Run Well, Keep Safe


Injury in athletes is both common and sometimes inevitable. Athletes are notorious for ignoring niggles and the pain of injury. How can we differentiate between the two and then what is the best way of managing them? As athletes we strive to improve ourselves by consistent training which progressively overloads our musculoskeletal system. Runners have huge resilience and the opiate release that occurs naturally with sporting activity can actually mask pain until the event has concluded. Injury and niggling pain will then interrupt our sporting endeavour and we can find it difficult to accept this problem and subsequently mismanage the recovery.


Pain occurs when there is soft tissue injury. When an injury occurs inflammatory mediators are released which activate sensory nerve endings. The brain receives these signals and identifies pain in order to restrict movement. This is what is known as useful pain. Regrettably many athletes will try and ignore this type of pain which is unwise.


If when running you get an acute, severe pain, it may be obvious but STOP. I find it hard to believe sometimes that multi-million pound professional footballers who do a hamstring then limp off round the field increasing the amount of damage that they are doing.


If after running you become aware that there is a niggling pain or ache then gently feel the painful area and see if this is localised. The simple immediate management can be abbreviated RICE. Rest, ice, compression and elevation. Such simple measures can speed recovery from nearly all soft tissue injuries. Rest stops further damage. Ice restricts the bleeding within the soft tissues as does compression and elevation reduces swelling. If the muscles are just very tight generally then massage and local heat alone may be sufficient. Muscle cramping can also generate significant pain and may indicate that your electrolyte and fluid balance is not as it should be and can be discussed with a health professional. If the day after running the pain continues then see if simple stretching alleviates followed by a gentle jogging programme but if the pain persists or gets worse in the immediate aftermath of your activity or the following day then advice may be sensible in order to facilitate recovery.


Usually it is reasonable for a runner with a niggling pain to leave it for a week with simple stretching and massage. Activities such as swimming may help or even changing shoes, something that we often do not do with sufficient frequency. A simple reassessment of your programme may be all that is required. If the pain persists after a week or if as I have said it gets worse than you need to consult a physiotherapist or an appropriate health professional. What should never happen is that the pain persists or gets worse with running which will indicate that there is structural damage that needs to be managed sensibly.


More mature runners can get pain from a prolapsed or slipped disc. That pain may radiate down the leg as opposed to being localised to a muscle and that will be the subject of a future article as it does require even more specialised assessment and treatment.


With any injury you continue, usually, to have three good limbs and a torso. These should continue to be trained and enable fitness to be maintained. This will allow for a much more rapid recovery after the primary injury has healed be it through your own endeavours or with physiotherapy assistance. I would also encourage that you question the following in your training and running programmes. These are a few tips:

  1. Have you increased your distance too much? I would advise only a 5-10% increase over a few weeks. Plan your own programme according to your own speed and capability. It is always easier and perhaps more fun to run with others and use them as pacemakers but know your own limits.

  2. Are you running every day? Active recovery is important. Personally I do not recommend running back to back days as there is an essential recovery time. This does not mean complete rest but a low impact activity such as cycling, swimming or general gym strengthening with low impact may be effective and actually help rather than hinder running speeds.

  3. Is the surface too hard and not varied enough? Most of our running is on concrete (road running) I would advise trying to run on varied terrain. This will give a less ground reaction force through your limbs (softer landing).

  4. Have you recently changed your trainers? Do you change your trainers enough? Have they been professionally prescribed by someone who can advise correctly? Your foot is the first point of contact so correct footwear is essential. We will be looking in more detail about foot mechanics later in the series.

The key message to all of this is that if pain persists or gets worse when you run it would normally indicate some degree of structural damage to soft tissues. This needs active management and in the next article I will be discussing how to self-manage and prevent simple but common injuries we all get as runners. I wish you and your running well, keep strong, stay tuned and enjoy.