Glutes: Linear and Rotational Training

Standard

I’ve had a lightbulb moment thanks to an Instagram post by Brett “the Glute Guy” Contreras, PhD. (I wish I’d saved the post. Now I can’t find it… Oh well.) He described training the glutes in both a linear and rotational fashion. This makes sense when considering the alignment of the muscle fibers of the glute muscles with the glute max being the best example. The fibers are diagonal which means they can exert force both both in a straight line and in rotation.

The gluteus maximus fibers facilitate both sagittal plane and transverse plane movement.

 

I’ve long used exercises that train the glutes linearly: squats, lunges, and deadlifts for example. And now I recognize that I’ve only scratched the surface or paid lip service to the rotational ability of the glutes. I’ve gained a new appreciation for some exercises that long avoided, such as the clamshell.

I’ve been doing more clamshells in my own workouts to help address some of the faulty foot mechanics that led to some recent toe pain. The glutes play a powerful role in controlling how the feet move and I believe clamshells and other rotational glute exercises have helped me.

Linear exercises

Rotational exercises

  • Clamshells
  • Lateral band walks
  • Hip airplanes
  • Lunges with rotation
  • Single-leg tube rotation

Anti-rotation exercises

These exercises impose a load on the body that will try to rotate you. Your job is to resist the rotational forces. These are really whole-body exercises but the glutes are definitely involved.

Exercise wisdom

In almost 20 years of training, I’ve thrown many babies out with some bathwater. I’ve fallen for dogma and rejected certain exercises because I thought they weren’t “functional” or had no carryover to life outside the gym. The clamshell exercise is one example. Who needs to have strong hips while lying down sideways? What use is that, especially to athletes?

It’s a relief to discover that very smart exercise professionals have had a similar experience. Physiotherpist, chiropractor, and pain expert Greg Lehman said this about the clamshell as it pertained to runners:

“I used to abhor the clamshell.  Then I started testing more runners with the clamshell. A number who tested strong in many positions would tremble during the clamshell.  Crazy, they had a lovely one leg squat, strong hip abduction but had trouble with 10 or 15 clamshells.  What does that tell me?  Such a massive deficit in function.  Would you suggest clamshells here or something to address that specific movement?  This seems like a case where I would suggest clamshells.  If a runner can’t do them I would want to address that deficit.

“But, do I want to see every runner doing them as part of a ‘functional’ program. Of course not.  They suck for that.  This is a case where the exercise prescription is ‘functional’ because it addresses a specific limitation in a specific runner.”

The clamshell is also recommended by physical therapist, and running/cycling coach Jay Dicharry.

I’ve returned to various exercises with a new appreciation. I hope that as I age and gain experience that I also gain wisdom. I must remember to maintain some skepticism about just about everything. At the same time, I should be willing to revisit what I think I know and reevaluate my thoughts.

8 Ways to Improve Your Running Posture

Standard

The position of the trunk and hips is critical for efficient, healthy running.

I’m pleased to share 8 Ways to Improve Your Running Posture, my latest article in Podium Runner. Running posture is vital for effective, healthy running. This article teaches you to mobilize joints that may inhibit good posture, and how to strengthen key muscles that reinforce good posture and make for stronger running. Here’s an excerpt:

Running is clearly a lower-body dominant activity. That said, you should understand that your body is an interconnected system more than it is a collection of parts. Running involves your entire body, from head to toes. That means your running posture—the position in which you hold your hips and spine while running—matters.

Optimal running posture is:

  • Comfortable: Able to run hard without pain.
  • Efficient: Use the least energy required for a given pace.
  • Minimally stressful: Forces generated by impact and propulsion are distributed evenly throughout your bones, muscles, and connective tissues.

Read the rest of the article, 8 Ways to Improve Your Running Posture.

Training Errors & Three Toos

Standard

The three twos: Too much, too fast, too soon.

Lately, I’ve been listening to Jason Fitzgerald’s Strength Running podcast. As the name implies, his show discusses

Running too much, too fast, too soon is a recipe for injury.

strength training for runners. I think it’s excellent and full of useful information. If you’re a coach or trainer who works with runners, or if you’re a runner with an inquisitive mind who wants to improve your performance then you will enjoy it.

recent episode reminded me that training errors may be the most common source of injury among runners. Jason said he had a cross country coach who used the term the “three toos,” meaning too much, too fast, too soon. Many of us get hurt by running too many miles, running too fast, and doing either or both before we’re ready for all that training stress. Research shows that injuries are often preceded by inappropriate, excessive increases in training stress.

