Managing Pain in the Active and Athletic Patient
Aaron Rubin, MD, FAAFP, FACSM
Kaiser Permanente Sports Medicine Fellowship Program
Peter Ronai, M.S., ACSM RCEP, CES, CSCS-D, FACSM
ACSM Program Director Certified
Clinical Associate Professor
Exercise Science
Sacred Heart University
ACSM Health & Fitness Summit
I. Introduction
A. Presentation outline/objectives
- To help health/fitness professionals understand how common, painful orthopedic conditions can affect
client exercise participation and tolerance and how physicians diagnose and treat them.
- To describe appropriate strategies health/fitness professionals can take to help clients remain physically
active, prevent de-conditioning and avoid damaging and reinjuring painful body segment(s) and/or
exacerbating pain
- To identify signs, symptoms and situations warranting that exercise professionals refer their client(s) back
to a physician/healthcare professional
- Discus the effect(s) that some common treatments for pain have on physical activity tolerance and exercise
performance
II. "What Is Pain"?
A. Definitions
- Subjective Descriptions
- Acute versus Chronic
III. What Purpose does Pain Serve (What Good Is It)?
A. A Warning System
- Decreases Risk of ongoing damage
- Tissues undergo characteristic phases of healing activity
- Pain can be deceiving (Not always a good indicator of tissue strength and healing)
B.. Role of Exercise Professionals
- Understand how tissue(s) and injuries heal
- Understand their scope of practice
- Develop safe, effective exercise programs in conjunction with guidelines established by client's
physician
- Communicate with client's physician when warranted
IV. Special Considerations During Exercise
A. Exercisers often use pain as a guide for return to activity and tissue health
- Pain levels often decrease well before tissue healing is complete
- Exercisers might believe they can return to workouts before the body is actually ready
B. Never overstress healing tissue
- Appropriately controlled therapeutic stress is needed to optimize collagen matrix formation
- Client progress from one phase of healing to the next
- Progress dictated by specific objectives (established by the physician and/or physical therapist
- New/worsening symptoms and/or reduced function warrant referral back to MD ASAP!!!!
V. Reconditioning Considerations
A. Inflammation Stage
- Preventing disruption of new tissue
- *Exercise Strategies- General aerobic and anaerobic training and resistance training of
uninjured extremities, with priority given to maximal protection of the injured area
B. Repair/Proliferation Phase
- Preventing excessive muscle atrophy and joint deterioration in the injured area; maintaining
muscular and cardiovascular function in uninjured areas
