RTTC #209 Before You Stop Running Because of Pain Listen to This

In this episode of Running to the Castle, Dr. Ali Marty breaks down one of the most common fears she hears from runners: that a painful week of training means they've injured themselves and need to stop completely. 

Drawing from three recent conversations with runners dealing with knee pain, shin splints, and IT band issues, Dr. Ali explains why a single normal week of workouts is almost never the cause of sudden pain, and walks listeners through the real questions to ask.

1. What did your warm-up and cool-down look like? 
2. What else changed in your life this week? 
3. Are you actually doing your post-workout recovery?

She shares how factors like moving to a home with stairs, wearing high heels to a wedding, or skipping foam rolling after speed workouts can quietly accumulate into pain that feels like an injury but isn't. 

Dr. Ali also busts the popular belief that strength exercises heal pain, using her physical therapy background to explain the 10 to 14 day natural healing window and why "Sally's" knee getting better after starting squats was a coincidence of timing, not cause and effect. 

The episode closes with a powerful reframe... pain is your body saying "not this, not right now"... not "stop forever."

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  Hi, I'm Dr. Ali
  I've been running for 15+ years and been in the rehab space since 2012 when I earned my Doctor of Physical Therapy Degree. I get injury prone runDisney runners across the finish line without feeling broken.

Transcript

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Hey, how's it going? Today I'm talking about before you stop running because of pain, listen to this. This is Running to the Castle, a podcast for injury-prone Run Disney runners on a journey to running magical miles. Join me, Dr. Alley, as I share the secrets I've gathered as a runner, doctor of physical therapy, and coach. You'll learn the exact ways I get my clients to the castle strong without feeling broken or held together with KT tape as they cross the finish line. In the past couple of days, I have had three, yes, three separate conversations with runners in Stronger Faster Finisher, one in my DMs, asking about asking about their training. And basically, they all were very nervous that they were training too much. And they were going and they were just going and doing too much because they had pain. One was knee pain, one was shin splints, and one was like I T band outer knee pain. So I guess two were knee pain. And with everything. So this, I will say, this is this is one thing that I really like doing. I feel kind of like a detective when I'm doing it. I don't know. It's it's taking in all of the different pieces and putting the puzzle together. My mind works so well with that. Like I was listening to a podcast that I listened to to run my business, my coaching business. And uh the person on the podcast was saying, like, well, what's your superpower? And I was thinking, I don't really know what my superpower is. Maybe it's this. Because like I feel like that meme where it's just like all those different numbers going around that lady's head, right? Like this is what starts happening when somebody is telling me, like, oh, I have this kind of pain, or I can't get past this pace, or I always, you know, can't, can't seem to, you know, have enough endurance to finish the half marathon, the 10 mile or or what have you. And so my mind starts putting all of these pieces together. And it's like, okay, let's take a breather. Because if you've been around for any length of time, you have heard me say, pain means not this, not right now. It doesn't mean stop completely. And that's one of the ways that how I coach is way different than how other people coach. And there it's to no fault of their own. That is, that's no problem, right? Like eventually the person will get better, stronger, faster if they follow that coach's advice. I'm not saying that that advice is wrong. I know from my physical therapy background, I know how much load a muscle can take, a tendon can take, a ligament can take, a bone can take. Like I know that information. And so, and and I know that information based like with how much your running, strength training, and and all of it put together. So I can look at or I can hear what somebody is doing for their training, and I can tell them whether it's too much training and they do need to back it down to help their pain, or if it's something else. And it could be something completely unrelated to running. So, what I don't want to have happen to you is I don't want to see you take a break for two weeks, come back to running. And the two-week break, yes, you started to feel better, but it comes right back after a two-week rest break. Now, going back to like these other coaches, personal trainers, and people who say, like, stop what you're doing, that's fine because they may not know this other information of how much the body can actually take, what descriptions and symptoms mean an injury that needs you to stop versus an injury that just needs an adjustment. And usually those coaches will say something like, Well, go see a healthcare professional. I am a healthcare professional. I am giving generalized advice and I am not your healthcare professional. So, of course, take this information with that in mind. And if you know your body, and I say this to my clients all the time too, because I'm not their physical therapist, but you know your body way better than I do. But let's work through this. And if you still think that you should stop rest and go get an x-ray, get an MRI, talk to a physician, absolutely I'm not gonna say don't do that. Let's work through it to see where we're at, right? So, one case in particular that I'm thinking about, this person had knee pain. And so they literally said to me, I can't imagine that one week of workouts pushed me over the edge and caused me to get injured. Just that statement alone, I can tell you no. Unless it's a traumatic injury, like you rolled your