A running joke among runners is, perhaps, that we’ve all pushed through “just” an ache and ended up being sidelined for months or longer. But it shouldn’t really be a joke. There is no shortage of stories of runners who keep clocking kilometres despite red flags that the ache in their foot was actually a stress reaction, which then turned into a stress fracture, which then turned into a full break.

“You have to play the long game,” Amelia Boone, 38, obstacle racing world champ and ultra runner, tells Runner’s World. “What are your goals? Always err on the side of caution.”

Boone hasn’t always erred on the side of caution. In 2016 she ran through what seemed to be a niggle in her adductor, in the lead-up to Western States. During a descent it felt like her leg was breaking in half. “I had thought it was a strain,” Boone recalls. “It was a femoral stress fracture.” She was on crutches for three months, sidelined for six.

Since then, Boone shuts things down early if she feels pain or something that changes her gait. As of this writing, she’s battling some yet-to-be-determined pains.

“I was positive I broke my femur again,” she says. “The imaging shows everything is totally fine. But I still feel pain, so how do I work through it?” A question many runners have asked themselves.

Runners are notorious for not listening to their bodies, particularly when it might mean stopping something they love, says Joel Allen, P.T., M.S.P.T. But early diagnosis and intervention can mean the difference between nailing that goal race or sitting out for months or more.

What an Injury v. an Ache Feels Like

When assessing your own aches and pains, a good rule of thumb is that an injury often feels painful, a sharp pain like a stabbing or shooting, says Allen, a veteran triathlete. In many cases, that acute painful sensation is indicative of a muscle tear or bone fracture.

Of course, overuse injuries can develop over time, Allen says. In that case, if you experience muscle soreness that lasts three or more days, he recommends seeking medical attention. Injuries aren’t going to go away after a few days, he explains.

If you’re trying to determine if you should run through pain, here are signs you might be injured:

• Sharp or stabbing pain
• Pain that lasts more than three days, even if it occurs only during running (not necessarily after)
• Swelling and bruising

Compared to typical soreness, which should:

• Dissipate within a couple of days; for example delayed-onset Muscle Soreness (DOMS) will come on 24 to 36 hours after a tough workout and then subside with light physical activity and time.
• Not interfere with everyday activities
• Feel better with light foam rolling and stretching

Even if runners don’t always listen when their bodies tell them to stop, they know their bodies well. Boone, for example, knows that pain that lasts for three runs is more than an ache. Or if she experiences pain during everyday, non-running activities, then that’s the sign of a more serious issue.

“Today I pay attention to the nature of pain,” she says. “As we get older, aches and pains might pop up when we start to run, but those should settle down within a mile or so. If they don’t, that’s a flag to shut it down.”

Keep an Eye Out for Common Running Injuries

Without the proper running mechanics, warmups and cooldowns, rest and recovery, and a gradual approach to training—yes, a lot of moving parts—runners will likely find themselves staring down a running injury at some point in their career, Allen says.

Common injuries include:

• Piriformis syndrome
• Shin splints
• Lower back pain
• Ankle pain
• IT band syndrome
• Plantar fasciitis
• Achilles tendinitis
• Runner’s knee
• Hamstring strain
• Stress fracture
• Hip bursitis
• Shoulder pain

Any weight-bearing joint—back, hip, knee, ankle, toes, and feet—Allen says, can be a common place for running injuries. So it’s important to pay special attention to these areas if they’re talking to you via aches and pains.

“People feel running is running, but it’s so technical, and running mechanics are so important,” he says, noting that as a breed, we need to focus on strength training, including core strength. Other physical therapists also suggest focusing on mobility and flexibility.

Allen emphasises the importance of not only a dynamic warmup but a dynamic cooldown, too. Especially as we age, these warmups and cooldowns can help mitigate the natural decline in muscle elasticity. “These don’t necessarily take up a lot of time,” he says. “It’s about making it a part of your routine, like brushing your teeth.”

