Your child comes home limping from foot pain after a running event. Do you (A) ignore it as long as they’re not complaining, (B) make them feel better with some medication, or (C) rush them off to the doctor? Is your answer “None of the above?” or “Maybe” or “I’m not sure?”

Running is part of the training program for all sports. If your child is in an athletic program, then they’ve probably had a running injury at some time or another. Your young athlete may tell you it’s nothing, maybe their coach pushed them to keep running, or they simply didn’t want to let down the team. Sometimes kids think the pain doesn’t matter and it will all go away in a couple of days. Maybe it will, but maybe it won’t. As a parent, it’s important for you to get involved.

You can help by following a few basic guidelines to (1) identify the severity of a running injury and know when it’s okay for your child to keep on running, (2) understand some basics of home treatment, and (3) know when to seek qualified professional help for an injury.

How Bad Is My Child’s Injury?

Running injuries can be complicated. There are over 20 different types, most of which are caused by training errors that can be corrected. When it comes to dealing with an injury; however, the type of injury doesn’t really matter – what matters is the severity.

Unfortunately, most parents (and even coaches) don’t know how to evaluate the severity of running injuries. So, as a physical therapist that specializes in running injuries, I developed a useful scale for staging running injuries, increasing in severity from Stage 1 to Stage 5.

Guidelines for Running Injuries

Here are some questions you can ask to help evaluate the stage of your child’s running injury. Keep in mind, if you are concerned, that it is always appropriate to consult a qualified professional at any stage.


Question 1: Does your child have pain that continues as long as they are running but stops when they stop running?
Evaluation: Stage 1, pain upon exertion.
Action: This is the first warning sign of an injury. Work with your coach and/or physical therapist to determine the cause of the pain (such as training technique or shoe problems) and correct it.

Question 2: Does your child have pain after they stop running but then it goes away?
Evaluation: Stage 2, pain at rest, immediately after exertion.
Action: This is the time to start injury management using the PRICE method.

Question 3: Does your child have pain during normal activities like walking, climbing stairs, or sitting at their desk? Or is there some ache or nagging pain that bothers them?
Evaluation: Stage 3, pain that persists during normal daily activities.
Action: Monitor this closely – this should be of concern if it doesn’t improve in a few days, or if it worsens. Limit running and employ injury management techniques.

Question 4: Is your child taking any kind of medication for pain, even an over-the-counter medication such as aspirin, Advil, or Tylenol?
Evaluation: Stage 4, pain that they take medication for.
Action: This is a very important stage. Medication masks the severity of an injury and allows it to get worse if they keep on running. If your child is taking medication, then they must cease running until it is out of their system.

Question 5: Does your child have pain that stops them from running or maybe even walking?
Evaluation: Stage 5, pain that is crippling.
Action: Stop everything and seek immediate professional advice.

Any type of running injury can be staged this way. Remember, even if your child is at Stage 1, pain-wise, if they are taking any medication for it, then they’re at Stage 4, which is one stage from crippling.

Stage 1: Pain upon exertion
Stage 2: Pain at rest
Stage 3: Pain that persists during normal daily activities
Stage 4: Pain that your child takes medication for
Stage 5: Pain that cripples your child

Stage 1 is the first warning sign. There is pain, but it stops when they stop running. This is the time to look for a cause, such as a shoe problem, and correct it.

Stage 2 is when pain persists for a short while after running but then goes away. In addition to finding and correcting the problem, this is the time to start injury management.
Stage 3 is when pain, even minor aches or discomfort, continues throughout the day. In addition to injury management, persistent pain should be closely monitored. If the pain doesn’t improve, disturbs sleep, or interferes with daily activities, then it’s time to seek professional help.

Stage 4, taking medication, is a critical stage. Note, even if a runner is at Stage 1 based on pain level, if they take any pain medication, including over-the-counter medication such as Advil, then suddenly they’re at Stage 4 which is one stage away from crippling. Pain that requires medication must be addressed immediately.