ankle, you stepped wrong and felt a pop in your knee, you got hit by a car, you fell down the stairs, you fell and landed directly on your knee or your tailbone or something like that. Those are traumatic, right? I'm not talking about that. If it was a regular workout week, no trauma happening, didn't get hit by a car, didn't fall down, didn't step wrong, it's unlikely, it is highly unlikely that the discomfort and pain that you're feeling now is an injury that's going to keep you out and was caused by this one week of injury. Excuse me, one week of workouts. So the runners did Princess Weekend and then followed the two weeks of rest and recovery, as I have laid out in my free training plans, in my stronger faster finisher program. And then this week was getting back into running. They pace tested, they did a speed workout, and they did a quote unquote long run. The long run was still low mileage in the three mile range. They did some cross-training and the that was it. And so just hearing that information, I'm like, unless I am not hearing something, excuse me, unless I don't know, unless they are withholding information, which I don't think they are, then this set of workouts is not the culprit, is not the cause of the pain. And so then we started diving into things. And so one of the first questions I ask is what did your warmup look like? What did your cool down and your post-workout recovery look like? Because all of the things to build the speed, to build the stamina, to build the endurance, all looked fine. They didn't go beyond the 10% rule because they're trained up to a half marathon race distance. So after a two-week rest and recovery with walking and 45-minute easy runs, 45-minute easy run for most runners is going to be between two and three and a half miles for my slow, slow category of runners. Right. So that's essentially having just one week off from that distance of running, and then they're repeating it this week, essentially. Let's look at the pacing. Is the pacing significantly different? No, because they did pace tests. So these are new paces, but they aren't going from zero because, like I said, they are trained up to the half marathon race distance. They were doing speed workouts at somewhat close to these paces. Now, of course, they're faster now, but it's not like they went from just walking to now all of a sudden sprinting for 45 minutes. So I was like, something isn't adding up. What was the warm-up? When I when does the pain come on? And what does the cool down and post-workout recovery look like? So we learned a couple of things. Post-workout recovery was next to none for most of these workouts. They admitted that typically they're just doing it on the long run or after the long run, not after the speed workouts, not after strength training, not after cross training. Oh, they also did strength training in the week as well. Um, so the post-workout recovery for anybody that's new, that's 10 to 15 minutes of stretching, all major muscle groups, foam rolling or massage gun or professional massage. And that's if it's foam rolling or massage guns, between five and 15 minutes, all major muscle groups. If it's a professional massage, I recommend at least 60 minutes. You only need to do that once a week. And then also a heat or a cold source. So if you like a hot Epsom salt bath, if you like a cold bath, those are my two recommendations because being submerged in the water does get uh is more effective. However, a moist hot pack can work or a cold pack can work as well. And all of those, um, the hot pack, the cold pack, those are 20 minutes at a time after every workout. And a hot epson salt bath is at least 20 minutes and a cold bath, whether it be your whole body or just the body part that is um in pain, that's three to five minutes. I do recommend this after all workouts, especially intense workouts, whether it's a long run, like long mileage, or a fast, intense workout. So I do recommend doing that. So if it's out of balance where the post-workout recovery is lacking, stopping working out, stopping your running, stopping your speed workout, stopping your long runs is not going to change your pain when you come back to it. Even if you take two weeks off, will you feel better after two weeks from a uh a pain that's like this? Absolutely, you will, because your body will have done what the heat, the ice, the foam rolling and the stretching were speeding up, right? Like those things stimulate your body to initiate or continue the healing process for any micro trauma that has happened, which when you're a runner, micro trauma is always happening when you're working out. It's natural to the muscles and the tendons. That is going to happen, but it's micro, it's super duper small. Most of the time you don't notice anything. But that's why you feel things like stiffness and tightness after a long or an intense workout, like later in the day or the next day. And it's why you're a little bit sore from that intense workout because you have some of this micro tearing. But when you stretch after your workout, when you use ice, when you use heat, and when you get massage or use the foam roller or the massage gun, you are stimulating your body to fix whatever is going on there. So instead of your body having to catch up 24, 36 hours later, it starts doing it right away. So you're already like a day and a half ahead of the game, right? But with the way injury recovery happens, whether it be micro damage or some real damage, the body can, if it's going to heal itself, it does it in 10 to 14 days. So taking two weeks off, which your doctor will tell you, oh, just take two weeks off and come back and see me, that's what they're going to say, because that's their tell. If it didn't get fixed in two weeks like it should, now it needs medical intervention. That's where that two-week timeline comes in. So if you take two weeks off to rest, will you feel better? Yes. But if the cause of the problem isn't fixed, you're going to just keep going in this cycle and you're going to keep having this pain. So, yes, maybe, maybe when