Can I keep Running Through Pain?

Can I just keep running through the pain?

This must be one of the most common questions I hear as a Physiotherapist. The shorter answer is, actually, yeh, probably. However, as with most things, it’s not quite that simple. So in this module, I’m going to break this down into 6 separate questions.

1. Is this a niggle or an injury?
2. Can I keep running through the pain?
3. Do I need to rest from running?
4. Will I be able to run my race?
5. How do I keep running through the pain?
6. How do I catch up to my training plan?

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Is this a niggle or an injury?

The difference between a niggle and an injury is not easy to determine. In fact, it is best left up to a qualified professional. So the question is do I need to get this looked at? Well, if in doubt yes. However, if runners ran to the doctor every time something hurt we wouldn’t have any space in the hospitals for any of the sick people.

So, I have a few little rules of thumb that I like to use to help runners decide if they need to get the painful area looked at

1. Give it a week, but no more. If it goes away within a week, consider it a niggle and carry on with your training.
2. If you are limping, get it checked. This one seems obvious but if the pain is bad enough to make you limp then you need to get it looked at as soon as possible.
3. If you have had this pain before, get it checked. The best predictor of future injuries his previous injuries. If you have had an issue before and it is coming back, the sooner you get it looked at the easier your rehabilitation will be.
4. If you have pain at night, get it checked. This is another obvious one, but running injuries shouldn’t hurt when you’re not running! Pain at night may indicate a more serious problem and you should get it checked immediately.

Can I keep running through the pain?

When working with injured runners, complete rest from running is almost never helpful. So running through pain is part of the rehabilitation process. However, it is not as simple as ignoring the pain. If you caught the episode on avoiding running injuries, you will understand that placing stress on an injured tissue is helpful in the sense that it allows that tissue to adapt to the stress. In this way, you can use running as a way to rehabilitate your injury.

However, this will require you to learn how to listen to your injury and adjust your training accordingly. The pain traffic lights system that we discussed in the episode on avoiding running injuries is an excellent tool to help you use running as a way to recover from a running injury. So how does the pain traffic light system work?

If you feel a little pain that isn’t really bothering you, you can think of it as green-light pain. Green-light pain is like 0-3 on a 1-10 pain scale. Just like the traffic lights, green light means keep going. If you are experiencing strong to severe pain as you run, say 6-10 on the pain scale, you are placing too much stress on the injured area. In this case, just like the traffic lights, red-light pain means stop.

So what’s orange-light pain? Orange-light pain hurts, but it’s not that bad. It’s not getting any worse and it’s uncomfortable but tolerable. When you stop the pain fades away within about 20 minutes and it doesn’t feel worse later that day or the following morning. Each time you run the pain is no worse. We’re talking a 4-5 on a pain scale.

Just like with the traffic lights, orange-light pain means proceed with caution. You probably aren’t going to run faster or further, but what you’re doing is okay. The other thing to consider if you’re planning to run through pain is whether or not the pain is stable. Stable pain means that it’s not getting worse each run. It’s part or the orange light criteria, but worth drawing special attention to. If the pain is slightly worse each run, I call that snowballing. Clearly, this is heading in the wrong direction and it’s better to get it looked at sooner rather than later.

That brings me to another important point. Getting your injuries looked at soon after they arise pretty much always shortens your recovery time. It is much easier for us to keep you running when you have a relatively mild injury. If you wait until it is so bad you can’t run, your recovery will take much longer.

Many runners hate going to the Physio as they think they will be forced to rest. However, any good physiotherapist knows that rest from running will allow weakening of the muscles, tendons, ligaments and bones, so they will only advise complete rest if it is absolutely necessary. If you have been told to rest by a medical professional, but you’re not sure that you need to, just get a second opinion. If they also say rest then you probably need to rest! It’s a good idea to have a local Physio whom you trust that you can call on when things crop up. This brings me to my next question…

Do I need to rest from running?

These are the things I look at as a Physiotherapist to help me decide if a runner needs to take a period of complete rest from running.