Under no circumstances should you allow your child to take medication in order to keep running, including prescribed oral or injected medications. Coaches, and even doctors, may be willing to give pain medication or cortisone shots and tell you its okay to for your child to keep running. It is not. Medication can mask the pain just enough to cause crippling. For anyone running on pharmaceuticals or injections the finish line is Stage 5.

Stage 5 is a crippling pain that keeps your child from running, or maybe even walking. Crippling doesn’t necessarily mean they’ll never run again. They could still recover from stage 5. But they may not recover from stage 5. You do not want your child to be at stage 5. Seek specialized professional help early.

Injury Management at Home: PRICE

Home management for running injuries is PRICE: protection, recovery, ice, compression, and elevation.

Protection means identifying and modifying the reason for the injury. The main cause is usually training error, which is a broad area and hard to define. The first thing to do is protect the injured structure and allow it to recover. That could mean a change in footwear, a modified exercise program, or resting.

Recovery is actively working to regain the normal function of the injured structure and may include massage, rest, and a modified training routine. It’s about moving from later stages on the scale back to earlier stages and regaining movement, strength, and function. It’s okay to train, as long as the injury is improving.
Medication may be a part of your child’s recovery if their sleep is disturbed and the medication is necessary for rest, but there must be no running until the medication is out of their system. Medication means Stage 4, and they can’t compete.

Ice means cold compresses. There’s a lot of discussion about applying ice packs. I like to go 360 degrees around the structure whenever possible.

Compression includes placing pressure on the injured structure (ankle, shin, knee, or hip) by wrapping toweling around the ice pack and using Ace bandages or Velcro straps.

Elevation means raising the injured structure above the heart – so ice, compression, and elevation are combined.

When to Seek Professional Help

For runners, some pain upon exertion is not unusual, but if you are concerned, then go ahead and take your child to a professional for evaluation, even at stage one.

Seek professional help immediately if you encounter any of the following warning signs:

• If your child is taking medication and continuing to run.
• If your child is being prescribed medication, or injected with medication, and being told they are allowed to run.
• If your child is consistently having pain at rest or pain that disturbs their sleep.
• If your child has pain that interferes with normal activities, such as walking or climbing stairs, and pain continues for more than a day a two or is worsening and not getting better.

Ideally, professional help means knowledgeable help by a runner with licensed medical credentials. Most doctors and physical therapists aren’t trained in running injuries, and finding a professional with specialized knowledge isn’t always easy.

Beware of any doctor who prescribes medication, or injects medication, and tells you its okay for your child to run. Medication can never treat the cause of a running injury; it only masks it and allows it to get worse.

F.A.Q.s


Q: Can I give my child medication for pain?

A: Always consult your doctor about giving any medication. The important thing is not to run while taking pain medication.

Q: Does my child have to stop running?

A: Not necessarily. Its okay for them to run as long as they are following their specific instructions for protecting the structure and recovery, and their condition is improving. (For example: changing the shoes, doing less mileage, going slower, doing their stretching exercises.) They can continue to train as long as pain is not disturbing their sleep, they do not progressively have to modify or reduce daily activities, and they’re not using medication.

Q: Can the right shoes help protect my child from a running injury?

A: Shoe problems are an avoidable cause of running injuries. You can learn more about athletic shoes at www.wilkpt.com/articles and at www.defectiveshoe.com.

Staying Safe

As parents, it’s our job to watch over our kids’ health and ask the right questions. Left to itself, any running injury could be crippling. It doesn’t matter if it’s plantar fasciitis, shin splints, or a stress fracture – taking Advil or receiving cortisone shots from a doctor and then running can progress any running injury from Stage 1 to Stage 5.

Remember, the first rule of management is protection. It’s better to put a management system in place early (such as the right shoes, exercises, or training routine) that can correct the problem before it progresses to higher stages.

Catching problems early is the key. Running is an important part of all sports, and making sure our kids are safe will keep it fun!

Bruce Wilk is a board-certified physical therapist, a certified running coach, and director of Orthopedic Rehabilitation Specialists in Miami, Florida, where he has managed running injuries for 28 years. He has 35 years of running experience, including 23 marathons, four Ironman competitions, and many triathlons.