The Active Maine Blog: Running & Living Inspired

The #1 Strategy to Embrace if You Want to Run Pain-Free

Written by Dr. Kelton Cullenberg, PT, DPT | Feb 20, 2025 8:31:43 PM

Runners often struggle with adjusting their training based on how their body is feeling, even though doing so is one of the best ways to stay injury free. 

Listening to our body can take practice.

But if you’ve been a runner for awhile, you likely are very used to feeling new aches and pains.

So why can it still be hard to adapt our training based on how we are feeling, even if we have many years of experience?

It often comes down to either a lack of understanding, or a combination of psychological barriers. 

Some of the most common barriers to listening to our body are: 

  1. Misunderstanding of physiology
  2. Not knowing what to be listening for / how to adapt
  3. Caring what other people think
  4. Being too rigid with training
  5. Exercise compulsion

While there’s varying degrees of severity for all of these factors, being aware of them likely contributing to your injury history and injury risk is the first step towards breaking these barriers.

If you need further help with either of the first 2, a running specialist physical therapist is a great resource. 

If you need further assistance with the rest on this list, finding a great sports psychologist can be game-changing. This is a good time for us to shout out one of our friends Dr. Alexis Wilbert, PsyD!

Let’s dig deeper on each topic:

Misunderstanding of physiology

It is common for runners to incorrectly think that they are going to significantly detrain from taking a day or 2 off from running. 

It can be helpful to understand the approximate detraining timeframes, so that you can be confident that adapting your plan occasionally isn’t going to have any significant impact on your fitness. 

There is minimal to no detraining cardiovascularly that happens when taking even up to 1+ weeks off from running. Your VO2max does not decrease and your heart’s stroke volume remains stable. Stroke volume is the amount of blood that is pumped through the body which each heart beat.

Between 1-2 weeks off from running, you can start to detrain slightly. VO2max may drop by 4-6%, mostly due to blood plasma volume decreases. Stroke volume starts to decrease slightly. Fortunately, when you do start running again these increase relatively quickly. 

Between 2-4 weeks VO2max drops 10-15%, stroke volume decreases further, and lactate threshold (ability to sustain a harder effort) starts to decline. 

So yes, we do detrain cardiovascularly relatively quickly, but not significantly until after at least 1-2 weeks off from running. It can be helpful to remind yourself this when you find yourself worrying about potentially missing just a day or 2!

Not knowing what to be listening for / how to adapt

What aches and pains are okay? Which do we need to take more seriously? 

It definitely takes time and practice to understand these questions, but here are a few guidelines: 

  • Soreness versus pain
      1. If you’ve been an active individual for a while, you’re likely familiar with muscle soreness. This typically is delayed from the activity you’ve done, often referred to as ‘delayed onset muscle soreness’ or ‘DOMS.’ This can sometimes take 24-48 hours to really set in after activity, and is more common when you’ve done a type of activity (or intensity level) that you haven’t done recently. 
      2. Pain is usually something that is felt sooner, either within the run itself or within a few hours after stopping the run. 
  • Soft tissue pain versus bone pain
      1. This is huge to understand - as bone pain is the main pain that we don’t push through. For bone healing to occur, we typically need 0/10 pain. However, with most soft tissue injuries it is okay (and sometimes necessary) to have up to mild pain.
      2. Signs of bone pain (suggesting a potential bone stress injury) include: 
        1. Pain that worsens with more activity, rather than warming up
        2. Pain that is constant, and may be present at night. 
        3. Feels better generally in the morning, and worsens later in the day with more accumulation of time on feet. 
        4. 6+/10 pain levels. 
        5. If the bone is superficial (shin, feet), there may be noticeable swelling. 
  • Other, non-pain symptoms
    1. Swelling, instability, and a noticeable limp are some other common symptoms that should be taken more seriously as these suggest larger underlying issues. 

Caring what other people think

Caring what others think is a deep rooted - and normal - psychological human trait. It helped early humans remain accepted by their tribe. If you were rejected by your tribe, you typically wouldn’t survive for long. 

However, human biological development was not prepared for the intense levels of scrutiny that can happen to our lives in the age of the internet, social media, and Strava. 

Runners will commonly push themselves to run more or run faster than perhaps they know they should, thinking about wanting their stats to look better to their friends, family, or coach. 

