Persistent and recurrent musculoskeletal pain in young athletes: an overlooked biopsychosocial determinant of return to sport trajectories - a focused narrative review.

Abstract

Introduction: Persistent and recurrent musculoskeletal pain is common in young athletes, yet its role in recovery and return to sport (RTS) decision-making remains insufficiently acknowledged. In youth sport, pain is often normalized or viewed primarily through an injury-centered lens, despite its potential to shape function, participation patterns, and athletic trajectories over time.

Areas covered: This focused narrative review aimed to (1) synthesize current evidence on persistent and recurrent musculoskeletal pain in young athletes and (2) propose a developmentally informed biopsychosocial framework for understanding its implications for RTS. Electronic searches were conducted in PubMed, PsycINFO, and SPORTDiscus for studies published from 1 January 2006, through 28 February 2026, supplemented by backward and forward citation tracking and targeted hand-searching of reference lists. It integrates evidence on definitions, prevalence, clinical presentation, psychosocial and contextual factors, functional interference, and RTS decision-making, conceptualizing ongoing pain as an overlooked determinant of RTS trajectories.

Expert opinion/commentary: In young athletes, pain should not be treated as a peripheral symptom or addressed only when recovery is delayed. More informed RTS decisions require attention not only to physical recovery markers, but also to how pain is experienced, interpreted, and managed throughout recovery. A developmentally informed biopsychosocial perspective may support earlier recognition, safer return decisions, more stable participation, and better long-term health outcomes.