By Dr. Jesse Riley, MS DC
Running pain isn’t just a nuisance – it’s confusing.
Just as we feel we are making strides in our training program for the upcoming race season, we start to feel those signs that we might be dealing with a running injury. Running pain is extremely frustrating and can be very debilitating. We often look to running as an emotional outlet from the daily frustrations that weigh on us and when that is taken away, we have a hard time dealing with one other thing. Living in the Golden & Denver area, there’s a certain amount of activity we all seek and desire.
With being involved in run clubs/teams, training partners, and coaches, when running pain gets bad enough, it not only affects your emotional outlet, it can also have an effect on you as a partner and parent as well.
And that’s the main problem with running pain: when it limits your ability to train, it interferes with your identity.
Many of us proudly occupy roles such as parent, partner, or caretaker. We choose to take care of others, and ourselves, every day because it’s what we love to do. When our everyday activities become challenging or even impossible, our limitations affect our psyche. When the running pain gets bad enough to affect your ability to perform even mundane tasks like getting up from a seat, walking up or down the stairs, or trying to catch your little one running around the store, we’re not fully participating in life the way we want to.
As isolating as running pain can be, you should know you’re not alone.
In fact, many people experience this every day:
As you can see, every runner gets injured at some point.
In fact, we often jest, the best way to prevent a running injury is to not run. We know you’re not visiting this page to stop running, nor are we that kind of Doctor that would ever tell you to stop. Quite the opposite in fact. All it takes is some sound strategy with where to start working from, advice on how to progress, and some initiative. Let’s expand on this.
At Modern Movement Clinic, we know what it feels like to suffer from running pain frustration. In fact, we see clients every day for this. This is the largest group we work with. To save you crucially important time in your recovery, here are the first five questions clients ask us that will spare you the confusion that comes with running pain.
This page covers the first five questions every client with running pain asks us:
- Is it really (insert area) pain or something else?
- What are red flags I should be looking out for?
- How can I take immediate steps NOW for my pain with running?
- How can I form a long-term plan for conquering running pain?
- What can I expect from my first Chiropractic visit?
Are We Sure It’s the (Insert Area That Hurts)?
A lot of different emotions come along with pain: bewilderment, shame, anger, disappointment, anxiety, and helplessness. Although these emotions can be a part of the recovery process, they also make hard to understand how we got to this point.
The good news is your pain can be outsmarted if you slow down and listen to what your body and mind are telling you. Listening to your body is a process that’s improved through trial and error. Together, we can learn to listen for the individual signals that YOUR body is communicating.
To slow down, follow these four keys to recovery: rule out other areas that might be contributing, identify painful movements, identify pain-free movements, and make sense of it all.
- Are You Sure It’s the (Insert Painful Area)? Ruling Out Other Areas.
Dr. Jesse follows a quote he learned a long time ago with all his studies with treating pain.
“He who treats the site of pain, is lost”.
In running pain recovery, and really any recovery from any area, if we spend all our time focusing on the area of pain, we’re missing our focus on how this came about in the first place.
We can make something like the knee the strongest it has ever been but if the problem revolves around the hip controlling the rate of adduction of the hip that overloads the distal tendons of the knee (it’s okay if this is a foreign language to you), we likely won’t turn the corner.
Motions like this aren’t inherently bad! This is why we talk about how things like load (think how much volume, intensity, or stress we place on an area like the knee or even the whole body) can come to a point where it heavily over exceeds capacity (think how much load can this area or the body tolerate in a given amount of time). If we overload an area just a little, the body can adapt. Just like why you can’t run a marathon Day 1 of your marathon training but by the end, you’re doing that or more. However, if we overload the area a lot and frequently, the body can’t keep up and we push into “the danger zone”. Kenny Loggins is doing his mic check.
At Modern Movement Clinic, we make sure to rule out the true cause by doing testing at multiple areas involved with running pain. We also take the time to explain concepts like load and capacity as to how they apply to the running gait cycle.
If your pain was not the result of a singular incident this should perk your ears up to look deeper into the root cause of your pain. Some other examples include:
Your running pain is commonly on one side
You had one area of pain around the the time another area of pain started
The pain radiates down your leg
You experience pain on the back side of the thigh or calf
You have pins & needles, numbness or tingling, or burning type pains in the hip
Any of this sound familiar? Don’t stop here then!
