The Importance of Aches and Pains: Red Light or Green Light?
by Mary DeLaney • Apr 22nd, 2010 • Category: Tips From a ProAs athletes we run a 35% probability of injury each year. If you are an elite or top performer the risk is 50%+. During training and racing you will have aches and pains. How do you know which pains you can train through and which should be a cause for concern?
We are calling the first type “Green Light” (GL) pain. Performing at your maximum capacity is very uncomfortable, even painful. This generalized discomfort is harmless. At the end of a long run or bike ride every muscle in your body aches: “Green Light!” Another muscle discomfort without specific point tenderness is Delayed Onset Muscle Soreness (DOMS.) The whole muscle is sore and worse the day after activity. This requires only rest, ice and reduced activity for a few days, and is a GL pain.
“Red Light” (RL) pain may require specific therapy to prevent further injury. Ignoring some of these pains can end your athletic career, at least temporarily. Localized pain during or after exercise, or that worsens after you stop, points to “Red Light” (RL) pain. This warns you to stop the activity and find the cause.
To quantify pain, the medical system uses the Visual Analog Scale (VAS.) The scale goes from 0 to 10, no discomfort at 0 to intolerable pain at 10. Pains that are VAS 0-3 are rarely serious. Localized pains VAS 4 or greater require attention.
Got a Cramp?
Cramps or “charley horses” are muscle spasms most commonly caused by inadequate salt intake and/or dehydration and are generally GL pains. Muscle soreness, but no real harm done. Cramps can be an RL pain if you are taking cholesterol-lowering drugs and did not have similar cramps before the medication was started. These drugs can occasionally cause severe muscle damage, so STOP the workouts and see your doctor.
Foot Discomfort
Burning pain in your forefoot while running near your max on a hot, hard surface is a GL pain, assuming it stops when you do. Try running on a softer surface. Make sure your shoes are wide and long enough. Acute onset, localized pain anywhere in your foot, that worsens as you continue to run, is an RL pain. If that pain is reproducible, (and not due to a nail in your shoe,) it may be a stress fracture. Often stress fractures don’t show up with regular x-rays. An MRI of your foot is the gold standard. Don’t ignore it!
Joint Soreness and Arthritis
Night pain is generally RL. Joint pain that regularly wakes you up and prevents you from going back to sleep is cause for investigation. It may be arthritis. It may be a torn rotator cuff (in your shoulder) and this pain will be worse when you lie on that side. Have it checked out.
Arthritis (if you are over 25, it has started) can cause joint pain that occurs at night, as well as during activity as the arthritis worsens. Arthritis can be RL or GL, check with a specialist. An auto-immune disease can cause one type of arthritis. Correct diagnosis and proper treatment stops this type of arthritic degeneration. There is no treatment to stop osteoarthritis (OA), the more common variety, but you can treat the symptoms with anti-inflammatory drugs and exercise. Research has shown it is very important to remain active. You must keep the joints moving!
Your Knees
Knee swelling that prevents you from fully bending your knee is an “effusion.” That is ALWAYS an RL. If you cannot fully straighten your knee and doing so causes pain more than VAS 2, it’s a big RL. STOP and see an orthopedic surgeon ASAP. The most common acute cause of this pain and swelling is a torn meniscus. Running on a torn meniscus can end your running career. A knee pain that can be either RL or GL is tenderness over the patellar tendon that worsens with activity and stays tender all the time. If there is no swelling, this is commonly patellar tendinitis, an overuse injury and will respond to reduction of activity and/or anti-inflammatory medication: GL. But, you still need an accurate diagnosis from a specialist to make an informed decision.
Pain in the Booty
Pain in the middle of your bottom (gluteus maximus) when you sit, that goes away or improves as you begin to walk, is commonly the GL “piriformis syndrome.” The usual cause is a lack of stretching, piriformis weakness, overuse and possibly a dysfunctional connection between you and your clipless bike pedal. This can also be proximal hamstring tendinitis, a GL problem that can become RL if you don’t treat it. Get help to sort it out.
Chest Pain
Chest pain can be both RL and GL. When you exercise and exceed your AT (anaerobic threshold) you may develop generalized chest discomfort due to the severe work of breathing-GL. RL pain is deep, dull, aching pain under the center of your chest that may also go into your jaw or left arm and worsens as you continue, generally making you feel bad all over. This could be angina, which indicates your heart muscle isn’t receiving enough oxygen because of reduced blood flow. If you think you are having angina, you should chew an aspirin and go to the nearest ER or call 911. You don’t want it to progress to a heart attack.
Red Light! Green Light!
