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There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport
  1. J P Caneiro1,2,
  2. Rafael Krasic Alaiti3,4,
  3. Leandro Fukusawa4,5,
  4. Luiz Hespanhol6,7,
  5. Peter Brukner8,
  6. Peter PB O'Sullivan1,2
  1. 1 Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia
  2. 2 Body Logic Physiotherapy, Perth, Western Australia, Australia
  3. 3 Universidade de São Paulo, Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, São Paulo, Brazil
  4. 4 Projeto Superador, Research and Data Science Unit, São Paulo, Brazil
  5. 5 Faculdade de Ciências Médicas Santa Casa de São Paulo, Masters and Doctoral Programs in Medical Science, São Paulo, Brazil
  6. 6 Universidade Cidade de São Paulo (UNICID), Masters and Doctoral Programs in Physical Therapy, São Paulo, Brazil
  7. 7 VU University Medical Center Amsterdam (VUmc), Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, Amsterdam, Netherlands
  8. 8 La Trobe Sport & Exercise Medicine Research Centre at La Trobe University, Melbourne, Victoria, Australia
  1. Correspondence to Dr J P Caneiro, School of Physiotherapy and Exercise Science, Curtin University, Bentley WA 6102, Australia; jp.caneiro{at}

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Are you careful with how you label an athlete’s pain?

Musculoskeletal pain in athletes is common, but not always associated with injury (ie, tissue damage).1 Damage occurs when load exceeds tissue tolerance, such as ligament tear or a fracture. However, pain in athletes that occurs in the absence of trauma and tissue damage is still often labelled an ‘injury’ by clinicians, coaches and athletes themselves. This highlights a gap between knowledge (tissue damage is not necessary for pain) and practice (assuming that all pain arises from tissue damage) in our clinical community.1 2 This applies particularly in the area of acute non-traumatic pain (such as back and joint pain). To help bridge this gap, we outline eight principles to guide clinicians who manage musculoskeletal pain in sport (see infographic in figure 1).

Figure 1

Infographic—principles to guide care of acute non-traumatic pain in sport.

1. In the absence of trauma, do not assume that pain indicates tissue damage

  • Labels such as ‘sports injury’, ‘overuse injury’ or ‘microtrauma’ convey that pain is caused by tissue damage, resulting in over-protection of the athlete. While …

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  • Twitter @jpcaneiro, @LucaHespanhol, @PeterBrukner

  • Contributors JPC and POS drafted the manuscript. All authors contributed and approved the final version submitted. JPC, RA and LF drafted the figure.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests JPC, PB and POS are members of the editorial board of BJSM. JPC and POS deliver educational workshops on patient-centred care.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.