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Sports fan or not, nearly everyone’s familiar with the phrase "No pain, no gain". The association between pain and performance improvements has long been preached by high school football coaches and fitness professionals alike. However, do we need pain to make progress? And how do we know when pain is a bad thing? We break down how to identify athlete injuries and more, below.
What is Pain?
Before we venture any further, it's important to distinguish between pain and soreness. Soreness is a common side effect of intense training. It’s a good indicator that you overloaded your body with a substantial enough stimulus to (hopefully) promote performance improvements. However, the presence (or lack) of soreness doesn't necessarily mean you had a good or bad workout, but it's usually smart to keep track of what you did and how you felt for the next 48 hours after your workout.
Pain, on the other hand, is usually more severe. You might even get the intuitive sense that something doesn’t feel quite right when you're feeling pain vs soreness. One of the easiest identifiers of pain versus soreness is that soreness doesn't develop for at least 12-24 hours after your workout. Conversely, pain can develop instantly, and you might be able to associate a specific movement or action you performed with the pain you’re experiencing.
Sometimes, we get weird pains in our joints that seem to go away once we pop the joint or warm the area up a bit. While these aches seem to align more so with pain than soreness, I still think it's a useful tool to keep track of whether or not these issues persist throughout your workout. Generally, most professionals in the field recommend maintaining pre-existing pain to a level of 4 out of 10, with 10 being excruciating and 1 being no pain at all. Therefore, if you have a bad joint or pre-existing injury, be sure to track how your pain evolves throughout your workout.
Athlete Injuries
From the above discussion, we generally associate pain with some sort of injury. We can define an injury as acute or chronic. Acute injuries happen instantaneously, like a sprinter suddenly pulling up with a strained hamstring. Alternatively, chronic injuries happen over time, likely due to an imbalance between work and recovery. Runner's knee (patella tendonitis) is a common chronic injury as are shin splints or even shoulder impingement.
When considering athlete injuries, we also need to remember that contact injuries are the prevailing form of injury in most sports. This is why we see higher incidences of injury in sports like American football or gymnastics compared to weight training. Intriguingly, sports like cross-country also boast greater injury rates than weight training which underlines the commonality of chronic injuries in runners.
Finally, we need a way to dissociate an actual injury from a small ache. In a research sense, we usually define an injury as an acute or chronic pain that impairs both performance and your ability to compete in your sport safely. To be defined as an injury, this pain has to result in you missing multiple practices (training sessions) or competitions. More serious injuries are usually problems that result in you missing at least 10-days of involvement in your sport.
Common Types of Injuries in Non-Contact Sports
Before we get started, I feel that it's imperative to remind you that this list is A) not exhaustive and B) not a replacement for medical advice. If you think you've injured yourself, set up an appointment with your doctor to ascertain the severity of your injury and generate a direction for rehabilitation.
Muscle Strain
A muscle strain is what happens when you tear a small handful of muscle fibers in a muscle. A mild muscle strain will definitely hurt and might swell or bruise some, but it shouldn't knock you out for more than a week or two. A more serious strain involves more muscle fiber tearing, will hurt quite a bit more, and will likely swell and bruise quite a bit. Depending on the muscle and mechanism of injury, this might keep you out for a few months. Finally, a grade three muscle strain is a complete tear of the muscle. Not only will this hurt quite a bit and produce substantial bruising, but you'll probably also notice a visible deformity in the muscle. A full tear might require surgery and, depending on the injury and mechanism, may never fully recover.
Strains are fairly common in just about every non-contact sport. Poor warm-ups, insufficient recovery, or sudden and explosive movements are usually to blame. There's not a lot you can do to avoid sudden and explosive movements, but you should be warming up properly and ensure you’re fully recovered from your last training session (or competition) before starting another intense workout.
Tendon Strain
Tendons are what connect our muscles to our bones. If we didn't have tendons, your muscles would not be able to move your body so they're pretty important. A tendon strain can happen through a similar manner as a muscle strain, but we usually see these with higher speed movements as tendons generally transmit proportionally more force during fast movements than slow movements. Tendon strains have a similar grading system to muscle strains; grade 1 strains are the least severe whereas a grade 3 strain is a full tear of the tendon.
