| What do I do with the Pain? This is a question asked by every athlete at some point. Truly, pain is part of the game. In 20 years of practice, I have not met an athlete who has not had pain. It’s a great topic because pain is the thing that motivates many to succeed and also creates barriers to success. Pain is a word that covers a lot of ground. There is the pain that you get in your muscles and lungs when you have been redline for 20 minutes to make your splits. (metabolic pain). There is the pain that you get when you realized that you forgot your shoes in your other bag as you unpack at the race. And the pain you get when you have missed your qualifying time by 30 seconds. (psycho-emotional pain) Then there is the pain the develops in your knee or your back or your hip after much training. (Injury pain). I will focus on this type of pain. It is useful for athletes to understand injury pain. First, pain is mostly a chemical process. You know this because how do you often treat the pain? Often with chemicals known as anti-inflammatories such as ibuprofen, voltaren or a host of other over-the-counter pharmaceuticals. When a tissue in the body is overloaded in an unhealthy way, the body creates chemistry that sends a signal to your brain that says something is wrong. A ligament, tendon, muscle, bone gets inflamed and, boom, you have pain. These are powerful little cells and molecules created by the tissue to shut the system down, and often force you to stop. You should know, however, that these chemicals create the foundational elements required for the healing process. In other words, these chemicals can be a good thing! When you have injury pain, there are two questions that you, or your healthcare provider, need to ask and then answer. The first is "what tissue is causing the pain". This is known as the structural diagnosis. It will take a good clinical exam and maybe some imaging tests to get this answer. The next is "what circumstances or conditions precipitated the pain". Also termed the functional diagnosis. Examples of functional diagnoses include weakness or muscle imbalances that prevent fast healing. If you can answer both of these questions, you will get a line on how to treat the pain and also get insight on how to prevent it in the future. Over the coming issues, we will review some of the injury pain common with endurance sports…. Stay tuned! Also - Let's make this interactive. If you have some topics you would like to cover. Log into the web site forum and let me know. Be Healthy Best Strong Be ProActive John Woolf, MS, PT, ATC ProActive Physical Therapy www.proactivept.com | 
