An analysis of pain intensity, injury incidence, and their associations with socio-demographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic

PLOS ONE RESEARCH ARTICLE An analysis of pain intensity, injury incidence, and their associations with sociodemographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 Likhit Amarttayakong1, Suppakorn Ruengyangmee2, Wiranya Nualkim2, Pimrawee Meelam2, Nattinan Rodchan2, Pattama Amarttayakong3, Nutcha Narom2, Kittithat Sudchoo2, Nitima Nulong2, Arada Chaiyamoon4, Sukrit Sangkhano ID2* 1 Faculty of Education, Department of Physical Education, Khon Kaen University, Khon Kaen, Thailand, 2 School of Public Health, Walailak University, Nakhon Si Thammarat, Thailand, 3 Faculty of Medicine, Mahasarakham University, Mahasarakham, Thailand, 4 Department of Neurosurgery, School of Medicine, Tulane University, New Orleans, Louisiana, United States of America * OPEN ACCESS Citation: Amarttayakong L, Ruengyangmee S, Nualkim W, Meelam P, Rodchan N, Amarttayakong P, et al. (2023) An analysis of pain intensity, injury incidence, and their associations with sociodemographic factors in high school athletes: A cross-sectional study during the COVID-19 pandemic. PLoS ONE 18(9): e0290587. https://doi. org/10.1371/journal.pone.0290587 Editor: Zulkarnain Jaafar, Universiti Malaya, MALAYSIA Received: June 8, 2023 Accepted: August 9, 2023 Published: September 8, 2023 Copyright: © 2023 Amarttayakong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All pertinent data appropriate for public disclosure have been comprehensively incorporated within the manuscript. However, due to confidentiality concerns, there are restrictions on sharing certain data. The sports school’s policy prohibits the dissemination of specific data, especially those that can identify minors. Furthermore, the Ethics Committee in Human Research at Walailak University has set limitations on data sharing Abstract This cross-sectional study explored the relationship between pain intensity, injury incidence, and sociodemographic factors in 120 high school athletes (mean age 16.78±0.91) participating in various sports. The aims of this study are to examine the correlation between factors and Verbal Rating Scale (VRS) for pain intensity, to investigate the correlation between sport types and injured region, and to explore the correlation between injured regions and VRS during training and game competition. Using VRS, we found 64 (53.3%) participants experienced pain during training, with varying degrees of intensity. Chi-square analysis revealed a significant association between VRS scores and school grade (p = 0.044) and cool-down practices (p = 0.037). However, no significant associations were found with gender, age, or sport type. In game competition, 29 (24.2%) participants reported experiencing pain. Here, there was no significant association between VRS and any considered variables. Lower limb injuries were predominant (n = 64), particularly to the knee (n = 23) and ankle/foot (n = 18). Certain sports, like Athletics, Karate-Do, Football, and Western Boxing, demonstrated multiple injury sites, whereas Thai boxing was associated primarily with ankle and foot injuries. Pain intensity varied by injury location, with the highest ’worst pain’ reported for elbow injuries during training and knee injuries during competition. Significant associations were found between injured region and pain intensity level during both training and competition (p<0.001). Our findings highlight the need for injury prevention strategies and pain management among high school athletes, emphasizing proper cool-down activities. Further research is warranted to confirm these findings and explore underlying mechanisms. PLOS ONE | https://doi.org/10.1371/journal.pone.0290587 September 8, 2023 1 / 15 PLOS ONE because the information could potentially reveal the identities of study participants. While the names of participants have been excluded from the dataset, some details might remain identifiable given publicly available information. Interested and qualified researchers are encouraged to contact the Ethics Committee in Human Research at Walailak University for potential data access, subject to legal and policy considerations, at . Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist. Pain intensity, injury rate, & socio-demographic correlation in high school athletes during COVID-19 Introduction School-based athletic programs are an essential part of many educational curriculums worldwide [1], contributing to the overall physical, mental, and social development of students [1,2]. These programs, however, carry an inherent risk of musculoskeletal injuries that can negatively impact the health and performance of young athletes [3]. Recognizing the significance of these injuries and the need for their management and prevention, a wealth of research has explored various aspects of sports injuries in student-athletes [4–7]. Understanding pain, its intensity, and related factors in the context of sports injuries in young athletes is critical, as pain is a key determinant of athletic performance and quality of life [8]. Moreover, it is an essential index of injury severity and a primary motivating factor for seeking medical attention [9]. The Verbal Rating Scale (VRS), a reliable tool for pain assessment, can facilitate accurate and effective evaluation of pain intensity experienced by student-athletes [10]. The value of the VRS lies in its simplicity, its ability to incorporate the subjective experiences of individuals, and its applicability across various contexts [11]. The COVID-19 pandemic has had significant impacts on virtually all aspects of life, including physical activity and sports practice. One of the crucial aspects that require attention is the alteration in sports practices at high school level due to the pandemic. Modifications such as reduced training intensity, restrictions on team gatherings, increased focus on individual skills, and in some instances, complete suspension of sports activities have been implemented [12,13]. These changes may have critical implications on the physical health, psychological well-being, and overall sports performance of high school athletes [14]. The limited access to regular training and competition opportunities during the pandemic could potentially exacerbate injury rates and pain intensity. Existing research suggests that abrupt changes in training load, whether an increase or decrease, can contribute to a higher risk of injury [15]. Consequently, the altered training regimens due to COVID-19 may influence the frequency, severity, and nature of sports injuries experienced by high school athle (...truncated)