When Should I Run Through Pain?

Legs and feet of joggers, running a marathon
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After a hard workout or a long run, you're most likely going to feel some overall muscle soreness. But when you feel pain in one particular spot, it could be a sign that something's wrong. In one study of over a thousand recreational runners, a quarter of them reported feeling pain before their race. This pain was typical of overuse injuries. Pain is a warning sign that you are training too much. You may need to slow down and let your body adjust properly to your training.

Grade Your Running Pain

Pain is very subjective; everyone experiences it differently. To determine how to respond to pain, think about how you would grade it on a pain scale of zero to 10 in terms of how you can tolerate the pain. Intolerable pain is a quick sign to stop running.

Mild Pain: 1 to 3

You feel this type of pain when you start to exercise, but it usually goes away as you start to warm up and continue running. The pain may be a sign of tendinopathy (for instance, pain in the front of the knee below the kneecap). This pain may be inconsistent and move around the body, or you may feel it bilaterally (in both knees, for example).

This kind of mild pain or discomfort is common and may be safe to run through. However, you don't want a mild pain to turn into a moderate or intolerable pain. Apply the P.O.L.I.C.E. treatment to the area of concern.

Moderate Pain: 4 to 6

This type of pain appears as you start exercising, but stays at a tolerable intensity throughout your run. It rarely passes your pain threshold and it doesn't cause you to limp or alter your running stride.

While it's okay to finish your run with this level of pain, it's best to listen to your body. What's tolerable for one person can be intolerable for another. If you are participating in a run you signed up for and have been training to compete in, you might want to finish. But if it is just a normal training session, it may be wise to stop so your pain doesn't get worse.

Resting and rehabbing this type of pain should take priority if you're experiencing pain after running, at rest, with daily activities such as walking, and/or it is affecting your sleep. Take a few days off from running and apply P.O.L.I.C.E. treatment, allowing your body to heal. A couple of days of rest or pain-free cross training now can save you from a full-blown running injury that sidelines you for a longer period of time.

Severe Pain: 7 to 10

This pain is severe in nature and you can feel it before, during, and after exercise. The pain increases as you continue running and will typically cause you to limp. You should never continue running when you feel this type of pain. Limping or any change in gait is always a signal to stop running. Consult your doctor or physical therapist and follow their recommendations.

Other Red Flags

Stop running and seek medical help for radiating pain, swelling, difficulty moving your limb or a feeling that it is giving way, numbness or tingling in an injured area, or an area that is painful to the touch. Also be aware of:

  • Sharp and/or radiating chest pain accompanied by excessive sweating and/or breathlessness; these are symptoms of a heart attack.
  • High body temperature with dry skin, dizziness, nausea or vomiting: You could be developing heat stroke.
  • Pain that is associated with tenderness over a bony landmark, such as on the front or inside of the shin bone. Bone stress injuries should not be taken lightly and can sideline you from running for weeks to months if not handled appropriately. Seek help from a healthcare professional like a physical therapist.

Don't go for a run with those symptoms. If they occur while you are running, stop as soon as possible and seek medical care. 

Running Pain from Head to Toe

Along with the pain scale, pinpointing where your pain is can help you determine what's going on and how best to respond.

Head

If you have a headache during or after a run, it could be caused by dehydration, bright sunlight, or exertion (due to swelling blood vessels). Taking over-the-counter pain medication should help. If it does not, or the headache is only on one side of the head, see a doctor. It's also important to get medical care if the first episode of exertional headache occurs after age 40, or the headache is accompanied by loss of consciousness, rigid neck, double vision, or vomiting.

Neck and Shoulders

Pain in this area may be due to being extra stiff with your running form, overusing your accessory breathing muscles, or a recent neck or shoulder injury. The repetitive impact nature of running can be bothersome, especially for shoulder injuries. It may be best to cross-train in the meantime and hold off on running.

Lower Back

High-impact exercise like running can cause soreness in the lower back, especially in runners just starting out in the sport. To address this, work on strengthening your core. Also work on unilateral lower body strengthening exercises along with core and trunk control exercises. Stretching is also important.

