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Nonpharmacological Management of Persistent Pain in Elite Athletes

Rationale and Recommendations

Moseley, G. Lorimer, DSc, PhD*; Baranoff, John, PhD; Rio, Ebonie, PhD; Stewart, Mike, MSc§; Derman, Wayne, MBChB, PhD¶,‖; Hainline, Brian, MD**

Clinical Journal of Sport Medicine: September 2018 - Volume 28 - Issue 5 - p 472–479
doi: 10.1097/JSM.0000000000000601
General Review

Abstract: Persistent pain is common in elite athletes. The current review arose from a consensus initiative by the International Olympic Committee to advance the development of a standardized, scientific, and evidence-informed approach to management. We suggest that optimal management of persistent pain in elite athletes requires an understanding of contemporary pain science, including the rationale behind and implementation of a biopsychosocial approach to care. We argue that athletes and clinicians need to understand the biopsychosocial model because it applies to both pain and the impact of pain with special reference to the sport setting. Management relies on thorough and precise assessment that considers contributing factors across nociceptive, inflammatory, neuropathic, and centrally acting domains; these can include contextual and psychosocial factors. Pain management seeks to remove contributing factors wherever possible through targeted education; adjustment of mechanical loading, training, and performance schedules; psychological therapies; and management of inflammation.

*University of South Australia, Adelaide, Australia;

Australian Institute of Sport, Canberra, Australia;

La Trobe Sport and Exercise Medicine Centre, La Trobe University, Victoria, Australia;

§University of Brighton, Eastbourne, United Kingdom;

Division of Orthopaedic Surgery, Institute of Sport and Exercise Medicine, Stellenbosch University, Capetown, South Africa;

IOC Research Centre, South Africa; and

**National Collegiate Athletic Association (NCAA), Indianapolis.

Corresponding Author: G. Lorimer Moseley, University of South Australia, GPO Box 2471, Adelaide, South Australia, Australia 5001 (

G. L. Moseley is a Principal Research Fellow with the Australian National Health & Medical Research Council. He has received support from Pfizer, Kaiser Permanente, Workers' Compensation Boards in Australia, Europe, and North America, the International Olympic Committee, the Port Adelaide Football Club, and the Arsenal Football Club. He receives royalties for books on pain and speaker's fees for talks and professional development courses on pain, physiotherapy, and rehabilitation. J. Baranoff has received funding from the Australian Institute of Sport. E. Rio is an Early Career Research Fellow with the Australian National Health & Medical Research Council and has received funding from the Australian Institute of Sport and is supported by the Australian Collaboration for Research into Injury and its Prevention (IOC center). She receives speaker's fees for talks on tendinopathy and rehabilitation. M. Stewart receives speaker's fees for talks and professional development courses on pain education. W. Derman has received support from the International Olympic Committee and the International Paralympic Committee. He serves on the advisory boards of Ossur SA and Adcock Ingram Pain Division for which he is personally remunerated. The remaining authors report no conflicts of interest.

Received January 30, 2018

Accepted March 14, 2018

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