you go back to running, you aren't running as far in your long run because you think you ran too far and went beyond that 10% rule. So instead of five miles next week, you you drop it down to three miles. But if you're not doing that post-run recovery and that post-workout recovery, and that's what the issue is, you're going to have this issue again. And so we start needing to look at these pieces. We also need to look at the pieces of what else is going on, right? Like what else happened this week? How was your sleep? How was your fueling? How was what you were eating and drinking throughout the week? Have you done something different in your activities just throughout the day? And with talking with this client, she moved. And now there are stairs that she's going up and down. Where she lived before, it was one story once she was in the home. So having to go up and downstairs all day, much different than staying on a single level, not going up and down. Are you wearing different shoes? Did you have to wear high heels because you went to a wedding that was 75 hours long and you don't usually wear high heels? Well, high heels are going to put stress and strain on your body and your muscles differently than if you are always in tennis shoes or flats. Right? Like I told this story a couple of weeks ago on a on the workshop that I did. And when I was in grad school, my capstone um my final research project was on Achilles tendinopathy, specifically non-insertional Achilles tendinopathy. So what that means is insertional means it where the Achilles tendon attaches to the heel bone, non-insertional is above that. So anywhere above that, but it's typically at a very specific spot, is very common in recreational runners and recreational runners in their 40s, specifically men more than women. So we had to do all of this research for this. And so when I was learning about Achilles problems and Achilles' tendinopathy, I also came across a lot of Achilles rupt. Not because they're related, not always related, but because of the term Achilles when you're researching. When we were researching it, we were talking about this example that was a news clip where somebody was going out on the tennis court who normally doesn't play tennis. She was doing some kind of promotion for something, and she was all dressed up in the tennis gear. She was in the tennis shoes, she was in the tennis skirt, everything. And she was hitting some balls for the promotion, and she ruptured her Achilles. And the people doing this news story were like, oh my God, like I can't believe she ruptured her Achilles. Like you'd think it would have been when she was in her high heels. Well, friend, it is not surprising to us in the physical therapy world that somebody who is normally in high heels and then goes into tennis shoes ruptured their Achilles because the high heel keeps your heel elevated. So it actually shortens your calf and shortens your Achilles. When you go into flat tennis shoes, you then stretch out that Achilles and you stretch out that calf muscle. That's why the heel drop is so important on running shoes and not changing that heel drop from shoe to shoe, like you personally not wearing different shoes with different heel drops, because it's going to put different stress on your Achilles. But no, it doesn't surprise any of us. Of course. Of course, that's when she ruptured it. Now, is that the outcome every time? Somebody who always wears high heels and then goes into tennis shoes, is that always the outcome? No, no, it's not. But I'm not surprised that it happened when she was wearing tennis shoes and not her high heels. But that's an example of something that's not running related, the shoe choice affecting some pain, right? So if it's a shoe choice from going to a wedding, which the heel, excuse me, the high heel, when you're in high heels, the most common symptoms I hear people say are front of the knee pain. And it's usually a sharp pain, like somebody is tearing at their skin or tearing at their muscle in the front of the knee and low back pain, because high heels make you arch your back and they make you uh bend your knee if you're going to compensate for how the high heels make the rest of your body look. And so if you're in high heels for seven hours, I know I said 75 hours earlier. 75 is my exaggerated number, in case you don't know. But let's say you were in them for seven hours because you were part of a wedding party and you start taking pictures at noon and then you're still dancing through seven o'clock and wearing your high heels, but normally you don't, does it feel fine when you're wearing them? Yeah, maybe. But the next day it might not feel fine, or two days later it might not feel fine, or not until you go on your run, it may not feel fine. So if you took two weeks off because that run felt like it injured your knee, but in fact it was because of the high heels. If you continue wearing the high heels, because maybe somebody gives you a compliment and you start wearing them, well, then that's gonna just keep causing this knee pain that wasn't caused by the run in this case. So when something hurts after a run, one, it's unlikely to be that singular workout or that singular week of workouts. Start looking at what did I do this week that's different? What in the workout and outside of the workout in my everyday life? Is sleep okay? Am I eating the same? Am I am I wearing something different? Am I just doing something different? Am I going up and down the stairs all the time? Did I sit in a weird position on the couch? Am I sitting like that all of the time? Right? Start looking at these other things in addition to what you're doing in the workout. Pain is your body's way of telling you not this, not right now. And if it's not happening during a workout, it can be really hard to pinpoint what's going on, but start looking at what did you do during the workout all week? What else is going on throughout your week? Am I doing my post-workout recovery? Because that's another thing. One of the top questions I get when somebody has pain is