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10/13/08 5:25 PM ET

Toughing it out not always right call

Playing through injuries is not simply matter of getting past pain

I got my pinkie caught in a door the other day. It's been pretty sore. It bothers me most when I have to go to the "shift" key, so I wasn't sure I was going to make it though the first paragraph, but with the help of "auto-correct" and a pep talk from my friendly neighborhood orthopedic surgeon, I'm determined to type through it.

"Everybody is likely playing with some degree of pain this time of year," says Arun Ramappa, chief of sports medicine in the Department of Orthopedic Surgery at Beth Israel Deaconess Medical Center. "It's a long season. There's little time to recuperate. As you might expect, guys are more banged up. But deciding to play hurt isn't a simple matter of being tough enough to take the pain. There's also the matter of risking more serious injury."

OK, so maybe he was talking about ballplayers and maybe I'm not risking all that much at this keyboard, but Ramappa says that a decision like this should be based on what is in a patient's own best medical interest. And that can vary depending upon the patient's line of business.

"In the culture of sports you are expected to tough it out," explained Ramappa. "The idea of letting your team down is unthinkable, so guys play hurt.

"There are also situations where a player recognizes that although he can tolerate the pain, his injury is impacting his performance and the thought of hurting the team's chances is what is most painful."

This could be what happened recently with Mike Lowell. Regardless, whether you are Mike Lowell or "Mike from Lowell," the decision to play hurt or sit out is a personal one. It also depends on a number of factors. Let's say a pitcher and a house painter both have slight tears in their rotator cuffs that impair their ability to work. The painter would love to have the surgery, but can't afford to miss work, so he "plays hurt." The pitcher could find a way to make the pain manageable, but he can't afford a career-ending injury, so he opts to shut it down for the year. Sometimes toughing it out has nothing to do with tolerance for pain.

"I understand that there are times when I'll recommend surgery and my patient will choose not to. I don't always I agree, but I understand," said Ramappa. "It's not a cut-and-dried situation where the same approach is right for everybody, but, in general, I would say if you can afford the procedure and you can afford the time to properly rehab, the benefits of correcting a problem ... beats playing or working in pain."

In these parts, Curt Schilling with his bloody sock is the poster boy of playing hurt. It's hard to imagine that Schilling's approach to his injury was right for anybody except him. The procedure he underwent during the 2004 playoffs, in which an injured ankle tendon was sutured into place in order to allow him to pitch, is an extreme example of the lengths to which people might go.

"I can't think of any other circumstance where a surgery like that would have been done," said Ramappa. "It wasn't done to get him through the season, it was done make it possible for him to play a few very important games over a short period of time ... a temporary fix until the offseason. It's not an approach any surgeon would take if you or I had a similar injury."

There's no World Series berth riding on the outcome of this article. No matter what happens, the time is soon approaching when my pinkie and the dinged up Red Sox will be able to shut it down. I'm pretty sure I can tough out a couple more weeks. GO SOX. (Ouch! ... darn shift key!)

Gary Gillis is a contributor to MLB.com. The BID Injury Report is a regular column on redsox.com. Beth Israel Deaconess Medical Center is the official hospital of The Boston Red Sox. This story was not subject to the approval of Major League Baseball or its clubs.