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Should I Keep Running?

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It is likely that during your running journey you will experience some pain. Running injuries can happen to anyone, ranging from those who have just started, to the most experienced runners.

It is important to have some understanding of pain you might be experiencing when running, so you know whether this is something you can continue to run with, or something that means you need to take a bit of a break.

Overall, it is very unlikely that any injury means you should stop running completely. Whether you need to take a break or not depends on what the cause of your pain is. Common running injuries can be broken down into overload injuries (like tendinopathy and patellofemoral pain), acute muscle tears, acute ligament tears and bone stress injuries.

It is best to see a Physiotherapist to get this diagnosed, however below is a summary of some common running injuries that you might experience.

Hip Pain
Knee and Thigh Pain
Ankle, Calf and Foot Pain

Tendinopathy

A tendinopathy is an injury to a tendon. Tendons connect our muscle to bone. They come under the umbrella term of an “overuse injury” and are very common in runners. It is the process of a tendon becoming ‘reactive’ to excessive loading, and often occurs when someone first starts running, or when load is increased, either with distance, speed or frequency, potentially in preparation for a race.

Signs and Symptoms:

Tendinopathy can occur in any tendon in the body. Some common signs of tendinopathy are:

  • Gradual increase in pain with no obvious moment in time where pain began.
  • Pain that is worse at the beginning of a run, and eases as the body warms up. Can then become more painful towards the end of a run, afterwards or the next morning.

Common areas to develop a tendinopathy:

  • Gluteal tendinopathy: Pain in the side of the hip.
  • Hip flexor tendinopathy: Pain in the front of the hip.
  • Patella tendinopathy: Pain in the front of the knee, below the kneecap.
  • Achilles tendinopathy: Pain in the lower calf, above the heel.

Do I Keep Running and How is it Treated?

A tendinopathy does not mean you should stop running completely, however a short period of rest and a reduction in load should be the first line of treatment. A little bit of pain when running is okay, as long as this is minor and not worsening. Using the ‘Traffic Light System‘ along with a ‘Pain Diary‘ is a good way to ensure your tendon is coping with the current load.

A Physiotherapist can help guide your return to running, and identifity what might have caused this tendon to be overloaded. Rehabilitation involves gradually strengthening the affected tendon, strengthening of surrounding muscles, making alterations to your running gait and potentially suggesting things such as a heel lift to help reduce load of certain areas.

How Long Will it Take to Heal?

This depends on how long you have experienced symptoms.

Most acute cases may only take 1-3 weeks, whereas long-term cases can take months to years to return to full capacity. This is why it is important to address these injuries early on, and not allow it to hold you back for longer than it needs to.

For more information on the pathophysiology of Tendinopathy, as well as more in depth treatment options, you can read our article here.

Other Load-Related Injuries

Similar to tendinopathy, joints and other areas can become overloaded. These are the other injuries that join tendinopathy under the umbrella term of “overuse injuries”. Some common examples are Patellofemoral Joint pain (runners knee), Iliotibial Band Syndrome and Plantar fasciopathy/fasciitis.

Should you keep running? In the long term – Yes. However, a short deload may be necessary to allow any inflammation to settle. It is also necessary to determine why you have developed this pain. Is it a weakness in your hips or quadriceps, or something in your biomechanics and gait that leads to an increased load at the knee? This is something you Physiotherapist can help determine.

Patellofemoral Pain (Runners Knee)

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The Patellofemoral joint is where our thigh bone meets our kneecap. This joint takes a signficicant amount of load when running.

Most of the time patellofemoral pain is caused by an increase in distance, speed or frequency, however it can also be caused by poor patella tracking, meaning the kneecap is not sitting in the correct position during movement. This is likely due to a muscular imbalance, and can be corrected with strengthening exercises.

Signs and Symptoms:
  • Pain in the front of the knee, above or next to the kneecap.
  • Pain increased with bending of the knee (running, squatting etc).
Do I Keep Running and How is it Treated?
  • Generally, a rest from running for a few days to weeks is indicated. This allows any inflammation to settle. Running is then gradually reintroduced, as long as pain levels remain low.
  • Strengthening of the quadriceps.
  • Strengthening of the hip and calves to distribute load more evenly.
  • Control exercises to improve patella tracking.
  • Taping, such as the McConnell method can be a short-term way to assist with patella tracking.
How Long Will it Take to Heal?
  • This often depends on the cause of the injury.
  • If it is purely an acute overload with no other factors, it may only be 1-3 weeks until return to normal activities.
  • However, if the injury has been around for longer, or if it is due to patella tracking and muscular imbalance, it is likely to be closer to 4-6 weeks.

