Two-thirds of painful training weeks in track-and-field athletes go unlabelled as injuries

Competitive track-and-field athletes reported musculoskeletal pain in a quarter of their training weeks, yet labelled only about a third of those painful weeks as injuries, according to a prospective cohort study of 96 Italian athletes published in BMC Sports Science, Medicine and Rehabilitation. The finding suggests that surveillance systems relying solely on athletes’ own injury reports capture only the more severe end of the weekly symptom burden.

Every one of the 96 athletes returned all 23 questionnaires, yielding 2,208 athlete-weeks of data.

Pain was reported in 557 of those weeks, or 25.2 percent. Athlete-labelled injury appeared in 184 of the 2,206 weeks in which the injury item was answered, or 8.3 percent. Of the 555 pain-positive weeks with both items answered, 375 — 67.6 percent — were not labelled as injuries by the athletes themselves. Most of those unlabelled painful weeks still involved some interference with training or competition, although in most cases the interference was mild.

The weeks athletes did label as injuries were consistently more severe on every measure recorded. Mean pain intensity in labelled weeks was 5.8 on a 0–10 scale, compared with 3.8 in unlabelled painful weeks. Severe interference with training or competition occurred in 58.9 percent of labelled weeks versus 1.9 percent of unlabelled ones, and inability to compete was reported in 40.6 percent of labelled weeks versus 1.6 percent of unlabelled weeks.

The study’s background notes that injury surveillance in athletics often depends on athletes reporting injuries, whereas weekly instruments developed at the Oslo Sports Trauma Research Center identify health problems through their consequences, because injury-based reporting misses many complaints. How much of the weekly symptom burden the athlete’s own injury label captures has rarely been quantified in the same athletes and weeks, which is the gap this study set out to address.

Longer usual session duration, higher body mass index and a previous injury were associated with weekly pain. Contrasts between disciplines and the weekly competition count were analysed as exploratory, and the discipline contrasts were imprecise, so no firm conclusions can be drawn about which disciplines carried different risks.

The authors conclude that because two thirds of painful weeks went unlabelled as injuries, and most of those weeks still involved some interference with participation, surveillance relying on athlete-reported injury records captures only part of the weekly symptom burden. They argue that consequence- and symptom-based monitoring with validated instruments is needed to capture the remainder.

The severity comparisons describe the weeks as recorded, and the associations with athlete characteristics come from an observational design, so they do not establish causation. Nevertheless, the central message is clear: the athlete’s own injury label identifies the more severe end of the symptom spectrum, and a substantial share of milder but still consequential painful weeks would go unrecorded in systems that count only self-declared injuries.

Subject of Research: Weekly musculoskeletal pain versus self-reported injury in competitive track-and-field athletes

Article Title: Weekly musculoskeletal pain beyond self-reported injury in Italian track-and-field athletes: a 23-week prospective cohort study

Article References: Sellitto, G., Pasquali, F., Ruotolo, I., Giglioni, G., Amadio, E., & Galeoto, G. (2026). Weekly musculoskeletal pain beyond self-reported injury in Italian track-and-field athletes: a 23-week prospective cohort study. BMC Sports Science, Medicine and Rehabilitation. https://doi.org/10.1186/s13102-026-02209-3

Image Credits: AI Generated

DOI: 10.1186/s13102-026-02209-3

Keywords: track and field, musculoskeletal pain, injury surveillance, prospective cohort study, athletes, self-reported injury, OSTRC, sports medicine, Italy, training load, symptom monitoring, Weekly