(This problem of excessive training isn’t confined to runners. Almost anyone from bodybuilders to cyclists to golfers with a zest for physical activity and competition, who believe himself or herself to be eternally bulletproof and able to withstand superhuman levels of grueling hard work may succumb. I think social media exacerbates the problem.)

I often write about aches, pains, and how to recover from injury. Much of what I do with clients involves doing specific exercises to either mobilize a joint, increase his/her movement skill, or get stronger in a specific way. My thinking (and I don’t think I’m the only one) goes that if this hurts then that exercise will fix it. That may not be the best way to approach a problem though. To get a full picture, I need to always remember to ask the question, “What happened before you got hurt.” Unless someone suffered an acute injury, it’s likely that he or she increased their training suddenly and did more work than his/her body could handle. Smart training is the best protection and that’s why hiring a coach to help you with your training is a good idea.

 

9 Exercises to Make Your Big Toe Work Better

Standard

The big toe might be the Rodney Dangerfield of the body. It don’t get no respect!

Whether you’re a runner or not, you will benefit from stronger, more competent feet—particularly the big toe, or hallux. Hallux mobility and stability are critical to how the foot absorbs shock, stabilizes the stride, stores energy, and pushes off.

Without adequate foot mobility and strength, any number of problems may arise, including pain in the ankles, shins, knees, hips, and lower-back.  When foot problems arise, we tend to rely on inserts, special shoes, tape, and other external aids to solve our problems. There’s a better way: Mobilize the feet and make them strong and engaged, starting with the big toe.

Read more of my latest article for Podium Runner.

Corrective Exercises: No Magic Fixes

Standard

I once thought of corrective exercise as a magic ritual that would instantly fix pain. I believed a Z-Health drill, an FMS glute bridge, NSCA balance exercise, exotic kettlebell move, or some specific stretch or core activation routine would instantly change something so that I could move freely without pain—and without thinking about it. That’s magical thinking and now I think otherwise.

Corrective exercise is only corrective if the movement skills or sensations learned during the exercise transfers to the “real-life” activity for which the correction is sought. This process entails diligent thinking and crucially, it requires awareness. A corrective exercise should promote awareness of how to use certain muscles and/or how to move or stabilize a limb in a new, more effective way.  Here’s an example:

At a recent running-related clinic conducted by running coach and physical therapist Jay Dicharry. we discussed a common problem among runners in which forward propulsion comes from too much lumbar spine extension and not enough hip extension. This is inefficient and may cause low-back pain, knee pain, and other problems. We learned several strategies to run in neutral posture while extending the hip. More specifically, we used the abs to bring the ribs down toward the pelvis, reducing lumbar extension, while simultaneously contracting the glutes to drive the leg backward. Several exercises helped us gain awareness of glute contraction, hip extension, and ribcage positioning. We didn’t stop with exercises. We took the awareness created by the exercises to the act of running. We had to think and pay close attention to what we were doing.

In the context of corrective exercise, my job is to facilitate habit change in my clients. I must select the exercises that help my client move and feel better. The exercises should have adequate similarity to the activity in which my client wants to improve. I must use cues that resonate with my client, that help them understand and feel the proper movement pattern.

This process may require using several exercises that link to the activity itself. For running, we may start with a simple exercise to simply feel a muscle, the glutes for example. We may start with some sort of bridge, lying supine on the ground. We may progress from lying on the ground to kneeling, to standing on two legs to standing on one leg, and then to running. All the while, I must use the right cues and instructions to keep the client focused on the task at hand. Finally, I must ensure my client repeats the new movement pattern. Repetition is essential for learning.

The corrective exercise process is fundamentally about habit change. It’s about focused learning to create and allow new, different movement. The new movement process must be practiced and ingrained so that it replaces the old, painful movement. Corrective exercise is not about an automatic fix.

Training Update: 10 Days Until Behind the Rocks

Standard

I’m running the Behind the Rocks 30k in Moab, Utah on March 23rd. It’s my first race of the season and my first race since my calf injury last year. I’m happy to report that all my parts feel strong. I’m pleased and proud to have overcome the problems from last year. Strength training aimed directly at the calf has been the key.

