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sports related injuries

Sports related injuries: How athletes and coaches can tell the difference between good pain and bad pain

‘No pain, no gain’: that famous cliché associated with sports and fitness training, is often heard but is not always correct. Sometimes, pushing yourself and creating pain in the muscles is beneficial and other times it is damaging. Physiotherapists and sports medics may be familiar with what are appropriate levels of pain that result in benefits, and levels that are too stressful that will cause injury. Fitness trainers and sports coaches may be less confident at making the distinction. This article (based on McFarland et al, 2003, Health and Fitness Journal 7(4), pp 11-16) is a guide to trainers and coaches to help them identify 1) appropriate levels of training and 2) whether acute injuries have occurred or chronic injuries are developing.

How much is too much?

During a tough training session an athlete will begin to tire. Fatigue is a sign that the body has been stressed. For a training effect to occur, the body needs stress to stimulate an adaptation in order to grow back stronger. The body needs just the right amount of stress at an appropriate frequency to optimise the training benefit. If the athlete is performing a conditioning session (for aerobic or anaerobic endurance), then an exhilarated feeling of fatigue at the end is the right level of training. An athlete would be unable to maintain the intensity of effort or would have to summon up mental strength to maintain the intensity, by the end of a tough session. After a conditioning workout, it is essential that the athlete refuels and rehydrates his body, and rests. If conditioning sessions occur too frequently or with insufficient nutrition then the athlete’s performance may decline. This is a sign of ‘overtraining’, that the training programme or workouts are beyond the athlete’s current physiology. If the athlete rests for a few days, assuming good nutrition, he should be able to perform well again. If the athlete’s performance stays depressed even after two weeks of rest, then t here may be a medical reason and a sports doctor should be consulted

Pain that persists

If an athlete performs strength training (lifting weights), then a certain degree of muscle burn during an exercise will be an appropriate sign that the athlete is training at the right level. This burn will normally cease the moment the exercise stops and start up again during the next set of the exercise. Any pain or soreness in a muscle felt during the performance of an exercise that persists while the athlete is resting between sets could be a sign that the athlete has over-stressed the muscle or tendon. For example, if the shoulder joint is sore whilst lifting a heavy dumbbell and the soreness continues during the rest period whilst the athlete simply lifts his arm up and down, the chances are there is some level of injury.

During a strength session the athlete would normally perform two to five sets of one particular exercise – with maybe 12-25 sets comprising a complete workout of four to eight exercises. The athlete will have reduced strength performance after the workout, maybe for a few hours. For example, walking up stairs may feel a little tougher than normal.

In the 24-48 hours following a tough workout, an athlete can develop soreness and stiffness in the muscles. This is known as DOMS, or delayed onset muscle soreness. This is very common when an athlete begins a new type of training or the level of training is increased very quickly. It is also very common in unconditioned adults following infrequent bouts of exercise. Eccentric exercise is also associated with increased levels of DOMS.

Dealing with DOMS

A little bit of DOMS is fine; some athletes even like it after a strength session as it tells them they have trained well, and a small degree of DOMS is okay for athletes to continue their training programme. Once an athlete is used to the exercise or workout then the severity of DOMS is usually reduced or disappears completely. DOMS that causes serious stiffness, muscle swelling or tenderness to touch is a sign that the training has been too stressful. Full rest is recommended before continuing with training in this situation, otherwise the muscle tissues could be damaged.

The tendons also adapt to stress, in the same way that muscles do, becoming better able to cope with high or repetitive forces. Too much too soon, however, can cause tendinitis, which is associated with pain, swelling and stiffness. A good indicator that the training has caused damage is when the tendinitis causes pain during normal daily activities as well as those connected with sport. For example, a knee may feel a little sore at the end of a four-mile run, suggesting patella tendinitis, but if this feeling ceases once the run ends then the athlete has probably done little damage. If, however, the athlete wakes up the next morning and the knee feels sore walking up and down stairs then the injury should be taken more seriously.

Stress to the bones can be detected by the feeling of aching along the length of the bone. Any feeling like this should alert the athlete to a possible stress fracture and encourage him to see a sports doctor.

Action to take

Any serious muscle, tendon or bone pain that is described above needs to be treated. There are four basic methods of treatment that will help most athletes and should be carried out immediately:

  • Rest. This means avoiding any activity which stresses the painful area. Athletes can still do upper-body weights and swimming when, for example, they have a leg injury . Aim to rest until pain symptoms have gone away. If the pain recurs after rest, it is a sure sign of an injury .
  • Ice. Useful at any time at controlling inflammation. Be warned, however, that if a muscle or joint needs to be continually iced after every training session then more serious treatment and rest will be required. Ice is effective, but if it’s always needed to reduce pain, then the athlete is probably pushing himself too hard.
  • Range of movement exercises. Stiffness is often associated with pain and increased resistance to movement will prevent an injury from healing fully. Non-stressful movements which promote the full range-of-motion are useful for any injured muscle or joint. Dynamic stretching exercises with no weights would be appropriate.
  • Anti-inflammatory drugs. Over-the-counter medication is also useful for reducing soreness.

Staying injury-free can be more of a challenge than training hard and getting fitter. Understanding muscle soreness and the appropriate levels and timescales of this pain will allow athletes and coaches to train at the right levels and rest for the proper periods to avoid injury and optimise fitness.

Raphael Brandon

sports related injuries