Sports Injuries and Exercise Pain: Why They Happen, What They Could Mean, What to Do Next and When to See a Physio
Sports injuries and exercise pain can follow a sudden event, repeated loading or a change in training demand. Learn what symptoms may mean, what to do next and when assessment is appropriate.
⚠ Clinical Note
This article is for educational purposes only. It is based on current clinical practice guidelines and peer-reviewed research and is not a substitute for personalised medical advice, diagnosis, or treatment. If you are experiencing severe, sudden, or rapidly worsening symptoms or symptoms described in this article as urgent seek immediate medical attention. For all other concerns, consult a qualified healthcare professional before starting any exercise or treatment program.
Key Facts
✔ Sports injuries can follow a fall, twist, hit or repeated loading. Sprains affect ligaments, while strains affect muscles or tendons. [1,2]
✔ Experimental pain studies show that athletes may experience and report pain differently from non-athletes; these findings do not diagnose an individual injury. [3,4]
✔ In youth and community sport, suspected concussion means immediate removal from play, no same-day return and healthcare review. Red flags require immediate referral to an emergency department. [5]
✔ For people aged 16 and over with a new episode of low-back pain, assessment should consider serious pathology. Routine imaging is not recommended unless there is an appropriate indication. [6]
✔ Physiotherapists are registered healthcare practitioners who can diagnose and treat a broad range of conditions, including sports injuries, sprains and strains. [7]
30-Second Summary
Sports injuries and exercise pain can follow a sudden event, repeated loading or a change in training demand that your body has not yet adapted to, and pain alone cannot tell you exactly what has happened. [1,2,3,4]
Stop the activity that caused a sudden injury; for suspected concussion red flags, go straight to an emergency department, and call 000 for an immediate life-threatening emergency such as a deteriorating conscious state, seizure or loss of consciousness. [1,5,8]
Arrange assessment when pain, weakness, swelling, reduced movement or loss of function persists or limits sport. [1,6,7]
Introduction
The uncertainty often starts with a simple moment: something happened, it hurts, and you are unsure whether to keep going. The same question can arise after a tackle, a rolled ankle, a hard landing, a long run or a week of extra training. It is difficult to make a sensible decision when the symptom has no clear name.
This guide explains how sports injuries and exercise pain commonly develop and what different symptom patterns could mean. It maps the options for understanding the problem, from immediate concerns to gradual training-related symptoms. It is written for someone who needs a clear next step without a diagnosis in hand.
Main Explanation: Sport pain is a signal, not a diagnosis
Pain is only one part of a sports-injury assessment. How the pain started, whether it is changing and what movements are limited all add context. Swelling, bruising, weakness or neurological symptoms add further information. [1,6,7]
An acute injury happens around a recognisable event such as a fall, twist, collision or forceful movement. [1] A gradual-onset problem can build through repeated loading after a change in training, competition, recovery or another stressor. The International Olympic Committee describes load as multifactorial and individual. High load is not automatically harmful, and no single marker identifies when every athlete has entered an unsafe state. [2]
Experimental pain findings do not provide a direct measure of tissue damage. [3,4] In a 2024 review of 36 studies involving 2,492 people, athletes had higher experimental pain tolerance and reported lower experimental pain intensity than control groups. The authors also found considerable variation between studies and said the mechanisms remained unclear. [3] A separate review found that one bout of aerobic exercise reduced experimentally induced pain in healthy people, but the evidence did not establish the same effect for acute injuries or people with chronic musculoskeletal pain. [4]
