It is cru­cial to en­cour­age peo­ple 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.

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.

Ce­cile Hosang is a phys­i­cal ther­a­pist and as­sis­tant lec­tur­er in the Fac­ul­ty of Sport. She is al­so a pain spe­cial­ist.