Pain is a tool to recover faster from running injury | DOC

#140 Pain is a tool to recover faster from running injury

Today on the Doc On The Run podcast, we’re talking about how pain can be used as a tool to recover faster from running injury.

Pain is a tool to recover faster from running injury. Today we are going to help you understand how a runner should measure pain in the injury recovery process.

But you have to realize you and your perception of pain are not normal.

Runners are not normal.

Runner’s pain level is not normal.

Runners lack the sensitivity to pain that normal patients feel.

These are all advantages when it comes to training and racing, but disadvantages when it comes to healing. 

But don’t worry, there is a flip side to this equation that is a little more positive. Runners have better somatic awareness than normal patients. You feel more nuances in the way your feet hit the ground and the way your legs feel when you are not having the best day. In a sense you feel musculoskeletal sensations better than average patients. 

If you want to get back to running sooner, you need to advance your activity faster than the average patient. You also have to figure out a way to maintain the maximum level of activity your healing tissues can withstand without causing any further damage and without impeding the healing process.

If you are a runner and you want to heal an over-training injury that may normally takes 6 to 8 weeks to heal you have to think carefully. Do you really want to just sit around and let your fitness vanish while you wait for a month and a half to two months for that one injured part to heal?

It is possible to heal an injured structure without losing all of your fitness. But the only way that can happen is if you maintain the activity that supports and strengthens everything else.

There is a fine line between healing while your running fitness diminishes and healing while simultaneously advancing your fitness.

You cannot evaluate this with an X-ray. You cannot evaluate it with an MRI or CT scan or any fancy test. However, If you understand basics of how the tissue heals you will quickly realize that there will be some response indicates whether or not you’re doing too much activity.

Pain, bruising, and swelling are the most reliable indicators of too much tissue damage.

Bruising is the worst sign. If you do any activity and you get an increase in bruising that means you did so much tissue damage that you actually had bleeding underneath the skin. Clearly that indicates way too much stress on the injured tissue.

Second on the list is swelling. If you do too much activity and the next day you have an increase in swelling in your foot then you definitely did too much activity the day before.

Both bruising and swelling are both signs you did too much. If you keep doing those things that caused the bruising and swelling you will definitely increase the damage to the healing tissue and delay your recovery.

Pain is a much more sensitive indicator. When it comes to healing and trying to figure out the line between too much activity and not enough activity, pain is your guide.

Normally doctors tell patients to look for pain and rate it on a scale of 1 to 10. A pain level of 1 is minimal discomfort, almost unnoticeable. A pain level of 10 would be excruciating. Think of somebody chopping off your leg with a dull axe.

Interestingly, in the last 15 years I don’t think I have seen a single runner with an injury who said they had a 10 out of 10 pain level. I even saw a woman who broke her tibia in half and only called it an 8/10 pain. 

The reason you and most runners don’t seem to note a high level of pain when injured is that you, as a runner have learned how to tune out pain and ignore it.

You try to ignore pain when you do hill repeats. You ignore pain when you run stairs. You tune out the pain and try to focus when you do speed work. And you shut out the painful noise in your legs when you are finishing a marathon.

Through the magic of neuroplasticity you have habituated yourself to down code your pain.

But you still have to try to look for, identify and rate your pain consistently and accurately if you want to stay active and keep healing.

You have to know where the line is. You have to be able to recognize the pain level which could cause damage. 

An increase in pain obviously signifies more stress and probably more tissue damage to the healing injury.

But a decrease in pain, a decrease in tenderness, signifies healing and increased tissue stability that can justify a slight increase in your activity level. But you have to look for the small changes in those pain levels.

As a runner who has learned to ignore high levels of pain, this job can be difficult. But it is absolutely necessary if you really want to advance your fitness ahead of schedule.

Your job in looking for pain and soreness is to put a number on it. 

If you think your pain is a 3 out of 10, but the next day you notice you actually have swelling, you did way too much activity and you were causing enough tissue damage to get rebound inflammation and swelling. So my guess is that a normal patient would’ve called that level of discomfort something more like a seven, eight, or nine out of 10 pain.

Over and over runners tell me they don’t really have pain, but they only feel some “discomfort.” You can call it whatever you want but you have to be able to assign a level of pain or a level of discomfort that you can track.

Just yesterday I was doing a phone consultation call with a runner who was trying to figure out whether or not she could transition off of her crutches. She tried walking around and putting 25% of her weight on the injured foot, while protected in a fracture walking boot.

She said she had no pain. She said, “I would not really call it any pain at all, it was really just discomfort.”

But she notices the next day she actually had swelling in her foot when she woke up. So my guess is her description of “discomfort” would be definitely describes “pain” by normal patient.

Of course her question was, “Should I just keep going with crutches and 25% of my weight on the foot, since it was only discomfort.”  

My answer was, “No way! You felt like it was only discomfort but you had swelling indicating it was enough trouble to stimulate an inflammatory response.” 

You will not heal with the continuing inflammatory response. So you have to back off if you see swelling. In a similar way, you have to back off if you feel pain. 

So if she feels like that 25% pressure causes a 2/10 pain level, then her job is to realize 2/10 on her pain scale is too much. She needs to start looking for a decrease to a 1.8/10 pain. 

Although it may seem tedious to look for the very small changes in pain level as you progress, I can promise you it is worth the effort.

You only have a couple of options when you are healing a running injury.

One option is to wait the prescribed 6 to 8 weeks and let that metatarsal stress fracture, sprained ankle ligament or Achilles tendon completely heal. If you do that you will completely decimate your running fitness. And it will take many months to earn your running fitness back.

Another option is to figure out how to start strengthening all of the non-injured structures sooner. The only way to do that is to move them and use them without causing further damage to the healing bone, tendon or ligament. You have to keep everything else healthy if you don’t want to lose your fitness.

Pain is your guide in that process. 

As soon as your pain level decreases you have a clear indication that the tissue is healing. There’s a little bit more collagen stabilizing the injury. If you have little bit more inherent strength, you can move just a little bit more without sustaining any damage.

If you push it just a little bit too far and you can recognize the subtle difference in discomfort (or pain) then you know where the line is an you know when to back off.

Pay attention. Keep track. Look for the subtleties and the changes in your pain level and you will get back to running sooner.

If you have a question that you would like answered as a future edition of the Doc On The Run Podcast, send it to me. And then make sure you join me in the next edition of the Doc On The Run Podcast!