Health Maintenance Insights (HMIs)
You Can Get Back on the Court When the Pain of Not Playing Exceeds the Pain of Playing
You Can Get Back on the Court When the Pain of Not Playing Exceeds the Pain of Playing
Jonathan D. Marmur, MD
Core rule
You Can Get Back on the Court When the Pain of Not Playing Exceeds the Pain of Playing
You Can Get Back on the Court When the Pain of Not Playing Exceeds the Pain of Playing
Every week, usually just after walking off the squash court or wrapping up a clinical consultation, I am asked the exact same question by an athlete dealing with a repetitive use injury. Whether they are battling a severe flare-up of tennis elbow or a stubborn, lingering case of plantar fasciitis, they all want a definitive timeline. They want to know exactly when they are cleared to resume playing.
Every week, usually just after walking off the squash court or wrapping up a clinical consultation, I am asked the exact same question by an athlete dealing with a repetitive use injury. Whether they are battling a severe flare-up of tennis elbow or a stubborn, lingering case of plantar fasciitis, they all want a definitive timeline. They want to know exactly when they are cleared to resume playing.
My answer is always the same: You can get back on the court when the pain of not playing exceeds the pain of playing.
My answer is always the same: You can get back on the court when the pain of not playing exceeds the pain of playing.
It is a highly reliable, self-regulating guidepost that relies on your own physical and psychological feedback. You will naturally weigh the frustration of sitting on the sidelines against the physical discomfort of lunging for a drop shot. However, this rule is strictly conditional. It only works under one absolute, non-negotiable requirement: You must be taking absolutely zero NSAIDs.
It is a highly reliable, self-regulating guidepost that relies on your own physical and psychological feedback. You will naturally weigh the frustration of sitting on the sidelines against the physical discomfort of lunging for a drop shot. However, this rule is strictly conditional. It only works under one absolute, non-negotiable requirement: You must be taking absolutely zero NSAIDs.
The NSAID Illusion:
The NSAID Illusion:
Athletes treat non-steroidal anti-inflammatory drugs (like ibuprofen or naproxen) as if they are harmless sports supplements. In reality, relying on NSAIDs for repetitive strain injuries is a biological trap, and the medical literature explicitly backs this up.
Athletes treat non-steroidal anti-inflammatory drugs (like ibuprofen or naproxen) as if they are harmless sports supplements. In reality, relying on NSAIDs for repetitive strain injuries is a biological trap, and the medical literature explicitly backs this up.
A rigorous randomized, double-blind, placebo-controlled trial evaluating tendinopathy found that adding anti-inflammatory treatment to physical rehabilitation provided absolutely zero significant difference in overall healing compared to a placebo. At the one-year follow-up, ultrasound and MRI results confirmed the medication offered no additive clinical or physiological benefit to the tendon repair process.
A rigorous randomized, double-blind, placebo-controlled trial evaluating tendinopathy found that adding anti-inflammatory treatment to physical rehabilitation provided absolutely zero significant difference in overall healing compared to a placebo. At the one-year follow-up, ultrasound and MRI results confirmed the medication offered no additive clinical or physiological benefit to the tendon repair process.
Pain is a highly evolved, structural protective mechanism. If you take an NSAID before a match, you are not fixing the micro-tears in your fascia; you are simply cutting the body's alarm wire. Playing on a chemically silenced injury virtually guarantees you will push past your mechanical limits and cause deeper, long-term structural damage.
Pain is a highly evolved, structural protective mechanism. If you take an NSAID before a match, you are not fixing the micro-tears in your fascia; you are simply cutting the body's alarm wire. Playing on a chemically silenced injury virtually guarantees you will push past your mechanical limits and cause deeper, long-term structural damage.
Furthermore, inflammation is the first necessary stage of the healing cascade. When you artificially blunt it, you delay tissue repair, trading true healing for a chemical illusion of wellness.
Furthermore, inflammation is the first necessary stage of the healing cascade. When you artificially blunt it, you delay tissue repair, trading true healing for a chemical illusion of wellness.
As an interventional cardiologist, I view the casual consumption of these medications with even deeper concern. NSAIDs directly interfere with endothelial function, constrict blood vessels, and elevate blood pressure. A massive meta-analysis published in the BMJ demonstrated that the probability of an increased risk of acute myocardial infarction surges after just one to seven days of NSAID use.
As an interventional cardiologist, I view the casual consumption of these medications with even deeper concern. NSAIDs directly interfere with endothelial function, constrict blood vessels, and elevate blood pressure. A massive meta-analysis published in the BMJ demonstrated that the probability of an increased risk of acute myocardial infarction surges after just one to seven days of NSAID use.
Trading your cardiovascular health for a temporary reduction in joint pain so you can hit a tennis ball is a remarkably poor bargain.
Trading your cardiovascular health for a temporary reduction in joint pain so you can hit a tennis ball is a remarkably poor bargain.
The Rare Exceptions;
The Rare Exceptions;
Are there appropriate uses for NSAIDs? Yes, but the window is incredibly narrow.
They have a legitimate role in treating specific, acute hyper-inflammatory medical conditions. An interventional cardiologist will utilize them for a patient presenting with acute pericarditis. They are also appropriate for a severe, acute gout flare, or for managing distinct systemic inflammatory conditions like ankylosing spondylitis.
Are there appropriate uses for NSAIDs? Yes, but the window is incredibly narrow.
They have a legitimate role in treating specific, acute hyper-inflammatory medical conditions. An interventional cardiologist will utilize them for a patient presenting with acute pericarditis. They are also appropriate for a severe, acute gout flare, or for managing distinct systemic inflammatory conditions like ankylosing spondylitis.
They are powerful medical tools designed for specific pathologies—they are not meant to be used as a pre-game ritual to manage the routine wear-and-tear of your athletic schedule.
They are powerful medical tools designed for specific pathologies—they are not meant to be used as a pre-game ritual to manage the routine wear-and-tear of your athletic schedule.
If your heel or elbow hurts too much to serve or sprint, stay off the court. Rest, rehabilitate the tissue, and wait until the psychological frustration of not playing genuinely outweighs the unmedicated physical discomfort of the injury. Let your raw biology be the ultimate judge.
If your heel or elbow hurts too much to serve or sprint, stay off the court. Rest, rehabilitate the tissue, and wait until the psychological frustration of not playing genuinely outweighs the unmedicated physical discomfort of the injury. Let your raw biology be the ultimate judge.
References:
References:
Heinemeier SK, et al. No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2021;49(7):1711-1720.
Heinemeier SK, et al. No Additive Clinical or Physiological Effects of Short-term Anti-inflammatory Treatment to Physical Rehabilitation in the Early Phase of Human Achilles Tendinopathy: A Randomized Controlled Trial. Am J Sports Med. 2021;49(7):1711-1720.
Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ. 2017;357:j1909.