Good Pain Versus Bad Pain For Athletes

In today's Hopkins Happenings post, hear from orthopedic surgeons Edward McFarland and Andrew Cosgarea, who explain the difference between "good pain" and "bad pain," signs to look out for, treatment options and more.

What exactly is good pain?

"No pain, no gain" is a common phrase heard by athletes. What is perceived as the "burn" in muscles during physical activity is additional stress put on the muscle, which helps to increase strength. This is "good pain," which should be short-lived and only occur during activity. The temporary fatigue should leave you somewhat exhilarated, not exhausted.

What are signs of bad pain?

If muscles, tendons ligaments, cartilage and bones are forced to react to stress too quickly, tissues begin to fail and respond in their own ways and begin to produce "bad pain." Failure can be caused by too much stress too fast, or by stress accumulated over time. Here are a few common examples of how each tissue reacts and causes bad pain.

  • Muscles - If a muscle is exercised too much, it may become very sore to move and touch, and may even swell. In sever cases, the muscle may be too damaged and parts of the muscle tissue may begin to die. In extremely rare cases, extreme overexercising of the muscles can lead to death. McFarland and Cosgarea generally recommend "whatever amount of exercise you think you can do, cut it by one-third the first few times."
  • Tendons - Tendons respond to too much stress but getting inflamed, which causes pain and sometimes swelling known as tendonitis. This typically occurs during exercise and can continue after exercise when doing activities that use that tendon or associated muscles.
  • Bones - When bones see increased amounts of stress, they respond by creating more bone in the areas with more stress, which helps strengthen the bone. But if bones see stress too fast, the bone will begin to fail. This can result in a stress fracture and pain along the bone. If untreated, the bone can actually break.
  • Cartilage - Cartilage is the tissue on the ends of bones that allows them to move smoothly over one another. Though cartilage sees wear and tear as we age, if stressed too quickly, it can cause pain and fluid in a joint. Joint swelling is a bad sign and indicates that the cartilage is irritated, with the swelling making exercise and daily activity difficult and painful.

How can good and bad pain be treated?

For any ache or pain, we recommend cutting back on exercise for a period of time, with the length of time dependent upon the severity of the pain. Don't do anything that hurts. Icing is also a recommended treatment after activity by way of an ice pack or ice massage for 20 minutes. Also, continue to move the joint or extremity to avoid stiffness. Medications such as over-the-counter pain relievers or anti-inflammatory agents can help to decrease pain and swelling.

When should I be concerned about pain?

It is advised to seek professional treatment if the pain:

  • Lasts for an extended period of time after exercise
  • Affects your sports performance
  • Does not go away with rest
  • Affects your function outside of athletics (walking, sleeping, etc.)
  • Is constant or increases over time and does not go away
  • Does not improve with treatment
  • Requires increasing amounts of pain medication
  • Wakes you up
  • Causes weakness, tingling or numbness in an extremity
  • Is accompanied by fevers, chills or severe sweating at night

What should I know about pain associated with injury?

Signs that an injury is more serious include severe pain that makes you nauseated or uncomfortable, deformity or immediate swelling at the injury site, loss of function, tingling or numbness and inability to move fingers or toes. Things do not swell/hurt for no reason and injuries that are more severe have more swelling and pain. If you have any question about whether an injury is serious or not, you should seek treatment sooner than later.

Want to know more? Visit hopkinsmedicine.org/orthopaedic-surgery/about-us/ask-the-experts/pain to read the full article and to request an appointment.

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