Experimental pain findings cannot establish whether an individual injury is safe to ignore or identify a specific damaged structure. [3,4] Seek clinical assessment if the symptom affects function, keeps worsening or comes with warning signs. [1,5,6,7]
Causes: How sports injuries and exercise pain develop
Sports pain rarely has one explanation. [2] A sudden event, the demand placed on a body area, previous symptoms, recovery and the way training has changed may all be relevant. [1,2]
This is an illustrative case. A recreational runner adds hills and longer sessions before an event, then notices gradually increasing pain around the knee. The timing does not prove a diagnosis. It gives a physiotherapist useful information about the recent load change, affected function and what may need to be modified during assessment. [2,7]
Sudden injuries can happen when a joint twists, a person falls or an external hit transfers force through the body. Healthdirect describes sprains as stretched or torn ligaments and strains as stretched or torn muscles or tendons. Pain, swelling, bruising and difficulty using the area can occur with both. [1]
Gradual symptoms are often linked with repeated exposure rather than one memorable incident. The IOC consensus notes that injury risk can be influenced by the rate at which load changes, recovery, psychological stress, travel and other factors. It also cautions that load must be prescribed and monitored individually because athletes respond differently. [2]
Sport makes this easy to see. A 2026 review of cricket injuries describes different patterns by role and level. Fast bowlers have particular exposure to lumbar spine and hamstring problems, while fielders and batters have different upper-limb and head-impact exposures. The review also notes that evidence is uneven across community, adolescent and female players, so elite patterns should not be treated as a prediction for every cricketer. [9]
Running provides another bounded example. A systematic review found that the knee, ankle and lower leg made up the highest proportions of running-injury sites, but the estimates varied with the study design and the definition of injury. [10] When knee symptoms are the main problem, the knee pain assessment guide explains how onset, location and function can help a clinician narrow the possibilities.
Symptoms: What the symptoms could mean
Symptoms can help describe what is happening, but they cannot confirm a diagnosis without an assessment. [1,3,4]
After an acute injury, pain, swelling, bruising or difficulty using the affected area may point towards a sprain or strain, but similar symptoms can occur with other injuries. If you cannot use the limb normally, are unsure whether a fracture or dislocation is possible, or the pain is severe, medical assessment is appropriate. [1]
Gradual symptoms may become more noticeable after a training increase or repeated activity. [2,10] Tracking when the symptom appears, which activity provokes it and whether movement or function is changing can give a clinician useful context for assessment. Repeated loading is a common feature of running injuries, but the running evidence does not allow a person to identify a specific condition from location alone. [1,2,10]
Concussion needs separate attention. In youth and community sport, symptoms after a head contact or force transmitted to the head can include headache, dizziness, nausea or vomiting, balance problems and visual changes. Fatigue, sensitivity to light or noise, feeling slowed or in a fog, memory or concentration problems and unusual emotional or behavioural changes can also occur. Symptoms can be subtle, delayed or more noticeable over the following hours and days. [5]
Under the youth and community framework, a person suspected of having concussion should be removed from play or training immediately and must not return that day. The symptom response of athletes is not a safe way to clear a head injury, particularly because pain perception and tolerance vary between people. [3,5]
For a closer look at a gradual-load presentation, the tendon pain and load guide describes why tendon symptoms may not follow a simple pain-injury relationship.