Fully embracing doing things for your own best interest can be challenging, but so incredibly important if you want to run healthy for years to come. 

A thought exercise I like to do to help when I find myself caring too much about what others think is envisioning myself as a 90 year old. Will my 90-year-old self care what these people think? I doubt it. So if I’m eventually not going to care, I might as well stop caring now. 

Being too rigid with training

There’s typically a lot of overlap with this one and all of the others on this list. Having challenges with any of the others can be strong reasons why people will not be flexible with their training. 

I’ve had to adapt my plan a ton of times throughout my 20+ years of competitive training. Through years of trial and error I’ve found that I always feel better a few days later if I adapt my plan when I know I’ve had a stretch of more soreness/aches/pains, worse sleep, higher stress, or eating less. 

I had an evening workout a few weeks ago where I started and could feel that I accidentally underfueled that day. I adapted the time goals for the workout to be a bit slower, and I took a longer rest break after the first rep to go to my car to get a snack I had brought for after. Sure, my rest interval was twice as long as planned, but I was then able to complete the workout, was better fueled, and didn’t experience any longer term setbacks because I decided to be flexible. 

Within-workout adaptations can be helpful, but if you’re feeling like you need to adapt a workout significantly, you’re almost always better to change that day to an easy shorter day and try the workout the following day! Re-read the ‘Misunderstanding Physiology’ section when needed to remind yourself that you won’t immediately detrain. 

Another challenge for many runners is being fixated on what their weekly training looks like, using an arbitrary week start date as either Sundays or Mondays. Do you ever wonder what your weekly volume graph would look like if your weeks actually started on a Wednesday? Or Friday? 

You may be surprised, but even shifting the start of your week by just ONE day can vary your weekly volume graph significantly. I’ve been analyzing my training with our new Find Your Steady State app (download for free in the app store), and one of the key features of the app is showing you this variety of data. You're doing the same training, but by adjusting your week’s start date by a day or 2 you see much different analysis. 

What does this mean? Don’t get caught up in what the charts say, unless you're fully analyzing your training with data views like in our app. Otherwise you are making training and recovery decisions around poor data.

Exercise compulsion

There are so many things that contribute to exercise compulsion. Disordered eating tendencies and a negative body image are common ones. If you think this could be you we’d strongly recommend reaching out to someone like Dr. Alexis Wilbert (a runner herself)!

Another contributor to exercise compulsion that we commonly see is people’s reliance on exercise, especially running, for their mental health and stress management. 

I personally need running in my life for many reasons. Managing stress and therefore helping my mental health is definitely one of them. But I do think there are a few things that can help prevent someone from having an unhealthy dependence on running.

Take a minute and think about why you run. Write down all of the reasons that come to mind. 

Some common answers we hear are: mental health, social aspect, escaping the kids/alone time, being outside, endorphins, enjoying setting/achieving goals and training for something, being competitive with self/others, weight management. The list goes on!

Once you’ve made your list, take each reason and brainstorm some other (non-running) things that achieve this reason? Just focus on one of your whys at a time.

For example, if one of my whys is that running is one of my main social activities, I’d brainstorm some other social activities that would bring me joy. If one of my why’s is being outside, what are some other outside activities that bring me joy? 

While it is unlikely that 1 activity can fulfill all of the reasons you like to run, you might find that a combination of activities can collectively fulfill at least some of these reasons.

I think this exercise is so underrated. Incorporating more of the other activities in your life that bring you joy can help you have less of a dependence on running, which in turn can help you be a bit more flexible, helping you stay injury-free and run more enjoyably and for many more years.

This is also super helpful when you find yourself injured. When you next find yourself unable to run as much as you’d like to, a combination of these other activities may help you maintain a higher quality of life during this (hopefully short) time period. 

Nothing can replace running, but sometimes partially doing so in the short term can preserve your running for the long term. 

 

TLDR: 

  1. Be flexible with your training.
  2. If you struggle with this, the first step is understanding why this is tough for you. What are your barriers?
  3. Once you understand your most typical barriers, it’s important to become more informed on the physiology and tactics that may help you overcome these barriers. 
  4. Reach out to a running specialist physical therapist and/or sports psychologist if you need any assistance!

-Dr. Kelton Cullenberg, PT, DPT