April 4, 2017

Mental Challenges When Returning to Running After Injury

So I talked about how to survive being an injured runner and then what I was doing to come back stronger after my metatarsal stress fracture, but I think I'm struggling right now with the return to running more than just being injured. So here's my long discussion to talk about it with all you readers. 

I finished the 6 week conservative return to running plan that my PT gave me with no problems, minus some soreness in my recovering foot a couple weeks. That plan which started with run-walk intervals and finished with 30-40 minute continuous runs had me around 10-15 miles per week, mostly on the treadmill.  After the plan I was trying to build up some longer runs outside so I could successfully finish the Philadelphia Love Run Half Marathon for which I was an ambassador. I kept my mileage from 15 building up to just over 20 miles a week with most of mileage come from a longer run on the weekend. I used the progression over consecutive weeks of 7.5 miles, 8 miles, 10 miles, 10 miles, rest, and then the half marathon. 

Happy just to be outside
Obviously my fitness is not where it should be, and I was not feeling great during the half marathon but I finished in a not too shabby 1:45 and change. My foot had been feeling sore when not working out which brought back to mind signs that I felt when I had a stress fracture that week before the race (not on race day or during the race) so honestly I was mostly focusing on how my foot felt during the race because I was so anxious as well as the fear that I was over-doing it. Yes, I've been dealing with a lot of anxiety about my injury recovery and running in general. 

Running is already a mental challenge but adding in the anxiety and fear of being injured has made it even tougher. There are multiple mental challenges that have made returning from an injury really hard for me. 


The first challenge is dealing with soreness and discomfort that may be felt in the recovered foot as the bone heals and is reported anecdotally from runners that it can happen for months or years after the injury.  The bone heals and forms a little callus so it should be strong, but how can I tell if it's normal soreness or pain signaling another injury? I also am extra anxious because my PT has me trying to change to landing on my midfoot instead of heel striking so in my mind I'm putting more force on the front of my foot, when actually I'll be putting less force through my foot all over (which he showed me on the fancy treadmill running analysis at PT). I've read all over the Internet, and it seems it's hard to tell, particularly when you are like me and are focused on it and hypersensitive to every feeling in your feet when running. Honestly I have so much fear of re-injury. 

Obviously if it's sharp pain that is bad and a sign of injury. If you have sharp pain, I'd get yourself checked out, just to be safeI can clearly remember when I had my stress fracture for about a week the pain was so sharp and throbbing, it hurt to even walk. There can also be phantom pains, which can be sporadic and vary in intensity in the area of the foot that was injured due to calcium buildup at the site of the bone recovery or just mentally induced kind of like PTSD. The possibility of another stress fracture when my foot was feeling sore last week had me in tears. It's hard for me to listen to my body when I'm so sensitive and hyper-focused on every little feeling in my feet. 

The second challenge is that progress is slow and steady. It's already April when I thought I would be back running like my old self, and I'm just not. I had the 6 weeks of just slowly building up from walking to running, not focusing at all on pace. Building up slowly after an injury to gradually increase the force placed on the healing tissues is key. This is especially true if you were completely off your foot in a boot or cast for a period of time which means your whole foot or body part needs to get used to the force of running again and rebuild strength. This also includes running every other day to start and not immediately adding speedwork or intense running back into your plan. This can be difficult mentally when you are just excited to get back to running. Try to think that going slow and steady now will help you stay healthy because some slow, short running is way better than no running. 

This article on Runners Connect has a great plan for getting back to running after a stress fracture and some symptoms during healing. My foot felt fine during the race and even the day after but the soreness for the week beforehand and a little bit a day after has me worried so I decided to take at least a week, maybe two off before running a lot again. 

The third challenge is social media or social comparison.  I love seeing that my friends or people I follow on social media are crushing races and getting PRs. However it can be tough to know that I'm slower and still am not at where I want to be. I want to be crushing races and having fun again! Most of my runs have been pretty tough with my legs feeling heavy. It's April and my stress fracture was in October/November so the idea of being hurt again had me in tears last week. I started my return to running plan in January so I thought I would be feeling more back to normal right now. I go between have little pity parties for myself and getting really upset at my level of fitness and being grateful because things could also be worse. I think taking a step back from social media, just as I suggested when being injured, can be helpful if it's hurting your self-esteem. 

Overall, the mental aspect of returning to running can be more difficult than the physical aspect of it. All I can do is try to take it easy, listen to my body, and trust the process. 

Accept no limits!

Side note: This article has a great discussion on the psychology of returning to a sport after injury

Have you ever had trouble coming back from an injury? What is your biggest mental hurdle in running? 


  1. Honestly, I think the mental part of an injury is 100 times worse than the physical part. It's really scary and hard! I think going easy on yourself, physically, mentally, and emotionally, is key to getting through the whole process--giving yourself the grace to not be who you used to be and to accept where you are right now as ok. I think it's also important to remember how many times over the course of non-injured running you've had weird aches or pains (not you specifically but you as a general you). I'd bet that on at least half of my runs, I feel some sort of twinge for a moment that, 99 times out of 100, goes away on its own, if I even pay enough attention to notice it in the first place. Obviously it's much, much harder to ignore things when you're hyperaware of them--and how could you not be after an injury?--but reminding myself that unexplained aches and pains are normal has been helpful to me in the past. It's when it lingers for days or gets worse or impacts me in such a way that it affects my stride that I start to worry. As for hyperawareness, I've also tried to do things while running that keep my mind occupied--counting backward in Spanish, for example, or counting the number of people I see wearing blue. Anything to give my mind something else to focus on so it stops making mountains out of molehills!

  2. I feel like the mental part is the hardest part of the process, between monitoring every little ache and pain and worrying about how much is too much. I thought I had done well recovering last fall but then slowly my injury returned. So now I am going to have an even harder time this time around. Im really not sure how I will ever be able to appropriate monitor whether I feel normal soreness or the warning sign that the injury is coming back.

  3. I always struggle coming back from an injury or being sick. I always want to bust straight out of the gate. Reminding myself to slow down and listen to my body is something I'm really focusing on! Thanks for the reminders!

  4. There's also that fear of reinjuring yourself again! Glad you are on the comeback, and you'll be back to your normal self very soon!

  5. I can relate to this on a different side. The feelings of I thought I would be back at a certain level by a certain point. Patience is a hard thing, but I think you're handling things pretty well. And I can definitely understand the anxiety of the injury coming back. Hang in there.

  6. The mental is always the hardest part - but glad you're on the path to recovery! XOXO

  7. I happy that you are coming back. Mental part of an injury is the hardest part of the process but I believe you will overcome it. Hope you will get well soon.

  8. It's always struggle coming back from an injury. Glad you are on the comeback and hope you will get well soon.

  9. As you know, I was really quite scared as I came back from my last (really major) injury. I was scared after all the others as well. A little fear is good--it makes you pay attention. Just keep taking care and building your confidence up little by little!