Reference Chart Wilk Pain Management Scale

5-Stage Classification System

STAGE 1 ACTIVITY-LIMITED	STAGE 2 DAILY FUNCTION	STAGE 3 REST PAIN	STAGE 4 MEDICATION	STAGE 5 DISABLING
⚠️ Pain only during specific high-intensity activities • No daily life impact • Pain stops when activity stops • Specific triggers only	🔄 Pain affecting daily activities • Stairs, sitting, walking hurt • Morning stiffness • Beyond training symptoms	🛑 Pain present at rest • Constant awareness • Sleep disturbance • Sedentary pain	🚨 Requires medication for function • Regular NSAID use • Impacts work/family • Considering injections	🆘 Severe functional limitations • Daily tasks compromised • Work modifications • Mobility limitations
COACH ACTION: ✓ Continue training with modifications ✓ Monitor closely ✓ Technique review ✓ Document triggers	COACH ACTION: ✓ Immediate load reduction ✓ Alternative training ✓ Assess contributing factors ✓ Consider referral	COACH ACTION: ✓ Suspend aggravating activities ✓ Pain-free movement only ✓ Begin rehabilitation ✓ Medical consultation recommended	COACH ACTION: ✓ Immediate cessation ✓ Medical evaluation required ✓ Pain-free modalities only ✓ Coordinate with healthcare	COACH ACTION: ✓ Complete training cessation ✓ Comprehensive medical team ✓ Support through rehab ✓ Medical supervision required

Sport-Specific Training Modifications

Stage	Running	Cycling	Swimming/Tri
1	• Reduce intensity 10-15% • Modify surface/terrain • Technique review	• Lower gearing emphasis • Position check • Reduce climbing	• Stroke technique review • Reduce aggressive positions
2	• Replace with pool running • Cross-train cycling • Alternative modalities	• Flat terrain only • Reduce duration 20-25% • Comfort position priority	• Single-sport focus • Avoid pain disciplines
3	• Non-impact only • Walking assessment • Pain-free movement	• Gentle spinning only • Stationary trainer • Pain assessment	• Pain-free disciplines • Active recovery focus
4-5	MEDICAL CLEARANCE REQUIRED Maintain fitness through tolerated activities only	MEDICAL CLEARANCE REQUIRED Pain-free movement only	MEDICAL CLEARANCE REQUIRED Gradual return protocol

Critical Decision Points

⚡ IMMEDIATE COMMUNICATION REQUIRED:

Any progression from Stage 1 → Stage 2
Any Stage 3 presentation
Any Stage 4 or 5 presentation

🏥 MEDICAL REFERRAL CRITERIA:

Stage 3: Medical evaluation recommended (especially if >48-72 hours)
Stage 4-5: Immediate medical consultation required

📋 DOCUMENTATION ESSENTIALS:

Daily stage reporting by athlete
Specific trigger identification
Intervention effectiveness tracking
Progression pattern monitoring

🚩 Red Flag Identifiers

Running:

Sudden mileage increases >10%/week
Surface transitions
Footwear changes
Aggressive downhill protocols

Cycling:

Position changes
Cleat/saddle adjustments
High-torque emphasis
Aero position adoption

Triathlon:

Concurrent high-intensity sessions
Brick workout progression
Technique-focused overuse

Framework adapted from Wilk et al. (1998) through the practical applications of Chris Johnson, PT

Clinical implementation should complement, not replace, appropriate medical evaluation when indicated.