Commentary
Is it OK to play in pain?
- by Dr. Dev Mishra , Mar 27, 2015
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.
(Dr. Dev K. Mishra is the creator of the SidelineSportsDoc.com injury management program for coaches. He is a Clinical Assistant Professor of orthopedic surgery at Stanford University. Mishra writes about injury management at SidelineSportsDoc.com Blog, where this article first appeared.)
I'd also distinguish between 'good' pain, and bad pain. 'Good' pain is muscle soreness from a good workout (the pain you feel when you're pushing beyond your comfort zone). But of course, this article doesn't really address that (except, perhaps, in the case of playing the next day when you feel sore). Good pain, you play through. Beyond that, the question is "will playing with pain exacerbate my injury, or have no effect?" If playing on it (pulled muscles, turned ankles, etc.) will make it worse, don't play. If not (many contact injuries or cuts), then as long as the player can tolerate the pain, it's their decision. Coaches should never encourage a player to play with pain when the player is reluctant, and the much harder job is for coaches to discourage (or prevent) players who want to get back on the field from playing with doing so will make their injury worse. I usually try some variation of "yes, I'd like to have you back on the field for this game too, but it is more important that you get fully fit for our next few games".