Calf exercises

Calf and lower-leg strengthening is my religion. I do specific calf strength exercises twice a week. I rotate among the following exercises. I also jump rope and do other two- and one-leg jumping exercises at least once a week:

I use several different weight and rep schemes for the exercises:

  • Heavy loads for <6 reps. This builds strong muscles and strong, stiff tendons. Stiff tendons are like stiff springs. Stiff tendons absorb and transmit forces efficiently which makes for efficient running.
  • Moderate loads for 8-15 reps. This builds muscle bulk. More muscle mass helps make muscles strong and durable.
  • I may go as high as 20-30 reps for the mini-squat. That’s due to the soleus muscle (the main muscle in that’s worked in the exercise) being comprised mostly of endurance muscle fibers. I typically put a barbell on my back.
  • For the jump rope, I’ll mix two- and one-leg jumping and I’ll jump for about 1 minute x 5 sets.

Other key exercises

The hip hike and offset lunge are great exercises for lower legs, quads, glutes, hip adductors and hip abductors.

I like the single-leg tubing squat as well.

Coaching

Finally, Coach Andrew Simmons of Lifelong Endurance has been indispensable. He listens to me, pays attention to detail, and inspires confidence. I’m grateful to have his guidance. If you’re looking for a running coach, I recommend him highly.

Calf Strength Progress

Standard

A calf injury derailed this previous racing season. I’m taking steps to avoid a repeat. Primarily I’m making my calves and feet stronger, not just the muscles but the connective tissue as well. My process is detailed in an article for Competitor Running. Every week, twice a week I spend time working on the lower legs. I treat it like religion. The work isn’t especially exciting but if I don’t do it then I can expect more problems. Thus, I don’t give myself the option to avoid the work. Here are the main features of my lower-leg workouts:

  • I choose two of the following:

    https://www.youtube.com/watch?v=darNO5nfl48&feature=youtu.be

  • Bent-knee or straight-knee depending on the part of the calf I want to target
  • High-weight/low-reps (< 6) to strengthen and stiffen tendons to improve running efficiency, and increase force production of the muscles
  • Lower-weight/higher reps (>8) for muscle hypertrophy which should also help with strength and durability.
  • I jump rope 6 x 1 min or I do various two- and one-legged hops once or twice per week.

I expect this program to enable me to train for and run several big races in 2019, including the Grand Traverse Run from Crested Butte to Aspen on 8/31. Sim sala bim.

 

An Abrupt End to the Racing Season :-(

Standard

It is with a snarling, frustrated, heavy relieved, accepting, grateful heart that I must call an abrupt end to my 2018 trail racing season. I’ll miss both the Pikes Peak Ascent and my main event, the Grand Traverse. It’s all due to a gimpy left calf and a bad decision on my part.

Good decisions

The calf strain came a few weeks ago while climbing during a race. I did the right thing. I quit the race and avoided further injury. I took two weeks off from running. I saw Dr. Nick Studholme who taped my foot and calf and helped me understand the injury. We decided on a collection of exercises to help the area heal and get stronger. I did calf and lower-leg strength work to my level of tolerance.

Last Monday I did an easy road run for the first time and I felt good. Great! Then I had a decision to make: Do I continue a slow, gradual return to running protocol? Or do I jump quickly back into hard training?

A bad decision

I chose option two, a seven-mile trail run with intervals. Everything felt fine until about mile three. I took a big step off a rock, landed on my left foot, and felt some pain low in the calf, the same area that was hurt in the race. I didn’t crumple in agony but there was noticeable discomfort. I kept running. I hoped the pain might fade out or simply be a minor annoyance. It hurt more as I ran and hurt less when I walked. That is a clear-cut indication of an acute injury that must be unloaded and allowed to rest. I made the wrong decision.

The Pikes Peak Ascent is two weeks away. Uphill running will put my calf under massive stress. I was running uphill when I hurt it the first time. Two weeks is probably enough time to start running again, but by god isn’t nearly enough time to prepare for an 8000 ft. ascent.

Madness

The 40+ mile Grand Traverse is four weeks away. Four weeks… That’s not much time… Is it enough time…? If you’re an endurance athlete then you may recognize the following line of “reasoning.” The conversation I had with myself went something like this:

“I’ve heard of athletic miracles, of players coming back from near-disastrous injuries and illness with incredible performances. Can that be me?”

“Can I replace running with mega-miles on the bike, rehab the calf, and get to the start line of the Grand Traverse?”

