8 Principles to Guide Care of Non-Traumatic Pain in Sport

This article was published on: 01/9/23 6:27 AM

In sports, non-traumatic pain contributes to being interrupted in management, there is still a continuing perception of what pain is, and some people still think that pain indicates an injury at the location of the pain. However, pain is a unique and complex experience. Even though you will feel pain, tissue damage is not always noticeable. Actual or potential tissue injury can cause pain. Genuinely, when our brain notices something that can damage our safety, we can feel pain.

Pain occurs when load exceeds tissue tolerance, such as ligament tear or a fracture. Even when there is no physical trauma, athletes experience discomfort, and clinicians, coaches, and athletes themselves frequently refer to tissue damage as an “injury.” This reflects a knowledge gap in our professional community—tissue damage does not occur for pain—and practice—which assumes that all pain results from tissue damage. This is especially true when it comes to acute, non-traumatic pain (such as back and joint pain). We present eight guidelines for clinicians who treat musculoskeletal pain in sports to help close this gap.

The three types of pain show the differences between the causes of pain.

The early warning system pain is caused by sensing noxious stimuli like holding your hand too close to the fire is called nociceptive pain. It acts as a safeguard against actual or potential harm by generating uncomfortable feelings and triggering the withdrawal response.

Inflammatory pain is pain that seeks to promote healing by preventing movements and touch after actual tissue injury has occurred. In this situation, the immune system has been activated. This pain is an abnormal nervous system function and a maladaptive process.

Pathological pain is caused by neuropathic (nerve damage) or dysfunctional pain (no tissue damage). The nervous system generates pain that goes beyond what is biologically necessary.

The eight Principles 

In the absence of trauma, do not assume that pain indicates tissue damage.

If your pain has no pathoanatomical basis, it shouldn’t be classified as an injury. Words like “overuse injury” can imply tissue damage even when none has taken place.

Do not refer for imaging unless suspicious of serious pathology, or when imaging directly influences care.

Athletes who do not experience discomfort frequently have abnormal findings. Imaging should only be done if there are warning signs or if a specific pathology may be suspected. Imaging that is not required raises the possibility of incorrectly identifying the source of pain and may result in intrusive procedures.

Explore biopsychosocial factors that may contribute to pain.

Athletes will experience pain in complex and multi-faceted and it is often not simply caused by tissue damage. An array of biological, social, and psychological aspects influence pain which can include but is not limited to training load, conditioning, levels of fatigue, sleep quality, mental health, and abdominal obesity.

Deliver positive messages about pain during examination and treatment

The athlete’s recovery may be impacted by how doctors talk about pain and injury. As opposed to damage, pain should be described as tissue sensitivity. Positive language promotes experience validation and lessens the threat of pain. This should serve to further the idea that the body is powerful rather than frail and injured.

Improve tissue tolerance to load.

Having pain doesn’t mean that athletes have to discontinue their activity. Rehabilitation should begin stepwise manner, continuing to load to achieve the athlete’s sport-specific strength and conditioning requirements. Athletes may use this as an opportunity to improve their physical and mental toughness and address issues like stress and sleep patterns.

Use passive treatments only as an adjunct to active management.

Some treatments are effective, but the relief from pain is for short-term purposes only. They should not form the foundation of treatments that involves manual techniques such as massage, mobilization, manipulations, dry needling, etc.

Use shared decision-making to build self-efficacy.

Allowing yourself to engage in informed decision-making will help you to build self-efficacy. Your experience and engagement empower you and allow you to communicate effectively with practitioners, coaches, sponsors, or other stakeholders concerning your care. 

Use an interdisciplinary approach to deliver a united message.

Coaches and medical personnel must work together to ensure that health messages are consistent from all pertinent parties.

Exercises should include sports activities such as walking, swimming, or riding a bicycle. It should also include stretching and strength training to prevent pain. Following the instructions of your healthcare provider or physical therapist.

Begin with light cardiovascular training. Walking, riding a bicycle, and swimming are great examples. These types of sports activities can help you to improve the blood flow to your back and promote the healing process. They also help you to strengthen muscles in your stomach and back.

Stretching and strengthening exercises are important in long-term activities. Remember that starting these workouts too soon after an accident will exacerbate your pain. Your back will feel less strain if your abdominal muscles are stronger. You can get guidance from a physical therapist on when to start stretching and strengthening exercises as well as how to perform them.