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The Psychological Health of the Athlete Immediately Post Injury

As I sat on the couch last Saturday with a group of friends, supported by an array of chips, dips and alcoholic beverages watching my favourite AFL team the mighty Richmond Tigers, something struck me. The Game was going well until Reece Conca of the Richmond Tigers went in for a courageous tackle, I jumped up in excitement cheering for a possible turn over, and then my heart sank, Conca had stopped in his tracks and was grimacing in pain. A huge gasp could be heard from all of us watching, followed by a period of silence that seemed like a lifetime waiting for him to shake it off. He didn’t.  He was bouncing on one leg clutching at his left hamstring. It looked bad, the commentator later confirmed a complete tear of the left hamstring and he was out for not only the rest of the game but also the remainder of the season. It was at this point a friend said out loud “how would you feel? Knowing your season is over, how do you come back from that?” I found myself thinking ‘what is going through his head right now?’ And then my inner nerd kicked in ‘what are the immediate thoughts going through an athletes head when they injure themselves and what role does psychology play in an athletes recovery period?

With all the news coverage focusing on the physiological health and recovery of the athletes I was motivated to do a little research for myself and stumbled across some very interesting information. Overtime coaches and athletes, with the assistance of science, have built a strong understanding of what physiological factors are involved in a sporting injury. I was interested to discover that it is becoming more and more apparent that the immediate psychological distress that can manifest at the time of an injury can in fact hugely impact rehabilitation and the athlete’s ability to return to competitive play.[i]

Coaching staff are recognising the importance of an athletes mental state from the moment of the injury and through the entire recovery period[ii].  A lot of responsibility falls on surrounding teammates and coaching staff, relying on their ability to notice any changes in the athletes’ behaviour or mental state. [iii] At an elite level team psychologists are playing a bigger role with in the team. Current Fremantle assistant coach Simon Lloyd, was high performance manager and club psychologist at Collingwood from 2005 to 2008 and similar roles at Hawthorn previous to that[iv]. I find it very interesting that Elite Sporting teams are recruiting coaches with psychological skills, and in future blogs I will endeavour to find out exactly how people such as Simon Lloyd are utilized in high level coaching roles.  The Canberra Raiders do not in fact have a full time psychologist on their coaching staff, however, during the 2011 season a psychologist was bought in to try and combat athlete issues[v], thus highlighting the increasing recognition of psychological health and its relationship with performance management[vi].

Ranges of practices are being implemented in the sporting industry to measure the mental state of athletes. One such measure is the implementation of post injury questionnaires and interviews.[vii] Taylor and Taylor suggest that immediately post injury there are many factors that contribute, and cause possible psychological distress. These factors are; the suddenness of the injury, lack of control felt by the athlete, possible disruption to the athletes sporting goals, immediate and potential long term pain and discomfort caused and finally the uncertainty of how the injury will impact the athlete.iii Athletes have described initial reactions of fear, frustration, helplessness and interestingly anxiety as to how the coach will react to the diagnosis.  Common thoughts recorded are also, ‘Will I ever be able to play again?’ ‘Will I lose my spot on the team?’ ‘How will I financially support myself if I lose my place on the field?’ and ‘Will my teammates think I let the team down? [viii]

It has become more and more apparent that an athlete’s mental state is vital to a quick recovery. Psychologists are now used to identify issues effecting athletes mentally and to assist them in managing these issues, keeping athletes mentally and ultimately physically healthy. When an injury occurs athletes need to set themselves new and realistic goals to an appropriate timeline of rehabilitation in order to return to play. It is again the role of the psychologist to implement strategy and aid athletes in setting and hitting these goals[ix].

In regards to the role of psychology immediately after injury, the treatment choices are specific to individuals. The Athletes psychological health when injured seems to be quite strongly dependant on state of mind before the injury occurs, due to the extreme emotional impact on the athlete immediately post injury how can we develop a generic guide to go by? [x]

By Annie Gallacher


[i] Weinberg R and Gould D (2007) Foundations of Sport and Exercise Psychology. (4th ed). Human Kinetics, Champaign IL.

[ii] Shuer ML,Dietrich MS. (1997) Psychological effects of chronic injury in elite athletes. Western Journal of Medicine  Feb;166:104-109

[iii] Johnston, LH and Carroll D(2000). The Psychological Impact of Injury: Effects of Prior Sport and Exercise Involvement, British Journal of Sports Medicine, 34, 436-439.

[iv] Fremantle Football Club Coaching Staff, viewed 13 September 2013 http://www.fremantlefc.com.au/footy-centre/coaching-staff

[v] Barrett, Chris(2011) Honesty the policy for Raiders with season on the line. The Brisbane Times, viewed 13 September 2013 http://www.brisbanetimes.com.au/rugby-league/league-news/honesty-the-policy-for-raiders-with-season-on-line-20110506-1ebx3.html

[vi] Roh J.L, Perna F.M. (2000) Psychology/counseling: a universal competency in athletic training. Journal of Athletic Training. 35: 4,458–465.

[vii] Tracey, Jill(2003) The Emotional Response to the Injury and Rehabilitation Process, Journal of Applied Sport Psychology, 15: 4, 279-293

[viii] Taylor J and Taylor S (1997). Psychological Approaches to Sports Injury rehabilitation, Aspen Publishers, Maryland.

[ix]  Crossman, J(1997) Psychological Rehabilitation from Sports Injuries. The International Journal of Sports Psychology, 16, 232-237.

 

[x] Scheizer CB, Brewer BW, Cornelius AE, Van Raalte JL, Pepitas AJ et al(2001) Psychological skills and adherence to rehabilitation after reconstruction to the anterior cruciate ligament, Journal of Sport Rehabilitation, 10: 165-172

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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):

Image

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.