Injury Occurrence and Psychological Risk Factors in Junior Football Players

World Journal of Sport Sciences 6 (4): 401-405, 2012 ISSN 2078-4724 IDOSI Publications, 2012 DOI: 10.5829/idosi.wjss.2012.6.4.1155 Injury Occurrence and Psychological Risk Factors in Junior Football Players Mohammad Hossein Alizadeh, Ali Pashabadi, Seied Mohammad Hosseini and Mehdi Shahbazi Faculty of Physical Education and Sport sciences, University of Tehran, Tehran, Iran Abstract: Football is a popular sport with a large number of injuries. It is necessary to understand injury risk factors to identify the injury-prone athletes and to develop injury prevention plans. Most studies have addressed physical and biomechanical risk factors but nowadays psychological factors are mentioned as an important risk factor predictor. The aim of the present study was to examine the psychological factors that could increase the injury risk among football players. Eighty one junior male football players (16-20 years old) completed Competitive State Anxiety Inventory (CSAI-2) and previous injury questionnaire. The results of Pearson correlation analysis revealed significant relationships between injury occurrence, cognitive anxiety (p<0.05) and somatic anxiety (p<0.05) but no significant relationship was found with self-confidence (p>0.05). It can be concluded that cognitive and somatic anxiety may increase the injury occurrence due to poor concentration and physiological changes. The findings support suggestions that psychological factors can be used to predict injury occurrence and anxiety was the predictor of injuries in junior football players. Key words: Soccer % Sport injury % Psychological predictor factor % Anxiety % Injury risk factor INTRODUCTION instability [10,11], lower extremity strength [11-13], muscular imbalances [12], decreased range of motion [14], Football is probably the most popular sport previous injuries and inadequate rehabilitation [2,14-16]. worldwide, with a growing interest and an increasing Some researchers have suggested that certain athletes, as number of players. It is a contact sport and challenges a result of their personality traits, have a particular physical fitness by requiring a variety of skills with tendency towards injury and individuals psychological different intensities. Nevertheless, football is also state could be related to the injury occurrence [17-18]. associated with a large number of injuries [1]. Hagglund Williams and Andersen (2007) found in a review of 40 (2007) stated that 65%-95% of Swedish elite male football empirical studies that 85% of those researches showed a players encounter at least one injury every year [2]. positive relationship between life-event stress and injury International football players reported an injury frequency risk [19]. of 9.4 injuries /1000 h of football practice [3]. Some models try to establish a connection between It is obvious that injuries have a significant impact on psychological b ackground and the occurrence of individual and team performance [4]. Understanding injury sport injuries. One of the most well known models is risk factors are essential to identify the injury-prone Williams and Andersen s (1998) stress-injury model. athletes and to develop injury prevention strategies. As The model posits the effects of psychological risk injury causation is usually complex, risk factors must be factors on injuries and other sport-related health recognized before interventions are being developed. outcomes. According to this model, injuries are mediated Interest in understanding sport injuries has led to the by the cumulative effect of acute and/or chronic general conclusion that two major factors influence sport physiological stress responses. This model posited that injury vulnerability: external factors; for instance, type of increased autonomic nervous system activation and sport, weather conditions and player s position [5] and possible simultaneous behavioral disruptions (e.g. sleep internal factors; for example, physiological and disturbance) resulted from heightened negative affect and psychological factors [6]. may act in synergy with the demands of heavy exercise to Most studies have addressed physical and increase risk of illness and injury [19]. Negative emotionbiomechanical risk factors, e.g. abnormal joint kinetics and linked increase in stress hormones (i.e. cortisol) may kinematics [7-9], joint laxity, mechanical or functional widen or prolong susceptibility to injury that is created Corresponding Author: Seied Mohammad Hosseini, Faculty of Physical Education, Tehran University, Tehran, Iran. 401

