Pain factor
Do you know what good pain versus bad pain is and how to manage it? The simple rule is do not try to work through sudden pain, as physio Lt Rob Orr explains.
Volume 11, No. 45, June 15, 2006

When the body is pushed beyond its limits, injuries to the soft tissue structures may result.

Timely and effective management can limit the severity of the injury, enhance the return to activity and help prevent recurrence.

With this in mind, this edition will look at the difference between ‘good’ and ‘bad’ pain and the self-management of a soft tissue injury.

Good Pain or Bad Pain
Before injuries and illnesses are discussed the difference between the ‘bad’ pain from injury illness and the ‘good’ pain felt during and after training must be distinguished.

So, what is the difference? Firstly, a sudden intense pain is bad. Stop. This is a ‘bad’ pain. The ‘good’ pain associated with physical training is in fact not actually a pain in itself but a feeling of discomfort. During a training session for example, you could be breathing heavily, it should feel uncomfortable but NOT painful.

You may feel fatigue and heaviness in the legs but this should decrease when you stop. After a physical training session, muscle soreness, or the more accurately termed Delayed Onset of Muscle Soreness (DOMS), may result. DOMS typically occurs around 12–24 hours following a session and may increase in sensitivity for up to three days following the session. DOMS is generally not of concern and will be discussed in a future article.

Good Pain – Subsides the minute you slow down or cease the activity, heavy limbs after a training session (fatigue), may ease with stretching.

Bad Pain – Sudden, intense, in the central back, chest or neck, radiating through limbs, prolonged muscle soreness (days after a work out ), unusual rib tenderness, gets worse with stretching.

If in doubt consult trained medical staff.

Soft Tissue Injury Treatment
When the soft tissue structures (ie muscle) are injured the well known RICED (Rest, Ice, Compression, Elevate, Diagnosis) protocol is followed.

Stop – This is the first and most important step. Do not try and ‘work through it.’ By not treating the injury immediately it has the potential to become worse and therefore increase recovery time. Not letting the team down for the last 10 minutes of the game could mean letting them down for weeks during a now longer recovery period.
The majority of exercise related injuries are ‘soft tissue’ injuries (sprains, strains, corks, bruising, muscle tears etc.) and, if the skin is unbroken, the RICED regime should be followed.

Rest – You have already stopped what you where doing, but it does not end there. You need to rest the injury until complete recovery. That does not mean ‘It feels a bit better now I’ll just play the last couple of minutes’. It should be noted that an absence of pain does not mean that the tissue has recovered and healed.

Ice – The coldness of ice causes the blood vessels to constrict, decreasing the amount of fluid and blood flow going to the injured site and into the surrounding tissue, (the cause of swelling). This assists in reducing local pain.

How – The ice should not be applied directly to the skin. It should be crushed to ensure a better mould and fewer edges and placed in a wet towel (this applies to ice bags and packs as well.) The ice should be left on for 15-20 minutes or until the area feels numb. If an intense pain is felt it should be removed immediately. Reapply every two hours, ensuring the skin is not still red from previous application.

Compression – A broad crepe bandage should be applied to help limit the swelling.

How – It should be applied directly to the injury site, not over clothing or shoes/boots and be as tight as a firm handshake.

If you are still using ice, the bandage can be soaked in cold water allowing the cold to diffuse through the crepe bandage.

A small tail of bandage can be left loose and applied over the ice pack to keep it in place.

The bandage must be loosened if it becomes painful, overly uncomfortable, feeling is lost in the extremities, (fingers or toes) or you feel a numbness or tingling. Remember the injured site is swelling and the bandage may tighten. If too tight the bandage will do more damage than good.

Action – Remove the entire bandage and reapply slightly looser.

Elevation – The injured site should be kept elevated above the level of the heart, allowing gravity to assist by decreasing the flow of blood and fluid to the injury.

Diagnosis – As soon as possible get the injury diagnosed by qualified medical personnel

The RICED regime should be observed for the first 48-72 hours depending on the severity of the injury.

A good player knows his or her limitations.

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