Prevalence of Pain and Psychological Distress in High‐Performance Swimmers: Job Stress and Associated Factors – A Cross-Sectional Study

Abstract

Introduction: High-performance athletes spend numerous hours per week training and therefore are more predisposed to suffer sports-related injury. Evidences show that depression and less severe degrees of emotional distress predict both: the onset of new episodes and persistence of pain.Objective: To examine the association of swimming training routines, job stress (effort-reward imbalance), overtraining-related subjective markers, and biological and sociodemographic factors with prevalence of pain and with psychological distress, in high-performance swimmers from the highest-level competition.Methods: Observational sectional study. Forty-two high-performance swimmers (N=42) from the most elevated competition level (World-class and Olympic) took part in the study as population census of the swimming athletes. Analyses were performed using c2, simple and multiple logistic regressions (via generalized linear models).Results: Prevalence of psychological distress was of 35.7%. Prevalence of pain was of 45.2% and there was significantly difference between men and women (p<0.001). Psychological, psychosocial, biological, socioeconomic and demographic factors were not associated with pain (p>0,05). Overtraining-related subjective markers and low reward were associated with psychological distress (p=0,020), but not with pain. Psychological distress and pain were associated with decreased performance and lower quality of life athletes.Conclusion: Few studies focused pain in high-performance athletes. The present study indicated that further attention is required in training routines, inside and outside the pool to prevent pain in high performance swimmers.Prevalência de dor e sofrimento psicológico em nadadores de alto rendimento: estresse no trabalho e fatores associados – um estudo seccionalIntrodução: Atletas de alto rendimento passam inúmeras horas por semana treinando e, portanto, estão mais predispostos a sofrer lesões relacionadas ao esporte. Evidências mostram que a depressão e graus menos graves de sofrimento emocional predizem ambos: o início de novos episódios e a persistência da dor.Objetivo: Examinar a associação de rotinas de treinamento em natação, estresse no trabalho (desequilíbrio esforço-recompensa) e outros fatores com prevalência de dor e sofrimento psíquico em nadadores de alto rendimento. Além disso, examinamos a relação de sofrimento psicológico e dor.Métodos: Estudo seccional observacional. Quarenta e dois nadadores de alto rendimento (N = 42) do nível competitivo mais elevado (World-Class e Olympic) participaram do estudo como amostra de conveniência. As análises foram realizadas usando c2, regressões logísticas simples e múltipla (via modelos lineares generalizados).Resultados: A prevalência de sofrimento psíquico foi de 35,7%. A prevalência de dor foi de 45,2% e houve diferença significativa entre homens e mulheres (p<0,001). Fatores psicológicos, psicossociais, biológicos, socioeconômicos e demográficos não foram associados à dor (p>0,05). Marcadores subjetivos relacionados ao excesso de treinamento e baixa recompensa foram associados com sofrimento psíquico (p=0,020), mas não com dor. Sofrimento psicológico e dor foram associados com a diminuição do desempenho e menor qualidade de vida atletas.Conclusão: É necessária maior atenção nas rotinas de treinamento, dentro e fora da piscina, para prevenir a dor em nadadores de alto desempenho.

The relationship between training load and pain, injury and illness in competitive swimming: A systematic review

“…Eleven of the fifteen studies stated no statistically significant differences or associations between a measurement of training load and the outcome reported (Cejudo et al, 2019;de Almeida et al, 2015;Harrington et al, 2014;Hidalgo-Lozano et al, 2012Martins et al, 2018;Su et al, 2004;Tate et al, 2012;Tessaro et al, 2017;Tomar & Allen, 2019;Walker et al, 2012). In the remaining studies, a statistically significant difference was reported between training load and injury (Ristolainen et al, 2014) and pain (Capaci et al, 2002).…”

“…A total of 1510 swimmers were included in the review with 11% of them categorised as elite (Hellard et al, 2015;Hidalgo-Lozano et al, 2012Martins et al, 2018), 36% club level (Capaci et al, 2002;Cejudo et al, 2019;Su et al, 2004;Tate et al, 2012;Tessaro et al, 2017;Walker et al, 2012), 23% master's level (Krüger et al, 2012;Tate et al, 2012), 3% collegiate (Harrington et al, 2014;Tomar & Allen, 2019) and 27% national level (de Almeida et al, 2015;Ristolainen et al, 2014). The mean age range was 8-49.5 years, with two studies not reporting age for one group, or all of their participants' demographics (Tate et al, 2012;Tomar & Allen, 2019).…”

“…A clinical assessment or screening process was conducted in two of the studies (Hidalgo-Lozano et al, 2013;Su et al, 2004) in conjunction with a set definition. Martins et al (Martins et al, 2018) did not provide a definition of pain but highlighted that a questionnaire which evaluated the occurrence of pain was administered. Pain was present if the responder answered "yes" to a question on the presence of pain.…”

“…While a number of consensus statements have provided clarity in the use of standard terminology over recent years, disparities in definitions stem from the specific sporting context for which the statements are developed (Roald Bahr et al, 2020). A total of four (Cejudo et al, 2019;Martins et al, 2018;Tessaro et al, 2017;Tomar & Allen, 2019) of the included studies were published after the release of the 2016 FINA consensus statement with none of them making reference to the guidelines and recommendations. A host of outcome definitions were used amongst the 15 studies included in this systematic review, showing large inconsistencies that may be a factor in the conflicting nature of the findings.…”

“…The guidance of a consensus statement may have aided authors in collecting both internal and external training load, which in turn would have improved the strength of the results. However, as only four (Cejudo et al, 2019;Martins et al, 2018;Tessaro et al, 2017;Tomar & Allen, 2019) of the studies included in this systematic review were published after the introduction of the most recent FINA (Mountjoy et al, 2016) and IOC (Schwellnus et al, 2016;Soligard et al, 2016) Consensus Guidelines covering load and the risk of injury and illness, their overall influence was diminished. Publication prior to 2016 reduced the likelihood of authors maintaining a high level of consensus in the operational definitions used for pain, injury and illness, as well as the protocols used to collect that information.…”