Supplementary data 1

Qualitative analysis of statements of Sports Students regarding their reasons to deal with pain in sports. Comments have been classified into categories on (i) Doing sports despite pain and injury, (ii) Physiological contexts, (iii) Pain tolerance and pain sensitivity, (iv) Decision-making process concerning injury break, (v) Personal statements and coping strategies, (vi) Conditions for sports Studies and (vii) Comments on positive effects of sport. In total, 29 comments were considered being non-substantial in regard to pain and injury, or contained personal communications as well as positive feedback, and are not reported in this file.

i. Performing sports despite pain and injury

1.1 At first I was only diagnosed with a bruised wrist. Since I wasn’t able to take more than five weeks off, I played handball again and took three practical exams (e.g. court sports, rhythmic gymnastics), thickly taped, with ibuprofen before game and training. As it didn't get any better after three months, I went to the hand surgery: I was diagnosed with a fractured scaphoid with subsequent surgery. If you have any questions, please feel free to write to me. Best regards
1.2 When I tore my ligaments last year, the pain wasn't the worst. The restriction of sports activities made it most difficult for me.
1.3 I experienced that pain and sport are usually connected.
1.4 Personally, I think it is completely normal for an athlete to have to endure pain, to some extent. Because no matter what sport it is, there are always situations that the body doesn't know about and therefore he finds it painful. A good example for this are the parallel bars in gymnastics: For a non-gymnast, this device is initially associated with pain, of course, but over time you get used to it.
1.5 Despite pain in my lower leg I passed my track and field athletics exam. For sports as a hobby, for me there no need to endure pain. Sport should be fun and not painful.
1.6 When you do sports on performance range, a slight pain that does not prevent you from training is considered to be normal. In competitive sports, the threshold for stopping training or taking a general break is clearly shifted backwards.
1.7 When it comes to achieving top athletic performance in competitions or exams, the majority of athletes agree to live with pain, as the doctor usually recommends a sports break, which is not viable at such times.
1.8 Since sports training can also be defined as the controlled destruction of the body structures, a certain amount of pain is indispensable in everyday sports at least at a certain performance level. However, a distinction must be made between intensity and perception: Pain caused by muscle soreness can thus be perceived as unpleasant, but also as satisfying (as a sign of a hard workout). However, real, intense pain always has a warning function and, in my opinion, has no right to exist at any level of sport. Whether pain should lead to the discontinuation of a training session or competition should always be the decision of the athlete.
1.9 Because of joy, motivation and pressure to train further, because one has a goal, the training or the competition is continued despite pain. Athletes think atypically, may not always have the health aspect and the best for their own body in mind at this moment, as long as it is still possible.
1.10 If it doesn't hurt too much, I just keep going, especially when it's about something (competition) or when I love the sport I'm doing!
1.11 Chronic complaints/pains accompany you for a long time. However, depending on the intensity of pain, you get used to it and can still make your everyday life and leisure time. In competitive sports, pain (more muscular than injury-related) was part of everyday life. Without them, one almost felt as if something was wrong. Concerning injury-related pain you need to assess and weigh up for oneself when it is time to think again about the structure of the surrounding structures despite the pain.
1.12 Since American football is a contact sport, pain is definitely part of it! Overcoming it is also a strong part and I have experienced that it makes you mentally stronger, at least for the game. But also a soccer game is played with light to moderate pain, which is possibly also due to the experiences from football sports.
1.13 Pain is part of sports.

ii. Psychological context

2.1 I have played handball for 15 years, but due to my studies and my home club I take a break. Whenever I had any pain in my muscles or joints, I just kept going. I tried carrying it of well. Or if I simply couldn't take any more, I took a very short break (e.g. walking back into the defence more slowly) or even continued. In addition, sport (handball) helped me a lot to psych up myself if I had problems or was in a depressed episode again. I was in my element and I was good at it. That gave me the strength to continue.
2.2 What is meant by athletic pain? I have interpreted it in such a way that it is both physiological and psychological. In the case of a marathon, the pain that can be felt (of the muscles, respiratory tract, etc.) and the pain of perseverance (psychological - "torturing yourself"). Then there is the pathological pain, due to degeneration or physiological changes caused by physical exertion. Plus the psychological pain, e.g. burnt out, tired, unmotivated, etc.
2.3 Personally, I think that the ability to endure physical pain during sports, for example, is greatly influenced by whether or not I am stressed by university/exams, complicated family matters, quarrelling with my partner, a cold, etc.
2.4 I think whoever has pain in sports or through sports does something wrong. Of course there can be injuries which you are usually more exposed to when doing sports than in everyday life. However, for me sport is something that helps against pain (headaches, mental pain, and listlessness).
2.5 I do have more psychological problems with my torn ligament than physical. I am afraid, it will happen again.
2.6 The mental pain during defeats is often much greater than the physical pain during training!
2.7 Emotional pain in failure is more difficult to cope with than physical pain. Pain goes away, success remains.

