Nip the nagging pain in the bud

You have this sharp/stabbing pain on the outside of your knee that comes on by mile 5 of the run. However, like most triathletes, you are committed and determined.

You must finish and you will finish this race. The pain had begun to show signs of being a problem in the weeks leading up to the race, but you had already come so far to prepare for race day. So, you push through. Over the next few months, this knee pain persists and becomes unbearable. You have no choice but to drop out of your A race by the end of the season.

Takeaway: Don’t ignore pain!

What is pain?

The Merriam-Webster dictionary defines pain as, “A localized or generalized unpleasant bodily sensation or complex of sensations that causes mild to severe physical discomfort and emotional distress and typically results from bodily disorder (such as injury or disease).” Pain serves an extraordinary purpose in the human body and, when a healthy body is able to modulate and differentiate various types of pain, it can prove quite useful. Nociceptors are specialized peripheral sensory neurons throughout the human body that send signals to the brain, communicating some form of damage and/or danger. These signals are often interpreted as pain in order to warn the body and alleviate the symptoms. There are several cases where the brain may misinterpret a non-painful stimulus as painful (known as allodynia), though this is often associated with some type of traumatic injury, surgery, neurological condition, etc. In a body without any of these conditions, this interpretation in the brain is not to be ignored.

How do I differentiate between workout pain and an actual injury brewing?

“No pain, no gain.” “Push through the pain.” “Pain is weakness leaving the body.” “Pain is temporary.”

Triathletes love to embrace these sayings to physically and mentally endure the most grueling of training sessions and tests (i.e. FTP and VO2 max tests). There is no question that a triathlete, no matter what level of performance, experiences some form of discomfort in a training session or a race. You did sign up to test your body’s physical limits, after all. However, there is a distinction between the expected workout discomfort and actual pain, where your body sends warning signals. 

Don’t let acute become chronic

Often, overuse injuries are sneaky and creep up over time before manifesting as a season-ending affliction. Here are signs that what you are feeling is not run-of-the-mill discomfort from exercising: 

• Concerning pain descriptors: Sharp/Stabbing/Electricity/Numb/Tingling

1. Yes, there is the expected muscle burn when performing intense exercise. This should reduce over time, as your muscles adapt to increases in load and intensity.
2. If the pain is sharp and/or stabbing in a pinpoint location (often in specific joints and/or muscles), this may be a soft tissue injury. Your body is trying to communicate that it is being used in a way that exceeds what the tissue capacity allows.
3. Electricity, numbness, and tingling are frequently indicative of nervous system involvement. Nerves have a not-so-pleasant way of communicating their irritation. (Common misconception: It is normal to feel numbness in your saddle area during a long bike ride. Not true! This may indicate pressure through your pudendal nerve and must be addressed with a change in saddle and/or getting a professional bike fit).

• Lingering DOMS

1. Delayed onset muscle soreness, also known as DOMS, is an expected amount of muscle soreness/aches post-workout. Onset is typically one-to-two days after exercising. The muscles are repairing after the muscle and connective tissue were stressed and disrupted through exercise. However, it is abnormal if there is lingering soreness in a specific body part lasting more than five days. This could be telling of a neuromuscular and/or musculoskeletal injury.

• The pain is replicated with a distinct action and is getting worse.

1. If there is a certain action that you perform (i.e. catch phase of swim stroke, downstroke of the cycling pedal stroke, heel strike of running cycle) and it causes pain in a specific area, it is likely not just a sore muscle.
2. Observe how the pain trends. Now, starting a workout is not always the most enjoyable, as athletes wait for their bodies to loosen and the joints to become lubricated. Stiffness and tightness is not uncommon when starting off a swim, bike or run; however, the discomfort often dissipates. If each time you perform a specific action (as described above) there is increasingly more pain, this is not a good sign and does not mean push through. 

Coaches communicating and protecting their athletes

Athletes and coaches typically set short- and long-term goals, which are crucial for a successful season. Throughout weekly workouts, they remain in constant communication. They may make necessary adjustments to the program, depending on life and work stressors, sleep quality and energy levels. By no means is any training program permanent. You are a team and work side-by-side through training and races. It is the coaches’ responsibility to ensure that their athletes are safe and healthy, remaining injury-free. Also, it is the responsibility of the athlete to be honest about what they are feeling so that the partnership can make an informed decision. Additionally, athletes sometimes require an outsider's perspective to see that an injury is developing. They may become so fixated on completing their workouts that they fail to realize their pain is worsening over time. Coaches, please observe your athletes in action, monitor their form and create a plan early to nip suspected injuries in the bud. 

Seek further medical management as needed

Athletes, trust your coach. They know what they are doing and often have highly effective training on how to treat certain ailments. Do as they instruct, as it is in your best interest. Coaches, I encourage you to help athletes find further medical management assistance when needed. Refer to physical therapy, chiropractic care, massage therapy and/or sports medicine when it is out of your realm of knowledge.

Stay healthy to achieve those long-term goals.

Bibliography

Dubin AE, Patapoutian A. Nociceptors: the sensors of the pain pathway. J Clin Invest. 2010;120(11):3760-3772. doi:10.1172/JCI42843 
https://www.merriam-webster.com/dictionary/pain 

Grichnik KP, Ferrante FM. The difference between acute and chronic pain. Mt Sinai J Med. 1991;58(3):217-220. 

https://fiercetraining.net/lactic-acid-hydrogen-muscles-burn/ 

https://www.physio-pedia.com/Delayed_onset_muscle_soreness_(DOMS)?utm_source=physiopedia&utm_medium=related_articles&utm_campaign=ongoing_internal 

https://www.painscience.com/articles/delayed-onset-muscle-soreness.php 

Kaur J, Singh P. Pudendal Nerve Entrapment Syndrome. [Updated 2021 Apr 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544272/