How Much Pain is Too Much?

One of the conversations I have with each patient that consults me for a running related injury is how much pain, if any, is safe to experience with training. One of my goals when helping someone rehab their injury is to minimize as much fitness loss as possible. That means keeping them at the highest amount of activity they can safely tolerate. So it is paramount to have ground rules for pain during, after, and overtime with exercise.

How much pain is too much? The answer to this question depends on the specific injury or tissue involved. I’ve touched on this before with tendon pain in a the previous blog here. I wanted to expand on that example with a graphic and present two other frameworks. Some of the differences are subtle but important. Understanding these frameworks in the context of your own injury can help to mitigate the threat of pain and put you in the driver’s seat of your recovery.

Disclaimer: this blog should not replace working with a running specialist for your running injury. Management of running injuries is multi-faceted, this is just one piece of the puzzle. You also must be sure you have the diagnosis correct for any of these to apply.

*These graphics were heavily influenced by Chris Johnson, Nathan Carlson, Rich Willy, and Tom Goom among others.

Ground Rules for Pain & Exercise ITB_PF Variation.png

Tendinopathies (Achilles, Patellar, Proximal Hamstring, Gluteal etc.) or non-traumatic soft tissue pain:

Ground Rules for Pain & Exercise ITB_PF Variation.png

Fascia, joint, and some nerve related pain: Iliotibal Band Syndrome, Patellofemoral Pain Syndrome (Runner’s Knee), Plantar Fasciopathy

Ground Rules for Pain & Exercise MTSS_BSI.png

Bone stress injuries: stress fractures, stress reactions, Medial Tibial Stress Syndrome (“Shin Splints”)

NOTE* Bone stress injuries can require a period of offloading and complete rest to heal before exercise can begin. Do not try to rehab your own bone stress injury. This graphic applies for someone that has taken the appropriate steps under medical supervision to heal and is ready to begin rehab and or a return to running program

I hope this helps you conceptualize your current situation or allows you to reflect on what you might have done different with past injuries. Navigating pain and exercise is a complex subject with several nuances. If you’re experiencing pain that is limiting your running reach out and we can create an individualized plan to help get you back to normal training.

Steve White, PT, DPT, OSC, CSCS

Steve White