what strength exercises can I do to fix this pain? One, strength exercises won't fix the pain. Can it help prevent it from happening again if it's a weakness issue? Yes. If strength exercises have ever helped somebody, whether it was you yourself or another runner on Facebook, I invite you to look at what else were you doing? This is something that I saw a lot in the physical therapy clinic, where somebody would come in and they'd say, Well, my neighbor Sally had knee pain. She's been seeing you for like a month or two. And she said that you'll give me strength exercises to fix my knee pain, because the strength exercises you gave her fixed her knee pain. And I am so glad that Sally doesn't have knee pain anymore. But it wasn't the strength exercises. Because in physical therapy, all of the other stuff we do, we do heat, we do ice, we do stretches, we warm up before exercise, we do mobility exercises to bring blood flow to the area. Maybe we do eSTEM, maybe we do dry needling. Like it's a whole combination. It's not one thing in particular. Now, is it a specific combination per person? Yes, absolutely. The kicker is we start off doing a bunch of these other things in the first two weeks to get things to calm down, the pain to go away, inflammation to go away, and things to overall feel better. And then at like the 10 day mark, then we start introducing a few. A few exercises that are that the muscle needs so that it does get stronger and we can prevent this later. Well, friend, in that 10 to 14 day timeline, the pain is the body is naturally healing, whatever micro tearing has happened. And it just so happens that at that same timeline, the person Sally started the strength exercises. So that's what Sally correlates as fixing the pain. But I promise you, that's not the case. It's a whole combination of things. Now, of course, yes, does movement help? Yes, because it brings blood flow to the area, and blood flow brings the good nutrients that help the healing process. If you don't have good blood flow, you don't have good healing. It's one of the biggest problems with smoking, is when you smoke, you actually damage the ends of the blood vessels. They're called capillaries. Or if you're in the UK, capillaries learned that from uh, oh, there's a song. Gosh, I can't think of it right now. There's a song, and it's very popular on Instagram and TikTok. God, anyway, she says capillaries. And I was like, what is that? It's it's we say capillaries here in the US. Anyway, the capillaries are the end point of your blood vessel where it attaches to the other thing, where it attaches to your skin, where it attaches to your muscle, your tendon, your ligament, your what have you. When you're a smoker, those are damaged. And so you don't have as many connections from the blood vessel to that area. So that's why people who smoke, it takes longer for them to heal. It's one of the reasons. Anyway, you need good blood flow to heal. And so doing some movement, like three squats, five squats, does that look like you're doing a strength exercise? Absolutely, because squats are a strength exercise, but in that dosage, it's more of a move, a mobility exercise to get blood flow and movement. But the timeline, and the timeline is very specific. I would start those types of motions at 10 to 14 days, like this squat. I would wait because I know the healing process timeline. And I know that the body will have healed the micro trauma, helped with the inflammation, helped with the pain. And so I can start doing those types of exercises now and not cause more micro trauma to already torn muscles or tendons. If I started it on day one and kept going, well, the body might not be able to catch up and heal. We needed those 10 days of not doing it. And so I did start those squats at that timeline to make it line up with the natural healing process. And then Sally notices pain relief at the 10 to 14 day mark. That's when we started doing movements and exercises that to her looked like strength exercises. So she correlates that with what healed her. So I totally get where you're coming from when you want strength exercises. I also know that everybody and their mom will say you have pain because you're weak. Okay, maybe I don't know you. I don't know you. Maybe, but pain doesn't get rid of, excuse me, strength exercises don't get rid of that pain. Can it prevent it from happening in the future? Yes. And just overall support your body so that if it's a positional issue, you don't get into that positional position again, or if it's um a control issue, like I see it a lot with shin splints, posterior shin splints, anterior shin splints, where it's it's a control issue of how the foot is landing. And so strength exercises will help that control issue. But strength exercises themselves do not heal those shin splints, just as an example, because that's the one that I'm thinking of there. Just like the strength exercises didn't heal Sally's knee pain. It just so happens that when those exercises were started, that was the timeline that it was okay to start them. And it was also the timeline where the pain really goes away if it's going to without medical management, more medical management, because by the time you're in physical therapy, that is considered medical management. Right? So if you're having pain with a workout, stop, take a step back, not literally stop in the moment. I mean, you can, but start thinking to figure out was it the workouts? Was it the accumulation of workouts? Was it all of these workouts together? Was it something else I'm doing? Is it something I'm not doing? And start figuring out that timeline. A lot of the time it's a lack of post-workout recovery because you're all really good at doing the stuff to build you up, doing the miles, doing the speed workouts. And we forget about the recovery stuff because it seems more like it's passive for running, like we need to run to get better at running. Well, yes. And we need to support our body so that we can continue to run. So I invite you to look at these things the next time you start having pain.