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Running With An Injury: When You Should & Shouldn't Keep Going

Injuries are unfortunate. They are also quite common if you are training for a race or participate in regular exercise. Some injuries can be prevented with careful program planning, cross-training, regular body work, proper refueling and nutrition, and well timed rest breaks. But often times, injuries still find a way to interrupt a well laid out plan. This can lead to a difficult decision: do you run and train through the pain? As a physical therapist, marathon runner, and yogi in Denver CO, I've dealt with my own injuries and helped countless clients heal and find their way back into pain-free exercise.

Sand Dunes National Park

The classic physical therapist response is "it depends" when a client asks if they should rest or to keep training through the pain. Often times it does depend, and the answer is usually complex because running is a repetitive activity; you put one foot in front of the other, over and over and over again! An 8 minute per mile pace results in about 1,400 steps each mile. That number increases to about 1,500 steps each mile at a 10 minute per mile pace. For anyone running regularly or training for a race, those steps add up quickly!

Each runner's stride varies in hundreds of different ways. A few main variations include heel strike vs. forefoot strike, amount of pronation through weight acceptance, degree of hip extension and thoracic rotation, and vertical vs. horizontal center of mass change. These factors can be altered based on shoe wear, terrain, pace, body mechanics, and fatigue. All these puzzles pieces can effect each-other and lead to the possibility of staying injury free, or developing an over-use injury.

Over-use injuries are caused by repetitive strain to a tissue that is unable to withstand the load that is being put on it. Tendons, ligaments, muscles, fascia, and joints are all susceptible to over-use injuries.

Common Running Over-Use Injuries Include

  • Patellofemoral pain (aka "runners knee")

  • Shin splints

  • Peroneal tendonitis

  • Achilles tendonitis

  • Glute tendonitis

  • Plantar Fasciitis

  • Low back pain

  • Stress fractures

  • Pelvic floor dysfunction

Pain can be an overwhelming and confusing sensation. Sometimes it might not even feel like actual pain! Training for a race usually means suffering through discomfort related to fatigue and soreness. This discomfort can often mask the beginnings of an over-use injury.

Clues that you are developing an over-use injury

  • It takes longer than 24 hours to recover from exercise

  • The same discomfort/pain occurs at the same distance or time of a run

  • You have to take medication to help fall asleep due to discomfort/pain

  • There is a nagging tightness that you can't seem to stretch out no matter what

  • Swelling occurs after a run or exercise

To Run, or Not to Run?

If you are suspicious that an over-use injury is developing, the first step is to take a rest break for 3-7 days. Your rest break is over when you can do all your normal daily activities without feeling pain or discomfort. Try a short and easy training session paying close attention to the return of your symptoms. If you remain pain-free during and after your easy training session, slowly build up your training load over the next 1-2 weeks. If you remain pain free this indicates that your training load was too much for your body and your tissue just needed a break. But if you attempt to resume your training and your familiar pain is there, it is time to seek extra help from a physical therapist with experience in manual therapy, dry needling, and running.

The key to treating an over-use injury is to find the root cause of the issue. If there is an underlying weakness, stiffness, or limitation motion, no amount of rest will fix that. If you continue to train through the imbalances, there is a high chance that the over-use injury will become worse. Physical therapists are experts in putting these puzzle pieces together and providing a targeted clinic and home exercise plan to resolve the root cause of issue, improve it, and get you back running!

Need help staying injury free - contact Jessica ( to develop a training program (inclusive of running plan, nutrition, and strength training).

Suffering from an injury? Book an appointment here:

Marathons: NYC 2018 (finish time 3:41), Chicago 2019 (finish time 3:26) Boston 2021 (finish time 3:32)

Other favorite races: Mt Marathon (Seward AK), Half Ironman Relay (Cabo San Lucas), Skinny Mini 6k (Anchorage AK), Cherry Creek Sneak (Denver), Colfax Half Marathon (Denver), Sunrise Triathlon (Boulder)

Picture: Chicago Marathon 2019 @ mile 20

Dr Jessica Klain PT, DPT, COMT, CSCS, OCS, CNPT

Board Certified Orthopedic Clinical Specialist (OCS)

Certified Strength and Conditioning Specialist (CSCS)

Certified Orthopedic Manual Therapist (COMT)

Certified Nutritional Physical Therapist (CNPT)

Certified Vestibular Specialist

Certified Concussion Specialist

Trigger Point Dry Needling Certified, Level 1&2

Certified Yoga Teacher

University of Florida, Doctorate in Physical Therapy (2009)

The Ohio State University, Bachelor of Science in Biology (2006)

Call/text: 720-295-0060


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