Is my running pain an injury?

Perhaps a running joke among runners is that we’ve all “just” overcome a pain and ended up missing it for months or more. But it really wasn’t meant to be a joke. There’s no shortage of stories of runners who still put on miles on the treadmill despite warning signs that the pain in their foot was actually a stress reaction, which then morphed into a stress fracture, which then morphed into a full break.

“You have to play for the long term,” Amelia Boone, 38, world steeplechase champion and ultra runner, told Runner’s World. “What are your goals? Always play it safe.”

Boone hasn’t always played it safe. In 2016, prior to traveling to the Western States, she had what appeared to be a pain in her adductors. Descending, it felt like her leg would break in half. “I thought it was a burden,” Boone recalls. “It was a stress fracture in the femur.” She walked on crutches for three months and took a break for six months.

Since then, Boone shuts things down earlier when she feels pain or something changes her gait. At this time she is struggling with some pains yet to be determined.

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

Runners are notorious for not listening to their bodies, especially when it might mean stopping something they love, says Joel Allen, PT, MSPT, facility director for physical therapy at St. Luke’s University Health Network in Quakertown, Pennsylvania. But early diagnosis and intervention can mean the difference between meeting that goal or putting off for months or more.

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What an injury vs. pain feels like

A good rule of thumb when assessing your own pain is that an injury often feels painful, a sharp pain like a sting or shooting, says Allen, a veteran triathlete. In many cases, this acute painful sensation indicates a muscle tear or fracture.

Of course, overuse injuries can develop over time, Allen says. In this case, if you experience muscle soreness that lasts for three or more days, he recommends seeing a doctor. Injuries won’t go away after a few days, he explains.

When trying to determine if you should be in pain, here are signs that you might be hurt:

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

    Compared to typical muscle soreness, which:

    • Dissipate within a few days; For example, delayed onset muscle soreness (DOMS) occurs 24 to 36 hours after a hard workout and then subsides with light physical activity and time.
    • Do not interfere with everyday activities
    • Feel better with light foam rolling and stretching

      While runners don’t always listen when their bodies tell them to stop, they know their bodies well. Boone, for example, knows that a pain that lasts three runs is more than just a pain. Or if she experiences pain with everyday activities outside of running, then that’s a sign of a more serious problem.

      “Now I pay attention to the nature of pain,” she says. “As we get older, pain can occur when we start walking, but this should settle down within about a mile. If they don’t, that’s a flag to turn it off.”

      Watch out for common running injuries

      Without proper running technique, warm-up and cool-down, rest and recovery, and a phased approach to training — yes, lots of moving parts — runners are likely to face a running injury at some point in their career, Allen says.

      Common injuries are:

      • piriformis syndrome
      • Shin splints
      • Lower back pain
      • ankle pain
      • IT Band Syndrome
      • plantar fasciitis
      • Achilles tendinitis
      • runner’s knees
      • hamstring injury
      • stress fracture
      • Hip bursitis
      • shoulder pain

        Any weight-bearing joint — the back, hips, knees, ankles, toes, and feet — can be a common site for running injuries, according to Allen. Therefore, it is important to pay special attention to these areas when they talk to you about aches and pains.

        “People think of running as running, but it’s so technical and the mechanics of running are so important,” he says, noting that as a breed we need to focus on strength training, including core muscles. Other physical therapists, like that at Pennsylvania’s Mobility Doc, also suggest focusing on mobility and flexibility.

        Allen emphasizes the importance of not only a dynamic warm-up, but also a dynamic cool-down. Especially as we age, these warm-up and cool-down periods can help mitigate the natural decline in muscle elasticity. “These don’t necessarily take 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 if something doesn’t go away or you feel a sharp, stabbing, or stabbing pain, it’s a good time to see a doctor, whether it’s a physical therapist, orthopedist, sports medicine specialist, 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: They don’t want to stop running just because something hurts.

        “You don’t have to be a runner to understand this, but it helps,” says Allen, who has had his share of running-related injuries. “Personally, I don’t tell anyone not to run unless I feel like it makes them feel worse or hurt them more or lead to more injuries.”

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

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

        Chloe Costigan, DPT, co-owner of Mobility Doc agrees: “Quietness alone rarely solves a problem. My goal is to keep you as active as possible as you move toward less pain.” She notes that keeping running gives her and her athletes a way, when possible, to measure the effectiveness of treatments and modifications . If prescribed treatment tactics “are not moving you away from pain and increased running tolerance, then we should scale back the volume and intensity of running a little,” Costigan tells Runner’s World. “This is a dynamic, ongoing conversation.”

        Former collegiate runner Blain Masterson lost a year of running to a stress fracture because he “just ran in pain” and didn’t trust (or was really stubborn) doctor’s orders. The 23-year-old high school English teacher entered his junior year of college with a goal of becoming number two on the cross-country team. Eight miles into a 17-mile 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 off my shoe and pressed on my cuboid [bone, in the midfoot] and a spider’s web of pain and heat spread over my foot,” he tells Runner’s World. “I kind of knew it was that [for my season].” He ran back to complete the 17 miles before he was diagnosed with a stress fracture.

        However, instead of following his doctor and trainer’s recovery plan, Masterson snuck out in the middle of the night to rack up miles. He felt shame and guilt when the injury flared up again, and he had to feign disbelief to his medical and coaching teams.

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

        He ended up pacing the latter part of his junior year and eking out an, albeit disappointing, senior season outdoors. He is left with the question of “what might have been” if he had followed his recovery plan.

        Masterson has sought multiple opinions, and Allen says it’s always good to get a second or even a third opinion—especially when you don’t want to hear the advice. For example, many physical therapists offer a free consultation. “In many cases, you don’t need therapy, maybe just guidance,” says Allen. “And we can nip it in the bud.” But again, that’s if you catch it early.

        What to do when you have a big race around the corner

        When runners have been training for a target race, especially a longer distance like a half marathon, marathon, or ultramarathon, it can be hard to accept that they might be doing it because of an injury.

        Boone retired from a race this spring to focus on her injuries and recovery. she’s eyeing another one in June. “I have plenty of time and come with a good base,” she says, pointing out that runners need to be flexible in their training to counteract pain and potential injury.

        Depending on the nature of the pain or a potential injury, Allen discourages telling his athletes to forgo a finish race altogether.

        “You have to see the big picture,” he says. “It’s better to go in healthy and under-trained than to come through an injury.” That could mean skipping the last 18 miles and focusing on cross-training; You won’t lose marathon fitness in a week or two, he says.

        Costigan asks her athletes, “What’s the point of running?” Are they trying to qualify for the Boston Marathon? Complete a World Marathon Major? “Identifying the motivation for racing is essential to determining if an athlete should be racing despite an injury,” says Costigan.

        Then she will estimate the cost of the race. “There’s certainly a risk that an athlete will feel worse after the race,” she says, noting that a torn Achilles tendon makes walking impossible. “It’s about finding a net positive outcome.” By tuning into your body, talking to a medical professional, and finding the best plan for you (and your pain), you can make the right decision about whether you should endure pain .

        Freelance Writer
        Heather is the former food and nutrition editor of Runner’s World, the author of The Runner’s World Vegetarian Cookbook, and a seven-time marathon runner with a personal best of 3:31 – but she’s most proud of her 19:44 5k and 5:33 mile.

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