Injuries and Running: When to Push Through and When to Stop

As a runner you have likely experienced that point in the run where things get a little, well, uncomfortable. Your breathing becomes more labored, your steps seem heavier, your muscles seem exhausted and your joints get stiff. For some, this can happen within the first mile of a run and for others this may not happen for twenty miles plus! The hard part for all athletes is learning to recognize when what we are feeling is the discomfort that comes from rigorous exercise and when it is actual pain that needs to be addressed. If you have ever thought to yourself something similar to the statements below then you know what I am talking about:

“My knee is kind of aching today, I’ll just keep going and it will loosen up.”

“Wow, my hamstring really hurts, oh well only two miles left”

“My legs feel like lead, I really need to start stretching more”

“My shins are killing me, I better ice them after this run”

I would wager to say that most runners have had thoughts along those lines at one point or another. The question is how do we know when to stop and when to push through? Healthy and injured are not necessarily black and white categories, there is a large gray spectrum that runs between the two. Exercise by nature will cause fatigue, it will cause soreness and it will take a toll on your body.   The important thing is to recognize when exercise is doing more harm than good, when you should push through and when you need to rest. According to Kristina Carter, PT, DPT, CMTPT, Program Director and Senior Physical Therapist at Tidewater Physical Therapy’s Williamsburg location even minor “discomfort” can turn into a major injury if not caught in time.

Here are some general guidelines to help clarify what is normal and what needs to be addressed:

  1. Fatigue and Soreness – Fatigue and soreness are natural responses to any exercise program that places a strain on your body. Soreness will usually appear 24-48 hours after an exercise bout and should not last for more that 24-48 hours. Pain that is prolonged, extreme, or isolated to one specific muscle or joint should be examined by a physical therapist or physician. Fatigue is also a common result of training. Be sure to schedule one rest day per week and re-examine your exercise regimen if you find that you are becoming excessively fatigued and unable to participate in your daily activities. Example: Long run on Friday, sore calves and thighs on Sunday. Recommendation: You can push through soreness or fatigue as long as you give yourself plenty of recovery time later.
  2. Mild Pain During or After Activity: Aches or pains that are mild in nature, and dissipate as the workout goes on are something to be aware of but not always a warning sign of an injury to come. Pay close attention to these minor pains and implement additional warm-up or stretching activities to help lessen their recurrence. If the pain persists or gets worse, it is time to have the injured area examined. Example: Aching in a joint that goes away as the workout goes on and doesn’t recur again after the workout. Recommendation: You can push through the initial pain as long as it progressively gets better.
  3. Pain That Starts Out Mild Yet Increases With Activity:   If your pain continues to get worse the more activity you do, then you definitely need to avoid that activity until you can do it pain free. Many times a physical therapist can help evaluate where the pain is coming from and help you alleviate it before it gets worse. They can tell you which activities to avoid and how to care for the injury to speed up recovery time. Example: Shin splints. Recommendation: Reduce high impact activities such as running. See a physical therapist for treatment and an exercise program to reduce the likelihood of recurrence.
  4. Pain That is Extreme or Persists Outside of Activity If you have severe, acute, persistent pain in a muscle or joint that is not alleviated with rest then you are suffering from an injury to that area of your body. This pain can happen instantly (like in the case of a hamstring pull) or, it can happen over time due when pain is ignored and becomes worse (like in the case of a stress fracture) Example: Severe pain in your left hamstring that does not allow you to continue activity; pain persists even when at rest. Recommendation: See a medical professional immediately.

Minor discomfort or exercise fatigue is easy to recognize, severe injuries are also not hard to identify. The gray area in between is where many runners get into trouble. What begins as mild can become major if you do not take the steps to avoid it. Remember the points listed above when evaluating your own condition, and when in doubt, see a physical therapist or doctor to have your pain evaluated and to get on an program to help return you to normal activity.