I read this great piece in Women’s Running Magazine on good pain verses bad pain and had to share it with my own readers! I’ve been talking a lot about these two and how a runner needs to understand the difference in order to push themselves to improve but know when to back off.
At the start of every high school cross country season, you get a lot of new runners to the sport that have never pushed their bodies like this before. What 15 year old (before they join a cross country team) has ever run a 35-plus mile week before? Done mile repeats at tempo pace (six times in a row)? And then followed it all up with 25 hill climbs on a massive trash mountain? I bet very few…
And as a result, these new runners push themselves (like they should) and feel the lactic acid build up in the legs, the pain in their muscles, the trouble catching their breathe, and so on. This is all “good pain” as we call it. It’s the stuff that makes you better – that is if you push through it.
However, at the same time, some runners feel different pains – pulls in their hamstrings, sore knees, shin splints, and serious trouble catching their breathe to the point of hyperventilation…These are what we call “bad pain” in some cases. (I’d say shin splints are a bad pain – but one that us runners know we have to push through…and keep running – on the grass or softer surfaces whenever possible.)
I tell my students all the time – know your body. Don’t quit a workout for “good pain” because then you’ll never reach your potential. At the same time, tell us (your coaches) when you have bad pain so that we can adjust if necessary. And by adjust I mean – send you to the pool or bike for a workout; and in worse cases, send you to the doctor to get checked out.
Anyway – here’s the article…and let me know what “good pain” feels like to you!?
After a strong week of running consistently, long distance and at a good pace, I woke up Sunday morning with severe and uncomfortable pain in the arch of my right foot. My Saturday morning run went fine and nothing seemed to bother the foot the remainder of the day…so I was confused with the sudden pain on the bottom of my foot. Out of fear and because it’s often what us runners do…I ignored it for the remainder of the day…limping while walking, skipping my planned long run and hoping the pain would just go away. Well surprisingly enough – it did. By afternoon, the foot felt fine. I put my foot in an ice bucket filled with water and ice cubes that night and hoped it would all be a distance memory in the morning. Monday morning came and the pain was back. I iced it again and waited until mid-day when it had completely gone away. I attended my team’s evening practice and with all feeling good, went for the five-mile run with no problems. I asked my coach his perspective and upon the suggestion of a San Francisco-based running friend, started to do some research on Plantar Fasciitis.
After a quick read-up on the ailment and its symptoms…it was clear. I am suffering from Plantar Fasciitis.
Plantar fasciitis is inflammation of the thick tissue on the bottom of the foot. This tissue is called the plantar fascia. It connects the heel bone to the toes and creates the arch of the foot. Plantar fasciitis occurs when the thick band of tissue on the bottom of the foot is overstretched or overused. This can be painful and make walking more difficult.
According to experts, you are more likely to get plantar fasciitis if you have:
Foot arch problems (both flat feet and high arches). (For those that know me…I have a very high arch. Until now, I never knew there were potential complications that could result from having a high arch. More on that here.)
Long-distance running, especially running downhill or on uneven surfaces
Sudden weight gain or obesity
Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
Shoes with poor arch support or soft soles
Plantar fasciitis is seen in both men and women. However, it most often affects active men ages 40 – 70. It is one of the most common orthopedic complaints relating to the foot. Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.
The most common complaint is pain and stiffness in the bottom of the heel. The heel pain may be dull or sharp. The bottom of the foot may also ache or burn. The pain is usually worse:
In the morning when you take your first steps. (In my case – I felt the pain in the morning after a long sleep as well as after sitting for a while.)
After standing or sitting for a while
When climbing stairs
After intense activity
Signs and symptoms:
Tenderness on the bottom of your foot
Flat feet or high arches
Mild foot swelling or redness
Stiffness or tightness of the arch in the bottom of your foot.
Treatment: I am in the process of icing and stretching my foot as often as possible. Additionally, I plan on purchasing a new pair of shoes with better arch support – something I’ve been too casual about. According to my research, you health care provider will usually first recommend:
Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) to reduce pain and inflammation
Heel and foot stretching exercises
Night splints to wear while sleeping to stretch the foot
Resting as much as possible for at least a week
Wearing shoes with good support and cushions
Other steps to relieve pain include:
Apply ice to the painful area. Do this at least twice a day for 10 – 15 minutes, more often in the first couple of days.
