Injury Prevention & Psychology

Athletic competitive sports stress both the body and the mind (Naylor, 2009). Although it is easy to identify injured body parts during a collision in sport, the psychological stresses that athletes experience are not as obvious (Naylor, 2009). But just as insufficient rehabilitation increases the risk for re-injury, an athlete may be inadequately prepared for the demands of a certain sport if mental aspects are not implemented in an injury prevention training program (Naylor, 2009).Prevention is the action of stopping something from happening (Australian Pocket Oxford Dictionary, 2007) and this seems to be a continuous challenge to sports medicine (Hanson, McCullagh & Tonymon, 1992; Johnson, 2006). Derived from a number of studies, the most common psychological factors that influence the risk of injury include:

  • low self-esteem,
  • no confidence,
  • low motivation levels,
  • history of stressors,
  • coping resources and
  • certain personality characteristics such as high state-trait anxiety, negative attitudes, behaviours, mood states and in particular high stress responses (Andersen & Williams, 1988; Hanson, McCullagh & Tonymon, 1992; Lavallee & Flint, 1996; Larson, 1998; Maddison & Prapavessis, 2005; Johnson, 2006). It is therefore crucial that coaches or fitness professionals identify and understand how to implement all possible mental strategies during training sessions to prevent the risk of injury.

Based on a substantial history of literature, the most influential and subsequently revised stress-injury model was created by Andersen & Williams (1988) and aimed at predicting the occurrence of sport injury. The purpose of the model is to examine a representation of injury which involves intrapersonal, physiological, cognitive, attention, social, behavioural and stress history variables that may influence injury occurrence (Andersen & Williams, 1988). It hypothesizes that individuals that have a history of many stressors (life events, daily hassles, previous injuries) with certain personality characteristics, such as locus of control, hardiness and trait anxiety, tend to aggravate the stress response, and with few coping resources (social support system, general coping behaviours, stress management) in a highly stressful scenario, will more likely judge the situation as stressful (Andersen & Williams, 1988; Johnson, 2006). Consequently, they will show signs of greater muscle tension, attention disruption and perceptual narrowing on the field and thus be at greater risk of injury compared to athletes who have the opposite profile (Andersen & Williams, 1988; Johnson, 2006).

It is therefore evident that the implementation and assessment of controlled interventions for preventing injury in a sport setting is an important aspect in improving athletic performance. Andersen & Williams (1988) stress-injury model includes possible prevention interventions such as cognitive restructuring, concentration training, imagery rehearsal and mediation.

An intervention strategy that has been reported to be most effective is relaxation (Walsh, 2011). Relaxation refers to changes in the body that produce the opposite effects of the “fight or flight” response triggered by the sympathetic nervous system (Walsh, 2011). It is specifically associated with decreases in heart rate, respiration rate, oxygen consumption and skeletal muscle activity but it also increases production of alpha brain waves and skin resistance (Gould & Udry, 1994). It has become an attractive approach for stress reduction due to its ability to bring physiological functions under control as well as increases in self-efficacy and other cognitive variables (Gould & Udry, 1994). In theory, preventing injury and enhancing performance is possible via relaxation training but only limited studies provide evidence that do not produce strong conclusions. There also seems to be a lot of empirical support between psychological factors and injury outcome but the relationship between intervention programs and athletic performance are sparsely documented. It is therefore evident that future research must investigate further into the effectiveness of psychological prevention programs such as relaxation training to increase an athlete’s sporting performance.

Below is the model of stress-injury created by Andersen and Williams (1988):


By Vanessa Gaynor



Reference List

  • Andersen, M.B., & Williams, J.M (1988). A Model of Stress and Athletic Injury: Prediction and Prevention. Journal Of Sport & Exercise Psychology, 10(3), 294-306.
  • Andersen, M.B. (1989), April). Psychosocial factors and changes in peripheral vision, muscle tension, and fine motor skills during stress. Dissertation Abstracts International, 49,
  • Gould, D., & Udry, E. (1994). Psychological skills for enhancing performance: Arousal regulation strategies. Medicine and science in sports and exercise,26(4), 478-485.
  • Hanson, S. J., McCullagh, P., & Tonymon, P. (1992). The relationship of personality characteristics, life stress, and coping resources to athletic injury. Journal Of Sport & Exercise Psychology, 14(3), 262-272.
  • Johnson, U. (2006). Sport injury, psychology and intervention: an overview of empirical findings. Int J Sport Exercise Psychol57, 1-10.
  • Larson, G. A. (1998). Psychosocial Variables: Predicting and Preventing Athletic Injury. Athletic Therapy Today, 3(1), 7-11.
  • Lavallee, L. L., & Flint, F. F. (1996). The relationship of stress, competitive anxiety, mood state, and social support to athletic injury. Journal Of Athletic Training, 31(4), 296-299.
  • Maddison, R., & Prapavessis, H. (2005). A Psychological Approach to the Prediction and Prevention of Athletic Injury. Journal Of Sport & Exercise Psychology, 27(3), 289.
  • Naylor, A. H. (2009).The Role of Mental Training in Injury Prevention. Athletic Therapy Today, 14(2), 27-29
  • Walsh, A.E. (2011). The Relaxation Response. A Strategy to Address Stress. International Journal Of Athletic Therapy & Training, 16(2), 20-23.

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