The Sports Medicine Approach to Managing Pain: Active Care
by Craig Liebenson

Did you know that treating pain with rest and medication might actually be making your pain worse? Sports medicine has shown that a more active approach that focuses on improving the function of the painful area can accelerate healing and prevent recurring pain.

Pain may be caused by an actual injury or as a result of fatigue from overwork. Athletes performing under demanding situations of professional sports can't just mask symptoms. They need to determine the source of the pain and take the necessary action to solve the problem. Chiropractic doctors specialize in the neuromusculoskeletal system which is the source of over 90% of the pain people experience.

What we have learned from sports medicine can be applied to everyone. Blending active care (education and exercise) with traditional passive care (for pain relief) has proven to be successful for managing chronic pain syndromes, herniated disc, occupational injuries, and other physical pains. It is a teamwork approach involving doctor and patient working together to restore the functional integrity of the body rather than just treating symptoms.

Musculoskeletal Injury
Direct trauma from an injury like a sprained ankle or whiplash to the neck is an obvious cause of pain. The pain is sudden and severe, and accompanied by chemical alterations like swelling and inflammation. Immediate evaluation is necessary to determine the extent of injury and initiate appropriate treatment. The prescription of rest, ice, supports, anti-inflammatories, or gentle stretching must be individualized for each patient so as to minimize pain and accelerate healing.

Repetitive Strain
The most common type of pain results from the cumulative stress of repetitive overuse. Examples of occupational activities that can lead to repetitive strain are: frequent bending and twisting (back), prolonged sitting (back or neck), or computer inputting (wrist, elbow, shoulder, neck).

The strain that a grocery checker places on his or her wrist is no less stressful than that of the stress placed on a tennis player's elbow or a runner's knee. Any task which is performed over and over again can lead to progressive overload of joints, ligaments and tendons. In the February 11, 1992 Journal of the American Medical Association, it was reported that repetitive strain illnesses in the workplace more than doubled from 1989 to 1990.

The Pain Cycle
A key element in pain management is successful treatment of the overloaded soft tissues. Chiropractic adjustments, acupressure, ultrasound, or postural exercises may be used to relax and mobilize the painful areas. When a pain cycle has been established, deconditioning in the form of muscle "spasm," joint stiffness, and muscle weakness are the inevitable result. Two approaches have been used with athletes to achieve lasting pain relief. First, the prescription of reconditioning exercises to improve the function and stability of painful tissues. Second, educational training in ways to reduce strain or risk of injury in the future. Examples would be advice on using an ergonomic chair or incorporating a biomechanical lifting technique.

Traditional Care vs. Sports Medicine
Gordon Waddell, A British orthopedic surgeon, wrote that "Management must change from a negative philosophy of rest for pain to more active restoration of function." Prolonged passive care in the form of rest, medication, and even physical therapy may not only be ineffective, but actually can be detrimental. Alf Nachemson, a Swedish orthopedic surgeon, said, "If something is injured and you start to slowly move it under controlled conditions, the structure heals quicker and better."

Sports medicine involves the patient as an active partner in his or her treatment. It is a challenging approach which can lead to overall improvement in the quality of one's life. A trained chiropractor is qualified to individualize a treatment program so that recurrent or chronic pain can be prevented. The combination of simple exercises, education, and encouragement are the ingredients that will lead to success.