1. Red Light Pain that comes on immediately with running. I’ll have my runners try and run for 2-3 minutes on the treadmill in the clinic and if they have 6 out of 10 pain then they pretty much need at least a week of rest.
2. Pain with walking. If it hurts when you walk, it is almost guaranteed to hurt when you run and you may need a week off to let it settle. There are some exceptions to this rule, but it usually holds true.

If you need to take a rest from running, then you should definitely work with your local Physiotherapist to help you with your recovery. However, it’s rare that I need a runner to completely rest for more than a week. I’ll usually start them with 1-minute running and 1 minute of walking for 3 repetitions. Then we build up from there following this interval program from the running clinic.

Will I be able to run my race?

Using the Pain Traffic Lights system discussed earlier, you should be able to keep running, albeit with some restrictions. This will allow you to keep training, but will you be able to run the race you’re training for?

Obviously, this depends on a number of factors. How bad is the injury? How much are you able to run without getting red-light pain? How long is it until the race? How much will your training volume and intensity increase in the upcoming weeks? So it’s not possible for me to answer this question without knowing the specifics of the situation. Even then, the answer is usually “maybe”.

Following the Pain Traffic Lights system, you can try to stick to your training plan for the time being and just pull out of any runs that cause red-light pain. At the end of the week, if you have been able to keep your pain in the orange-light zone, you can try adding either more volume or more intensity the following week, but not both.

Adding more volume might mean adding a few extra minutes or kilometres to each run. Adding more intensity might mean adding some strides or sprint intervals. Again, I can’t say exactly what to add but the idea is just to do a little bit more than the previous week and see how the pain behaves. If it stays in the orange-light zone, you can do the same again next week.

In this way, you can add a little more volume or intensity to your training each week. If you are able to increase your fitness enough without irritating the injury, then you’ll be able to run your race.

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If you’re training for a marathon specifically, I talked about applying this concept in my contribution to Marathon Training Tips from Xero Shoes.

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How do I keep running through the pain?

There are some simple small changes that you can make in order to keep running through pain.

1. Change all of your runs to low intensity or slow runs. Faster running usually places more mechanical stress on the tissues of the body. Runners who have injuries usually find it easier to return to slow pace running rather than faster workouts like tempo runs or hill repeats. My general rule of thumb for running through pain is to add volume before intensity.
2. Add in walk breaks. Usually, a walk for 30 seconds each kilometre or one minute for every 10 minutes of running is a welcome break for whatever is causing the pain. This will often allow you to do more running in total by giving the tissue that is hurting a little break during the run.
3. Run more often. Take your weekly running volume and spread it over more runs. For example, if you usually run 4 times a week and do about 30km in total, change that to 6 runs a week, 5km each. This prevents the stress on the injured area from building up during the course of long workouts but allows you to retain most of the training benefits.

How do I catch up to my training plan if I have been injured?

DON’T! Trying to catch up to your training plan will force you to increase the training stress faster than was originally intended. You already showed that you weren’t able to adapt to the original training stress, so increasing the rate at which you increase that stress would be a recipe for disaster.

Rather than trying to run the same amount as prescribed in your training plan, replace some of the running workouts with cross-training workouts like biking, rowing or elliptical. You want to retain the physiological demands of the training plan but avoid the mechanical demands that would be placed on the injured area by running. You just take your running training plan for the week and do the same workouts on a bike, elliptical or rowing machine.

For example, if your training plan calls for a 40 minute run with 8 hill sprints that would last about 30 seconds each, you can recreate that workout on the bike. A 40-minute bike ride during which you whack up the resistance and go hard for 30 seconds for 8 sprints. This method allows you to continue to progress your fitness while giving the injured area a chance to recover.

Conclusion

To sum up, just running through the pain is not the answer, however, complete rest from running is also the wrong approach. If you’re having pain with running, work with an expert and use the advice in this episode to help you include running as part of your recovery strategy.

Discussed in this episode

Click to jump to that part of the video…

• 00:00:58 Is this a niggle or an injury?
• 00:02:39 Can I run through the pain?
• 00:05:45 Do I need to take a rest from running?
• 00:07:12 Will I be able to run my race?
• 00:09:28 How do I run through pain?
• 00:11:10 How do I catch up to my training plan?