Persistent pain exists in professional football, as it does across all levels of society.
I have talked about persistent pain in professional football for many years: formally as a clinical lecturer at QMUL on the Sports Medicine MSc, working with clubs and players, and informally to raise awareness of what we can do.
Recently I was part of a webinar conversation with Mark Leather and Andy Thomas — both share my concerns and importantly, we all see a way forward.
You can watch and listen here.
Examples of presentations include:
- post-injury persistent pain
- persistent niggles with no obvious injury (the player often on the couch or the medical room)
- gradual build up of persistent aches and pains
- specific conditions featuring persistent pain, e.g./ migraine, IBS
- common persistent pains, e.g./ low back pain, anterior knee pain
- recurring pains, sometimes referred to as recurring injuries — here it is important to differentiate pain and injury as they are different and there are different needs to be met
Yesterday’s news featured Gary Pallister who described suffering migraines during his playing career.
He described his pain as ‘sickening’, and believes his migraines were due to repeated heading of the ball over many years. Others share his fears about the long-term effects of this part of the game.
Lecturing and delivering webinars to practitioners who work in sport has given me a platform to talk about persistent pain and a way forward.
The first step is acknowledging persistent pain exists and players are suffering.
This naturally leads to the question, what can we do to help them?
In very general terms, we can help the player understand their pain, and then together create healthy habits that deliver peak performance, whilst skilfully managing painful moments.
To help the players, the issue must be known, which requires a safe and open environment in the club to talk about the lived experience: compassionate and caring conversations.
The medical and health team plays a key role in high performance by delivering the highest standards of care, from acute injury management to deep listening and guidance to specialists for specific issues such as persistent pain.
How the player feels and their health come as one, which is directly related to performance on the pitch.
There is no separation of medical/health, performance, conditioning, coaching and management. Each is entwined intimately with the other.
A player is not a set of parts.
He or she is a living, dreaming, hoping, acting, feeling, thinking human being with all the complexity you would expect.
It has taken them their whole life to kick the ball in this moment. Not just the training, coaching and conditioning, but everything: early care, growing up, school life, all experiences so far.
To understand persistent pain, you need to see and understand the whole person in their lived world.
There is no reduction, and certainly the lived experience of pain, which you can’t see, cannot be reduced to anything less that the whole person.
Pain is not generated where the player feels it, and past experiences, expectations and beliefs play the major roles in pain, both acute and persistent).
The body tissues are where pain is felt (embodied), but they don’t generate the sensation or perception. They are not the cause, even when injured. This is too simple an explanation and based on cause and effect, which does not exist in the real world. There are too many hidden states and variables at play.
This is the basic understanding of pain enabling effective care, and why I argue this must be part of education for practitioners together with forming an approach that helps.
Certainly with persistent pain, the approach, attitude and application of care matters as much as any specific technique or method.
Pain is part of sport
This is perhaps one of the reasons persistent pain gets lost or dismissed or normalised in some cases.
However, this runs the risk of the pain and the way the player responds becoming entrenched and going down the route of more suffering, worsening performances, and more frustration.
Pain is part of sport. And in some sports more than others, part of the culture.
For an interesting look at pain in Japan and aikido, read Robert Twigger’s book, Angry White Pajamas; subtext: A Scrawny Oxford Poet Takes Lessons from the Tokyo Riot Police.
In my opinion, players can be educated about the pain they experience, which is key to understanding their experiences and throws light on the way forward.
They will also understand their role in getting better.
Getting better is an active process of learning and growth. The body systems that generate pain update their predictions, and hence the experiences lived by the player.
The practitioners role is guiding, supporting and encouraging. No sustained change to persistent pain comes from passive treatments — i.e./ doing things to players.
This is no different to learning a musical instrument, or indeed any skill a player is honing.
Only they can do it, and this is why I have advocated for Pain Coaching over the past 20 years.
A positive way forward
There is a positive way forward.
Here are some suggested ways in no particular order:
- training and mentoring for medical and health teams in clubs
- understand pain
- a modern approach based on latest understanding of persistent pain
- working closely together and with the other teams
- working with external specialists, e.g./ Pain Coach
- communicating complex needs with performance, coaching, management teams
- player education: pain, self-care — helping individuals find their own way
- bringing the medical/health, performance, coaching and management closer together
- the superteams approach
- safe environment to talk and share
- shared values
- effective communication
Drawing on related and associated fields there are many positive approaches and ways to help players move from persistent pain to performance, or places of purpose.
If you would like to talk to me about persistent pain in your club and what you can do, contact me at richmond@richmondstace.com
r.s.