8 Principles to Guide Care of Non-Traumatic Pain in Sport

4 min read. Posted in Pain
Written by Physio Network info

A recent study proposed a set of principles to use as treatment and education guidelines for managing non-traumatic pain in sport.

We reviewed this study in a recent issue of our Research Reviews – where industry experts break down the most recent and clinically relevant studies, for immediate application in the clinic.

What you’ll read below is a snippet from the review.

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Back to the study!


STUDY TITLE: There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport – Caneiro J et al (2020)

Study reviewed by Dr Sandy Hilton in the November 2020 issue of the Research Reviews


Key points from the study:

  • There is a gap between what is known about pain and how non-traumatic pain is described to athletes.
  • In the absence of trauma or tissue damage, pain in an athlete is still commonly referred to as an injury.
  • Implementing the changes proposed will require a shift in pain management in sports and sports medicine.


Okay, let’s dive into it!


Background and Objective:

In sport, non-traumatic injuries continue to be an issue for management, with persisting misunderstanding of the nature of pain and a continued belief by some that pain means there must be an injury at the site of the pain.

To address the need for education at all levels (athletes, trainers, coaches, doctors), the authors of this editorial paper proposed a set of principles to use as treatment and education guidelines.



This was an editorial paper with a supplementary infographic designed for easy sharing within facilities and organizations.



The authors proposed 8 principles to guide care:

  1. In the absence of trauma, do not assume that pain indicates tissue damage.
  2. Do not refer for imaging unless suspicious of serious pathology, or when imaging directly influences care.
  3. Explore biopsychosocial factors that may contribute to pain.
  4. Deliver positive messages about pain during examination and treatment.
  5. Improve tissue tolerance to load.
  6. Use passive treatments only as an adjunct to active management.
  7. Use shared decision making to build self-efficacy.
  8. Use an inter-disciplinary approach to deliver a united message.



  • Despite excitement about the “explain pain” model of education, it has not shown to be strong when tested against a control group for back pain.
  • Despite agreement that self-efficacy and patient choice is helpful for back pain, it is an organizational challenge to push for limited visits and greater independence.
  • De-adopting outdated organizational and educational habits also continues to be a challenge.


Clinical Implications:

The authors of this paper provide some good examples of how the guidelines can be used to change the language around treating non-traumatic pain in sport. These examples are appropriate for all pain conditions as they highlight the nature of pain itself, regardless of the location of the pain or the skill level of the person feeling that pain.

The concepts outlined in this paper should be foundational in training programs and provide a roadmap for quality care. They also encourage creativity and individualization of program design. This is helpful for developing self-efficacy for the patient and for keeping clinicians and trainers engaged, as it avoids the numbing boredom of one-size-fits-all protocols.

As the authors state, adopting these principles would require a cultural change. It is a worthy effort that could help reduce the burden of pain and prolong participation in sport and promote better overall health.


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Here’s the 11 other studies from our November 2020 issue:

  • Landing Mechanics with Patellar Tendinopathy
  • Imaging Guidelines for MSK Conditions
  • Effect of Exercise on Pain in Osteoarthritis
  • Exercise Progressions for the Achilles Tendon
  • Custom Insoles for Plantar Heel Pain
  • Exercise Adherence Strategies for Younger People
  • Training Load and Injury – Research Challenges
  • Rate of Force Development after ACL Reconstruction
  • Smartphone Use and Neck Pain in Young Adults
  • Physical Activity and Mobility Disability in Older Adults
  • Surgery for Chronic MSK Pain – Where is the Evidence?


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