Chronic pain can be confusing and frustrating – especially for athletes who depend on their bodies for performance. Many athletes assume that persistent pain means an injury is not healing, but modern pain research shows that long-lasting pain often reflects changes in how the nervous system processes pain rather than ongoing tissue damage (1).
What is chronic pain?
Chronic pain is pain that lasts longer than three months, often exceeding normal tissue healing time. In many athletes, the nervous system stays highly protective even after tissues recover (1).
Why do athletes experience chronic pain?
High training volumes, repetitive movements, limited recovery time and psychological pressure can increase sensitivity in the nervous system, contributing to persistent pain (2).
What is central sensitisation (CS)?
Central sensitisation is when the brain and spinal cord become overly responsive, amplifying pain signals so pain lasts longer, spreads, or is triggered by normal movement (3).
How common is CS in athletes?
Research in elite softball athletes shows that central sensitisation can occur in athletes with long-standing pain, and may affect a subset of those training or competing at high levels (4).
How is CS assessed?
Clinicians look for features such as disproportionate pain, widespread sensitivity, fatigue-related flare-ups and symptoms influenced by stress or sleep, along with questionnaires and sensory testing (2).
Does chronic pain mean my injury hasn’t healed?
Not necessarily. In chronic pain, the nervous system can remain sensitised even when scans or tissue assessments are normal, which means pain can continue after healing has occurred (1).
What contributes to central sensitisation in athletes?
Repeated microtrauma, high training loads, inadequate rest, fear of reinjury, emotional stress and previous persistent pain experiences can influence the nervous system and contribute to CS (3).
What treatments help athletes with chronic pain or CS?
A multimodal approach works best. This typically includes pain neuroscience education, graded exercise, load management, and strategies addressing sleep, stress and recovery, rather than relying on passive treatments alone (5).
Can athletes return to full training?
Yes. With structured, graded loading, improved recovery habits and confidence-building strategies, many athletes successfully return to full performance as nervous-system sensitivity decreases (5).
References:
1. Isa A.S., Chetty S. Physiology and Pathophysiology of Chronic Pain (Part I). Southern African Journal of Anaesthesia and Analgesia. 2021.
2. Nijs J., Torres-Cueco R., van Wilgen C.P., et al. Applying Modern Pain Neuroscience in Clinical Practice: Criteria for the Classification of Central Sensitization Pain. Pain Physician. 2014;17(4):447–457.
3. van Wilgen C.P., Keizer D. Neuropathic Pain Mechanisms in Patients with Chronic Sports Injuries: A Diagnostic Model Useful in Sports Medicine? Pain Medicine. 2011;12:110–117.
4. Zhou X., Zhao P., Guo X., Li M., He Y. Study on Central Sensitization in Elite Athletes of the National Softball Team. Biomed J Sci & Tech Res. 2023;52(5):44044–44050.
5. Nijs J., Malfliet A., Ickmans K., Baert I., Meeus M. Treatment of Central Sensitization in Patients with Chronic Pain: Time for Change? Expert Opin Pharmacother. 2014;15(12):1803–1815.