Try wearing a heel cup, felt pads in the heel area, or shoe inserts.
Use night splints to stretch the injured fascia and allow it to heal.
If these treatments do not work, your health care provider may recommend:
Wearing a boot cast, which looks like a ski boot, for 3-6 weeks. It can be removed for bathing.
Custom-made shoe inserts (orthotics)
Steroid shots or injections into the heel
Sometimes, foot surgery is needed.
Expectations (prognosis): Nonsurgical treatments almost always improve the pain. Treatment can last from several months to 2 years before symptoms get better. Most patients feel better in 9 months. Some people need surgery to relieve the pain.
Complications: Pain may continue despite treatment. Some people may need surgery. Surgery has its own risks. Talk to your doctor about the risks of surgery.
Prevention: Making sure your ankle, Achilles tendon, and calf muscles are flexible can help prevent plantar fasciitis.
Side note: As of late, I have been wearing out the toe area of my running shoes very quickly. It seems my big toe has been moving up and down more often and creating a hole in the top mesh are of my shoes. If you look at your foot when you raise your toe, you will notice that your arch and plantar fascia stretches or flexes. I am now wondering if this is all related…
Wondering what the most common injury that I see these days on our high school running team? Shin splints! Almost everyone goes through them at some point – some much worse than others and some facing the pain for a much longer time period than others. The “shin splint” has also, a result, become the catch-all term for lower leg pain that occurs below the knee either on the front outside part of the leg (anterior shin splints) or the inside of the leg (medial shin splints).
The question is why and how to prevent/lessen them once they’ve hit.
I’ll start out with the why:
A primary culprit causing shin splints is a sudden increase in distance or intensity of a workout schedule. This increase in muscle work can be associated with inflammation of the lower leg muscles, those muscles used in lifting the foot (the motion during which the foot pivots toward the tibia). Such a situation can be aggravated by a tendency to pronate the foot (roll it excessively inward onto the arch). Also, a tight Achilles tendon or weak ankle muscles are also often implicated in the development of shin splints. (This is another reason that slow mileage build-up is so important for the body.
So what do do with your shins once you are feeling the pain?
Ice your shins to reduce the inflammation (or pain)! The best way, we’ve found, is getting small dixie cups and filling them with water; putting them in the freezer and once frozen take them out, rip off the lip of the cup and run the frozen cups up and down your shins for 10 minutes each. Take a break and do it again. Some people will say to stop running – but this option is unfortunately not possible for all of us! As an athlete, you need to decide how bad the pain is and whether you can push through or not. Injuring yourself worse is not a good option either.
Gently stretch your Achilles if you have medial shin splints, and your calves if you have anterior shin splints. Also, try this stretch for your shins: Kneel on a carpeted floor, legs and feet together and toes pointed directly back. Then slowly sit back onto your calves and heels, pushing your ankles into the floor until you feel tension in the muscles of your shin. Hold for 10 to 12 seconds, relax and repeat.
In a sitting position, trace the alphabet on the floor with your toes. Do this with each leg. Or alternate walking on your heels for 30 seconds with 30 seconds of regular walking. Repeat four times. These exercises are good for both recovery and prevention. Try to do them three times a day.
If you continue running, wrap your leg before you go out. Use either tape or an Ace bandage, starting just above the ankle and continuing to just below the knee. Keep wrapping your leg until the pain goes away, which usually takes three to six weeks. Other options – if the pain is excruciating – are: cross-training for a while to let your shin heal. Swim, run in the pool or ride a bike. (See my post on pool running.)
When you return to running, increase your mileage slowly. As I said, the cause of shin splints if often increasing your mileage too quickly.
Also, make sure you wear the correct running shoes for your foot type specifically, over pronators should wear motion-control shoes. Severe overpronators may need orthotics.
Have two pairs of shoes and alternate wearing them to vary the stresses on your legs.
Avoid hills and excessively hard surfaces until shin pain goes away completely, then re-introduce them gradually to prevent a recurrence.
If you are prone to developing shin splints, stretch your calves and Achilles regularly as a preventive measure.