As a marathoner, as a well as a *Doctor of Chiropractic that happens to care for athletes of all abilities (recreational to national athletes) and ages (from as young as my own “Little Runner” 2-year-old son to seniors keeping active), I often hear the following phrase: “I just ran/pushed through the pain.” When I was growing up I also often heard the exercise motto we are all still familiar with: “no pain, no gain.” Naturally as athletes we want to push those boundaries and better our Personal Bests, so isn’t “pain” a necessary part of the process? However, in the words of American Olympian runner Molly Huddle in Runner’s World 2021 which I fully agree with, “It’s time to stop glamorizing the ‘no pain, no gain’ mindset.”
[World Marathon Majors completion at London Marathon 2023 (left), starting with Boston Marathon 2013 (right)]
What is pain?
First, we need to understand what is pain. Pain is a neurological process, with biopsychosocial causes triggering this pathway. The brain receives a combination of sensory bodily inputs and nociceptor signals (detect potentially dangerous environmental stimuli) travelling up the spinal cord. Then, the Central Nervous System interprets this stimuli, and formulates a potential response via nerve signals travelling back down the limbs. If the brain interprets a potential threat, then pain signals alert the body accordingly, triggering the unpleasant bodily sensation we know of as “pain”. In short, pain is merely a signal that something may potentially be wrong with the body. Thus, pain in itself should never be used as an accurate indicator of root issues. Another takeaway here is that one’s entire Nervous System (brain, spinal cord, and nerves) is vital. Bear in mind it is even possible to not feel any “pain” despite potential body damage already sustained, especially if one’s Nervous System is not firing well at any point.
Qualifying pain
Next, we need to qualify the term “pain”. I do so by classifying one’s sensations as “good pain” versus “bad pain”. Last year at London Marathon 2023 I finally finished my Abbott World Marathon Majors Six Star Journey with an average marathon finish time of 2 hours 54 minutes over 6 marathons, a 10-year journey that started in Boston Marathon 2013. It is no surprise that regular chiropractic care continues to keep me running well since my first visit in 2010. Boston Marathon is (in)famous for “Heartbreak Hill” about 32km into the 42.2km race, a point in which I proudly say I experienced “pain”. What kind? It was in my terms “good pain”: quadriceps muscles feeling heavier with extra lactic acid, breathing getting more laboured, and trying hard to mentally focus on cresting that hill. However I did not worry, because this is a shared experience even among Olympians. Another kind of “good pain” is the general soreness in the legs especially when going down staircases post-marathon, something I have frequently personally seen even among top Kenyan runners. These sensations are self-limiting and dissipate with the right recovery in a few days.
“Bad pain”
On the other hand, please do not mess around with “bad pain” to any body part, otherwise you risk acute or long-term damage to your spine and overall health. If you experience any of the following, please recalibrate or temporarily stop your training, otherwise you risk ruining the sustainability of your sporting journey: numbness, weakness, sharp or electric-like pain, burning sensation, radiating sensations down any of your four limbs (e.g. toes or fingers), worse symptoms on coughing or sneezing, everyday activities of daily living affected (e.g. bending, standing, wearing socks, sleeping), or unable to bear weight. Experiencing any of these issues should never be seen as a “Badge of Honour”, and it is imperative we also look out for fellow athletes to gently nudge them into the right direction.
[“Check Engine Light”]
Check your engine
When we suffer any of the above signs or symptoms, we should look into the root cause of them, rather than covering them up. When driving and the “Check Engine Light” comes on, it makes sense to bring their vehicle to the mechanic. Potentially it is just an early warning of a potentially bigger issue, in which case nipping it in the bud quickly is cost-effective and even possibly life-saving. Or would you rather ignore this light, until the engine literally breaks down on the expressway? In an even more important way, pain functions as an indicator warning us there are potential bodily issues like spinal misalignments. If we athletes just dismiss them as a “normal” muscle strain, it may escalate into more serious sensations like numbness or sharp pain, at which point the road to recovery would be longer.
Recalibrate if you are in pain
Assess and recalibrate to have sustainability in your sport. By the time pain sets in, there has likely been stress to the body, possibly silently building up for weeks (or years) earlier over repetitive micro-trauma from your sport. Athletes at this point should not “push through the pain”. I took care of a dancer before that continued to push herself through classes despite struggling to tie her shoelaces due to her low back misalignments, so I had to strongly advise her to prioritize her recovery until her spine stabilized. Recalibration does not mean complete bed rest (unless in more severe cases), so you can still move because “motion is lotion”; the caveat is the right kind of motion matters. For example, for a temporary period you can reduce your running kilometers, minimize intensity of your workouts, cross-train via the elliptical or walk in the pool, any combination of which would take pressure off those stressed joints. Recalibrating will be more helpful in the “long run”.
Look into the root cause and consider gentle chiropractic care
At the same time, look into the root cause of your pain(s), rather than just ignoring or covering up the symptom. Athletes sometimes brush things off as a minor “muscle” issue, but if it persists for weeks despite resting and light stretching, there is nothing “minor” about it. Please do not delay gentle and specific intervention, for example through chiropractic care. Chiropractic focuses on correcting vertebral subluxations – spinal misalignments that cause nervous system interference. Muscles attach to bone, so if the bone is misaligned (even slightly) and we only focus on stretching or massaging those tight muscles, it may not be addressing the root cause of the imbalance. Gentle chiropractic adjustments via a vibrating instrument called an Arthrostim and a protocol called the Koren Specific Technique (KST), allow us *Doctors of Chiropractic to locate and correct these body stresses, so the body can be allowed to self-heal for recovery and optimal sporting performance. The advantage of this gentle and specific technique is that there is no “popping, cracking, or twisting” of the spine, allowing athletes to be adjusted when sitting, standing, or in their unique Posture of Subluxation (POS) associated with their sport.
[Marathoner and *Doctor of Chiropractic at Family Health Chiropractic Clinic]
My own story of training injury-free
I shared in my earlier blog post after placing runner-up Singaporean at the Standard Chartered Singapore Marathon 2017 the following: “In the bigger picture, athletes are not merely trying to avoid aches and pains or to stay injury-free, but more importantly to maximize athletic potential in the long run.” This is true for me, having received regular chiropractic checks since 2010 and adjusted when necessary. Since 2010 until today in 2024, I have not sustained any (over)training injury despite routinely running >100km weekly. I have also neither needed to take any more than 2 consecutive days off planned training due to any musculoskeletal issues, nor resort to taking any painkiller or muscle relaxant for any joint discomfort. This allows me to train consistently and perform optimally on the roads. This is also why I am so passionate about spreading this message: injuries do not have to be part and parcel of sports, even at the higher levels. It comes about with a preventive health approach by investing in my own spinal health proactively (rather than reactively), something especially important for athletes.
If you are in the unfortunate position of suffering any sport injury (whether diagnosed or suspected), think about the bigger picture so you can keep hopefully safely doing what you love in your later years. Hitting that temporary “pause” button to recalibrate, and getting your imbalances sorted out first, would also give you peace of mind when resuming training again on a well-aligned foundation.
So the next time someone tells you for example that knee pain is normal for athletes, you can tell them it may be common but definitely not “normal”.
In health,
*Dr. Ashley Liew (Doctor of Chiropractic)
* – not a medical or dental qualification