When Should I See a PT for Running Pain and Injury?
Every runner has probably asked this at some point: “is this pain just a normal part of running, or the start of an injury?” It comes with a lot of runaway thoughts -
“Do I stop or keep going? I don’t want it to get worse.”
“What if I’m damaging something, and I won’t be able to run anymore?”
“I have a race in 1 month; I can’t get injured now!!”
If that sounds familiar, you aren’t alone, it’s very grey territory. Personally, I can’t remember the last time I was on a run and didn’t feel something. In this post, I’ll break down the difference between pain and injury and help you decide when it’s worth seeing a physical therapist.
Understanding Pain: Your Body’s Alarm System
In 2020 The International Association for the Study of Pain (IASP) updated their definition of pain for the first time since 1979: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” They qualify that definition with six additional key notes:
Pain is always a personal experience that is influenced to varying degrees by biological, psychological, and social factors.
Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons.
Through their life experiences, individuals learn the concept of pain.
A person’s report of an experience as pain should be respected.
Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being.
Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain.
Woof. Let’s break this down.
Nociception vs. Pain:
Nociceptors are sensory nerves that respond to high threshold stimuli – things like pressure, temperature, or any other noxious stimulus – something that could cause damage. They send a warning message to our brain saying, “Hey, something might be wrong.”
Our brain is then responsible for determining if the threat is a real problem and the response. If you put your hand on a hot stove, the heat triggers the alarm bell and your brain says, “OUCH! MOVE!” What’s neat is that our brain can suppress those alarms if necessary and create no pain. For example, a soldier may suffer a gunshot wound but continue fighting, unaware of the injury until the situation calms down. Mechanical damage is real, but the brain suppresses the pain response in favor of immediate survival. Conversely, our brain can create pain in the absence of tissue damage. Consider phantom limb pain as evidence: there is no tissue left to hurt, yet patients continue to report pain as if the limb were still present.
Pain Maps:
There is not one pain area of the brain. fMRI studies, such as one published in Nature in 2022, show that people have individualized “pain maps” in our brain – patterns of activity that light up in response to pain. While some areas (like those involved in sensation and movement) show consistent activity in people; others associated with memory, emotions, and attention vary.
That means pain is deeply personal, and everyone brings unique memories, emotions, and interpretation to their experience with it. In almost every single patient interaction I’ve had, people tell me “I don’t know, it’s kind of hard to explain.” And that makes sense - how do you sum up your entire life’s experience in one sentence? This is why I hate pain rating scales. Asking someone to rate their pain is like asking them to rate how much they love someone on a 0/10 scale. You can’t. Nonetheless, pain ratings are treated as a “vital sign” in the medical world and medical providers use ratings to make important medical decisions. If you’re a clinician reading this, you need to dig into and recognize how a patient behaves and perceives their pain, not just ask about a number.
Pain Changes Over Time
Imagine if every time a squirrel jumped onto your porch, your house alarm went off. It’s not a break-in, but the alarm can’t tell the difference anymore. One of the most interesting things about your body’s alarm system is that it can rewire itself and become more sensitive.
A fascinating study in 2013 on back pain showed that when low back pain becomes chronic, the brain starts processing it less like a physical threat and more like an emotional experience. That means pain becomes less about tissue damage and more about how we feel, what we remember, and what we fear.
Not every runner deals with chronic back pain, but this idea still matters. Runners often deal with pain that drags on for weeks or months. When these symptoms linger, it’s not just the discomfort that’s frustrating, it’s the emotional weight of not being able to run. Running is more than exercise for a lot of people; it’s a stress reliever, a routine, even a social outlet. Being sidelined can lead to feelings of frustration, anxiety, or even depression. Those emotions don’t just sit in the background — they amplify pain. The longer we’re unsure about what’s happening or how to fix it, the more likely the pain is to feel "louder," even if the injury itself hasn’t worsened.
The key takeaway: the longer pain goes unaddressed or misunderstood, the more our brain and nervous system can amplify the signal. Your nervous system is constantly evaluating: is this safe? Am I in control? Can I keep doing this?
