I use the scale outlined below daily with my injured runners. This scale works for nearly every injury. The image above is a scale that is likely burned onto the whiteboard in my office.
A professor in college drilled into our brains that: a tissue, is a tissue, is a tissue. For those with no medical background, it equates to the underlying fact that a tendon injury in your ankle will likely respond the same as a tendon injury in your shoulder: a tendon is a tendon.
The same rationale can be said for joints, ligaments, and the like. In my work with running injury rehab I’ve developed protocol/system that is based on the “a tissue is a tissue” method. My patients have likely heard at one point or another. Although rather simplistic, the rule applies to nearly all running injuries and is rooted on a foundation of tissue resilience and the ability to accept load. Two very important principles if you’re looking to successfully run after an injury.
Load acceptance and loading until failure reaches far beyond injury rehab. Engineers know this fairly well. For example, a bridge can accept a certain load before buckling. An elevator cable can withstand a specific weight limit before straining (or breaking). The same can be said for your (insert your running injury here). It can withstand so much load until re-injury.
My simple scale can help you better understand the threshold of breakdown for your injury. I’ve used this thousands of times in practice and actually developed it when dealing with my own injuries (yes I get injured, too).
The Scale: 0 to 5, How Much Does It Hurt?
Zero (0): “I don’t feel anything.”
Zero is pretty easy. This is typically the point you’re thinking yourself, “hey, maybe this is the time it won’t hurt?” It’s usually a subconscious hail mary that your (insert injury here) is finally gone for good.
One (1): “I think I feel it?”
A one rating is that “is this all in my head” question. You’re running and you think you feel it, but are typically unsure. This isn’t anything to fret, keep going (not that you were going to stop anyways).
Two (2): “It doesn’t hurt, but I definitely feel it.”
Ok, so at this point you’re fairly positive you’re not crazy. You definitely feel it. A “two” on the scale can go either way. It can loosen itself up and retreat to a “one” or “zero” or can progress. This is where you ideally stay close to home. You can keep running, but the street signs now read “proceed with caution.”
Take home from zero to two:
As you can see, I’m not telling you to stop running. I equate the sensation of “feeling” your injury or “being aware” to loading tissue that is simply not fully healed. News flash, it can take up to six months for tissue to fully remodel (heal back to normal).
The zero to two stage can (but not usually) last months. Just proceed with caution and patience.
Three (3): “It hurts a little, but I can run through it.”
There’s no doubt that this thought has crossed your mind when attempting to return running. Crossing over from a two to three on my running scale equates to the beginning stages of breakdown.
The “slight pain” you feel may be manageable, but it’s a sign that your injury is failing. The bridge is beginning to buckle.
Four (4): Pre-Limp – “I probably shouldn’t be doing this.”
Although you shouldn’t be running, you’re likely still putting one foot in front of the other. At this point every foot strike is shredding, tearing, and destroying your injury. It doesn’t matter than you only have a few minutes left of your run.
Think of it this way: the average runner hovers around 80 steps a minute. An additional 10 minutes of running exposes your injury to 800 additional repetitions when it’s already sending signals to stop. If you had a sore arm, would you lift a weight 800 more times? (Please say no)
Five (5): Limping
So by now the pain is fairly strong. You can’t hide your limp and it’s clear you shouldn’t be running. You’ve gone overboard at this point. Plan on resetting your injury clock a few weeks or even back to day one.
Progressing Through the Scale
Most runners will progress from a 0 (“I feel nothing”) to a 3 (“It hurts just a little”). The progression of symptoms is a clear indication that your injury is failing to withstand the barrage of foot strikes. If you start at “three” within 30 seconds you’re not ready to run (sorry).
Don’t run on denial. It either hurts or you feel it. Black and white. Once you’re at the “it’s about to start to hurt” pull the plug. Walk. It doesn’t matter that you’re only a block away from home. Every foot strike is damage.
With time, you’ll slowly watch your time to symptoms or pain onset increase. What started at five to 10 minutes is now 30. If you continue to run with patience you’ll avoid becoming a patient.