Let’s face it, no one ever walks into the physiotherapist’s clinic because they feel awesome. The thing that usually brings them in is pain of one sort or another. Whether it’s acute pain from a recent incident or a niggling pain that’s been bothersome for a while, people seek out physios because something hurts. Embracing the updated biopsychosocial model of pain, Karen Litzy gave us tips on how to talk with athletes about their pain, and more importantly, to really listen. However, the updated terminology and language used in the literature about pain may be unfamiliar to many practitioners. Therefore, today’s newsletter installment in our series on pain will clarify some terms and explain pain behaviors frequently seen in injured athletes.
No endeavor besides athleticism sees pain as a requirement for performance. Those who frequently complain or comment on their soreness or pain, even when uninjured, may have a tendency toward catastrophizing. The trait of catastrophizing becomes more evident when an athlete suffers an injury that prevents them from participating in sport.
Just as it sounds, catastrophizing is the Henny Penny (or Chicken Little) of pain behaviors. It signifies an overly sensitive alarm system sensing danger with the slightest provocation or noxious stimuli. Athletes who catastrophize demonstrate these three behaviors:
Rumination– repeatedly thinking about or constantly focusing on the pain. Athletes who ruminate complain of hurting all the time and struggle to identify anything that makes the pain better.
Magnification– perceiving the pain as a significant threat. Athletes who magnify believe that the pain indicates something is terribly wrong and that whenever the pain intensifies, the physical injury worsens as well. They also may feel that the injury is career ending, whether the significance of the damage makes this true or not.
Helplessness – believing that nothing can be done to make the pain or injury better. Athletes who display helpless believe they will have to live with the pain forever and can’t see how they will cope. They may imagine that that their life as an athlete is over and worry as to how to live a meaningful life without sport.
When athletes dwell in these negative thoughts based on a current or prior experience of pain, it is called situational catastrophizing. Interestingly, those with no experience of pain at all can demonstrate this negative tendency in what is known as dispositional catastrophizing. A study at Eastern Kentucky University found that 72% of pain-free athletes surveyed still demonstrated positive pain catastrophizing scores (PCS), albeit significantly lower than those of athletes with current or previous pain experiences(1).
As expected, of the 291 Division 1 NCAA athletes surveyed, those with the more recent pain experiences demonstrated the highest PCS(1). Athletes with prior injuries showed less positive PCS than those with current pain, but not significantly less(1). These scores may reflect the fact that these athletes may still believe that their function is impaired because they still feel pain, even after the tissue damage has healed.
Screening athletes prior to sports participation would allow sports professionals to identify those with a tendency toward dispositional catastrophizing. Those athletes may need a greater amount of pain education to equip them with the coping strategies necessary to deal with a possible injury. If an athlete hesitates to return to sport despite appropriate healing and rehab, further dialogue may be needed as to their pain perception and implication for function. In the next newsletter, we'll discuss issues around the fear avoidance behaviors that may arise from catastrophizing.
Alicia Filley, PT, MS is the former editor and a long-time contributor to Sports Injury Bulletin and its sister publication Sports Performance Bulletin, she has 30 years’ experience working in rehabilitation, sports injury, and sports performance. Alicia holds a bachelor's and a master's degree in physical therapy. She is a practicing physical therapist and avid hiker, runner, and cyclist. When not writing and researching, Alicia can be found putting our findings to the test outside on the ...
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Practical injury prevention advice, diagnostic tips, the latest treatment approaches, rehabilitation exercises, and recovery programmes to help your clients and your practice.
Dr. Alexandra Fandetti-Robin, Back & Body Chiropractic
"The articles are well researched, and immediately applicable the next morning in the clinic. Great bang for your buck in terms of quality and content. I love the work the SIB team is doing and am always looking forward to the next issue."
Elspeth Cowell MSCh DpodM SRCh HCPC reg
"Keeps me ahead of the game and is so relevant. The case studies are great and it just gives me that edge when treating my own clients, giving them a better treatment."
William Hunter, Nuffield Health
"I always look forward to the next month’s articles... Thank you for all the work that goes into supplying this CPD resource - great stuff"
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