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Should I run today? What’s Good Pain? What’s Bad pain?
By Dane Verwey
This is a topic that so many runners find ever so frustrating….
1) Knowing the difference between an acceptable discomfort and a bad pain.
2) Determining when it’s OK to run? When do we need to rest? Or modify training?
I love trying to keep runners running when I can, as keeping us running, keeps up our load tolerance of all our tissues, keeps us consistent, which in turn keeps us strong physically and mentally. We can continue to run through some niggles and ‘good pains’, it’s the nature of the sport: it’s repetitive and to get better you do need to stress your body. As runners if we listened to every niggle, we wouldn’t run much at all. So it’s a fine line. However, with experience we get to know how hard we can push our body. With consistency our bodies can tolerate more stress than before, as it adapts overtime.
Running changes our brain chemistry. Over time if we have done it long enough, you catch the running bug! It makes us feel good. How many of us are grumpy when we don’t run? Running releases a whole host of neurotransmitters in our brain that activate the ‘pleasure’ circuits of our brain. Running becomes a pivotal part of our happiness/self esteem/stress release. The need for this from a wholistic balance point of view often clouds our judgement. Often we keep running even if we know we are sore!!!!
However there are some pains we CAN’T or SHOULDN’T run through. These are bad pains.
So firstly, how do we determine what a good pain is and what a bad pain is? And then secondly, how do we know whether we should:
continue to run as per the training plan?
Modify training? (tinker the run- shorten it, slow it down, change the surface, change shoes, do less reps)
Choose to cross train: alter- g, swim/deep water run in the pool or jump on the bike/elliptical trainer.
or (dare I say it) have a complete Rest day or 2?
Is the pain Good or Bad?
To determine this, you need to think 3rd person about it. Put passion aside.
Good pain: my definition
-Self rated as a 1-2/10 stiffness kind of pain.
-It generally warms up, with running or throughout the day.
-The pain doesn’t last long after exercise.
-It’s not obviously swollen.
-It doesn’t make you limp.
-You hardly feel it with activities throughout the day.
-The trend is it seems to be improving.
Eg.
Muscular burn after a hill rep session
Muscle soreness after getting back to the gym again
DOMs( delayed onset muscle soreness) in calves after first spike session,
DOMs in hamstrings after first speed session for a while,
DOMs in quads after a long run with lots of technical input, or a hilly trail
Good pain should be fine with positive responses to the following battery of questions/tests:
Determine Irritability:
-You can you walk for 30 mins without pain.
-You are comfy with most daily activities.
-No pain or minimal pain with single leg stance for 10 seconds.
-No pain or minimal pain with 10 single leg squats.
-No pain or minimal pain with jogging on the spot for 1min.
-No pain or minimal pain with 10-15 jumps.
-No pain or minimal pain with 10-15 bounds.
-No pain or minimal pain with 10-15 hops or 30 seconds of hopping.
-No pain or minimal pain with a 4-5 min treadmill run tolerance test.
Bad Pain: my definition
-Stronger/sharper pain or a constant unrelenting tiring, never ceasing dull ache kind of pain.
-Generally impairs normal movement, slows you down, makes you limp.
-Pain lasts for a long time after exercise.
-Symptoms aren’t getting better with time, potentially they are getting worse.
-Pain that is present at rest, at night and can be constant.
-Treatment and pain medication are failing to alleviate symptoms.
-Any pain associated with an old injury.
-Any pain that gets worse with running.
-Often visibly swollen.
-Any pain that fits the pattern above and you suspect to be bony in origin or an early stage irritated tendon/plantarfascia or unresponsive shin pain…(get diagnosed as for these you may need to stop running for a small period to get better again).
Bad pain fails the following battery of tests:
Determine Irritability:
-You can’t walk for 30 mins without pain.
-You aren’t comfy through out the day.
-Pain with single leg stance for 10 seconds.
-Pain with 10 single leg squats.
- Pain with jogging on the spot for 1min.
-Pain with 10-15 jumps.
-Pain with 10-15 bounds.
-Strong pain with 10-15 hops or 30 seconds of hopping.
-Strong pain with a 4-5 minutes treadmill run tolerance test.
What running or training can I do?
Everyone is an individual, there is no recipe to this reasoning process.
Start by asking yourself:
What is your running goal?
Is it good pain or bad pain?
