The Physical Trauma of Injury for Athletes: Implications for Physical Educators

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1 The Physical Trauma of Injury for Athletes: Implications for Physical Educators Frank Marino, Charles Sturt University Introduction The increasing emphasis on high level training of athletes has also seen an increase in injury rate and a consequent need for more sophisticated injury management techniques. Active participation in sport requires athletic prowess for both physical and mental components and for more elite participation the greater the physical and mental readiness needed. However, regardless of the level of participation minor and/or major injuries will occur with biological rehabilitation time being predictive to some extent. Psychological rehabilitation time is not so easily predictable and therefore to assume that it coincides with biological rehabilitation may be prudent. Sport psychologists, trainers, coaches and physical educators should be aware of at least two psychological factors in injury management. The first is to be able to identify life stress events that may predispose athletes to injury and secondly to be able to identify and evaluate psychological reactions to injury. The former has been researched to some degree. Hardy and Riehl (1988) found that injured athletes had significantly higher negative life stress than uninjured athletes and that athletes who reported high total life changes were injured more frequently than those with lower total life changes. This was also supported by Hanson, McCullagh and Tonymon (1992) finding that negative life stress increases the severity of injury. Kerr and Minden (1988) also found that as competition approaches a pattern of increasing injuries are evident suggesting that psychological intensity rises provoking a stress-injury relationship. Chan and Crossman (1988) have found that some psychological characteristics exist in marathon runners who have been deprived of running due to injury. It has been suggested by Rotella and Heyman (pp , 1993) that there is a common sequence of psychological reactions similar to the reactions put forward by Kubler-Ross On Death and Dying (1969). The reactions include (1) disbelief, denial; (2) anger; (3) bargaining; (4) depression; and (5) acceptance and resignation. The purpose of this study was to identify the psychological parameters in an athletic population as outlined by Rotella and Heyman (1992) and secondly to identify various psycho-injury

2 relationships. Method There are no published inventories at the time of this study that measure the psychological variables associated with the occurrence of injury other than the Profile of Mood States inventory (POMS) that was not considered appropriate given the variables under question. A pilot study was conducted to clarify the types of variables that needed assessment. The subjects were 131 college age physical education students (91 males, 40 females). Their ages ranged from 18 to 40 years with a mean and standard deviation of years. Each subject completed a questionnaire in classroom settings designed to assess psychological variables associated with injury. The questionnaire consisted of two parts, the first being general questions regarding age, sex, type of injury, sport played and whether there was a need for surgery. The second part of the questionnaire consisted of 14 items to be ranked on a 5 point Likert scale (1= strongly agree (SA), 2= agree (A), 3= undecided (U), 4= disagree (D), 5=strongly disagree (SD) ). The questions asked pertained to pain, disruption to mobility, rehabilitation time, disruption to normal everyday activities, injury occurrence during contact sport, apprehension, concern for functional capacity in later years, concern for injury recurrence, denial, frustration, bargaining, depression and acceptance. Results Frequencies of responses indicate that the majority of injuries were ruptured ligament/tendon (29.8%), breaks (27.5%) and sprains (18.3%, see figure 1) with only 29 of the 131 respondents requiring surgery. The responses to Likert items were grouped as either positive (SA,A), Undecided (U), and Negative (SD,D). Frequencies for the responses to psychological variables indicate a strong concern for disruption to mobility and everyday activities (figure 2), time in rehabilitation (figure 3), concern for injury recurrence (figure 4), concern for functional capacity later in life (figure 5), denial, frustration (figure 6), bargaining, depression (figure 7) and acceptance of injury. Correlation coefficients were generated for selected variables with moderate but significant relationships obtained between level of pain and disruption to mobility (r=.49, p<.001) indicating that the higher the perceived level of pain the

