Athletes Play Through Pain-What Does That Mean for Rehabilitation Specialists?

CONTEXT: Pain in sport has been normalized to the point where athletes are expected to ignore pain and remain in the game despite the possible detrimental consequences associated with playing through pain. While rehabilitation specialists may not have an influence on an athlete's competitive nature or the culture of risk they operate in, understanding the consequences of those factors on an athlete's physical well-being is definitely in their area of responsibility. OBJECTIVE: To explore the factors associated with the experiences of subelite athletes who play through pain in gymnastics, rowing, and speed skating. DESIGN: The authors conducted semistructured interviews with subelite athletes, coaches, and rehabilitation specialists. They recruited coach participants through their provincial sport organization. Athletes of the recruited coaches who were recovering from a musculoskeletal injury and training for a major competition were then recruited. They also recruited rehabilitation specialists who were known to treat subelite athletes independently by e-mail. SETTING: An observation session was conducted at the athlete's training facility. Interviews were then conducted either in a room at the university or at a preferred sound-attenuated location suggested by the participant. PARTICIPANTS: The authors studied 5 coaches, 4 subelite athletes, and 3 rehabilitation specialists. INTERVENTIONS: The authors photographed athletes during a practice shortly before an important competition, and we interviewed all the participants after that competition. Our photographs were used during the interview to stimulate discussion. RESULTS: The participant interviews revealed 3 main themes related to playing through pain. They are: Listening to your body, Decision making, and Who decides. CONCLUSION: When subelite athletes, striving to be the best in their sport continue to train with the pain of an injury, performance is affected in the short-term and long-term consequences are also possible. Our study provides some insight into the contrasting forces that athletes balance as they decide to continue or to stop.

Autonomic nervous system activities during motor imagery in elite athletes.

Motor imagery (MI), a mental simulation of voluntary motor actions, has been used as a training method for athletes for many years. It is possible that MI techniques might similarly be useful as part of rehabilitative strategies to help people regain skills lost as a consequence of diseases or stroke. Mental activity and stress induce several different autonomic responses as part of the behavioral response to movement (e.g., motor anticipation) and as part of the central planning and preprogramming of movement. However, the interrelationships between MI, the autonomic responses, and the motor system have not yet been worked out. The authors compare a number of autonomic responses (respiration, heart rate, electro skin resistance) and motoneuron excitability (soleus H-reflex) in elite and nonelite speed skaters during MI. In contrast to the nonelite athletes, MI of elite speed skaters is characterized by larger changes in heart rate and respiration, a greater reliance on an internal perspective for MI, a more vivid MI, a more accurate correspondence between the MI and actual race times, and decreased motoneuron excitability. Two observations suggest that the changes in the autonomic responses and motoneuron excitability for the elite speed skaters are related to the effects of central motor programming: (1) there was no correlation between the autonomic responses for MI and those recorded during mental arithmetic; and (2) mental arithmetic did not significantly alter motoneuron activity. It is suggested that in elite speed skaters, the descending neural mechanisms that reduce motoneuron excitability are activated even when full, vivid MI is performed internally. These inhibitory responses of the motor system may enhance actual motor performance under conditions of remarkably high mental stress, such as that which occurs in the Olympic games.

Variable effects of a behavioral treatment package on the performance of inline roller speed skaters.

We investigated the effects of a treatment package on the performance of correct relay tags with 4 inline speed skaters. The treatment package included verbal praise following correct tags, visual feedback of performance data, and instruction for improving performance. Initial gains in the frequency of correct tags were not maintained at 6-month follow-up when baselines were reestablished. Performance on the second intervention phase for the 3 original subjects was variable and differed from the initial phase, whereas the original findings were replicated in the 4th subject. Possible reasons for this variability and implications for future research and behavioral sport interventions are considered.