Ouch! – Should I keep running?

We’ve all been there…..something just doesn’t feel right on your run. Maybe it’s a twinge of the hamstring, an ache in the knee, or a dull pain in your shin. Do you keep running? Should you walk? When will you be able to run again? Should you use ice after your run? What about a hot pack? Maybe both? These are some common questions that I hear when someone is seeking advice about a running injury.

When someone tells me they felt pain on their run, my question back to them is often, “did you finish your run?” Their answer is almost always, “well….yes.” I chuckle to myself sometimes because of the mentality that runners have. You are already a couple of miles from your house, you might as well finish the run then deal with whatever injury you have later. There is a fine line between pushing too far through aches and pains and not pushing hard enough. If we stopped running whenever we felt a little something, the truth is, most of wouldn’t be doing much running at all! On the other hand, pushing through some injuries can have detrimental outcomes and turn those running shoes into cross training shoes pretty quickly!

There are many different injuries that range from mild to severe and within those injuries, there are even different phases (acute, sub-acute, and chronic).  Each injury is treated a little differently and each phase of healing requires different types of treatments. While it is impossible to give specific instructions without knowing the diagnosis of the injury, I am going to provide you with some general guidelines on what to do when you feel something that’s not right on a run.

Was there a specific mechanism of injury? Did you step the wrong way off a curb and roll your ankle? Did you push the pace and feel your hamstring pop? Typically, if there is a sudden, specific event that occurred to cause your pain, that’s not good and you should stop running.

 Immediately after an injury occurs, it is in what is called the acute phase of injury. During this time, there are signs of inflammation that will be present including redness, swelling, pain, heat, and loss of function. Applying ice to the injured area is a good thing to do during the acute phase. Generally, 20 minutes of ice on followed by 1 hour off is a good rule of thumb to allow sufficient cooling of the injured tissue followed by return to normal temperature.  There is a common misconception that it is only necessary to apply ice in the 48 hours after an injury occurs. That is not necessarily true. Ice can and should be used whenever there are signs of inflammation present. So if you have some redness, swelling and pain present for greater than 48 hours after the onset of injury, go ahead and ice it! Switching to a hot pack too soon can cause ill effects, while sticking with ice is usually a safe bet.

It’s fairly easy to tell when an injury occurs if there a specific mechanism, but how about those aches and pains that kind of sneak up on you? These are the most common that I see in the adult running population. In the middle of a seemingly good run, you start to notice a pain. You can keep running, even at a pretty decent pace. Maybe you even finish your long 20 mile training run, but there’s still that nagging pain. Sometimes it hurts after your run, sometimes it doesn’t. Should you keep running?

Here’s where it gets tricky. Remember, these are general guidelines to follow. Injuries that don’t get better after some activity modification and at home remedies need to be checked out by a medical professional. I like to use a self-report pain scale to help people judge what they can and can’t push through. On a scale of 1 – 10 (10 being the most pain), I advise that the pain level stay at a 4 or lower.

Often, runners will experience pain or tightness when they first start a run, but once they run for a little while, they actually feel better. That’s a good thing and it’s ok to keep running.  If there is a low level of pain at the beginning and it remains the same throughout the run and even after the run; I usually say, if you must run, then go ahead and continue. Pain levels that increase to over a level 4 throughout the run are not good and running should be stopped.

In the case of any injury, whether you are running through it or not, there are things that you can be doing to help yourself heal. A few key areas to consider when dealing with injury are ice/heat, tissue flexibility, tissue extensibility, support, and strength.

Ice / Heat – Depending on your current level of pain and inflammation, application of ice or heat to the injured area can be beneficial. If there is swelling, redness, heat and pain present, applying a cold pack can help to reduce the inflammation. In a chronic state of injury, where there is a decreased blood flow to the injured area, using a hot pack will help to increase blood flow, bringing helpful nutrients to the area and making the damaged tissue more receptive to stretching.

Tissue Flexibility – Tissue flexibility refers to the ability of a muscle or tendon to lengthen to allow normal motion of a joint. Stretching the affected body part, as well as surrounding muscles can help to restore normal tissue length as well as joint range of motion. Self-stretching, as well as devices such as the Strassburg Sock, ProStretch, or stretch out strap can be used to increase tissue flexibility.

Tissue Extensibility - Tissue extensibility is different than tissue flexibility, as it refers to the ability of individual muscle and collagen fibers to glide more efficiently over one another. Increasing tissue extensibility can allow for greater tissue flexibility. Keeping the muscles and surrounding fascia will increase the health and function of the tissue; allowing it to be stronger and more flexible. Self-massage tools such as a foam roller, Stick, Foot Rubz, or Trigger Point ball can be beneficial in increasing tissue extensibility.

Support – Providing support to an injured area through compression or strain reduction can help to keep you running while you are working to correct the underlying cause of the problem. Sometimes just a little extra support is all you need.  Products such as inserts, compression socks, or braces / straps can help to support an injured area.

Strength:  Check out the Sports Medicine Corner of our website for ideas on injury prevention exercises.

In future editions of the Sports Medicine Corner, I will be elaborating on the different phases of injury (sub-acute and chronic) and different products that you can use to help yourself during each phase. In the meantime, check out our Injury Tool Chart or ask a Fleet Feet staffer to explain it to you the next time you are in the store.

Remember, when in doubt, ice. If running makes the pain get better or remain the same (up to a level 4), proceed with caution. Increases in pain with running to greater than a level 4, stop and seek medical care.