Improving Methodological Quality in Meta-Analyses of Athlete Pain Interventions: An Overview of Systematic Reviews

TL;DR

This paper reviews the quality of meta-analyses on athlete pain interventions, finding low methodological rigor and limited clinical applicability.

Contribution

The study provides an overview of systematic reviews on athlete pain interventions, highlighting methodological flaws and preliminary effective treatments.

Findings

Physical exercise modalities, acupuncture, photo biomodulation, and topical medication showed potential pain reduction benefits.

Interventions like manual therapy and platelet-rich plasma lacked consistent effects.

All reviews focused solely on pain intensity with minimal sport-specific analysis.

Abstract

Background: Pain is a disabling issue in athletes, with significant impact on performance and career longevity. Many randomized clinical trials (RCTs) have explored interventions to reduce pain, leading to multiple systematic reviews with meta-analysis, but their methodological rigor and clinical applicability remain unclear. Objective: To provide an overview of systematic reviews with meta-analysis on interventions aimed at alleviating pain intensity in athletes, identifying knowledge gaps and appraising methodological quality. Methods: CINAHL, Embase, Epistemonikos, PubMed, Scopus, SPORTDiscus, and Cochrane Library were searched from inception to February 2025. Systematic reviews with meta-analysis of RCTs evaluating interventions to manage pain in athletes were considered. Athletes without restrictions in terms of sports, clinical, and sociodemographic characteristics were included. Overlap between reviews was calculated using the corrected covered area. Results: Twelve systematic reviews met inclusion criteria. Physical exercise modalities (e.g., gait retraining, hip strengthening), acupuncture, photo biomodulation, and topical medication showed potential benefits in reducing pain intensity. Other interventions, such as certain manual therapy techniques, platelet-rich plasma, or motor imagery, did not show consistent effects. All reviews focused solely on pain intensity, with minimal stratification by sport or clinical condition which may affect the extrapolation of meta-analyzed findings to the clinical practice. Methodological quality was often low, with flaws in reporting funding sources, lists of excluded studies, and certainty of evidence (was mostly rated as low/very low). Overlap was variable across the interventions. Conclusions: Given low/sparse certainty and minimal sport-specific analyses, no strong clinical recommendations can be made; preliminary signals favor proximal hip strengthening, gait retraining, photo biomodulation (acute soreness), and topical NSAIDs pending higher-quality syntheses. Future reviews should consider mandatory GRADE; pre-registered protocols; sport- and condition-specific analyses; and core outcome sets including multi-dimensional pain.

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