The “gladiator” mentality throughout sports history has been widely celebrated and glorified. For avid sports fans such as myself, we can remember those seemingly impossible performances by such revered modern-day warriors as the late, great Kobe Bryant, shooting and making two free throws after tearing his Achilles.
While every performance and memory is unique, we’ve all likely seen and can recount some version of it: The athlete has trained extensively and exhaustively for this event, culminating in an ultimate “battle,” during which he or she sustains an injury. We, the spectators, watch in awe as the athlete powers through the pain to emerge the victor and ultimate champion. There are countless movies with this premise, and some variation of it still occurs today. But at what ultimate cost? And how does an athlete know when it’s “worth” the risk to play through pain or when it’s best, safest or career-saving to pull back? The answers are nuanced and can depend on various factors, but the risk of playing through pain or injury is high.
First, it’s essential to consider the distinction between muscle soreness and pain. Soreness and muscle aches are part of the experience of sports and vigorous exercise for most athletes. The sensation of soreness is typically described as generalized, dull and without sudden onset. It often starts after a rigorous workout and may be lingering when the next exertional activity begins. When this type of pain is not debilitating, doesn’t cause the athlete to compensate for it with overuse of other body parts or doesn’t require an alteration of standard body mechanics, then it’s probably safe to finish the game, match or competition. However, even in cases where an athlete attributes pain to generalized soreness, if that sensation has lasted longer than a few days after the activity has ended, further evaluation should be considered.
Pain that may indicate the occurrence of a more acute injury, however, is frequently described as sharp, with a sudden onset and localized to one specific area of the body. Pain that causes a significant change in form/technique, is accompanied by weakness, or functional deficit is a definite red flag. This type of pain likely indicates that an injury has occurred. In this case, play should stop, and an experienced and qualified physician should evaluate the injury as soon as possible. In many cases, this simple instruction is far easier delivered than heeded.
[See: Back Pain in Runners.]
Whether we like it or not, the “warrior athlete” — the one who overcomes seemingly insurmountable odds to play and perform at the highest level while visibly injured — has been elevated to hero status countless times throughout sports history. So, it’s no surprise that we’d be hard-pressed to find an athlete, at virtually any level of play, who hasn’t played through pain or injury at some point during his or her athletic career. These societal sports’ currents run powerful and deep.
The best and most effective approach to reducing the incidence of playing through the pain that develops into catastrophic injury is education. We can help minimize injury risk so that players can make informed decisions for their specific set of circumstances. For that to happen, there must be supportive and trustworthy relationships between the coaches, athletic trainers and physicians involved in the athlete’s care. When it comes to the physicians in this equation, it’s crucial for players to honestly believe that their doctor is on their team and has their best interest as a priority. To achieve this goal, doctors must be adept at encouraging a culture of empathy and understanding with their patient athletes.
Finally, it should be noted here that this discussion of playing through or pulling back is centered on adults. Children are far too young to make such nuanced decisions for themselves. Additionally, their young bodies are still developing and must be more strongly safeguarded against injury. Plus, kids are even more highly influenced by pressures (whether those pressures are perceived or real) from their coaches or parents to “perform.” They want to make us adults happy, and as a result, many end up playing through injury when they unequivocally should not. Additionally, adult athletes who are idolized by young children can model great discernment for our youth when they make the tough but brave decision not to play through pain or injury.
In a nutshell, if you’re an athlete who is experiencing pain: When in doubt, sit it out, and get a proper evaluation as soon as possible. An earlier diagnosis of what’s causing the pain typically leads to earlier and often simpler interventions. Getting to the bottom of the pain sooner rather than later might cost a game or two — but that’s a far smaller price to pay than an entire athletic career.
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