One of the most overlooked areas in sport is the athlete pain experience, and this is not just about injuries. Until only recently, the athlete as a person, outside their identity as a competitor, was put on the back burner. Both the emotional and the pain experiences of the body are in a silent crisis, mainly because nobody is guarding the henhouse. Most coaches and athletes worry about burnout, but if we do our research, we’ll see that athletes quit more because of a negative experience with sports than from losing the will or passion to compete.If we do our research, we’ll see that athletes quit more because of a negative experience with sports than from losing the will or passion to complete, says @spikesonly. Click To Tweet
In this article, I review seven issues and corresponding solutions for how to work with athletes who might be on the edge. If you are an athlete, a coach, a parent, or even a fan, I am confident that you will learn something new and useful.
Are Your Athletes on Pain Drugs?
Recently, a parent asked about monitoring their son’s workload, as on paper it looked like he was overtraining. The problem, common in today’s modern youth sport environment, was he was underpreparing and competing all the time. He was also taking a lot of over-the-counter pain medications.
Some of his teammates were doing the same, and a few were rumored to be experimenting with edibles and CBD oil drinks. We can poke fun at the primitive medical tools from the American Civil War, but we are not so far off from them today. When we see a metal butter knife scraping a patella while a modern athlete sips whiskey, maybe we need to rethink things.
One solution, if implemented properly, is communicating the soreness, not the pain, of an athlete so they calibrate their pain experience via analog or app monitoring tools. The timeless wellness questionnaire is simply a rapid way to communicate and start a dialogue with a perspective. Like I mentioned, if you don’t use the information immediately, the use of questionnaires becomes another annoyance to athletes, instead of a way to have better decision-making and record-keeping.
A heart-to-heart talk with an athlete who experiences soreness that is atypical starts the process of managing unnecessary drug use and can lead to a connection beyond just sets and reps or sprints. The goal is not necessarily to be in charge of drug dispensing, but if you are not privy to their pain medications, do you really know what’s going on? Talking and tracking are great ways to create a net to catch things that sometimes fall through the cracks of training.
Pain Education Is Overrated, but Still Explain It
Nearly a decade ago, Adriaan Louw spoke at the Boston Sports Medicine and Performance Group about pain science. In my opinion, pain science should be a part of all coaches’ educations, but it’s not going to solve your problems. Even a world-renowned expert—a clinical scientist—experienced severe pain from a twig scratching his foot. The brain doesn’t play tricks on you; it’s just a faulty computer that is far from perfect at managing information.The attitude toward pain is a huge component of a successful migration out of chronic pain and acute struggles during return to play, says @spikesonly. Click To Tweet
What therapists and coaches should do is focus on not focusing on injury or chronic pain and stop treating patients like victims. By all means, make sure you are professionally responsible, but the attitude toward pain is a huge component of a successful migration out of chronic pain and acute struggles during return to play. I highly recommend balancing pain education with athlete mental skills, specifically with the right sport psychology and mindset coaches. When you spend most of your time explaining pain and doing excessive education, the athlete starts to only hear about pain and becomes fixated. The right balance requires experience and a track record of success years after rehabilitation or similar, and it’s a good thing plenty of great support staff exist.
Biomechanics Matter More Than Ever
One of the polarizing elements of sport is how much biomechanics matter with athlete injuries. Of course, the possible pain that accompanies soft tissue damage must also be managed. For me, a big difference exists between extreme pathomechanics (eventual tissue failure) and overuse syndromes that may just be normal. Running mechanics or gait analysis is always questioned because sometimes injury and pain are more workload than technique, but when we need answers for why a knee is so swollen, “getting strong” doesn’t help the cause much.
The other extreme, where one small deviation from the norm is blown up to be the holy grail fix, is not the solution either. Usually, the perfect storm of fatigue, years of wear and tear, mechanics, and other environmental issues are the cause. Just as pain science was critical of overzealous posture and technique zealots, looking the other way on direct mechanical loading to structure is problematic. The issue is that, unlike cars, engineering with humans is managing regeneration of tissue, not just a wear pattern that tends to be linear.
So I don’t create confusion, I do think the body can handle a lot of mechanical load that isn’t perfectly distributed and progressed. With all the ACWR hype, sometimes athletes are able to do far more or far less than predicted, but the principle stays the same. The human body can fail, and the causes are likely to be so multifactorial that special metrics or even key performance indicators are far from perfect. Today, I think we have enough science to support the value of errors in technique, but we don’t know how the body adapts over time. It’s going to be a while before we have enough solid information to know how technique interacts with injury mechanisms, but for now, when performance and mechanics decline and athletes are training hard, the risk of injury may be higher.
Inflammation and the Body
Systemic inflammation, be it an alarm response or general lifestyle, is a problem. Some fascinating and problematic examples are the results of dental disease, specifically gum disease. In one case, an athlete (who was near to retiring) saw his inflammation off the charts, and it was linked to his severe gingivitis. After a few deep cleans, his bleeding subsided and his hs-CRP, a biomarker for inflammation, was restored to a normal level.
Other case studies are just as interesting, but the key point is to monitor blood and other biomarkers of the body. Just routine testing a few times a year is more than enough to screen out health problems that invade the space of performance. Without a platform of wellness, athletes sometimes collapse like a house of cards.
