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“It only hurt once, from beginning to end.” - James Counsilman, college swimming coach (after swimming the

English Channel at the age of 58).

“Pain is inevitable; suffering is optional.” - Unknown

increases the athlete’s ability to do so. In rehabilitation, recognise that the injury pain is temporary while healing occurs. This improves the athlete’s ability to cope.

Relaxation and imagery As covered in sportEX medicine earlier this year (6), relaxation and imagery induces physical changes in the body that may alleviate pain. Diaphragmatic breathing and specific muscle relaxation exercises improve blood flow to the affected areas and decrease muscle tension. This facilitates healing and decreases the pain caused by guarding and bracing. Performance imagery improves an athlete’s focus for optimal performance. For example, a cyclist may feel burning in her thighs, but imagines her legs as pistons rapidly pumping, appropriately distracting from the pain. Pain imagery uses a graphic mental picture of the pain and changes it so that relief can be seen (see Issue 15 Jan ‘03 for a detailed description). Coping imagery improves tolerance as the athlete includes the pain experience in his image of peak perfor- mances (eg. being aware of the extreme fatigue and cramping while running a personal record).

Choosing a realistically positive perspective regarding the pain may be the most effective strategy. Pain informs the athlete about her body’s condition or stage of healing. Alterations in pace and effort can then be made in response to this information and enhance performance. When considered objectively pain is an ally, not an enemy. During competition where others are experiencing similar pains, an opportunity to excel at pain tolerance can decide victory. Pain may also be viewed as a personal challenge and foster a sense of accomplishment when competition or training ends.

Conclusion Pain is a part of sport. It is not inherently negative. Athletes choose their emotional and coping reactions. They choose the impact pain will have on performance. They may catastrophize

and feel disabled leading to more pain and suffering, inconsistent performances, and slowed healing in rehabilitation. A better approach is to objectively evaluate the pain using education from coaches and physiotherapists. See the challenge in pain tolerance. Understand that pain is temporary and believe you can perform despite it. Take advantage of the opportunity to excel through the pain using realistically positive self-talk, relaxation and imagery. In addition to facilitating these skills, therapists are encouraged to ask their athletes about their pain and listen carefully for opportunities to educate and reduce anxiety. Some athletes will want to ‘tough it out’ and may avoid expressing pain concerns. Remember pain is both sensory and emotional. Help the athlete deal with both and avoid describing pain as either ‘physical’ or ‘mental’. This will build trust and facilitate rehabilitation.

References 1. Addison T, Kremer J, Bell R. Understanding the psychology of pain in sport. The Irish Journal of Psychology 1998;19:486-503 2. Sullivan MJL, Stanish W, Waite H, Sullivan ME, Tripp D. Catastrophizing, pain, and disability in patients with soft tissue injuries. Pain 1998;77:253-260 3. O’Connor EA. “I can’t stop thinking about how much it hurts”: Catastrophising in rehabilitation. sportEX medicine 2002;14:6-7 4. Williams SL and Kinney PJ. Performance and nonperformance strategies for coping with acute pain: The role of perceived self-efficacy, expected outcomes, and attention. Cognitive Therapy and Research 1991;15:1- 19

5. Stevenson MK, Kanfer FH, Higgins JM. Effects of goal specificity and time cues on pain tolerance. Cognitive Therapy and Research 1984;8:415-426 6. O’Connor EA. Sport skills applied to rehabilitation: Relaxation and imagery. sportEX medicine 2003;15:7-8

Dr Edmund O’Connor, PhD, is director and chief psychologist of the PEAK, Pain and Headache Programmes at Rehabilitation Professionals in Grand Rapids, Michigan, USA. He is a certified consultant through the Association for the Advancement of Applied Sport Psychology and a member of the United States Olympic Committee Sport Psychology Registry.

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