In gymnastics, every detail and line is highlighted. Those recovering from injury use flesh-colored athletic tape to be less distinguishable. Competing to achieve flawless execution — the Perfect 10 — is part of the environment of the sport. But that pursuit might come with a price: According to the recently released NCAA National Study on Substance Use Habits of College Student-Athletes, the proportion of women’s gymnasts who reported using narcotic pain medications — nearly 18 percent — is the highest among student-athletes in any sport.

Overall, the use of pain medication, both prescribed and nonprescribed, has decreased among student-athletes since the release of the last NCAA substance use study in 2014, but health care professionals still are examining how best to manage pain among college athletes. The NCAA Sport Science Institute will host the Summit on Pain Management in the Collegiate Athlete this July in Indianapolis. NCAA Chief Medical Officer Brian Hainline hopes the summit leads to pain management recommendations for member schools.

In the meantime, gymnasts continue to have a unique relationship with pain. “Many gymnasts have high perfection needs and tend to be high achievers in and out of the gym,” says Chris Carr, a sport and performance psychologist at St. Vincent Medical Group in Indianapolis, “and with many of those athletes you may have underlying tendencies of anxiety and managing pain.”

College athletes who used narcotic pain medication in the past year: