My colleague Ben is an avid runner. Last year he embarked on a plan with a goal of running the Chicago Marathon to gain qualification for the 2016 Boston Marathon. His training went really well and by October he was in great shape. He cruised through Chicago and easily made the BQ time.
However, by late fall, I noticed that Ben’s posts on Strava were diminishing. I assumed he was just recovering from the marathon, but when I checked in with him he explained that his foot had been giving him trouble. It seemed that the high volume had exacted a price. I asked if he had seen anyone about this and, like a typical doctor, he replied, “No, I’m sure it’s nothing.”
I was not so sure.
Running is a particularly injurious activity, mostly afflicting our musculoskeletal system in varying degrees of frequency and severity. The medical literature is inconsistent but review articles have suggested that anywhere from 15 to 20 percent of runners experience a running injury of some sort each year and that the number of running injuries can be as many as 12 per 1,000 hours of running. 
However, as anyone who runs on a regular basis knows, it is not at all unusual to experience some discomfort during or at the end of a run. The question then, is how do we respond to that? Is it safe to run through the pain? Can I simply wait this out or does this require medical attention now? The answer to this question is not always so straightforward, but let’s put together some general guidelines to help make the decision a little easier.
First, why do we feel pain and how it is transmitted? Pain is generated by one of two mechanisms:
- Specialized nerves responsible for detecting pain innervate many tissues. When directly stimulated, pain is perceived. An example of this is the skin. When cut, local pain fibers indicate pain in the specific area.
- Many tissues have no pain fibers. Local injury is still perceived as pain but in this case it is through a more indirect mechanism. When tissues of this type become injured, they release chemicals that produce an inflammatory response. Inflammation results in an increase in local blood flow that causes warmth and swelling. The swelling itself often stimulates local pain fibers but even in the absence of this, the inflammatory mediators are sufficient to induce a response that is perceived as pain. Examples of this kind of pain include injuries to the cartilage that lines our joints.
Pain can be treated in two ways:
- A drug may block the transmission of pain fiber signals. Examples include narcotics and acetaminophen.
- You can interfere with the inflammatory process. Examples include the application of ice, compression or anti-inflammatory medication.
It is of the utmost importance to recognize that treating pain does NOT remedy the underlying running injury! By misinterpreting a decrease in pain after taking an ibuprofen as a sign that an injury is healed, a runner can return to activity too soon and exacerbate the problem.