Perception of musculoskeletal pain in athletes
The results as recorded after the application of the questionnaire to athletes. Chronic stress, cortisol dysfunction and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. The endogenous opioid system and pain management.
| Рубрика | Медицина |
| Вид | статья |
| Язык | английский |
| Дата добавления | 22.11.2021 |
| Размер файла | 21,2 K |
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PERCEPTION OF MUSCULOSKELETAL PAIN IN ATHLETES
Bogdan-Alexandru Hagiu, Rares Alexandru Puni,
Radu Mihai lacob
Враховуючи всю важливість, яку тренери приділяють болю у всіх його проявах, ми прагнули оцінити прояви болю у молодих спортсменів. Наше дослідження було проведено на 118 спортсменах як чоловічої, так і жіночої статей, які заповнили анкету, в котрій містилась інформація про відчуття в опорно-руховому апараті, а також основні фактори, які можуть впливати на чутливість до болю. Результати показують, що найбільша інтенсивність опорно-рухового болю фіксується відразу після тривалих фізичних зусиль, а найменша - під час спортивних ігор. Це дозволяє зробити висновок, що ця невідповідність може бути викликана значним виділенням ендогенних опіо'їдів під час гри. З іншого боку, дисбаланс кортизолу в плазмі, застосування анальгетиків або добавок суттєво не впливають на сприйняття болю. Факторами, що сприяють підвищенню сприйняття болю, є стать спортсмена, велика кількість щотижневих тренувань, тривалість спортивної кар'єри спортсмена, кількість важких травм, яких він / вона зазнали.
Ключові слова: м'язовий біль, атлети.
Given the importance that coaches give to algia in all its manifestations, we aim to evaluate the perception of pain in young athletes. The study was conducted on 118 both male and female athletes who completed a questionnaire collecting information on the perception of musculoskeletal algia along with the main factors that may influence algia sensitivity. The questionnaire gathered complex information on age, the particular sport they practiced, age when they started practicing it, total number of weekly training sessions, number of competitions attended by the subject, number of injuries suffered, their location, if hospitalization was needed, duration of recovery, the possibility the subject ever had to give up sports and / or suffered from overtraining syndrome, their participation to psychological training programs, their assessment of the intensity of pain both at rest and during exercise, during and immediately after competitions (using a scale from 1 to 10, with 1 corresponding to minimum pain and 10 to maximum), the use of supplements.
The results show that the highest intensity of musculoskeletal pain is recorded immediately after sustained physical effort and the lowest during sports games, leading to the conclusion that this discrepancy could be caused by a significant discharge of endogenous opioids during games. On the other hand, plasma cortisol imbalances, the use of analgesics or supplements do not significantly affect the perception of pain. The factors contributing to the increased algia perception are the athlete's gender, the high number of weekly workouts, the duration of the athlete's sports career, the number of major injuries he/she suffered.
Key words: muscular algia, athletes.
Introduction
Medicine does not have a monopoly on describing and analysing pain in sports, since it has been recorded a significant transition from physical to bio-psycho-social approaches [6]. While specialists in ergo-physiology have made efforts to discover the effects of sports injuries, the study of pain psychology has shown that it is perceived differently by athletes and by the non-practitioners [1]. Given the importance that coaches have to attribute to pain and the risk of injury in sports [7], our paper aims to evaluate the intensity of pain felt by young athletes in correlation with the various factors that may influence algia sensitivity. Considering that pain perception is related to stress and incongruences in plasma cortisol levels [2], the participants to our study were also questioned about the use of cortisone based products. It seems that supplementation of vitamin D in subjects with a demonstrated deficiency results in reduced perception of pain [3], and supplementation with vitamins C and E reduces aerobic-induced muscle damage [8]. The effect of vitamin C and supplementation on muscle damage and oxidative stress in female athletes: a clinical trial. As a result, the participating athletes were questioned whether and what type of supplements they use.
Materials and methods
The subjects of our study were 118 professional athletes, 51 male and 67 female. The questionnaire gathered complex information on age, the particular sport they practiced, age when they started practicing it, total number of weekly training sessions (to appreciate the influence of systematic effort on algal sensitivity), number of competitions attended by the subject, number of injuries suffered, their location, if hospitalization was needed, duration of recovery, the possibility the subject ever had to give up sports and / or suffered from overtraining syndrome, if the subject was ever diagnosed with high cortisol plasma levels, been treated with hydrocortisone or similar medication, if they ever experienced chronic musculoskeletal pain and where is it located, their use of cortisone-based or other analgesic medications, their participation to psychological training programs, their assessment of the intensity of pain both at rest and during exercise, during and immediately after competitions (using a scale from 1 to 10, with 1 corresponding to minimum pain and 10 to maximum), the use of supplements.