Then reason through a risk:benefit analysis.
-How soon is the race (you will be more willing to rest if it isn’t for 12 months compared to 12 days), -How invested are you (have you payed for flights and accommodation in an overseas marathon)? -How prepared are you (if you are the fittest you have ever been resting is hard); is the bulk of the training done? -Will you still be able to run to a level you will be happy with? -What will be the risk/consequence of running or taking some time off?
-Will the injury get considerably worse by running or racing on it?
-How much fitness will you lose if you cross train or rest? -Are you tapering off your training at this point, anyway? -Will you be able to maintain your fitness with cross training? -If it is ‘good pain’ irritability is generally low, so depending on the urgency of your running goal (you do a risk:benefit analysis) you may continue full training or modify training ever so slightly.
What running can you do?
Lets see what you can manage and tolerate by performing a small run tolerance test. Continue to run and see monitor your response during, after and next day? If the pain is still a 1-2/10 the morning after, this running load forms the basis of your return to run program.
Eg. Chronic Achilles tendon pain- gets stirred up and sore for 3 days straight with hill reps and short, fast, uptempo speed work around the track. However, copes well with long slow runs at the moment and 20 minute tempos or fartlek sessions. This runner gets ‘bad pain’ with hill repetitions and speed work at the moment but ‘good pain’ with long easy runs and 20 minute tempo sessions. So we now know how to structure her training for the next three weeks.
We would then re assess where she is at after this point to see if the tendon has strengthened or adapted any further. Maybe she will tolerate some 400m reps with a slower runner now?
While I’m here, when progressing a runner back from injury/pain, it’s important to do it as gradually as you can and change just one variable at a time. I often ensure the duration/time on the feet runs are up to an appropriate level before I add intensity, change terrain, footwear, hills etc…
-If it is ‘bad pain’ irritability is generally high, and flares are probable with a poor program, so you will need to change your running schedule (you will need to add a combination of the following; some-rest, cross training, or some modified/reduced running training) -Cross training that doesn’t cause pain is acceptable however don’t suddenly do 5hrs as this will use valuable energy that normally goes into recovery. -With cross training you want it to replicate the demands of the sport and be specific to the runner’s goal. -After several days of easing the training load, icing, potentially trialling over the counter oral anti-inflams, irritability should be re-assessed.
If there is still little to no improvement in pain and you are unsure what to do? I’d recommend getting a diagnosis and plan from a ‘running physio’.
Here we would do a risk : reward analysis pending on the pathology, the runners injury history, the urgency of the runners running goal, the treatment and amount of offloading needed, the training you can do, the risks involved.
Bad pain that likely needs some kind of time off running to get better includes reactive ‘Acute Angry’ cases of:
-shin spints -plantarfasciosis -tendinopathy
Where the pain is strong and just not going away, you will likely need a small period of no running to settle them down.
If the pain is just a 1-2/10 in these above tissues, then I’d classify this as good pain. You may modify training (deload) to allow the tissue to regenerate. However, I’d keep running on a deloaded running program, while performing appropriate rehabilitation exercises and progressing gradually with signs that the tissue is handling increasing loads. With time the tissue will strengthen and adapt and cope;
High risk stress fractures:
-Navicular -Neck of Femur -Anterior cortex of tibia
-Stress fractures are very easy to miss, so can be slow to get diagnosed.
-Not always sharp pain, sometimes dull- symptoms can vary enormously.
-Often gradual onset, occasionally spontaneous.
-Often runners still have full joint movement/good strength.
-There is always a loading history.
-High risk group- females with low BMI.
-There is pain with impact and weigthbearing.
-Bony focal tenderness.
-Bone stress injury pain gets worse with running, whereas soft tissue injuries warm up with running.
-They often have ‘constant’ low level pain.
-Often night pain.
-Often evidence of swelling.
-If what initially is thought to be soft tissue isn’t responding think bone.
Because of the risk of non-union and extended time off from running if you have a stress fracture (often 8-10 weeks, non weight bearing) you need to be aware of these warning signs or “red flags” that can indicate bone stress issues, and see a health professional.
Anyway, I want everyone to keep this information I have created for future reference, perhaps stash it away in your running diary, so you have it for future reference.
I hope this clears the waters a little when attempting to work out the seriousness of your pain and whether or not you should run through it?
Dane Verwey
SSPC Physiotherapist