Inflammation can stem from the brain due to emotional trauma. It’s really hard to extract deep personal events from athletes, and you will not be able to screen this out with a quick combine interview or over a Zoom meeting. Athletes who come from broken homes are not exactly a rare breed, and escaping danger or pain is the reason many athletes drive themselves to be great. Sport is an outlet, and often the best athletes are just finding a way to wrestle demons.Athletes who come from broken homes are not exactly a rare breed, and escaping danger or pain is the reason many athletes drive themselves to be great, says @spikesonly. Click To Tweet
Coaches can help with support by making sure they have the right support systems in place. Many available resources are not expensive, and a lot of therapists are progressive. You don’t need to worry that an athlete will feel like they have a problem if they seek treatment; such intervention is often very subtle and not the cliché “lay on the couch and talk” as in the past.
Another point is to make sure the athlete isn’t treated like a patient, as the wrong intervention can indeed backfire. Focusing on a problem can magnify a struggle, so it’s best to pass it to a trained expert who is licensed to manage more difficult problems. Just as returning to play requires an athlete to be confident in the joint or muscle injured, an athlete needs to be discharged in some way or they will be running from their problems, sometimes literally.
Digital Brain Strain
Unplugging isn’t new, and I love the book Unplugged by Andy Galpin, but I will say it’s not about getting off screens. Instead, it’s about a lifestyle your athletes believe is realistic. Don’t expect athletes to pick up hobbies or start cross training with hikes in the woods—they won’t find it relaxing, and it could become a second job for you. For example, take walks in nature—how would athletes do this when they live in a city?
The affinity with nature is exploding. The number of indoor sanctuaries I have installed with contractors has increased tenfold. Obviously, I am not a carpenter, but the need for clean air, quiet sound, and green surroundings was overwhelming during the start of the national lockdowns. When the outdoors is taken away or restricted, you need to bring the outside inside. Nature is healing, and what used to be the video game room is now a lush garden where athletes can relax. Regular people who don’t participate in sport are also emigrating to a greener experience.
Phone etiquette, specifically smartphones, is the most powerful recommendation I have for athletes who are digitally native. Want to start a better life? Monitor phone use so it’s at a minimum. Social media time is now TV time and getting off the computer or tablet is more important than doing breathing drills. Why spend all this time working on relaxation when you are on the phone doom scrolling? Instead of checking into rehab for drugs and alcohol, we are seeing people detoxing (theoretically) from devices. Working more organically, calling on a landline, and only checking phones when necessary are all a great start.
Modern Mindfulness and Gratitude
Breathing and meditation are hard for those not wired to sit still. The irony is that most of the best candidates for mindfulness training are the worst at letting go of things. Therefore, we need to redefine what we consider mindfulness and look at more movement-oriented options outside of the cliché yoga and tai chi. Obviously, with what we have available, this can be quiet spinning rides using a biofeedback option or even just closing one’s eyes along with a haptic heart rate sensor. Unplugging from technology is not an on or off—just a reduction of intensity, similar to a dimmer light.Unplugging from technology is not an on or off—just a reduction of intensity similar to a dimmer light, says @spikesonly. Click To Tweet
Now for gratitude or gratefulness, two popular buzzwords with life coaches who promise better sleep and reductions in anxiety. The main concern I have is sustainability. When does giving thanks get old? Prayer, for example, is something many athletes do consistently, but what about those who are not religious? The commitment to saying thanks and being grateful for what you have can be a difficult journey, mainly because life has ebbs and flows that are not easy. A good approach is to collaborate with those who have had experience designing this for years.
What About Recovery Modalities?
The last area is the timeless question about the value of massage and other “treatments.” In no way am I suggesting that using a muscle vibration gun will heal your torn ACL, yet being pampered feels good for a reason. The human pain experience is an area that we all now understand due to science, but maximizing comfort is essential as well. We know through current research on pain that massage may be very much a placebo effect in some areas; however, it’s a little hard to swallow just dismissing it as a placebo therapy that has no effect in performance and rehab when other physiological changes occur. Transient modulations of neuromuscular performance won’t fix anyone, but it’s a cognitive therapy that requires external application at times.
Bodywork is littered with a lot of bogus snake oil; fortunately, coaches and/or therapists can use simple PNF stretches and other techniques when athletes don’t feel ready. Regardless if it’s just a temporary parlor trick biologically, it’s necessary when sport is played by those needing something beyond a pep talk. I don’t like any manual therapy or devices that are designed to cause severe discomfort or pain to mask injuries; I just know manual therapy isn’t about trigger points and other dated ideas. In my opinion, manual therapy for athletes and patients will not fix injuries; they just help us cope with them or act as a temporary bridge.
Thermotherapy is making a comeback. What was thought of as a problem—specifically ice baths and saunas—is starting to make more sense when you look at the timing and sequence. Thermo neutral temperatures, specifically water in pools, is always considered a therapy, as the experience is radically different from a cold plunge or steam room. You don’t need to jump into a frozen lake, but you do need to have a plan to ensure you don’t cause a retarding effect to your recovery. Like my other article on active recovery, sometimes taking a break from everything and just getting rest works wonders, but the recovery process is more complicated than glycogen and soreness charts.
Take Action and Be Proactive
Clearly, this is just a personal journey over the last few years, but I recommend that you work with therapists who are holistic and educated on pain science. In addition to pain science, I recommend working with competent therapists who understand mechanical loading of the body, as athletes don’t do normal “human” things, and extrapolating normal activities of daily life to the sporting context is wishful thinking.We need more life screening with athletes since what happens between the ears will likely surface in the body, says @spikesonly. Click To Tweet
Remember, sports medicine is specialized because sport is an option, so I encourage athletes and coaches to work with medical professionals proactively. I don’t mean we need more movement screening, but we need more life screening since what happens between the ears is likely to surface with the body.
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