Every athlete wants to know the answer to this.
It is not uncommon for runners to experience pain. It is also not uncommon for runners to continue running with their pain. In a UK study of 1100 parkrun regulars; more than 50% had a current self-reported injury & 86% were continuing to run through despite pain, consequently impacting performance and in turn leading to an overall reduction in running volume (Linton et al., 2018).
Complete rest from their chosen sport is an athlete’s nightmare. Often, there are ways of modifying training & ensuring the athlete doesn’t de-skill or decondition, but how we react to an injury depends on the injury presentation & diagnosis.
When visiting a physio, some of the initial questions we will ask you are about your pain. I will want to delve deeply to understand it’s presentation, how it impacts you & your reason for coming to physio. This accounts for how the pain presents day to day, what makes it worse/better, how it reacts to your sport (during & after) etc. etc. I even want to know the strategies that you have already tried (whether they’ve worked or not). Have you tried complete rest – does this help? Have you implemented exercises? – if so, which? The more info the better. And from this subjective questioning I am in a much better position to diagnose & advise on how best to proceed with your current pain complaint.
We will also discuss pain levels & albeit subjective, this scale out of 10 (10/10 being excruciatingly painful) can help us establish what activities you can (& can’t) push through. To avoid aggravating things & ensure healing is taking place, I advise athletes to keep their pain <4/10 not only during the activity but also monitoring levels after & into the next day. I do not want to see pain increase the next morning as a delayed response. Using this scale, an athlete can often continue training as long as regular subjective questioning ensures activity & pain levels are improving throughout the process.
However sometimes modifying training load and/or rest might be our only option & here’s why:
- High Irritability & pain levels – In some cases, that pain level is simply too high (<4/10) & continuing to run for example will simply flare it up each time for a good 24-48hours. This sensitivity (& in some injuries, inflammation) can simply be delaying the healing process & simply elongating the time spent out of your normal training routine.
- Tissue Healing – in some injuries there is physical damage to tissue integrity (muscle, tendon, bone) & as a result, it just can’t tolerate the impact of running. Continuing to run on these compromised tissues delays healing, worsens the tissue quality & therefore worsens the injury itself.
- Compromised technique – We all know that limp or slight change in gait in response to pain but imagine that multiplied as you increase the load on that painful source with your more explosive activity. Something has to give & often it’s your technique, which in turn compromises other tissues, your performance & training quality.
Common Running Injuries & their management
As I mentioned earlier, training can often be modified in relation to the athlete’s subjective pain report however diagnosis can also be VERY important. With the correct diagnosis we can know that training won’t compromise healing in certain injuries & therefore training modification is a good option. With a diagnosis we can even consider different training loads in their own right i.e. elevation, speed that might be better for certain tissues & can even use running analysis to prompt certain running techniques to offload that specific injury & ideally keep you running.
There are however some injuries that you just CANNOT run through and I can’t stress this enough. These are most often bone stress injuries & this is what I was referring to earlier when the tissue (the bone) just cannot tolerate the load that is being put on it. Continuing to load these injuries can make things exponentially worse from an initial slight bone stress reaction to a potential stress fracture. Listen to your physio!
And so, as a physio & endurance runner myself, I understand the importance of running. If there are ways of modifying the load to find that said sweetspot, we will find it but we can’t turn our backs on pain & MUST respect the injury & physiological healing process.
*Remember – the diagnosis is important so seek a medical professional’s opinion before running through pain.