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].


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