Are you sore? Are you hurt? Are you Injured?
"Are you hurt or are you injured? What that really means is 'are you a pussy or are you tough?' Can you take it or not?"
"Just because you’re hurt doesn’t mean you’re injured.”
“I’m sore, but not injured.”
“I’ve got that good soreness.”
What do these statements mean?
The dictionary definitions:
Sore: a part of one's body that is painful or aching
Hurt: injury, damage, harm
Injured: damage, hurt, impair
Pain: a signal in your nervous system that something may be wrong
Yikes – we are already in big trouble given the overlap in these definitions.
What is an "injury?"
In 2005, the International Olympic Committee (IOC) held the 1st IOC World Conference on Prevention of Injury & Illness. They defined injury as "any physical complaint sustained by a player that results from a football match or football training, irrespective of the need for medical attention or time loss from football activities.’’
They continue to make more distinctions:
"An injury that results in a player being unable to take a full part in future football training or match play as a ‘‘time loss’’ injury." "Physical complaints are common among athletes, and unless someone is available to examine athletes on a daily basis, many will go unrecorded."
"An injury that results in a player receiving medical attention is referred to as a ‘‘medical attention’’ injury."
The paper Injury and illness definitions and data collection procedures for use in epidemiological studies in Athletics (track and field): Consensus statement defines injury as, "A physical complaint or observable damage to body tissue produced by the transfer of energy experienced or sustained by an athlete during participation in Athletics training or competition, regardless of whether it received medical attention or its consequences with respect to impairments in connection with competition or training."
In the medical world the time-loss definition is the one most commonly used. Based on this definition, an "injury" would be a physical complaint that prevents a person from playing their sport or participating in a physical activity.
The paper, How elite athletes, coaches, and physiotherapists perceive a sports injury looks at the different perspectives of athletes, coaches, and physiotherapists and their perceptions of injuries within the context of sport.
Athlete: “An injury is something wrong with my body that stops me from doing my sport in a perfect way.” “If you really change your training and are not able to play, then it should be an injury.” “After a strength training, you could be sore and that can be quite painful. I mean, you can barely touch [the body area] sometimes, but that is not an injury.”
Coach: “What we use to identify if an athlete is injured, is based on his/her performance during training or even before training.” “[An injury] is more or less everything that prevents the athlete from having a normal or regular training.”
Physiotherapist: “An injury is when a player is not able to perform at his best.” “Pain is not injury. An athlete has pain because he/she is training a lot, but it doesn’t mean that he/she is injured. The muscle and the soft tissue are inflamed, they are working excessively. There is pain but it doesn’t mean injury.”
In fitness what most people mean by “soreness” is Delayed Onset Muscle Soreness (DOMS). DOMS is defined as “a type of ultrastructural muscle injury” or the recovery from Exercise Induced Muscle Damage (EIMD) defined as “morphological alterations on muscle tissue.” Yes, you can see the confusion in the medical terminology also.
Usually felt after unaccustomed or strenuous exercise, DOMS/EIMD is “soreness” that starts as early as 6 hours post exercise, peaks at one to two days, and may last up to one week. It may present as increased soreness, pain, stiffness, and swelling, loss of range of motion around a joint, and the inability to perform certain movements via lower force production ability in those muscles (Source).
A recent paper discusses a new theory for DOMS: that it is neural (nerve) microdamage vs muscle microdamage. The main function of the muscle spindle is proprioception, "an internal representation of the body’s position and movement, or "a global sense of ourselves."
This “soreness” can cause a disruption of proprioceptive input (compromise one’s ability to sense joint position and force production), alter the biomechanics of the adjacent joints, cause electrolyte imbalances, upregulation of inflammation, and oxidative stress.
The authors state that an acute stress response occurs (think of red lining your car) because the "fatiguing muscle cannot satisfy the force generating demand." This causes an uptick in sympathetic activity (flight or fight) and ultimately mechanical damage to the spindle and impaired energy supply to the mitochondria (energy producing furnaces in each cell).
Additional studies suggest that this can impair “motor learning” or your ability to perform physical movement with proper technique.
Now that you know this, I suggest paying very close attention to your body and how it feels during and after you train.
