• physical activity
• fatigue
• injuries
• training

Pain and fatigue are common reasons for athletes to avoid, or reduce, sporting participation. Despite commonly coexisting, they are usually treated as distinct entities. Both sensations are often interpreted by medical staff as indicating that physical activity should be reduced or avoided, either due to tissue damage (pain) or excessive training (fatigue). But paradoxically, that management plan—relative rest—means that athletes avoid what keeps them healthy, fit and resilient—physical activity.

Coaches sometimes view the sensations of pain and fatigue as indicators of physical and/or psychological weakness; they should be ignored to ‘toughen up’ athletes, sometimes leading to athletes unhelpfully provoking symptoms. These opposing views between medical staff and coaches—which often reflect limited understanding regarding the interaction of training load, beliefs and other external factors on pain and fatigue—often place the athlete in a conflicted state. ‘Should I tell (the medical team) or should I remain stoic’ (figure 1). We discuss the parallels between pain and fatigue, and how their management reflects the lens through which these …