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

Injury surveillance in athletics often depends on athletes reporting injuries, whereas weekly instruments developed at the Oslo Sports Trauma Research Center (OSTRC) 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. We estimated the weekly prevalence of musculoskeletal pain and of athlete-labelled injury in competitive track-and-field athletes, quantified the discrepancy between them and compared labelled with unlabelled painful weeks. Ninety-six competitive athletes registered with the Italian Athletics Federation, with at least four years of structured training, from ten facilities in central and northern Italy, completed a purpose-built weekly questionnaire for 23 consecutive weeks (January–July 2025), which asked separately about lower-limb or spinal pain and about whether the athlete considered the complaint an injury. Associations with athlete characteristics were estimated by generalised estimating equations with robust variance clustered by athlete; discipline contrasts and the weekly competition count were analysed as exploratory. All 96 athletes returned all 23 questionnaires (2208 athlete-weeks). Pain was reported in 557 weeks (25.2%), and athlete-labelled injury in 184 of the 2206 weeks in which the injury item was answered (8.3%). Of the 555 pain-positive weeks with both items answered, 375 (67.6%) were not labelled as injuries, although 319 of these (85.1%) involved some interference with training or competition, mild in most. Labelled weeks were more severe on every measure recorded (mean pain intensity 5.8 versus 3.8 on 0–10; severe interference 58.9% versus 1.9%; inability to compete 40.6% versus 1.6%). In comparisons between athletes, longer usual session duration, higher body mass index and previous injury were associated with weekly pain; discipline contrasts were imprecise. Two thirds of the weeks in which pain was reported were not labelled as injuries by the athletes, although most involved some interference with participation. The label identified the more severe end of the symptom spectrum, so surveillance relying on athlete-reported injury records only part of the weekly symptom burden; consequence- and symptom-based monitoring with validated instruments is needed to capture the remainder.