Every runner will at some point feel an ache or a pain that will force them to ask themselves — should I keep going? Should I train today? Should I take a rest day?
Physiotherapist Wendy Epp walks through a few simple questions to ask yourself before your next run or training session. When are you just experiencing short-term pain (i.e. hurt) and when are you putting yourself at risk for a running injury (i.e. harm)?
Self Diagnosing Training Injuries
When it comes to exercise injuries, a few factors play into initial pain diagnostics: intensity (scale of 1-10), location, familiarity (new or recurring) to name a few. However, the key question is: what is the tissue response to activity?
If your muscles feel tight and sore, but after a walk or run the tissue feels better, looser and more responsive, then we know we are dealing with tissue that still has a relatively healthy response to load. Which almost always means it is safe to keep moving.
3 Questions to Ask Yourself When You Have Lingering Pain
If you have lingering pain or injury and want to make a good training decision, here are a few simple questions to ask yourself before your next run or training session:
1. Did I have any difficulty finishing my last run?
2. Do I have any aches or pains that have lasted more than 2 days? Is that muscle or tendon or joint still irritable 72 hrs post-run?
3. Am I feeling excessively tired the day after my run? Am I not able to complete life-related-tasks?
If the answer is NO to all 3 questions: Good news - you can reasonably continue with your training program.
If the answer is YES to one or more questions: DO NOT increase your intensity, mileage or do a hill/tempo workout until all answers are no. This could cause harm. This is a reasonable time to seek assistance from your healthcare provider, sport medicine clinician or coach.
Interpreting Your Pain While Training
Pain During Warm Up
If you feel pain during the warmup of your run (i.e., the first 5 min), but then it goes away, you can safely continue. But monitor the situation.
If it goes away within 1-2 mins of walking, then you can try to resume your run.
If it returns a second time, stop and do not run again that day. Treat the area with principles of “recovery” (ie. Ice, heat, stretch, rest) and use the 3 questions noted above to determine when you can return to your training program.
Pain Onset While Running
If your pain comes on during a run, it should never be greater than a 4/10. If your pain is above a 4/10 for more than 2 days with rest, you should be assessed by a health care practitioner experienced with sport injuries as you may have an evolving injury.
Post Run Pain
If the pain starts shortly after your run, and is less than a 4/10, treat with ice and one your next scheduled training day, repeat the same run but take 10-15% off your pace or mileage.
Delayed Pain Onset After Run
If muscular pain comes on 24-36 hours later, it could be delayed onset muscle soreness, aka DOMS. DOMS usually presents 24-48 hours after a new activity or change in your running pace or mileage and can last for 1-3 days. It is the normal soreness and stiffness response for muscles to work and the result of muscle repairing and rebuilding itself due to your hard efforts. You can safely continue to work through your running plan.
Signs of Inflammation Are Significant
A muscle that is sore from workload (DOMS) is not going to be red, hot, swollen, puffy, tender to touch (typical signs of inflammation). Signs of inflammation are significant and one should pay attention. When signs of inflammation are present, adding more workload on is rarely a good idea. For example, if you have a big, hot, swollen toe and you think going to do hill repeats will make it better, it won’t. However, DOMS is a muscular response that will typically feel better getting out the door and enjoying activity.
When are Pain Symptoms Non-Negotiable?
There are some symptoms and injuries that are considered the no-fly zone. If you experience any of these symptoms, you should be assessed by a health care practitioner experienced with sport injuries.
- Nerve pain – Numbness, tingles, pins and needles burning sensation, a loss of reflex or loss of motor power. The muscle under load fatigues very quickly. If you continue to run and load the muscle with nerve pain, you can actually prolong the injury and possibly lead to permanent damage.
- Pain interferes with normal activities of daily life. For example, you are incapable of managing your work, preparing meals, or fulfilling basic needs.
- When pain worsens/escalates with ongoing activities or added load.
- Pain accompanied with weakness/instability that impairs you from safely moving/training. For example, instability in a knee joint that makes you feel significant anxiety about running downhill, for fear of falling.
- Pain alters you gait sufficiently that other injury likely to occur – never change your running gait to pretend the injury doesn’t hurt. This will just cause problems in other parts of your body.
Ponder This When You Experience Training Pain
Often, managing any of the issues listed above is not simply “do not run.” Instead, consider the following steps to help you get back to full strength:
- Modify your training,
- Use non or partial load-bearing activities (ex. Cycling, swimming)
- Focus on a different type of fitness (ex. Strength/flexibility) to keep you moving forward while the injury heals.
If you are uncertain about how to proceed, search for a clinician that understands your sport, your goals and is willing to be creative in helping you keep up the good work!
Wendy Epp, B.Sc.PT, Diploma Sport Physiotherapy of Form Physiotherapy
Wendy has had a 30 year career as a function-based physiotherapist who uses assessment tools and movement strategies to help patients in a wide array of sports including, but not limited to; triathlon, running, cycling, skiing, and baseball. Her love of sport and travel generated a perfect fit to become a sport physiotherapist in private practice, travel part-time with the Canadian Freestyle Ski Team, and work as a Medical Manager at the 2010 Vancouver Olympic Games. She has taken an active interest in the perils of the aging athlete which has led her to OA management and movement science to improve function and retain/regain joint health.
