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How Psychosocial Factors Influence Athletes' Responses to Injury

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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.

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Although psychosocial aspects related to athletic training have been identified as essential components of entry-level athletic training education, many ATs still appear to desire more education and understanding in this area. Findings from the current study suggest that ATs perceived injured athletes to experience a number of psychological responses as a result of being injured. The top 3 rated psychological responses were stress or anxiety, anger, and treatment adherence problems

According to the ATs, the 3 main characteristics of athletes who cope well with their injuries were positive outlook, adherence and treatment compliance, and showing up to treatment. Conversely, the 3 main characteristics of athletes who did not cope successfully with their injuries, as reported by the ATs, were poor adherence/attendance, noncompliance, and negative attitude. The sample also reported using a number of psychosocial strategies in their work with injured athletes. The top 3 psychosocial strategies were keeping the athlete involved with the team, using short-term goals, and creating variety in rehabilitation. Moreover, ATs also expressed a clear desire to learn more about motivation, using effective communication, and setting realistic goals. In addition, ATs reported having limited access to sport psychology services; however, those who did have access did appear to use these services in making referrals. Moreover, most of the ATs indicated not using a written procedure as a guideline for this process. The finding that ATs in the current sample perceive injured athletes to experience psychological responses as a result of their injuries appears to be consistent with the findings of Larson et al.2 Larson et al2 also noted that injured athletes typically experience stress or anxiety, anger, and treatment adherence problems when injured. Additional research further supports these findings.

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Multidisciplinary efforts to understand sport injury risk, response, and recovery are at the forefront of those concerned with the health of high-intensity athletes. The unique demands of short duration highintensity sport – such as heavy training volume, tedious and repetitious exercise, high pain tolerance, intermittent or continuous bursts of all-out effort, and contact with opponents or exposure to other physical hazards – are associated with sport injury and interrelated health risks like overtraining, burnout, and disordered eating

Scholarship blending the biological, behavioral, and social sciences – a biopsychosocial approach – advances our understanding of the complex etiology associated with sport injury, and the multitude of variables affecting response, recovery, and prevention. This paper overviews current literature outlining ways in which sport psychology and socioculture influence injury occurrence and response in high-intensity athletes contextualized within a broad biopsychosocial framework. Sport psychology is defined as the cognitions, affects, and behaviors of sport participants, and sport socioculture as the social and cultural structures, climates and processes influencing sport participants. In line with the ethic of elite sport organizations (e.g., International Olympic Committee, 2009), high-intensity athlete (a) health and (b) sport training and performance are both central outcomes of concern in assessing the roles of psychology and socioculture in sport injury.Understanding the public health nature of the problem of sport injury involves definition and documentation. Although significant variability exists among definitions used for sport injury investigations, among their most common elements are that: (a) the injury was incurred while training for or competing in a sport, (b) medical care was sought, and (c) time loss from practice, training and/or competition occurred (Hootman et al., 2007).

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To summarize, these three factors affect the intermediate outcomes, as such as the range of motion, the strength and the endurance of a muscle, the joint laxity, the perception of pain, and the duration of the recovery. Finally, the intermediate outcomes influence the outcomes of the rehabilitation, such as functional performance, quality of life after injury, satisfaction of the treatment, and readiness and desire to return to sport

A central role in this model is played by psychological factors; in fact they have a reciprocal relationship with biological and socio-contextual factors, and with intermediate and final outcomes.

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Hootman JM, Dick R, Agel J. Epidemiology of collegiate injuries for 15 sports: summary and recommendations for injury prevention initiatives. J Ath Train 2007: 42(2): 311–319.

Hrysomallis C. Relationship between balance ability, training and sports injury risk. Sports Med 2007: 37(6): 547–556

LaMott EE. The anterior cruciate ligament injured athlete: The psychological process, Ph.D. dissertation. University of Minnesota, Minnesota, USA, 1994. Available at, Publication Number: AAT 9501110.

Lovell M. The management of sportsrelated concussion: current status and future trends. Clin Sports Med 2009: 28: 95–111.

Maddison R, Prapavessis H. A psychological approach to the prediction and prevention of athletic injury. J Sport Exerc Psychol 2005: 27: 289–310

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