A tendon tear might be a little more difficult to identify the severity of. Many tendons have substantially less blood supply than muscles, so bruising isn't always a major side effect of a minor tendon injury, but larger tears will still create a new palette for your skin. This lack of blood flow also means that tendon strains usually take longer to heal than similarly severe muscle strains. Usually, a tendon strain is accompanied by a "popping" sensation at the joint in question. You might not even feel pain right away—heck, a good friend of mine tore his patella tendon while squatting over 500 pounds. He then finished his workout by deadlifting 600lbs for multiple sets and reps. Only later, after he had sat down for a few hours of paperwork, did his knee start to hurt. The body can be amazingly mysterious sometimes.
If you think you have a tendon injury, obtaining the opinion and intervention of an experienced physical therapist can offer dividends for your return-to-play timetable. Rehabbing a tendon injury can require a multi-faceted approach and professional input is always well-worth the investment.
Cruciate Ligament Sprain/Tear (ACL, MCL, LCL)
The cruciate ligaments are connective tissues in your knee that control the movement of the knee. Ligaments are tissues that connect bones to other bones and, as such, they generally have poor blood flow related to tendons and muscles. Just about everyone has likely heard of someone experiencing an ACL tear, but in non-contact sports, cruciate ligament injuries are pretty uncommon. The most common culprit for a cruciate ligament injury involves some sort of twisting or torsion at the knee with the foot planted. Cutting movements in American football or soccer are often to blame. But these injuries can happen in everyday life too; a friend of mine sprained his MCL by tripping on a trailer hitch on a truck, so clumsiness is also a likely contributor.
If you have knee pain following twisting or torsion at the knee, you might consider getting medical attention as this could be indicative of a cruciate ligament injury. You'll likely have some pain and swelling, and your knee might also feel pretty unstable. The downside is that if you've done enough damage, surgery is a stronger possibility than most other injuries as the cruciate ligaments rarely heal on their own.
Tendonitis
The last two issues we're going to discuss are common chronic injuries, rather than acute which means that the injury occurs over time. Tendonitis is probably the most common injury in endurance and strength athletes and is considered an overuse injury. A more accurate way to describe tendonitis is simply an imbalance between tissue damage and tissue repair. Much like our muscles, tendons can also experience micro traumas during intense training. Ideally, we repair and rebuild tendons before subjecting them to additional stress. However, if you repeat training without sufficient recovery, these micro-traumas never fully heal and can eventually cause continual pain, discomfort, and inhibited range of motion. Some of the pain can be managed with anti-inflammatory medications as inflammation certainly increases the sensation of pain with tendonitis.
The most common forms of tendonitis in endurance athletes are jumper's knee (patella tendonitis) and Achilles tendonitis. Both injuries can make running, jumping, and weight training quite uncomfortable. If the pain becomes unbearable, I'd recommend seeing a physical therapist who may refer you for treatments such as cortisone or platelet-rich plasma (PRP). Training to alleviate and overcome tendonitis needs to be personalized to both your injury and your "return to participation" goals and, thus, it is difficult to offer overarching recommendations.
Shoulder Impingement
Shoulder impingement is somewhat similar to tendonitis in that it is largely influenced by inflammation in the joint. The shoulder joint is a common area for pain, especially in strength athletes or swimmers. A primary issue is the general design of the shoulder and the rotator cuff muscles. One such of the rotator cuff muscles, the supraspinatus, has the unfortunate anatomical placement of residing just under the acromion bone that extends from the scapula, over the shoulder, and attaches to the clavicle. As you raise your arm to the side or overhead, the acromion can "rub" or pinch the supraspinatus, thus potentially damaging and inflaming it.
Using proper form, improving shoulder mobility and stability, and enhancing rotator cuff strength are all great ways to ward this issue off. Alas, the inherent design of the shoulder lends itself to slowly causing problems with the supraspinatus over time. It's not an unavoidable injury by any means, but planning "prehabilitation" exercises in your program are a fantastic way of maintaining healthy shoulders. If you have a pinching or throbbing pain in your shoulder with overhead movements, you might want to see a physical therapist ensure you're dealing with an impingement and not a more serious injury. A therapist may refer you to an orthopedic surgeon, but the surgeon will likely administer cortisone before choosing surgery.
Final Takeaway
Pain and injuries can be difficult to discern from the everyday soreness you feel from intense training. However, we offered some clues that should help you better distinguish between the two. As always, smart planning and paying attention to your body does wonders for preventing injury and ensuring optimal performance.
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