3 greater the disruption to mobility. The association between rehabilitation time and disruption to everyday activities (r=.41, p<.001) and rehabilitation time and depression (r=.42, p<.001) indicate that the injury per se may not be a cause for depression but rather a function of time spent in rehabilitation. A moderate but significant relationship was found between concern for injury recurrence and concern for functional capacity later in life (r=.51, p<.001) indicating that the higher the predisposition for injury recurrence the greater the concern for functional capacity in later years. Correlation coefficients between the type of injury and psychological variables did not yield significant results indicating that type of injury may not be associated with subsequent psychological distress. Stepwise multiple regression equations were computed on selected psychological variables. The predictor variables were concern for functional capacity in later years, depression and frustration. The regression for functional capacity in later years proved to be significant, F(3,127)=21.51, p<.00001, R2=33.7% with the best predictor being concern for injury recurrence. The interpretation of this model suggests that feelings towards injury recurrence are positively related to concern for functional capacity in later years. The regression on depression was also significant, F(3,127)=16.84, p<.00001, R2=28.5% with rehabilitation time being the best predictor. This indicates that a reduction in rehabilitation time may alleviate the overall effect the injury may have on depression as psychological distress. The regression on frustration also yielded significant results, F(3,127)=13.08, p<.00001, R2=23.6%, depression being the best predictor indicating that depression is positively related to the amount of frustration experienced after injury. Discussion The findings of the present study indicate that there are particular psychological characteristics that injured athletes experience. The data indicate that ruptured ligament/tendon type injuries are most prevalent with breaks and sprains having lesser occurrence. Since the results of this investigation did not yield a significant correlation between the type of injury and any particular psychological variable it would be logical to assume that type of injury is not a major factor in the psychological distress of these athletes but rather, pain due to

4 injury and subsequent disruption to mobility are the overriding factors. Perhaps the most important findings of this study are the psychological characteristics displayed by this sample. The questions related to denial, frustration, depression, and acceptance of the seriousness of the injury all rated positive in terms of percentage responses (SA,A) giving credence to the model proposed by Rotella and Heyman (1992). On the other hand the characteristic addressing bargaining in terms of giving away the sport that caused the injury was ranked negatively by the majority of the respondents (SD,D). The authors postulate that this is a function of age since it would be reasonable to assume that the younger population in this sample are unlikely to give away a sport that may have financial rewards at some later time. A characteristic that has not appeared previously in the literature is the concern that the respondents show regarding their functional capacity in later years. Since this characteristic was associated with a concern for injury recurrence there may be implications with respect to ongoing stress during sport participation. Anderson and Williams (1988) have indicated that stress may be a contributor to a narrowing of the visual field giving way to irrelevant information. It has also been noted that there may be an increase in generalized muscle tension. Given these two factors, athletes that experience a continual concern for reinjury while participating may be in a reinjury-stress mode increasing the likelihood of injury. Furthermore, Nideffer (1983) has indicated a clear link between the anticipation of injury and the subsequent physiological changes such as, increases in respiration, heart rate, blood pressure and muscle tension thereby compromising fine motor movement, timing and joint flexibility. Psychological changes such as a decrease in the ability to shift attention may lead to decision making problems. It has been shown by Chan and Grossman (1988) that prevention from running in marathoners due to injury leads to significant psychological and emotional distress compared to subjects with no restriction. In particular depression-dejection and tension-anxiety rated lower in the profile of mood states (POMS). In the present study frustration and depression were also an important variable with rehabilitation time being an important predictor. Thus, the implication being that the greater the time spent in rehabilitation the greater the awareness of the possibility of weight gain, muscle atrophy and time away from participation that may have a direct negative effect on selfesteem and body image as indicated by Eldridge (1983), Chan and Grossman (1988).

