How to Know When to Address Pain: Lessons from Hank

This week, I had an interesting conversation with a runner named Hank. He asked a question that many of us have pondered:

"But I’m sore so often from running and mountain biking... how am I supposed to know if it’s something I need to take care of or just power through?"

This is a great question and one that’s harder to answer than it seems. How do you know when something is truly wrong? If you’re an active person, you’ve undoubtedly experienced pain during your activities. But does that mean you should stop doing the things you love whenever there’s pain? Fortunately, no!

The I3 Model: How Overuse Injuries Happen

At Base Camp, we use the Incomplete, Incidence, Injury (I3) model to help determine when to take pain seriously and when it might not be a big deal.

Injuries happen and develop over three phases:

1. Incomplete mechanics or recovery

2. Incident

3. Injury

1. Incomplete Mechanics or Incomplete Recovery

INCOMPLETE MECHANICS:

Imagine trying to do high-level CrossFit, but you can’t get your arms all the way overhead. Or running a marathon when you can only do seven single-leg calf raises. These are examples of incomplete mechanics. While they don’t guarantee injury, they certainly set you on the wrong path in the injury cycle.

INCOMPLETE RECOVERY:

There are three primary domains for recovery:

- Sleep

- Nutrition/Hydration

- Stress Management

If any of these are below 80% (rate yourself on a scale of 1-10), you’re not fully recovering from your activities. It's always a combination of these two factors. Better mechanics can buffer for poor recovery, and vice versa.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank was limited in his ankle range of motion and sleeps an average of 6 hours per night.

2. Incident: Check Engine Light

This is the first sign that something is wrong—the 'check engine light' your body sends to signal that something is off. Incidents include any symptoms or signs of pain and are often the hardest to interpret. Take these signals seriously. Part of why injury prediction is tricky is that the incident may not even be in the area of the actual injury. You may have a shoulder 'hot spot' that turns into a lower back injury or ankle stiffness that turns into knee pain.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank has hamstring tightness that always worsens when he increases his volume.

3. Injury: Limiting

The word 'injury' can be hard to define. Can we call it pain? Well, we’ve all had pain during activity that went away on its own or was just part of the activity itself (looking at you, hill repeats). What about tissue damage? There are millions of people walking around with meniscus tears who don’t even know it and have no symptoms.

Here’s the definition we use at Base Camp: Any time you have a symptom that keeps you from doing what you WANT to do, or HAVE to do, then it is an injury.

- Tingling so bad you can’t carry your groceries in? Injury.

- Knee pain that only starts when you hit 22 km, but you’re training for a marathon? Injury.

CASE STUDY: Hank, runner with Achilles tendon pain

Hank triggered his Achilles pain after a hard hill session.

Take Home Lessons

1. LISTEN TO YOUR BODY. Your body will send you signs that something is wrong, and that you need to do something about it.

2. ACT EARLY. When you are injured, it's late in the game to take action. We can't focus on the incomplete mechanics or recovery until we get the pain under control. It is way more efficient to focus on your mechanics and recovery BEFORE they become an issue.

3. YOU CAN GET BACK TO YOUR ACTIVITY. Injuries suck, but they don't have to limit you forever. Most of the time you don't even have to stop your activity.

CASE STUDY: Hank, runner with Achilles pain

Hank and I are now working to calm down his tendon pain, while he is prioritizing his sleep. Next, we will shift to improving Hank's ankle range of motion, and improving his lower back stiffness (the cause of his hamstring tension). Finally, we will reintroduce volume, intensity, and elevation to his running.

Dr Mark Murdoch is a runner, chiropractor, and rehab specialist in Vernon, BC.

Every week he works with runners, mountain bikers, and adventure athletes who want to get back to their sport better than ever.

Ready to get back to running PAIN FREE?

Start with a free consult with Dr Mark here: CONTACT