“Are there miracle drugs? Can steroids help? If so, should I attempt to use them?”

(I’ve never considered steroids but I did learn a few things about them. The good news is that several significant factors including ugly/weird other effects put me off this route.)

Panic

I screeched into a blistering panic for about 48 hours. I came up with all sorts of irrational, desperate thoughts. It was agonizing and depressing. The emotional part of my brain had a flailed and reeled as the rational part held up the facts about my injury and the reality of running a 40-mile race in four weeks.

Waaah! The poor privileged white man may not get to run recreationally through the woods! 

In the context of the wider world, of suffering, of true hardship, this was not an actual problem… but sometimes things bother me.

Sanity and calm

I spoke with my coach, Andrew Simmons of Lifelong Endurance. He helped me. He did what a good coach should do: Tell the truth. We both agreed that Pikes was out. As for the GT, he said there was a far outside possibility that I could jog/hike the race, stagger across the finish line in misery,  damage my calf severely, and destroy my ability to run for 60-90 days. These were the facts. My decision was crystal clear. No more racing. Heal up. Get ready for next year.

We agreed to reconnect again in several weeks. He recommended I be able to run 20-25 miles per week with 10-12 mile long runs before I commit to serious training.

To be very clear, I place no blame on Andrew or the running plan for my injury. I was making solid progress and I have been entirely satisfied with Andrew’s coaching. I fully intend to enlist his help again on future races.

The upside

Adverse events are guaranteed to happen. Any athletic endeavor comes with risk. Trail running is risky. Ultra-distance running even more so. There are innumerable variables that must align for a successful race and a successful season. It’s entirely likely that something or several somethings can go wrong. How does one react? To me, that’s a crucial issue. Does one wallow in self-pity and self-criticism or is there a better way? I choose to observe several positive details:

First and most importantly, my mind is right. I love the training: running in the mountains, preparing to race. My motivation is sky high—I love the process! — and I am deeply grateful for my time on the trail in the mountains. I have every intention of running the races I missed this year. I carry no negative emotions around trail running.

Second, I try to be resilient in these circumstances. I’m not Mr. Spock, I have emotions and I definitely experience the intense anguish familiar to any athlete who’s hobbled by an injury. Once the teeth gnashing and the freakout is over though I try to move forward in a positive way. Ruminating and stewing over past events is wasted energy, it won’t heal my calf faster, and unless you have a time machine I can borrow so I can go back and fix my mistake, I’ll never be able to change the past. Move forward.

Third, I recognize the significance of my weak link. My left lower-leg/ankle/foot/calf is a continual problem. I do just enough rehab/strength work to push the problem away, then I ignore the weak link and the problems return. I believe the recent hard running I’ve done has exposed the weak link again. Calf work is boring for me. I don’t like it so it’s easy to avoid it. The problem is that it’s critical for my running success. (I’ve discussed this in the past.) It stares me in the face. I have a choice: I can continue to follow the same process and thus I should expect the same problem to return. Or I can devote significant energy to build up my lower leg, armor it, make it strong and resilient, and expect to perform better. I have a chance to make a better choice going forward and address my calf strength the way I should.

Finally, I had a great experience working with my coach. We moved my running in the right direction. Specifically, we worked on tempo runs. I got faster over longer distances. The hard runs felt good and I made progress. My final long run of 20 miles felt superb. I fully believe that I’ll return to a high level of performance with Andrew’s guidance.

There is always an upside to a regrettable situation. Always. Now I get to spend a lot of time on the mountain bike!

The Left Calf Strikes Again. No Running for A While.

Standard

Damnit.

Two weekends ago, I was looking forward with much enthusiasm to the 25k Under Armor race at Copper Mountain. I’d completed a strong 20-mile run the previous weekend to cap off several weeks of hard training. I felt good and everything seemed in proper working order. So it was a surprise to me that I had to quit the race at mile two due to calf/Achilles pain.

The race started immediately with a long climb. It wasn’t terribly difficult, nothing for which I didn’t feel prepared. I was warmed up, had done some running-specific joint mobility drills, and I felt 100% ready to go. Temperatures were in the 60s and the sky was clear. Everything seemed in place for a good performance.

Noticeable calf pain started about 30-minutes into the race. It got worse with every step. Nothing snapped or gave way but the pain came on within several minutes and it quickly slowed my pace.