Understanding the cause of pain and discomfort is necessary to make informed decisions about both activity and treatment. A pain that you’ve had before, clearly know the cause and can make go away: Green Light. A new pain with a VAS greater than 3 may be a Red Light pain. Knowing the difference between those kinds of pain helps you make rational decisions in your training and racing.
Train safe!
MARY DELANEY is a triathlete, skier, kayaker, hiker, sailor, and scuba diver who runs a coaching and rehabilitation business, called Rehab to Racing, that she started with her husband. Rehab to Racing helps injured athletes get back to their sports… {more}
Thanks, Mary for the excellent and useful information!! I agree, training safe is the key.
Btw, the Athleta top pictured is absolutely gorgeous! I especially love the bold graphic print and vivid colors; it’s a real must-have for spring-summer riding and the gym too. Hmmm, I’m getting it!!! :)
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thanks for the tips Mary. I pulled my hamstring but good a week ago and have been fighting myself between red light and green light all week! I know it’s a red light injury but I really want the green light!! This was a good reminder that I need to let my body heal so I can keep going for years to come. Ditto on the Athleta top!
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This is the most enlightening piece on sports-related pain that I’ve yet read. Thank you!
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Patience is such a huge part of rehabilitation. But, it is much easier to be patient if you are confident that you have a correct diagnosis and your therapy will resolve the problem. Bottom line is that you need to be sure of what you have and for that, you often need to seek professional advice, not just talk to your neighbor or the guy at the gym who “had the same thing last year and rubbed some magical potion on it” and it was fixed. It is well worth getting your problem diagnosed properly so you can get back to doing what you love!
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Fantastic article and very timely for me. I have been having these exact conversations with others in the gym who believe that ANY pain is terrible. Your words have confirmed that I am not working too hard; rather, I am breaking down and building up muscle tissues in the right manner.
I had a little pattela swelling a month go and took the course of action just as you mention; gain a diagnosis. After a month of PT (no tears), I am almost fully recovered and ready to continue the “forward motion” of life. Body awareness is a high priority so thanks again for separating our levels of concern when we feel the workout. :)
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One of the most clear and easy to read as well as informative articles ever! And just in time for my get back in shape program! Thank you.
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Tina,
Thanks for your feedback! I really appreciate it! Good luck with getting back in shape! It is so worth it! Many years ago I heard this and I think of it often: “Nothing tastes as good as being fit feels.” Good mantra, I think.
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Great article! I injured my knee 6 months ago trail running. I tried to rehab it myself realizing that the “intense” pain pointed to a more severe injury. At the time, I preferred denial! Anyway to make a long story short, I had a complex medial meniscus tear requiring surgery. I wish that I had done this sooner. My recovery has been amazing. I am back to running and mountain biking less than a month postop. I am not at the level I was at prior to my injury but I am confident that I will be there soon!
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Great and informative article!
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Excellent article – good one to keep on hand for reference.
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Hi Mary,
Usually if I start out too fast or start on a hard surface (pavement) my lower front outside leg muscles cramp up. If I walk, slow down and get on a softer surface these muscles will relax and I can continue with my run. Is there any way to work on this type of issue with PT or ? I normally always run on trail, but sometimes races/events have a mixture of surfaces.
Thanks for your help and the article. Very helpful.
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After experiencing the grief of heel spurs and resulting complications from them (ruptured heel), wish more would be published on what to do to keep from being struck with plantar fascia problems.
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I have been experiencing an awful lot of pain in the front of my leg from just below my knee to my ankle, when I walk briskly. I thought it may be shin splints but it hasn’t gotten any better in 3 years! I used to be a runner and this pain is very dibilitating. I want to get out there and exercise (I force myself) but it is very discouraging. I have packed on the lb’s and I am NOT happy! Please advise!
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Regular areas that give you pain can benefit from attention. I kept getting injuries to my achilles tendon so my heel always hurts, when I start running, during and after but then I noticed when I lifted weights using the leg machine that it improved. As the muscle under my thigh got stronger, it took some of the stress off the heel and same with my back muscles, too. I just wanted to add that you can improve on an injured area with consistent effort. It also helps to do yoga or other intense stretching techniques to help loosen areas that may be causing injuries from being too tight. Don’t ever underestimate the power of stretching, especially if you are over 35! I also think that pain is relative to activity but if it disturbs your sleep, you should see a doctor.
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Awesome article! Great info and very comprehensive. Having suffered with more than one of these issues in my running life, I know that knowledge of the injury and how to treat it is the best line of defense. Am I the only person who is very surprised that Mary doesn’t address shin-splints in this article? Every runner I know has had them, at least once. Would love to get Mary’s take on how to both treat and prevent them. Thank you!
