Pain: when to stop and seek assessment

The decision

Should I stop this run, get urgent help, or arrange assessment?

Get urgent help

Stop after injury if the limb is deformed, numb, unusually cold or discoloured. Seek emergency assessment; use local emergency services when needed.

Evidence

Do not run through deteriorating function

Inability to bear weight, major or worsening swelling, or severe or worsening pain needs prompt assessment. Fever with an injured area also warrants urgent advice.

Evidence

Respect possible bone pain

Focal recurring bone pain warrants stopping impact exercise and clinical assessment. Suspected bone stress should not be tested by repeatedly running through pain.

Evidence

Knee pain is a symptom

Knee, Achilles or foot pain cannot be diagnosed from its location alone. Persistent or worsening symptoms deserve professional assessment; a pain score is not permission to continue.

Evidence

What to record for an assessment

Describe the location in your own words, when it started, whether there was a fall or sudden event, and which activities reproduce it. Note swelling, changes in walking, and whether everyday tasks are affected. Record what you changed recently: route, training, footwear or recovery opportunities. Bring the history rather than trying to prove a diagnosis with repeated painful self-tests. This information helps a professional ask better questions; it does not identify the injured tissue by itself. A watch declaring you recovered cannot overrule symptoms or urgent signs.

If the problem is assessed as patellofemoral pain

For assessed patellofemoral pain, a 2024 best-practice synthesis supports education and knee-focused exercise, sometimes combined with hip-focused exercise. Additional measures depend on the person and findings. That is useful direction for a consultation, not evidence that all knee pain needs the same exercises, orthoses, taping or gait change. Ask what supports the diagnosis, which activities to modify, and how improvement will be judged. A generic instruction to change your foot strike skips the assessment the guidance requires.

Evidence

Why one pain rule does not fit every problem

Clinician-guided tendon rehabilitation may use pain monitoring to adjust activity. That approach cannot simply be transferred to suspected bone stress, acute trauma or an unexplained swollen joint. Nor does temporary symptom relief establish that running is appropriate. If you already have a rehabilitation plan, use its agreed limits and contact the treating professional when the pattern changes. If you have no diagnosis and are unsure whether to continue, stopping the provoking run and arranging assessment is more useful than inventing a numerical permission threshold.

Evidence

Use the framework without self-diagnosing

Consider two hypothetical situations. A runner develops an unexplained painful knee during a long outing and begins limping. The useful decision is to stop the provoking activity and arrange assessment, not search for an exercise that permits finishing the distance. Another runner already has an assessed tendon problem and a clinician-agreed activity plan. Their decision is to follow that plan and report an unexpected change, not substitute advice intended for a different condition. Neither example supplies a diagnosis. The distinction is whether the problem has been assessed and whether current symptoms match the agreed plan. Do not repeatedly reproduce symptoms just to decide which example you resemble. When contacting a professional, ask three clear questions: what must be ruled out, what can I safely do while waiting, and which change means I should seek help sooner?

Use this with

• Recovery Protocol
• Ultra Training Framework
• Foot care over long race days
• 100 mile: plan for the hours after dark

Evidence and limits

Evidence: Mixed. Direct general injury-triage guidance; not running-specific diagnosis. Triage information cannot identify the injured tissue; emergency services must be localized.

• Sprains and strains (opens in a new tab) · Appraisal and population
• International Delphi consensus on bone stress injuries in athletes (opens in a new tab) · Appraisal and population
• Best practice guide for patellofemoral pain based on synthesis of a systematic review, the patient voice and expert clinical reasoning (opens in a new tab) · Appraisal and population
• Dutch multidisciplinary guideline on Achilles tendinopathy (opens in a new tab) · Appraisal and population

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