Reader to Reader: Should I run through the pain?

Learning how to manage injury – and the threat of injury – is an unavoidable side-effect of being a runner, but how can you tell whether the sudden onset of pain will pass in a couple of miles or is a sign of something more serious? Is the only option to give up and go home, or should you struggle on regardless?

"I have suffered with patellar tendinitis for a while now and have being thinking, is pain just a sensation? When I perform certain movements (like squats) I get a pain but it does not limit my mobility. Surely if you have an injury that is just painful you can carry on, and only if you have an injury that limits mobility you should stop? How do we know pain isn’t a good thing?" – livetorun

So detailed and philosophical were your answers to this week’s question that the traditional Reader to Reader advice-giving format just wouldn’t do them justice. Nevertheless, we’ve done our best to summarise the main points from the thread and we think you'll agree the result makes for a fascinating read. Don't even think about clicking elsewhere - pull up a pew, then get exercising your grey matter by joining the debate...

• Recognise the distinction between pain and discomfort
  I think it’s worth recognising the difference between pain and discomfort on all levels. What many people describe as pain is actually severe discomfort. Pain is a nerve response to damage that is occurring, discomfort is not. Pain is designed to stop you in your tracks from continuing the same action so as not to cause further inflammation, deterioration etc. Discomfort is when you overreach, stretch yourself, or push yourself beyond the norm etc. Pain takes your breath away. If you are in pain you will not be able to continue the same action at the same level of effort regardless of what that activity is. If you can, you are not in pain, you are just experiencing discomfort, whether mild or severe. Depending on the biological process causing that discomfort, this could in time lead to pain - it's then that you should stop the action, investigate and treat the cause. As a runner, discomfort helps us to improve and keep going, get faster, run further, without being in some form of discomfort we would never improve, but pain is the result of something else, something that is going wrong in our bodies and if you are really in pain, this should not be ignored. – fatgirlslim
• Conceding to your physical limitations is not a cop-out
  Be very careful about which injuries you choose to try and run through. If you ignore a serious injury, eventually something will fail in an irreparable way. It's one thing to be “hard”, and be able to ignore the kind of pain that is transitory but ignoring a serious pain that is trying to tell you that something is wrong is a form of denial and can have serious consequences. Pain is not 'just an emotion'. It is one of a number of subtle signals that your body provides which, if you heed them appropriately, will allow you to bring your body to its full athletic potential. If you choose to ignore them - and this is your choice - you will live with the consequences, which could include a seriously limited capacity for performance, weight bearing, or basic movement. We're all runners here, and I doubt there are any of us who haven't turned a niggle into a proper injury because we thought, “oh, it's nothing, I can run through it”. But because of this, and the time off it inevitable causes, we learn when to listen to the warning signs. Simply trying to be a hard-case won't stop your body breaking down. It'll do it anyway. – Slowboy
• Use a scoring system to keep things in perspective
  My advice is to rate pain on a scale of one to 10. Anything up to three or four and I'd train as normal providing it starts to go away within a week. Five to six I'd train gently, seven take a break, and eight upwards see a physio, doctor or whoever is appropriate. Another thing I bear in mind is what type of pain it is. For a stitch, bloomin’ well ignore it as best you can; for a muscle pull or ache, work gently through it. For knee pain, work through it providing it doesn't get any worse as in fact, it should start to ease off over time; for a ligament, tendon or bone, be very careful indeed. – Little Lizard
• High tolerance levels are no solution to the reality of injury
  Pain is a physical sensation, not an emotion. It's hardwired to be aversive for a very good reason - it stops us damaging ourselves. There are various disorders where people have much reduced or no pain sensation, and they do themselves a lot of damage. I've got an unusually high pain threshold and this is actually quite annoying. I tend to get injuries which worsen because I don't notice them soon enough. I have to train myself to pay attention to little things and fix them before they stop me running. My performance also suffers because I'm not so good at noticing when I need more water or food, or too cold. The crucial factor seems to be control/expectancy, rather than being 'used' to it. – Duck Girl
• Overriding your neurochemical system goes against its primary purpose
  Pain is a neurochemical response to an injury of tissue. Pain would not occur if everything was working as it should. In cases of minor injury and minor inflammation, it is quite possible to school yourself to ignore the pain. However, the very act of ignoring your pain can put you at further risk of injury for the simple reason that pain is there to alert you to the fact that something should be allowed to heal before proceeding. The way we 'control' pain is based on the theory that for pain to travel along a nerve, it has to go through a 'gate'. In order to 'ease' pain or 'control' it, the idea is to close the gate and prevent the signal going to the brain. The way we 'close' the gate is by stimulating the nerve so the pain is 'avoided'. For example, if you knock your shin against a chair leg, it will hurt. If you then rub the shin this stimulates the nerves and closes the gate where the pain impulse is going to the brain. The pain is then stopped or at least lessened. When we are 'learning to ignore' pain we're not really solving the problem, we're actually contributing to it because we're likely to make things worse. – Cath.
• Dwelling on the negative can undermine recovery
