Training for an endurance event invariably leads to some degree of aches and pains. Difficulty arises when trying to decide what “normal” wear and tear is and what a potentially serious injury is. As an endurance athlete I personally deal with this issue frequently and as a sports medicine physician I am asked about this dilemma daily. While I do not want to discourage anyone from seeking medical advice, that would be bad for business, there are some common sense guidelines that an athlete can use when trying to answer the question “when do I need to see a doctor?”.
Most athletic injuries are chronic overuse problems but acute traumatic type injuries will happen. It can be tempting to take a wait and see attitude with these but a visit to the emergency room may be more appropriate.
Don’t’ Wait If:
- Pain is not adequately controlled with over the counter pain medicine and ice
- There is a noticeable deformity
- You are unable to bear weight on the injured extremity.
More common to the endurance athlete are overuse injuries that occur when your body does not adapt to the training load and breaks down resulting in pain.
Types of Overuse Injury:
- Plantar fascitis
- Achilles tendonitis
- Iliotibial band syndrome
- Tennis elbow
- Rotator cuff tendonitis
If the inevitable pain of training cannot be controlled with relative rest (backing off), over the counter pain medicine and icing a visit to a health care professional may be required.
Pain, while not desirable, is to be expected at some point during training. If the discomfort you feel is limited to the activity and doesn’t interfere with your form it may be fine to try to work through it. Specifically pain that is noticeable during warm up, improves as you loosen up, and possibly returns towards the end of a workout is less worrisome.
Warning signs for more serious problems:
- Constant unremitting pain
- Pain that interferes with sleep
- Pain that worsens significantly with activity and takes more than overnight to recover.
- Significant swelling that lasts more than a few days
- Locking and catching occurs when there is a mechanical block such as torn cartilage in a joint.
- True giving way indicates a ligament or tendon tear.
- Knee or ankle buckling with weight bearing or twisting and shoulder giving way with reaching are concerning symptoms.
How long does one wait for the pain to improve?
Difficulty arises when trying to decide how long to give the pain to improve. No concrete guidelines for this are available. Pain in a child or teen that lasts more than 2 weeks or in an adult that lasts more than 3 to 6 weeks would concern me.
- Some minor swelling often occurs in the initial stage of a benign overuse injury.
- Noise coming from a joint such as popping or catching doesn’t necessarily indicate a problem if they are not associated with locking or catching.
- Weakness frequently occurs in the early stages of injury due to muscle inhibition from pain and swelling.
Fortunately for us most of the aches and pains of training resolve with time. The trick is determining when giving the injury time will not do more damage. Hopefully these tips can alleviate the initial panic that occurs when training leads to discomfort. Pushing through the pain can be done safely if technique is not sacrificed, if recovery after a workout is quick and if the issue resolves in a sensible amount of time.
Dr. Scott Logue