- What Hurts My (Insert Painful Area)? Identify Painful Movement
Your clinician needs to know what movements are painful so that they can help chart the route to your recovery.
The first step any good clinician or therapist will take you through is a movement assessment. Sometimes you know that “when I do this in my running, it hurts.” Other times, there are many motions that elicit pain.
The movement assessment helps us identify where we feel pain, and when.
The more information we have, the faster we can put together the story of how we might modify your running program (limiting speed or elevation or perhaps a walk:run ratio) to allow the body to calm down and flush out the irritation in the area. Notice we didn’t say “you should stop running”. We know you get that all the time and quite frankly, it’s wrong information typically. We make every effort to give you particular cues or modifications in your run to KEEP you running in some regard because we know running.
The movement assessment consists of the client replicating different scenarios that involve movement in different ways. Many of these tests are applicable to various segments of the running gait. We educate our endurance athletes that running involves multiple planes of motion. As we run forward, we are moving in the sagittal plane, however, because we live on a planet that has gravity, and we are landing on one leg at a time, we can sway side to side and this involves the frontal plane. Lastly, as we swing our hips and arms forward and backward, we are rotating along the transverse plane. For example, a joint like the hip can move in all three planes under load and this is why we have to take a deeper dive into analyzing the movement.
When we test these movements, we can pinpoint which motions are causing problems for your running.
A great example would be noting that “When I go for a run, I start to notice knee pain as I run downhill,” or “My hip bothers me the first few miles and starts to shake out until I get to X miles.”
Differentiating painful movements are what gives us a larger picture of the overall situation.
Taking a holistic view of your specific circumstances is what typically separates traditional clinicians or therapists from modern practitioners. For modern practitioners, we know anatomy rarely ever dictates pain. There is often acute trauma (such as broken bones, lacerations, etc.) and more notably, mechanical overuse with running, that underlies pain.
Understanding painful movements is an important step to learning about how we will chart your path to recovery together.
- What Feels Okay For My (Insert Area of Pain)? Identifying Pain-Free Movements
Focusing on what movements feel okay with running is JUST as important as identifying what feels painful.
We use clues from your movement assessment to get an idea of what movements do not cause a threat right now. Know that as time moves on, your movement portfolio will get bigger and you’ll be able to do more activities with far less pain.
With the information of what motions feel okay, we’ll make a plan to get you back moving.
Starting with movements that feel okay, you’ll slowly regain your ability to get back to running and start building mileage and volume. We’ll add special modifications customized to you to increase your activities even more. With the ability to move more, you’ll rebuild your confidence, step-by-step (pun intended).
Confidence is key!
- Making Sense Of Everything
Now that we have a clearer picture of the source of your pain, what movements are limited, and what movements feel okay, it’s time to put the puzzle pieces together.
Through extensive continuing education and current research (something else your practitioner should be keen on), pain has been found to be much more like an alarm system for your body, NOT A DAMAGE INDICATOR.
Think of your pain as a smoke alarm.
A smoke alarm is incredibly helpful for alerting you to a potential fire, but if you’ve ever cooked in an apartment, you know the alarm can also be touchy. When we repeatedly force our body into movements that feel painful, the alarm bells may be ringing all the time. This is not only annoying but also confusing. Therefore, we want to modify or avoid irritating movements right now.
For now, limit motions that hurt and do more of what feels good.
No, it’s not rocket science, but it will make a huge impact on your recovery. When we talk about movement that feels “good,” this doesn’t mean that the exercises make you feel like you’re on a tropical vacation. But, if the motion feels doable then do more of it or even progress it.
Moving more in a supported way will get you back on track in no time.
Movement assessments are so important because this information can’t be gleaned from an X-ray or just touch. Movement tells us which direction to go in. You’ll also read below why X-rays or MRIs doesn’t always need to be something we need initially.
Instead, take the first steps by assessing your movement with a professional.
In regards to things like stress reactions and stress fractures, we look for specific clues and information from us sitting down and discussing your pain along with testing. We commonly work with your orthopedic doctor to make sure we either limit the mileage or reel back on running as a whole however rarely if ever do we tell you to completely rest as the body needs some stress to adapt and heal.