by high-intensity and high-volume training [20]. Williams decreased risk of injury among athletes and to make and Andersen (1998) divided risk factors into three main recommendations to sport medicine teams and categories: personality, history of stressors and coping coaches to prevent injuries. The aim of the present resources. Personality can affect what situations an study was to examine psychological factors that could athlete apprehends as stressful [19]. increase the injury risk among Iranian junior football Other models are Model of the influence of players. psychological factors on sports injury by Junge (2000), with three distinct psychological categories including MATERIALS AND METHODS coping resources, psychological stressors and emotional state [21]. Another one is Johnson and Ivarsson s (2010) Participants: Participants were 81 male football players of empirical model of injury risk factors. This model Tehran Junior Super League Championship (Asia Vision) emphasizes that personality factors, stress and coping who were selected by convenience method. The mean age influence the injury risk especially among football players of the sample was 17.95 ± 1.139 years (Range =16-20) and [22]. Some other important psychological factors are they had 5-9 years of experience in soccer. Those players anxiety (somatic and cognitive) [21] and self-confidence in national team were excluded from the study. [23] that are derived from Multi-Dimensional Anxiety Theory [24]. Instrument Ivarsson and Johnson (2010) suggested four Anxiety: The Competitive State Anxiety Inventory CSAI-2 personality trait factors that significantly predicted injury: was used to measure competitive anxiety [31]. Participants somatic trait anxiety, psychic trait anxiety, stress rated their anxiety responses over the multidimensional susceptibility and trait irritability [25]. However, constructs of cognitive anxiety, somatic anxiety and psychological factors (Inhibition, aggression and risk- self-confidence through 27 items with nine items taking) did not emerge as predictors in study of Schwebel representative of each construct. Symptom intensity [26]. Bandura (1997) hypothesized that an athlete with low levels were rated on a scale ranging from 1 (not at all) to self-efficacy would also be fearful of the sport 4 (very much so) leading to intensity scores ranging from environment and consequently lack confidence in 9 to 36 for each anxiety and confidence construct. Validity attaining a positive outcome (e.g. avoiding injury). Hence, and reliability of the CSAI-2 in Iranian athletes was athletes with lower confidence in avoiding injury would reported by Farokhi and Hakak (2000) [32]. be more likely to be injured than those confident in avoiding injury [23]. Short et al. (2004) observed negative Injury: Self-reported previous injury questionnaire in relationships between worry/concern and confidence in various body parts (neck, shoulder, humorous, elbow, avoiding injury; also they cleared that injured athletes forearm, wrist and fingers, hip, femur, knee, calf, ankle and have lowest confidence in their ability to avoid re-injury fingers and torso) including fracture, sprain and strain [27]. Although the findings of Galambos (2005) supported was used for injury occurrence. Participants were asked to suggestions that psychological measures have utility in report the number of injuries during the last 12 months by predicting athletic injury, they did not mention anxiety as completing self-reported previous injury questionnaire a predictor factor [28]. Williams and Andersen (1998) following researcher s explanations [33]. Participants were found a positive relationship between a sport injury required to report only those injuries that required medical occurrence and competitive trait anxiety [19]. attention or withdrawal from training for one day or more The literature shows that psychological factors seem [34]. Finally, total number of injuries was used in the to have an effect on the risk of soccer injury in statistical analysis. adolescents [29]. Steffen et al. (2008) observed a Data normality was examined by K-S test and then relationship between anxiety and injury