The Race to the Start Line: Returning to Running After Having Covid-19

In March 2020, Dr. Niall Elliott was planning for the summer Olympics with his colleagues at the British Olympic Association. Plans were drawn for what to do if an athlete suffered a catastrophic injury or a mental health crisis in the final lead up to the Games. There were meetings on how to move some of the world’s finest athletes across the globe and how to address logistical snafus.

They had plans in place for nearly everything, except a global pandemic, he said.

Overnight, Dr. Elliott began providing support and care for athletes who were locked out of training facilities and fearful of how this new virus could affect their athletic careers. The questions were endless and the answers scarce.

“We were very cautious at the start because it was a new virus,” Dr. Elliott said. “We just didn’t know what the impact would be on the body.”

The urgent question for athletes: How long would Covid-19 knock you out and when could you get back to training?

Olympians and weekend warriors have been asking that question ever since. And the answer continues to shift as doctors learn more about the coronavirus and as its variants wreak havoc on training schedules.

The key is resetting expectations and rethinking a timeline for a full return to play or a return to running.

“Compared to most viral illnesses, the expectation that athletes should have is that it takes on average twice as long to get back to where you were,” Dr. Tod Olin, the director of the Exercise and Performance Breathing Center at National Jewish Health in Denver, said. “So if someone usually returns to their activity within a week of having a seasonal flu, it may take two weeks to come back after having Covid-19. But it’s also taken some three to four weeks for a lot of people, and a fraction of people take considerably longer.”

That’s a hard pill to swallow for athletes looking to return to their previous selves as soon as symptoms subside. And it’s not easy to tell runners to slow down when many of their goals are to speed up.

In June 2020, Dr. Elliott published a protocol that has evolved and been adopted by other physicians as more data has become available on the virus and how it affects athletes. The initial protocol pointed to a six-stage gradual return to play, starting with a minimum rest period of 10 days and working up to increased frequency, duration and intensity of training sessions.

In the two years since, doctors have distinguished how to direct athletes based on above-neck symptoms and below-neck symptoms. Patients who have above-neck symptoms tend to recover more quickly and are able to return to athletics faster than those with below-neck symptoms who may suffer from fatigue, aches, pains and lung or heart issues.

That distinction — along with patients who test positive but remain asymptomatic — helped Dr. Elliott adjust his guidance to a five-stage protocol, one that better serves athletes looking to return to training. Patients now can skip ahead to different stages of the protocol depending on their symptoms and their severity.

And in the year of post-vaccine data, doctors have found that pushing the pace or intensity in training sessions can dramatically backfire.

“They are used to solving all problems by trying harder,” Dr. Olin, who has worked extensively with Olympic athletes, said. “And Covid-19 is seemingly unique if you push too hard — if you train through this — there’s this phenomenon of the setback, one that’s analogous to a hamstring injury, where if you were getting a little bit better and then you try to drop the hammer for a workout and you are three months back.”

I should know, it happened to me. I tested positive for Covid-19 in early May and started getting back to my running routine, albeit at a slower pace, without any true workouts, shortly thereafter. To my great surprise, I tested positive for Covid-19 again four and a half weeks later. (Yes, really, it’s very possible.) If I were antsy to return to running the first time, I was bouncing off the walls the second. This week, I thought I had recovered enough to do a short speed workout. But when I hit that first interval, it’s like my body laughed at me: “Nope.”

I learned that getting to the start line of a race, or to the field of play, should not be a race at all.

But athletes, and arguably runners in particular, have a special brand of impatience when it comes to lacing up their shoes again. When we asked readers of the Running Newsletter to share their stories of returning to running after Covid-19, hundreds shared their ongoing frustration and small victories. Many shared a sense of gratitude for returning to a race, and countless expressed dismay that their recovery is still ongoing.

Aquene Kimmel, a 26-year-old runner, said her first run after testing positive for Covid-19 last December was “a slow jog that felt tougher than it had in years.” Hills are still harder for her than she remembers, and her pace isn’t quite back to where it was, she said.

Dave Madigan, 52, had Covid in March, and despite going back to running slowly, he said he found the effort harder than it should be. “My VO2 max isn’t much different to what I would expect, but I feel really exhausted,” Madigan wrote, referring to oxygen uptake, a way of measuring aerobic fitness. “I tried some short intervals, but they were way harder than normal.”

It took Jenna Ciongoli, 38, a few months to not feel so winded. “Even now, seven months later, while I’m back to running as much as before, I still don’t feel as fast as I was,” she wrote.

As a pulmonologist in the ever-active city of Denver, Dr. Vamsi Guntur of National Jewish Health is accustomed to these responses and has started talking to athletes about readjusting their expectations.

“What we consider recovery compared to what athletes consider recovery is different,” Dr. Guntur said.

“One Olympic athlete very early on, pre-vaccine, said, ‘I’m just used to pushing myself. I want to push myself,’” she recalled. “I said, ‘I know you can, but I don’t want you to.’”

It’s a sentiment doctors and experts are sharing even more widely post-vaccines, warning of regression if athletes return to high intensity training or racing before their body is ready.

“You will always have another competition, another race, another training session,” Dr. Elliott echoed.

“But you only have one body,” he added. “You’ve got to look after it.”