5 The majority of respondents (55.8%) underestimated the seriousness of the injury whereas 24.4% were undecided as to the seriousness of the injury. The data supports that of Crossman, Jamieson and Hume (1990) that athletes in some cases significantly underestimate the disruptive effects of the injury. The rationale offered by Crossman et al. (1990) are that higher level athletes have generally learned to ignore various minor injuries and therefore tend to underestimate the potential effect an injury may have on training and performance. Given that the present sample are college age physical education students and are continuously involved in physical activity this assertion may hold true. Limitations Since subjects were asked to review past events memory and recall may contaminate the actual reporting and ranking of the psychological variables however, a more prospective type investigation may call for anticipation of psychological effects which, may be representative of initial feelings rather than total time course feelings. Conclusion Generally the psychological reactions to injury as put forward by Rotella and Heyman (1992) seem a reasonable model in light of the limited research however, our findings suggest that bargaining is not a crucial variable in the context of giving the sport away. There are certain psychological variables that need attention such as concern for functional capacity in later years in which case the attending physician should have responsibility for informing the patient about expectations and limitations of the injury. The physical educator and/or trainer should empathize with the injured individual and that rehabilitation time need not be spent at home away from the team or training per se but rather the individual should be made a functional part of training in some way so as to minimize time away from their sport and to alleviate some psychological distress such as frustration and depression. References Anderson, M. & Williams, J. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport & Exercise Psychology, 10, Chan, C. & Grossman, H. (1988). Psychological effects of running loss on consistent runners. Perceptual and Motor Skills, 66, 875-

6 883. Crossman, J. Jamieson, J. & Hume, M. (1990). Perception of athletic injuries by athletes, coaches, and medical professionals. Perceptual and Motor Skills, 71, Eldridge, W. (1983). The importance of psychotherapy for athletic related orthopedic injuries among adults.international Journal of Sport Psychology, 14, Hanson, S., McCullagh, P. & Tonymon, P. (1992). The relationship of personality characteristics, life, stress, and coping resources to athletic injury. Journal of Sport & Exercise Psychology, 14, Hardy, C. & Rich, R. (1988). An examination of the life stressinjury relationship among noncontact sport participants. Behavioral Medicine, 14(3), Kerr, G. & Minden, H. (1988). Psychological factors related to the occurrence of athletic injuries. Journal of Sport & exercise Psychology, 10, Nideffer, R. (1983). The injured athlete: Psychological factors in treatment. Orthopedic Clinics of North America, 14(2), Rotella, R. & Heyman, S. (1993). Stress, injury, and the psychological rehabilitation of athletes. In Applied Sport Psychology (pp ). ed. J.M. Williams, Mountain View:Mayfield Publishing Company.

7 ABSTRACT The Psychological Trauma of Injury for Athletes: Implications for Physical Educators. The increasing emphasis on high level training of athletes has also seen an increase in injury rate and a consequent need for sophisticated injury management techniques. It is questionable whether physical educators, coaches and trainers are equipped to handle or recognize the psychological trauma associated with injury. The study reported in this paper assess the psychological effects of injury in an athletic population. A questionnaire was administered to college age physical education students which asked them to consider the circumstances surrounding their injuries. Descriptive statistics, correlation coefficients and stepwise regression equations were utilized with significant findings pertaining to several psychological variables. In particular rehabilitation time, and concern for mobility in later years. The subjects generally exhibit the common sequence of predictable psychological reactions to injury. This has major implications for physical education and coaching specialists in terms of awareness, recognition and management of psychological trauma related to injury. The Psychological Trauma of Injury for Athletes: Implications for Physical Educators. Frank Marino Charles Sturt University - Bathurst c/- Physical Education & Recreation Centre Panorama Ave Bathurst NSW 2795

8 Conrad Raine The Australian College of Physical Education c/- 57 Edwin St Croydon NSW 2132 Figure 1. illustrating the percentage of injuries reported Figure 2. illustrating percentage responses to disruption to everyday activities Figure 3. illustrating the percentage responses for the perception of time spent in rehabilitation Figure 4. illustrating the percentage responses for concern for injury recurrence Figure 5. illustrating the percentage responses for the concern of functional capacity in later years.

9 Figure 6. illustrating the percentage responses for the perception of frustration during injury. Figure 7. illustrating the percentage responses for the perception of depression during injury. PAGE12