Results
The emerging data, following the application of the questionnaire, was gathered in Table 1. The numbers are between extreme values.
Table 1. The results as recorded after the application of the questionnaire to athletes
|
Gender |
51 M / 67 F |
|
|
Age |
18-24 |
|
|
Which sport do you practise? |
Handball, Basketball, Volleyball, Athletics, Sports Dance, Rugby, Wrestling, Bodybuilding, Cycling, Karate |
|
|
Since when? |
4-16 years |
|
|
Total numer of weekly trainig sessions |
4-20 hours |
|
|
Number of sports competitions you attendeded |
20-300 competitions |
|
|
How many major injuries did you suffer from? |
0-5 |
|
|
The location of your injuries (upper limbs, lower limbs, truck, pelvic area, neck, head) |
upper limbs 80%, lower limbs 20 % |
|
|
Did your injuries required hospitalization? |
5% YES, 95% NO |
|
|
How long was your recovery? |
4 months - 6 months |
|
|
Have you ever had to give up sports and / or been treated for suffering from the overtraining syndrome? |
0,84% YES, 99,16% NO |
|
|
Have you ever been diagnosed with high cortisol levels? |
100% NO |
|
|
Are you currently suffering from chronic musculoskeletal pain? If affirmative, please specify location (upper limbs, lower limbs, back - upper / lower, trunk, shoulders, pelvic area, neck) |
YES lower limbs 4%, NO 96% |
|
|
Have you ever been treated with hydrocortisone or similar medication? |
100% NO |
|
|
On a scale from 1 to 10, measure pain intensity (10 being maximum and 1 minimum) |
While resting; 1-10 During training sessions; 1-9 During games; 1-10 Immediatly after physical effort; 1-10 |
|
|
Did you follow or are you currently following a psychological training program? |
100% NO |
|
|
Did you use analgesics other than cortisone? Specify the name of the medicine (s) |
brufen, other anti-inflammatory drugs |
|
|
Do you use supplements? Specify type (for recovery purposes, stress support), trade name and give as many details as possible about the composition of the product (amino acids, vitamins, etc.): |
Isoton Energy Activ 3, Vitamax, Vitamin C, Calcium, Magnesium, ON 100% Whey gold Standard - relocation, + ON Amino Energy, Sargenor, Glutamine, Aspirin, Food Glucose, My Protein Creatine Monohydrate, My Protein BCA Amino Acids, Supradyn |
Table 2. Pain while resting
|
Rating scale for evaluating pain (1-10) |
Number of answers |
% |
|
|
1 |
28 |
52,83% |
|
|
2 |
7 |
13,20% |
|
|
3 |
5 |
9,43% |
|
|
4 |
3 |
5,66% |
|
|
5 |
3 |
5,66% |
|
|
6 |
2 |
3,77% |
|
|
7 |
2 |
3,77% |
|
|
8 |
0 |
0% |
|
|
9 |
2 |
3,77% |
|
|
10 |
1 |
1,88% |
|
|
Total: 53 |
The analysis of the responses revealed that the intensity of pain is higher for the female athletes, with a number of 18-20 weekly training hours, aged 21-25 years, with 13-16 years of sports practice, with 3 to 5 major injuries. Overall, the results show that the perception of pain in the participating subjects was not influenced by cortisol plasma level imbalances. In the case of the responding athletes, the percentage of athletes who have suffered from the overtraining syndrome is too low to establish a correlation with pain perception, awhile the use of analgesics or supplements has no influence upon algia perception.
Tables 2, 3, 4 and 5 detail the responses to pain perception.
