Sports Ethics: Play Through Pain

“Pain is your friend.”  “Pain lets you know you are still alive.” “Pain is good.” So Master Chief yells at the beleaguered SEAL recruits in a great movie G.I. Jane.

This lesson, so central to military life, pervades the moral culture of athletic competition. Every athlete trying to be a warrior, and here athletics draws heavily from millennial old origins as preparation for life combat, must learn to fight through pain and to seek goals despite  hurt and obstacles. Playing through pain is a central moral tenet of sports. It exemplifies three virtues critical to athletic success: self-mastery; courage; sacrifice.

It does not matter the moment we tune into sports, but pain splays through the games and the wounded fall before us with startling regularity. If we were not so inured to the carnage, we would be appalled by our callousness. This last month twenty five and counting baseball starters are out for at least three months. Seven Boston Red Sox outfielders alone are on the disabilities list. The first week of NFL pro to-practice saw at least three players end their seasons before even doning pads.  Derek Rose writhed on the floor with an ACL and the Chicago Bulls saw their playoff hopes collapse. The great Junior Seau committed suicide, too much pain. The NFL continues to try to bring to justice the players who deliberately attempted to end the effective careers of other league players through injuring them, not just pain. And this is only one month! 

All this endless pain in sports and life means we should not forget master chief’s lessons.. Pain is our friend, because pain signals to the athlete that his or her body has stressed beyond the point where it can continue to function at full efficiency and still be healthy. Pain signals deeper injury, inflammation, nerve overload, neurotransmitters warning and adrenalin flooded emergencies. The body floods itself with chemicals to deal with pain; some seek to quiet the pain, others to kick up the level  of awareness or body performance for a short time to get through the pain. Sometimes the body narrows the focus of the mind and eyes to prepare for and overcome the danger that body announces.

The ability of an athlete to be aware of and monitor their pain is important. In every sport every athlete lives with attrition of physical skill and strength over a season. They realize there are times when as an athlete they need to play with the pain because it is bearable and will not detract form their performance level. There are moments when they need to demonstrate courage to their teammates and encourage them to also play with a reasonable level of pain out of loyalty to each other; the contagion of a leader, if he or she can do it, so can I.

Last year Washington State University started a redshirt freshman quarterback Connor Halliday against Utah. It was his first start after a stunningly successful first game the week before. He played on cloud nine full of energy and adrenal protection. During the game he took some hard hits and suffered contusions and injuries, nothing that seemed out of the ordinary for the normal pain and injury that football inflicts upon its players. Yet later that day he ended up int he emergency room with a lacerated liver. The WSU doctors had run all the regular and protocol based tests when he was injured and nothing came up. This type of injury remains internal and not immediately evident; its pain should have alerted the quarterback of the severity. But like so many young athletes in the thrall of competition and loyalty and cortisol induced protection from pain, Halliday did not recognize the signals or refused the listen to them; he was going to play come hell or hi water.  To understand the culture of sport and athletes, it is important to listen to what his coach said after complimenting him for  "unbelievably courageous outing." "He hung in there and took hits and threw the ball under duress and pain. I'm very proud of his toughness and grit."

Yet even bearable pain may be a reason to leave the field. First, as in the case of the young quarterback, it may be the tip of an extensive set of damages not yet fully unfolded. It may be the warning signal that the body is pushing limits and catastrophic failure is shortly to occur. Playing on may intensify injuries or magnify the range of the loss. Secondly, even a bearable injury can detract from performance. It may be that a player hurts her or his team by staying on the field as an act of courage or self-mastery. Yet this important point is often missed and when Jay Cutler left the field of play for this reason the NFL's professional football semi-finals, he was vilified.

Pain serves a survival function and as an early warning system to people about the need to protect and attend to their body. It alerts athletes that worse is on the way if they keep pressing against the signals of the body. The young quarterback could have destroyed his life.

Pain manifests as a real physiological phenomena exhibited by neural and chemical responses. But pain is also experienced subjectively, and many persons have different responses to the same physical impact; they read their body differently. Individuals can be trained to deal with higher levels of pain, physical or mental, over time. Dealing with high levels of pain can be learned, and levels of pain that would paralyze a person at the beginning of training can be tolerated and functioned through later.

People experience pain subjectively, and the classic medical scales ask patients to rate pain 1-10. In real life, people might talk of mild or unbearable. It might be stabbing or throbbing or intermittent. It might explode or linger and thrum. The scaling and different manifestations make diagnosing and living with pain an art, not a science.

Sometimes the pain recedes because the pain initially signaled a level of muscle, vascular or pulmonary performance that the sport required pushing past. Pushing past meant experiencing the braying complaints of lungs, muscles and mind as the athlete learns to develop higher levels of endurance, strength or odd skills that require unique vascular and muscle specializations. The capacity of the body to function without hurting itself grows with practice and strength.

At other times the pain simply reflects bodily disorder and breakdown. The picture of Curt Schilling with blood flowing from a bone sticking through his foot as he pitches the Red Sox to a World Series win exemplifies the play through pain mystique and myth and imperative of sports. Jack Youngblood finishing a football game with a broken leg also ranks in the pantheon.

The key to remember is that  playing through pain has serious short and long term costs. First, pain distracts the athlete. It takes indirect concentration and focus to keep the pain at bay, and this distracts from utter complete presence to the task at hand. Second, the pain diminishes actual physical performance and limits physical actions. When a player is injured, they can often keep playing with adrenalin and team loyalty and support holding them together. But once on the sideline the adrenaline falls, the contagious strength of a huddle falters and the full measure of pain explodes and debilitates the player. The next time they go out, the deterioration of performance becomes obvious.

Finally, pain’s early warning nature signals later cost. Players who keep playing through the pain like a torn meniscus just tear the meniscus apart until they play bone on bone. Players with a ripped muscle continue to fray the muscle or micro-fracture grows into a greater break in the bone. Players compensate on the field and in compensating put excessive stress on other unprepared bones and muscle and end up multiplying injuries. The longer the player plays through the pain, the longer the healing and the greater the possibility of more injury and hence even longer healing. In my world of college athletes, the most common medical reason for waivers after major immediate injuries like ACL or broken bones involves players coming back too early, not giving their injury or body time to fully heal.

It makes perfect sense to play through certain types of pain. The accumulated aches, pains, strains, twists and bruises of a season nag at performance and harass a player’s focus. Good athletes know their own bodies well. They usually know when their body has reached its limits. Good athletes, like good professionals, learn to master these physical pains. They also learn to master and play through the mental pains that arise from daily life that ensnare daily suffering or worries about family or child or finances or breakups or friends. Playing through these pains mirrors a primary moral requirement of life.

The legendary status of playing through pain deserves its moral status. To do this humans manifest honor, strength of will, loyalty to goal and team. These are admirable traits and deserve praise. So modern athletes will “power through.”

But we have learned that more often than not playing through the pain of major injuries or threatening injuries makes no sense for athlete or team either in short run or long run. This is especially true for younger athletes who do not have the fine grained sense of their bodies or a well developed sense of self-preservation. This is why college and high school athletics must have independent and empowered doctors on the field to stop the athletes and stop the coaches when they prefer to risk the Achilles Choice that I have often discussed  to seek glory and victory.

The sacrifice of playing through pain makes little moral sense for young or college athletes. Players and doctors know this, even if coaches regularly forget it.