Treatment Options: What assessment and treatment may involve
Treatment depends on the injury pattern, its effect on function and whether urgent medical care is needed. Physiotherapy is one part of care and does not replace emergency assessment. [1,5,6,7]
A physiotherapist can assess and treat a broad range of conditions, including sports injuries, sprains, strains, muscle aches and pains, back pain and knee pain. Physiotherapy may involve movement-based care, exercises and advice about using the affected area, with the specific approach shaped by the presentation. [7]
For a mild sprain or strain, short-term RICE first aid may be followed by exercises that strengthen the injured area as it starts to heal. Moderate or severe injuries may need bracing, taping, bandaging or specific exercises, and some injuries need medical assessment before rehabilitation begins. [1]
For gradual symptoms, treatment may involve changing the provoking load and then rebuilding capacity progressively. That does not mean following a universal percentage increase or copying an exercise plan from someone with a different injury. The IOC guidance supports individual and flexible load management. Prevention evidence shows that strength, proprioception (awareness of joint position), balance and other programmes can reduce injuries in some sports, with results varying by intervention and population. [2,11]
For people aged 16 and over with a new episode of low-back pain, the Australian clinical care standard recommends assessment for serious pathology, self-management and physical activity where appropriate, and selective rather than routine imaging. It also recommends review and referral when symptoms, signs or function persist or worsen. [6]
For suspected concussion in youth and community sport, treatment begins with removal from play, healthcare review and a graded return to learning, work and sport. The framework includes a period of relative rest, gradual activity and healthcare practitioner checkpoints. [5]
Self-Management: What to do next
The safest first step after a sudden injury is to stop the activity that caused it or clearly increases the symptom. [1] Pain scores can vary between people, so consider function and other symptoms rather than using the score alone to decide whether to continue. [1,3,4]
For a suspected mild sprain or strain, RICE involves resting the injured area, using a cold compress or ice pack for 20 minutes at a time, applying compression and elevating the area while resting. Do not place ice directly on the skin. This advice is for the sprain-and-strain situation described by the cited guidance, not a universal treatment for every sports injury. [1]
For gradual symptoms, reduce or alter the activity that provokes them and track training volume, intensity, recovery and function. A short-term reduction is different from abandoning all movement. The right level depends on the affected structure and symptom response. Persistent or worsening pain should be assessed rather than managed by guesswork. [2,11]
For people aged 16 and over with a new episode of low-back pain, prolonged bed rest is discouraged. The Australian standard encourages people to stay active and continue or return to usual activity as soon as feasible, with practical modifications and review when symptoms worsen or fail to improve. [6]
Under the youth and community guidance, a person with suspected concussion should not return to play or training that day. They should not be left alone initially, should be accompanied by a responsible adult and should not drive until cleared by a healthcare practitioner. Worsening symptoms require immediate medical attention. [5]
Medication and other treatment decisions should be discussed with a qualified clinician rather than used as a substitute for assessment. A return date depends on the injury, the person and the clinical findings. [1,5,6]
When to See a Physiotherapist
Arrange a physiotherapy or medical assessment when pain persists, keeps worsening, recurs with the same activity or limits movement, strength, weight-bearing or sport. [1,6,7] Healthdirect specifically advises medical review when a sprain or strain causes a lot of pain, when fracture or dislocation is possible, or when symptoms have not improved within a week. [1]
Assessment is also appropriate when a gradual training-related symptom is changing your technique, reducing your tolerance or making return to sport uncertain. A physiotherapist can help identify the movement and load questions that need answering, but the assessment does not replace emergency care for serious symptoms. [2,7]
Emergency warning signs: seek help before physiotherapy
For suspected concussion in youth and community sport, remove the person from play immediately and arrange healthcare-practitioner review. Go straight to an emergency department if any of these warning signs are present: [5]
- Neck, alertness or behaviour changes: neck pain, a deteriorating conscious state, increasing confusion, agitation or irritability, a severe or increasing headache, or unusual behavioural change. [5]
- Severe symptoms: repeated vomiting, loss of vision or double vision, a seizure or convulsion, or a visible skull deformity. [5]