Is that “soreness” really a good thing? Not if it inhibits your movement, occurs more than once or twice, or lasts longer than a day or two.
Here is a guide for how to understand what is going on …
When Did the Pain Begin
During the workout (while performing an exercise)?
Immediately After the Workout?
Hours After the Workout?
The Next day?
Amount of Pain
How much pain are you in at rest? 0 = no pain, 10 = agony
How much pain does the movement you wish to perform cause?
Type of Pain
Did you feel a “pop” “snap” “immediate sharp pain” or other feeling that says “something is not right?”
What is the quality of the Pain? Sharp, Dull, Ache, Throb, Deep, Shallow, Tingling, Numbness, Shooting, Stabbing
Length of Time You Have Had the Pain
For how long have you had this pain?
Is this the 1st time you have had this pain (have you injured this area before)?
Do you have Edema (Swelling)?
This paper on hamstring injuries discusses the effect of edema on return to sports in professional soccer players. MRI was used to determine the amount of swelling and also the amount of muscle damage. The results showed that edema on its own was not "associated with the time needed to RTP [Return to Play]" in these professional soccer players. They key factor that slowed return to play was the addition of muscle damage as shown on the MRI>
Do you have Ecchymosis(Bruising)?
The amount of bruising after a muscle strain occurs is dependent on the amount of tissue injured and the severity of the muscle strain.
A muscle strain occurs when muscle fibers cannot cope with the demands placed on them by exercise overload and leads to tearing of the fibers. It is a contraction-induced injury in which muscle fibers tear due to extensive mechanical stress.
Do you have Limited Range of Motion?
If range of motion is limited, this is a clear sign that the area is not ready to be fully loaded.
Where Exactly is the Pain
In a muscle or in a joint? This is a BIG one!
In the mid-belly of the muscle or where the muscle becomes the tendon or where the tendon joins the bone? Become familiar with differentiating these three. It’s important.
The Oslo Sports Trauma Research Centre (OSTRC) Overuse Injury Questionnaire asks these questions:
Have you had any difficulties participating in normal training and competition due to injury, illness or other health problems during the past week?
Full participation without injury/illness
Full participation, but with injury/illness
Reduced participation due to injury/illness
Cannot participate due to injury/illness
To what extent have you reduced you training volume due to injury/illness during the past week?
To a minor extent
To a moderate extent
To a major extent
Cannot participate at all
To what extent have injury/illness affected your performance during the past week?
To a minor extent
To a moderate extent
To a major extent
Cannot participate at all
To what extent have you experienced injury/illness related to your sport during the past week?
No pain or symptoms
Mild pain or symptoms
Moderate pain or symptoms
Severe pain or symptoms
Honesty (Look in the mirror)
Can you "go" or not? Can you put the pedal to the metal?
Are you truly recovered? This paper discusses recurrent muscle strains in Australian Rules Football. It states,
"Careful management of players is warranted in the weeks
after apparently successful return to play, given that injury
risk is raised for an extended period.
These data point to a 15-week window where increased risk
of muscle strain persists. This is more than half a season in
Australian Football. This fact should be shared with relevant
parties when return to play decisions are made."
Here is a very telling comment by a coach - hint - it's all about communication....
“An athlete was very close to qualifying for the Olympics (…) and we kind of pushed a little bit and she had some soreness (…) She was not completely honest with me about how much she was hurt and I was also blinded by the goal. I didn’t quite take it as seriously as I should. And maybe, if we had a week off, she would have been in the Olympics. But she was not.”
Recovery: "It is SAFE and NECESSARY to MOVE and EXERCISE."
If you are not sure, get a proper assessment. Work with a skilled practitioner who understands both training and injury care.
Listen to Brian Shaw 1:19 - 1:44
"I had a really great coach when I first started pulling and I was very, very strong at that time but my back looked like a fishing pole, right? And he told me, he's like, Brian you have two choices. He said you can either take some weight off and you can learn how to do this correctly and you can have a long career and I guarantee you can pull a ton of weight or you can continue doing what you are doing and you can have back surgery in a few years."
What do you think Brian chose?