Is there a solution in preventing injury by managing stress?

The ability to regulate one’s own level of emotional response often influences an athlete’s performance in a positive or a negative way (Gould & Udry, 1994) which can increase risk of injury in sports events and competitions at any level (Pensgaard & Ursin, 1998). The existence of stress is not the concern rather it is the manner in which the athletes manage the stress to prevent the occurrence of injury is what matters most. Approximately 50% of reported stress experiences occur before competition, therefore this indicates that athletes need to be adequately prepared to face this period with suitable strategies to prevent injury (Pensgaard & Ursin, 1998). Many researchers claim that psychological interventions could prevent or reduce injuries in sport (Andersen & Williams, 1988; Pensgaard & Ursin, 1998; Gould & Udry, 1994). But in terms of long-term benefits these interventions are primarily dependent on whether the athletes and coaches implement and adhere to the injury prevention behaviours (Chan & Hagger, 2012).

Andersen and Williams (1988) proposed model of stress and athletic injury suggests that it is influenced by psychological interventions such as cognitive restructuring, relaxation skills, autogenic training and imagery/mental rehearsal. These interventions have been shown to work reasonably well in managing stress in clinical settings but do they prevent injury from occurring during competition or at all??

Cognitive restructuring focuses on replacing negative self-statements and images with positive self-affirmations and images of performance that is desired (Gould & Udry, 1994). This intervention has been associated with superior performance in elite athletes but definite conclusions are not evident (Gould & Udry, 1994; Naylor, 2009). Studies have reported the effectiveness of lowering arousal states but have not examined injury prevention as a dependent variable.

Progressive muscle relaxation is a type of relaxation training that focuses on continuously tensing and relaxing the individual muscle groups in the body (Hanafi, Hashim & Ghosh, 2011). Engaging in this exercise helps individuals develop body awareness and educates them how to release muscle tension (Hashim & Yusof, 2011).Although it is apparent that relaxation training promotes enhanced performance in athletes by reducing stress levels, research only indicated that it reduced injury rates, it did not prevent injury from occurring.

Autogenic training is based on passive concentration of bodily perceptions that are facilitated by exercises to control one’s own body and distress signs. It consists of self-suggestion of heaviness and warmth of arms, legs, and abdomen, rhythm of breath and heartbeat (Farne & Jimenez-Munoz, 2000). In many sports, athletes are subjected to autogenic training as a relaxation technique included in their mental training (Takai, Saijo & Kusumoto, 2009). Although advantageous are obvious by the results shown in the Table 1, there is no evidence in current literature to suggest that this intervention actually prevents or even reduces injuries in athletes.

Imagery rehearsal, also known as mental skills training is defined as consistent rehearsal of a physical task in the mind in the absence of any gross muscular movement to achieve a desired result (Kendall, Hrycaiko, Martin & Kendall, 1990). An example includes mentally practicing a tennis stroke. Literature suggests that practice of imagery enhances performance more than not practicing at all (Warner & McNeill, 1988). Imagery rehearsal combined with progressive relaxation seemed to reduce swimming injuries by 55% and football injuries by 33% (Davis, 1991). Although enhanced performance is evident, studies in this area contain too many practical tasks and individual differences to draw definitive conclusions on its effects of preventing injury. No literature into the effects during game situations or competition performances was identified, only clinical trials.

Limitations of past research are evident when examining the stress-injury relationship. Firstly, most research only investigates a single cause of injury, preventing the complexity of potential responses and secondly, there has been a lack of reports indicating severity of the injury. Individual differences also need to be taken into consideration. In theory, reducing injury rates and enhancing performance is possible via these interventions but only limited studies provide evidence that do not produce strong conclusions. Future research must investigate further into the effectiveness of psychological prevention programs with a specific focus on prevention of athletic injury to enhance sporting performance.

 Table 1: Shows the advantages and disadvantages of the interventions mentioned within the stress-injury model created by Andersen & Williams (1988).




