Sports Medicine: Pain!!

By Todd S. Ellenbecker, MS, PT, CSCS

Q: During the summer tournament season, several of my players usually complain of aches and pains from playing back-to-back tournaments.  As a coach, what should I know about playing with pain, and does the no-pain, no-gain theory apply?

A: Coaching a player who is having pain is not an easy situation.  However, by understanding the implications of the type and location of the pain, coaches will be able to deal more effectively with this problem.

Location, Location, Location.

The location of the player’s pain is actually very important.  Pain located in, and directly over, joints (i.e., knee, shoulder, elbow, etc.) is usually serious and typically requires evaluation by a medical professional.  Joint pain is very hard to play through and often leads to further damage to the individual.  The no-pain, no-gain theory does not apply here at all.  A player should not continue to play with joint pain, unless he or she is closely supervised by a medical professional and coach. 

Pain located in muscles (i.e., thigh muscles, forearm muscles etc.) is usually less serious and comes from repeated exercise and training activity.  This type of pain is also difficult to train or play through, but is not considered as serious.  The presence of this type of pain indicates to the coach and player that the current training and playing load is too strenuous or frequent and should, if possible, be modified before further injury occurs.  Due to the copious blood supply in muscles, they heal and recover far more quickly than joint or tendon injuries.  A player can continue playing with muscular discomfort, but should be monitored closely. 

What do I mean by monitored closely?  As a physical therapist treating tennis players, I often see players recovering from a knee injury who develop shoulder or elbow problems upon their return to play.  The key here is compensation.  Oftentimes players playing with muscular discomfort and the excessive fatigue that usually accompanies it compensate by using fewer body segments and, therefore, sub-optimal stroke mechanics to produce power in their shots.  This can lead to additional injuries and clearly is not in the best interest of the player.  That is why players playing with even muscular discomfort should be monitored for compensations that may lead to further injury.

Type of Pain

The type of pain a player is experiencing also helps to determine whether rest, medical treatment or continuing to play is the appropriate course of action.  The chart on this page (NOTE: edit if this chart cannot fit on this page  - i.e. next page) provides a theoretical breakdown of pain levels that can help medical professionals and coaches to better understand an athlete’s pain.  Levels 1-4 are types of situations or descriptions of pain that typically can be played through.  Pain does not interfere with normal stroke mechanics, is not constant and is not present during sleep or rest.  Levels 5 and 6 however, describe pain levels at which players should not continue to play.

Early Action and Attention

Even with lower levels of pain, early action and attention to the player’s aches and pains should be undertaken.  Applying ice to the affected areas after tennis play or any workouts is indicated.  This helps to decrease the pain and inflammation by reducing blood flow via vasoconstriction.  Evaluating the player’s stroke mechanics and workout schedule is also indicated.  The importance of rest as a component of a player’s program cannot be overstated.  Finally, early evaluation of the injured area by a sports medicine specialist is often indicated to rule out more serious injury.  A coach should never feel silly for taking a player to a sports medicine specialist to have an injury evaluated early on.  Sports medicine specialists know how important early recognition and treatment are and will appreciate the ability to intervene during the initial stages of pain.

Key Points for Coaches

  • The no-pain, no-gain theory does not apply, particularly to a player with joint pain.
  • Early recognition and attention to pain and injuries are critically important.
  • Remember ICES – ice, compression, elevation and support as a first line of defense when a player is having pain.
  • Pain levels that result in compensated stroke mechanics are particularly harmful and can lead to injuries in other areas of the body.

Todd Ellenbecker is a physical therapist and certified strength and conditioning specialist at Physiotherapy Associates Scottsdale Sports Clinic in Scottsdale, Arizona, and the Chairman of the USTA Sport Science Committee.