in young football Pearson correlation was performed to examine the player [30]. Johnson and Ivarsson (2010) studied relationship between anxiety and injury occurrence psychological predictors of sport injuries between junior (p=0.05). male and female football players studying at football high schools in southwest Sweden. Their results showed that RESULTS the main factors were life event stress, somatic trait anxiety, mistrust and ineffective coping [22]. The majority of football players reported at least one Sport injury researches focusing on psychological injury over the previous 12 months (78% of the sample) factors seem to have the potential to discover with an average of 3.03 (SD= 2.73, range =0-11) injuries psychological factors that might lead to increased or over the previous 12 months (Table 1). 402

Table 1: Demographic characteristics of subjects (n = 81) Variable Mean SD Age (years) 17.95 1.13 Height (cm) 175.3 5.98 Weight (kg) 70.62 7.82 Injury (in 12 month) 3.03 2.73 Cognitive Anxiety 22.84 4.9 Somatic Anxiety 18.86 5.53 Self-confidence 22.93 3.96 Table 2: Correlation matrix among the study variables (n = 81) Variables r P value Injury- Cognitive Anxiety 0.276* 0.01 Injury- Somatic Anxiety 0.237* 0.03 Injury-self-confidence -0.143 0.2 *- Correlation is significant at 0.05 (2-tailed). The Pearson correlation analysis revealed significant relationships between injury occurrence and cognitive anxiety (r=0.27, p=0.01) and somatic anxiety (r=0.23, p=0.03). Relationship between self-confidence and injury occurrence was not significant (r= -0.14, p=0.2) (Table 2). DISCUSSION The aim of the present study was to examine the relationship between psychological factors and injury risk among junior football players. Results of Pearson correlation showed a significant relationship between somatic anxiety (r=0.237) and cognitive anxiety (r=0.276) with injury occurrence but self-confidence had no significant association with injury occurrence (r= -0.143). 2 According to the results (R 100), somatic and cognitive anxiety explained 5.6 % and 7.61% of injuries in junior football player. The finding is consistent with previous studies supporting the positive relationship between competitive trait anxiety and sport injuries. Johnson and Ivarsson (2010) showed that injured athletes had a significantly higher level of somatic trait anxiety than non-injured athletes [22]. Our results are also similar to findings of Petrie [35], Williams and Andersen, [6], Steffen et al. [30] and Ivarsson and Johnson [25] establishing a positive relationship between competitive trait anxiety and sport injuries. A potential explanation for the relationship between cognitive anxiety and injury occurrence is that potentially stressful situation has a positive effect leading to an increased level of state anxiety and/or peripheral narrowing [36]. According to Kerr and Fowler (1988), athletes with a high level of trait anxiety more often reported narrowing concentration and attention than other athletes [37]. These findings could explain why anxiety is often found to be a predictor of sport injuries. High anxiety levels also seem to lead to peripheral narrowing, thus higher injury vulnerability. Athletes who are not sufficiently apprehensive of threatening stimuli could be more likely to throw themselves into situations beyond their capacity to control [22]. In such cases, the athletes could be exposed to a high risk of injury. Thus, in the present study the injury occurrence increased as cognitive anxiety raised. In the current study, somatic anxiety showed to have a significant relationship with injury occurrences which is consistent with Perna et al. [38], Perna et al. [20] and Williams and Anderson [19] studies. In an extension of the Williams and Andersen model, Perna et al. [38] posited that increased autonomic nervous system activation and possible concomitant behavioral disruptions (e.g. sleep disturbance) resulting from heightened negative affect may act in synergy with the demands of heavy exercise to increase risk of illness and injury [20,37]. That is, psychological distress may impair muscle growth and repair processes by prolonging the presence of post exercise catabolic hormones (e.g. cortisol) that also impair immunity and inhibit the secretion and action of anabolic factors such as growth hormone and insulin-like growth factors [20]. Negative emotion-linked