Comprendre et agir sur la douleur des sportifs de haut niveau
Approche fondée sur les mécanismes de la douleur, multimodale et centrée sur la décision clinique
Mots-clés :
douleur, sportif de haut niveau, nociplasticité, retour au sport, gestion de charge, bio-psycho-socialRésumé
La douleur du sportif de haut niveau constitue un enjeu clinique, éthique et de performance. Elle est fréquemment associée à une lésion, mais la relation douleur–tissus est souvent non linéaire, en particulier lorsque la douleur persiste. Les cadres contemporains recommandent de raisonner en mécanismes (nociceptif, neuropathique, nociplastique), d'utiliser des outils d'évaluation comme aides au profilage (et non comme preuves), et de privilégier des stratégies multimodales intégrant la gestion de charge, l'exercice progressif, l'éducation, la récupération (notamment le sommeil), et les déterminants psychologiques et sociaux. La prise en charge en sport d'élite doit également tenir compte de la pression de performance, du risque de “masquage” de la douleur et de la santé à long terme. Cet article propose un cadre pratique d'évaluation et d'action, et synthétise ce que la littérature a clarifié entre 2020 et 2025, ainsi que les incertitudes persistantes.
Références
Ardern, C. L., Glasgow, P., Schneiders, A., Witvrouw, E., Clarsen, B., Cools, A., et al. (2016). 2016 consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine, 50, 853–864.
Bahr, R., & Krosshaug, T. (2005). Understanding injury mechanisms: a key component of preventing injuries in sport. British Journal of Sports Medicine, 39, 324–329.
Bouhassira, D., Attal, N., Alchaar, H., Boureau, F., Brochet, B., Bruxelle, J., et al. (2005). Comparison of pain syndromes associated with nervous or somatic lesions and development of a new neuropathic pain diagnostic questionnaire (DN4). Pain, 114, 29–36.
Brinjikji, W., Luetmer, P. H., Comstock, B., Bresnahan, B. W., Chen, L. E., Deyo, R. A., et al. (2015). Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. American Journal of Neuroradiology, 36, 811–816.
Buckthorpe, M., & Della Villa, F. (2020). Optimising the late-stage rehabilitation and return-to-sport training and testing process after ACL reconstruction. Sports Medicine, 50, 657–678.
Caneiro, J. P., Alaiti, R. K., Fukusawa, L., Hespanhol, L., Brukner, P., & O’Sullivan, P. P. (2021). There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. British Journal of Sports Medicine, 55, 75–77.
Drew, M. K., & Finch, C. F. (2016). The relationship between training load and injury, illness and soreness: a systematic and literature review. Sports Medicine, 46, 861–883.
Edwards, T., Spiteri, T., Piggott, B., Bonhotal, J., Haff, G. G., & Joyce, C. (2018). Monitoring and managing fatigue in basketball. Sports, 6, 19.
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The Journal of Pain, 14, 1539–1552.
Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews, 4, CD011279.
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., & Turk, D. C. (2007). The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychological Bulletin, 133, 581–624.
Hainline, B., Derman, W., Vernec, A., Budgett, R., Deie, M., Dvořák, J., et al. (2017). International Olympic Committee consensus statement on pain management in elite athletes. British Journal of Sports Medicine, 51, 1245–1258.
Koch, M., Klügl, M., Frankewycz, B., Lang, S., Worlicek, M., Popp, D., et al. (2021). Football-related injuries are the major reason for the career end of professional male football players. Knee Surgery, Sports Traumatology, Arthroscopy, 29, 3560–3568.
Kosek, E., Clauw, D., Nijs, J., Baron, R., Gilron, I., Harris, R. E., et al. (2021). Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain, 162, 2629–2634.
Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of Physical Medicine and Rehabilitation, 92, 2041–2056.
Malcolm, D. (2006). The social construction of pain in sport. Sociology of Sport Journal, 23, 278–298.
McNamee, M. J., Partridge, B., & Anderson, L. (2015). Concussion in sport: conceptual and ethical issues. Kinesiology Review, 4, 190–202.
Moseley, G. L., & Butler, D. S. (2015). Fifteen years of explaining pain: the past, present, and future. The Journal of Pain, 16, 807–813.
Neblett, R., Cohen, H., Choi, Y., Hartzell, M. M., Williams, M., Mayer, T. G., et al. (2013). The Central Sensitization Inventory (CSI): establishing clinically significant values for identifying central sensitivity syndromes. The Journal of Pain, 14, 438–445.
Nicholas, M., Vlaeyen, J. W. S., Rief, W., Barke, A., Aziz, Q., Benoliel, R., et al. (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain, 160, 28–37.
Nijs, J., Apeldoorn, A., Hallegraeff, H., Clark, J., Smeets, R., Malfliet, A., et al. (2015). Low back pain: guidelines for the clinical classification of predominant neuropathic, nociceptive, or central sensitization pain. Pain Physician, 18, E333–E346.
Nijs, J., Lahousse, A., Kapreli, E., Bilika, P., Saraçoğlu, İ., Malfliet, A., et al. (2021). Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. Journal of Clinical Medicine, 10, 3203.
Palmer, D., Cooper, D. J., Emery, C., Batt, M. E., Engebretsen, L., Scammell, B. E., et al. (2021). Self-reported sports injuries and later-life health status in 3357 retired Olympians from 131 countries: a cross-sectional survey among those competing in the Games between London 1948 and PyeongChang 2018. British Journal of Sports Medicine, 55, 46–53.
Purcell, C., Fullen, B., Walsh, C. B., Van Oirschot, G., Ward, T., & Caulfield, B. (2024). Another world of pain: athlete and sport physiotherapist perspectives on the unique experience of pain in sport. BMJ Open Sport & Exercise Medicine, 10, e002020.
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: a critical review. Expert Review of Neurotherapeutics, 9 , 745–758.
Raja, S. N., Carr, D. B., Cohen, M., Finnerup, N. B., Flor, H., Gibson, S., et al. (2020). The revised International Association for the Study of Pain definition of pain: concepts, challenges, and compromises. Pain, 161, 1976–1982.
Reardon, C. L., Hainline, B., Aron, C. M., Baron, D., Baum, A. L., Bindra, A., et al. (2019). Mental health in elite athletes: International Olympic Committee consensus statement (2019). British Journal of Sports Medicine, 53, 667–699.
Rio, E., van Ark, M., Docking, S., Moseley, G. L., Kidgell, D., Gaida, J., et al. (2017). Isometric exercise to reduce pain in patellar tendinopathy in season: is it effective “on the road”? Clinical Journal of Sport Medicine, 27, 253–259.
Silbernagel, K. G., Thomeé, R., Eriksson, B. I., & Karlsson, J. (2007). Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with Achilles tendinopathy: a randomized controlled study. American Journal of Sports Medicine, 35, 897–906.
Treede, R. D., Rief, W., Barke, A., Aziz, Q., Bennett, M. I., Benoliel, R., et al. (2019). Chronic pain as a symptom or a disease: the IASP classification of chronic pain for the ICD-11. Pain, 160, 19–27.
Vlaeyen, J. W. S., & Linton, S. J. (2000). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 85, 317–332.
Warden, S. J. (2010). Prophylactic use of NSAIDs by athletes: a risk/benefit assessment. The Physician and Sportsmedicine, 38, 132–138.
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(c) Copyright Dr Mahjoub Abdeddaim, MD (Auteur) 2026
Ce travail est disponible sous licence Creative Commons Attribution - Pas d'Utilisation Commerciale - Pas de Modification 4.0 International.
