Tag Archives: Knee pain

07Mar/18
Persistent injury in sport

The toll of persistent injury

Persistent injury in sport

Rugby player Dave Attwood talked about the toll of persistent injury in The Guardian today. This is likely to be one of the greatest fears of any sports person, particularly for professionals with a career at stake, and who identify with their game.

The physical nature of the training and the sport itself, particularly considering the extent of contact in rugby, both present a risk of injury. This would be accepted by players, with pain being part of the deal. It is expected and perhaps even revered as a demonstration of commitment. No pain, no gain continues as a philosophy.

Then we have pain that persists, which gradually begins to intrude into the player’s attention at inappropriate times. Thinking about pain rather than the game will inevitably affect performance and outcome. Beyond the white lines, the pain seeping into day to day life takes the suffering to a new level. This is a typical story for chronic pain. A sequence of priming events akin to a kindling fire, building and building along a timeline.

Not only does the player need to deal with the pain itself and the day to day rehabilitation, he or she also has to cope with a shift in their role. All of the above are ample causes of suffering, which can take its toll on anyone. We are all vulnerable to a greater or lesser degree. And this is why the modern understanding of pain and injury is so important across society, including professional sport. The biomedical model does not provide any long-term solutions to persistent pain, yet it continues to predominate in both arenas. This must change.

In sport, acute care is usually very good. However, identifying players who could be at higher risk of developing chronic symptoms should be a routine part of screening. Medical teams in sport need to be armed with knowledge allowing them to identify the factors the pre-exist but also be aware of characteristics of the acute injury that may heighten the risks; early, uncontrolled pain for example.

Dave Attwood: ‘Compulsory counselling for long-term injuries will stop stigma’ 

Attwood suggests that counselling should be compulsory. He acknowledges that not everyone will persist with this kind of input, however relevant it might be for that person. The opportunity to talk about the effects of an on-going injury would offer a non-judgmental arena of safety for players to express fears and worries. If players were also educated about persistent pain and injury, they would realise that a change in emotional state and thinking is typical, thereby reducing the stigma. Of course, the stigma arises from the existing culture that is misinformed when it comes to pain. Much of the education enabling pain to be understood would be very similar in content to that of a modern pain management programme.

To see a high profile player speaking out about the issue of persistent injury will hopefully encourage others to seek the right kind of help. Dealing effectively with on-going pain is a specialist area that requires a comprehensive approach that addresses all aspects of the experience. Medical teams may need to call upon external specialists to work with them for particular players. This is something that I have done and it works very well, particularly because professional clubs typically have great facilities and staff who you work with to cover all angles: strength and conditioning, diet, sports doctors, physios, massage therapists etc. But, it all starts with understanding pain.

‘Pain and injury are not the same and they are not well related’

To understand pain means that you know what you must focus upon, without fear, to achieve results. In managing painful moments and seeking to overall overcome the pain problem, it takes dedicated practice, encouraged by positive coaching. The content of the practice varies according to the nature of the problem and the necessary approach. That is for the specialist to decide and communicate with the player and medical team.  The Pain Coach Programme that I designed is commonly a blend of sensorimotor training, mobilisations of different types, skills of being well, and practices that bolster resilience, focus and hence performance. This sits in with input from other fields, very much embracing teamwork with the player’s best interests at the heart. A typical aim is to achieve greater than pre-injury performance.

The coverage of on-going injuries is typically negative from the press, fans, the team and the club. Instead there must be understanding, compassion and encouragement. The right conditions for recovery must be created, easing the pressure off the player so that he or she can truly focus on their job of the moment, getting better. So, well done Dave Attwood and The Guardian for raising the issue, another example of chronic pain in society. It is time for change.


  • Pain Coach Programme — for players suffering persistent or recurring injuries and pain
  • Pain Coach Mentoring & Workshops for clinicians and therapists who want to build their skills and knowledge in chronic pain
  • Pain Coach Workshops for medical teams

t. 07518 445493 or e. [email protected]

Richmond M. Stace MSc (Pain) BSc Phty BSc (Hons) PGDN | Specialist Pain Physiotherapist, Pain Coach, Clinical Lecturer (MSc Sports Medicine @ Queen Mary’s University London) & Entrepaineur. 

Blended with my clinical work and workshops is the Understand Pain social enterprise that has the purpose of driving social change with regards pain, the number one global health burden.

30Sep/12

Why does my knee hurt when I run?

The success of the London 2012 Olympics has had a huge impact upon society including the greater participation in sporting activities. This is a truly vital legacy and we must seek to pervade this healthy mindset to all corners of the country and across all the age ranges to optimise the benefits.

