When Torsten asked me some time ago whether I would like to participate as a guest in his endurance blog podcast , I was immediately hooked. When he then told me that he would like to talk to me about the issues of injuries and pain while running , the matter was already scratched for me. After all, the topic is exactly what I deal with every day.
As a physiotherapist, I have specialized in the often complex subject of pain and injuries in athletes and I look after amateur and competitive athletes both on site in my practice in Wiesbaden and as part of my online physiotherapy .
Hope in terms of social media
At around the same time as the interview request came in, I joined the Perseverance Blog Facebook group . The idea was simply to catch a glimpse of the injuries and complaints the members have. And to experience the group live that Torsten always raves about and describes them as the best community ever. And I can understand Torsten on the last point.
Within the first few days alone, I was able to see what a nice atmosphere and what kind of strong support there is in the group. To be honest, the group has given me a little hope for social media again, as otherwise I know a lot of groups in which people tend to be below room temperature.
But that’s not what this blog post is about, it’s about pain when walking. And since questions keep coming up in the Facebook group about what you can do if you are in pain while running, I want to give you instructions on how you can help yourself and how I always go about therapy with runners.
So let’s start!
What to do if you experience pain while walking
Up to now you have been running regularly, you have gradually been able to improve yourself and cope with ever longer running distances and have found a crisis-proof hobby or perhaps even a crisis-proof passion with running and have integrated it into your everyday life as a habit. And then suddenly it happens.
You suddenly have pain while or maybe only after running. Whether in the foot, in the knee, in the hips, in the back or in another place – suddenly it hurts and you do not know what to do. Maybe only a short break is necessary, but maybe something is worse and you have to see a doctor and you won’t be able to pursue your passion for a long time.
When pain occurs, the best thing you can do is to stay calm for now. Pain keeps coming back in our lives without anything bad having happened. According to estimates (and this is also reflected in my experience as a therapist) around 80-90 percent of the pain we feel is harmless and does not pose a direct threat to us or our body. In most cases it is not sometimes you need to see a doctor and take a long break from exercising
When should you definitely see a doctor?
For me there are only 3 scenarios in which it is immediately necessary to see a doctor if you have pain while or after running.
- You have had a clearly definable accident while running that explains the pain and after which the pain occurred.
Examples of this could be that you twisted ankle, slipped or tripped and fell as a result, or any other form of severe trauma that resulted in injury.
In some cases, muscle, ligament or tendon injuries can also occur without high external forces. This type of injury is rare in runners, but of course it can be such an injury. Most of the time, however, you will feel a “click”, “pop” or a similar reaction in the area of the musculoskeletal system under stress, which gives you an indication that something might be pulled or torn.
- After running – either immediately after or over the next 24-48 hours, inflammation occurs in the area of pain.
Inflammations are characterized by the following 5 signs:
Loss of function / restricted mobility / restricted resilience
In medical jargon, inflammation is only used in combination. This is important because otherwise inflammation is often cited as the cause of all kinds of pain, although there are no or only individual signs of inflammation (such as pain). Of course, inflammatory processes can also be present in such a case. But only when the above signs of inflammation are present, you probably can’t avoid seeking medical help and advice.
- You suffer from previous illnesses in which sudden pain when exerted can have serious medical consequences
There are some illnesses for which sudden pain, especially if it lasts longer than a few minutes or hours, should be checked for medical attention. These include above all osteoporosis, as well as its preliminary stages or related diseases, which can significantly reduce the resilience of the bony skeleton. Other diseases that are treated with long-term cortisone medication can also be relevant here, because long-term cortisone medication can also reduce the load-bearing capacity of the bony skeleton and trigger osteoporosis.
This point should not worry you that you might suffer from one of the diseases mentioned. Rather, it should be a quick reminder, if you suffer from these diseases or have had to take cortisone for a long time, you should consult a doctor if you experience sudden pain during physical exertion. But in that case, you probably already know that.
If at least one of these 3 points applies to your pain, I would recommend you to have a medical clarification about where the pain is coming from and what exactly you can do about the pain.
