Soreness vs. Injury: What’s the difference?

At one time or another all runners experience soreness during and after runs. Many of us also unfortunately become injured. What is the difference between the two and should you alter your training regimen?

Being a competitive runner and a physician, I have found myself in this scenario literally hundreds of times. Unfortunately, I never received good answers to this question from the medical professionals whose help I sought prior to becoming a doctor. This is a major part of the reason I became a physician.

Defining the terms soreness and injury properly is important to understanding the difference between the two. Soreness is mild discomfort that lasts 1-3 days. It usually subsides, or lessens after the warm up period during exercise. Most of the time soreness is related to a hard running effort or race just prior to onset. It could also be from participating in a new activity, or can be exhibited as chronic joint pain that comes and goes related to training volume. You can usually continue training through soreness by decreasing mileage, pace, and overall impact exercise exposure.

More intense and concentrated pain in one particular area usually indicates an injury. The pain can last longer than the 1-3 days associated with soreness, and generally worsens over time without treatment. Injury usually requires time off from running and many times medical treatment.

Here are some simple guidelines to follow:

Soreness

1. Pain is usually symmetrical; i.e.; It will be present in both legs equally.
2. Can be in the belly of an affected muscle, such as the calf, quad, hamstring, or buttock. This is called delayed onset muscle soreness. The pain usually peaks in intensity 48 hours after a hard effort and most cases is resolved four days afterward. Some severe cases after marathons and ultra-marathons can last up to 7-10 days.
3. Most soreness will not be painful when immobile/sedentary.
4. Usually involves a larger or broad area that sometimes cannot be pinpointed.
5. Large amounts of delayed onset muscle soreness can make you sleepy and hungry. Get plenty of sleep, food, and water.

Injury

1. Pain that lasts longer than 1-3 days
2. Most of the time injury pain is asymmetrical; i.e.; It will only be present in one leg, foot, knee, etc.
3. It can cause you to limp and alter your running pattern or gait. Compensatory gait can cause many other problems. It could be subtle at first, but as the injury worsens the pain becomes more pronounced.
4. Injuries can be painful even when sedentary.
5. Usually involves a small focus of pain that hurts when pressed or palpated and can be pointed at with one finger.

In some cases, it can be hard to distinguish between soreness and injury. Soreness and injury are not always "black and white." For example, many times the two lie on a spectrum where soreness can develop into an injury if not rested adequately. If training intensity and volume are not sufficiently altered during episodes of soreness, the soreness can progress to an injury. This progression can take as little as one run or it can happen over the course of a few weeks.

Sometimes they exhibit the same characteristics. Soreness and injury can both be more pronounced when getting out of bed in the morning and after periods of rest. They both also can lessen in intensity after several minutes of running. As soreness is progressing to injury, the pain will last longer into the run. Both can also related to worn out running shoes. One of the first things I do when I have soreness for more than three days is replace my running shoes. However, by that time it can be too late and time off may be required.

Reduce your training intensity first

While you should reduce your training volume and intensity during episodes of soreness, it doesn't necessarily mean that time OFF is needed. Often light activity may speed the resolution of soreness. After all of my marathons I take the day after the race off from running. However, I always try to walk about two miles. Another alternative is bicycling. Cycling will allow you to get the activity but will take the impact away from the areas that have soreness. If you do choose to run during periods of soreness, you should swallow your pride and slow your pace significantly.

If soreness lasts longer than three days without improvement, time off from running is the next thing that should be done. Try to remain active by participating in aerobic exercise that does not stress the sore/injured area. Swimming and cycling are the best ones. Elliptical and rowing can also be good depending on the location of the soreness. Keeping your metabolic rate high during periods of soreness and injury will help you recover more quickly, however the key is to avoid stressing the sore and injured areas. If pain persists longer than two weeks without any running, you should seek the help of a medical professional with sports medicine experience. Personally I have always preferred doctors that are also avid athletes.

Dr. Crispell is a foot and ankle specialist at Riddle Hospital in Media, PA. He is a guest contributor to Sports Doc.

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