What’s Up with Next Day Pain?

May 16, 2017

Physical therapist Lisa Reinke tells us why we may feel fine while running but experience pain the next day.

As a physical therapist who works specifically with runners, I often get asked why pain may not show up until the day after a workout. There are three main reasons why this occurs:

1. Muscles and joints that are “warmed up” or “stretched out” during and after running and will tighten up if not properly stretched or “cooled down.”
2. Our bodies compensate in the way we run to avoid pain. But when going back to daily activities, pain may increase because of the different positions and activities we complete throughout a day.
3. Over time, poor mechanics in our running will cause “wear and tear” on different joints, bones or muscles. Pain after running can be an early warning sign.

Let’s break down some of the types of pain you may experience:

General pain — beginning program or training plan
When beginning a running program from scratch or returning to a regular routine after time off, an individual may experience muscle soreness. This appears 24-48 hours after activity, in the form of delayed onset muscle soreness (DOMS). This soreness is normal and almost expected as your body gets used to the demands of running that are different from the demands of regular daily activity. Individuals may also experience some minor bone or joint soreness from the impact load, since running requires your body to absorb three times your body weight.

Muscle and joint soreness should subside within a week, and healing may be accelerated if you integrate stretching or strength training into your program. If your symptoms do not improve within seven days, contact your physician, a physical therapist or athletic trainer and discuss your symptoms.

Heel/arch pain
The classic signs of plantar fasciitis include heel pain in the morning and heel or bottom of the foot pain delayed after running. Pain after time off one’s feet is another classic symptom.

When a person runs, the plantar fascia (which is a structure on the bottom of the foot that attaches at the heel and fans up to the toes) stretches with the repetitive landing and flattening of the foot. If a runner has an excessive amount of pronation, it is likely he or she will “over-stretch” this structure quicker. When a runner stops running and the constant stretch/stress of the ground no longer puts that same pressure onto the plantar fascia, it will tighten up, causing pain at the heel when body weight is applied.

Stretches, massage techniques, orthotics (shoe inserts) and other treatments can help ease plantar fasciitis symptoms. Consider signing up for a video runners assessment to identify the source of the pain.

Knee pain
Runner’s knee and IT band syndrome are two common types of knee pain for runners.

IT band syndrome is classified by pain on the outside of the knee. Pain may hide during a run but present as soreness afterward when someone bends to tie a shoe, goes up or down stairs or even sits too long. This may be because the knee doesn’t bend to the degree it might with squatting or taking stairs, or because the pain is masked since the body is warmed up during the run.

Runner’s knee pain may often occurs in the front of the knee. It may also worsen when squatting or navigating stairs.

If you are experiencing knee pain, it is best to have your running mechanics assessed. This is typically where these types of injuries originate.

Back pain
Back pain also often decreases when a person is running, simply because the back is warmed up. Back pain is often caused by a lack of movement of the spine, which is why exercise can be helpful. 

Another cause of back pain is lack of stability, or excessive movement of the spine without control. A person’s back stays upright while running, but he or she may not have the muscles to support his or her back when engaging in an activity that calls for more bending of the spine. An unstable core can be another culprit when a large amount of motion in the spine causes later discomfort.

It’s best to be treated early for any back pain that increases during or after running.

Finally …
If you’re having pain after running, I highly recommend getting checked out. You can start by calling the Bellin Run Injury Hotline (920-430-4595) to discuss your symptoms, or schedule an appointment with your primary care provider or a physical therapist. Having a video running assessment is a great way to get to the root cause of your pain and get you back to running — and daily function — pain-free.

Lisa Reinke is a physical therapist with Bellin Sports Medicine who specializes in the treatment of running-related injuries and gait assessments for the injured runner or walker. Lisa has participated in several road races, bike rides and triathlons. You may email Lisa at Lisa.Reinke@bellin.org with questions regarding running or walking injuries.

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