Discussion: "Let pain be your guide"

I'm heard "Let pain be your guide" from PT's all over the place for years, as a good thing to do when deciding how much to exercise. But just how much pain and/or discomfort should be the guide?

Due to mild, but consistently increasing hamstring pain, I have now gone 16 days in a injury-recovery training mode.

The first week was mostly just no-running, then on 12/24, I did a test run at TheDabbler's pace on trails around VF park. On that ~50 minute run, my left leg was mildly uncomfortable for part of the first 5 mintues, and part of the last 10 minutes, but more or less 100% the rest of the time.

The day after that test run, I had to bail on a run after 3 minutes because my L hamstring was pretty sore before every L footstrike (even before the foot hit the ground) and not warming up at all (even after slowing down and going for 3 more minutes.)

I haven't run even 2 minutes in a row since then, but I did run 5x200m with 100m walking rest yesterday, and it was only very mildly sore during/after the run.

I've got my right leg as a reference, and the right leg is totally fine up to 3-4x the strength training level that produces some pain in the left leg and that threshold has only moved a little in the past 10 days. The pain is duller, and I'm running a little more (meaning a few minutes instead of nothing.)

By far the hardest thing is knowing precisely how much soreness is good, and how much is bad. At the level I've been training the last few days, my left leg has only been mildly achy on/off when not exercising, and only mildly sore during strength training and running.

So, should I push a little harder - not so much that it hurts a lot, but perhaps more volume at current low level of soreness? Or should I do less training so that it doesn't hurt at all?

I'm afraid that if I do use nearly-zero pain as the threshold, I'll be stuck with almost no training for quite some time - perhaps because I need to do _some_ exercise, that's not going to be perfectly comfortable - perhaps because I've got to exercise may way through a scar tissue period or something? - just to get it strong again?

And conversely, I'm also afraid that if I push a little harder, or longer, that I might do enough damage that I'll move the pain threshold back to where less exercise seems to be doing the same amount of damage...

This reminds me of a Sting song title -- "Let Your Soul Be Your Pilot" or something like that...

Hmm... well, I think that there is some merit to the PT adage. And I also think that you don’t need to stop until you are free from pain completely, because doing so will ultimately delay your recovery. Of course, overdoing it will reverse recovery. So, you navigate a perilous course nigh Scylla and Charybdis.

I actually think what you are doing makes a lot of sense. My experience is that injuries are diverse across and within people. One of my ankle injuries was not the same as another; and I’ve never had an injury like my formerly chronic hamstring problem. Whatever you do, don’t do that.

I guess my only two heuristics now are 1) not to race while injured (and race is meant more as a state of mind) and 2) do complementary training to any extent possible. You don’t need to “run” per se to maintain aerobic capacity and I imagine there are other exercises you can find to maintain conditioning and even strengthen the injured muscle and complementary ones. Personally, I like cross training but others are similarly effective.

Wait, is the hamstring pulled or what? I haven't quite figured out what the actual injury is, except for the fact that it hurts. In my experience, hamstring pulls are really annoying and take forever to go away, but have almost never made me cut down on training significantly. I pulled my hamstring in Italy, perhaps trained a bit less the following two weeks, hobbled around once in a while, and (stupidly) raced on it once, but eventually it went away without me doing anything special....But then, that's my usual approach to injury, so perhaps you shouldn't listen to me! :)
At any rate, I hope it gets better, Wyatt!

Thanks for chiming in Clem & Boris.

As for hamstring soreness, it wasn't a pull that happened fast, but rather something that didn't hurt until two days later, and even then only mildly and occasionally while running, but then over a few weeks it became most of the time when running, then all of the time when running, then when walking up stairs, then when sitting (never bad, mind you, just there more and more of the time.) Even though it wasn't severe, I decided that the down-trend needed to be stopped.

As for hamstring soreness in general, I too have heard anecdotally that it may not matter much too to keep exercising on it - for example football players always keep playing even with sore hamstrings, and they eventually go away. But this seems different (and Clem's certainly got a story of a sore hamstring that didn't go away on it's own, or fast, even with concerted effort...)

I definitely need to do some kind of aerobic training that doesn't make this hurt to keep in shape, as this has been long enough to I'm sure start cutting into that. Perhaps swiming/water-running and I may try a few machines. Unfortunately, that means I may have to bite the bullet and pay for a gym, as the only thing I've got now is a treadmill and a few weight things in the basement and a key to my old apartment's gym, which isn't much better than my basement.

In many previous long-term injuries (which I seem surprisingly suceptible to) I have indeed found cross-training to at least be something to put my energy into. And on the way out of the injury, it's rarely 'perfect' - but it gets to a point where slowly increasing the training volume doesn't make it any worse, and then when I get back up to 30+ minute runs, it seems to get better, and only after I'm back up to 3-6 hr/week of easy running, and the pain is almost totally gone, do I risk doing hard stuff like racing full effort (intesity 4), and probably even longer before I do intervals/repeats.

So while I can certainly see a way out, I'm a rather upset at how this is turning into a long way out, rather than a short way out, and I'm trying to figure out how to make it a medium way out. I still think I've got a reasonable chance of running the A-events in FL & GA, but the intesity level I'll be able to push (if at all), and the amount of fitness I'll have lost are big ?'s

I guess I've really gotta hold the fitness somehow.

You'll probably lose some running fitness no matter what, but you need not lose much general fitness if you take your current regimen and add some corss training and/or aqua exercises. (I really like the idea of those but never had the facilities to do them.)

A lot of these professional athletes (as I did) get MRIs to know exactly what the problem is. Once you know that you have a tear and exactly where it is you can gauge what to do about it. Mine happened to be in probably the worst spot. A mid hamstring thing is much easier to treat/stretch/etc.... So, I don't agree with Boris categorically. I think ignorantly running through some things is the worng idea. On the other hand, I've had some conventional hamstring soreness (e.g., after long O) that I was able to resolve within 2-3 weeks completely with ony minor concessions.

I have on and off hamstring (upper part ...) soreness for last, hm, 3 years or so. And it hurts after most long O-runs, but I've adopted for that pain. Usually it's gone after several days and only light soreness keep bother me.

But I definetely know what are you talking about as a "professional" sprinter from the past:)) In 8 years of training I had only one major injury - guess what kind? - left upper part of hamstring. I remember I got it training on indoor tracks (which was designed for track and fields athletes and bikers at the same time with heighten curves), but it was gone by itself when we moved to outdoor tracks.

I still think you can't do speed workouts at all, just forget them for now. Try to apply some athletic (warming up) ointment (not the pain relief ones) before workouts and use athletic support (elastic bandage) during runs.