Running With Pain

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Provided by Runner's World

When a stomachache or muscle cramp hits you midrace, Should you go on or go home?

Almost halfway into the 2003 Boston marathon, Dennis Fisher found himself trying to settle an internal dispute. Severe leg and stomach cramps brought his pace to a crawl--interrupted by several dashes to Port-a-Johns. A little voice told him to quit, that this misery wasn't worth it. But as he struggled along, he thought of the charity he was running for, the Make-A-Wish Foundation, and all the e-mails he'd have to send to friends and family explaining why he didn't finish his fifth marathon. "I really, really didn't want to drop out," says the 35-year-old journalist from Plymouth, Massachusetts. "In my head at that point, I saw quitting as a sign of weakness."

So Fisher sucked it up and finished in 4:40, an hour off his goal time. After the race, he downed a bottle of water, then immediately vomited. His wife took him to the emergency room, where he was treated for kidney failure. Fisher made a full recovery, but left the hospital with perspective. "Clearly a race I should have dropped out of," he says.

When you're faced with a race-day setback--whether it's one you wake up with (upset stomach, fever) or one that pops up midstride (calf cramps, twisted ankle)--there's a decision to make. And assuming you've trained long and hard for the event--be it a 10-K or a marathon--it's likely to be one tough judgment call. If you drop out, you might be haunted with the question of how you would've done had you gone on. But bowing out can prevent a small issue from becoming a serious one. Doctors believe Fisher's kidney failure arose from dehydration (warm weather, multiple bathroom stops), anti-inflammatories (taken before the race), and 26.2 miles. Had he quit when symptoms started, he may have avoided the trip to the ER. Learning how to listen to your body could help you avoid a similar fate. Here's expert advice on when to press on and when to pull out.

Roadside Diagnostics

The extra effort of racing doesn't always feel good. Indeed, experts say that when you exert yourself, a certain amount of discomfort is normal, and you can generally run through it without harming yourself or risking injury. A familiar ache or pain is most likely not cause for an early exit, says Craig Moore, M.D., a family practitioner specializing in sports medicine in Bellingham, Washington, and a 2:19 marathoner. If you've had an ongoing case of Achilles tendinitis, say, it won't come as a shock if your ankle starts to hurt midrace. "If you feel a nagging, continuous ache, but it doesn't worsen, then you can usually keep going, especially if you recognize it as nothing new or you're nearing the end of the race," he says.

However, pain that's severe, unexpected, or unlike any that you've experienced before is a red flag. "No sensation should be more than a dull ache," Dr. Moore says. "If you feel something that's sharp, piercing, or stabbing, you should slow down to see if it subsides." If it doesn't, or it intensifies, walk to an aid station or wait for medical help to come to you. Chest pain, pressure, or tightness are symptoms that demand immediate attention. Also, if you feel or hear a pop or snap--signs of a muscle or ligament pull--don't run another step. If you stop immediately, you could recover quickly enough to run a "plan B" race in a few weeks (see "Moving On," below). Keep running, however, and you'll risk a complete tear, which may mean months of no running at all--let alone racing.

Lewis Maharam, M.D., medical director of the ING New York City Marathon and Elite Racing's music marathons, says your running gait will also help you gauge your ability to go on. "If the pain becomes such that it changes your running form--you're favoring one leg, you have trouble bearing weight on a leg, or you're doubled over, your body's telling you that something's wrong," he says. But before you hail a ride to the finish, first try adjusting your pace. "If you're struggling to do eight-minute miles but you're able to maintain your form and run comfortably at a 10-minute or 12-minute pace, you could abandon your time goal and just focus on finishing," Dr. Maharam says. "There's a difference between racing a race and running a race."

Next: Consequences of Running Through Pain