iii. Pain tolerance and pain sensitivity

3.1 Pain is relative in itself, so it's a matter of individual perception. As a gymnast, pain is part of our sport to a certain extent. But this makes it difficult to say if/when one is "really injured".
3.2 I would have added as a possible question, the extent to which pain has already occurred in accidents. I think it is crucial what pain someone has endured in order to be able to judge how he can cope with his everyday life with relatively less pain. Personally, I have already been hit by a car, have broken my vertebrae, etc. and can therefore very successfully eliminate minor pains such as two or three broken ribs or a broken nose and thus continue to play sports and cope with my everyday life without any losses.
3.3 Before my Achilles tendon rupture I also had other sports injuries (e.g. ligament ruptures). Usually, my sensation of pain is not very great for the somatic pain. Most of the time on the day of the accident and sometimes the day after, I am very annoyed that it has happened and that I am physically and sportively limited for a certain time. But then I quickly become "reasonable" and concentrate on getting well again and temporarily enjoying other things than sport in order to make my life worth living. In fact, I tend to recover quite quickly. I can handle pain well because I know that it is temporary. On the other hand (and mainly) because I consciously decide to do (so much) sport and at the same time consciously take the risk of hurting myself (as well as the positive consequences for my health). My principle is: When I make a decision, I have to live with the consequences. I am always free to reflect on the (possible) consequences, to study the pros and cons and to change my decisions. So far, however, the fun and health aspects of sport have been so important to me that I accept the possibility of injury (and therefore pain).
3.4 In my opinion, the pain tolerance becomes higher through competitive sports and one gets used to the fact that muscles, joints or other things ache regularly. Often the pain is also ignored.
3.5 I have been living for ten years with a broken vertebra in my lumbar spine due to a gymnastics accident at the vault. I can handle it very well and usually don't notice it anymore. My experience of pain has increased considerably since then.
3.6 I learned from my trainer that you shouldn't always complain about pain, especially with small things (stomach ache, etc.). Besides, there are people in the world who are much worse off than me! Due to my injury at the cruciate ligament and the training pause, I learned that you have to take such situations as they come, after all, you can't change anything in this moment. The only thing you can do: Always look positively into the future and make the best of it!
3.7 Pain (sore muscles) after sports has a rewarding effect on me.
3.8 As an athlete, in my opinion, I missed the mention of simple muscle soreness. These are pains that most people are happy to accept or even long for.

iv. Decision-making process concerning injury break

4.1 In sports studies, the feeling of being physically exhausted (a lot of training on hot days, aching muscles, pain due to too much training (shins), etc.) is simply part of it. It's up to you to assess your physical abilities and also to break off strains in time that are too strenuous on your body. In addition, one can do a lot of preventive work and should do so. Protracted sports injuries may be annoying, but even then you should not start too early again in the long run and brake yourself. One should admit one's pain and learn to deal with it as well as possible and to find one's own mediocrity between bearable, non-damaging pain and admitting the pain.
4.2 In any case, it is not bad to obey the advice of a doctor for a break of sports in order not to risk even worse injuries/pains.
4.3 I have already done sports while injured (strained ligaments/ligament strain). From experience, sports enthusiasts don’t adhere the break recommended by the doctor. Thus, you can feel the injury for a longer time and I also had some relapses.
4.4 For me personally, pain is an aspect that can often not be avoided in sport or almost 'belongs' to sport in a small way. In spite of pain, I often do sport and more or less consciously neglect my health. Since I have not had any major injuries so far, I have not had any problems during my studies. Especially during my studies to become a teacher, the demands during the semester (examinations excluded) can usually be taken with pain. What bothers me personally about my handling of pain and what I would like to change in the future is the conscientious handling of injuries (especially knee problems, which occur more frequently). This is difficult for me, because it is required both in my studies to do sports, but also privately the urge to do sports, usually outweighs the fear of health hazards.
4.5 After injuries, I often started sports much too early, so that the healing process, and thus the pain, lasted longer. Pain in sports is often neglected too much. The doctor is only consulted in case of more serious injuries. However, slight pain can also lead to incorrect posture.
4.6 If you are in pain, you should not continue to train unconditionally, but go to the doctor and follow his instructions. You have to work with the doctors to get better.