It’s not uncommon to have some odd ache or pain that fades out after a few minutes of activity. Not this time. Every step was more painful than the last. I stopped a few times, wiggled my foot, stretched the calf a little, tried to do anything at all to fix the issue and no luck. I was limping. One of the rules of pain to which I adhere is that if the pain is enough to alter my mechanics then it’s time to stop the activity.

This felt like an acute injury with pain brought on due to tissue damage. This pain wasn’t behaving like chronic pain. A light-speed PowerPoint presentation of possible outcomes flashed through my mind as several race-related questions materialized:

  • Could I limp and hobble my way to the finish? I had about 13 miles and a lot of climbing left to do. At best it would take all day and I would limp painfully across the finish line. At worst I would have a seriously injured calf and wouldn’t be walking for weeks.
  • What about my other races??? I have two other races, including the main event, the Grand Traverse on Sept 1. That’s the goal and the primary focus for this season. Anything that derails that race is to be avoided. This was a strong argument to quit.
  • My ego sprang to life, the ego that identifies as a runner, a personal trainer, a very fit person, and someone who knows how to guard against injury. For good or ill, this ego needs others to know all these things, and see me as I want to see myself. To tell others that I quit a race could be a serious blow to Mr. Ego. This emotional, irrational dude pleaded to find a way to push on.
  • Some 43-year-old part of my being chimed in. This individual seemed educated, experienced, emotionally balanced, and most importantly, honest. This voice evaluated the evidence and stated clearly, “Stop now! You’re done. Don’t be stupid. Not only is it the right decision, it’s the only decision.”

I quit the race, earning myself my first DNF (Did Not Finish) and limped down the mountain to the base. Boo hoo. It was a drag. It was frustrating. I was angry. All normal emotions in this circumstance. That said, I didn’t flush myself too far down the toilet of despair.

I’m not the first runner to quit a race. In fact, my bet is everyone who races in any serious way quits a race due to injury. No one can guard against every potential obstacle. I did the best I could to prepare but I’m not perfect. Further, it’s not like I did anything stupid. I didn’t get drunk the night before. I didn’t forget my shoes at home. I didn’t sabotage myself. (Continuing the race would definitely have been an act of self-sabotage.) Beating myself up ad nauseam would’ve been wasted energy, it wouldn’t have helped me heal faster, and it wouldn’t help me on my next race.

The good news is I made the right decision. I quit when it should have and I avoided a bad injury. I got some crucial information too: I must strengthen the left calf. I must be more thorough than I’ve been in the past. (Here’s a rundown of what I’ve written about the subject.) Here’s what I know:

  • First and foremost I must let this injury heal. It would be a massive mistake to let it partially heal then go run and injure it again. This may take two weeks or more.
  • My left lower leg strength (as measured by single-leg heel raise ability) is significantly weaker than my right.
  • I’ve paid lip service in the past to my left lower leg. I must devote more time and effort to making it strong and keeping it strong.
  • Once my calf heals and once I’m able to load it, I must worship at the altar of calf raises and other lower-leg exercises.

In an effort to maintain my conditioning I will replace running with cycling. Is cycling a good replacement for running? Not really. Considering various kinematic differences in turning a crank with my legs vs running (lack of eccentric loading in cycling, connective tissue contribution in running, joint angles, body position) cycling is noticeably different from running. Is there a better alternative? No.

Pain Science for Runners

Standard

This post is mostly the same as my recent article in CompetitorRunning.com. I discuss several exercises in the article designed to help runners overcome common painful issues related to running. For this post, I include pics and videos of the exercises. Here it is.

Pain Science for Runners

Acute vs Chronic Pain

Chronic pain is frustrating. Painful feet, ankles, knees, hips, and low-backs are common in runners. Chronic pain may bring fear that you’re broken, weak, and fragile. Thus you avoid many meaningful activities. You may obsess over your pain. This is the fear-avoidance cycle and it fuels itself.

Chronic pain is different from the pain of an acute injury such as a bone fracture; dislocation; or a cut, scrape, burn, or puncture. Chronic pain lasts long after an acute injury has healed.

Pain serves a valuable purpose but with chronic pain, the pain remains after it has served its purpose. Chronic pain comes from a “broken pain system,” akin to a car alarm that goes off for no reason. Fortunately, you can overcome chronic pain and start running again.