What Are Red Flags When It Comes To Running Pain? Signs To See Medical Specialists That Aren’t Physical Therapists or Chiropractors
Running pain isn’t ALWAYS caused by a mechanical event.
It can stem from an underlying cause. However, this scenario is very unlikely. As in, only 1% of cases, unlikely. The other 99% of cases fall under the non-emergency category and rehab is the best initial step. This is when you would see a movement therapist like at Modern Movement Clinic.
However, for the 1% of those with an atypical case, we want to make sure you don’t ignore the signs to get the help you need.
If you are experiencing any of the symptoms below, you should seek out further medical advice, such as the Emergency Room, a medical specialist, or your General Practitioner depending on the situation.
History of Cancer
History of Vascular Disease
Unexplained Weight Loss
Consistent and Ongoing Infection or Fever
Prolonged Use of Steroids or Any Drugs That Inhibit the Immune System
Significant Trauma (Accident or Trauma Recently)
Prone to Fractures (Osteoporosis or Osteopenia)
Loss of Bladder or Bowel
Numbness and Tingling In the Groin Area (Saddle-Like Paresthesia)
Numbness and Tingling In Your Arms (Especially If Upper And Lower Body)
Major And Noticeably Motor Weakness In Lower Extremities (Hard Picking Up Legs or Drop Foot)
Limited Spinal Range of Motion (All/Majority Directions Supremely Limited)
Neurologic Findings Persist Beyond One Month
Visual & Auditory Disturbances
Severe or Unexplained Headaches
Trouble With Balance & Coordination
Chest Pain, Unusual Swelling, or Shortness of Breath
Schedule With Your Orthopedist/Primary Care Physician
Previous History of Stress Fractures
Previous or Currently Diagnosed Osteoporosis & Osteopenia
Consecutively Missed Menstrual Cycles
How Can I Take Immediate Steps NOW For My Running Pain?
Do I Need An MRI For My Pain?
Turning to imaging, through X-ray or MRI’s, is often our first instinct.
The inclination to go straight to imaging is common, but more often than not you don’t need to spend the time and money. In fact, getting an image scan first can often INHIBIT your progress as the report offers little explanation to understand what’s important. Reports with too much information and too little explanation can lead us down the WebMd rabbit hole and to further confusion.
Valid reasons for getting image scanning would be if you’re experiencing any red flags mentioned above or if we do not see any improvements in your treatment. In this case, you will likely take an X-ray before an MRI. This is even if it is a suspected stress fracture and if some of the signs above, mixed with testing, will do advanced imaging to confirm.
Okay So What Can I Do About My Running Pain?
Summed up in two words: keep moving.
People commonly want to stop and rest when experiencing pain. Although rest is relaxing, new research says rest is less beneficial than if we just kept moving on with life, especially with running. After all, this is just a speed bump. We’re slowed down but it doesn’t mean we won’t get to where we want to be, pain-free running (obviously speaking on consistent and lingering pain). Massage therapy, dry needling, soft tissue, and adjustments or mobilizations are a nice addition to the therapeutic experience, but the most reliable therapy is activity and exercise.
To act in your recovery now, start by moving and making a plan.
How Can I Form A Long-Term Plan For Conquering Running Pain?
We’re glad you asked!
Having a long-term plan will be your biggest asset in distance running pain recovery.
Consider the following questions to make a personalized plan that will work for your lifestyle.
Setting a Goal
Your goals must align with you personally. We often make goals that don’t relate to who we are or what we care about. Instead, create goals that are realistic and have personal meaning to you.
This especially applies to running because it’s likely how you got into it in the first place. That’s kind of our argument, however. We know you HAVE to get back to running because it allows you to have some sanity. Why does it provide you sanity and honestly, what can we do in the meantime (pssst the answer is strength training) to take part of that load?
Remember that running injuries are more common than they aren’t so placing that amount of dependency on something that historically doesn’t reciprocate the appreciation, learn to be fluid and flexible with your goals.
Where Are You At Now? – Current Fitness
Your activity level should be on par with where you are fitness-wise. That way, the pace of progress you see is a level you feel comfortable with. If this is your first time training for a marathon or ultramarathon, that’s okay! You may just need more consideration to think through what reasonable expectations look like.
