Dealing with chronic pain in adaptive athletes

IT IS crucial to encourage persons with disabilities to engage in both recreational and competitive sports.

However, as we work on pathways to increase the number of adaptive athletes in our region, we must be aware that these individuals are also particularly susceptible to injuries and pain.

Core risk factors for pain in this population generally include biological, psychosocial, and external aids.

The biological factors are vast and specific to each athlete’s disability and sport. Changes in muscle function, impaired balance, and structural differences in body parts are common causes of pain. Athletes who use a wheelchair will suffer shoulder injuries due to overuse, while ambulant athletes suffer both upper and lower limb injuries.

Wheelchair sports include tennis, basketball, archery, fencing, track, javelin, discus, and shot put. These all involve heavy upper limb use, predisposing the athlete to shoulder overuse injuries, such as rotator cuff injuries, and degeneration of the joints, as seen in osteoarthritis. At highly skilled levels, the risk of contact, collisions, and falls while playing these sports increases. Injuries to the wrist and hand can emerge from the placement of the hand to propel the wheelchair. Permanent wheelchair users may not get adequate “rest” of the limb following injury, training, or competition as they rely on their upper limbs for all daily activities. This may lead to a cycle of inflammation, permanent damage, and chronic pain. Other wheelchair athletes, such as those with spinal cord injuries, experience pain due to their condition and its sequelae. Pain arises from discomfort associated with the wheelchair, positioning issues, specifically to the neck and back, and painful spasms and abnormal muscle tone.

PSYCHOSOCIAL FACTORS

Cognitive differences highlight psychosocial factors that predispose adaptive athletes to injury and pain. These present deficits in cognitive function and influence how information is processed between the athletes and their participating sport. This may pose challenges with communicating their pain or injury to coaches and health professionals.

Adaptive athletes may also have an impaired ability to take action to avoid impending injury. The professionals working with adaptive athletes must employ diverse communication techniques and aids, such as the Pain Faces Scale, for documenting pain intensity, pictures, demonstrations, and monitoring changes in behaviour. Other non-verbal communication, such as gestures, body part protection, activity changes, and participation, should also be closely observed.

The use of equipment, including mobility aids, adaptive devices, and prostheses, poses injury and pain risks if they are faulty, ill-fitting, or become a fall hazard. Adaptive athletes experience pain due to nerve damage (neuropathic pain) from their disability and new injuries. This type of pain can arise from central causes such as stroke (cerebral vascular accident– CVA), peripheral causes (crush injuries, amputations, fractures), metabolic causes (diabetes), and others.

The typical complaints of someone with neuropathic pain include sharp, shooting, shocking, burning, numbness, pins, and needles, among other abnormal and uncomfortable sensations. These types of pain can be debilitating, difficult to treat, and often constant and chronic. New and worn equipment and devices may create pressure areas and expose adaptive athletes to this type of pain.

Persons who have had amputations typically use a variety of prostheses to aid their mobility. Running blades are a popular example for track athletes, while upper limb prosthetics can allow participation in weightlifting, swimming, and fencing. Amputees have permanent nerve disruption at the site of amputation. A particularly interesting phenomenon in some people with amputation is phantom pain.

This is a situation where the person is experiencing pain in the part of the limb that is no longer present. The cause of phantom pain is not well understood, but it may be due to faulty processing in the nervous system. Amputees may also experience residual limb pain, which occurs in the remaining part of the limb and is usually neuropathic. Using prosthetics carries the risk of contact pressure on the skin where it is attached, discomfort from improper fit, and sub-par design. Pressure areas on the skin are especially problematic because of the pain, while skin and tissue breakdown can lead to severe complications such as bone infection.

The impact of pain and injury is significant in the adaptive athletic population. Sports and recreation are instrumental for engagement in physical activity, social inclusion, and optimising health and wellness. Reduced sporting activity can lead to adverse effects such as muscle weakness, unwanted weight gain, isolation, loss of income, and demotivation.

Adaptive athletes must receive appropriate training, coaching, prompt and comprehensive medical care, and rehabilitation. This is necessary to reduce and eliminate, where possible, their risk of injury and chronic pain.

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