YOU CAN MANAGE !
Sometimes it’s okay to run with pain.
We’ll tell you when Dick Vile, 58, a software
developer from Dexter, Mich., has felt pain in his right knee for more than a
year. But he’s kept on running- with his doctor’s blessing.
An MRI of Vile’s knee showed
nothing obvious and his doctor thinks that whatever is causing the pain (it
might be a tiny tear in the connective tissue of a tendon) won’t get worse if
Vile continues to run. “My doctor told me to ice it like crazy, but keep
running as I have been,” Vile says.
This is the kind of advice most
of us would love to hear when we’re hurting. But doctors usually choose to err
on the side of caution. “It goes against traditional to tell patients they can
run through pain,” says Cherise Dyal, M.D., an orthopedic surgeon in Wayne,
N.J. “Pain is a signal that should not be ignored and runners should seek
medical attention for any persistent pain.”
That said, there are some-emphasis
on the word some conditions that are okay to run through. In these
instances, running may not be comfortable, but it probably won’t make things
worse either. “As long as running doesn’t increase the pain, then it’s
usually okay to continue,” says Carol Frey, M.D., assistant professor of
orthopedic surgery at UCLA.
Rules to Run By
When you have pain, ask yourself
these three questions before you try to run through it:
- Do you see anything abnormal at the site of the
pain? There should be no obvious lumps or bumps in the painful region,
says Robert Anderson, M.D., an orthopedic surgeon with the Miller Orthopedic
Clinic in Charlotte, N.C. And after a run, there should be no visible
swelling, redness or warmth in the area. If you see any of these
abnormalities, do not run.
- Does the pain disappear once you warm up? As a
general rule, if you can warm up the sore or painful area, such as a muscle
or tendon, it’s probably okay to proceed,” says Richard T. Braver, D.P.M.,
who runs a sports podiatry practice in Englewood, N.J. Try warming up the
area with a slow jog, heating pad, massage or flexibility exercises specific
to the painful spot.
- Is the pain relatively minor? To help you
answer this question, try to rate your pain on a 1-to-10 scale, with 1 to 4
being mild pain. You’ll feel this kind of pain when you are warming up,
but it goes away after you start running. It’s usually fine to run through
this level of pain. Moderate pain-5 to 7 on the scale, continues as you run,
but isn’t debilitating and doesn’t cause you to change your running
form. Moderate pain also disappears after you run. “You can keep running
with moderate pain, but it needs medical attention because it will not get
better by itself,” says Janet Sobel, a physical therapist in Chevy Chase,
Md. With moderate pain, you need to be certain that it is not causing you to
change your running form or you may risk injury elsewhere. This is because
the body is a “linkage” system and if one part hurts or isn’t working
correctly, the body may avoid putting pressure on the painful area by
transferring weight to another area, which can aggravate this new spot. Pain
in the 8 to 10 range is often present at rest, usually gets worse as you
run, and does not go away after you stop. This kind of pain is serious, so
don’t run. You need medical attention.
Guide to Pain
Here are several typical running
ailments, with advice on running through them (or not)
- Achilles tendonitis:
If the tendon is swollen
you shouldn’t run on it. You risk doing more damage or even rupturing the
tendon. But if the pain is mild and you can warm up the area so that the
pain goes away after 5 minutes of running it’s unlikely you’ll do
- Ankle sprains: This is a tough one. During
those first few days after the sprain, if your ankle is painfully swollen to
the point where you can’t easily bear weight or walk on it comfortably,
then don’t run. Instead, ice and elevate it. The trick is knowing when you
can resume running. Dr. Braver suggests no running until you can balance on
your injured foot for 30 seconds with your eyes closed. “Also, you must be
able to do a toe rise with the injured foot without pain,” he adds.
- Black toenails: No problem running with these,
but cut your nails short, grease up the toes with skin lube or petroleum
jelly and buy running shoes that are a half-size bigger. Watch out for
painful blisters under the nails and have them drained by a doctor if
- Heel spurs: It’s fine to run with a heel spur
as long as the pain is tolerable and the area is properly protected with a
heel cup or cushion. “I am
often asked about running with heel pain,” says Dr. Dyal. Heel pain is
usually an overuse phenomenon. “Patients will probably not feel better if
they continue to run, but they can do so if they’re willing to run with
band syndrome: If you can warm up the area to the point where there is
no pain along your outer thigh, then it’s fine to run. It’s important to
keep your mileage down though.
pain: This is usually a sign that the back of the kneecap is rubbing on
the femur or thighbone. It’s okay to run if there’s no swelling and the
pain disappears after 5 minutes of exercise. But don’t run if the pain
sticks around and causes you to hobble all day.
A neuroma is caused by pinching or irritation of one or more nerves in your
forefoot. The pain is usually between your third and fourth toes with
numbness or tingling extending through those toes. As for running with a
neuroma, let pain be your guide. If the pain is not forcing you to change
your gait, then running on a neuroma probably won’t make it worse. Wider
shoes will often help.
fascitis: As long as there is no acute swelling or intense pain in the
bottom of the foot, it’s probably okay to run a little, says Sheldon Laps,
D.P.M., a Washington, DC., sports podiatrist. “ However, don’t run on
consecutive days, instead, cross-train on alternate days.” Dr. Braver also
suggests wearing a good arch support or orthotic. You can also tape your
foot for more support.
pain: The general rule is no running for 3 or 4 weeks after soft-tissue
procedures, such as surgery on neuromas and tendons and no running for 6
weeks to 3 months for bone procedures, such as on hammertoes or bunions,
says John Pagliano, D.P.M., a sports medicine podiatrist who practices in
Long Beach, Calif.
Dr. Braver recommends a
longer layoff after soft-tissue surgery-sometimes as long as 3 months. “The
majority of patients have little discomfort walking 3 weeks after surgery, but I
like to see good muscle strenghth and function before they return to running,”
he says. After that, running is probably beneficial. It takes about a year for
scar tissue to “remodel” and the excessive motions of running (compared with
walking) may help to break up scar tissue and get the new, soft tissues to
splints: “It’s fine to run with shin pain if it’s just
uncomfortable, but not if it’s painful,” Dr. Braver says. One key test:
if you feel shin pain just walking around, don’t run. See a medical
professional. You need to checked for a possible stress fracture.
ailments: It’s usually fine to run through the discomfort caused by
corns, calluses and blisters. The same goes for bunions and hammertoes since
the pain is usually caused by the shoe simply rubbing against the deformity.
fractures: Everyone agrees on this one. Do not-repeat, do not-run if you
have any kind of fracture. Running on a stress fracture can lead to
fracturing the bone all the way through. Then you’ll be faced with a much
longer recovery period and several months off from running. A bad fracture
can also lead to other complications that may require surgery. It’s just
not worth the risk. See a doctor instead.