How to feel about pain
The difference between pain and injury, plus 7 scenic halfs in Arizona, California, Colorado, Massachusetts, Oregon, Utah + Wyoming
Editor’s note: I hope you’ll forgive me for being late with this week’s newsletter, as I was glued to the news in shock, horror and dismay yesterday (like you, no doubt). Thanks so much for your patience, and I hope you enjoy this fantastic new essay by our friend Amanda Loudin, who explores something nearly every runner experiences at one time or another: how to tell the difference between ordinary pain and serious injury, and what to do about it. — Terrell
Like all runners, there’s nothing I fear more than being laid off my favorite activity due to injury. This is especially true during the pandemic—it has been something of a lifeline for me the entire nine months. So, when I felt an out-of-the-blue pain in my shin a couple of weeks ago, I panicked.
My thoughts immediately began swirling: What if it’s a stress fracture? What if I have to work out indoors all winter? I don’t want to lose fitness. On and on, rinse and repeat.
But then I took a step back. I’ve been running for more than 20 years and I’ve learned a few things about injury and pain in that time. Most of what I’ve learned is thanks to the wisdom and guidance of my physical therapist, Gene Shirokobrod. I interviewed him recently so that I could share some of his insights on pain and injury, and how to understand the difference.
Take a deep breath
The first thing you should understand about pain is that you have a bias where it is concerned, stemming from your past experiences.
Sprained an ankle at some point and managed to get back to running three weeks later? You might then be fairly confident if you twist your ankle on a trail run. Had a stress fracture in your tibia 20 years ago that laid you up for six weeks? Then you, like me, might be fearful when you feel something off in that general location.
“You experience pain based on whether or not you’ve felt it before,” says Shirokobrod. “If you’re feeling pain in a particular place for the first time, that uncertainty can make it feel worse. If you’re familiar with it, your response will be formed by how it resolved before.”
But how do you determine if that pain means injury? That’s where it gets a little trickier and also, worth some evaluation. “Pain is a response to a new stimulus,” explains Shirokobrod. “Your nervous system is raising the question of ‘what’s going on here?’”
To figure out how to proceed, you have to look at pain on a spectrum, recommends Shirokobrod, and also determine what’s causing it in the first place. “Most injuries have a pretty clear pattern or event,” he says. “Look back and see what might have changed to bring on the pain. Shoes? Mileage? Something else?”
In my case, with my shin, it appeared during a planned cut-back week. I did a workout involving jump roping, something I don’t do all that often. The next day, upon getting out of bed, I felt that ache in my shin. While I did have a stress fracture in my other tibia way back when I first started running years ago, I took a few deep breaths and began thinking things through.
I haven’t made any jumps in weekly mileage in ages—in fact, I run within the same three- to four-mile range every week. Speedwork? Not that. I may throw in a few pick-ups here or there or some strides at the end of my runs, but that’s where it ends. New shoes? Also a no.
I strength train like a champ multiple times per week, so I knew I had that going for me, too. My diet is solid and really, other than the jump roping, nothing stood out as a contributing factor to my pain. I decided to proceed as usual for the next few days and test the shin out.
If your gait changes
Shirokobrod reminds that the initial inflammatory process following injury usually lasts about seven to 10 days. “This is when you should monitor the site of pain,” he says. “Is there increased swelling, redness or heat? That’s when you should see a medical professional.”
If, on the other hand, the pain starts to subside, and the swelling or other symptoms associated with it begin to go down, it’s probably a safe bet that you can start returning to normal activity.
Where do you absolutely need to draw a line? “If your gait changes to compensate for pain, that’s a good sign to stop,” says Shirokobrod.
With my shin pain, it didn’t really start subsiding in those first few days, so I decided that for peace of mind, an MRI was in order. I contacted an orthopedic doctor I have worked with in the past and he agreed, getting me in for the scan quickly.
In the meantime, I fretted and planned for how I would manage the coming dark winter without running.
The good news is that, in the end, I needn’t have worried. All was well with my shin bone and the only thing that showed up was some inflammation in the shin muscles, more than likely brought on by the jump roping.
In spite of all I’ve learned from my wise PT, I still panic sometimes. But overall, I’ve come a long way with my reaction to pain and have learned that a few days of evaluation and rest can go a long way toward peace of mind.
Disclaimer: Neither I nor my PT is recommending running on injury. Rest as needed while determining the next proper step.
Quote of the day
Races you’ll love running
Run Through Time Half Marathon
Salida, Colo. | Saturday, March 13, 2021
A scenic, challenging run along the historic and spectacularly scenic Ute Trail in Colorado’s Arkansas Valley, which in mid-March can be completely dry with sunny skies — or covered in snow two to three feet deep. You’ll have six hours to complete this course, which runs on a combination of single-track trails and jeep roads, climbing some 2,000 feet between the start and the finish line, at elevations between about 7,000 and 7,800 feet above sea level. Of course, with all that climbing uphill comes some incredible rewards, including views of Salida and the valley below.