Those seeking immediate gratification will have pulled out the old trainers, dusted off the bike in the shed or grabbed the shorts (or briefs) and visited the local pool – see Get Active London. This is indeed a welcome shift towards more active lifestyles at a time when we have increasing understanding of the benefits of regular exercise for both body and brain.

Turning our attention to a consequence of either taking up running for the first time or re-starting having had a break, inspired by the mighty achievements of our athletes, there can be a few aches and pains in the knees. Sometimes the onset will be quick and at other times gradual. I will look briefly at why this can happen, remembering that when you increase your level of exercising it is usually quite normal for there to be some pain afterward. If you are unsure it is advisable that you seek the opinion of your local health professional as soon as possible so that the correct treatment and management is started.

Training methods

A sudden change in the demands upon our joints, particularly the knees in running due to the impact, can trigger local sensitivity in the joint and surrounding tissues. We should think carefully about the baseline, or start point from where the programme can be progressed. Too much too soon will hurt and especially if there is not adequate time between exercising bouts for a good level of recovery in the early stages. It may not be the first time out but the second or third that the pain begins.

The shoes that are used are vital. You do not have to spend a small fortune on the latest running kit but it is sensible to have a good trainer that is suitable for your foot type and provides the right kind of support. If you have pulled out an old, smelly pair of runners from under the stairs, you may have problems. Make a visit to a good quality running shop, for example Run & Become.

Where you decide to go running will determine the loading upon the joints. Start easily and gradually build up the time and speed, thinking about where you are training. Up and down hills and uneven grouns will pose more of a challenge of course.

Old injuries

If you have had a problem with your knees before, re-starting running could re-ignite the pain. It is not totally out of the question to take up running again, but you should ensure that the motor control, movement and proprioception is adequate and then gradually build the intensity. It will be best to seek advice in this case as there maybe some essential rehabilitation training that is required before starting the running programme.

++++++

There will be many people enthusiastically exercising as a result of the Olympics and this is to be commended. It is important to really consider how to start training, the baseline and progressions and using the right equipment.

If you have any questions please contact us here or call 07518 445493

01Feb/12

Can’t get over that skiing injury?

To the skier, the thought of watching friends and family clumping off in their boots towards the lift whilst sitting with a leg up, packed with ice and the daily paper, is intensely frustrating. Injuries happen. In many cases with the right early treatment, perhaps surgery and definitely a thorough rehabilitation programme, the symptoms resolve and the leg works again, good as new. However, there are a number of cases when this does not follow suit and the pain and limitations continue. There are reasons for this occurrence and they extend beyond the health of the tissues that almost always go through a healing process.

There are some complex mechanisms at play in the nervous and immune systems that are really useful when we first have an injury. This of course includes pain that is part of the way the brain defends the body when we damage ourselves. The way in which we go about protecting and treating ourselves is driven in part by the pain that motivates these actions: rest, seek advice or take analgesia. That is what pain really is, a motivator to take action to promote healing and survival. In the early stages of having injured tissues, often ligaments at the knee, this is really useful and important. Briefly, the damaged tissues release chemicals that sensitise the local nerve endings, stimulating a volley of danger signals to be sent to the spinal cord. Here, secondary neurons send this information to the brain for scrutiny. On deeming there to be a threat, the brain engages protective responses including pain, changes in movement and healing. Sometimes we can injure our tissues and the brain decides that something else is more important, perhaps escaping from the mountain, and will send signals down to the spinal cord to interfere with those coming from the tissues. The end result is the feeling of no pain and therefore you can take yourself to safety. Then it can start hurting. All in all, the responses will vary as will our ability to cope.

The early bombardment of the spinal cord and brain with danger signals that can also be influenced by the context of the injury, e.g. really scary, leads to changes in the properties of the neurons in the spinal cord. This means that subsequent signals can be amplified. It also means that normal signals (e.g. light touch) can start to provoke a painful response as can areas not directly involved. In the latter case one can find that the area of pain grows (click here). The on-going activity in the nervous system and other systems such as the immune system, endocrine system and autonomic system underpin the experience of persisting pain and protection, including altered movement that is so important to normalise.

In the case that the problem persists, the treatment is different. The tissues are addressed as one would expect with manual therapy, massage and other local treatments. However, alongside these traditional techniques are a range of strategies and treatments that are based upon the latest pain sciences that target the changes aforementioned and others. These strategies target the mechanisms at play and at source reduce the threat and hence the pain, normalise motor control and sensation of the affected area and restore function so that there can be a progression back to pre-injury activities.

For further information please contact the clinic: 07518 445493