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Yes it hurts but can I still run?

If you are a serious runner then 2 things are certain.

  • At some point you have experienced pain associated with running
  • Nothing is more painful then being told you aren’t allowed to run

As someone who treats a lot of runners I know, it hurts. Not just the injury, but the thought of having to stop running can have even the strongest runner in tears.

Now here is the good news: Having pain or even being injured does not necessary mean one has to stop running. There are in fact many disadvantages to a complete rest from running. Training adaptations are easily reversible and rest can induce a partial or complete reversal of training adaptations that may have taken weeks to develop. From a cardiovascular point of view,  VO2 max, blood volume and stroke volume are a few of the variables that have been shown to decline with less than 4 weeks of rest . Research also shows that the fitter you are the bigger the declines.

Unfortunately, there is very little research into what happens to runners from a musculoskeletal standpoint during periods of rest. I can tell you from a clinical perspective I see a lot of runners who have taken breaks for a period as short as 3 weeks (due to injury, holiday, lack of time), tried to resume running to their previous levels, and sustained injuries.

Cross training you say? Well yes if one must, but exercise is extremely sports specific. This means that when the body is placed under a specific form of stress, it starts to make adaptations that will allow the body to improve at withstanding that specific form of stress in the future. When you train for a specific sport, neurons responsible for those specific movements will develop better and faster lines of communication-improving co-ordination and efficiency during those specific movements. In short swimming is not going to help you improve your running. Of course its better than nothing.  However, the best way to develop sports specific physical fitness is to train the energy systems and muscles as closely as possible to the way they are used in your sport.

In addition, some amount of stress is actually important for tissue healing. This amount of stress is often termed optimal loading. Optimal Loading means placing the best possible amount of force through the injured area in order to stimulate and improve tissue healing, promoting early recovery.

Now don’t get me wrong. Sometimes a complete break from running is the only thing that can aid recovery. Too much force or aggressive exercise can of course worsen an injury . In addition there are certain conditions when continuing to exercise MUST be avoided and can result in long term damage (Stress fractures as one example)

So when experiencing pain, how does one know whether they can run or not?

The guidelines set in the article are by no way an exact science because as far as im aware there is no specific research done on this particular topic. What is written below is based purely on my clinical experience after trial and error on 100’s of patients. In addition this article is not intended to replace good solid medical assessment (and treatment). Every patient is different and there may be some muscle weakness/flexibility/imbalance issues that need to be addressed. If in doubt make sure you see a good physio or orthopaed.

I have found that the most important indicator of whether you have to stop running or not is pain levels. Pain is a complicated concept and its detailed discussion here is beyond the scope of the article. However, below are 10 points which may help you decide whether to continue running

 

  • Severe pain, swelling and bony tenderness are usually signs of more serious injury and should be looked at by a professional before you run again
  • Some amount of pain is acceptable when running. This is obviously very subjective. If your pain levels are on or below a 3/10 (on a 10 point scale) then you can try to run
  • If you are already experiencing more that this level during your day by just walking sitting or standing, then running will aggravate your symptoms and is not advised
  • When running with pain, try and run a short amount of time (a few kilometers) and see how your body reacts. You may feel great when running, but a few hours later pain levels can increase
  • Try and change your running style and see if it helps- try shorter strides, increase your cadence, try and land “softer” on your feet
  • Wait at least 24hours (some say 48hours) to see your bodies reaction to the pain. If your pain levels have not worsened either during the run or after 48hours you can continue to run keeping your runs short
  • If pain levels decrease- slowly increase your distance by 10% per week. If you experience more than a 3/10 go back to the previous level of running where your pain was less.
  • Don’t run every day if in pain. Have a day on day off
  • If pain worsens even after a short run- you need to take off a few days and rest. If pain does not improve- go see your physio
  • Lastly if you are continuing to run and things aren’t getting worse, but also aren’t improving- seek help

For additional information please visit us at www.physiotelaviv.com

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