Injury: When To Run, When To Stop

Most runners have grown out of the 'if it isn't hurting, it isn't working' mantra. But what's the difference between a routine twinge and a potentially disastrous injury?



by Patrick Milroy

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Picture the scene (you may not have to try too hard). You’re in good shape, you’re enjoying your run and suddenly something hurts. How do you know whether to run through it – crying ‘no pain, no gain’ – or to rest for five minutes; whether to walk home immediately or go straight to Accident & Emergency? This article should help you to decide. Its core is a list of aches and pains, what they might be, and what you should do in each case.

There are a few general rules you can apply to pain. If something hurts so badly you can’t walk on it, don’t try to run on it, for example. Having said that, you learn to recognise your own body’s signs of pain - such that you can run through heavy legs, for example. You’ll learn to recognise this feeling of lactic acid build-up by experience, and because the symptoms tend to come on gradually.

In some cases, if you feel pain on a training run it’s quite sufficient to stop and stretch, change the surface you’re running on or go to the other side of the road, and see if it makes any difference. Also – and the best immediate option in a race – try changing your pace either up or down for a couple of minutes.

Once you’ve got home, RICE (rest, ice, compression and elevation) is a principle worth applying to almost any injury. If the pain hasn’t disappeared the next day, don’t try to run on it. The only time it can be beneficial to run through pain is during rehabilitation when you may need to overcome a little initial stiffness to regain the muscle’s flexibility.

If you’ve done all this and yet the symptoms persist, you need to bite the bullet and see a GP or a therapist. At my clinic, we’ve managed to educate runners to the point where they typically only wait two months after an injury before seeing us, rather than six, as they used to – but I would rather they only waited two days. You run the risk of an injury becoming chronic and much harder to treat if you leave it untreated for more than 48 hours, and any medic would prefer you came to see them sooner rather than later. If an injury hurts so much you can’t even put weight on it, it’s probably a serious one, and you should get advice immediately.

The only knot we haven’t tied is what you should do about pain in a race. It’s just not realistic to stop and stretch out every niggle when you’re in a competitive environment. Some pains come and go within a couple of miles and you never know what caused them, but if a pain (rather than a tired ache) gets continually worse during a race, you should take it seriously. Better to ease off and try again in a fortnight than to be laid off completely for a month.

Lower-back pain

Is the pain… one that’s been developing over a few days or even weeks?

If so… it’s a typical lower-back problem that starts off as a low-risk ache and becomes more dangerous if it goes untreated and the pain increases. If you feel a sudden back pain, it’s more likely to be serious.

You should… stop and stretch. If the pain gets worse, abandon your run and seek treatment. Most lower-back pain has a specific cause that you need to address before it gets better.

Foot pain

Is the pain… a numbness?

If so… it could be due to poor blood circulation.

You should… loosen your shoelaces, and wiggle your toes a bit as you run. When you get home, apply the RICE treatment if necessary, and seek help if the numbness continues.

Is the pain… a crescendo pain (one that starts off mildly and gradually increases as you run)?

If so… it could be a stress fracture.

You should… take it seriously. The foot has such a complex and delicate structure that you should walk home and see a specialist as soon as possible.

Is the pain… a blister forming?

You should… aim to minimise the friction against your skin. Putting a tissue around the area can be a good ad-hoc way of relieving pressure – as can applying a generous quantity of spit.

Twisted ankle

Is the pain… tolerable enough to run on?

If so… the body’s natural endorphins will be helping to mask the pain and you can carry on if you have to. However, this tends to further damage the ligaments in the area and make you more susceptible to another twist. If the pain is intense or the joint is swollen, you shouldn’t try to restart your run at all. (More about ankle sprains.)

You should… ideally get home straight away, rest, apply ice and compression, and raise the leg (the ‘RICE’ treatment). Try to keep the joint mobile but avoid stressing it.

Knee pain

Is the pain… a dull ache under the kneecap?

If so… it’s probably runner’s knee (in which the kneecap doesn’t move properly across the bones it rests on, often due to a muscle imbalance).

