Study finds athletes fear being judged as weak when they experience pain or injury

Trinity researchers have undertaken the first multi-centered, international, qualitative study exploring the athlete experience (in their own words) of sporting low back pain (LBP).

LBP is common in rowers and can cause extended time out from the sport and even retirement for some athletes. Rowers from diverse settings (club and university to international standard) in two continents were included in the study.

The findings have been published in the British Journal of Sports Medicine.

In an Irish context, rowing is currently one of our most successful sports and Rowing Ireland has 4000 registered racing members. About 50% of elite rowers in Ireland will have an episode of rowing related low back pain in a year. Australia is one of the biggest rowing nations in the world. Researchers at Curtin University in Perth, who partnered on this study are globally respected for their back-pain research.

With the evolution of professional sport, the mantra of 'win at all costs' pervades. This attitude is present even in grassroot sports. Focus has shifted from enjoyable participation to prioritizing performance outcomes, leading to athletes being regarded as an asset, commodity or an investment.

A culture of toughness and resilience is encouraged but this can create confusion when it comes to reporting pain and injury which is common in sport. Athletes commonly internalize a myth that pain equates to weakness and personal failure. There is a rising interest in the influence of sporting culture on athlete's welfare; athlete abuse through mistreatment following injury is part of this.

For many sports, athletes' health is not prioritized, and this is now recognized as a form of abuse. Some athletes are not provided with a culture and environment where they can report pain and injury without negative consequences. To understand the extent of this issue and to safeguard athletes, their voice and experiences need to be heard in research.

Qualitative research allows athletes to tell their stories in their own words and is a good method of exploring their lived experience. By understanding what an athlete's experience of pain and injury is will lead to a better management of injury and better outcomes. It is likely to contribute to prevention of injury.

The key messages from the study are:

• Rowers in this study felt compromised by their LBP and in many cases felt that the prevailing culture and environment did not allow them to be open and honest about their LBP for fear of exclusion.
• Many felt that they had to continue competing and training when in pain. This may have increased risk of a poor outcome from their LBP as well as the poor negative emotional/mental experience that they encountered
• Rowers experience of LBP can lead to isolation and can have a profound effect on their life beyond sport.

Dr. Fiona Wilson, Associate Professor, Physiotherapy, School of Medicine, Trinity College said,"This study presents a powerful message that athletes fear being judged as weak when they have pain and injury. They feel isolated and excluded when injured. They feel that there is a culture within sport that values them only when they are physically healthy. This leads athletes to hide their pain and injury which is likely to lead to poorer outcomes. Some of this may come from within the athlete and some may be reflective of cultures in some settings in the sport. Our findings will impact not just rowers but any athlete who has experienced pain and injury, allowing their perspective to be considered. This will lead to the design of more tailored injury management programs and will also crucially create a sporting environment where an athlete's physical health and welfare is at the core. The findings from this study can be applied across sports and this has been reflected in the Twitter response to this paper, with athletes and clinicians from diverse sports, recognizing these findings from their own experiences."