Here you are, nearing the end of your training plan, anxiously anticipating your first marathon. You have prepared well, trained smart, and successfully completed each long run. Yes, you have had your share of soreness, aches and pains, but nothing has altered your training schedule. You are now tapering in anticipation for race day, reducing your miles, allowing your body to recharge for that final test of your endurance. But something is wrong…your knee hurts (or any other body part for that matter). It seems like this pain sprung up out of nowhere. A million questions are likely going through your head. Am I injured? Why do I hurt after tapering for the last week? Should I test it out and try a long run? Will I be able to even finish my marathon? Should I even run the marathon at all? Was all this time and dedication a waste?

Traditionally, injury and pain have been thought as being associated with mechanical issues where a certain body part (e.g. the ankle, knee, calf or other structure) gets overused due to training error. In many cases this is true. Tissues are overloaded, develop inflammation, and become sensitive; your brain recognizes this and you experience pain. Simply put, pain is the alarm system that alerts you to protect your body. This alarm system is commonly activated by a training error of too many miles, too much speed work, or too many hills where the body has not been given ample time to adapt to the new training loads. So why would pain occur when weekly miles have been reduced during your taper? You may be thinking there simply is no mechanical or traumatic event that should cause injury at this point. You may be right. Here, a broader understanding of pain can bring some clarity and comfort during a stressful time as this.

Although not well known it is well established that factors such as worrying, anxiety, fear, and even poor sleep have the ability to amplify alarm signals to the brain that together generate a pain experience. A significant reduction in weekly mileage may prompt some stress, especially if running is used as a way to control stress. A novice marathoner may also have some anxiety, fear, or worries about the race. Although perfectly normal, these thoughts may amplify the bodies alarm system. This anxiety may lead to poor sleep and poor sleep may feed into more anxiety. These factors alone or collectively can potentially amplify what may be a minor pain to something quite painful even in the absence of injury, and this is normal. If you are experiencing pain during your taper, consider other factors that may be playing a role in how you are feeling. So what should you do?

  1. Given the above information, remember, “Hurt does not equal harm.”
  2. Take a deep breath and relax, trust your training. You’ve gotten this far haven’t you?
  3. Focus your attention on your pre-race training plan and taper your miles appropriately. Don’t attempt to “test it out” with another long run.
  4. Get some sleep. Sleep helps in multiple ways for recovery, is part of a successful training plan, and reduces the body’s sensitivity.
  5. Eliminate the “what-ifs.” Additional worrying certainly isn’t helpful. Think positive and visualize your successful preparation for race day.
  6. If you are still concerned, or have been nursing an injury throughout your training plan DO seek help from a sports medicine expert who is experienced in treating runners who can help guide you in the right direction.
  7. Good luck, and enjoy the race!

Benjamin Maschke is a physical therapist at TRIA Orthopaedic Center in Bloomington. He has a passion for treating runners, and enjoys running himself. His running group usually consists of pushing his two daughters in their stroller while holding the leash of the family goldendoodle. When he’s not pushing a stroller you’ll find him running off road on various trails in the area.

References:

  • Ligthart et al 2013. Anxiety and depression are associated with migraine and pain in general: an investigation fo the interrelationships. The Journal of Pain, 14,(4), 363-370.
  • Louw A, Puentedura EJ. Therapeutic Neuroscience Education: Teaching Patients About Pain; A Guide for Clinicians. Vol 1. Minneapolis, MN: OPTP; 2013.
  • Louw A. Therapeutic Neuroscience Education: Educating Patients About Pain. Course Manual. April 18-19, 2015.
  • Robson S, Gifford LS 2005 Pain and Brain – A Revolutionary Approach to Chronic injury. Peak Performance, 221: 1-4.
  • Robson S, Gifford LS 2005 Pain and Brain – The Biopsychosocial Method of Chronic Injury Rehabilitation. Peak Performance, 222:8-11.
  • Schuh-Hofer et al. (2013). One night of total sleep deprivation promotes a state of generalized hyperalgesia: A surrogate pain model to study the relationship of insomnia and pain. Pain, 154(9), 1613-1621.