Running through Pain? Strategy and Mindset

By: Tiago Ribeiro

Approximately 7 Minutes Reading Time


Brief Article Overview


  • Running is a fantastic form of exercise, with a low barrier of entry.
  • Unfortunately, chronic pain is commonly associated with running.
  • Modern pain science has repeatedly shown that the state of tissues (muscles, tendons, bone) is not strongly linked with pain, especially over prolonged periods of time.
  • The state of tissues (bio), your emotional state (psycho), your immediate environment and social support (social) all contribute to the pain problem.
  • This is known as the “Biopsychosocial Model”.
  • Usually, pain occurs simply because of doing too much, too soon. So being more strategic with training volume would be the first port of call.
  • People tend to focus on the physiology of pain. Try to incorporate emotional and social factors as possible influencers for chronic pain too.




Who doesn’t want to feel the infamous runners high, a euphoric state that occurs after running? We love working with endurance athletes. There are plenty of events throughout the year which help provide you with a clear goal, giving everyone a strong sense of focus and direction.


Sadly, there is also a high incidence of chronic pain associated with long-distance running. Knees, hips, lower back, shins, feet…the list goes on! One UK study reported a 50% injury rate amongst recreational runners, with 86% of those continuing to run through the pain!


Eventually, this pain can act as a barrier to exercise and something as simple as going out for a park run can seem like a struggle. This can be pretty frustrating, especially if you’re training for an endurance event. The ability to accumulate training volume (going longer and faster) is the name of the game! Let’s touch a little on modern pain science, to develop a strategy to help keep you on the roads.


Lorimer Moseley, a former researcher at the University of Oxford and now a clinical scientist is changing our current views on chronic pain in humans (watch his TED Talk). His research has shown that simply having an understanding of what pain does (and doesn’t) represent, can improve the experience altogether!


In our experience, clients often feel their pain is a consequence of being “broken”, “dysfunctional” or “weak”. This develops an avoidance strategy, which becomes unproductive and sometimes exacerbates issues. Injuries and pain need to be treated with respect and correct due diligence. At the same time, better client education and encouraging more of a positive mindset can mitigate f, speed up rehabilitation and get you back to training.


Professor Moseley makes four key points with regards to chronic pain;


  1. Pain doesn’t provide us with an accurate insight into the state of our tissues.
  2. Pain is influenced by lots of factors, not just exclusively to strict physiology. The “Biopsychosocial Model” maps out other factors influencing pain, including somatic (how the body feels), psychological (what the mind feels) and social domains.
  3. The relationship between pain and the state of the tissues becomes less predictable over time.
  4. Pain is best seen as our brain’s perception of danger or threat, a warning signal if you like.


Managing Workload


Getting our heads around these principles can be really important in helping manage our response to pain during periods of high workload. Running is a really impactful activity, more than people often think.  We’ve heard many people say they avoid weight training in the fear they may hurt themselves. Running actually involves much greater forces than most weight training exercises and involves greater overall workload.


Every single foot strike when running generates ground reaction forces of more than twice your body weight.


Embarking on a new running regime in preparation for an event is an exciting time! Upon signing up, it’s common to go from one casual run on the weekend, straight to two runs a week, one longer steady-state and one threshold or interval session (click here to learn more).


What may appear as a small increase, is in fact a near doubling in training volume, as well as an increase in intensity. You’re running more often, longer and faster, which means bigger impacts and more of them!


Someone with a history of chronic pain will have more sensitive tissues and a lower threshold for handling increases in workload as well as displaying less movement variability. The body has guarding mechanisms which narrow movement options. All of this makes them a touch more vulnerable to niggles, aches and pains as they increase running volume.


Training Volume and Sun Tanning


Although it’s easier said than done, when these pains present themselves, it’s important that we don’t over-react. Rather, just remember that you’ve simply probably done a little too much, too quickly.


This is where our sun tanning analogy may be useful. Small, gradual UV exposure will build a bronzed tan. Large UV exposure over short periods of time leaves the skin burned and sore. This is the same as training volume and injury.


Also, like someone who has pale skin is more prone to becoming sunburnt, those who have a history of chronic pain are at higher risk of further injury or pain. Individuals, therefore, need to be appropriately strategic when increasing training volume.


Although there is an art to tailoring progression in training programs, due to the fact we’re all so different, a good rule of thumb is to try and limit week to week increases to no more than 10%.


Image 1 - Acute/Chronic Workload and Likelihood of Injury
Pain is Complicated


It’s so much more than exercise, wear and tear, tightness, weakness, joint strain or over-enthusiasm. There are so many factors which influence your pain experience, which goes beyond a training program (see image 2).


It’s always worth thinking about the other things in our lives which could contribute to physical pain. Some are obvious, others are not. For example, are you particularly stressed at work? Have you had a string of late nights and early mornings in the past week? Stress and a lack of sleep can often initiate flare-ups, which can go unnoticed (click here to read more on sleep).



Image 2 - Multiple Variables Contributing to Chronic Pain
Mindset & Flare-ups


Referring to Moseley’s last point; viewing pain as an output of the brain and how it perceives our state of being, as opposed to an accurate insight into the state of specific tissues. This output is influenced by many, many things but understanding your own body can help you process the situation better.


One thing commonly seen in anyone who suffers from a flare up in the lead up to an event, is an anxious and worrisome approach. Given the history, this is totally understandable and questions arise. What have I done wrong? Is it another slipped disc? Have I strained something? Do I need to work on my core? Or my glutes? Is it my pelvic angle? Is it my gait? Maybe it is, maybe it isn’t, but the research doesn’t really support many of these concepts. At least, not in chronic cases.


Understanding a flare up is most likely a case of sensitive tissues that have been asked to do too much, too soon in conjunction with other life factors. It can help to calm us down that a little easing off the gas is all we need. We have the ability to consciously play a role in how we handle this flare up, so make the most of it!


Managing training with a history of pain can be a tricky task, but it can be done with the right support in place. If you have any questions, feel free to reach out to Common Purpose. We’d love to help out in whatever way we can.





Food for thought? If this has encouraged you to think about your health, fitness & wellbeing, why not click this link and fill out our enquiry form. We’d love to see how we can help you on your journey.


Disclosure: This article is not to be used as medical advice. If you are currently experiencing physical or mental health issues, please seek professional advice from a fully qualified Nutritionist, GP or Physiotherapist.