Pain science reveals several important points regarding chronic pain. Most important is that pain rarely equals harm or damage. You can be hurt and strong at the same time. (You can also have damage with no pain. Ever find a bruise but have no memory of how it got there?) Chronic pain is the result of a sensitized nervous system aka central sensitization (http://www.instituteforchronicpain.org/understanding-chronic-pain/what-is-chronic-pain/central-sensitization). Contributors to sensitization include:

  • Beliefs such as you’re broken and further activity (running) will break you more.
  • Lifestyle factors: job stress, relationship stress, lack of sleep, poor diet, lack of exercise
  • Coping strategies: Avoiding running out of fear which drives you deeper into despair and further sensitization.
  • Emotions: catastrophizing, fear, anxiety, anger, rumination
  • Tissue stress: Tissue stress can definitely contribute to pain. Remember though, tissue damage is typically a minor contributor to sensitization.

All of the above factors may be kindling for a pain fire. One too many stressors may spark the fire. You feel pain when the accumulation of stress exceeds your brain’s perceived ability to cope. There are two ways to tackle pain. One way is to decrease the stress that contributes to pain. Another way is to increase your resilience and get strong.

Confront your pain

You can lower nervous system sensitization in several ways:

    • General physical activity
    • Talk with a counselor
    • Various therapeutic techniques: massage, foam rolling, manual therapy, hot, cold
    • Consistent sleep schedule
    • Improve your diet
    • Load and strengthen the place that hurts.
    • Resume running

Your bones, connective tissue, joints, and muscles are very strong and they respond well to loading. If you’ve been guarding and resting part of your body then it gets weaker. Structures like the Achilles and patellar tendons need strength, not more rest. Physiotherapist, chiropractor and pain expert Greg Lehman favors gradual strengthening as one of the best ways to reduce pain.

Get strong – Load it!

Loading strengthens muscles and connective tissue while and provides an analgesic effect. Physical activity boosts your mood, builds self-efficacy, and shows that you’re not broken. By engaging in exercise you break the fear-avoidance cycle. Here are several exercises to help with several conditions. A comprehensive guide is beyond the scope of this article.

Isometrics:

Isometrics work well to calm pain. Contract and hold with no motion for 30-60 seconds. Perform isometrics frequently throughout the day.

  • Right: Heel raise loaded with a kettlebell for Achilles and plantar

    Heel raise

    fascia pain. Use a bent or straight knee.

  • Below: Wall sit for patellar pain. Progress from two to one leg.

    Wall sit

     

 

 

 

 

 

 

 

  • Below: Straight-leg bridge for glute/hamstring pain. Progress from two to one leg.

Straight-leg bridge

HSR (Heavy Slow Resistance) training:

Exercises should be exhausting in 5-10 slow, deliberate reps. (Most of these can also be done as isometrics too.) Start with bodyweight then add weight via barbells, dumbbells, kettlebells, weight vests, machines, or rubber tubing/bands. Persist into pain no higher than a 4 on a 1-10 scale.

Heel raises for Achilles tendonitis can be done with a straight or bent knee.

Loading the knee and hip reduces knee pain.

Band knee & hip extension

Band walks

Side bridges target abs and hip

Band leg press (A squat can be done in a similar way.)

IT Band syndrome

1-leg squat

1-leg bridge

Band leg press (A squat can be done in a similar way.)

Resume activity

Exercise is medicine. If you’ve avoided running for a while then it’s time to run! A little bit of running will help you understand that you’re not broken and the physical activity will help calm your nervous system. You’ll use the process of graded exposure. Add work gradually, keep pain at a minimum, and you’ll increase your capacity for activity.

Try a run/walk protocol like this:

  • Week 1: 1 min. run/3 min. walk, repeat 10x
  • Week 2: 2 min. run/2 min. walk, repeat 10x
  • Week 3: 3 min. run/1 min. walk, repeat 10x
  • Week 4: 40 min. run

Perform each workout twice per week on non-consecutive days. Pain should be no higher than a 4 on a 10-scale (1 = no pain, 10 =  very painful) and pain should not alter your running form. Don’t push through severe pain.

Flare-ups

It’s not uncommon for pain to flare up after activity. Don’t be alarmed. You haven’t done more damage. You’ve pushed a boundary and your nervous system has overreacted. Reduce your activity level a little bit next time you exercise.

Finally

You may need more information beyond this article. A physical therapist or other medical professionals can help guide you through recovery. Injuries such as stress fractures definitely need to be unloaded and rested. If your pain gets worse with activity then seek medical care.