Understanding Pain While Running: When It’s Normal and When to Pay Attention

By: Hayden Gray, DPT,

A Guide for Runners from ProForm Physical Therapy in Salisbury, MA 

When runners come into ProForm Physical Therapy with pain, a large part of the visit is spent discussing pain education. My goal isn’t always to eliminate the sensation immediately. Instead, I help runners develop a better relationship with pain, rather than automatically running away from it.

This concept isn’t just for runners. It applies to anyone experiencing pain during exercise, training, or daily activity. Understanding how pain works can help you train smarter, recover faster, and avoid unnecessary fear around movement.  

Pain Does Not Always Mean Injury 

One of the most important things to understand is that pain and injury are not always the same thing.

Pain is simply a signal from the brain telling the body to pay attention to something. It’s part of our body’s natural protection system designed to keep us safe.

Think about it this way. If you broke your leg but felt euphoria instead of pain, you would likely continue moving the same way and cause much more damage. Pain forces us to slow down, assess the situation, and modify behavior. In that sense, pain provides useful information. However, the signal isn’t always perfectly accurate.

Pain is influenced by many factors including:

 • Previous injuries

 • Fatigue

 • Stress

 • Training load

 • Sleep quality

 • Expectations or fear around movement

Two runners could complete the exact same run and experience completely different levels of discomfort afterward.

Context Matters When Evaluating Pain 

Whenever pain occurs, the first step is to evaluate the context.

For example:

Scenario 1: Acute Injury 

You trip and roll your ankle while running.

In this situation, there is a higher likelihood of tissue injury, and the pain is likely signaling something that needs attention.

Scenario 2: Training Load 

You increase your mileage or run a hard workout.

In this case, pain may simply reflect fatigue, stress on tissues, or temporary irritation, which is often a normal response to training.

These two situations can both produce pain, but they require very different responses.

The “Cost of Effort” in Running 

Take marathon training as an example.

I know that when I race a marathon next month, there will be moments during the race—and certainly in the days after—where I experience discomfort.

That doesn’t mean I’m injured.

Sometimes pain is simply the cost of effort.

During hard training or racing, muscles, joints, and connective tissues are exposed to high levels of stress. Your body responds by sending signals that indicate temporary overload.

In those moments, the goal isn’t panic. It’s observation and assessment.

Ask yourself:

 • Does easy movement help?

 • Does rest improve the symptoms?

 • Is the discomfort improving each day?

 • Does modifying intensity help?

These questions help determine whether you’re dealing with normal training soreness or something that needs further evaluation.

Discomfort Can Be Part of Adaptation 

For runners, a small amount of discomfort during training is not always a bad thing.

The body adapts to stress.

Running, strength training, and racing place mechanical stress on muscles, bones, and connective tissues. With proper recovery, that stress leads to:

 • Stronger muscles

 • More resilient tendons

 • Improved bone density

 • Better performance

The key skill for runners is learning how to interpret the signals your body gives you.

Mental Strategies for Managing Pain While Running 

Over the years, there are several mental frameworks I’ve adopted as a runner that help manage pain more effectively.

Acceptance-Based Coping 

Instead of immediately resisting pain or becoming frustrated by it, acknowledge that it exists.

Identify what may have caused it and recognize that fluctuations in discomfort are often a normal part of training.

Acceptance doesn’t mean ignoring pain. It means not letting it control your decisions.

Attentional Focus 

Shift your attention toward factors you can control, such as:

 • Sleep

 • Hydration

 • Nutrition

 • Recovery runs

 • Mobility work

 • Adjusting training intensity

Often, small adjustments can dramatically improve how your body responds.

Cognitive Reframing 

Instead of viewing pain as purely negative, try to see it as useful feedback.

Pain may indicate:

 • Increased training load

 • Fatigue

 • Stress

 • Tissue irritation

 • Occasionally injury

When pain becomes information instead of something to fear, it becomes much easier to manage.

Internal Locus of Control 

One of the most powerful mindset shifts is recognizing that your response to pain is within your control.

You may not control when discomfort arises, but you can control:

 • How you interpret it

 • How you adjust training

 • How you support recovery

Gradual Exposure 

Avoiding movement completely can actually increase fear and sensitivity.

Instead, gradual exposure to the activity that caused discomfort helps both the body and the brain rebuild confidence.

This is a common strategy used in modern sports physical therapy and rehabilitation.

Zooming Out 

Instead of focusing on one bad run, look at the bigger picture.

Ask yourself:

 • Are symptoms improving over several days?

 • Are you able to run a little farther or faster?

 • Is recovery happening quicker?

Training is a long process, and temporary discomfort does not define your long-term progress.

Why Pain Education Matters for Runners 

Pain perception is different for everyone.

Each runner brings their own history, tolerance, training load, and expectations into how they interpret discomfort.

But learning to differentiate why pain may be occurring is incredibly valuable.

Pain isn’t always something that needs to be feared or avoided.

Often, it’s simply something that needs to be:

 • Understood

 • Respected

 • Managed intelligently

The better relationship you build with these signals, the more confident you’ll feel continuing to move, train, and perform. 

Need Help Understanding Your Running Pain? 

If you’re dealing with persistent pain while running, a professional assessment can help determine whether you’re experiencing normal training stress or an underlying injury.

At ProForm Physical Therapy, our team specializes in helping runners stay healthy through:

 • Running gait analysis

 • Strength training for runners

 • Injury rehabilitation

 • Performance optimization

Our goal is simple: keep runners running. 

Stay Fast,

Dr. Hayden Gray, DPT 

Running Specialist

ProForm Physical Therapy