Ouch! The Body's Language of Pain - What it Means and What to Do About it.

author : jsanko
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Everyone has had it happen to them at some point during training or a race. You are out there swimming, biking or running when all of a sudden you feel a twinge. Sometimes it is a sudden sharp feeling in a joint or muscle. Other times it is a nagging ache that didn’t seem to be there minutes ago. The difficult part is in interpreting what these symptoms mean. Does this represent something serious? Should I stop immediately or just walk it off? Should I rest a few days and see how it goes? Should I see a doctor? The answers to these questions are often not readily apparent, and that can occasionally lead to important consequences. This article will outline some basic principles on how to interpret pain and how to respond.

Pain is a very important sensation, albeit an unpleasant one. Pain fibers are found throughout the body and act as a type of defense mechanism. When we inadvertently do something that causes pain, we learn to not do that action again. This can be helpful in many situations, and forms the basis upon which children learn about their environment. Once a child has sensed pain from an object that is hot or sharp, they are unlikely to touch it again.

Pain is also an important feedback sensation. If we injure a structure in our body, molecular interactions associated with the injury activate local pain fibers and we sense that something is wrong. Often the pain will be localized to the area of injury, but in many instances pain is referred elsewhere.

When trying to understand what your body is telling you with a sensation of pain, it is helpful to be analytical. Pay close attention to the characteristics of the pain as this can often lead to a fairly accurate self-diagnosis.

Where is the pain located and how is it distributed?
The physical location of pain is often the best clue as to its cause. Most athletic injuries occur in the extremities, but central problems are encountered as well. It is strongly recommended that any sudden abdominal or chest pains be heeded with extreme caution, and are seen as an indication to cease activity immediately and consult a physician.

With respect to the distribution of pain, localized pain is almost always associated with a problem in that immediate area. Diffuse pain is harder to pin down and may be due to a local problem or to something distant with pain referred elsewhere. A good example of this is groin pain that is actually referred from an injured knee or thigh.

For localized pain, try to identify an exact point of maximal pain. Is it within a muscle? A joint? Or does it feel deeper as if it were within a bone?

How did the pain begin?
Pain that begins very suddenly is generally associated with more serious problems, while pain that develops over an extended period of time usually indicates problems that are less extreme.

Can you describe the pain?
People have a very hard time describing pain; however, it can be a very important clue to the nature of the problem. Sharp pain is associated with tears of muscles or ligaments, deep aching pain is seen with bony injuries, while pressure or throbbing pains are often related to localized swelling from overuse. Burning pain is common with injuries to nerves. While these are not hard and fast associations, they may be helpful.

Is the pain reproducible?
When the same movement or stimulus reproduces the exact same pain, this is a sign that the pain is due to a specific injury. Usually this also means that continuing with the activity will worsen the injury and exacerbate the pain.

Pain that is not reproducible is less likely to represent a serious injury and more likely means that a transient problem occurred.

Are there any associated symptoms with the pain?
Pain may occur in isolation or can arise at the same time as other symptoms. For example, a sharp pain in the shoulder may be associated with tingling in the hand. This could mean that the injury affects more than a local structure in the shoulder; it also likely affects one of the nerves coursing down the arm.

The most important associated symptoms to note and take very seriously are shortness of breath (beyond the normal exercise induced heavy breathing) nausea and vomiting, weakness or loss of sensation in a limb, and headache.

What makes the pain better? What makes it worse?
Pain related to injury of a joint or muscle will invariably worsen with movement and improve with rest. Pain that persists at rest needs to be taken very seriously as it may represent a more severe problem.

The response of pain to therapy is also useful in determining the cause. Pain that gets better with the application of heat or ice is suggestive of an inflammatory problem from an overuse type of injury. Anti-inflammatory medications such as ibuprofen also ameliorate these kinds of pain.

Does the pain recur after sufficient rest?
If, after taking a prolonged rest from training or racing, the pain completely abates, this is a good sign. However, pain that recurs soon after the resumption of activity does not augur well. Generally, this is a sign of either an incompletely healed injury or, if the period of rest has been substantial, that a non-healing injury has occurred.

How long did the pain last?
Persistent pain is more concerning than pain that is short lived. Occasionally, a misstep or improper movement puts a sudden stretch on a muscle or ligament and a sudden but brief pain is felt. When an injury is more complete, as in a sprain, pain will persist and often worsen.

In summary then, not all pain associated with training or racing should be taken to signify a serious injury. In many instances, pain is simply our body’s way of telling us to change something about what we are doing, as injury may be imminent. Certainly, pain should never be completely ignored, but rather listened to and interpreted as best as possible.

The characteristics of pain can help delineate not only what the problem is, but also how we should respond. Pain with the following qualities should be heeded carefully as a sign to stop the activity—if only briefly—in order to assess the situation:

  • Sudden onset

  • High intensity

  • Sharp in character

  • Associated with other important symptoms

  • Does not get better with rest

  • Reproducible with the same activity

Pain of this type should be taken as a strong sign to call it a day and seek the attention of an athletic therapist or physician.

More benign pain may still indicate a potential injury that may worsen with continued activity. For this reason, cessation of activity is recommended with a subsequent period of rest:

  • Gradual onset

  • Moderate intensity

  • Aching in nature

  • Abates with rest

  • Improved with the application of ice or heat or the use of anti-inflammatory medications.

If after a sufficient period of rest the pain recurs, it may be a sign to consult a physician.

Lastly, any pain with the following characteristics MUST be taken as a sign to stop all activity immediately and consult a physician promptly:

  • Chest pain

  • Abdominal pain that comes on suddenly and does not improve promptly with rest

  • Associated serious symptoms

Of course, everyone is different and each situation that causes pain must be considered carefully before acting. However, by following these general rules, it is hoped that the avoidance of any serious consequences can be assured.

Train hard, train healthy.

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date: June 5, 2006

Author


jsanko

Began triathlon in 2001 and have now completed two IMs, (Canada, 2004 & Coeur d'Alene 2005) as well as many halfs and even more olys and sprints.
Written for first Inside Triathlon and now Triathlete Magazine since 2003. Mostly a web based column called 'Ask the Tri Doc' but also now have two print articles as well.
Member of the Canadian Alpine Ski Team Medical Group 2001-2003

Author

avatarjsanko

Began triathlon in 2001 and have now completed two IMs, (Canada, 2004 & Coeur d'Alene 2005) as well as many halfs and even more olys and sprints.
Written for first Inside Triathlon and now Triathlete Magazine since 2003. Mostly a web based column called 'Ask the Tri Doc' but also now have two print articles as well.
Member of the Canadian Alpine Ski Team Medical Group 2001-2003

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