If none of the 3 points apply to your pain, you can use the strategies described below and do something about your pain yourself.
But first I would like to explain to you where your pain is probably coming from. This knowledge is also of decisive importance for self-treatment later on.
Where does your jogging pain come from?
The most common cause of pain in runners is not an injury, but rather a mismatch between stress and resilience .
For example, if you increase the load too quickly while running by increasing the 10 running kilometers to 20 running kilometers per week, the stress is too high for your current resilience. This can lead to overloading and pain in the area of your musculoskeletal system, but especially in the areas that are stressed when running.
Depending on the anatomy, biomechanics, running style and various other factors, pain in the area of your ankles, knee joints, hip joints, etc., can occur.
In addition to excessive stress, impaired resilience can also be the cause of your pain. Despite the constant running distance weekly, pain can occur if your resilience becomes less.
Why regeneration and sleep are so important
The cause of a reduced resilience is usually a lack of regeneration or excessive physical and psychological activation. For example, if you reduce your sleep duration from 8 hours per night to 6 hours per night – for whatever reason – your regeneration is reduced and your resilience decreases.
As a result, your normal running quota of 10 km per week can suddenly exceed your resilience and pain can arise.
The two scenarios described above are just one of many ways in which a disproportion between stress and resilience can occur.
The complex interplay of stress, resilience and regeneration can be explained using the picture of a rain barrel.
Imagine your resilience is a rain barrel. The higher your resilience, the more capacity the rain barrel has. The rain that flows into the bin are the loads that affect you. The more you are burdened, the fuller the bin is.
The process represents your regeneration. Whenever you relax and rest, the water level in the barrel sinks.
As long as the bin is only filled to the brim with rain, you are painless. As soon as more rain runs into the barrel than it can hold and the barrel overflows, the load exceeds your resilience. The result is overload and pain.
What pain really means
Pain is not so much an expression of an acute injury in the painful area, but rather an expression of the relationship between stress and resilience in this area of the body and often in your body as a whole.
The pain that occurs as a result of an imbalance between stress and resilience serves as a protective mechanism to prevent you from long-term overload and the resulting injuries.
Pain is more of a delusional signal or a signal from your body that you should change something in the current situation and the current stress. So that this stress does not lead to an injury in the future.
“Pain usually occurs well before damage to the affected tissue. As an alarm system to protect against injuries and inflammation and to give you a signal that you should change something in the current situation. “
What can you do yourself against your pain while running?
What can you do yourself against your pain while running?
If we interpret pain more as a warning signal and a signal to adapt to the current stress situation, two strategies emerge as to what you can do about your pain
- Vary your running style
A temporary change in your running style can reduce the strain on your muscles, joints and skeleton while running, which can reduce your pain or go away completely.
In many cases, it is not necessary that you run completely pain-free. However, you should adapt your running style so that the pain only occurs slightly and does not increase either while running or afterwards.
To find out what level of discomfort or pain is permissible when running, you should listen to your feelings on the one hand – your own body feeling is usually a good starting point – and on the other hand simply experiment and try out.
If the running went well with 10% pain and the pain was no longer during or after the run, then this is a good starting point. If the pain increases or if you feel more sensitive in the pain area after running, then you should adjust the variables the next time you run so that the pain is maybe only 5% or maybe 0%.
There is neither right nor wrong here, even with my patients it is mostly trying out and experimenting.
You can change many components
There are several ways to vary your running style to reduce the stress of running.
A reduced running speed automatically ensures that your body is less stressed, as you need less strength to build up speed. Shortening the stride length and thereby increasing the stride frequency also leads to less stress with every step, as you have to apply less force per step to push yourself off the ground.
If your pain only occurs after a certain distance, you can either keep the running distance so short that you only run until the pain occurs. Or you run in stages.
You choose the route so that you don’t have any pain when running. Then you take a short break in which you can either walk slowly or do stretching or mobilization exercises that you find comfortable and that relieve your pain.
