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Is it OK to play in pain?
by Dev Mishra, February 17th, 2012 1:52AM

TAGS:  high school boys, high school girls, youth boys, youth girls


By Dev K. Mishra, M.D.

"What’s the difference between discomfort and pain? And is it OK for me to keep playing if I just have a little bit?" Those are two of the most common questions I’m asked by injured young athletes, and I'm guessing the same is true for our sports medicine colleagues across the country. The answers are different from person to person, and specific to the type of injury too.

Pro athletes know that there’s risk involved in their sport -- their profession. Medication is sometimes used to get an adult, pro player through a game. I have a very hard time using that approach in a young athlete who has a long lifetime of activity ahead.

There are many factors that go into a decision whether we allow a young athlete to play through some discomfort, whether we recommend that they take time off, or whether we prohibit them from playing. Key amongst the factors is the exact diagnosis of the problem, and some other factors we consider are the athlete’s age, sport, position, time during the season, and importance of the event or competition.

Knowing the exact diagnosis is important

We have to start the decision process with the diagnosis. It’s not enough to just say “knee pain,” we need to be specific. One of the problems I have with certain health practitioners is that decisions about treatment and play are made without a specific diagnosis. See a qualified medical practitioner to get a diagnosis, and then using a combination of the other factors a skilled sports medicine specialist will advise in making a decision that allows for safe sports participation.

Understanding again that individual decisions need to be made between the player, parents, and physician, there are still a few general comments I can make. Many types of tendonitis can be managed with braces during play and ice/stretch/massage after a playing session. Most fractures and stress fractures will require holding the young athlete from play until healing is complete. All hamstring injuries get rehab until healed. Ligament injuries to the knee will generally not allow return to play until fully healed, but some ligament injuries around the ankle can allow play with a brace.

Everyone has a different response to pain

One person’s mild “ache” is another person’s “severe pain.” I usually recommend against playing if the young athlete tells me he or she needs medication like Advil or Motrin in order to play. To me that’s a sign that we need to get that injury properly healed. For many other injuries it is sometimes safe to continue playing, although performance might suffer.

Sometimes it is safe for the young athlete to play through some discomfort, but start with the exact diagnosis and get guidance from a sports medicine specialist for the proper decision.

(Dev K. Mishra is the creator of the injury management program for coaches. He is an orthopedic surgeon in private practice in Burlingame, Calif. He is a member of the team physician pool with the U.S. Soccer Federation and has served as team physician at the University of California, Berkeley. This article first appeared on

1 comment
  1. tim francis
    commented on: February 17, 2012 at 9:04 a.m.
    While this article makes good sense, I'm hesitent to send it to my team families. While caution is noted, it may not be clear or stong enough: The overall 'grey area' message may be mistaken as a false 'OK' to play, particularly if the injured player can not accurately tell the extent of injury. This may also be particularly dangerous for players who love to play so much that they don't take injuries seriously enough or can't control their compulsive urge to play despite pain.

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