Psychology of Sports Injuries. Leonie Lightfoot England Athletics Coach Development Manager BASES Probationary Sport Scientist

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2 Psychology of Sports Injuries Leonie Lightfoot England Athletics Coach Development Manager BASES Probationary Sport Scientist

3 This afternoon s session Explain the importance of dealing with injuries using an interdisciplinary approach Understand the psychological factors predisposing an athlete to injury Identify and explain the psychological reactions to injury Be aware of factors affecting the rehabilitation process Have knowledge of appropriate interventions regarding injury prevention and treatment

4 Interdisciplinary Approach Physiology Biomechanics Psychology Sports Injury

5 Interdisciplinary Approach Biomechanical Perspective Injuries occur due to failure of some biological structure Failure will have occurred because the application of force was more than the body was able to adapt to Biomechanists investigate.. - magnitude, direction and distribution of force - force loading - frequency of application

6 Interdisciplinary Approach Physiological Perspective Strength the ability to produce and withstand force placed on the body Flexibility ability to move joints through a full range of motion Fatigue Overuse injuries and their production is complicated BUT - If tissues are strong, moderately flexible and not fatigued, we have a better chance of not getting injured

7 Interdisciplinary Approach Psychological Perspective Predisposition to injury: identify those at greater risk Reaction to Injury: understand typical responses of athletes Rehabilitation : optimising recovery speed of recovery and maintenance of performance levels

8 Discuss.. What are some of the psychological issues associated with injury that you may have encountered?

9 Pre-disposition to Injury

10 Stress and Injury Model Potentially stressful athletic situation Stress Response Cognitive Physiological/ Appraisals Attentional changes Injury Williams and Andersen (1998)

11 Stress and Injury Model Any cognitive appraisal that leads to the stress response puts an athlete at risk of injury e.g. perceived stress due to competition situation Physiological/ Attentional Changes: Excessive muscle tension Attentional style narrows Decision making decrements

12 Stress and Injury Model Personality History of Stressors Coping Resources Potentially stressful athletic situation Cognitive Appraisals Stress Response Physiological/ Attentional Changes Injury Interventions Williams and Andersen (1998)

13 Stress and Injury Model Personality Factors Not directly related to injury but related to how an athlete reacts to stress response Hardiness, locus of control, competitive trait anxiety, intrinsic motivation Coping Resources Any behaviour which assists an individual to deal with a stressful situation Social support, stress management techniques, attentional strategy

14 Stress and Injury Model History of Stressors Life stress is related to the incidence of illness Positive Life Stress studying for exams, raising a family Negative Life Stress divorce, death in family, job loss More life stress is associated with greater incidence and severity of injury (Patterson et al,1998)

15 Stress and Injury Model Previous Injury Worries about recurrence of injury e.g. whether or not they have fully recovered, are vulnerable to further injury Distracted and inappropriately focussed during comp Protecting an injury can lead to altered mechanics BUT lessons learnt from mistakes associated with past injury can also lower the probability of future injury

16 Case Studies Identify potential causes of a stress response in this individual What life stressors are they likely to experience? What potential sources of social support can you identify?

17 Application Understanding these factors can be helpful in helping coaches to identify at risk individuals Assisting athletes in developing coping skills and supportive social relationships will help deal with a potentially stressful event Interventions : -prevent stress response Change cognitive appraisal Modify physiological/attentional aspects of stress response

18 Impact of Injury Far more than physical Confidence Self Esteem Sense of Identity The way an athlete reacts emotionally to an injury can impact on physical recovery

19 Responses to Injury Stage Model 5 Stages of emotional response (Kubler Ross 1969) Denial refusal to accept Anger Why me? Bargaining Prayers/offer to change lifestyle Depression Deep grieving Acceptance Accepts fate Rotella (1985) Injury is seen as a symbolic loss by athlete predictable sequence of emotional changes on way to recovery BUT does not account for variations between individual athletes

20 Responses to Injury Cognitive Appraisal Models Stress and coping approaches : Emotional + behavioural response to any physical trauma is determined by their interpretation (appraisal) of the situation (Lazarus, 1993) Individual differences (Lazarus and Folkman, 1984) Factors affecting appraisal: Experience of previous injuries Adequacy of coping resources Uncertainty of situation Percieved control over the setback

21 Personal factors (psychological and/or historical characteristics Situational factors (injury related and social/environmental characteristics such as stressful life events) Cognitive Appraisal (interpretation of injury) Emotional Response (e.g. anger, depression) Behavioural Response (adherence to rehab programmes) Moran (2004)

22 Reactions to Injury Identity loss Large commitment to sport its their life! Role Change Fear and Anxiety Uncertain future Less perceived ability to cope =anxiety Free time to think = doubts = affect healing

23 Reactions to Injury Separation and loneliness Can no longer train with squad Time to fill Loss of confidence/ performance decrements Feel indestructable/powerful Injury=vulnerability Return before physically/ psychologically ready could prompt re-injury

24 Injury Prevention and Rehabilitation Interventions

25 Imagery Facilitate relaxation, reduce stress and potential for injury Facilitate the healing process Control pain by association and dissociation Maintain skill during rehabilitation through mental practice Block replay or rumination of the injury incident which may have a negative impact on recovery

26 Healing Imagery I had developed a bone spur on my right heel. My achillies tendon became so sore as a result that I could not bear the pressure of my shoe against it..the doctor x-rayed it and told me that I had 2 options, an operation which would have a 50% chance of running again or I could just stop running! Subsequently consulted an osteopath and naturopath He suggested that I imagine the spur dissolving, and then to imagine my heel in the healthy shape that I would like it to be. I did this half a dozen times in the next couple of weeks, while continuing the treatment. I went back to see him a few weeks later and during the course of the examination he stopped to check which heel is it? I have not had a single day off from heel pain since, and that was twenty years ago.

27 Positive Self Talk Identify most common irrational thoughts e.g. I ll never get better, this is hopeless Identify when they are most likely to occur Replace with a positive statement e.g. this injury gives me the opportunity to work on my weaknesses

28 Rehabilitation Interventions Rapport Understand the injury from the athlete s point of view Positive outlook, chance to learn new mental skills Education Knowledge of their injury Knowledge of recovery process Typical reactions to injury Recovery is rarely smooth!

29 Rehabilitation Interventions Goal Setting LT goal injury recovery and full participation in sport Intermediate stepping stones to full fitness should be agreed with the athlete Positively phrased ST goals are recommended to ensure optimal motivation for daily rehabilitation schedule Over compliance and under compliance Action plans for setbacks

30 Rehabilitation Process Spare Time Management Compare training before the injury to training after Fill the gap Life Stress Management Life stress at time of injury? Educate/help if problem is ongoing

31 Rehabilitation Interventions Social Support Identify people who can provide support and encouragement during the recovery process Medical team, coach, training partners, family, friends Technical Support Emotional Support Educate social support groups Contact with athlete who has had same injury Integrate athlete into club

32 Questions?