By Ian Nurse, DC

Over the past few months, I’ve had the pleasure of highlighting some of the most prominent running related injuries including IT band syndrome, Achilles tendonitis, Runner’s knee, and piriformis syndrome. We have also explored different treatment options such as Active Release Technique (ART) and Graston to help you get through any injury and put you back on the road. This month, I want to take a preventative step and discuss the red flags of injury. As runners, we are constantly dealing with aches and pains. In fact, I can’t remember the last time I had a run that didn’t involve some little annoying ache that made my mind wonder, “Is this something that is going to hurt during my next race?”

Hopefully, this article will provide some guidelines to help you answer that question. As an ART/Graston provider, treating running injuries everyday, I’ve seen first hand how important it is for runners to know these red flags so that they can curtail the injury process into an easy fix as opposed to a chronic problem.

As mentioned earlier, all runners must become accustomed to having aches and pains while running. Running isn’t easy! With each foot strike, a single leg is forced to absorb five times one’s body weight. Aches and pains are a normal response from our body as it learns to adapt to that burden. As one’s muscles grow stronger, many of these little annoyances will disappear. However, some will not and we must also listen to our body and recognize when we are asking too much of it.

Here are a few guidelines that usually indicate normal aches and pains (and should allow you to keep running:

Mild pain while running; however, it doesn’t change your gait. In other words, it’s not making you limp or even shorten your stride to make you experience less pain. A good example of this type of pain would be those first few minutes of a run where you are stiff and probably a little sore but after getting warmed up, you are good to go.

You have some pain while running but as soon as you stop you don’t feel the pain again. Muscles, tendons, and ligaments can get overworked while running and start asking for some rest. If the pain you have goes away immediately when you stop running and doesn’t come back, you should be in the clear. Though, it’s always good to monitor these types of pain and keep tabs on when and how long you felt them.

In light of the previous guideline, the duration of a certain pain can be an indicator of its seriousness: discomfort that only lasts 2-3 days is usually a characteristic of normal aches and pains. If it lasts more than 3 days, training may be altered and preventative measures might be necessary.

The below guidelines, on the other hand, are more indicative of a true injury that may need both rest and medical advice:

Feeling pain in the same location for several runs in a row. You felt a little twinge a few days ago in your calf that you didn’t think much of at the time but now a week has past and it’s still there.

Pain that worsens as the run continues. As mentioned earlier, it’s normal to be a little sore at the beginning of your runs. However, if the pain increases the farther you run, something is definitely in need of attention.

The pain is starting to change your gait. This is a big red flag in my book. Not only are you probably aggravating the current injury but you are most likely injuring something else (usually the opposite calf or glute) by altering your stride to compensate.

The quality of the pain can also act as a red flag. Stabbing, knife-like pain (as felt when one pulls a muscle or with IT band syndrome) is not a normal ache and pain.

Pain that consistently interrupts sleep also indicates a more serious injury process. Our bodies heal themselves while we sleep (yup, you can use that as an excuse for a 2 hour nap on a Sunday afternoon). If you wake up due to pain, your body is doing some serious healing (usually something bone related like a fracture) and you should seek medical advice.

Sometimes the body not only speaks to us but also shows us there is some sort of injury process happening. Swelling and discoloration are two additional red flags that will also help your health care provider determine the gravity of your injury.

While there may seem to be several guidelines to remember, the most important one is to be mindful of your body, to listen to it, and to respect its limitations. As runners, we love the idea of “No pain, No gain.” Unfortunately, that can’t always be our mantra. Understanding this will keep injuries at bay and allow for more consistent and effective training.

Ian Nurse is a chiropractor and 2:25 marathoner. Oh yeah, he’s recently engaged too. Congrats Ian and Amanda! This article originally appeared in the Nov/Dec 2013 issue of Level Renner. Get your free subscription today (box in upper right portion of screen).