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How Psychosocial Factors Influence Athletes' Likelihood of Injury

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Within applied sport psychology it has become of extreme importance to understand the psychological factors that accompany a successful athletic performance. In order to understand what psychological processes might be contributing to quality of performance, it is important to look at the specific psychological constructs with theoretical relevance to optimal performance. Majority of studies done in sport have been conducted from a social cognitive perspective, which places an emphasis on an individual’s thought processes to explain the reasons for their behavior. In themselves, psychological skills are distinct yet interrelated components separated for research and training purposes.

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Athletes’ emotional reactions to injury include feelings of loss, denial, frustration, anger, and depression. Positive emotions such as happiness, relief, and excitement have been reported as well. The attainment of rehabilitation goals and the prospect of recovery may engender a host of positive emotional responses throughout the course of rehabilitation. It seems that these responses are influenced by a wide array of personal factors (eg, athletic identity, previous injury experience, injury severity, injury type, current injury status) and situational factors (eg, life stress, social support satisfaction, timing of the injury). Emotions typically fluctuate in response to rehabilitation progress and/or setbacks. Emotional states typically move from negative to positive as athletes progress through their rehabilitation and a return to competition draws nearer. Studies have shown an increase in negative affect as the return to sport approaches, possibly because of anxieties over reinjury, the uncertainty of what lies ahead, as well as concerns that postinjury goals may be unrealized. Return to sport may alternatively be viewed as a functional reality check challenging denial that may have falsely bolstered athlete expectation. In summary, individual differences in emotional response over the course of rehabilitation are varied, complex, and fluctuate with rehabilitation progress and setbacks. Demographic factors such as age have also been found to influence rehabilitation adherence. For example, Brewer and colleagues found that age moderated the relationship between psychological factors and 2 kinds of adherence: home exercise completion and home cryotherapy completion. Older patients were more adherent when they were self-motivated and perceived high levels of social support, whereas younger patients were more adherent when they were highly invested in the athlete role as a source of self-worth.

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Traditional rehabilitation programs are designed to ensure an athlete's full return to preinjury levels of physical fitness, but a growing body of research highlights the importance of also addressing psychological responses within the rehabilitation context. One of the ways in which the injured athlete's psychological response to sport injuries has been explained is through the Integrated Model of Response to Sport Injury Rehabilitation. According to the model, an individual athlete's cognitive appraisal of the injury (ie, how the athlete views the situation), as well as the athlete's emotional (ie, how he or she feels about the injury) and behavioral (ie, how he or she acts and reacts to the injury situation) responses are influenced by a range of personal (eg, injury characteristics and individual differences) and situational (eg, sport, social, and environmental influences, including social support and the sports medicine team) factors. The model recognizes the interaction among the cognitive appraisal and emotional and behavioral responses as a dynamic and bidirectional cyclic process, which in turn has an effect on both physical and psychological recovery outcomes (Ray R, 1999). Thus far, a wealth of evidence exists in support of the model. Most athletes appear to be psychologically affected (emotional response) when injured, and these psychological responses can have a significant influence on the quality and speed of the sport-injury rehabilitation process. Support for the use of psychosocial strategies (a behavioral response) during sport-injury rehabilitation has also been documented in the literature. For example, goal setting, imagery, positive self-talk, and relaxation strategies have been useful in helping athletes cope with pain, stress, and anxiety and address self-efficacy, self-esteem, and confidence-related apprehensions, as well as concerns with rehabilitation motivation and adherence. In addition, the role of sports medicine professionals (a situational factor) in influencing injured athletes' cognitive appraisal of the injury, emotional and behavioral responses, the rehabilitation process, and the physical and psychological recovery outcomes is also important (Kottler JA, 1986).

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To sum up, according to existing results, the influence of stress-coping strategies is somewhat questionable. From the numerous psychological attributes that have been investigated in relation to sports injuries, only competitive anxiety has been shown to be associated with injury occurrence. A personality profile typical of the “injury-prone” athlete does not exist. However, several studies have shown a certain readiness to take risks (lack of caution, adventurous spirit) on the part of injured athletes. In this review, the current knowledge regarding the relationship between psychological factors and sports injuries is presented and a stress theory model is developed.

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Ray R, Wiese-Bjornstal DM. Counseling in Sportsmedicine. Champaign, IL: Human Kinetics;; 1999.

Kottler JA, Brown RW. Introduction to Therapeutic Counseling. Pacific Grove, CA: Brooks/Cole;; 1986

Jacobson E. Progressive Relaxation. Chicago, IL: University of Chicago Press;; 1938.

Voight M, Callaghan J. The use of sport psychology services at NCAA Division I universities from 1998–1999. Sport Psychol. 2001

Cramer Roh JL, Perna FM. Psychology/counseling: a universal competency in athletic training. J Athl Train. 2000

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How Psychosocial Factors Influence Athletes' Likelihood of Injury
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