Everyday Pain Management For The Athlete Of Aging

by Jonathon Sullivan MD, PhD, SSC | January 22, 2020

stabbing class athlete in action

In this article I’d like to share some thoughts on pain with you, and how we should deal with pain as athletes. But it’s critical that you understand that what I’m about to say is not medical advice from your physician. I’m a coach who just happens to be a doctor, describing his personal approach to pain.

As one of my most experienced clients said recently, “Everybody hurts from something.” This is simply a prosaic restatement of the First Noble Truth: All Life is Suffering. Pain is universal. And the Masters Athlete, the Athlete of Aging, approaches training in the sure knowledge that one can be older and hurting and strong or older and hurting and weak

But the ubiquity of pain most emphatically does not mandate or even recommend the passive acceptance of pain. Of all the ages of the history of man to have pain, you’re living in the best, because our options for the treatment or even ablation of pain are more diverse and more effective than ever before. 

The following assumes that we are confident your pain is musculoskeletal in origin, that appropriate referral and evaluation by a professional health care provider, as indicated, has ruled out serious underlying processes or systemic illnesses, and that there is no significant limitation in activities of daily living or other cause for medical intervention. If you are barfing or have a fever or literally cannot walk, wipe your butt, or feel your unmentionable parts, you should be in the ER, not searching Dr. Google or wiping yourself with Ben Gay. 

None of this should have to be said, but…there. I said it. 

So with all of that out of the way, let’s talk about a workaday approach to the aches and pains that bedevil all athletes, young and old. 

Step 1 is to internalize what was just said: aches and pains affect all athletes. It’s part of the package, the price of doing business. When your muscles are sore, when a joint is tweaked or your back is out or a hamstring is strained, remember that this is part of what it is to be an athlete, living a vibrant, active life. As Rippetoe once said (albeit more indelicately) when you grab Life by the Bosom, sometimes you get slapped. It’s totally worth it. 

Step 2 is to affirm to yourself, repeatedly, that you are not broken. Musculoskeletal pain isn’t the end of your gains, it isn’t the end of your training career, it isn’t the end of your active engaged lifestyle, and it isn’t the end of you. This, too, shall pass. 

Step 3 is to treat musculoskeletal pain aggressively with over-the-counter analgesics and anti- inflammatories. The key here is to stay ahead of the pain

Pain is like a weed. The longer it is left uncontested, the deeper and stronger will be its roots, the more extensive and ramified will be its branches, the farther will be its reach, and the longer and darker will be the shadows it casts on your training, your function, and your well-being. That weed needs to be sprayed, stomped, whacked, and rooted out every time it shows so much as a shoot. Leaving musculoskeletal pain untreated is literally begging that pain-weed to become a sapling, and a sapling to become an oak. It’s so unnecessary. 

I cannot, as a mere physician and coach, advise you on the treatment of your pain over the interwebz. I can simply tell you what I do. 

What I Do

Acetaminophen (Tylenol or generic),1000 mg every 4-6 hours, 3-4 times a day, for a maximum of 4 grams (4000 mg) in 24 hours, even if the pain is minor. 

Plus: An NSAID like ibuprofen, aspirin, or naproxen, as directed, with food. These days, my NSAID of choice is aspirin 325 mg with food morning and night, even if the pain is minor. 

I always take these medications as directed on the package, and I take these medications because I have no contraindications or allergies to them. My doctor is cool with them. 

And yes: I take my NSAID (aspirin) and acetaminophen together, because they have somewhat different mechanisms of action, they work beautifully together, and I like going after my pain weeds with both a weed-whacker and a spritz of round-up at the same time. It’s a weed, people. It deserves to die. 

You, of course, may arrive at a different go-to analgesic strategy for your pain after discussing these matters with a doctor who Understands That Thing We Do. But let me say that again: you need to discuss your go-to analgesic strategy with your doctor. But once you have that strategy, you need to use it. Do not let your pain dig in. Stay ahead of it. 

Step 4 is to use wraps and supports liberally to support tweaked joints and strained muscles. There is no shame in supporting structures recovering from minor injuries and protecting them from re-injury. And there is no glory, only stupidity, in abjuring such support. This conflation and confusion of glory and stupidity is a constant factor in human affairs and human suffering, and nothing good has ever come of it (see Gibbon, W). 

Step 5 is to keep moving. Nothing will exacerbate and prolong minor musculoskeletal pain like immobility. If it’s not a broken bone, a dislocated joint, an ischemic limb or gangrene, or a traumatic amputation, you probably need to keep moving on it – under your physician’s endorsement, of course. 

Your back hurts? Squats and deadlifts. You have mild shoulder pain? Presses. You have a torn adductor? Empty bar squats, sets of 25, on the second day after injury. 

Seriously. In the setting of musculoskeletal pain from training and minor injuries (sprains, strains, tweaks, DOMS), early mobility re-establishes function, preserves the habit of training, affirms the athlete’s non-broken-ness and identity as an athlete, promotes salutary blood flow, reduces scarring and dysfunctional remodeling of tissues, reduces pain, enhances mood and well-being, and makes you look like a Total Bad-Ass. It’s win-win. 

Step 6 is to monitor your responses to all of the above. Training-associated musculoskeletal pain improves. That is its natural history. In those unusual circumstances where it does not improve after a week or three, or in those unusual cases where it becomes worse, then re-evaluation, possibly by a specialist and possibly with more advanced imaging, is indicated. 

In other words: don’t be dumb. If you’ve done all the above and your pain is getting worse, it’s time for another call to your doctor and probably a referral to a specialist – by which I mean Orthopedics or Sports Medicine, not Siam Sally’s Happy Ending Massage Pavilion. 

Pain is part of life, and the Athlete of Aging is given no exemptions. Our pains are different from the more chronic, more dispiriting, more hopeless pain suffered by our fellows who surrender to the decay and decline of the Sick Aging Phenotype. But pain we shall have, nonetheless. The difference is that the Athlete of Aging has strength, stamina, perspective, and greatness of spirit on his side—not to mention modern analgesics that would have seemed like divine intervention to our forefathers. Pain is a primitive and necessary biological signal for damage and danger, but once the damage has stopped and the danger is past, it confers no additional benefit, no honor, no reward. Put minor musculoskeletal pain in its place so you can get back to your training, back to your work, and back to your life as a strong, vital, productive Athlete of Aging.

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