Running with Pain

Running with pain is not uncommon for most runners.

…But how do we know when to continue, or when to stop?

The first thing to highlight when discussing the topic of pain, is that pain does not equal damage. Yes, there may be damage if there is pain, not there does not need to be. Pain is our personal warning signal, like a fire alarm. It rings off to make us aware of potential danger. If we are feeling pain, we do not need to jump to the worst conclusion that we are damaged, and everything must stop!

However, we definitely should acknowledge it and think about why it may be happening.

…Pain is a complex topic, and perhaps one that needs its own blog post!

For the context of this article let’s just say: when we feel pain from running, it does not mean that we have damaged a tendon, or ‘pulled’ or torn a muscle. More times than not, it is a sign that we have done a bit too much, and our body is starting to complain about it.

The reason that it is quite common for runners to experience niggly episodes of pain is because it is quite easy to over train. The nature of the activity is very repetitive. There is little movement variability, and so the same forces are being absorbed by the body over and over again. Runners tend to be gradually increasing their speed, and distances, their quantity of runs. So, it is easy for the body to become overloaded and start to complain.

So how do we know when to stop running with pain, or to push on through?

Well, there is no hard science to give us this answer, it will be based on difference factors, very much weighing up the risk and reward. For example, the approach taken may change depending on whether a runner is close to a race or not. It may change based on the location of pain – bone stress issues or reactive tendons may require more caution.

A structured assessment and reasoning process to determine whether a runner should continue, or stop is important to help make that decision. Running physio Tom Goom outlines a 4 step process that he uses to guide this process.

1. Assess readiness to run.

If the severity and irritability levels are low then it may be possible to continue running. We would be looking for the runner to be able to perform the following:

• Some level of running either pain free or mild discomfort.
• 30min walking without pain
• Most daily activities without pain – In a research paper by Silbernagel et al. (2015), it was advised that general activities of daily living should be able to be completed with pain levels below 2/10 for someone to be ready to continue running.
• Adequate strength, control, and flexibility could be assessed, with equal measures between left and right sides.
• It would be sensible to assess impact tests, whereby the runner may hop, bound, or jump for a set amount of time or repetitions. These activities mimic the impact demands of running and so must be tolerable.
• Testing 2-5 minutes of road or treadmill running will highlight if the runner is able to tolerate running.

2. Determine current ‘run tolerance’.

• After determining the readiness to run, we would want to find our what the level of run tolerance is. That is, how much running can they do before pain. How far, how fast. Further considerations could look at footwear, time of day, surface.
• It is then important to check their 24 hour response to running. This will demonstrate the irritability levels. Experiencing low level pain is acceptable, but it this pain lingers past 24 hours, then it tells us that the runners tolerance was exceeded.
• The runner’s ‘baseline’ run tolerance can be determined by taking the amount of time they can run before pain starts, and taking around 10% off that time. This gives us a level whereby they can run, without pain setting in and may act as a good start point for the next stage.

3. Graded return to based on goals.

• We could take the baseline run tolerance and use that as a starting point for the return to working towards to runner’s goal.
• Starting with the longest run for week one being set at the baseline distance.
• Each week that distance can be increased by approximately 10%, so that the load is gradually increased at a rate at which the body can adapt.

4. Monitor response and modify where needed.

• There is an element of trial and error when returning to running after pain. The approach may need to be tweaked as the program progresses.
• Some progressions may be a bit too much, resulting in pain flares ups after 24 hours. Therefore, it is important to monitor the response after runs and modify where needed.
• This could be reducing the distance, adding more recovery time, adapting the strength, and conditioning elements.

So, although this process is far from being fool proof, we can see how having a structure in places helps to remove guess work and brings in a clear reasoning process to return to running.

If you are a runner and have been experiencing some running related niggles, please feel free to get in touch with me at alex@central-therapy.uk – I would be happy to help.

At Central Therapy’s Lowdham clinic in the Nottingham area, we have a dedicated set up including a treadmill, to work with runners to gauge run tolerance and to perform gait analysis.

www.central-therapy.uk