What are the criteria for issuing a fit to run medical certificate?

Criteria for Issuing a Fit to Run Medical Certificate

A fit to run medical certificate should be issued based on a thorough assessment of cardiovascular health, musculoskeletal readiness, and resolution of any previous injuries, with specific criteria tailored to the individual's running goals and injury history. 1

General Medical Assessment Criteria

Cardiovascular Evaluation

• Risk classification - Determine if patient falls into:

  • Class A: Apparently healthy individuals 1
  • Class B: Known, stable cardiovascular disease with low risk 1
  • Class C: Known cardiovascular disease with higher risk 1

• Cardiovascular screening requirements:

  • For Class A individuals: Basic screening with medical history and physical examination
  • For Class B individuals: Medical supervision during initial prescription, ECG monitoring during early training phases
  • For Class C individuals: Medical supervision during all exercise sessions until safety established 1

Musculoskeletal Readiness

Following bone stress injury or other musculoskeletal injuries, the following criteria must be met:

• Resolution of bony tenderness 1

  • For low-risk injuries: Tenderness should be monitored but complete resolution may not be necessary
  • For high-risk injuries (e.g., anterior tibial cortex): Complete resolution required for at least 1 week

• Pain-free walking status 1

  • Must demonstrate pain-free walking for:
    • 30-45 minutes continuously, or
    • 1-1.5 miles distance
    • For 3-14 days depending on injury severity

• Functional movement assessment 1

  • Single leg hop test (strongly correlated with return to running readiness)
  • Single leg squat assessment
  • Lower extremity strength (75-85% compared to uninjured side)

Specific Testing Requirements

For General Fitness Certificate

1. Cardiorespiratory assessment:

   • Target heart rate evaluation based on age 1
   • Exercise capacity assessment (minimum 6 METs for unrestricted certificate) 1
   • Blood pressure response to exercise (appropriate rise required) 1

2. Musculoskeletal evaluation:

   • Assessment of muscle strength and power
   • Flexibility testing
   • Biomechanical analysis for runners with previous injuries 1

3. Evidence of radiological healing (if applicable):

   • Not necessary for low-risk injuries
   • Required for high-risk locations (anterior tibial cortex) 1

Return to Running Protocol

For individuals recovering from injury, a graduated return protocol should be included with the certificate:

1. Initial phase: Walk-run progression

   • Begin with 30-second to 5-minute running increments
   • Start at 30-50% of usual pace
   • Alternate days for first 2-4 weeks 1

2. Progression phase:

   • Increase running increments by 1-5 minutes or 100-400m
   • Follow 10% progression rule for weekly distance increases
   • Monitor for pain during and after running 1

3. Surface recommendations:

   • Begin on level surfaces (treadmill or track)
   • Progress to varied terrain as tolerated 1

Special Considerations

Contributing Factors to Address

• Nutritional factors
• Menstrual health/Relative Energy Deficiency in Sport
• Footwear assessment
• Training errors
• Biomechanical factors 1

Certificate Content Requirements

The medical certificate should clearly document:

• Date of examination
• Period of fitness or limitations
• Any specific restrictions or conditions
• Return to activity protocols if applicable 2, 3

Common Pitfalls to Avoid

1. Inadequate cardiovascular screening - Failure to identify underlying cardiovascular conditions that may pose risk during running

2. Premature return after injury - Issuing certificate before adequate healing, particularly for high-risk bone stress injuries

3. Overlooking contributing factors - Not addressing biomechanical issues, nutritional factors, or training errors that led to previous injuries

4. Insufficient documentation - Medical certificates should clearly state the purpose, examination date, and objective findings to avoid legal issues 2

5. One-size-fits-all approach - Certificates should consider the specific running goals (recreational vs. competitive) and previous injury history 1

By following these criteria, healthcare providers can issue evidence-based fit to run medical certificates that prioritize patient safety while supporting appropriate physical activity.