By Luther Chiew (Physiotherapist)
Premier Sports Medicine
This article provides general information and does not replace an
individual assessment or medical advice.
Need help with recurring running pain? See our Running Injury Clinic assessment and treatment.
Running with pain can sometimes be managed by changing your training,
but pain alone cannot tell you if it is safe to continue. The answer
depends on where the pain is, how it started, how it changes during the
run, how you move and how you feel later that day and the next morning.
Sudden, worsening or very localised pain, limping, swelling or loss of
function are reasons to stop and seek an assessment.
The short answer: Mild, stable symptoms may sometimes be monitored while
you reduce the load. Stop if the pain is sharp or worsening, changes
your stride, follows a sudden injury, or is paired with swelling,
weakness, numbness or trouble bearing weight.
What should you check before your next run?
Ask these five questions before deciding to run again:
-
How did it start? Pain after a jump in training is different from
pain after a fall, twist, pop or collision. -
Where is it? A broad muscular ache behaves differently from one
small, sharply tender point over a bone or joint. -
What happens as you run? Note if the symptom settles, stays stable
or builds with every kilometre. -
Does it change how you move? Limping, guarding or shortening one
side’s stride means the run is no longer normal for you. -
What happens later? Record the response after the run and the next
morning, including pain, stiffness, swelling and normal daily
function.
Does pain always mean tissue damage?
No. Pain is a protective experience influenced by tissue sensitivity,
recent load, sleep, stress, previous injury and the situation around
you. It does not provide a direct damage reading. At the same time, pain
is useful information and should not be ignored.
This is why two runners with the same pain score may need different
plans. One might have delayed muscle soreness after a new strength
session. Another might have an early bone stress injury. A score by
itself cannot separate those situations.
When might modified running be reasonable?
A short, easier run may be reasonable when all of the following apply:
-
The symptom is mild and familiar rather than sudden or sharp.
-
It stays stable or settles as you run.
-
Your stride and normal function do not change.
-
There is no notable swelling, instability, numbness or weakness.
-
The symptom returns to its usual level within a monitoring period
agreed with your practitioner.
For some tendon problems, a physiotherapist may use the response during
exercise and the following morning to guide load. That approach should
not be copied across every type of running pain.
How can you change your running load?
Change one or two variables, then watch the response. Useful options
include:
-
Reduce the distance or total running time.
-
Slow the pace and remove intervals, sprints or hard finishes.
-
Choose a flatter route and avoid hills if they provoke the symptom.
-
Use short run-walk blocks instead of continuous running.
-
Add a recovery day between runs rather than running on consecutive
days. -
Use a lower-impact activity if it is comfortable and suitable for
you.
Do not make several large changes and then guess which one helped. Keep
a simple note of distance, pace, surface, symptoms during the run and
your response the next morning.
When should you stop running and get checked?
Stop the run and arrange an assessment if:
-
The pain is sharp, rapidly worsening or follows a pop, fall, twist
or collision. -
You cannot bear weight normally, your leg gives way or you are
limping. -
There is significant swelling, bruising, joint locking or loss of
movement. -
You have one very tender point over a bone, pain at rest or night
pain that is increasing. -
You have numbness, tingling, new weakness or a loss of normal
control. -
The area is hot and red, or you also feel feverish or unwell.
Call 000 for chest pain, severe breathing difficulty, collapse or
another medical emergency.
What about soreness after a new session?
Delayed-onset muscle soreness often begins several hours after
unfamiliar or harder exercise and may peak over the next day or two. It
is often spread through the trained muscle rather than limited to one
sharply tender point, and it improves as the muscle recovers. It should
not cause major swelling, joint instability or an inability to walk
normally.
If you are unsure that it is normal post-training soreness, take the
easier option and have it assessed.
Can runners with Achilles pain keep running?
Sometimes. In one randomised trial involving people with Achilles
tendinopathy, participants continued tendon-loading sport while
following a pain-monitoring model and a rehabilitation program. The
researchers did not find worse outcomes than active rest in that
specific group.
This does not mean every person with Achilles pain should keep running.
A new rupture, severe pain, marked weakness or another diagnosis needs a
different response. The useful lesson is that complete rest is not
automatically required for every tendon problem; load can be adjusted as
part of a condition-specific plan.
What if the pain improves after warming up?
Improvement during a warm-up can occur with some tendon and joint
problems, but it is not a clearance test. Look at the full pattern: the
start of the run, the later kilometres, the hours after training and the
next morning. If the symptom keeps returning, is getting easier to
provoke or is slowly limiting your training, get it assessed.
How long should you rest from running?
There is no single rest period for all running pain. The plan depends on
the suspected problem, severity, normal daily function and your response
to loading. Some runners need a short reduction in distance or
intensity. Others need a temporary break from impact and a staged return
using walking and running intervals.
What happens in a running injury assessment?
A running assessment at Premier may include your training history,
current symptoms, previous injuries, goals, strength and movement
capacity. Treadmill video may be used when it adds useful information.
Your physiotherapist can then explain the likely problem, discuss what
you can keep doing and map out changes to running load and
rehabilitation.
The practical next step
If pain is recurring, worsening or changing how you run, bring your
recent training pattern and symptom notes to an assessment so the plan
can match your body, your running and your goals.
If running pain keeps returning or is stopping you from progressing,
book a Running Injury Assessment with Premier Sports Medicine in
Brunswick, Fitzroy North or Thornbury.
References
-
Silbernagel KG et al. Continued sports activity, using a
pain-monitoring model, during rehabilitation in patients with
Achilles tendinopathy. American Journal of Sports Medicine. 2007. -
Ardern CL et al. 2016 consensus statement on return to sport from
the First World Congress in Sports Physical Therapy, Bern. British
Journal of Sports Medicine. 2016. -
Soligard T et al. How much is too much? IOC consensus statement on
load in sport and risk of injury. British Journal of Sports
Medicine. 2016. -
Caneiro JP et al. There is more to pain than tissue damage: eight
principles to guide care of acute non-traumatic pain in sport.
British Journal of Sports Medicine. 2021.
About the author
Luther Chiew is a physiotherapist at Premier Sports Medicine with an interest in running, sports and overuse injuries. His background includes strength and conditioning, and he holds a Bachelor of Applied Science and a Master of Physiotherapy Practice from La Trobe University.
Read Luther’s practitioner profile.
Clinical content reviewed and approved by Luther Chiew, Physiotherapist.
This article provides general education. An individual assessment may lead to different advice.
