Playing Through Pain

Pain is an infinitely curious subject. We, as a scientific community, know so little about the phenomena. Pain's most objective measure to date is through the Visual Analog Scale – a diagram that shows 0/10 pain with a smiley face and 10/10 pain with a crying face. Suppose that this scale can accurately measure the subjective experience of pain within one individual. Even then, we have no idea why some individuals experience a stimulus (e.g., ankle sprain) as 1/10 pain and why others experience 10/10 pain. Modern research is exploring an array of possible explanations for these nuances but has a long way to go.

In the meantime, clinicians are left to practice with inadequate tools. Interviewing patients daily allows us to track the increase or decrease of pain over time. However, this can be influenced by things like mood or duration/quality of sleep the night before. Is it even worth it to track subjective interpretations? I would argue yes. Although the tools we have aren't perfect, they give us better data to work with than if we write them off. Besides, even if pain tolerances vary, it can help us understand the athlete's perception of their ability to play through it. There is even some research that suggests ~3-4/10 is the line between beneficial sacrifice and furthering damage.

Should subjective pain experience shape our practice as clinicians? This one is a gray area for me. Encouraging someone to fight through pain and manipulating them into self-harm are often divided by the thinnest of lines. Consider the way elite athletes are often told things like, "no pain, no gain" and "pain is temporary". Imagine if we told children these same things. How do coaches sound telling a sobbing 12-year-old that what they are feeling is actually good for them? Don't get me wrong, I think there is likely a beneficial middle-ground between being "tough as nails" and being a "cry baby". Teaching kids that crying isn't always the solution and that, sometimes in life, things get tough, and you can't let them shake you from your mission.

Fitness Influencer Alex Hormozi says that the difference between manipulation and help is intention. And while I don’t fully agree with this philosophy, I do think it applies well to sports medicine. Telling young athletes to push through pain in appropriate circumstances seems much more acceptable through the lens of trying to help them become physically and mentally tough enough to achieve their athletic goals.