Do psychosocial factors predict pain after participation in an ultramarathon race?

Master Thesis


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BACKGROUND Participation in ultramarathon races is increasing globally. Although endurance running has numerous physical and psychological benefits, due to the excessive volume of training and the physical and emotional demands of completing an ultramarathon event, exercise-induced muscle damage and delayed-onset muscle soreness are common. Recovery is central to improving performance and is also a determining factor in return to training. Recovery requires both physical and psychological adaptation. However, there is limited research exploring the effect psychosocial factors play on pain recovery following competition, particularly in endurance runners. More specifically, the role fear avoidance beliefs, pain catastrophizing and self-efficacy play in pain recovery following an ultramarathon race. This information is important to contribute to the limited research on the association between psychosocial factors and recovery from pain in endurance runners. Additionally, this information may provide insight into pain recovery following the Comrades Marathon and reduce time away from running. AIMS AND OBJECTIVES The aim of this study was to investigate the relationship between psychosocial factors (fear avoidance beliefs, pain catastrophizing and self-efficacy beliefs) and pain recovery in runners following the 2017 Comrades Marathon. The specific objectives of the study were to explore whether the psychosocial factors of pain catastrophizing, fear avoidance beliefs and self-efficacy beliefs: a) predict pain in ultramarathon runners after competing in the Comrades Marathon; and b) affect recovery in runners competing in the Comrades Marathon. METHODS This study had a descriptive, longitudinal cohort design. Healthy ultramarathon runners between the ages of 20 and 60 who had qualified for and were intending to compete in the 2017 Comrades Marathon were included in this study. Participants who failed to provide informed consent, reported any signs of illness two weeks prior to the race or any relevant medical or surgical procedure that would prevent participation in the race, were diagnosed with a history of chronic pain or who did not complete the race were excluded. All participants were required to complete a medical and sports history questionnaire and baseline psychosocial questionnaires (Athlete Fear Avoidance Questionnaire, Pain Catastrophizing Questionnaire, Self-Efficacy Questionnaire) two weeks prior to the race at a presentation evening held at participating running clubs. Recovery from pain was recorded by completing a pain logbook (Pain Severity Score of the Brief Pain Inventory) starting the evening of the day on which the Comrades Marathon was run and on each night for nine days following the race, with a total of 10 entries. The questionnaires were validated in previous studies by a panel of experts and were available in both hard copy and electronic format. RESULTS The study sample consisted of 77 participants with a mean age of 41 years, 45 (58%) of whom were male and predominantly English speaking (74%). The majority of participants (78%) had completed the Comrades Marathon previously with 13% being novices to the ultramarathon distance. The average finishing time for the study participants in the 2017 Comrades Marathon was 10 hours and 16 minutes. Seventy percent reported that they had previously used pain-relieving medication after a race. The majority of participants(86%) documented a history of injury, with 55% reporting a current injury. Only 6% reported currently using chronic pain-relieving medication. The baseline psychosocial questionnaires revealed that the majority of the participants demonstrated low fear avoidance beliefs (79%), low pain catastrophizing beliefs (88%) and high self-efficacy beliefs (97%). It took five days from the day of the Comrades Marathon for 75% of the runners to score a pain rating of one or lower in the pain logbook and seven days for 75% of the runners to report no pain. There were no correlations between psychosocial factors and pain recovery in this sample of Comrades runners. There was no correlation between finishing times and pain during recovery. CONCLUSION In conclusion, this study showed that in this sample of ultramarathon runners pre-race psychosocial factors had no effect on recovery following the 2017 Comrades Marathon. High self-efficacy scores, previous experience, higher pain tolerance and better coping strategies in ultramarathon runners may be contributing factors to these results. Future research needs to explore endurance runners who do not complete the race, assess the profile of the ultramarathon race and assess different recovery markers