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
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 the doctor? 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 kilometres 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.
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.
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.
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. (Here’s how to strengthen your ankles.)
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.
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.
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.
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. (Beware of these nine health foods that could sabotage your running.)
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.