All too often, when my patients enter my office with a running-related injury, on day one their first question is "how soon can I get back to running?"

While this may seem like a reasonable question, there are many factors that influence a safe return to running. Depending on the severity of the pain/injury, how long the pain has been occurring and several other factors related to the overall fitness and body mechanics of the athlete, my response to their question most often is one they do not want to hear: "You should not run until you are pain-free."

Working with enough runners, I realize they will continue to run even while recuperating from the injury. However, instead of just running through the pain, they should first follow a regular training routine that includes ways to at least reduce pain and improve body mechanics.

Running requires the highest level of stress and impact than any other activity; it is essentially a single leg jump repeated over and over for the duration of the run. Would it make sense to clear a patient to return to running if he or she is unable to complete a double leg jump with proper form and control? What if the runner cannot perform a standing heel raise or pass the heel raise strength test of 25 full-motion heel raises without compensations?

While I mostly see patients after injuries or dysfunctions have progressed to a function-limiting problem, which requires several months of rehabilitation, there are a growing number of athletes taking advantage of preventative or proactive examinations in order avoid these pain syndromes or injuries from occurring altogether.

I recently had a running coach come to my office for a proactive fitness examination and running video analysis and the results were quite eye opening. Early into the fitness examination we found glaring weaknesses evident with her trunk/core and hips impacting her lower extremity stability. Common compensations were identified and I was able to immediately provide her with proactive exercises to begin addressing her problem areas. Let me emphasize that while she is an avid, pain-free runner and also a running coach, even she was able to benefit from a proactive approach to prevent excess stress and strain on her body.

These are a few examples of the basic fundamentals in strength, flexibility, endurance and stability that must be achieved before recreational running is "safe." Once these are corrected, then the athlete is fit to run and can continue to enjoy running to be fit.

Read more Sports Doc for Sports Medicine and Fitness.