The Development of an Upper and Lower Limb Pain Assessment Framework for Athletes

Athlete pain experience is understood through a multidimensional, biopsychosocial lens and is influenced by a host of contextual factors (psychological, cognitive and socioenvironmental) alongside aspects of sensory perception (neurophysiological and biomechanical). Many of these factors are sport-specific in nature and unique to the phenomenon of athlete pain. Upper and lower limb pain has a high prevalence in sport, significantly impacting athletes’ performance within sport and their quality of life outside of it. Published literature regarding athlete pain is sparse, due in part to the dominance of the time-loss injury definition focusing on an athlete’s availability to compete rather than the influence of pain on performance and health. Additionally, the multifaceted nature of understanding pain is at odds with the pressurised environment of competitive sport, where a simplified biomedical model (pain = tissue damage) pervades, leading to underreporting. However, qualitative insights are emerging, with the importance of listening to the athlete’s voice, building strong relationships with an athlete’s support team, and taking time to educate athletes regarding their pain all being highlighted. There is a need to delve further into athlete pain and pain assessment experiences to improve performance and health outcomes. Whilst a set of guiding principles exists, comprehensive guidance regarding the conduct of pain assessment for sports physiotherapists who work with athletes is needed. This programme of research focuses on developing an upper and lower limb pain assessment framework for athletes. Current pain assessment practices are presented, identifying gaps in contextual pain assessment, also mirrored by qualitative insights derived from focus groups with athletes and sports physiotherapists. Upper and lower limb athlete pain assessment priorities, including sport-specific and multidimensional pain assessment items, the choice, timing and application of pain assessment strategies, and the value of building strong relationships and communication pathways to support athletes in understanding pain were identified. Integrating these findings, a consensus development process was undertaken with international sports physiotherapists, establishing recommendations for upper and lower limb pain assessment. A comprehensive set of athlete pain assessment items and essential aspects for assessment is presented. A proposed prototype framework delivers a scaffolding for sports physiotherapists to conduct assessments with athletes, providing guidance on each of the key domains of athlete pain assessment, examples of how each assessment item can be implemented and the frequency with which it is likely to be required. Clinicians now have access to i) a comprehensive database of contextual pain assessment tools and ii) guidance on how to apply them. Future research will develop this prototype by improving the pain assessment item selection process, ultimately leading to better decision making and outcomes for athletes experiencing upper and lower limb pain.