Pain Mechanisms, Psychosocial Factors and Physical Exam in Athletes

Thomas describes nociceptive, neuropathic and nociplastic pain, and how to rate severity and sensitivity, the newer term for irritability. Knowing the pain profile helps educate athletes, who often hold a mechanical view of pain, and guides how much symptom provocation is acceptable in rehab. Elite athletes have higher pain tolerance, which helps with normal training soreness but can lead them to push through injury. Alongside depression, anxiety, catastrophizing and fear avoidance, athletes face specific stressors such as negative appraisal of their own performance and pressure from teammates, coaches and family. Stressed athletes have higher injury risk and a greater chance of persistent back pain. Athletes avoid activity less, which helps rehab, but elite athletes often become endurance copers who suppress pain and train through it. The physical exam covers static posture and movement, including range, where movement comes from and velocity, since slower movers tend to have more pain. It also covers capacity (muscle size, strength, endurance, power and VO2max), neural mechanosensitivity and neurological testing, and palpation for tissue sensitivity and soft tissue or bony changes.