preferred)
XT = Acceptable on Run Days PRIOR to Run

Week Day of the Week

S M T W Th F S

1 10 min XT, ST 10 min XT, ST 15 min XT, ST 15 min

2 XT, ST 20 min XT, ST 20 min Rest 30 min XT, ST

3 30 min 30 min Rest 40 min XT. ST 40 min 20 min

4 ST 40 min XT 40 min 40 min Rest 30 min

5 50 min Rest 40 min XT, ST 40 min 30 min 50 min

6 Rest 40 min XT, ST 50 min 50 min XT, ST 60 min