You can find more in depth information here.

Iliotibial Band Syndrome (ITBS)

Iliotibial Band Syndrome refers to pain relating to the ilitiobial band, and is one of the most common causes of pain on the outside of the knee.

It is thought that development of ITBS is usually due to an increase in load, where repetitive knee flexion leads to friction of the ITB over the bursa, or bony prominence where the ITB inserts.

Signs and Symptoms:
  • Sharp pain on the outside of the knee.
  • No obvious moment in time where pain began.
  • Pain related to repetitive knee flexion.
Do I Keep Running and How is it Treated?
  • Reduction in load to allow acute inflammation and irritation to settle.
  • Gradual reintroduction to running, beginning on flat surfaces only.
  • Strengthening of the hip abductor muscles.
  • Gait analysis and adjustments to biomechanics.
How Long Will it Take to Heal?
  • Returning to full, pain-free running may take as long as 6-12 weeks.
  • This can be faster in more acute cases.

You can find more in-depth information here.

Plantar Heel Pain (Plantar Fasciitis)

Plantar heel pain, commonly referred to as plantar fasciitis is an umbrella term for pain localised to the bottom of the heel. Although most people know this as plantar fasciitis, it is not always due to an overload of the plantar fascia, and can involve other structures. Generally, this pain is due to an overload of the muscles that stabilise the foot and support it’s arch.

Signs and Symptoms:
  • Pain on the bottom of the heel.
  • No obvious moment in time where pain began.
  • Heel pain with the first few steps in the morning.
Do I Keep Running and How is it Treated?
  • Primary treatment is load management, involving a reduction in the aggravating tasks (running), followed by gradually reintroduction based on symptoms.
  • Calf stretching if ankle range of motion is found to be reduced.
  • Calf strengthening if calf strength is found to be reduced.
  • Education surrounding biomechanics and gait patterns that could lead to increased stress at the heel. Use of orthotics such as a heel lift to take pressure of the plantar fascia.
  • Education surrounding use of good, supportive footwear when running.
How Long Will it Take to Heal?
  • Acute cases of plantar heel pain may only take 2-6 weeks until return to full running.
  • However, if left untreated or treated poorly then plantar heel pain can last for months to years.

Acute Muscle Tears and Strains

Commonly referred to as a ‘Muscle Strain’, acute muscle tears will present a lot differently to any load related injuries mentioned above, and their management will be quite different. These injuries are less common in distance running, as they mostly occur as you prepare to activate a muscle when sprinting, or stretch a muscle when trying to stop quickly. These can occur in any muscle, however most commonly will be in the hamstring, quadriceps or calf muscles.

Signs and Symptoms:
  • Specific moment in time where pain began.
  • Pain with muscle use and stretching.
  • Localised pain in a muscle belly (not where it inserts!).
Do I Keep Running and How is it Treated?
  • If you have torn or strained a muscle, you should not continue running and will need to rest and protect the injured muscle, giving it sufficient time to heal.
  • There is less room to manoeuvre with muscle tears compared to load related injuries, as it is much easier to cause more damage.
  • You should see a Physiotherapist to diagnose the severity of your injury, as this will change recovery time and treatment.
  • In general, treatment involves an initial period of rest using methods such as RICER or PEACE + LOVE, which you can read more about in the link below.
  • Once pain is reduced, treatment involves gradual strengthening and slow reintroduction to running.
  • Returning to activity too early after a muscle tear puts you at a high risk of making the tear worse.
How Long Will it Take to Heal?

This depends on the severity of the strain, and be anywhere from 1 week to 6 months, so it is important to see a Physiotherapist to diagnose your injury.

General healing timeframes are:

  • Grade 1 (mild strain): 0-2 weeks
  • Grade 2 (moderate tear): 2-6 weeks
  • Grade 3 (severe tear): 6 weeks-6 months

You can read some more information here.