$55 and up | Sign up here
San Luis Obispo Spartan Trail Half Marathon
Santa Margarita, Calif. | Sunday, April 11, 2021
Run along the hills and trails of California’s central coast at this day (and nighttime) race at Santa Margarita Ranch, a 14,000-acre working cattle ranch and vineyard whose history dates back to the 18th century, when it was settled by Franciscan missionaries. “Dash past vineyards and epic open landscapes, surrounded by the towering Los Padres National Forest,” organizers from the Spartan race series say about this event, which will be obstacle-free and take place over two days — with a 10K running on Saturday night and the 50K and half marathon running on Sunday morning.
$84.99 and up | Sign up here
Whiskey Row Half Marathon
Prescott, Ariz. | Saturday, May 1, 2021
Billed as “one of the toughest marathons in the United States,” this race in a small, gorgeous northern Arizona mountain town definitely lives up to its reputation, with a 1,000-ft. climb from the starting line to the half-way point in the race. You’ll start and finish downtown, next to the majestic Prescott courthouse, and from there make your way along paved roads through town. Later stretches of the race unfold along the dirt forest service roads inside the 1.2-million acre Prescott National Forest.
$80 and up | Sign up here
Jackson Hole Half Marathon
Jackson, Wyo. | Saturday, June 12, 2021
Brilliant blue skies over the majestic peaks of the Tetons off in the distance will be your constant companion at this race, which runs in the early summer just south of both Grand Teton and Yellowstone National Parks. You’ll start the race in Teton Village, which lies just south of the national park, and follow the bicycle trail that runs alongside Highway 390. All throughout, it’s a high-elevation race — from the start at about 6,300 feet above sea level, the course follows a long, steady descent to about 6,200 feet at the mid-way point of the race, with several rolling hills along the way.
$80 and up | Sign up here
Town & Country Half Marathon
Newburyport, Mass. | Sunday, June 13, 2021
You’ll get to run through a coastal Massachusetts town known for the stark beauty of its rocky coastline and beaches as well as its distinct culture and architecture at this race, which starts and finishes at the RiverWalk Brewery. From there, the race runs into the rural areas outside town, along rolling country roads lined with white picket fences, and along stretches of the riverfront along the Merrimack River when you’re in town.
$69.99 and up | Sign up here
The Dam Half Marathon
Oakridge, Ore. | Saturday, June 19, 2021
Run a course that some past runners have called the “most scenic in Oregon,” including a long stretch along the Hills Creek Dam in the Willamette National Forest near the small town of Oakridge, which lies just over a half-hour’s drive from Eugene. From the start along the banks of the Willamette River, you’ll run a trail that leads across a bridge over the river and then into the surrounding forest. Later miles unfold along the dam and beside the deep blue river flowing, with pine trees towering over the highway for much of the way.
$84 and up | Sign up here
Grand Circle Trailfest
Kanab, Utah to Page, Ariz. | Thursday, Sept. 29 - Saturday, Oct. 2, 2021
Three days of races take you through three national parks — a 13-miler in Bryce Canyon National Park the first day, followed by a 12-miler in Zion National Park the second day and a 10.6-miler around Horseshoe Bend, the famous winding spot along the Colorado River near Lake Powell where it begins to flow into the Grand Canyon (and the subject of untold thousands of photos over the years). The biggest challenge on the final day (other than the elevation) is that you’ll run through miles of soft sand, so you’ll have to stop several times to dump it out of your shoes as you run. If you’re a fan of running out in the wild spaces of our national parks, put this one on your list.
$775 and up | Sign up here
A song to run to today
“Running to Stand Still” from the album The Joshua Tree by U2.
Words to run by
“The chief beauty about time is that you cannot waste it in advance. The next year, the next day, the next hour are lying ready for you, as perfect, as unspoiled, as if you had never wasted or misapplied a single moment in all your life. You can turn over a new leaf every hour if you choose.”
— Arnold Bennett
Thanks for the info on pain. I think we (runners) have a higher tolerance for pain or we just flat out ignore it. It’s good to know that if it continues past a week or 10 days, we should seek help.
Hope you & your family are feeling better! I never saw a follow up on the 100 miles for December. I actually ran farther than 100 miles! 123.91 miles!!! I was shocked & proud.
As for the crazy stuff going on in the world—I feel the frustration of people who think they have been cheated, no one is held accountable or pay for their crimes, & nothing will change. I have participated in many peaceful protests for ideas I believe in. Violence is not the way to get change. That only aggravates people & causes more pain & despair. When you feel your voice isn’t heard though, that is frustrating. I try to do the best that I can with my actions, my voice, & influencing those around me. Change starts with me and with you and with each one of us. I hold tight to that & do my best to be a better person each day.
Thanks for all you do for us!!!
Timely post! The day after my long run last weekend I had severe back pain the next morning. I took a few days off from running primarily because I just didn't feel like running. After a few days of no noticable improvement I went to the doctor and was told I have a pinched nerve. PT is already helping so should be back to "normal" soon. However, it was a scary but good reminder to be smart and not try to run through the pain.