Hips

If you spend a lot of time sitting, your hip flexors (the muscles at the front of your hips) are probably tight and can be uncomfortable when you run. This should improve as you gain experience running, and also if you make sure to stretch and use a foam roller in that area. It's also important to warm up prior to running.

However, if you experience pain or swelling on your hip joint, or pain on the outside of the hips where there is a bony bump, you may have bursitis. Taking a break, along with a cross-training program and stretches you can do at home, would be beneficial (followed by a gradual return to running).

Knees

Runners can experience a couple of different overuse injuries that involve knee pain.

If your pain is on the outside of the knee, inflammation of the IT (iliotibial) band may be to blame. This tendon runs along the outside edge of the thigh, from the hip to the knee, and you should see a doctor or physical therapist for treatment.

If you feel pain around or under the kneecap, you may have runner's knee. Rest and ice the knee, and work on strengthening your quadriceps (on both legs).

If the pain goes from the top of the knee to the top of the shin, you could have patellar tendinitis. You can sometimes treat this with the P.O.L.I.C.E. method, but if that doesn't work or you have a lot of swelling, check with your doctor.

Shins

Pain in either the front or the back of the shins could be due to shin splints. This overuse injury can happen in new runners who try to run too much too soon. You can treat shin splints with rest and ice. But if the pain persists, check with your doctor to make sure you don't have a stress fracture.

Ankles

Soreness on the back of the ankle could mean Achilles tendinitis, which may be treatable with the P.O.L.I.C.E. method and anti-inflammatory medications. Sudden, sharp pain after a fall or a twist of the ankle could mean a fracture or sprain; you'll need to see a doctor for treatment.

Feet

If your feet feel numb or tingly, check whether your shoes are too tight. If your pain is mostly in your heel, and it's worse first thing in the morning, that's a sign of plantar fasciitis. If you experience a sudden, sharp pain, or pain that gets worse and worse as you run, this could mean a stress fracture—which requires immediate treatment.

Stress fractures can also occur in the hip, shin, and ankle.

Pain Prevention

Continuing to run with pain is a set-up for poor movement habits and patterns and potentially an overuse injury. Pain corrupts movement, which leads to compensating and working other areas of the body overtime.

It may be hard to reduce your running in order to prevent it, but in the end, you'll be able to run more if you stay injury-free. Always add mileage gradually and take rest days. These steps help you avoid over-training.

You might also check in with a running coach or physical therapist to see if improving your form would help with some of the discomfort you feel. For example, knee pain is often caused by overstriding (also called heel striking), in which a runner lands heel-first with her foot far out in front of her body. You can correct this by working on taking short, quick strides, trying to keep your feet underneath you.

How to Run Through (Minor) Pain

If you are at 4 or below on the pain scale, it's usually okay to keep running. Try these strategies to push through and finish your run.

  • Think outside your body. Let your mind take over. Try to focus on the outside and everything going on around you. Look around at other runners. Chances are there's someone else who looks a lot worse than you feel.
  • Change your stride. A slight adjustment can make a huge difference in your level of discomfort. Try to lengthen or shorten your stride a little, or kick up your heels a little bit. You don't need to do it for a long stretch—just enough to switch up the muscles you're using.
  • Distract yourself. Do whatever it takes to keep your mind occupied: Sing songs, play mental games, count people, talk to other runners. If you're in a race, focus on the spectators cheering and read their marathon signs. Pick a landmark, such as the next mile marker or water stop, and focus on getting to that. Don't think about how much farther you have to go to finish. Break your run into smaller segments.
  • Talk to yourself. Whether you think to yourself or actually speak out loud, give yourself a pep talk. Keep repeating your running mantras. Remind yourself what you've sacrificed to get to this point. Remember how you've run through fatigue and soreness before and how you can do it again. A review of research studies on self-talk found it to have a positive effect on athletes.
  • Take a walking break. Yes, it's perfectly okay! Walking during a long run or race gives your running muscles and joints a chance to rest and recover, and can really break up the monotony. Your mind can focus on doing something different, which can be a huge mental boost.
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