Rest it or get it looked at? Running and sports injuries and when physical therapy helps

The quick rule for athletes

A minor strain or flare-up can often be managed for a few days at home by easing off the activity that provokes it while staying active in other ways. See a physical therapist when the pain changes how you run, lift or play, when it has not clearly improved within one to two weeks, when it keeps returning in the same place, or when you have a race, a season or a competition coming up and need a plan. Some signs, such as being unable to bear weight, a joint that looks out of place or extreme swelling, call for prompt medical evaluation first.

I am Dr. Brent Lockett, a Doctor of Physical Therapy, and I run Osteopractic Physical Therapy & Pain Relief in North Dallas. My own interest in physical therapy started when I was an injured young athlete trying to get back to basketball, and many of the people I treat now are runners, lifters, golfers and weekend competitors. Most of them have one question: do I have to stop?

Sudden injuries and overuse injuries behave differently

The National Institute of Arthritis and Musculoskeletal and Skin Diseases separates sports injuries into two groups. Acute injuries happen suddenly, such as a sprain or a dislocation. Chronic injuries develop gradually and usually come from overuse of one area of the body, which NIAMS calls repetitive overload; tennis elbow and stress fractures are examples.

The distinction matters for what you do next. A sudden injury usually announces itself clearly, and the question is how serious it is. An overuse injury creeps up: a knee that aches after long runs, an Achilles that is stiff every morning, a shoulder that complains at the end of every swim. Those are easy to ignore until they stop you, and they are almost always about load, meaning how much, how fast and how often, rather than bad luck.

Signs that need medical attention first

NIAMS lists warning signs of an acute injury that need a health care provider, including not being able to put weight on a leg, knee, ankle or foot, a bone or joint that is visibly out of place, and extreme swelling or bruising. It notes that a dislocated joint typically requires immediate medical treatment. Add to that list numbness or weakness that is spreading, pain in a shin or foot that is sharp in one small spot and worse with every run, which can point to a stress fracture, and any head injury.

If any of those apply, see a physician or an urgent care clinic first. Physical therapy often plays a large part afterward, and NIAMS notes that a provider may recommend a course of physical therapy for rehabilitation.

What you can sensibly do at home first

For a minor injury without those warning signs, NIAMS notes that many injuries can be managed at home with rest, ice, compression and elevation, often shortened to RICE. In my experience, the rest part is best understood as relative rest: back off the specific thing that provokes the pain, not all movement. A few practical steps for the first week:

• Reduce the provoking activity, such as distance, speed, hills or weight, rather than stopping training altogether
• Keep moving the rest of the body: cycle if running hurts, train the upper body if the knee is sore
• Use pain as a guide; mild discomfort that settles by the next morning is usually acceptable, pain that builds during the session is not
• Notice what makes it better and worse, and when it hurts: at the start, during, after or the next morning
• Do not try to train through sharp pain or a limp to hit a weekly target

Why complete rest often backfires

Stopping everything feels responsible, and for a few days after an acute injury it can be. But tendons, muscles and bones adapt to the load placed on them. Rest them completely for weeks and they lose some of their capacity, so the first run back asks more of them than before the injury. That is a common reason the same Achilles or hamstring goes again two weeks into a comeback.

Overuse injuries in particular usually need the right amount of load, not the absence of it. A sore tendon often does better with a carefully graded strengthening program than with a month on the couch. The skill is in finding the dose that the tissue tolerates today and building from there, which is a large part of what I do with athletes.

When to book a physical therapist

These are the situations where, in my experience, an examination saves more time than it costs:

Bring your training log if you keep one, or simply a note of what your last six weeks looked like, along with the shoes you train in. Changes in volume, pace, surface or equipment in the weeks before the pain started are often the most useful clue in the whole examination.

• Pain that has not clearly improved after one to two weeks of sensible changes
• Pain that changes how you move, such as a limp, a shortened stride or a guarded swing
• The same injury returning for the second or third time
• Pain that is creeping up week by week as training volume rises
• A race, season or competition on the calendar that you do not want to miss
• Recovery after surgery, when you want a structured path back to sport

How sports physical therapy works with me

Every session is 60 minutes, one-on-one with me, at the clinic or where you train. For athletes, I use a full-body evaluation to find the compensation behind the pain, because the sore knee is often reacting to a stiff ankle or a weak hip, and the sore elbow to a grip or shoulder pattern. The examination includes the movements of your sport, not just a table test.

Treatment combines hands-on work where it helps, such as manipulation or dry needling for a muscle that reproduces the pain, with loading that rebuilds capacity. Where heavy loads are not yet tolerated, I often use blood flow restriction training. A 2019 position stand in Frontiers in Physiology sets out its methodology, applications and safety considerations, including its use to build muscular strength and size, and before using it I review each client's vascular and cardiac history. Sports performance therapy is also useful before and during a season, as a screen to catch problems early, not only after an injury.

Getting back to full training

Returning to sport is a sequence, not a date. NIAMS notes that a rehabilitation program that includes exercise and other types of therapy is usually recommended before returning to the activity that caused the injury. In practice, each stage has a test you pass before moving to the next:

A small flare-up along the way is normal and does not mean starting over. It usually means one stage was added too quickly, and the answer is to step back one level for a few days, then build again. What matters is the trend over weeks, not any single session.

• Daily activities and walking without pain
• Strength in the injured side close to the other side
• Sport-specific movements at low intensity, such as jogging, light swings or bodyweight lifts
• Speed, jumping, cutting or heavier loads, added one at a time
• Full training, with volume brought back gradually rather than all at once

Habits that keep athletes out of the clinic

Most overuse injuries I see follow a jump in load: a new training plan, a race build, a return after time off, or a sudden switch of surface or shoes. Increase one thing at a time, keep strength training in your week even in peak season, and pay attention to sleep, which affects both pain tolerance and recovery. Treat a niggle that lasts more than a few days as information rather than an insult.

A short strength routine two or three times a week, covering the calves, hips, trunk and upper back, is, in my experience, one of the most useful things a runner or court athlete can add to a training week. It does not need to be long or complicated; it needs to be regular, and to get gradually harder over the months.

Long, hot stretches of the Dallas summer also change how training feels; many runners shift to early mornings or shorter efforts, and that kind of adjustment is part of managing load too. If you want to know how long a plan is likely to take for your injury, read how many physical therapy sessions it takes.

Booking an assessment around your training

The first step is a free discovery visit, in the clinic or by video, to talk through the injury, your training and your goal date. No physician's prescription is needed. If we go ahead, the first full session includes the examination and treatment in the same hour, and you leave with a plan that keeps you as active as the injury allows.

Sessions take place at my clinic on North Central Expressway or at your gym, so you can be assessed on your own equipment; I explain the pros and cons in in-home and in-office physical therapy. I also offer a 30-minute dry needling session for focused relief before a race or after a heavy training week. My practice is out of network, and you receive a superbill after every session.

Questions people ask me