Successful management of tissue injury cannot rely solely on pain responses because tissue healing is not directly related to pain. Pain without identifiable pathology is common in athletes, 1 and as a result medical labelling remains an ongoing challenge. Therefore, we argue that, for the benefit of athletes, there is an urgent need for a clear distinction between pain and injury (see Infographic).

Synonymous use of pain and injury in research and clinical practice may negatively impact clinical management. First, benign and normal fluctuations in pain may be seen as signs of sports-related injury, which could impact performance negatively. Second, viewing all pain as a direct sign of tissue injury may lead to underprioritising of psychological and social aspects of return-to-sport. Third, athletes being told they are ‘injured’can lead to unnecessary assessment and interventions, 2 particularly when a clear clinical diagnosis is lacking yet the reports of pain remain severe. Last, when pain is linked to unconfirmed injury, fear and anxiety may be heightened. Indeed, current evidence shows fear avoidance, fear of reinjury and pain catastrophising are common in response to an injury in athletes. 3 Thus, a clearer distinction between pain and injury, paired with a person-centred and educational approach, seems necessary.