“...When something hurts, pay attention. ”

Pain affects training and athletic performance. But pain is also an important sign that must be paid attention to. It gives you feedback on how your body is currently working and warns you that things are not going well. Pain can cause you to alter your stride and result in other injuries. The biomechanical changes that you make as a result of pain can cause more pain, stress fracture, strains, and other injuries far away from the site of the original problem. When something hurts, pay attention. Find out why it is hurting and what you should do to make the pain stop.

Remember, pain is not normal. Your feet, legs, back, arms and any other part should not be hurting and interfering with your sports activity. This is a warning. If you want to succeed you will have to make changes, see your doctor, and find out why it hurts, what to do and stop the pain so you can safely continue your sport. To do otherwise is to risk serious injury and a long time interruption of your sports activity.


Overuse is the cause of most sports injuries seen in a clinical practice. make sure you read and pay attention to the online article on how to "Stay Out Of The Doctor's Office" and avoid the terrible "toos". Too much, too soon, too often, too fast, and too little attention paid to pain.

“...Overuse is the cause of most sports injuries. ”

Pain Scales

There have been several pain scales described over the years. Three approaches are presented below. The proposed phases of pain by Robert Nirschl M.D. is thorough and applicable to pain in non-athletes and athletes. The scale of Pribut is a simplified approach for the athlete to consider. The scale of Puffer & Zachazewski (1988) is also presented. Previous pain scales similar to these and being either 3 (combining P & Z scales stages 2 and 3) or 4 point scales have been presented since the late 1970's in various lectures and informal texts.

Pribut Pain Protoypical Staging Of Overuse Injuries In Athletes

Stage 0. No pain is present before, during or after activity. Minor discomfort may be experienced at various times during training or racing.

Stage 1. Pain or stiffness after activity. The pain is usually gone by the next day.

Stage 2. Mild discomfort before activity that goes away soon after exercise is commenced. No pain is present in the latter part of the exercise. Pain returns after the exercise is completed (starting within 1 to 12 hours later and lasts up to 24 hours).

Stage 3. Moderate pain is present before sport. Pain is present during sport activity, but is somewhat decreased. The pain is an annoyance which may alter the manner in which the sport is performed.

Stage 4. Significant pain before, during, and after activity. The pain may disappear after several weeks of rest.

Stage 5. Pain before, during, and after activity. The athlete has stopped their sports participation because of the severity of the pain. The pain does not abate completely even after weeks of inactivity.


Nirschl Pain Phase Scale of Athletic Overuse Injuries

Phase 1. Stiffness or mild soreness after activity. Pain is usually gone within 24 hours.

Phase 2. Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity, but return afterward, lasting up to 48 hours.

Phase 3. Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity, but does not cause the athlete to alter activity.

Phase 4. Similar to phase 3 pain but more intense, causing the athlete to alter performance of the activity. Mild pain occurs with activities of daily living, but does not cause a major change in them.

Phase 5. Significant (moderate or greater) pain before, during, and after activity, causing alteration of activity. Pain occurs with activities of daily living, but does not cause a major change in them.

Phase 6. Phase 5 pain that persists even with complete rest. Pain disrupts simple activities of daily living and prohibits doing household chores.

Phase 7. Phase 6 pain that also disrupts sleep consistently. Pain is aching in nature and intensifies with activity.


Puffer & Zachazewski

Type 1 pain occurs after activity only

Type 2 occurs during activity, but does not impair or restrict performance

Type 3 occurs during activity and is severe enough to interfere with performance

Type 4 is classified as chronic and unremitting.



Managing Overuse Injuries: A Systematic Approach
MAJ Francis G. O'Connor, MD; LTC Thomas M. Howard, MD; Catherine M. Fieseler, MD; Robert P. Nirschl, MD, MS

Pribut, SM: Online Survey of 8,000 Runners. Online https://www.drpribut.com/ . Unpublished preliminary data. 2003.

Puffer JC, Zachazewski JE: Management of overuse injuries. Am Fam Physcian 1988;38(3):225-232

Macintyre JG, Taunton JE, Clement DR, et al: Running injuries: a clinical study of 4,173 cases. Clin J Sports Med 1991;1(2):81-87