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Underwater Running During Injury Rehab of An Endurance Runner

Quick Hit Summary

For a highly competitive athlete, nothing is worse than being injured. In this article I discuss how the CasePerformance team helped an endurance runner under our guidance through a knee injury, using underwater running as the base of our training.

The Stress of Injury

As any highly competitive athlete can tell you, there is nothing worse than being injured. The injured athlete often faces both physical and psychological challenges as they work towards regaining their health. In doing so, they must deal with the fear of losing shape (psychological) as well as the actual loss of physical training capacity (physical). These concerns are even greater if the athlete experiences them during a competitive season.

I was reminded of this while working with a highly competitive endurance runner who we’ll refer to as “Elizabeth”.

Elizabeth’s Story

Figure 1. Elizabeth (#307) competing in a cross country meet.

Elizabeth was a highly accomplished high school endurance athlete. By the time she was heading into her junior (11th grade) year of school, Elizabeth had already placed at state level meets. Shortly after the conclusion of a disappointing cross country season during the fall months of her junior year, in which she faded badly during the final few races of the year, she asked for our assistance.

In short time, with her input, Justin Andrews created an endurance running program for Elizabeth whereas I (Sean Casey) assisted her on nutrition and non-specific training (flexibility, resistance training, etc). We had a great off-season and were primed for a successful season. Then it happened – just as the season was about to start, Elizabeth slipped & fell while running on trails, injuring her knee.

Following the first few of days of relative rest, Elizabeth was itching to get back to physical activity. However, she was still experiencing discomfort in the knee at rest which became sore with walking any sort of extended distance. Upon seeing a doctor, Elizabeth was informed that there likely wasn’t any major ligament tears or fractures; potentially a mild sprain and bruising of the bone.

Operation “Get Healthy”

With clearance from the doctor to progress at a level tolerable, Justin, Elizabeth and I discussed options to get her back on her feet and competing. The first goal was to get her moving again while minimizing impact on the knee. Things were a bit tricky from an endurance training perspective as we sought to maintain her level of fitness while minimizing loading of the knee. Elizabeth was not a huge fan of biking and even though it minimized impact, an elliptical still placed too much stress on the injured knee. Thus, we turned to deep water running. Below is one of our training weeks.

Figure 2 Underwater training week for Elizabeth created by CP endurance coach Justin Andrews.

As you can see, in designing her endurance workouts, Justin Andrews alternated easy/moderate/hard training days similar to what Elizabeth would have been doing if she was running on solid surfaces (ie – road, track grass). For a lady who loves to train, Elizabeth loved the ability to push her body hard, while having virtually no direct loading on the knee joint.

With respect to my contributions to her non-specific injury rehab program (ie – flexibility and resistance training), I had to make a few alterations as well. In contrast to training on land, while underwater running, one has to actively pull their leg up and down against water resistance (which is much greater than air resistance). As a result, Elizabeth & I both noticed that she had greater tension in the hip/leg muscle groups vs. normal; thus we increased the amount of time spent with flexibility training, especially that of her hip flexors, etc.

We were able to continue with most of our resistance training exercises which targeted lower body and core strength/stability, making just a few slight adjustments along the way.

Back to Racing!

Figure 3. Elizabeth back on the track again!

Altogether, we were off from hard surface running for ~ 3 weeks. During this time, 2 weeks were spent in the pool. The final week was spent between interval and tempo based training done on an elliptical and easy runs completed on grass/rubberized track surfaces.

Although we were confident that we maintained her fitness during this time of rehab to the best of our abilities, the questioned still lingered – how well would it actually translate to race pace. We were all a bit nervous for Elizabeth’s 1st first meet back. To our delight she ended up winning the competition! The weather was quite windy so the times were naturally slower; that said, she ended up winning the 3k race. Racing conditions were much better her next meet and to our delight, Elizabeth’s times fell right where Justin had predicted they would be (at this point in the season) before the injury ever happened.

As the season progressed, Elizabeth's times improved as well, leading to a great run at state which saw her set a new personal best in the 3k!

Wrapping it Up

As discussed above, we were able to maintain Elizabeth’s level of fitness pretty well during the 2+ weeks that we were unable to run on solid surfaces. First and foremost, this was related to the fact that Elizabeth worked extremely hard, following the plan we mutually created "to the T". Additionally I believe creating underwater running sessions similar to what we would have done if she was running on hard land (ie – repeats, intervals, etc) was critical to the preservation of her fitness level.

A note of caution… Please do not misinterpret this article as me saying "Underwater running can be used in place of surface running". That is not my intent and should not be extrapolated as such; I would never use it as the base of my program for a healthy runners. Rather my goal in writing this is to discuss how underwater running can be used as a means of endurance training for runners during times of injury, using one of the CP athletes we've used it with, as an example.

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Written on April 21, 2015 by Sean Casey
Last Updated: April 27, 2015

This information is not intended to take the place of medical advice.Please check with your health care providers prior to starting any new dietary or exercise program. CasePerformance is not responsible for the outcome of any decision made based off the information presented in this article.

About the Author: Sean Casey is a graduate of the University of Wisconsin-Madison with degrees in both Nutritional Science-Dietetics and Kinesiology-Exercise Physiology. Sean graduated academically as one of the top students in both the Nutritional Science and Kinesiology departments.
Field Experience: During college, Sean was active with the UW-Badgers Strength and Conditioning Department. He has also spent time as an intern physical preparation coach at the International Performance Institute in Bradenton, FL. He also spent time as an intern and later worked at Athletes Performance in Tempe, AZ. While at these locations he had the opportunity to train football, soccer, baseball, golf and tennis athletes. Sean is also active in the field of sports nutrition where he has consulted with a wide variety of organizations including both elite (NFL’s Jacksonville Jaguars) and amateur athletic teams. His nutrition consultation services are avalable by clicking on the Nutrition Consultation tab.