That Four-Letter Word

That Four-Letter Word

That Four-Letter Word


I have seen a fair number of injured runners in my office over the years. I’d like to think they specifically seek my professional services because they feel that, as someone who has been known to put in a few miles once in a while, I might know a bit more about running injuries than the average, more sedentary physician or therapist.

I’d like to think that, but I sometimes suspect that more often the real reason is that people believe I am more likely to be in sync with them psychologically and consequently they will never hear me utter that dreaded, four-letter word — rest! No serious runner (is there any other kind?), after all, wants to be told “If it hurts when you do that, don’t do that!” Or, “It’s just one race … what’s the big deal?”

Now, I know it is a big deal, especially when you’ve pointed for months toward a particular race, gotten yourself out of bed at an ungodly hour every morning, pounded the pavement for miles on end, etc., etc… I know it is tough to have to give up on a goal, and I know it is very hard to just not be able to run for any extended period of time. But, I also know that sometimes, you just have to.

Prescribing rest is often a difficult call. Much depends on the specific structure that has been injured, as well as the severity and duration of the problem. The runner’s goals and schedule also play a role. But perhaps the most important part of the decision-making process is having a thorough knowledge of the physiology and chronology of tissue-healing. Since different injuries result in different healing processes, it is mandatory that we know which ones heal better with rest and which respond more favorably to controlled stress.

Fractured bones, for example, are a fairly simple proposition in most cases. We know that bone has a certain required healing time (6-8 weeks for the most part) and that with few exceptions, the two or more broken pieces must be approximated (joined together), held in that position and protected (rested) for the duration of the healing period. Soft-tissue injuries are a bit more complex since there are many different types of these structures (tendons, ligaments, muscles, nerves…), all of which have differing healing times both between and within these categories. They are also more difficult because most of the time we either cannot or do not want to immobilize the area.

There are a few general principles that can be followed to help decide if rest is necessary:

When the pain is consistent over two or more consecutive runs.

When the pain starts at a fixed point after beginning a run, with the intensity increasing as the run continues.

When symptoms are even slightly noticeable when not running.

When the area is also moderately to severely sensitive to touch or pressure.

When these signs are present, it is an indication that the degree of inflammation of the injured area is great enough that continued stress to the tissue is likely to result in further structural breakdown and damage. This may be true even if the offending cause (overpronation, muscle imbalance, etc.) is addressed, since the tissue has been weakened and may not be able to sustain even a minimal amount of stress. Again, we can use the analogy of the fractured bone. It may, for example, take an enormous amount of force to break the thigh bone, but you wouldn’t suppose that you only need to avoid that kind of force during the two month healing period; just putting normal weight on the leg may be too much to allow proper repair.

Accordingly then, “rest” is sometimes an unavoidable prescription. The duration of this non-running period varies from case to case. In any case, an attempt to resume running should not be made until the last two signs listed above are no longer present. The good news is that “rest” does not mean complete cessation of physical activity. Other aerobic exercise programs — biking, x-country skiing, swimming — can and should be undertaken (as long as they do not cause the same pain symptoms) to maintain cardiovascular fitness and, most importantly, combat some of those “I’ll die if I can’t run” feelings we all go through if we’re forced to stop.

The other thing to remember that will help you get through your unwelcome layoff is that it is only one race, one month, or even one season. Look at the long-term picture. We all have plenty of days, weeks, months and years remaining to enjoy the activity we love. How much better we will enjoy it if we’re painfree!

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).