Playing Through Pain

There are some injuries to specific body organs/parts in which the sports medicine community will not allow an athlete to continue to compete. These include injuries to the brain (i.e., concussion), vital organs (lung, heart), and internal organs. These types of injuries can cause fatal injuries if an athlete continues to compete.

However, in many cases, athletes are given the choice of whether they want to try to compete with an injury. Each injury will carry its own risks to the athlete, but the decision is ultimately the athlete’s decision to make (as long as her or she is 18). While amateaur athletes commonly experience and debate this, professional athletes do as well. Take Lyndsey Vonn as an example.

Olympic downhill skier Lyndsey Vonn was in that situation at the 2010 Winter Olympic Games. Vonn sustained a “deep contusion” to her right lower leg while training in Austria on February 2, 2010 (Dufresne, C., February 11, 2010). Because she feared the results, she initially refused to have the lower leg x-rayed.

Vonn is a two-time defending World Cup champion and was considered a favorite for the gold medal in the Winter Olympic Games. Because of her success, she had a tremendous amount of pressure to compete and to win the gold. The only problem was that she had “excruciating pain” in her leg (Defresne, C., February 17, 2010). She stated her “shin was throbbing in her boot.”

“Throbbing” pain is a symptom of an acute injury usually indicating that an area is swelling due to increased blood flow. The “throb” is actually related to the heart beat of the individual. In an acute injury, blood vessels are broken or torn in and around the damaged area. When the circulation to the area increases (i.e., heart rate increases moving more blood flow to the extremities), blood is pumped into the area. Because blood vessels in an acute injury are torn, the blood is pumped into spaces between the soft tissues rather than through the circulatory system.

Vonn’s ability to ski depended on how much pain she could tolerate and how much her lower legs were jarred during the ski runs (i.e., number of bumps that need to be maneuvered in and around).

Safe return of an athlete to competition is dependent on two things. The first is the athlete’s physical recovery from his/her injury. This would include criteria such as range of motion, strength, power, and functional ability. The second is the athlete’s mental status. Fear of reinjury or lack of confidence in the injured limb’s ability to handle the demands of the sport can play significant roles in the athlete’s safe return to sport.

Athlete’s recovering from injuries experience a number of emotions including:

• Anxiety
• Tension
• Depression
• Frustration
• Anger
• Fatigue
• Fear of reinjury

An athlete who is fearful of reinjury may be tentative in his/her approach to the sport. Rather than focusing on the specific demands of the sport, the athlete may be distracted with focused attention on the injured limb. This distraction alone is enough for the athlete to succumb to another injury.

According to McArdle, S (January 2010), fear of reinjury can range “from mild concern to a range of maladaptive psychological outcomes and disorders”. More importantly, the author states that “fear of reinjury can play a role in the athlete’s successful return to the sport.”

So how does an athlete overcome the fear of reinjury? First, the athlete needs to recognize that fear is a valid emotion for an athlete returning to competition. The athlete needs to be able to discuss his/her feelings openly and in a safe environment.

Second, ideally, the athlete has physically healed to the point where he/she is able to compete without pain. In a perfect world, the athlete has full range of motion of the joints affected by the injury, full strength and power in the muscles affected by the injury, and has successfully completed a progressive series of sport-specific functional activities.

In an ideal world, the athlete also has had time to complete all of the necessary rehabilitation and is pain-free before he/she returns to compete. But in Lindsey Vonn’s case, time was limited. She did not have the luxury of waiting.

Vonn needed to weigh the risks of competing on her injured leg. This discussion needed to take place with her team physician and her coach. It is the physician’s responsibility to inform an athlete of all of the physiological risks that he or she may incur if the decision to compete includes the risk of further injury.

Pain medication is also a consideration for injured athletes who choose to compete. There are many different types of pain medications both over-the-counter and prescribed.

The downside of taking pain medication is that it does reduce the pain felt in an injured area. Although this sounds like a good thing, an athlete on pain medication may cause further injury because he/she does not feel the pain. The worst case scenario is that an athlete plays through pain, does not feel the pain, and then causes significant more damage to the tissue without knowing it. In the long run, this can set back an athlete’s rehabilitation even longer.

Ultimately, it is up to the injured athlete to weigh all of the risks and benefits of competing with an injury and then make his/her decision. Hopefully, it is one based on sound reasoning and an understanding of physiology rather than on emotion. Lyndsey Vonn and her team evaluated the risks and were able to get great treatment for her to compete with her painful leg. And she was able to win the Gold Medal!

If you suspect that you have a sports injury, it is critical to seek the urgent consultation of a local sports injuries doctor for appropriate care. To locate a top doctor or physical therapist in your area, please visit our Find a Sports Medicine Doctor or Physical Therapist Near You section.

More Information

Read about sports injury treatment using the P.R.I.C.E. principle - Protection, Rest, Icing, Compression, Elevation.


Dufresne, C. (February 11, 2010). With Lindsey Vonn’s Injury, U.S. Medal Hopes may take One on the Shin. Los Angeles Times.

Dufresne, C. (February 16, 2010). Lindsey Vonn Makes Official Training Run but Isn’t Entirely Happy. Los Angeles Times.

Dufresne, C. (February 17, 2010). Weight of Expectations Rides on Lindsey Vonn’s Shoulders. Los Angeles Times.

McArdle, S. (January 2010). Psychological Rehabilitation from Anterior Cruciate Ligament – Medial Collateral Ligament Reconstructive Surgery: A Case Study. Sports Health 2:73-77.

Ray, R., & Wiese-Bjornstal, D. (1999). Counseling in Sports Medicine. Human Kinetics: Champaign, IL.

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John Diveris

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John Diveris, MD
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