Cognitive Restructuring-Stress Management Training (Gould & Udry, 1994; Johnson, 2006; Johnson, Ekengren & Andersen, 2005; Warner & McNeill, 1988) ↑Concentration, ↑Brain Activity, ↑Awareness, ↓Negative thoughts, ↓Thought disruption, ↓Injury rates, Easily taught, No special equipment required -decreases in number of injuries only prevalent during intervention period-only works for some individuals in some situations
Relaxation Training-Progressive Muscle Relaxation (Walsh, 2011; Gould & Udry, 1994; Warner & McNeill, 1988) ↓Heart Rate, ↓Breathing Rate, ↓Blood Pressure, ↓Muscle Tension, ↓Stress related hormones, ↑Self Efficacy, ↑Attention Span, ↑Positive Mood, ↓Depression, ↓Injury rates, Easily taught, No special equipment required -↓ injury risk but does not prevent injury in sport.-Only short term effects observed in research, not enough research on long-term effects-Inconsistent evidence on the number of sessions required before mastery of technique is achieved.
Autogenic Training (Farne & Jimenez-Munoz, 2000; Warner & McNeill, 1988) ↑Self efficacy, ↑ Self esteem, ↑Skin temperature, ↑Nerve activity, ↑Positive Mood, ↓Emotional tension, ↓Respiratory rate, ↓Depression, ↓Stress levels, Regulates blood circulation, Easily taught, No special equipment required -Must be combined with other therapies to be effective-Takes one to two months to become sensitive to the warmth and weight of one’s body.-Motivation therefore needs to be acquired by athlete to gain results.
Imagery/Mental Rehearsal/Meditation (Kendall, Hrycaiko, Martin & Kendall, 1990; Johnson, 2006; Hecker & Kaszor, 1988; Warner & McNeill, 1988)  ↑Self-confidence, ↑Self-control, ↑Focus, ↓Blood Pressure, ↑Brain activity, ↓Stress levels, ↓Thought disruption, ↓Injury rates when combined with progressive muscle relaxation training, Easily taught, No special equipment required -Works better in experienced performers than novice-Imagery combined with relaxation is more effective than imagery alone.-Evidence of slow process to achieve results therefore less motivation by athletes can be seen.-Coaches cannot see how the patient is practicing and thus there is little opportunity for correction.

By Vanessa Gaynor

Reference List

  • Andersen, M. B., & Williams, J. M. (2007). A model of stress and athletic injury: Prediction and prevention. D. M, Smith, Bar-Eli, Essential readings in sport and exercise psychology. Champaign, IL: Human Kinetics, 325-330.
  • Chan, D. K. C., & Hagger, M. S. (2012). Transcontextual Development of Motivation in Sport Injury Prevention Among Elite Athletes. Journal of Sport and Exercise Psychology34(5), 661.
  • Davis, J. O. (1991). Sports injuries and stress management: An opportunity for research. The Sport Psychologist.
  • Farne, M. A., & Jimenez-Munoz, N. (2000). Personality changes induced by autogenic training practice. Stress and Health16(4), 263-268.
  • Hanafi, H., Hashim, H., & Ghosh, A. (2011). Comparison of Long-term Effects of Two Types of Relaxation Techniques on Choice Reaction Time and Selected Psychophysiological Variables Following Repeated Sub-maximal Iintensity Exercises in School Level Athletes. International Journal Of Applied Sports Sciences23(1), 183-197.
  • Hashim, H., & Yusof, H. (2011). The Effects of Progressive Muscle Relaxation and Autogenic Relaxation on Young Soccer Players’ Mood States. Asian Journal of Sports Medicine2(2).
  • Hecker, J. E., & Kaczor, L. M. (1988). Application of imagery theory to sport psychology: Some preliminary findings. Journal of Sport & Exercise Psychology10(4), 363.
  • Johnson, U., Ekengren, J., & Andersen, M. B. (2005). Injury prevention in Sweden: Helping soccer players at risk (Doctoral dissertation, Human Kinetics Publishers).
  • Johnson, U. (2006). Sport injury, psychology and intervention: an overview of empirical findings. Int J Sport Exercise Psychol57, 1-10.
  • Kendall, G., Hrycaiko, D., Martin, G. L., & Kendall, T. (1990). The effects of an imagery rehearsal, relaxation, and self-talk package on basketball game performance. Journal of sport & exercise psychology.
  • Naylor, A. H. (2009).The Role of Mental Training in Injury Prevention. Athletic Therapy Today, 14(2), 27-29
  • Pensgaard, A. M., & Ursin, H. (1998). Stress, control, and coping in elite athletes. Scandinavian journal of medicine & science in sports8(3), 183-189.
  • Takai, H., Saijo, O., & Kusumoto, Y. (2009). A Comparison of Psychological and Physiological Responses to Autogenic Training and Autogenic Feedback Training: The Response of Athletes New to Autogenic Training. International Journal Of Sport & Health Science7(2009), 50-58.
  • Walsh, A. E. (2011). The Relaxation Response: A Strategy to Address Stress. International Journal Of Athletic Therapy & Training. 16(2). 20-23.
  • Warner, L., & McNeill, M. E. (1988). Mental imagery and its potential for physical therapy. Physical Therapy68(4), 516-521.

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