increases in stress hormones (i.e. cortisol) in turn may increase prevalence of injury that is created by high-intensity and high-volume training illness among competitive athletes [38]. Extant models posit that when added to physiological demands of exercise training, psychological stress may cause interactive perturbations in attention, affect, behavior and stress hormone mediated disruptions to immune and skeletal muscle system recovery [19, 22]. In the present study, there was a negative correlation between self-confidence and sport injury occurrence but not significant. Our study was inconsistent with Short et al. [27] study that found a negative significant relationship between self-confidence and injury occurrence; the reason may be the difference in the number of participants as their sample included 434 subjects in three different sports. Magyar and Chase (1996) suggested that fear of injury exists when an athlete lacks confidence in the ability to perform successfully in a threatening or taxing situation [39]. Injured athletes have expressed low self-efficacy in their perceived ability to perform skills and movements required by their specific sport without re-injuring themselves [40]. 403

CONCLUSION 9. Sigward, S.M. and C.D. Powers, 2007. Loading characteristics of females exhibiting excessive valgus According to the results of the present study and moments during cutting, Clin Biomech, 22: 827-833. previous researches, psychological aspect seems to be 10. Ostenberg, A. and H. Roos, 2000. Injury risk factors added to the list of sport injury risk factors; this aspect in female European football. A prospective study of along with other risk factors may influence injury 123 players during one season. Scand J. Med. Sci. occurrence in junior soccer players. Therefore, Sports, 10: 279-285. psychological factors should be considered in injury 11. Soderman, K., H. Alfredson and T. Pietila, 2001. preventing programs. Future research could be Werner S. Risk factors for leg injuries in female soccer conducted with a control group to examine possibility players: a prospective investigation during one outof psychological intervention to prevent sports injuries. door season. Knee Surg Sports Traumatol Arthrosc, Also, it is necessary in future researches to examine 9: 313-321. psychological factors in other skill levels and ages. 12. Knapik, J.J., C.L. Bauman, B.H. Jones, J.M. Harris and L. Vaughan, 1991. Preseason strength and flexibility REFERENCE imbalances associated with athletic injuries in female collegiate athletes. Am J. Sports Med., 19: 76-81. 1. Reilly, T. and M. Williams, 2003. Science and soccer, 13. Askling, C., J. Karlsson and A. Thorstensson, 2003. 2nd ed. Routledge, London and New York, Hamstring injury occurrence in elite soccer players 2. Hagglund, M., M. Walde n and J. Ekstrand, 2006. after preseason strength training with eccentric previous injury as a risk factor for injury in elite overload. Scand J. Med. Sci. Sports, 13: 244-250. football: a prospective study over two consecutive 14. Arnason, A., S.B. Sigurdsson, A. Gudmundsson, seasons. Br J. Sports Med., 40: 767-772 I, Holme and Engebretsen L. Bahr, 2004. R. Risk 3. Waldén, M., M. Hägglund and J. Ekstrand, 2005. factors for injuries in football. Am J. Sports UEFA Champions League study: a prospective study Med., 32: 5-16. of injuries in professional football during the 15. Surve, I., M.P. Schwellnus, T. Noakes and 2001-2002 season. British Journal of Sports Medicine, C. Lombard, 1994. A fivefold reduction in the 39: 542-546. incidence of recurrent ankle sprains in soccer players 4. Kontos, A., 2004. Perceived risk, risk taking, using the Sport-Stirrup orthosis. Am J. Sports Med., estimation of ability and injury among adolescent 22: 601-606. sport participants. Journal of Pediatric Psychology, 16. Tropp, H., C. Askling and J. Gillquist, 1985. 29(6): 447-455. Prevention of ankle sprains. Am J. Sports Med., 5. Zarei, M., N. Rahnama and R. Rajabi, 2008. Effect 13: 259-262. of soccer player post on rate of sport injury in Iranian 17. Junge, A., J. Dvorak, D. Rosch, T. Graf-Baumann, Pro league, Harekat, 39: 65-78 J. Chomiak and L. Peterson, 2000. Psychological and 6. Williams, J.M. and M.B. Andersen, 2007. sport-specific characteristics of football players. Am Psychosocial antecedents of sport injury and J. Sport Med., 28: 22-28. interventions for risk reduction. In: Tenenbaum, 18. Lysens, R.J., M.S. Ostyn and Vanden Y. Auweele, G. and R.C. Eklund, eds. Handbook of sport 1989. The accident-prone and overuseprone profiles psychology, 3rd edn. New York: John Wiley and of the young athlete. Am J. Sports Med., 17: 612-619. Sons, pp: 379-403. 