v. Personal statements and coping strategies

5.1 Sports and pain belong together. In order to perform better, one must be able to cope with pain to a certain extent.
5.2 No pain, no gain :)
5.3 For me, Pain goes with sports. Among other things, it is a sign that I have trained hard and a confirmation.
5.4 Pain is part of sports.
5.5 A brief comment on the last question: I am currently writing my Master's thesis and therefore no longer have an examination phase. During my studies I only felt pain in the area of "gymnastics". Nothing was ever diagnosed, despite repeated MRI on the knee. Meanwhile I have no more pain there. The outer ligament is due to Illiotibialis syndrome and goes away immediately after the running session in which it occurs. All in all, I survived my studies without much pain. Nice idea for a thesis!
5.6 Use common sense!
5.7 I think that I have a very good way of dealing with pain and at the same time I am rarely affected by injuries and pain. There were very few injuries due to sport, but they could be cured completely. Recently I have had some hip problems (on the right), which I can get under control through physiotherapy.
5.8 I have occasional pain during sports, but not much. I don’t participate in competitive sports and do not feel the need to continue to push my body despite pain. When certain movements hurt during sports, I simply try to avoid them.
5.9 Worst pain of my life during the operation - necessary to restore the cruciate ligament and thus the sports function.
5.10 I had a herniated disc, but I am good with it and I am almost painless.
5.11 Sometimes you just have to "clench one’s teeth and to follow through it".
5.12 As for the listlessness & fatigue mentioned in the questionnaire, it is related to my circulation (not sport). Due to the lack of energy I tend to have a bad mood. Studying helps me, despite the pain, because it encourages me to do sports (so it doesn't bother me).
5.13 Frequent muscle soreness after sports competitions.
5.14 After 16 years without big injuries, the small damper, where I had to run with crutches, did me good, but even after six weeks I am very careful and not as daring as much as before... but I gain confidence and strength.
5.15 I do have fibromyalgia. This is why I started doing sports. So I regularly do have pain, I am a pain patient, but I think it would be much worse without doing sports. Good luck for your thesis!
5.16 I've often had ligament tears, which always throw you back, but you can keep up your fitness in the gym to come through... but if you get two injuries you said “It works again!” - It’s very frustrating... But that will pass!
5.17 Pain takes you further in a way. You learn to coordinate things and to deal better with pressure and stress.
5.18 Since I got injured more and more often during my sports studies (last year five times), I learned to deal with it, but also to pull the "emergency brake" for me at a certain point. (Example: Practical examination in snow sports - injured by several falls or a strong fall before the day of the examination. This meant that only a minimal vertical movement was possible and I tried to cover the pain for my personal circumstances with a lot of ibuprofen (a total of approx. 1200mg). After the return, I was signed off work from the doctor for five weeks plus physiotherapy or lymphatic drainage. In consequence the test was, in my opinion, badly performed due to this bad conditions.

vi. Conditions for sports studies

6.1 The demands placed on sports students are in some cases exaggerated if one assumes that sports students are already active people and probably already do enough sports outside of university. I see little sense if I have to do another 8-12 hours of sports per week for the university.
6.2 At the moment I am doing an internship abroad and therefore do sport less intensively than during my studies. During my sports studies (teaching), I try to reach a relatively good level in unfamiliar sports within a short time. This is a strain that many bodies cannot withstand and then react with pain to the overload (my experience during my studies).
6.3 Pain in sports is now (unfortunately) almost normal for me. Apart from the muscle aches, injuries in sports studies happen quite quickly, especially if you take a practical course in a sport that you haven't been involved with very often before. A slight injury, such as a strain or the like, is not a bad thing in itself - it becomes annoying and problematic if you cannot train for the examination due to the injury or participate in it at all. Or you have to train under pain so that you don't have to take the course and the exam again. This can be quite frustrating in the long run, or if it happens repeatedly.
6.4 In my sports studies I have the feeling that pain is not taken seriously and you are expected to continue, regardless of symptoms. According to the motto: "Bite your teeth together and get through" (will be over sometime).
6.5 Personally, I have already taken practical exams with torn cruciate ligaments and pain, only not to lose a semester.
6.6 Had severe pain around the distal biceps tendon last year. Nevertheless, I passed the practical exams in weightlifting, bouldering and gymnastics, despite worries about injury.
6.7 Due to the necessity to keep one's body fit during sports studies, there is not only physical pressure, but also psychological pressure if it does not work as it should or injuries occur. The pressure to perform in exams then leads to the fact that one goes through the training or practical exams despite intensive pain. Personally it happened to me that I only experienced intensively fun and joy to do sports again after I had passed all exams.

vii. Comments on positive effects of sport

7.1 I think whoever has pain in sports or through sports does something wrong. Of course, there can be injuries, which you are usually more exposed to when doing sports than in everyday life. However, for me sport is something that helps against pain (headaches, mental pain, listlessness).
7.2 I have made the experience that I have become a little more conscious in dealing with my body through the beginning of my sports studies. Through lectures in physiology and anatomy, I got to know my body a little better and created consciousness.
7.3 I think that I have a very good way of dealing with pain and at the same time, I was rarely hit by injuries and pain. There were very few injuries due to sport, but I cured them completely. Recently, I have had some hip problems (on the right), which I can get under control through physiotherapy.
7.4 I have occasional pain during sports, but not much. I am not in competitive sport and do not feel the need to continue to drive my body despite pain. When certain movements hurt during sport, I simply try to avoid them.