Modern Movement Clinic always keeps your needs and abilities in mind while pushing you towards progress.
Where Are You At In Life? – Personal Situation
Life gets crazy, doesn’t it? Maybe you’re a new parent. Maybe you have a new job that is a bit more demanding. Maybe you’re taking care of your partner or a loved one. Everyone has their own specific situation that we consider.
As it applies to running, it takes a ton of time out of your day. This most certainly applies to setting PR’s and any racing distance that is beyond half marathons. It’s a lot of 5:30AM runs and staying in on Friday nights to wake up early on Saturday mornings for long runs. When injury occurs, that doesn’t necessarily mean we throw out the training book.
We still need to prioritize your own health. We just need to find out when that should be and what it looks like now if we are limiting volume and adding more strength.
Consistency – Can’t Water Your Lawn With a Bucket
The biggest myth in any rehabilitation program? That progress requires 120% effort, all the time.
On the other hand, you can’t put in 0% effort and expect results. However, consistency is the single most important factor in reaching pain-free progress. We know this first hand with running as you didn’t start your marathon training by running a marathon day one.
Lighter and less aggressive exercises more frequently are much better than heavy and aggressive exercises a couple of times a week. Good consistent input yields good consistent output. We can always build and progress these exercises to again match the stresses of running but if you’re body isn’t ready for it, the body is telling you to tangent.
Remember the pain alarm? Remember how doing good movement makes the alarm calm down? Imagine doing it consistently during the days and weeks. (Cue mind-blowing gifs)
Like the heading says, and like people of Denver and the mountain west know, you can’t expect a green lawn by slinging water out of a bucket into the backyard. Consistency is key.
Control – What We All Want Out of This
When we experience running pain, or any pain, we can feel like we’ve lost control.
Feeling like you’ve lost control in your life makes you feel like your efforts don’t matter. Apathy towards your pain is the OPPOSITE of what we want. Instead, buckle in. You’re in the driver’s seat here and you get to control the acceleration and ETA most of the time.
Being aware of your recovery and progress gives you a higher success rate. Seeing progress encourages you to continue forward and maintain consistency.
Outcomes – Don’t Expect Easy Street
Any good plan has pitfalls. Some pitfalls we anticipate and others we may not see coming at all. We often expect because we follow the program that a positive response will result 100 times out of 100. Have you ever studied for a test and STILL did bad? Just me? Okay.
No, I’m not saying you must be physically active 24/7 to recover from your running pain. But a mindset of setting goals of continuing to move, self-efficacy, and consistency does make the work more sustainable. You may even start to notice other positive benefits in your life as a result (like even coming back a stronger runner).
Sometimes people believe that rehab from an injury should be a progressive upward slope. Injuries and pain are tough. Everybody responds differently and at different rates. We all come from different backgrounds and experiences with pain and injury which can manifest in recovery. However, by having a plan in place, we do create more control in the face of the uncontrollable.
What I Do Need To Do Now?
If you’ve gone this far, don’t quit now! (That’s a joke and motivation at the same time!) But it obviously means you care. I care too. The first thing is making sure you stay active. Whether you are an athlete or not, you don’t need to be sidelined. Whether this is with running pain, we can do alternative exercises and movements outside of just running that can have these areas work in different ways.
You would get this from an assessment at Modern Movement Clinic and any other good movement therapist who practices with an evidence-based approach in the greater Denver area and Jefferson County. You may be an endurance runner, sprinter, skimo, OCR athlete, or just a weekend warrior but that doesn’t mean you need to put your activity to a halt. Movement is medicine.
Other Miscellaneous Questions
Active vs. Passive Therapy – Did I Say We Had to Move?
I like massages, vibration guns, heat, mobilizations, adjustments, and dry needling just as much as the next person.
We call this type of treatment passive care.
When you perform different therapeutic techniques to yourself, we call this active care. A lot of research actually shows you recover faster when this is part of the plan. The adage “If you give a man a fish, you feed him for a day. If you teach a man to fish, you feed him for a lifetime” takes full shape here.
At Modern Movement Clinic, you have options.
