Playing in Pain: Courageous or Crazy?

playing-in-pain

Pain and sport go hand in hand. To a degree, pain is an inevitable consequence of pushing our bodies to their limits and to actively engaging in activities that place our physical wellbeing at risk. Pain is accepted, managed and even embraced by sportspeople from amateur to elite level – that’s why we refer proudly to our achievements taking ‘blood, sweat and tears,’ and when something hurts we pop a paracetemol, hold ourselves together with tape and take to the field anyway.

“There is a difference between the brave that will be there at any cost and the ones that a little pain can make a difference”

The not-so-subtle message behind these words from Jose Mourinho yesterday: toughen up. Chris Smalling and Luke Shaw aren’t the first footballers to be confronted with this type of accusation. Daniel Sturridge is praised for his talent but criticized for how often – and apparently how easily – he is on the injury list. Is it fair to expect sportspeople to suck up the pain and get on with it, or are we being too hard on them? Does playing through pain indicate courage and selflessness or shortsightedness and stupidity?

In recent months, back page headlines have been dominated by accusations of systematic doping in Russian sport and the release of information about TUEs (Therapeutic Use Exemptions) granted to athletes to allow them to take certain prohibited drugs for medical reasons. The debate about doping in sport asks many varied ethical questions, but perhaps the one most relevant to this issue is why we punish athletes for masking pain chemically, but allow, encourage and expect them to handle it psychologically. If you have an illness or injury bad enough to require restricted medication, should you be competing at all?

This leads me on to what pain really means. Firstly, let’s consider what the impact of pain on an individual level. It’s important that we distinguish between pain thresholds and pain tolerance because playing in pain isn’t just about what hurts and how much, but also about what an individual person’s ‘ceiling’ is: what we can manage or where our physical and mental limits to cope lie. Pain threshold will affect how bad it feels when a boxer is punched in the face or a rugby player is smashed in a huge tackle. Pain tolerance is what determines whether or not they can carry on playing, and how much it does or doesn’t affect their future performance.

The second aspect of this is how important being at your physical optimum actually is. In sports where performance is primarily determined by peak fitness – whether in speed, endurance or power – a relatively minor injury can be hugely significant. In sports where a more complex blend of physical capacity, strategic awareness and technical execution are required, an injury may have an impact, but doesn’t necessarily make it impossible to compete. Typically, this is why a sprinter doesn’t compete with a tight hamstring, but a hockey/football/rugby player might call it a niggle and crack on.

In some situations, these decisions are taken out of a sportsperson’s hands. Recently updated rules on concussion in many sports are a good example of the wider health of an athlete being prioritized over getting back onto the field of play. A blanket ruling reduces the potential effects of commercial interests and external pressure on sports doctors on duty of care towards athletes, but it is unrealistic to expect every case of pain and injury in sport to be assessed and managed in this way.

“Pain is temporary, glory lasts forever”

There are numerous examples of sportspeople playing on despite bad injuries or severe pain. What is it that made Terry Butcher keep heading the ball despite bleeding profusely out of his stitched-up forehead? Why was Kate Richardson-Walsh prepared to endure extreme pain and risk further damage when she played on after having her jaw broken by a hockey stick during London 2012? Perhaps the craziest of all was Terry Sawchuk – an ice hockey goalkeeper who played before helmets were mandatory and had more than 600 stitches to his face during his career.

Maybe the decisions of these sportspeople are made simpler by what their sports mean to them; perhaps playing in pain is about more than toughness or tolerance. Perhaps it’s a symbol of what you’re prepared to endure for a lifelong goal or giving everything for your team. Having said that, bravery comes in many forms. Sometimes, asking for help or admitting you don’t think you can handle pain might be just as brave as soldiering on. If you can’t do your job properly, you might be letting your team down by putting on a brave face. Is winning a medal or being the tough guy (or girl) enough to risk your long-term health or a ‘normal’ life beyond sport?

There’s often a fine line between brave and stupid, and perhaps in the end it comes down to hindsight. Playing in pain is a bit like attempting an audacious goal – if you go for it and it works out, you’re a hero. If it turns out to be a bad choice, you’re an idiot. It just depends whether you can handle the situation and whether you think the risk is worth it.

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