Sports Medicine Research: In the Lab & In the Field: Keep Playing and Adapting (Sports Med Res)
Monday, October 9, 2017

Keep Playing and Adapting

A longitudinal exploration of pain tolerance and participation in contact sports.

Thornton C, Sheffield D, and Baird A. Scand J Pain. 2017. [Epub Ahead of Print].
https://www.ncbi.nlm.nih.gov/pubmed/28850410

Take Home Message: Athletes who start participating in contact sports are more pain tolerant and become less catastrophizing than new athletes who stop participating.

A patient with greater pain tolerance is more likely to adhere to a rehabilitation program after injury. Understanding how different factors affect an athlete’s pain tolerance can help clinicians anticipate who may have lower tolerance and then tailor a rehabilitation program to optimize adherence. One key factor may be participation in contact sports; but, it remains unclear if athletes in contact sports start with a higher pain tolerance or acquire a higher pain tolerance while participating in the sport. Therefore, Thornton and colleagues completed a study to compare changes in pain tolerances over a season among athletes who started to participate in contact sports and those who started but then stopped participating (disengage). The authors recruited 102 individuals (47 = male, 55 = female) who were about to start their first season of a contact sport (i.e., rugby, American football, mixed martial arts, and kickboxing). All athletes were seen at the beginning of the season, and then again at 4 and 8 months. During each session all athletes completed a demographic questionnaire, the Sports Inventory for Pain (SIP15), and a pain bothersomeness questionnaire. Pain tolerance was assessed with a cold pressor and ischemic pain test, with pain being measured on a visual analog scale. At both the 4- and 8-month time points, coaches provided the researchers with participation data for the athletes. The investigators then divided people into those who participated in their contact sport and those who stopped participating (disengaged). While participating athletes always had a greater tolerance to ischemic pain, pain tolerance to cold was only higher than the disengaged athletes at the 8-month follow-up. Participating athletes always reported higher coping scores. However, athletes had similar catastrophizing at baseline but then the participating athletes catastrophized less at the 2 follow-up visits.

The authors suggest that commitment to contact sports is related to maintained or increased
pain tolerance, direct coping, and decreases in catastrophizing over an athletic season. This study helps clinicians gain insight into the impact that contact sports can have on an athlete’s response to a painful stimulus and why some athletes may stop participating in contact sports. Ischemic pain tolerance, which was always higher in the participating athletes, is thought to relate to pain with exertion. In contrast, the cold pain threshold, which differed between groups over time, may be related to exposure to ice bags/baths. The study is interesting and may indicate that athletes engaged in contact sports learn to deal with pain better (catastrophize less) than those athletes who disengage from contact sports. Engaged athletes may also have more experience coping with pain, which may aid the learning process. One important limitation is the difficulty in being able to consistently classify athletes as engaged or disengaged. Athletes from different sports were included in the study, and with each sport having different practice and game schedules, classifying athletes as either engaged or disengaged varied from athlete to athlete hurting the generalizability of the study’s findings. Clinically, the findings in the study can help clinicians understand how engagement in contact sports relates to pain tolerance. This can easily carry over to rehabilitation after injury as engaged athletes may cope with pain better than athletes who are less interested in returning to play. If a clinician feels an athlete is disengaging from their sport, perhaps they should take a closer look at the psychological aspects of the patient’s recovery (e.g., coping strategies, catastrophizing), which may modify their pain tolerance and promote adherence to the rehabilitation program.

Questions for Discussion: Do you feel the trend demonstrated in this study is true in your current clinical practice? Have you ever needed to improve engagement with an injured athlete and if so, how did you do this?

Written by: Kyle Harris
Reviewed by: Jeffrey Driban

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