Running Through Pain and Running Injury Management
We are approaching some big spring marathons and with increasing mileage and intensity, it’s not uncommon to find yourself with some recurring aches, pains or injury. Maybe you’re the type to just run through it more and more until you’ve dug too deep a hole. Or maybe you THINK you’re doing the right thing by resting and waiting for pain to subside only to be making yourself weaker and perpetuating the problem.
Here is your guide to the management of your running related pain or injury to help get you to the start AND finish line.
How Much is Too Much OR Too Little?
"Can I run through pain?" is one of the most common questions I get. The answer, everyone’s favorite - it depends. But let's hope this blog provides a little clarity on the topic. Unfortunately, without this information, there are usually 2 distinct camps I see: the push too hard and the pull back too much. Here is what’s wrong with both.
P U S H T O O H A R D
This one is the most obvious on the surface. You let your knee, hamstring or achilles pain and strain spiral. You just ignored the increasing pain from week to week because you just CAN’T possibly stray from your strict marathon training schedule. The problem here is that increasing pain = increasing inflammation. And what was initially something a little PT and load management could solve has now gotten too severe to get you pain free by race day. Now you’re staring down the barrel of dropping out or trying to perform through pain.
P U L L B A C K T O O M U C H
This may generally be considered “the smart choice”. You felt pain so you immediately cleared your training schedule for the next 2 weeks and kicked your feet up to rest it. The problem here is that many soft tissue injuries like an achilles or hamstring are a result of weak tendons. Thus, complete rest only perpetuates this problem by further letting that tendon/muscle weaken. So you may return in 2 weeks feeling a bit better, but your pain may eventually return and land you in the same place you were by race day.
Load Response, The Pain Traffic Light, PEACE & LOVE
Proper load management and guided adjustment to your training schedule is the key to overcoming your small setback. The training runs you miss instead of pushing through too much pain won’t set you back as much as a spiraling injury will. And over-responding to small amounts of pain will get you nowhere to solve it.
P A I N T R A F F I C L I G H T
Instead, think about managing your response to running/training using the pain traffic light analogy. Here’s how it works:
Based on a 0-10 pain scale, 0 being no pain and 10 being the worst you've ever felt
Pain increase with training up to a 3 can be considered safe, above a 5 and you should stop the activity and 4-5 meaning proceed with caution and a sense of what your body can handle
These parameters are all assuming the following:
Increase in pain subsides within 24-36 hours or before your next workout
Pain/stiffness is not increasing week to week
These parameters are not applicable to boney injury so if there is a concern that pain is coming from bone, it's important to get seen by a PT or doctor ASAP and stop impact activities until confirmed.
Common sites of boney injury include the foot, shin and top of the femur so be cautious especially if your pain is located around these areas.
P E A C E & L O V E
For a new and acute injury, you may have grown up swearing by RICE (Rest, Ice, Compression, Elevation) as the solution too many soft tissue injuries. Fortunately, there have been many advances in the way we approach pain and injury, leaving this acronym overly simple and a little outdated.
PEACE & LOVE more appropriately encompasses the continuum of rehab from immediate acute care through long term management. It also takes into account the importance of education as well as the complex biopsychosocial aspect of pain.
Here’s how to apply it if you end up with an acute injury during training
PHASE 1 = immediate 2 - 5 days
🤕PROTECT - Avoid activities that provoke pain in the initial hours/days. If we’re dealing with fracture this is longer and with some injuries a little shorter
⏫ELEVATE - for removal is swelling (if present) which contributes to pain and motion restriction
💊AVOID ANTI-INFLAMMATORIES - Now this is the big current shift. Inflammation is a natural step in the healing process, blunting it may slow healing and recovery. Use ice and NSAIDs sparingly and as needed for pain
🩹COMPRESSION - with swelling present, this can promote further reduction in the joint with taping, bandaging or compression garments
📚EDUCATE - understand your injury, especially WHY it occurred. Seek the guidance of a physical therapist and avoid WebMD self treatment🤦🏻♀️
PHASE 2 = the phase of healing after immediate inflammation
🏋🏽LOAD - as soon as able, loading promotes healing by creating resilience and strengthening for the weakened area. This is especially the case with tendinopathies
🧠OPTIMISM- the brain is a powerful thing and a MAJOR piece of how we perceive pain. Condition your brain for optimal recovery with a confident and positive outlook. Rehabbing an injury is bumpy road
🩸VASCULARIZATION - aerobic repetitive activity to promote blood flow and healing
🏃🏻♀️EXERCISE - restore mobility, strength and proprioception with returning gradually to activity of choice
T H E T A K E A W A Y
If you have ended up with a new injury the key will be managing your response to load using these 2 major tools and guidelines. First think PEACE & LOVE and let the pain traffic light guide what is OK as far as response to activities.
Seeking the guidance of a physical therapist first is the best way ensure a quick return to training. Often times waits for the orthopedic are too long and the ultimate result is PT anyways. At The Run RX, our physical therapists are also runners, personal trainers and run coaches so we have a thorough understanding of your training and how to best get you to the start line.
Schedule a discovery call today if you need more guidance on managing you injury!