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Great article, but I still don’t know if my pain is GL or RL. It’s a cronic pain in my hip that sometimes runs down the back of my leg. It’s VOS is 2, but consistent for several years now. My PT brother-in-law says bursitis, but I would think that would eventually go away. I guess I should check it out to find out for sure.
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Tamara,
Your shin “cramping” sounds like the beginning of shin splints. You are right to be running on soft surfaces and slowing to a walk when you feel it coming on. You can work on that by strengthening that muscle. To do that, keep your heel on the floor and lift your foot off the floor. Repeat that several times throughout the day. Then be sure to stretch that same muscle (tibialis anterior) by holiding your foot and stretching your foot downward, pulling your toes away from your shin (like a ballerina foot.) If it continues to bother you, you should consult an orthopedic physician to rule out a stress fracture. Train safely!
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Sheila, Sorry to hear about your shin pain. I just made a comment (see above) to Tamara about a similar issue. Since yours has been going on for 3 years, it is now very chronic and I would recommend you seek medical advice from an orthopedic physician. You may need an MRI to figure out what is really going on. In the meantime, you can crosstrain. How about some biking, water running, or swimming? All of those things will keep you strong and burn calories.
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Colleen. It sounds like your hip pain needs a good diagnosis. Maybe bursitis, but maybe something else. The fact that it is running down the back of your leg makes me think it is more than bursitis. Clearly, you can see it won’t just “go away.” You need to seek the opinion of an orthopedic physician who can properly diagnose it and then recommend proper treatment. Then you can get on with working out and feeling great again!
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Kathy, thanks for the comment on shin splints. I can see that more information needs to get out there about shin splints. Read some of my comments above on this nagging issue. Actually, not every runner has shin splints. Beginning runners, upping your mileage too quickly, running lots of hills, and tibialis anterior (the muscle next to your shin bone) weakness can contribute to this painful syndrome. But, it can also be a stress fracture of your tibialis anterior, so if it is continuing, you whould get that checked out. I will write an article on this and post in in my Chi blog.
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Aloha from Hawaii…recently i suffered a cardiac event…i am (was an ardent outirgger canoe paddler) and am 78 years old as well. I love my canoe paddling and the training that went with it. That meant lots of cardio along with the paddling. a few weeks ago we were sprinting, it was rainy and cold. since i am a steersman i wasn’t paddling as hard as the rest of the crew. during the sprinting session got a pain in my chest…started to spread to my arm. I ignored it but when we quit and put the canoes away it seemed to be intensifieing. Went home and took a hot shower..no releif so did the smart thing and went to the ER. sure enough…blood test showed I was experiencing a cardiac event (Doc speak for heart attack. ) So on to plan B. However I do have a question…does cold have any effect on blood flow, I was quite cold…or was I so cold because I was experiencing the event?
aloha, Donna
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Donna, WOW! That is very scary! Do you know the the first sign of cardiac disease in women is very often a full-blow heart attack? You were so smart to go to the ER. I hope you are participating in a cardiac rehab program. If your physician did not recommend you do that, you need to talk to him/her about that. It is extremely helpful, even for serious athletes, such as yourself. There is a hidden, but very real, psychological injury that goes along with the physical cardiac event, itself. So, be sure to talk to your doc about that! Now, sorry for long answer to short question. The cold would not have caused the heart attack, or even influenced it. You were most likely quite cold because you were having the event. I will say again, that you were very lucky to have survived. If you had just gone to bed…let’s don’t think about that! Happy training and rehab!
Mary
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Hi Mary, Important topic and article you wrote!
I have a pain after running and strength trainging exercise. It is headache mostly at the occiput that can become whole head pain (sometimes throbbing) and sharp eye pain (both eyes) that lasts for 5-7 hours after exercise. I drink electrolytes the day before and day of exercise. the VAS level is a 5-8 range.Any ideas? Thanks
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Hi Mary, glad you found the article helpful! This pain you are having is worrisome to me (and obviously, to you. too.) It may be blood pressure issue or it could be something more serious. I would strongly recommend you consult a neurologist. Your family doctor can refer you. Anytime you have pain that lasts that long, is that intense (5-8/10) and is in your head and eyes you need evaluation immediately! When you call for the appointment, emphasize the severity of the symptoms, just as you have here. And, be sure you pursue this until you find the cause and have it treated! Please let me know what you find out! All the best, Mary
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Excellent article! I just experienced my first serious DOMS after a half-marathon and your article was helpful in my understanding that my quads would recover – and they have!
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Kathleen, congratulations on your half-marathon! Awesome accomplishment! And it can certainly cause DOMS. I am glad you were able to recover and that my article was helpful in understanding it. Now, what is the next event?
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