From Novice to Pro: What Athletes Need to Know About Their Pain from From Novice to Pro: What Athletes Need to Know About Their Pain

From Novice to Pro: What Athletes Need to Know About Their Pain

Pain is a feeling triggered in the nervous system. The perception of it is highly individual and depends on a lot of factors. Some may feel it as discomfort, others as agony. It may be sharp or dull; it may come and go; or it may be constant.Whatever the case, pain is one of the most important sensations a person can feel, especially athletes because they need to be acutely aware of their bodies, says Dr. Aneesh Singla, Harvard-trained, DC-area pain specialist and the author of Why It Hurts: A Physician’s Insights on the Purpose of Pain, which comes out on May 9.

Pain is an alarm system

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The real purpose of pain for the body is being an alarm system, Dr. Singla says. “You have to be able to recognize when that alarm system is sending an important message.” The severity of the pain tends to indicate the severity of the injury, he adds. “Listening” to the pain is crucial if you are to get a proper diagnosis. "Pain is a warning sign of possible injury," Dr. Singla says. "If you feel it, consider the reason for the pain alarm, and if it is an early warning of an injury." 

Biggest mistake

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One of the biggest mistakes Dr. Singla says he sees among patients is when athletes choose to persevere through the pain. For example, a soccer player feels certain uncomfortableness in the ankles but keep playing. "They could develop an ankle sprain as a result of continuing to run while experiencing the ankle pain."

Can you damage the muscle and not know it?

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This is a very common question patients ask, Dr. Singla says. It’s a myth to think that once pain has been treated and you no longer feel it you can injure the area again and not know it, he adds. “Luckily, the body is too smart and its alarm system is very hard to shut off.” It’s like when you touch a hot stove. You back off immediately because you feel pain, no matter how many times you’ve done it before. 

Pain is an important sign of your limits

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Pain is really important for athletes because it allows them to recognize their limitations, Dr. Singla says.  For example, exercising leads to the buildup of lactic acid, which gym-goers feel as a burning sensation, he adds. You have to push just after that point to cause micro-tears in the muscle fibers (the process by which muscle grow). If you’re not doing something properly, such as lifting the wrong weight, not having the right technique or overstretching, you will feel pain.

Psychological side of pain

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Certain pain experiences result in anxiety. “It has a protective mechanism,” Dr. Singla says. You don’t want to feel the pain again so you are more careful when you are working out or training. This can also be applied to non-athletic situations. “When you have an exam and you suddenly realize ‘Oh, I have to study,” Dr. Singla says. This is anxiety (pain) telling you what to do to avoid injury (failing a test).

The mind-body connection and pain

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Chronic stressors in the body can be toxic to the body. “Psychological distress can cause physical symptoms such as backaches or stomach aches,” Dr. Singla says. If athletes, for example, didn’t perform well during a competition or lost badly, they may be scared to enter a race again because of fear of letting themselves and others down, Dr. Singla says. This is when adaptive stress can be very helpful, he adds. You just realize that you have to go out there again, practice more, and do better. But you have to have the right mindset.”

Memory of pain

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The memory of pain can be very powerful, Dr. Singla says. “You can wear that ankle brace even if you don’t need it anymore because of fear of re-injury.” This has to do with the concept of resilience, which applies to everyone, especially athletes. “This is the ability to stay functional in face of adversity,” he adds.

Pain from biological perspective

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Looking at pain from a biological perspective is very important, Dr. Singla says, because you can adjust and adapt to avoid injuries. For example, you can wear an ankle brace for extra support or you can switch to a new position in your sport, he adds. 

Best treatment

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“We are always trying to get a patient better with the least invasive treatment,” Dr. Singla says. A conservative approach is preferred over an aggressive one, he adds, but this also depends on how you define “conservative.” Herniated disk will, ideally, first be treated with medication, physical therapy, and possibly steroid injections. Surgery would be aggressive and considered last. “Not everyone with an injury is going to need surgery,” Dr. Singla says.

Pre-injury signs

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“Pain is a warning sign that we may be about to be injured,” Dr. Singla says. An athlete with normal pain sensitivity will feel pain that is caused by an injury, he adds. “There is no specific guideline.” If the pain goes away in two days, the athlete probably doesn’t need to see a doctor because it was just a strain, he adds. However, if the pain is severe and persistent, and is not getting better with home therapy such as rest, ice, compression and elevation, it’s probably a more serious injury and you should have a professional look at it, Dr. Singla adds. Very few people are born without this ability. The rare inherited condition that leaves people with an inability to feel physical pain is called congenital analgesia.

Preventing pain and injuries

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All athletes in general, regardless of their sport, should be very careful when they start a new activity. “They need to build up to that activity,” Dr. Singla says. This means doing the appropriate types of conditioning exercises, getting medical advice and clearance, using proper equipment, and following a strict training regimen, especially if they are recovering from a previous injury. Mild pain issues can be treated with ibuprofen, Tylenol, ice, compression, rest and elevation.

Medication

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Using pain medication and how much of it is an individual decision between a doctor and a patient. “You don’t want strong meds for mild conditions,” Dr. Singla says. “People think that if you take more you get more pain relief but this is not always the case. The body gets tolerant to the medication and needs more.” Pain relievers such as oxycodone, hydrocodone, codeine, morphine, fentanyl and others, can be very dangerous. An overdose can cause a person to stop breathing.

"Pain-free" is not always an achievable goal with chronic pain

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You need to feel pain in order to be functional because you need to learn what to do to avoid injury, Dr. Singla says. “Pain is a symptom of a problem; now you have to find that problem and fix it.” The only way you’re going to be 100 percent pain-free is if you are under anesthesia, which is essentially a coma, Dr. Singla says. “This is not an option.”

Pain expectations

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Setting expectation is the hardest part about treating pain, Dr. Singla says. “If someone comes in with high expectations, they are going to leave unhappy because the reality is that we can’t really treat a chronic problem 100 percent.” Fifty percent relief is a reasonable goal, he adds. “We don’t always have an answer to pain.” You can completely recover from a torn ACL when it comes to pain, but this is not always the case with other conditions.

From Novice to Pro: What Athletes Need to Know About Their Pain