When Pain is an Injury - Snap, Crackle, Ouch!

Occasional aches and pains are part and parcel of marathon training, but when is the pain symptomatic of injury?

The fact that I'm a chiropractor doesn't exempt me from the consequences of over-exuberant training. In fact, one could argue that my running foibles inspired me to become what I am today.

I remember my first twenty-mile training run, back in my days as a student at the University of Montana. I was training for the Governor's Cup: an annual marathon in Helena.

The training run itself went fine. But when I lay down on the couch afterwards to rest, I discovered I couldn't get up. That day I learned the difference between the joy of accomplishment and the pain of stupidity.

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Balancing work and rest

Training is a balance of challenging the muscles to new limits, and giving them time to rest. It's a give and take affair: overstress the muscles to make them stronger, and then give the microscopic damage that occurs within the muscle fibers a chance to repair.

Not giving the muscles enough time to recover leads to burnout and increases the risk for overuse injuries. These injuries range from simple muscle strains that heal with rest, to meniscus tears and stress fractures that can require surgical treatment.

Unlike other sports, running involves a lot of repetitive movement. The feet and legs go through the same basic motion through hundreds of foot-falls. Compounding this problem is the fact that running is a high-impact activity, which many of us do on relatively hard surfaces.

Reading the Symptoms

The people at greatest risk for injury are first time marathoners, partly because their bodies aren't use to the mileage, and also because they are less able to distinguish between a normal ache or pain and the beginning of a serious injury.

Here's a few basic guidelines:

Learn the difference between mild, moderate and severe pain. The severity of pain isn't strictly a factor of how much it hurts, although that's certainly part of the equation. It also has to do with when the pain comes on, how long it lasts, and whether it continues after the athlete stops running.

An injury may start as an ache during a run, or as prolonged muscle soreness afterwards. The difference between this and normal delayed onset muscle soreness is that injury soreness is confined to a specific area, such as the ankle, foot or knee.

A mild injury is one which the runner may feel during warm-up and several hours after the run is over. The best treatment is ice and in some cases, light stretching. Cutting back slightly on mileage, and especially hard work-outs or long runs until the pain subsides will prevent the mild injury from progressing to the next level.

A moderate injury causes pain during warm-up and later in the run as well. The runner will also feel localized pain several hours after the workout: that muscle soreness can last up to forty eight hours after the run. At this point, it's important to cut back on training significantly.

Cutting weekly mileage in half may be a hard pill to swallow, but it's better than having to miss the race due to a serious injury that takes weeks, or months to heal.

When pain continues throughout the run, and in some cases forces the runner to modify his form, it has progressed to a serious injury. At this point, it's important to stop running and seek professional help. The painful area is often tender to the touch.

The road back

Most runners would rather chew glass than take time off. The body gets used to running, and doesn't want lose the feeling of well-being that comes from it. High-mileage runners worry about weight gain during breaks from running, and runners training for marathons worry even more about loss of fitness.

The unfortunate fact is that no cross-training activity completely replicates running, although deep water running comes close. But the longer the runner tries to train through a serious injury, the worse that injury will become.

The best course of action is to see a specialist who is familiar with running injuries. This may be a physician, physical therapist, or specialized chiropractor like myself. Find out as much as possible about the injury: the best ways to promote healing, and what cross training activities will maintain some aerobic fitness without making the injury worse.

I like to think that all runners are closet couch potatoes: we run hard in the morning so we can lie on the couch and watch football in the afternoon. But nobody wants to be sidelined on a permanent basis. For more information on diagnosing and treating running injuries, log onto

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