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Pain is a slippery concept—it’s highly individual, and an individual’s perception varies by circumstance. Sure, listen to your body, but by definition, an endurance athlete is someone who is conditioned to endure discomfort. The basis of training, too, is to repeatedly stress your body and pull back—aches and pains are a part of life for an athlete.
“There’s a perception that pain is bad, that it’s to be avoided completely, and that can lead to over-medication,” says Harvard-trained pain specialist Dr. Aneesh Singla. “On the other hand, if you ignore pain, you risk making the problem worse. Pain is a protective warning signal. It’s important to feel it and listen to it.”
How much pain is too much?
“It’s hard to know,” Singla says. “If it’s mild pain, stop the activity that causes it to hurt—get in the pool or the weight room—and do RICE: rest, ice, compression, elevate. It should go away within a few days to a week. If it’s hard to walk or stand, or the pain persists for more than two weeks, get a diagnosis. You really want to prevent pain from becoming chronic—which is defined as lasting more than three months. Chronic pain is much harder to heal.”
Is it ever OK to mask pain? “Ibuprofen decreases inflammation, which is detrimental for the body. Inflammation causes joint erosion, but so does continuing to run on an injury,” Singla says. “If it’s just muscle soreness and it goes away in a few days, ibuprofen is fine.”
What about cortisone? “It’s a strong anti-inflammatory. For something like bursitis, a temporary flare-up, it’s helpful. If you have a bone bruise or a stress fracture, you need to take time off. Cortisone should not be an opportunity to get back out there.”
And Vicoden? Forget about it. We are in the midst of an opioid crisis, Singla notes, partly because in the 1990s, the pharmaceutical industry started recommending opiates for chronic pain despite its addictive qualities. “A triathlete who uses opioids to get through a workout is getting into a bad cycle.”
Singla has found, maybe to Type A athletes’ annoyance, the body will prevail over even the most sophisticated pain meds. “I can drop pain by 50 percent, maybe even 80 percent, but it almost never goes to zero. If there’s a serious injury, the alarm will still be on and the athlete will be forced to heed it.”
Of course, taking time off presents athletes with a different kind of pain, and more complex symptoms. Sidelined athletes may become anxious and depressed, mental states that cause their own problems, and may even manifest as physical pain, Singla notes.
“Pain can be a transformative event,” he says. “It should bring about change. Maybe you run on a treadmill instead of concrete, or you swim or lift weights. Regardless, pain can teach you to listen to your body, which is an important lesson to learn.”