Niggle or Injury?

You’ve been there, pushing the boundaries during training, a race or that long-awaited event. But that’s the point, right? No pain, no gain!

But how do you know if that uncomfortable niggle is worth your attention or not? Should it keep you up at night or can you just let it be?

I’ve been working with runners from various backgrounds for more than a decade, and it still amazes me how you incredible people have the determination to ignore your body’s signals. Don’t get me wrong, ignorance can be bliss, but for the most part, knowing how to distinguish between good and bad pain is a run saver!

Your body is amazing: it comes with its own built-in IT system. And hopefully I can help you figure out the user manual.

When I assess a runner in the claws of discomfort, I usually ask some standard questions to determine what we’re dealing with, and work out the best possible treatment plan.

Question 1

Is it pain or muscle stiffness?
Asking this question immediately helps assess the seriousness of the condition. Pain is generally described as a physical feeling that goes with the word Ouch! It’s a very personal feeling and not all people experience the same sensations – this makes it difficult to pen down on paper.

But if you’ve knocked your little toe against the edge of that solid antique chair you inherited from your favourite aunt and you are now curled up in a ball spewing profanity… well, that’s pain! If the kind of pain you’re feeling during or after running comes close to this, or even just remotely in the ball park, it definitely needs further inspection.

Delayed onset muscle stiffness (DOMS) or more commonly known as muscle stiffness can be described as a muscle tweak, over stretching or pulled muscle sensation. This feeling is generally not painful but definitely uncomfortable as you might find yourself walking funny or having difficulty sitting down and standing up. If this is what you feel, don’t stress, this too shall pass.

Question 2

Sharp pain or a dull ache?
A sharp pain is very prominent and localised to one specific spot. Generally, you can point this out with one finger. This pain usually makes you think twice about performing a specific movement and you try to compensate for it by rather using other parts of your body. This kind of pain needs your full attention and should be explored further.

A dull ache is less prominent and less local. It’s usually pointed out with your entire hand and is more of an annoyance and not necessarily sore enough to prevent daily activities. Keep an eye on this one, it should go away! If not, get to your local biokineticist pronto.

Question 3

Only when you move, or even when you’re sitting still?
Runners sitting still? Yes! It happens. If your discomfort is due to overloading (too much running or strength work), you’ll feel limited discomfort while being stationary and more discomfort with movement. When you move, your muscles contract (work), and when you don’t move, they are in a relaxed state inviting quiet time.

If it hurts even when you’re sitting still, you need to consider the fact that this could be indicative of a more serious issue. Inflammation and limited blood circulation don’t care what you’re doing, but will increase your level of discomfort.

Question 4

Localised to one side or both?
Let’s say only one of your calf muscles is acting up. This might indicate something more serious. It’s very possible that calf worked harder, due to muscle weakness in the other leg.

If you have pain in both of your calves, this could just be due to a really hard run, causing DOMS. Both legs acting up is better than just one; it’s a sign both areas worked equally hard simultaneously.

Question 5

How long has it been hurting?
With any form of physical activity, there is a certain level of expected discomfort. That’s the way exercise works. You load your muscles with strain and then they recover, helping you improve your results slowly but surely. However, prolonged discomfort could indicate a more serious problem.

Sore muscles and stiffness from exercise (DOMS) can occur immediately after your run or exercise regime and can last up to 48 hours.
Unless you’ve sustained a major injury (think back to ouch!), this is normal and you don’t need to be concerned.

If your discomfort last longer than this, it’s time for a recovery plan. And yes, it can include the dreaded R… rest!

Your biokineticist will also probably advise on ice and heat treatment, light stretching, foam rolling, and compression. If you suspect something more serious (ouch!), please consult your healthcare provider for advice and urgent medical attention.
And yes, hearing something snap, tear, or pop is serious!

Question 6

Has pain increased or reduced?
Think of a bruise, a nice purple and blue shiner – we’ve all had them! Initially it’s very painful but after a few days the pain starts to go away and the beautiful colours fade. Same goes for discomfort or pain, sometimes you just need to wait.

But this only applies when the pain is fading with time. And no, you just coping better with the pain or learning to live with it, is not the same as the pain fading away.

If your initial pain stood at a seven out of 10 and after a few days it’s a definite four out of 10, you can probably breathe a sigh of relief. But if the opposite happens and your pain jumps to a nine out of 10, something serious is going on.

Summary

Keep asking yourself these six questions whenever you experience any level of discomfort. If pain is an old friend, it may be a good idea to keep a pain diary. Write down what you’re feeling, the intensity of the sensation, when it started, and (importantly) what you did over the last few days.

This will help both you and your healthcare provider to identify a pattern if any, the seriousness of your discomfort, any muscle weakness and whether you need to change your current training programme. This diary should be seen as a short-term task! If your discomfort is the result of something serious, the longer you wait, the longer it will take to rehabilitate.

When in doubt, don’t hesitate to speak to a professional – don’t ever let pain or discomfort become a bigger problem than it currently is. There is no such thing as running through pain or running it away.

Anca Wessels is a biokineticist registered with BASA (Biokinetic Association of SA) and HPCSA, as well as a certified sport massage therapist. Visit WesselsBio on Facebook.