Running Pain Versus Injury and When It’s Worth Seeing a PT
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
At its root, pain isn’t necessarily a sign of damage, it’s our body’s way of saying, “Hey, something might be wrong.” Think of it like our body’s internal security system to threats. Our sensory nerves are the trigger for the alarm bell when it detects a threat, and our brain is the one in charge of 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!”
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 that are activated in response to a painful stimulus. Some brain areas (like those involved in sensation and movement) show consistent activity in people; however, there is variability in other brain areas associated with memory, emotions, attention, and more.
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 just can’t. It’s also what makes being a physical therapist challenging. I’m doing my best to understand you, and it takes time for that to happen.
Pain Changes Over Time
One of the most fascinating things about pain is that your body’s alarm system can rewire itself and become sensitive. 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.
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 lives 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 can actually 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. That’s why education, context, and the right rehab plan matter so much — they help turn the alarm down.
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: Nothing. Your alarm went off and your brain assessed it as a false alarm. Keep training.
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 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.
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.
Disclaimer:
This blog is for informational and educational purposes only and is not a substitute for medical advice, diagnosis, or treatment. Every runner is different, and what works for one person may not be appropriate for another. Always consult with a qualified healthcare provider before starting or changing your training or rehab program. If you're dealing with pain or injury, reach out to a licensed physical therapist or medical professional.