  In my experience, 'pain' is definitely a description of the relationship you assume with the sensations you are getting. I had a hip flexor injury for a year and though there was a 'physiological cause' the worry that I had about it exacerbated the injury so it rumbled on for ages. When I tackled it with a physio, his position was that most injuries are caused through misuse and resting is an unsatisfactory answer because once you go back to using it you just cause it again. He thought the best strategy was to run with it but crucially to also let go of the idea of it as a problem and a threat. I'd therefore say, adopt a lightness of attitude to the injury - assume it will get better (I visualised my hip flexor loosening as I became less anxious about it), treat runs like tests of how to re-educate your use of your muscles so as not to hurt yourself, massage the area and keep a diary of how much discomfort you feel throughout the run and later. – Wedders
• Responding to pain is innate to the human condition
  It's good to push yourself and mental strength is important. But, pain is your body's way of telling you something's wrong. For example, babies are often given a heel prick test when they're born - the natural, innate response is for the baby to pull their foot away, in other words away from the source of the pain. This is before their behaviour could possibly have been influenced by others and they obviously have no understanding of verbal communication. In the case of running, if it hurts, keeps hurting, and things start getting swollen, your body is trying to warn you something isn't right and you would do well to heed that warning. Push yourself yes. Break yourself or prevent you from doing the thing you love just sounds foolish to me. – Pootleflump
• Stepping outside your comfort zone is a key element of training
  Pain is a warning. It’s a natural product of evolution as those who choose to ignore it completely ultimately die out. It can be useful to be able to "ignore" some pain - or rather be aware of it and choose to continue your activity for a while – as this is the very basis of progressive overload, the underlying mechanism for most training regimens. The trick is to know how far over the line you can go before you inflict too much damage for the body to be able to naturally repair. – Dad Of Two
• Conserve your energy by shortening your stride
  I recommend taking a shorter stride and a quicker cadence when hill climbing. This makes hills a lot easier and less tiring, enabling you to run freely when you get to the top. Taking larger strides fatigues me quickly and makes my hamstrings ache for days! – Rach E
• Pain operates on a subconscious level to preserve our well-being too
  Pain is a gift. In my opinion, there is no way pain is a product of evolution, it’s just too sophisticated a warning system. Without pain, life is unbearable. Without pain, you would not blink every few seconds, your eyes would dry out and you'd go blind. Without pain, you would walk the exact same way, step after step, never performing the subtle shifts and alterations in stride length and pattern that you do (although you don’t consciously know it). You'd develop blisters, but never limp. Those blisters would get infected, and wear down to the bone. Without pain, you'd cut yourself, burn yourself and damage yourself. Your joints, your skin would wear down. You would self-destruct. – flyaway
• It comes down to the age-old 'fight or flight' scenario
  The human body is possible of dealing with a much higher level of pain in emergency "fight or flight" situations than it would day to day. My understanding of this is that increased levels of adrenalin and other such neurotransmitters lead to a flooding of the pain receptors such that the pain signals are less likely to get through. The body can (either through design or evolution) temporarily suspend the regulatory governor of pain in order to allow actions more important to our immediate survival (such as fight or flight). And if one is able to self-induce this sympathetic nervous response then it is possible to go beyond the normal limits imposed by pain. Hence, during a race, whilst our sympathetic system is in full flow, we are focusing on reaching the finish line as quickly as possible, and can essentially ignore the pain from our legs. – Dad Of Two
• Pain is too complex a concept to meaningfully compare experiences
  I’d argue very strongly that the varied use of the word ‘pain’ to cover all of these completely different experiences is a reflection of the inadequacy of our language rather than any universal truth about the experience of pain. Running is an interesting arena to explore this idea. Pushing yourself to the limit of your endurance and capacity to sustain exercise can also be described as self-induced pain in pursuit of a goal. In my life I’ve experienced acute physical pain of broken limbs, punctured flesh and tearing muscle. I dealt with this pain as I’d been taught to deal with it from an ex-Sergeant Major dad – I dealt with it stoically, with as little noise and fuss as possible and made jokes about it to the people who came to my aid. No doubt I gave the impression that I had a high pain threshold. Of anyone thought that they’d be completely wrong - I was in very real agony, but I chose not to show it. I’ve also experienced chronic pain that lasted almost a year after an injury. This pain was there 24 hours a day. It intruded into my sleep, it prevented me concentrating, it was a constant nagging part of my consciousness and accompanied me wherever I travelled. I’m not sure I dealt with this pain as stoically as the acute pain. I’m also not sure that you could meaningfully compare the experiences or use the same inadequate word to describe how both experiences actually felt – Corinth
• Don’t forget why you run
  All of us ignore pain from time to time - when we have a 'bad' run, or get a stitch or something. The art lies in knowing when fleeting, transitional pain, becomes more serious. If you're getting pain and discomfort a lot, even if it is at a low level, your body is certainly trying to tell you something. Tendonitis is known for its sneaky onset, and when ignored, for resulting in a partial or complete tear of the tendon in question. Ruptured tendons are not fun, and require surgery to fix. That's a long time with no running. Ultimately, whatever your theory about pain and how the mind responds to it - it is much more fun running without pain so it's well worth trying to do something about it! – JoTheLibrarian