Language has been a major focus in recent times in regards to chronic pain management, however its relevance to acute injuries is often under appreciated. This editorial proposes 8 recommendations in terms of language used in the case of acute injury.


  1. In the absence of trauma, do not assume that pain indicates tissue damage
  • Assuming the presence of tissue damage may cause an athlete to adopt overly protective behaviours, possibly leading to altered movement patterns and unnecessary deloading.


  1. Do not refer for imaging unless it will directly influence care, or when there is suspicion of serious or specific pathology
  • Unnecessary imaging may show unrelated findings that can increase fear and anxiety related to the condition.


  1. Explore biopsychosocial factors that may contribute to pain
  • Factors such as training load, sleep and fatigue, diet, athlete beliefs, mental health, competition and training pressures, and sport-related & non-sport-related support structure can all influence injury occurrence and rehab outcomes, and as such should be explored by the clinician. 


  1. Deliver positive messages about pain during examination and treatment
  • Positive language should validate the athlete’s pain, while decreasing threat and fear. Pain during examination should be framed as “tissue sensitivity”


  1. Improve tissue tolerance to load and sports exposure
  • Building load tolerance capacity is a vital component of rehabilitation. Load quantity and type should be specific to the individual demands, and the process of loading should start as early as is safe to do so. 


  1. Use passive treatments only as an adjunct to active management
  • Passive treatments may be useful early on, but may lead to reliance if used excessively.


  1. Use shared decision-making to build self efficacy
  • Shared decision making helps an athlete take charge of their own health.


  1. Use an interdisciplinary approach to deliver a unified message
  • Delivering a consistent message across the entire team will help reinforce important health messages and build the athlete’s confidence in those guiding him/her. 

1. Caneiro JP, Alaiti RK, Fukusawa L, Hespanhol L, Brukner P, O’Sullivan PP. There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. BMJ Publishing Group Ltd and British Association of Sport and Exercise Medicine; 2020.

About the author

Sam Gilbert

Sam Gilbert is a registered physiotherapist with the Australian Physiotherapy Association (APA) and certified strength and conditioning specialist (CSCS) with the National Strength and Conditioning Association (NSCA). He holds a bachelor’s degree in Physiotherapy from Latrobe university (Melbourne, Australia) and a master’s degree in Exercise Science (Strength and Conditioning) from Edith Cowan University (Perth, Australia).

A 3rd Dan black belt in Shinkyokushinkai Karate under the World Karate Organisation (WKO), Sam participated for over 20 years in full contact competition, winning multiple state and national titles, and culminating in a 4th place in the heavyweight division of the Shinkyokushinkai World Cup in 2009.

As the co-founder and clinical director of Club 360, the premier multi-disciplinary health and fitness center in Tokyo, Japan, Sam has combined his practical experience with an in-depth study of sports performance in relation to combat sports, and strives to help other combat athletes reach their full competitive potential, whilst at the same time decreasing injury risk and increasing competition and training potential.

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By Sam Gilbert