by Brian Hay MS, DPT, OCS

Runners are constantly battling aches and pains.  How do we know what pain is ok to push though and what pain is not.   As a physical therapist I always educate patients that symptom recognition is the most important part of training.  It is typical to experience discomfort while increasing your distance and intensity.  However, it is not normal to experience pain.   Discomfort is general muscle soreness and joint pain that  resolves within 24 hours and it is a normal reaction to exercise.   Stiffness that resolves with stretching or activity is also a normal reaction.  Pain is distinguished by being present at the start of your run and gets worse as you continue or it forces you to change your running stride. Pain keeps you awake at night.  Pain is not okay, and you should not train when you have pain!

Brigham and Women’s Hospital categorizes running pain into 4 categories:

Type I: After activity: stretch affected area well (at least 3 to 5 reps, hold each for at least a 30 count), long, slow, gentle stretch, then ice for 20 minutes. Continue to progress program if discomfort appears to be muscle soreness. If joint pain and/or swelling develops, increase rest between exercise sessions and decrease activity level to previous level.

Type II: During activity, at beginning then dissipates: maintain same activity level and low intensity until symptoms dissipate.

Type III: During activity, gradually develops and intensifies: decrease intensity of activity, stop and stretch to relieve symptoms.  If symptoms are not relieved,  stop activity.  If symptoms continue, decrease activity to previous level.

Type IV: At night, keeps you up or wakes you up: bad, doing too much; total rest until symptom free, decrease activity to previous level and keep intensity low.

Upon waking: In the morning, upon waking, then dissipates: sign of more to come, decrease activity to previous level and keep intensity low.

If you are experiencing pain follow the R.I.C.E. method.

RICE works!
R =  Rest
I =  Ice
C =  Compression
E =  Elevation

If you continue to experience pain at rest or with running after a few days of R.I.C.E., you should contact your physician or physical therapist.  The sooner you address the pain the sooner you’ll be able to return to running.

For more information on injury prevention or injury recovery, please feel free to contact me:


phone: (401)726-7100