You should… try running in the same direction on the opposite side of the road (to change the camber); move onto a softer surface; or stride out for a while to free up the knee joint. You can also try changing your shoes. If the pain persists, book an appointment with a physiotherapist, because it will only get worse.

Is the pain… around the knee on the outside of the leg, and coming on slowly with each stride?

If so… it’s likely to be iliotibial band syndrome (an inflammation of the long fibrous tissue that extends from the hip along the side of the upper leg.

You should… stop and stretch the area (try the standing stretch in which you cross your feet and extend one side of your body upwards until you feel a stretch around your hip). Also, try running on the opposite side of the road. Get a diagnosis if the pain doesn’t go.

Is the pain… just below the kneecap?

If so… err on the side of caution and take it to be a patellar tendon strain.

You should… jog gently home and apply the RICE treatment. As with any tendon strain, running through it is asking for trouble. If it still hurts the next day, have it looked at. Acute tears can require weeks in plaster, and in most cases recovery is likely to take months rather than weeks.

Muscle pain

Is the pain… sharp?

You should… determine the sort of sharp pain it is. If it’s a cramp, rest for a couple of minutes and massage the area. Having a drink, especially a sports drink containing electrolytes, will also help. If it’s more of a sudden tightness, in the calf for example, stretch the muscle, and again, massage the area. Continuing to run without taking action just makes a tear more likely. If the pain means you can’t run without limping with each step, you’ve torn the muscle. Stop, walk home and apply the RICE treatment.

Is the pain… an ache?

You should… drop your pace and think about turning home if there’s a chance that it’s the recurrence of a chronic injury. In this case your running style or shoes could be the problem, so expert advice is recommended. If the ache is all over your legs, you’re just tired – so dig in, it’s good for you!

Is the pain… a radiant pain which spreads along a muscle, especially in the upper leg?

You should… stretch the whole muscle, including the area at the top of it, because the pain is likely to be caused by a tightness. You could be suffering the effects of a slipped disc, which you feel in your thigh, for example. Treatment by a physiotherapist, an osteopath or a chiropractor is essential, because no matter how much you stretch, the problem won’t go away until you address the cause.

Chest pain

Is the pain… more of an ache, and only occurring with each deep breath you take?

If so… it’s just likely to be fatigue in your chest muscles and/or your ribs.

You should… slow down until the pain clears.

Is the pain… spreading to your neck and shoulders, or being accompanied by severe sweating or faintness?

If so… it could be heart-related.

You should… stop immediately and hope that someone is nearby to help. If it’s a heart attack, you probably won’t be able to do much to help yourself. If the pain has gone after two minutes, it was probably nothing serious, but in any case, it is worth a precautionary check-up.

Is the pain… across your diaphragm (the sheet of muscle that separates your guts from your lungs) rather than in your chest?

If so… relax (literally). It’s just a stitch.

You should… adopt one of the many ways of getting ride of a stitch. My favourite is to stop and touch your toes a few times. Alternatively, take a very deep breath into the diaphragm, then carry on running for 15 seconds while holding that breath.

Faintness

While faintness isn’t a pain or an injury, it’s something that most of us feel at one time or another, especially in races. Most of us will carry on running unless we start to feel decidedly unusual.

If you’re unsure, you’ll feel better after a couple of minutes’ rest if it’s just natural weariness (if you feel giddy, lie down with your legs raised to improve bloodflow to your brain). High-energy food and drink will help.

If you’re on the point of collapse, though, it often takes a fellow competitor or training partner to spot the signs. These include a vacant expression, dogged persistence and complaints of dizziness or chest pains. If you spot someone in a state like this, try to suggest they at least walk for a couple of minutes and have some food and liquid – faintness may be a symptom of dehydration, as well as energy depletion. You should also be aware of the risk of hypo- and hyperthermia, and ensure that they do not become too hot or too cold.