19. Williams, J.M. and M.B. Andersen, 1998. 7. Cowley, H.R., K.D. Ford, G.D. Myer, T.W. Kernozek Psychosocial antecedents of sport injury: Review and T.E. Hewett, 2006. Differences in neuromuscular and critique of the stress and injury model. Journal of strategies between landing and cutting tasks in Applied Sport Psychology, 10: 5-25. female basketball and soccer athletes. J Athl Train, 20. Perna, F.M., M.H. Antoni and A. Baum, 2003. 41: 67-73. Cognitive behavioral stress management effects on 8. Krosshaug, T., J.R. Slauterbeck, L. Engebretsen and injury and illness among competitive athletes: a R. Bahr, 2007. Biomechanical analysis of anterior randomized clinical trial. Ann Behav Med., 25: 66-73. cruciate ligament injury mechanisms: three- 21. Junge, A., 2000. The influence of psychological dimensional motion reconstruction from video factors on sports injuries. Review of the literature. sequences. Scand J. Med. Sci. Sports, 17: 508-519. Am J. Sports Med., 28: 10-15. 404

22. Johnson, U. and A. Ivarsson, 2010. Psychological 33. Rajabi, R. and H. Samadi, 2008. Laboratory manual of predictors of sport injuries among junior soccer corrective exercise for post graduated students. players, Scand J. Med. Sci. Sports, 21: 129-136. Tehran University Press, Tehran. 23. Bandura, 1997. Self-efficacy: The exercise of control. 34. Deroche, T., Y. Stephan, B.W. Brewer and New York: Freeman C.L. Scanff, 2007. Predictors of perceived 24. Martens, R., et al. 1990. The Development of the susceptibility to sport-related injury, Personality and Competitive State Anxiety Inventory-2 (CSAI-2). Individual Differences, 43: 2218-2228. Human Kinetics. 35. Petrie, T.A., 1993. Coping skills, competitive trait 25. Ivarsson, A. and U. Johnson, 2010. Psychological anxiety and playing status: moderation effects on the factors as predictors of injuries among senior soccer life stress-injury relationship. J. Sport Exerc. Psychol., players. A prospective study, Journal of Sports 15: 261-274. Science and Medicine, 9: 347-352. 36. Rogers, T.M. and D.M. Landers, 2005. Mediating 26. Schwebel, D.C. and B.K. Barton, 2006. Temperament effects of peripheral vision in the life event and children s unintentional injuries. In M. Vollrath stress/athletic injury relationship. J. Sport Exerc. (Ed.), Handbook of personality and health, pp: 51-71. Psychol., 27: 271-288. New York: Wiley. 37. Kerr, G. and B. Fowler, 1988. The relationship 27. Short, S.E., J. Reuter, J. Brandt, M.W. Short and A.P. between psychological factors and sport injuries. Kontos, 2004. The Relationships Among Three Sports Med., 6: 127-134. Components of Perceived Risk of Injury, Previous 38. Perna, F.M., M.H. Antoni, M. Kumar, D.H. Cruess Injuries and Gender in Contact Sport Athletes, Online and N. Schneiderman, 1998. Cognitive-behavioral Journal of Sport Psychology, 6: 3. intervention effects on mood and Cortisol during 28. Galambos, S.A., P.C. Terry and S.A. Locke, 2005. athletic training. Annals of Behavioral Medicine. Psychological predictors of injury among elite 20: 92-98. athletes, Br J. Sports Med., 39: 351-354. 39. Maygar, T.M. and M.A. Chase, 1996. Psychological 29. Emery, C.A., W.H. Meeuwisse. and SE.V. Hartmann, strategies used by competitive gymnasts to 2005. valuation of risk factors for injury in overcome fear of injury. USA Gymnastics Online, Adolescent Soccer: implementation and validation of http://www.usaymnastics.org/publications/techniq an injury surveillance system, Am J. Sports Med., ue/1996/10/psychological-strategies.html. 33: 1882-1891. 40. Doyle, J., N. Gleeson and D. Rees, 1998. 30. Steffen, K., 2008. Injuries in female youth football Psychobiology and the athlete with anterior cruciate Prevention, performance and risk factors, dissertation ligament (ACL) injury. Sports Medicine, 26: 379-393. from the Norwegian School of Sport Sciences. 31. Martens, R., R.S. Vealey and D. Burton, 1990. Competitive anxiety in sport: Human Kinetics. 32. Farokhi, A. and E. Hakak, 2000. The comparison between two type of state and trait anxiety in male athletes participating in international competitions of sports and nations cups. Harekat, 4: 55-62. 405