Sometimes we need to manage the acute pain while also knowing that movement is medicine. Why not have both? Exercise and movement yield the best long-term results and you guessed it, give you control.
Should I Be Stretching My Running Pain Away? – What If I Said No?
Stretching for recovery is one of those ideas that has persisted for decades.
However, as more research comes to light, we have found that stretching out your area of pain can potentially inhibit progress.
It all comes down to “why do we feel like we need to stretch?” Most of the time, clients feel a need to stretch “because it feels tight.” But what if your tightness is a reaction from the body as opposed to a symptom?
Remember our conversation about the body’s alarm system?
The nervous system is kicking in here and sending you different messages. In this case, the nervous system makes the area “tight” to protect the area since it feels under threat. Oftentimes, when we stretch this actually makes the nervous system tighten up MORE.
At the Modern Movement Clinic, we commonly suggest simple movements that are pain-free or very minimal in pain that help let the nervous system know that we don’t have to have a “helicopter parent” overseeing everything. Commonly loading the area in a way that’s mildly comfortable to the area is the best approach as this provides a stress-adaptation response and can calm things down quickly.
What About Massage Or Cool Gadgets? – I’m Hip, Too!
In short, absolutely!
My answer to these things is “if it feels good and you don’t notice any repercussions…go for it!” Sometimes relaxing by getting something like this is the step you need to move out of the pain phase.
Foam rollers, vibration guns, cupping, performance tape…it’s all fine and we say use it if you see benefits. Many have their theory of what it is doing but they are all just modifying the sensation of pain and that is it. Although these should not be viewed as a long-term solution to the problem and don’t address the problem in how it likely manifested, they have benefits that many people see every day.
To Ice Or to Heat, That Is the Question!
We get the question, “Should I use ice or heat for my area of pain?” all the time, and for good reason. The RICE (rest, ice, compression, elevation) principle has been around for years and it’s just easy, right?
At Modern Movement Clinic, we know that the evidence has shown that ice doesn’t help in the way that we previously thought. In fact, the creator of the RICE method has publicly addressed his theory to say as much. We suggest using what feels best to you.
For example, in Dr. Jesse’s personal experience with pains he’s had (yes, he’s human), he enjoys heat more so than cold because he PERSONALLY feels like it relaxes his body more.
If it helps, use it. If you don’t see a benefit, you don’t need to continue to do it. If it makes matters worse, look elsewhere.
In the end, use what works as there are no rules to this, just guidelines.
What to Expect From Your First Visit (And Practitioner)
Whether you work with Modern Movement Clinic in-person, online (oh yeah, we can do that, too), or with another therapist, make sure the first part of your recovery comes from working with a licensed healthcare professional.
Not your running buddy, Ran-dy, not your parents, and definitely not Reddit or Facebook groups …unless any of them are licensed healthcare professionals who have trained and passed examinations to do so.
Many other professionals in the health and wellness industry are great additions to helping some areas of your running pain, but they are not trained to make clinical assessments and diagnoses as this is out of their scope of practice.
Let’s see what else your examination and experience look like with a practitioner from Modern Movement Clinic.
Don’t Wear Your Sunday’s Best (Unless It’s Athleisure)
If you’re coming to Modern Movement Clinic, whether an online consultation or a live visit in our Denver-based clinic, you’re going to move. Clearly. We might even make you run if you can tolerate that so bring your shoes and we can analyze those as well.
We get that sometimes you might be coming from work or going to work, but to get the answers you seek, we need to see how you move. Bring a change of clothes if you’re coming from another activity. Dress in comfortable clothing that allows for freedom of movement.
Are You A “Fashionably Late” Person? Read This Then
We’ve all been there, right? Traffic hits, weather turns, kids are screaming bloody murder, and inevitably time speeds up. It happens!
However, we recommend that you leave 10 minutes earlier than what the navigation says on your phone if it is your first visit. This ensures you find our location without being rushed when we sit down to chat.
This can take away from the emotional component of your pain and limit our ability to get the entire picture of what is causing your pain.
The first visit lasts around 90 minutes unless indicated by the practitioner. Corresponding visits will be based on the time you and the practitioner agree upon.
We’re Pretty Modern – Doing Things Digitally
We want to remove as many complications as possible for you.