Acute Ligament Tear / Sprain

Commonly referred to as a sprain, acute ligament tears refer to damage of a ligament, the tissue connecting our bones and holding joints stable. These injuries most commonly occur in the ankle or the knee, especially if running on unstable surfaces such as trail running.

Ligament sprains and tears refer to the same injury, however sprain may be used to describe injuries of lower severity, whereas tear may describe more serious injuries.

Signs and Symptoms:
  • Specific moment in time when pain begain.
  • Swelling or bruising at the injury site.
  • Feelings of instability.
  • Pain surrounding a joint (typically knee or ankle).
Do I Keep Running and How is it Treated?
  • Do not keep running on a ligament sprain/tear. Running on a torn ligament and potentially unstable joint is high risk of causing further damage in the ligament and surrounding structures.
  • It is important to see a Physiotherapist to assist in diagnosising the severity of your injury, as this will change treatment.
  • In general, you need to protect the ligament using the PEACE + LOVE approach, which you can read more about in the link below.
  • Initially protection is the highest priority, and depending on the severity of your injury, you may need to a brace to provide the joint support and stop the ligament from tearing more, especially if feeling unstable.
  • Rehabilitation will consist of gradual return to activity, alongside strengthening of surrounding muscles, as well as balance and proprioception exercises to return to full function.
  • Some severe cases including ruptures, especially those involving multiple structures, may require surgery.
How Long Will it Take to Heal?

This depends on the severity of the tear. General rules are:

  • Grade 1 = 0-2 weeks
  • Grade 2 = 4-12 weeks
  • Grade 3 = 6 weeks – 6 months

Read more here.

Bone Stress Injuries

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Bone stress injuries are another overuse injury that are common the running population. These injuries exist on a broad continuum, and their severity varies greatly. These types of injuries occur when someone has been training at a high load for an extended period, or has recently increase their running intensity, distance or frequency.

As we use our bone, cells called Osteoclasts carry out resorption of bone that is loaded when running, and cells called Osteoblasts form new, strong bone in it’s place. The process of new bone formation is slower than old bone resorption. This means, if we run too frequently and at too high of a load, we do not allow bone formation to occur, and bone’s will gradually become weaker and weaker. If symptoms are ignored for long enough, this can progress to a stress fracture.

Signs and Symptoms:
  • Gradual onset of pain.
  • No obvious injury.
  • Pain during activity, or even when walking.
  • Pain can be present at rest or at night time.
  • Tenderness to touch over the injured area.
  • Recent increase in load (intensity, frequency, duration), or extended periods of high level training.
Do I Keep Running and How is it Treated?

You need to have a break from running if you have a bone stress injury. How long will depend on how far along the bone stress continuum the injury is.

For lower level and low-risk injuries:

  • A period of time away from running, until other activities are pain-free is indicated.
  • In this time, you should complete strengthening exercises to maintain muscle strength, and address any deficiencies that may have caused the injury.
  • After this, you may gradually return to running. However, initial running load should be quite low, and gradually built back up.

If a more severe injury is suspected, or it is in a high risk position such as the neck of femur:

  • A longer rehabilitation period is required. Often imaging may be required to determine the extent of the injury and best course of action. MRI is the gold-standard imaging modality.
  • If indicated, a specialist referral can be necessary to discuss further treatment options such as surgery. However this is only in more severe cases.

It is important to see a Physiotherapist for this type of injury, as they can assist in diagnosis the severity, referral for imaging and specialist, as well as ruling in and out other potential causes. Your Physiotherapist will also assist in your strengthening and return to running program.

How Long Will it Take to Heal?

This depends on the severity of the injury, as well as the injured area. Certain parts of the body are higher risk, and thus more caution should be taken. Healing timeframes vary greatly, however some general rules are:

  • Low severity, low risk areas = 2-4 weeks
  • Low severity, high risk areas = 4-8 weeks
  • High severity, low risk areas = 4-8 weeks
  • High severity, high risk areas = 9-12 weeks

Physiotherapy Assessment and Treatment

If you are concerned that you have injured yourself when running, or are just after some general advice, you can book in to see one of our Physiotherapists. You don’t need a referral to make an appointment, just book online here, or call on (02) 4929 3898.