How soon after Covid can you run again?

If you've been diagnosed with coronavirus, caution is the word when it comes to running

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Colorado-based Katie Sznewajs considers herself among the lucky ones. Diagnosed with Covid back in August along with the rest of her family, 43-year-old Sznewajs experienced flu-like symptoms but didn’t require hospitalization or a long layoff.

After a week-long bout with the illness, she turned a corner and began to slowly feel more like herself. Today she’s back to her normal running mileage and feeling no long-term consequences from the disease.

Others, however, aren’t nearly as fortunate. Severity of illness from the coronavirus varies widely, from those suffering no or cold-like symptoms, to those with devastating long-haul symptoms that severely restrict any level of activity.

Because the medical world is still figuring out the disease, runners who experience Covid are generally left with more questions than answers when it comes to returning to the sport they love.

It’s a group of athletes who love to push their bodies, and in the past, may have hurried back to racking up the miles. With Covid, however, that’s a big gamble.

Plenty can go wrong

Jordan Metzl, M.D., a New York-based sports medicine specialist well known as “the athlete’s doctor,” points out that, even though we’ve been living with Covid almost a year now, the guidance surrounding it is ever evolving.

“This is a new disease, and we see short-term and long-term ramifications every week,” he says. “The more we learn, the better our advice becomes, but that’s continually changing.”

In particular, advice involving return to running gets tricky because everyone who gets the disease seems to experience it in a different way.

“If you break an ankle, for instance, we can predictably give you a timetable for when and how to return to activity,” Metzl explains. “With Covid, we don’t have that database yet. It seems to be a different disease for everyone who gets it.”

What is known is that in some cases, heart and lung damage are a result of the infection, making a hasty return risky. According to an article in the British Journal of Sports Medicine, a meta-analysis of six studies with over 1,500 patients found that 8 percent suffered acute cardiac injury, for instance.

‘This is a new disease, and we see short-term and long-term ramifications every week.’

“The issue of myocarditis looms large,” confirms Matthew Sedgley, an orthopedic specialist in Maryland. “Some studies early on raised the possibility of it being very common. Newer data may not confirm that, however.”

The old rules of return to play don’t apply to Covid. “One thing we’re starting to advise is that those who exhibit symptoms need to be more careful than those with a positive test who are asymptomatic,” says Metzel.

Even within the symptomatic patients, however, there’s a wide range of severity. How much implication this has on the recovering body remains a question mark. However, the more severe the symptoms, the more cautious the return should be. “If you’ve had Covid, we want to see a slow return,” says Sedgley, “I recommend 10 days symptom free before beginning a cautious progression.”

Caveats to this, says Sedgley, include anyone who was sick enough to be hospitalized. “Then a larger work up is in order,” he says, “with an ECG, ECHO and labs.”

When it comes to the respiratory component of the disease, Metzl’s published guidelines, based off several studies to date, can prove helpful. These specify, for instance, that those with severe respiratory symptoms be followed by a specialist, who can recommend exercise guidelines as time goes on.

Easy does it

One thing everyone can agree on is that, as you return to running, be prepared for a few steps back if you’re experiencing heavy fatigue. “If you had Covid and feel lousy after exercise, back off,” says Metzl. “This is not a time to ‘run through.’”

Sznewajs, who is a breast cancer survivor, paid close attention to how she felt once she resumed running. “I knew not to rush back,” she says. “I tried to let my body heal first, and then started with walking.”

Like other runners, Sznewajs was anxious to get back out there and wishes she had guidance for doing so at the time. “My doctor didn’t really have recommendations and just told me to be aware of my symptoms,” she says. “So I rested and then eased back in with baby steps.”

‘I knew not to rush back. I tried to let my body heal first, and then started with walking.’

Metzl emphasizes the importance of listening to your body, as Sznewajs did. “Many runners see a race on the calendar and want to push to get in the training,” he says. “Runners are used to enduring and dealing with pain, but this isn’t the time for that.”

Ignoring this advice can lead ot what Metzl calls a “chutes and ladder” effect: “You are headed up the ladder but then push too hard and go down the chute back to where you began,” he says.

“This is like a stress fracture times 20 — if you try to run through fatigue, it can be a very big setback.”

— Amanda

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