Pain can start as a minor tweak or a twinge. At first, it may hurt only when you move a certain way, but it can soon morph into chronic pain. From knee pain to ankle sprains to rotator cuff tears and shin splits, figuring out when it's safe to work through the pain or when to stop and see a doctor can be difficult.
"Pain is a protective mechanism to avoid damage," says Steven Gausewitz, MD. "Whenever you have substantial pain, it's a sign you're doing too much or doing it too fast." Here are explanations of the most common workout pains and how to tell the difference between those you can work through and those that may be damaging.
Ankle Strains and Pains
From landing awkwardly during squat jumps to twisting unnaturally in Zumba class, your ankle often pays the price for missteps. This can cause mild to severe sprains of the ligaments on the ankle's exterior.
For any sprain, avoid walking on it and treat it with rest, ice, compression and elevation. If it's simply sore, it may be due to tendonitis, says Dr. Gausewitz. "Rest and ice it. You can't really work through it." Biking, rowing and swimming are better choices than weight-bearing exercises.
Signs of Bad Pain: If you can't keep weight on your ankle, see a doctor for X-rays, says David Geier, MD. "This is especially important if combined with tenderness felt when touching the bone on the outside of the ankle, which could indicate a fracture."
Knee pain can occur suddenly or begin as a crunchy sound, turning into a chronic ache. "For the most part, knee injuries are rarely an emergency unless you're lifting heavy weight and tear something," says Dr. Gausewitz.
Pain while walking down stairs, for example, is often due to patellofemoral problems, during which you feel discomfort behind the kneecap and a grating sound in the knee if the leg is extended straight. Work through it by avoiding exercises that trigger the pain, adding knee-strengthening exercises into your routine and modifying exercises such as squats, squatting only within a pain-free range of motion.
Signs of a Bad Pain: Hearing a pop at the time of the injury, significant swelling within the knee or buckling or locking of the knee can indicate a serious injury and should be checked by a sports-medicine doctor, says Dr. Geier. "These symptoms indicate a possible torn ligament or meniscus tear."
Hip pain should never be ignored. The location of hip pain helps suggest the cause, says Dr. Geier. "Pain felt in the groin usually comes from the hip joint itself (the ball-and-socket part of the joint) or the femoral neck (the top of the leg bone)." Repetitive activity can cause bursitis (inflammation) and pain on the outside of the hip, and a pain in the buttocks may be nerve-related or result from a lower-spine condition.
Signs of a Bad Pain: "Pain in the groin that increases toward the end of a run, especially if it is coming on earlier and earlier and taking longer to go away, could be a sign of a stress fracture in the femoral neck," says Dr. Geier. This symptom is especially worrisome in both young and perimenopausal women engaging in long-distance running. This injury may require surgery and should be checked by an orthopedic doctor.
Pain, stiffness or discomfort in the lower back can happen even if you're not a regular gym-goer, but it's more common in athletic people. "It is often a muscle strain," says Dr. Geier.
For mild pain, avoid exercises that make the pain worse, such as incline treadmill workouts (keep it flat), bent-over rows (do seated rows), high-impact aerobics and overhead shoulder presses. Simple treatments like rest, ice and stretching are often enough to resolve the pain.
Signs of a Bad Pain: Pain accompanied by nerve symptoms such as numbness or tingling down the leg and weakness indicate that a herniated disc may be causing pressure on a nerve root. Dr. Geier stresses seeing a doctor immediately if you experience these symptoms.
Mid-Back and Upper-Back Pain
Feeling a twinge between your shoulder blades while lifting weights may simply be a sign of bad lifting technique. Lifting too quickly can also cause a tweak of the spine, says Dr. Gausewitz. "Although sometimes, neck problems create referred pain to the shoulder blades." Be sure you're using the correct weight to allow you to perform your repetitions with proper form.
Signs of a Bad Pain: See an orthopedic sports doctor if you experience sharp, stabbing pain or have difficulty breathing, says Dr. Geier. "It could suggest a more serious condition, such as a thoracic herniated disc." In some cases, pain between your shoulder blades may be a sign of a heart attack. If you've never experienced this sensation and it's accompanied by chest pain and breathlessness, call 911 immediately.
If you feel pain in your shoulder or a sudden heavy catch or snap while lifting something overhead, you may have strained the rotator cuff muscles that stabilize the shoulder. "It may start out as a simple impingement syndrome, one of the most common causes of shoulder pain," says Dr. Geier.
This occurs when the shoulder blade puts pressure on the rotator-cuff muscles. Arthritis or bursitis may also be behind the pain. For simple strains, ice, avoid overhead activities and anti-inflammatories or cortisone injections usually resolve the problem.
Signs of a Bad Pain: If your shoulder feels like it's coming out of the socket or you experience severe pain and swelling, you may have a tear or other serious injury and should be evaluated by a doctor.
Achilles Tendon Pain
Jumping around on your toes in aerobics or high-impact classes can cause pain in the Achilles tendon. This is the largest tendon in the body and connects the calf muscle to the heel. "Most 'good pain' refers to a muscle that gets sore," says Dr. Gausewitz. "Any pain around a joint that's around for a few days is normal."
If you notice the pain and swelling worsens with activity, you may have Achilles tendonitis. Ice, rest and stretching the calf muscle will help.
Signs of a Bad Pain: Swelling and symptoms that worsen with walking, especially uphill or on uneven surfaces, may be signs of a partially torn Achilles. Other signs may arise while walking on stairs, running, jumping, hopping or when performing heel raises. See a doctor immediately — delaying treatment can result in a shortening of the torn tendon.
Even if you've never played golf or tennis, pain on the inside of your elbow, commonly called golfer's elbow, and pain on the outer elbow bone, called tennis elbow, are common overuse injuries. A muscle weakened from overuse can develop microscopic tears in the tendon, resulting in inflammation. Resting the arm, anti-inflammatories, changing your grip and using a stiffer tennis racket can help, says Dr. Gausewitz.
Signs of a Bad Pain: Your doctor may recommend surgery for extreme cases if the pain does not improve with traditional treatments after six to 12 months.
If you feel pain in the middle of your heel or along the arch while running and it's particularly painful when you first step out of bed in the morning, you may have plantar fasciitis. This inflammation of the connective tissue runs along the bottom of your foot. It occurs on the underside of the heel and increases the risk of knee pain over time.
"It can take a long time to get rid of," says Elizabeth Matzkin, MD, assistant professor in the department of orthopedic surgery at Brigham and Women's Hospital. If you suspect plantar fasciitis, avoid speed work and hill training. Massage, anti-inflammatories, supportive footwear and ice can also help. Increase training mileage gradually, replacing worn running shoes and running on soft surfaces instead of asphalt or concrete.
Signs of Bad Pain: If the pain lasts for more than a few weeks, see a sport podiatrist. Treatments include orthotics, cortisone injections, splints and anti-inflammatories.
If you run the same route every day or recently took your run from treadmill to asphalt, your shins may become painful. Pain may start in the front of your ankle and continue up the kneecap in some cases.
Shin splints — inflammation of the bone caused by overuse — can cause pain during and after your run. Decrease your mileage at the first sign of shin splints, as they could lead to a stress fracture if left untreated. Ice, rest and anti-inflammatories help.
Signs of a Bad Pain: If, after modifying your mileage, icing and resting, the pain doesn't decrease or subside, seek medical attention. In some extreme cases, shin splints manifesting as severe stress fractures may require surgery.
Read more: 6 Simple Shin Splint Stretches and Exercises