Athletic Pain: Performing at Your Best When Your Body Hurts

Whether you're a weekend warrior out for fun or a professional athlete, consistent top performance is always the goal. Pain undermines it in every direction. A nagging injury shortens practice sessions. Pain forces small technique changes that expose weak spots in your game. Opponents sense weakness and gain confidence. The athlete in pain loses concentration on the event and starts protecting the injury instead. The cumulative effect is loss of the joy of competition — and often, ultimately, loss of the sport itself. The Joe Montanas, Sandy Koufaxes, and Larry Birds have all had chapters end this way.

This article covers what actually works to prevent athletic pain, what to do immediately when an injury happens, and when to see a specialist. The specific advice has evolved over the last twenty years — some of it in ways that surprise most people.

The single most important predictor of avoiding sports pain is doing the boring things well:

• Stretching and warm-up before activity.
• Sport-appropriate technique — the right form for what you're doing.
• Proper equipment for the sport, in good repair, fitted correctly.
• Gradual training progression, not weekend heroics after weeks of inactivity.
• Adequate sleep and nutrition. Both matter more than most amateur athletes realize.
• Recovery between hard sessions. Chronic overtraining is a common source of nagging injury.

Each of these is a book of its own. The point is that pain prevention starts long before the event.

This is worth its own section, because thinking has changed considerably — and the right answer depends on who's asking.

For the weekend athlete — the Saturday tennis player, the Sunday golfer, the pickleball regular, the recreational cyclist — the older concept sometimes called "preloading" still holds up. Taking a couple of over-the-counter pain relievers (ibuprofen or acetaminophen) about an hour before the event reduces the soreness during play and the stiffness the next day. The reasoning is the same as pre-operative pain medication before surgery: it's easier to prevent pain than to chase it once it's set in. For the casual athlete, that's a reasonable, effective, and safe strategy.

The picture changes for endurance events and for serious or professional athletes on a regular training schedule. In that population, routine pre-event NSAIDs raise legitimate concerns:

• Kidney effects. NSAIDs reduce blood flow to the kidneys. Combined with the dehydration and reduced blood flow of a long endurance event, that can produce acute kidney injury.
• Hyponatremia. NSAIDs contribute to fluid retention and can push sodium into a dangerously low range during long events.
• Gastrointestinal bleeding risk goes up during hard prolonged efforts, particularly running.
• Training adaptation. Regular NSAID use appears to blunt some of the muscle-building and tendon-strengthening adaptations that training is supposed to produce. If you're training to get stronger, you don't want to work against that.

So the short version: preload is fine for the weekend athlete. For endurance events and serious athletes on a training schedule, use pain medication for a specific reason on a specific day rather than routinely.

The old advice was RICE — Rest, Ice, Compression, Elevation. The framework served a generation of athletes well, but the person who coined it in 1978, Dr. Gabe Mirkin, publicly retracted the ice-and-rest recommendation in 2014. Prolonged ice and prolonged rest, it turns out, delay healing rather than speed it. Current sports medicine frameworks (called PEACE & LOVE, or POLICE) still protect the injury in the first day or two — but push earlier movement and gradual loading.

Think of it in two phases:

• Protect the injured area from further stress.
• Elevate to reduce swelling.
• Compress with a wrap or sleeve.
• Ice for pain relief in short intervals — 15 to 20 minutes at a time, with skin protection. Ice is a pain reliever, not a healing accelerator; don't overdo it.
• Avoid prolonged rest. Gentle movement within your pain tolerance is better than complete immobilization for most soft-tissue injuries.

• Optimal loading. Progressive, controlled movement and gradual reintroduction of load is now understood as one of the main drivers of tissue healing. Absolute rest is no longer the goal.
• Range of motion first, then strength, then sport-specific movement. Skipping steps is how re-injury happens.
• Pain as a guide, not a stop sign. Some discomfort during rehabilitation is expected. Sharp pain, swelling that increases the next day, or loss of function is a signal to back off.

A related question: should you take NSAIDs after an acute injury? Short-term use for pain is reasonable. What we've come to understand is that inflammation is part of the healing process — not an enemy to be crushed. Blocking inflammation aggressively and for weeks may delay recovery of muscle and tendon tissue. Use anti-inflammatories to control pain in the first few days if you need to; don't take them routinely throughout a multi-week recovery.

The most common mistake in amateur athletics is returning too soon. A good working benchmark: return to full sport when the injured side has recovered roughly 90% of the strength and range of motion of the uninjured side, and when sport-specific movements can be performed without pain. Feeling "pretty good" is not the same as being ready to compete. This is where a physical therapist earns their fee — objective measurement rather than optimism.

Some athletic pain does not resolve on the expected timeline. When pain outlasts the tissue-healing window — generally six weeks for muscle, longer for tendon and cartilage — additional evaluation and treatment options are worth considering. These are the kinds of problems a pain specialist can help with:

• Tendinopathy. Tennis elbow, patellar tendinopathy, Achilles tendinopathy, and rotator cuff tendinopathy that has not responded to physical therapy. Platelet-rich plasma (PRP) is an option for the right patient. Ultrasound-guided injections can deliver treatment precisely where it's needed.
• Chronic joint pain. Radiofrequency ablation (RFA) of sensory nerves supplying a joint can provide months of relief when conservative measures have plateaued — most commonly used for knee osteoarthritis and facet-joint low back pain.
• Nerve entrapment. Numbness, tingling, or shooting pain along a specific nerve distribution deserves a workup. Ultrasound-guided injection and hydrodissection can relieve entrapments without surgery.
• Myofascial pain and trigger points. Dry needling and trigger-point injection remain effective for stubborn muscular pain.
• Complex regional pain syndrome (CRPS). A rare but serious complication of an injury or immobilization — disproportionate burning pain, skin and temperature changes, hypersensitivity. Early recognition matters; treatment outcomes are much better when it's caught in the first few months.

Newport Pain Management has provided interventional pain diagnosis and treatment in Newport Beach since 1996. Our medical director, H. Rand Scott, MD, is a board-certified anesthesiologist who completed subspecialty training in pain management and served as an attending physician at the Pain Management Clinic at Penn State Hershey Medical Center before founding Newport Pain Management. He holds privileges at Hoag Hospital and Newport Center for Special Surgery and directs the KetaCure Ketamine Infusion Center.

To request an evaluation, call (949) 759-8400 or visit the contact page.

This article is for general education and is not a substitute for individual medical advice.