Five Problems You Should Not Try to Run Through-
Every single day, runners make judgements about the aches and pains they gather along their routes. The majority are blocked-out, and the running continues, perhaps with the aid of ice, anti-inflammatory medication, adjusted mileage or intensity, or, in many cases blind hope that the pain will "just go away". While most running related problems are not serious, rarely symptoms may indicate a problem that cannot be ignored without risk of serious consequences. While running up Pompey Center Road recently, in the midst of an unseasonably beautiful and warm sunny afternoon, I found myself negotiating with knee pain. ,To distract myself I thought of five situations that runners should not ignore, not try to run through, without seriously pressing their luck. One must keep one’s allotment of good fortune for the times one really need it, and not waste it on training in pain in such cases.
The number one most important problem is chest pain. There is no excuse for running through chest pain, especially if left sided, plus or minus radiation of the pain down the arm or into the neck. Sure, the pain could just be indigestion, or a rib muscle cramp, but chest pain should be acknowledged. Seek professional help, especially if there is dizziness, shortness of breath, a history of sudden death in the family, or prior smoking, high cholesterol, or high blood pressure. Such pain may indicate an impending heart "event", like death for instance.
Another serious problem, though not likely to kill a runner, is hip or groin pain (pain in the front of the hip, in the region of the skin crease, or radiating into the thigh). This pain should not be neglected, especially if there has been an associated increase in training intensity or mileage. Perhaps the worst stress fracture I can think of is that of the femoral neck, the junction of the sjaft and ball of the thigh bone. Such a fracture can be a career ending injury.
Next is back pain accompanied by leg pain, particularly pain that "shoots" down the thigh, particularly the back of the thigh, occasionally below the knee to the foot. The leg pain typically is "electrical" in nature, and may present without back pain, or with numbness, weakness or rarely, bladder or bowel troubles (loss of control). Unless running from a pit-bull, I cannot understand while anyone would try to "run through" , this problem, but I have heard this story countless times.
Shin pain, if progressive, persistent, and localized may indicate a tibial stress fracture. Nearly all runners will attribute shin pain to shin splints, and will run through this injury, at least at first. Once again training intensity and mileage are culprits, as is excessive pronation (flat foot), new shoes, running on the same side of the road, etc. A good clue is the distribution of pain and tenderness. Shin splints are usually tender longitudinally up and down the leg, typically medially (on the inside), whereas stress fractures are more localized, like the shape of a coin.
Finally, not all knee pain is "runner’s knee". Knee pain, especially after a run and accompanied by swelling, should not be ignored. Swelling is the best indicator of a potentially serious problem. Small amounts of fluid within the knee joint more often than not go unnoticed by runners. A good test to increase your recognition of fluid is to place the palm side of the hand immediately above the kneecap and push downward. If the normally concave areas on the sides of the kneecap bulge, fluid is likely to be present, which may indicate torn cartilage, or damaged joint surfaces (arthritis). Running under these conditions may make the knee seriously worse.
Everyday in my office I see runners with overuse injuries. All try to manage their problems, and most are successful with minor injuries. However, these five situation are in a category by themselves, and merit prompt recognition for the special dangers they present to the runner’s well-being and future success. If in doubt, get it checked out!
Dan Wnorowski, M.D.