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Discuss this article

I have been diagnosed with shingles. I am off work for a couple of weeks but feel generally ok. Can I carry on light jogging to maintain fitness?
Posted: 06/05/2006 at 09:02

shingles is a VIRAL infection - stressing your body can lead to a weakening of the immune system so be careful, it might make matters a lot worse.
Light jogging is a relative thing, but as long as you kept it to light by your standards, slow and don't go out if you start to feel really tired, then no harm done.
Any doubts, consult your Doc is always the best course.
Posted: 06/05/2006 at 16:56

You have my symapthy, shingles is the very bugger to shake off. My grandma got shingles and she was never well again, it finished her off.
Posted: 06/05/2006 at 17:51

Thanks, you are echoing the warnings of my wife. Iam desperate to get back to some form of fitness but shingles has followed 6 months of sinusits so physically I'm at rock bottom.Every one in my running club thinks I've left!!!
Posted: 06/05/2006 at 20:21

I've had shingles: it tends to come on when you are stressed or run down. Have you had acyclovir? I think it only works if you have it in the first 48 hours, but I had it and only had a small patch of the rash that cleared quite quickly. I agree you need to rest though: even if you get over the shingles quickly, getting it is a warning sign. You say yourself that you are at a physical low.
Posted: 07/05/2006 at 00:23

Thanks Rowan. I am on acyclovir, I don't feel too bad but I have been stressed and sinusitis has left me run down. I will probably rest and start light jogging in a couple of weeks time.
Posted: 07/05/2006 at 08:37

Hoping you are over the worst now! I spent one whole night trying to sleep in a cold bath as it was the only thing that stopped the itch! But it didn't last too long...
Posted: 08/05/2006 at 10:00

I worked for someone who ran FLM two days after the onset of a dose of shingles and was fine, but I wouldn't recommend it :oS
Posted: 08/05/2006 at 10:01

Being an older person and having suffered from arthritis in the hips for some years,I recently had a total hip replacement.A few days after the operation I had Shingles.I have now had it for 10 weeks and it is still pretty painful.At least it took my mind off the hip.Now,I am trying to get walking fit,before giving running another go.From the way things are going this could take a while.
Posted: 08/05/2006 at 15:32

I got this a number of years ago now. I had been run down after a series of bad colds. I did not know what it was for a week or so, and by the time I got to the doc he said it was too late to treat it. It was a bit sore, but cleared up a few weeks later and has never come back. I am now running 60mpw with no ill effects. I think the key thing is to be patient. Wait till it has cleared up. You have many more years of running left, you do not want to spoil it by rushing back a week or two too soon.
Posted: 08/05/2006 at 15:56

Thanks DundeeRunner, it is frustrating. I feel drastically unfit and I am running the New Forest Half Marathon in September. This seems like a while away but I will be starting my training from scratch.
Posted: 08/05/2006 at 17:51

Does anyone experience lower back tightness, stiffness or inflexibility when they have had Shingles or the time leading up to having Shingles???
Posted: 23/08/2009 at 18:19

I am in the 8th week of of a nasty outbreak of shingles.  2 months ago I ruptured the Plantaris muscle/tendon complex deep inside my left my left calf.  I was just walking across the street and pop went the weasle.  I had recently built up my trail mileage to 40 mpw and the combination of this injury and being tore up pretty good physically (after some of the 20 milers I'd completed on the very techy and steep hills of our trail system here in Issaquah Wa on Cougar/Squak/Tiger mountain), steered me right into the horrible condition known as shingles.  WOW!  Never known such pain. 24/7 for this long. I feel scared and alone with this damn thing even tho' my training partner/wife of years has been so wonderful and supportive thru' this whole thing. 

My question is can I run these hills without destroying what's left of my immune system?  


Posted: 23/11/2011 at 16:16

elo iv been running for 2 yrs now and im really suffering wiv pain in my knee and now im also getting pain in my thigh( top out side part) i have all the correct foot wear and i wear knee support i have had to cut right down on my running which im not very happy with been t doctors and they say to stop running err NO n take up swimming boring lol any ideas...
Posted: 24/03/2012 at 13:06

I have had terrible luck trying to run through injury. As far as I am concerned you should suck it up and just get better. There is always some other kind of training you can do even if it is just arm curls!

 I'm currenty holed up with injury and wrote about it here: http://regularrunner.com/dont-run-through-injury/

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Posted: 23/04/2012 at 00:48

I got 2 PB's while I had shingles I was given antivirals though and didn't feel too bad apart from the pain!!!
Posted: 23/04/2012 at 11:27

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