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Running Related Ache or Injury?

One of the most common questions I receive as a Doctor of Physical Therapy, strength coach, and runner is:

How do I know if I should stop running? With the follow up, or assumed question being, is this a training related pain or an ‘actual injury’?

(Here is where I’ll inject the disclaimer that this information is for informational and entertainment purposes only and is not to be taken as individual medical advice, see your physician or physical therapist for your specific case. I’ll be happy to help individually or point you in the correct direction if you contact me).

When we run, train, and push ourselves physically, we’re bound to experience discomfort and sometimes outright pain. However, there are differences between the ‘burn’ felt in muscles during a hard training session, the transient joint pains felt at times during warm ups or late in runs, and actual ‘injury’-pain that is a signal from our body that something is potentially injured and needs attention.

First off, it would help to define what an ‘injury’ actually is… which evidently is harder than one might initially think… in fact, there have been so many definitions thrown around that an entire study was performed and published in 2015 to get a consensus from over 30 running related researchers of what a ‘running related injury’ is. Answer (with 80% agreement from the researchers): “Running-related (training or competition) musculoskeletal pain in the lower limbs that causes a restriction on or stoppage of running (distance, speed, duration, or training) for at least 7 days or 3 consecutive scheduled training sessions, or that requires the runner to consult a physician or other health professional.” (1)

Side note: it's interesting to me that they limited it to lower limbs only, while research focuses on and says that a majority of running related injuries involve the legs, I see an equal number of runners for low back and spinal pain.

While each individual’s situation needs to be explored and addressed, there are some general guidelines you can follow to differentiate between training related aches, and injuries that should alter your plan and lead you to seek professional help. Bodies, and the injuries they endure, are complex and most injuries are multifactorial. There are no hard and fast rules, and these listed below are an amalgamation of research results, wisdom passed down from respected coaches and rehab therapists, and my personal experience.

What to think about:

  1. Intensity and quality of pain: pain scales vary, but if we take the generic 0-10 pain scale (0=none, 10=knock me out, I’d rather be unconscious), generally 0-3 pain is safe to train within. Pain that passes into the moderate or severe range (5+/10) is often not a good idea to push through. Also, dull and achy pain is generally safer to train through than sharp, shooting, boring, piercing or electric pain.

  2. Pain patterns: a pain that you start with but warms up and goes away is generally safer than pain that you start with (or comes on during the run) and doesn’t go away or gets progressively worse. Also, if your pain lingers long after your run, it’s a sign that something is trending the wrong way.

  3. Overall trend: if the pain is mild, warms up and goes away during the run, and has improved overall in the past week or two- you’re trending positively. If it’s getting worse each run, starting earlier in the runs, getting sharper and more intense- it’s time to make changes and/or seek help.

These last two are pretty strong indicators of an injury that needs to be addressed.

  1. If you are taking pain medication to get through the run or through the day.

  2. Your pain causes you to change your running and/or walking gait or limp.

If your pain sounds more like the bolded examples above (or you say yes to 4 or 5) it may be evident that things are worsening rather than improving. This not only means that your training and race plans likely will eventually be derailed, but you risk larger scale injuries such as stress fractures, muscle tears, etc. The issue should be addressed.

Now when I say it needs to be addressed, this doesn’t necessarily mean you need to see your PT, physician, etc- it may improve with self-imposed changes such as a week of decreased mileage and more diligence with supportive exercises and stretching. Though seeking experienced help will likely speed and smooth the process.

The old adage of ‘ounce of prevention equals a pound of cure’ can be extended to include the idea that ‘Two weeks treating a mild injury can prevent a 2-3 month rehab of a major injury’.

When done correctly, I believe that most running related injuries can be avoided with recognizing mild but persistent symptoms early on and making changes that prevent progression to pain and 'injury' (having to miss 7 or more days or 3 consecutive training sessions).

And as always, feel free to contact us to if you find yourself in either boat and have questions on how to get back on course.

  1. Yamato, Tiê & Saragiotto, Bruno & Lopes, Alexandre. (2015). A Consensus Definition of Running-Related Injury in Recreational Runners: A Modified Delphi Approach. The Journal of orthopaedic and sports physical therapy. 45. 1-24. 10.2519/jospt.2015.5741.

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