We have an online booking option that allows you to take control of your recovery from the comfort of your home. Your payment is taken care of online through our scheduling app, your exercises are all digital, and a recap of your session emailed to us after you finish.
After all, it is the 21st century and your rehab and performance should reflect your needs today.
We’re Here For You. Not Our Egos.
Finding the right healthcare provider can be hard as it sets the tone for your recovery process. Some things to look for are listed below:
- Does Physical Testing – clinical and physical examination is paramount as it relates to what your goals are. It takes time and analysis to do this. You shouldn’t be rushed in and out of the space. We don’t use special gadgets and gizmos to do the analysis unless it is needed and even then, they shouldn’t be regarded as cure-alls but as an adjunct. All that glitters is not gold quite often.
- Focuses On You – at the Modern Movement Clinic in the Denver, Colorado area, you’re not a number. You’re not even a deductible. If you come here, you are a priority. What matters to you in your recovery? That’s our priority, too! Did we just become best friends?! Now let’s get you better so we can go do karate in the garage.
- Lets You Have Independence- we like you moving and being your best self. We realize some people have an easier time with that than others do and that’s okay! We aren’t pushy at Modern Movement Clinic. You have options. Sometimes options can be confusing, so we always make time to talk with you about your options so you’re well informed about what option fits best for you.
- Grows With Your Goals – things can change in a recovery plan, and you want someone who can change with you. When you improve, you don’t want to be doing the same things right? BOOOORRRRIIIINNNGGG. At the Modern Movement Clinic, we are constantly tweaking, progressing, and altering movements to fit your needs and goals.
What Kind of Questions Should Be Asked During the Exam For Your Running Pain?
During a history, we are creating the story that surrounds your challenges, getting more background information, and asking you things you may have not considered yet. Together, these help you inform your own goals.
Here are some types of questions that should be asked in your history:
- Where is your pain located?
- When did this start?
- Is this something that is constantly present, or comes and goes?
- What does the pain feel like?
- Does this change with activity?
- What does your pain scale look like?
- Are there any medications or interventions you do now that make it better? What about things that make it worse?
- Do you have any numbness, tingling, or weakness of the area or other areas corresponding with your pain?
- What’s been your experience with this pain thus far? Have you already seen anyone for this?
- How is this pain with running inhibiting your day?
- What is this pain taking away from you right now?
- If you had no pain at all right now, what would you be doing differently?
- Do you have any short and long-term goals after reading those last two questions?
Whether it is getting back to playing the piano, hitting a PR in the Denver Marathon, or simply catching your littlest one running around the house, our goals for recovery should reflect where we are. We all need to have these types of questions discussed to set the best and most successful plan. You’ll find that at Modern Movement Clinic.
You might be thinking at this point “Okay Doc…you sound like you know your stuff. What’s next?”
What’s next is letting all this sink in.
Modern Movement Clinic is a cash-based practice that prides itself on how efficient, well-read, and communicative we are with who we work with. Notice we said ‘with’ and not ‘on’. You’re not a patient. You’re our client and with that comes a working relationship.
The time you spend with us is exactly that, with us. If you booked with Dr. Jesse Riley, your time is spent with Dr. Jesse Riley. That’s a rare thing in clinics today and quite honestly what separates insurance-based clinics from cash-based clinics. Don’t read that the wrong way. The insurance-based clinic is trying to make ends meet by commonly having a higher volume of people at one time but the system itself needs a “modernizing” of its own. That’s for another post though.
In any recovery plan, there will be ups and downs, but when working with someone like a movement therapist and chiropractor at Modern Movement Clinic for your running pain, know those downs will come with a little motivation, a little advice, and a lot of movement to get us out of that and moving back towards our goals.
We see cases of people having running pain for days, weeks, months, and even years. For as long as it goes on, don’t let this dictate that will take as long to eliminate it. At Modern Movement Clinic, you’ll gain the empowerment to know you can control this, enlightenment to know what your body is telling you, and education to carry with you moving forward.
We’re only a few clicks or a phone call away and we appreciate your consideration.
***Content of this blog is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Seek the advice of your physician or other qualified health providers with any questions you may have regarding a medical condition.***