Running Pains: An ounce of prevention is worth a pound of cure close to race day.


Ask enough runners about their goals while training for a race, and you’ll likely hear a common theme: “Stay healthy.” From mild shin splints to chronic plantar fasciitis to debilitating stress fractures, injuries can do everything from temporarily cramping your running style to knocking you out of the game for months. While injuries are never convenient, they can really be a pain when they happen weeks out from that major race we’ve had on the calendar for so long.


“Runners—myself included—tend to be very stubborn and not want to stop running when injured,” Meg Sullivan, the Chicago Area Running Association’s director of training, says. “Sometimes, all they need is two to three days of no running to prevent losing two to three months, and it’s only after learning that the hard way that I fully understand that.”


How we deal with those injuries is almost like a tale out of a Choose Your Own Adventure book. Take path A—ignore it—and you risk doing more harm than good.


“If [runners] have an injury or they’re dealing with some pain, they don’t want to see a doctor or a physical therapist because they’re afraid they’re going to be told they can’t run,” Laura Gleason, a physical therapist at Athletico and co-manager of its endurance program says.


Take path B—address it—and you may save yourself the disappointment of pulling out of your goal race.


“There are some injuries that can be rehabilitated in a short amount of time so that even if the runner develops an injury towards the end of the training, they can still participate in the event,” Dr. Sara Brown, a board-certified family and sports medicine physician with Chicago Primary Care Sports Medicine, says.


Granted, recovery time does depend on the injury. “If they have suffered from a stress fracture or a torn muscle or tendon a month or two before the race, then they will likely not be able to participate in the event,” Brown says.


Recognize there’s a problem.

You want to catch the injury before it reaches that point where you’re looking at weeks in a boot or surgery. Tightness and pain can both indicate a developing problem.


“If pain persists after running, I recommend seeking medical advice,” Brown says.


If you’re running with CARA, you have access to a hotline fielded by Novacare’s staff members where you can have your injury-related questions answered. Alternatively, you can visit a physical therapy office for a free injury screening.


“If you feel pain somewhere, you obviously want to get it checked out, consult your physician,” David Reavy, a physical therapist who founded React Physical Therapy, says. “You can always go to a physical therapist for free screenings as well so they can help point you in the right direction.”


Your best bet? “A sports medicine physician is the most appropriate choice for a running injury,” Brown says. “They would be able to treat the whole body, so it does not matter where the injury is located.” A physician can order the tests necessary to rule out a stress fracture, refer you to a sub-specialist, or prescribe anti-inflammatories or physical therapy.


Get treated sooner, not later.

With everything on your already-full plate, scheduling a doctor’s visit to investigate a pinch or some tightness may not happen until you’re struggling to walk. But the “if it ain’t broke, don’t fix it” mentality doesn’t exactly work with running, especially if you wait to seek some relief from your ailments a week before your event.


“Unfortunately there’s just not as much that we can do right before the race,” Gleason says.


From the physical therapist’s perspective, you don’t want to reach the point where you can’t run anymore.


“Get potential injuries checked out early,” Gleason says. “One of the most common mistakes I see with runners training for a big race is they ignore those nagging aches and pains and then it can turn into a more serious injury. If a runner has pain two or three months out from a race, it’s much easier to treat.”


Running’s not over, it’s different.

An injury treatment plan depends on the type of injury you have and its severity. But even at their worst, injuries don’t necessarily mean hanging up your running shoes and kissing your marathon dreams goodbye.


“Our absolute last resort is to shut a runner down,” Gleason says. “Our goal is to keep them running and enable them to achieve whatever goal they’re looking to reach.”


You may spend some time on the Alter-G or the Sproing, alternatives to regular treadmills that lessen the impact underfoot and can help reinforce good running positioning.


“While you’re rehabbing you want to keep you want to keep your endurance up,” Denise Smith, a physical therapist at Accelerated Rehabilitation Centers who heads up its Love to Run program, says. “You don’t want to lose what you had.”


You may also change your running technique, which may have caused you to overuse some muscles and misuse others.


“As physical therapists, we’re movement specialists, so why shouldn’t we be the ones teaching someone how to move the right way?” Smith asks.


Sure, your running routine might take a bit of a hit as you re-train your muscles, but doing so can allow you to continue running and keep up your fitness levels.


“A lot of our patients continue to run when they’re in therapy because what we do is treat the cause as well as the symptoms,” Reavy explains. “When you’re treating the cause, you’re taking the force off the injured area allowing it to heal.”



Sidebar: How much does it hurt?

You don’t want to stop running, but sometimes your pain is signaling you have to. Dr. Sara Brown offers three guidelines to keep in mind with regards to pain while running:

  1. Pain that causes you to limp or change your gait.
  2. Pain that gets progressively worse
  3. Pain worse than a 3 out of 10 (or 5 out of 10 for race day) on the pain scale.


If your pain fits one of the three categories, seek medical advice.


Sidebar: Back on the road

You’ve had a clear MRI, you’ve graduated from physical therapy and you’ve gotten your doctor’s permission to resume your regular training. You’re ready to run, but you don’t want to find yourself on the sidelines once again.


“One of the biggest fellowship factors for injury is previous injury,” Gleason says. “Once you have had an injury, you may be susceptible to having it again. The reason for that is primarily that people don’t rehab 100 percent.”


How does this happen? Once you feel better, you may give up on the exercises you learned at physical therapy, quit warming up before your run to muscles to prepare for activity or let your running technique regress to its former problems.


Sticking with what you learned during rehab—and not overdoing the running. As Sullivan says, “I think the key to staying healthy is finding the balance that works for you.”