Picture this. You are running out in the bush on a Sunday morning with the pack and 10km into a 20km stint your calf starts to tighten up. You try to ignore it but it keeps twinging and then starts to move into your achilles tendon. Given you are at the furthest most point from home what do you do? Do you try and ignore it and hope it goes away the further you go, or do you call it and pull the pin and tell the guys you will walk home and get one of them to pick you up once they return back to where everyone has parked their cars? Deciding whether to run in pain, through pain or ignore it can be the difference between the development of a new injury and weeks on the sideline or making it to the race you have been targeting in a couple of weeks. So how do you decide?
Well, generally pain is your body`s way of letting you know that something is not exactly working the way it should. It is a warning sign that a particular tissue or structure is under stress or inappropriate load and that you should take notice of it. I sometimes hear people saying that it would be so good if they didn`t feel any pain so they could keep going forever and not stop exercising. While this might seem good in theory, in reality is probably not much different to saying that it would be good if you couldn`t feel a flame burning your skin if you held it under a candle. Ultimately you will hurt yourself.
Now this is the case for a lot of injuries but one such tissue that can be an exception to the rule can be tendon. Latest research with regards to tendon injuries has helped health professionals realise that just completely resting them doesn`t fix them. In fact, often resting a tendon injury completely can mean more pain at rest. The research has shown that what is called APPROPRIATE loading is what can help improve pain coming from tendons. So at different stages of rehab it may actually be acceptable to have a mild degree of discomfort. This doesn`t mean that it is fine to run through an achilles or patella tendon injury, but what it may mean is that a low grade discomfort may be acceptable during some loading activities. I can hear you asking please explain as it would seem I have contradicted myself. I will use an example to illustrate:
John is a fun runner with a goal of running 20 minutes at the local park run in a few weeks but lately his right achilles tendon has been hurting when he gets halfway through a run. It hurts when he gets out of bed for 5 to 10 minutes until he has a shower in the morning and the day after a run he certainly notices it more than if he doesn`t run. How does he decide if it is ok to run? Well, the important questions a health professional would ask John would be how much pain does he feel in the achilles at its worst on a scale from 1 to 10, with ten being severe pain. If he reports more than a 2 or 3 then that activity is inappropriate at that particular point in time. The other critical line of questioning is whether that pain is greater than 3 at the time, 2 hours later after the activity or more importantly the next day. Surprisingly, a lot of people don`t link pain the next day with the physical activity they have performed the day prior. Again this is especially relevant with tendon pain.
So back to John, if he can say for certain that his pain in the achilles doesn`t extend beyond a 3 at all of those above times he could continue to run at the same level. If, however over the next couple of weeks, the pain escalates to greater than 3 then he will have to back off the length or intensity of his runs, stop hills, change running surfaces or actually stop load bearing completely until his resting pain comes down below the 3 out of 10. He could ride or swim to keep fitness up but without overloading the tendon. Also he shouldn`t completely stop loading the tendon but find an APPROPRIATE exercise with which to load the calf and achilles enough to allow it to respond and adapt but without doing so excessively. This can be hard to determine alone and is probably best done with the advice of your treating health professional. That may mean doing some bodyweight single leg calf raises or seated isometric holds in a gym or any other physio directed exercise that has been deemed to be appropriate at that stage. It could mean not stopping running completely but dropping back to a walk / jog programme, whereby John alternates walking for a set distance or time with running for a set distance or time and continues to do so for a few repeats. This gradual loading again may mean the difference between getting back to John`s running goals or not. But remember this, each person`s programme will need to be individually tailored to his or her needs and goals.
So yes it matters if you have pain when you exercise. It matters where it is, how bad it is and how long it hangs around for during, after and even the next day. If you are not sure what or how badly you have hurt something while exercising, it is probably best to seek professional advice before blindly pushing through the pain.- Michael Pierce is a Sports Physiotherapist of 23 years and a former elite triathlete.