- Loss of consciousness or limb symptoms: loss of consciousness, or weakness, tingling or burning in the arms or legs. [5]
In Australia, call 000 immediately if the situation is life-threatening or the person is deteriorating rapidly, including with a deteriorating conscious state, seizure or loss of consciousness. [5,8]
Do not leave someone with suspected concussion alone initially, for at least three hours. They should be accompanied by a responsible adult and should not drive until cleared by a healthcare practitioner. If symptoms worsen, seek immediate medical attention. [5]
Contact training should not resume until the person has been symptom-free at rest for at least 14 days and has been cleared by a healthcare practitioner. Competitive contact sport should not resume before a minimum of 21 days after the concussion and the required symptom-free period. [5]
For people aged 16 and over with a new episode of low-back pain, go to an emergency department urgently if any of these warning signs are present: [6]
- Bladder, bowel or saddle-area changes: new difficulty passing urine, inability to empty the bladder, loss of bowel control, or loss of feeling around the groin or buttocks. [6]
- Weakness or serious context: progressive weakness in the legs, significant trauma, or concern about infection. [6]
In Australia, call 000 if the situation is immediately life-threatening or the person is deteriorating rapidly. The Australian standard also recommends earlier review for severe or progressive back or leg pain that is not responding to other care. [6,8]
For gradual-load symptoms and concussion, return-to-sport timing depends on the presentation rather than a single calendar date. [2,5] The decision depends on what happened, what the person can do safely, how symptoms respond to increasing demand and whether a clinician identifies a reason for further medical review. [2,5]
Key Takeaways
- Record what changed in training, when the symptom appears and which function is limited before an assessment. [2,10]
- Treat a suspected head injury as a stop-and-review problem, not a test of whether someone can keep playing. [5]
- For a mild limb injury, seek review for severe pain, possible fracture or dislocation, or failure to improve within a week. [1]
- A return-to-sport decision should match the person’s capacity and clinical clearance, not a calendar date. [2,5]
References
- healthdirect. Sprains and strains. Healthdirect. 2024.
- Soligard T, Schwellnus M, Alonso JM, et al. How much is too much? (Part 1) International Olympic Committee consensus statement on load in sport and risk of injury. British Journal of Sports Medicine. 2016;50(17):1030–1041.
- Thornton C, Baird A, Sheffield D. Athletes and experimental pain: a systematic review and meta-analysis. The Journal of Pain. 2024;25(6):104450.
- Wewege MA, Jones MD. Exercise-induced hypoalgesia in healthy individuals and people with chronic musculoskeletal pain: a systematic review and meta-analysis. The Journal of Pain. 2021;22(1):21-31.
- Australian Institute of Sport, Sports Medicine Australia, Australasian College of Sport & Exercise Physicians, Australian Physiotherapy Association. Australian Concussion Guidelines for Youth and Community Sport. 2024.
- Australian Commission on Safety and Quality in Health Care. Low Back Pain Clinical Care Standard. 2022.
- healthdirect. Physiotherapy. Healthdirect. 2023.
- healthdirect. Calling triple zero (000). Healthdirect. 2025.
- Nawabi O, Pandya N. Injuries in cricket: a review. Current Reviews in Musculoskeletal Medicine. 2026;19:35.
- Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. Journal of Sport and Health Science. 2021;10:513-522.
- Stephenson SD, Kocan JW, Vinod AV, Kluczynski MA, Bisson LJ. A comprehensive summary of systematic reviews on sports injury prevention strategies. Orthopaedic Journal of Sports Medicine. 2021;9(10):23259671211035776.
Frequently Asked Questions
No. Experimental pain studies show that athletes can experience pain differently from non-athletes, but they do not diagnose the cause or severity of an individual injury. [3,4] Sudden injury, swelling, loss of function or worsening symptoms still warrant assessment. [1,5,6,7]
Not always. Stop the activity that caused a sudden injury or suspected concussion. Gradual symptoms may need a temporary reduction or change in load, while low-back guidance generally discourages prolonged bed rest. [1,2,5,6]
No. For people aged 16 and over with a new episode of low-back pain, routine imaging is discouraged when there are no indicators of serious pathology. [6]
Feeling better is important but is not the only return-to-sport criterion. The injury, function, response to increasing demand and any clinical restrictions must be considered, with specific concussion timelines and clearance requirements in the Australian youth and community framework. [2,5]
In Australia, Healthdirect states that you do not have to see a doctor before seeing a physiotherapist. Urgent symptoms, suspected fractures or dislocations and concussion red flags still need the appropriate medical pathway first. [1,5,7]
Book Now
Was this article helpful?