When does pain become a running-related injury?
In a previous post, I shared a formal definition of a running-related injury: pain that causes you to stop training and seek help. That definition is useful because it shows that pain alone isn’t the full story, it’s what the pain leads you to do. Pain is the signal. Injury is when those signals cause disruption.
Think of it this way: your body’s alarm system is working just fine if it briefly goes off and then quiets down. But if it keeps going off every day — or if it gets louder and starts interfering with your daily life — that’s when we stop calling it “just noise” and start calling it a problem.
So the real question becomes: when does pain cross the line into injury? The answer isn’t black and white. Because pain is personal, deciding what to do about it takes some intuition, pattern recognition, and sometimes help from someone who’s seen these patterns before.
Let’s break this down with three common running scenarios:
Scenario 1: Fleeting Pain
You start out on a run. As you get to the first half mile, you notice a little pain develop in the side of your hip. It lasts for about 2 minutes and feels fine, so you keep running. You finish the run and don’t notice it again.
What to do: Watch out for more regular or consistent pain, but no need to change training. Your alarm went off and your brain assessed it as a false alarm.
Scenario 2: Persistent, but Stable Pain
This time, the hip pain lasts your whole run. It was manageable, but it goes away after you stop. You do some of the rehab exercises you found online. The pain improves on your next run, but a month later, it’s still hanging around.
What to do: This is the grey area - the alarm isn’t blaring, but it’s going off a lot and isn’t quiet. Here is where you need to make changes, so it doesn’t develop into an injury. If you know how to make smart adjustments in your training ecosystem (rehab, intensity, volume, recovery, etc.), you might not need help yet. But if you’re unsure, stuck, or starting to feel frustrated or anxious, that’s a great time to check in with a PT.
Scenario 3: Worsening and Unclear Pain
You feel that same hip pain again, but now it’s earlier in the run and it lingers longer. It starts to feel different - more intense and unpredictable. You rest, try exercises, and skip a run, but it’s not improving. The next time you run, you’re limping.
What to do: Not good. Alarm is getting louder and maybe constant. This is where you most likely need a guide. When symptoms get more sensitive, less predictable, and makes you skip a few training days, that’s an injury. You don’t need to wait till it’s “bad enough” to see someone. The earlier you start addressing pain, the easier it is to make it go away.
When Should You See a PT for Running Pain?
You don’t need to see a physical therapist for every ache or tight spot. Pain is part of training, and sometimes it comes and goes without issue. But when pain starts to get confusing, persistent, or disruptive, it’s time to take it seriously and make adjustments.
Use this checklist as a guide. You might benefit from seeing a PT if:
You’re new to running and have started to have pain you don’t understand.
Pain is becoming more noticeable or constant.
You have pain that is causing you to miss runs or races.
You’ve tried your usual strategies, but they’re not working.
You’re in pain and have no idea what to do.
Even if you are just looking for reassurance or a second opinion, that is a valid reason to get help. Every situation is unique and needs a personal touch.
REFERENCES
"IASP Announces Revised Definition of Pain." International Association for the Study of Pain, 16 July 2020, https://www.iasp-pain.org/publications/iasp-news/iasp-announces-revised-definition-of-pain/.
Kohoutová L, Atlas LY, Büchel C, Buhle JT, Geuter S, Jepma M, Koban L, Krishnan A, Lee DH, Lee S, Roy M, Schafer SM, Schmidt L, Wager TD, Woo CW. Individual variability in brain representations of pain. Nat Neurosci. 2022 Jun;25(6):749-759. doi: 10.1038/s41593-022-01081-x. Epub 2022 May 30. PMID: 35637368; PMCID: PMC9435464.
Hashmi JA, Baliki MN, Huang L, Baria AT, Torbey S, Hermann KM, Schnitzer TJ, Apkarian AV. Shape shifting pain: chronification of back pain shifts brain representation from nociceptive to emotional circuits. Brain. 2013 Sep;136(Pt 9):2751-68. doi: 10.1093/brain/awt211. PMID: 23983029; PMCID: PMC3754458.