After you have actively filled your break for 5-10 minutes, you run another stage.
With the variations described above, you can usually “keep walking” despite the pain without increasing your pain.
The important thing here is that you consciously take back something and don’t try to build on old best performances.
2.Start strength training for your painful area (s)
Regular weight training is actually a must for every runner, actually for every person. It is not for nothing that the WHO has included 2 units of strength training per week as a minimum in its guidelines for exercise and health.
Regular strength training improves the strength of the muscles, improves the resilience of all components of the musculoskeletal system (ligaments, tendons, joint capsules, fascia, bones, cartilage, intervertebral discs, etc. become more resilient), reduces the risk of injury and improves your running economy (you need less muscle strength when running)!
If there is already pain, targeted strength training is one of the best options to improve the resilience of the affected structures.
To use the analogy of our rain barrel: Regular strength training ensures that your rain barrel becomes larger and can absorb more rain (higher loads) in the future without overflowing.
Twice a week strength training for the painful areas and the surrounding joints – i.e. exercises for the muscles around the knee, for the muscles of the ankle and hip joints – is a good start.
Choose the exercises so that they are strenuous for you, but cause little or no pain. As with running, the pain should never be felt during or after the exercises. If the pain gets worse, try taking some intensity out of the exercises next time.
As with any effective strength training, the point here is to increase the intensity of the exercises over time so that you become stronger in the individual exercises.
The only difference to classic strength training is that the pain often dictates the intensity of the exercises and not only your strength is the limiting factor.
Incidentally, Arne Menzel is a member of the team of experts on my running course “My first 10 kilometers – more than just running”. As a physiotherapist, he covers the very important area of injury prevention and also shows many strength exercises especially for runners and the area of fascia training.
If that sounds exciting to you, I can recommend my online course “My first 10km – more than just running” . In 10 weeks I will take you by the hand together with my team of experts and will gradually introduce you to the elements of holistic running training. Interested? Then take a look here:
All information about the 10 km running course
- Allow yourself more relaxation
Regeneration and recovery are important factors in running. Your body can only adapt to your running training and you can become more efficient over time if you incorporate sufficient recovery phases into your everyday life.
Recovery and regeneration are even more important when it comes to pain. Since your body or individual areas of the body are reaching their limits – that’s why the pain occurs – it is all the more important that you recover sufficiently. This ensures that your body or the affected areas of the body are no longer constantly stressed and that you can get used to the stress of running again over time.
In addition to adequate sleep, at least 7 hours a night, a balanced diet / sports nutrition plays a decisive role in optimizing regeneration.
But daily moments of relaxation can also support your regeneration. These moments of relaxation can be a walk, a good book, your favorite music, or whatever inspires you and lets you calm down.
- If nothing helps, take a break
As a physiotherapist and enthusiastic amateur athlete, it is difficult for me to write the following words now. Also because I and probably many out there want the most effective and quick solution possible for every problem.
But sometimes, despite all the good ideas, approaches and attempts, nothing else helps than just taking a break.
Taking a break does not mean that you shouldn’t do anything anymore, but if none of the above strategies help you, simply take a 1-2 week break and then slowly start again at 50%.
Maybe you can still do strength training during your break from running. Maybe you just need a short break completely.
There is no magic bullet here, too, try and see what works for you!
- It is not just the burden of running that is rain for the bin
Not only physical factors such as running speed, distance, frequency of runs, running style, footwear when running, as well as other physical loads such as strength training, physical work, etc. are stressful for your body. Psychological and emotional factors can also Be a burden. These factors can include stress, fears, worries, negative beliefs, but also all other things that burden you psychologically and emotionally.
And it is precisely these factors that are highly individual. What burdens me can be a completely normal part of life for you and vice versa!
Here I find the analogy with the rain barrel very appropriate and also use it in discussions with my customers and patients.
As long as your rain barrel (your resilience) is big enough and your regeneration (the drain of the rain barrel) is not neglected, you can endure a lot of stress without getting pain.
