Nirschl Pain Phase Scale of Athletic Overuse Injuries

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Phase 1. Stiffness or mild soreness after activity. Pain is usually gone within 24 hours.

Phase 2. Stiffness or mild soreness before activity that is relieved by warm-up. Symptoms are not present during activity, but return afterward, lasting up to 48 hours.

Phase 3. Stiffness or mild soreness before specific sport or occupational activity. Pain is partially relieved by warm-up. It is minimally present during activity, but does not cause the athlete to alter activity.

Phase 4. Similar to phase 3 pain but more intense, causing the athlete to alter performance of the activity. Mild pain occurs with activities of daily living, but does not cause a major change in them.

Phase 5. Significant (moderate or greater) pain before, during, and after activity, causing alteration of activity. Pain occurs with activities of daily living, but does not cause a major change in them.

Phase 6. Phase 5 pain that persists even with complete rest. Pain disrupts simple activities of daily living and prohibits doing household chores.

Phase 7. Phase 6 pain that also disrupts sleep consistently. Pain is aching in nature and intensifies with activity.