Brazilian study homes in on injury prevention among high-performance athletes

New scale evaluates pain profiles and identifies which athletes are likely to put their bodies to the test.

By Karina Toledo

Agência FAPESP – Pain, whether caused by intensive training, injury, distance from one’s family or elimination at a major competition, is a factor that high-performance athletes must address daily throughout their careers.

A study conducted at the School of Physical Education and Sports at Universidade de São Paulo (EEFE/USP) shows that the personality profile of an athlete influences not only the perception of pain but also the manner in which he or she deals with it – and on the road to success this could be as important as physical ability.

“Given the difficulty of distinguishing the limits of his or her abilities and the different forms of pain, the athlete finds himself or herself faced with the possibility of injuries. This study has a significant preventive feature. We adapted a methodology that could offer indicators for the technical team and health professionals to better understand an athlete’s complaints with regard to identifying when s/he reaches the limit before injury,” explains Professor Katia Rubio, coordinator of the FAPESP-funded study.

The study is the fruit of a previous project entitled “Olympic memories for Olympic athletes”, also coordinated by Rubio. The initial objective of the study of Olympic athletes, which is still underway, was to relate the life stories of all Brazilians who have ever participated in the world’s premier sports event.

“The issue of pain came up very frequently in conversations with athletes, even when we did not ask about it. When questioned about pain in their lives, the majority said there can be no professional career without pain. For some, feeling pain at the end of a training session was an indication of a good day’s work,” Rubio continued.

The interviews conducted during the project were the source of the newly released book, Atletas do Brasil Olímpico [Brazilian Olympic Athletes]. The work has a chapter dedicated to pain that tells stories such as those of gymnast Soraya Carvalho, who, at the last minute, could not compete in the 1996 Atlanta Olympic Games because of a fracture caused by excessive training.

“I said that I was in pain, but they thought that I was just complaining to rest since the pace of training had been very intense. My complaints were not taken seriously [by the technical team], and that cost me the Olympic Games,” Carvalho stated in the book.

There are also examples of athletes with a tendency to ignore the signs of pain and push the limits of their body in the name of sports, as in the case of runner Joaquim Cruz. The athlete suffered several injuries as a result of training for years with improper shoes and on unsuitable tracks. In his interview with Rubio, Cruz recalls the mental strategies that he developed to deal with pain and that allowed him to win two Olympic medals – a gold in the 1984 Los Angeles games and a silver in the 1988 Seoul Games.

“Before the Seoul Olympic Games, I had undergone surgery and got it into my mind that everything would work out and it did. Many people told me that after surgery you are never the same. I did not let that affect me. And to overcome those thoughts, I thought “if what they are telling me is true, it will not be in my case. I am different and I will overcome this,” explained Cruz.

To gain an in-depth understanding of the dimensions of pain in the life of professional athletes, Rubio’s group evaluated 216 Olympic-level Brazilian competitors in seven sports: athletics, basketball, soccer, handball, rugby, table tennis and volleyball.

All responded to a questionnaire known as a Pain Inventory for Sports, originally developed by U.S. researchers and adapted to Brazilian conditions by Rubio’s team.

“In a pilot stage of the project, we utilized hospital psychology scales to evaluate pain, but we realized that the instruments used for the regular population are not feasible for sports people, because athletes are much more resistant to pain. We had to adopt a specific scale,” explained Rubio.

To measure how much pain perception is related to the psychological profile, the researchers used a well-known psychological model, the Factorial Personality Inventory (FPI). The researchers also conducted a qualitative study in which in-depth interviews were undertaken as part of the sample. Portions of the results were released in an article published in Revista Brasileira de Psicologia do Esporte.

“In the beginning, we worked with the hypothesis that there would be two major types of pain: that related to training (a habitual and even pleasurable pain) – and that from injury pain, which the athlete cannot control and which generates great fear because it puts the longevity of the athlete’s career and endorsement deals at risk. Afterwards, we incorporated other dimensions of pain, such as the pain of being dropped from a team, the pain of feeling homesick, the pain of defeat and the pain of falling into obscurity, which emerge during transitions in an athlete’s career,” explained Rubio.

Coping models

The Sports Pain Inventory has five subscales: direct coping, cognitive coping, catastrophization, avoidance and body consciousness. The sum of the results of each of the subscales indicates the pain coping model of each individual, explained Rubio.

Athletes with high levels of ‘catastrophization,’ for example, tend to be desperate when faced with an injury and adopt a pessimistic outlook. “They think that everything will go wrong, and this is reflected in their engagement with physical therapy. The rehabilitation period will probably be much longer in these cases. That is why significant psychological effort is important to shift this individual to a more optimistic outlook,” affirmed Rubio.

Athletes with high levels of avoidance, for example, become less competitive when injured because they tend to hold back to avoid pain. On the contrary, those with higher scores in ’direct coping’ tend to ignore the pain and interpret it as part of the competition.

“In the qualitative part of the study, we uncovered the story of an athlete who competed while suffering from fractures. He recalled that he continued to play as if nothing had happened because the result was very important to him,” explained Rubio.

The athletes with the highest subscale in ’body consciousness’ are those who managed to perceive the body’s signs, a case described by volleyball player Ana Richa, who first played on the court and later in beach competitions.

“We were the lab rats for training theory. They used every kind of experiment on us: the Japanese, Russian and Cuban training [practice] schools…. I knew my limits, respected my body. They told us to go to the limit. Perhaps my body was privileged, perhaps I saved myself. The fact is I am here, in full form, but my colleagues are not,” Richa comments in the book.

Lastly, there are athletes with high levels of ‘cognitive coping’, who use mental techniques to stay focused on the task at hand, either in training or physical therapy. “It is these individuals who talk to their pain and who go to the Internet and get all the information available on the condition to discuss the best options with the team,” explained Rubio.

In the researcher’s opinion, this knowledge of the pain coping profile of each athlete paves the way for more effective interventions – both from the preventive and rehabilitative points of view.

“The idea is to improve the instruments that we used in the study in order to apply them to the day-to-day activity of sport, contributing to prevention programs. The results also allow us to develop hypotheses for future studies that will help, for example, to identify the profile of an athlete who is likely to use performance-enhancing drugs,” stated Rubio.

Atletas do Brasil Olímpico [Brazilian Olympic Athletes]
Author: Katia Rubio
Publisher: Editora Kazuá
For more information: www.editorakazua.com.br/editora-kazua-apresenta-o-livro-atletas-brasil-olimpico-de-katia-rubio.