If there is a disproportion between load, resilience and regeneration, pain can occur when running. Not because running is bad for you, but because at that moment it makes the rain barrel overflow.
Running isn’t always the cause of your pain
Just because the pain occurs while you run or immediately after you run does not mean that the pain is running in itself. The cause of the pain is that “everything comes together” at that moment, as it is always said.
And this also explains why a training plan that has worked well for weeks or even months suddenly leads to complaints.
Maybe because the stresses and strains in your everyday life have increased – maybe a new job or an exhausting project at work, a private crisis or fears about the future that are not at all unusual in times of Corona or other factors that are stressful for you.
Or regeneration has been neglected recently. And mostly both come together. Because challenges at work, crises in everyday life, fears for the future etc. not only burden us. They usually take us in such a way that rest – sleep and free moments of relaxation – simply fall short. And that means that relaxation is neglected!
And viola – the rain barrel fills up more and more and suddenly overflows while running.
There is always more than one factor that leads to pain
It is important that you understand that there is seldom a single factor that is responsible for your pain. As with the picture of the rain barrel, there are various factors that fill your rain barrel. And all of these factors play a role. Depending on how much the individual factors burden you, some factors play a larger role and others a smaller role. You alone can decide which role which factor plays.
And of course it also plays a role how well you can change the factors. If your job is currently very stressful for you, but you have no way of changing your job so that it is less stressful for you, then this can be an important factor in causing your pain. For the relief of your pain, however, the factor may possibly be irrelevant, since you cannot change it.
And what might overwhelm you at first, because you realize that there are many things that burden you – by the way, this is normal and each of my patients and I would even go so far as to say each of us has that – is at the same time a great opportunity.
Because you don’t have to get rid of all stresses in order to let water out of your rain barrel, but simply start with a stress that you can control and try to reduce it gradually.
And mostly small adjustments are enough to prevent the rain barrel from overflowing.
Make yourself aware of your burdens and look for a factor that you can change well.
It is best to write down the factors that weigh on you. Then find the one or a few points that you can influence and, above all, where you can imagine that you can implement the change in the current situation well.
What can you do yourself against your pain while running?
- Get support
Pain during exercise can quickly become overwhelming, even with the best guidance. That’s exactly what I experienced firsthand. Actually, the subject of pain in sports is exactly my area of expertise and yet when I suddenly found myself in the situation of regularly getting back pain during training, I was totally overwhelmed with the situation.
As the saying goes: Sometimes you can’t see the forest for the trees.
If you feel the same way with your pain, it may make sense to seek support from a physiotherapist, a trainer who specializes in pain, or a sports medicine specialist.
Unfortunately, there are many physical therapists, coaches, and sports medicine professionals who can help superficially. However, they can usually only accompany you for a small stage on the way to pain-free sport. That’s exactly why I chose this focus, because a holistic offer was rather manageable and the competition was low😉
You need more than “just” treatment
It is important that you seek support from someone who does not just treat you, but works out a clear and structured plan with you on how to get back into your sport.
A wide variety of treatment techniques, such as manual therapy, osteopathy, trigger point or fascia treatment, etc. can all temporarily relieve pain and are justified in some severe and acute pain.
These techniques fail to get you back on track, preferably without pain.
For this you need a structured plan of what you can do yourself in order to be able to run again step by step.
Depending on how severe your pain is, what causes your pain, and how you respond to a modification in running style and weight training, this plan may take longer or shorter. But without an active therapeutic approach – that is, you do something yourself, you cannot expect from my experience that the pain will permanently improve.
Therefore, this point is an absolute must for me when choosing a therapist, trainer or sports doctor. Can he show you a clear roadmap how you can get your pain under control again and guide you in implementing this plan? Or are you only offered therapy modalities in which you behave passively and are treated.
Pain when running – a few final words
Pain is an extremely complex phenomenon and usually neither the doctor nor the therapist can tell you with absolute certainty where your pain is coming from. Simply for the reason that many different factors play together and ultimately trigger the pain.
As complex as the pain phenomenon is, the treatment is usually simple.