When to See a Doctor (And When to Listen to Them)

You know your body, and when something doesn’t go away or you have feelings of sharp, stabbing, or shooting pain, it’s a good time to seek medical attention, whether that’s a physical therapist, orthopedist, sports medicine doctor, or a general practitioner. And there’s something to be said about finding healthcare providers who are runners (or exercise enthusiasts) because they tend to get it: You don’t want to just stop running because something hurts.

“You don’t have to be a runner to understand, but it helps,” says Allen, who’s had his own share of running-related injuries. “Personally, I never tell someone not to run unless I feel it’s going to make them feel worse or injure themselves more or lead them down the line of more injuries.”

Instead, Allen tries to find ways to modify running—a less voluminous or intense training program, finding different surfaces or shoes, or adding flexibility and strength exercises.

Of course, these modifications are possible if runners are assessed and diagnosed early. “Once you have a stress fracture, you have a stress fracture,” Allen says. “There’s no magic pill to fix that.”

Chloe Costigan, D.P.T., agrees: “Rest alone infrequently resolves an issue. My goal is to try to keep you as active as possible while moving toward less pain.” She points out that when able, continuing to run gives her and her athletes a way to measure the effectiveness of treatment and modifications. If prescribed treatment tactics “aren’t moving you away from pain and increased running tolerance, we should back off a bit of volume and intensity of running,” Costigan tells Runner’s World. “This is a dynamic, ongoing conversation.”

Former collegiate runner, Blain Masterson, lost a year of running due to a stress fracture from running on “just an ache” and not trusting (or, really, being stubborn about) doctor’s orders. The 23-year-old high school English teacher was heading into his junior year of college with sights on the number-two spot on the cross-country team. Eight miles into a 17-miler Masterson felt a burning sensation on the top of his right foot. He brushed it off, ran another five miles before sitting down to investigate.

“I took my shoe off and pressed down on my cuboid [bone, in the midfoot] and a spider web of pain and heat spread over my foot,” he tells Runner’s World. “I kind of knew that was it [for my season].” He ran back to complete the 17 miles before he was diagnosed with a stress fracture.

Instead of following his doctor’s and coach’s recovery plan, though, Masterson would sneak out in the middle of the night to log miles. He felt shame and guilt when the injury would flare up again, and he’d have to feign disbelief around his medical and coaching teams.

“The doctors knew what they were talking about, but I was stubborn, and I knew I had sacrificed the long-term benefit for the short-term pleasure,” Masterson says.

In the end, he ran off and on throughout the latter part of his junior year and eked out a senior outdoor season, albeit a disappointing one. He’s left with the question of “what could have been” if he’d followed his recovery plan.

Masterson sought several opinions, and Allen says it’s always good to get a second or even third opinion—especially if the advice is something you don’t want to hear. Many physical therapists, for example, offer a free consultation. “In a lot of cases, no, you don’t need therapy, maybe just some guidance,” Allen says. “And we can nip it in the bud.” But again, that’s if you catch it early.

What to Do If You Have a Big Race Around the Corner

When runners have been training for a goal race, particularly a longer distance like a half marathon, marathon, or ultramarathon, it can be hard to accept that they may have to table it for an injury.

Boone pulled out of a race this spring to focus on addressing her injuries and recovery; she’s eyeing another one in June. “I have plenty of time, and I’m coming in with a good base,” she says, noting runners have to be flexible with their training to address aches and possible injuries.

Depending on the nature of ache or possible injury, Allen stops short of telling his athletes to forgo a goal race altogether.

“You have to look at the big picture,” he says. “It’s better to go in healthy and undertrained than push through an injury.” That might mean skipping the last 30- kilometre and focusing on cross-training; you won’t lose marathon fitness in a week or even two, he says.

Costigan asks her athletes, “What is the point of racing?” Are they trying to qualify for the Boston Marathon? Complete a World Marathon Major? “Identifying the motivation for racing is imperative in determining whether an athlete should race through an injury,” Costigan says.

Then she’ll assess the cost of racing. “There is certainly a risk that an athlete will be worse after racing,” she says, noting a ruptured Achilles tendon makes walking impossible. “It’s a matter of finding a net positive.” Tuning into your body, talking with a medical expert, and figuring out the best plan for you (and your ache) will help you make the right choice about whether you should run through pain.

 

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