Table 3. Pain during training sessions
|
Rating scale for evaluating pain (1--10) |
Number of answers |
% |
|
|
1 |
7 |
13,46% |
|
|
2 |
7 |
13,46% |
|
|
3 |
8 |
15,38% |
|
|
4 |
4 |
7,69% |
|
|
5 |
12 |
23,07% |
|
|
6 |
2 |
3,84% |
|
|
7 |
8 |
15,38% |
|
|
8 |
2 |
3,84% |
|
|
9 |
2 |
3,84% |
|
|
10 |
0 |
0% |
|
|
Total: 52 |
Table 4. Pain during sports games
|
Rating scale for evaluating pain (1-10) |
Number of answers |
% |
|
|
1 |
11 |
23,91% |
|
|
2 |
10 |
21,73% |
|
|
3 |
2 |
4,34% |
|
|
4 |
5 |
10,86% |
|
|
5 |
7 |
15,21% |
|
|
6 |
5 |
10,86% |
|
|
7 |
5 |
10,86% |
|
|
8 |
0 |
0% |
|
|
9 |
0 |
0% |
|
|
10 |
1 |
2,17% |
|
|
Total: 46 |
Table 5. Pain immediate y after physical effort
|
Rating scale for evaluating pain (1-10) |
Perceived pain intensity (number of answers) |
% |
|
|
1 |
8 |
17,02% |
|
|
2 |
8 |
17,02% |
|
|
3 |
8 |
17,02% |
|
|
4 |
6 |
12,76% |
|
|
5 |
4 |
8,51% |
|
|
6 |
1 |
2,12% |
|
|
7 |
7 |
14,89% |
|
|
8 |
2 |
4,25% |
|
|
9 |
0 |
0% |
|
|
10 |
3 |
6,38% |
|
|
Total: 47 |
Discussions
When analyzing tables 2, 3, 4 and 5, the results show that the highest percentage of musculoskeletal pain intensity 1 was recorded while resting (52.83%). The highest percentage for intensity 10 (6.38%, corresponding to 3 subjects, all female) was recorded immediately after the effort. It is noteworthy that none of those subjects mentioned the maximum pain as present during the training sessions. The percentages corresponding to intensities 8, 9 and 10 are 5.65% for rest time, 7.68% during training, 2.17% during sports and 10.63% immediately after the exercise. It is well known that endogenous opioids are released into the blood stream both during sports training and as a consequence of acute exercise [4] and that these substances relieve pain [5]. This probably explains the relatively small percentage of subjects experiencing intense pain during games. It is possible that in some young athletes, experiencing pain during rest could be triggered or exacerbated by late-onset muscle pain, and the increase in pain intensity immediately after exercise is the result of immediate muscle fever. In fact, given the small number of subjects suffering from chronic musculoskeletal pain, it can be inferred that pain was generally inherent to muscle fever. Since none of the subjects followed a psychological training program, we cannot appreciate the influence of this particular factor on the perception of pain.
Conclusions
athlete stress pain management
1. Pain was perceived more intensely by female subjects who followed a training program with many weekly hours, whom have been practicing sports for a long period of time (and consequently the chronological age is correspondingly higher) as well as by subjects who have suffered a relatively large number of major injuries.
2. Apparently, cortisol plasma levels, use of analgesics or supplements do not significantly influence the perception of pain in the participants to our study.
3. In performance athletes, the highest intensity of musculoskeletal pain is recorded immediately after physical exercise and the smallest intensity during games.
4. A plausible cause for feeling less pain during games than during sports training could be the discharge of endogenous opioids.
References
1. Addison T, Kremer J, Bell R. Understanding the psychology of pain in sport. The Irish Journal of Psychology. 1998; 19(4): 485-503.
2. Hannibal KE, Bishop MD. Chronic stress, cortisol dysfunction, and pain: a psychoneuroendocrine rationale for stress management in pain rehabilitation. Phys Ther. 2014; 94(12):1816-25.
3. Helde-Frankling M, Bjorkhem-Bergman L. Vitamin D in Pain Management. Int J Mol Sci. 2017; 18(10): 2170.
4. Harber VJ, Sutton JR. Endorphins and exercise. Sports Med. 1984; 1(2): 154-71.
5. Holden JE, Jeong Y, Forrest JM. The endogenous opioid system and clinical pain management. AACN Clin Issues. 2005; 16(3): 291-301.
6. Milne C. Pain and injury in sport: social and ethical analysis. Br J Sports Med. 2006; 40(11): 950-951.
7. Nixon HL. Coaches' Views of Risk, Pain and Injury in Sport, with Special Reference to Gender Differences, Human kinetics journals 1994; 11(1): 79-87.
8. Taghiyar M, Darvishi L, Askari G, Feizi A, Hariri M, Mashhadi N.S, et al. The effect of vitamin C and supplementation on muscle damage and oxidative stress in female athletes: a clinical trial. International Journal of Preventive Medicine. 2013; 4(Suppl 1): 16-22.
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