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