Psychological Factors and Sport Injuries: What a Sport and Performance Professional Can Do? Part 2
In Part 1 of this post, there was a big information dump. This post picks up with an example. Hopefully, there has been enough time between the two posts to allow for different thought processes to occur to help with integrating the material. Let’s remind ourselves where we are headed. The example that we will discuss today is of a female-identifying athlete with an anterior cruciate ligament (ACL) injury to help demonstrate the nuance required of a sport and performance professional (SPP) to help an injured athlete.
Injured Athlete Characteristics
The example athlete for this discussion is a first-time injured, female-identifying athlete with an anterior cruciate ligament (ACL) injury from running. It is essential to acknowledge that women are close to three times more likely than men to injure their ACLs due to increased knee mobility (Petusheket al., 2019). In this athlete's case, she appears to be at increased risk because she is training heavily for a multiple marathon season and has a lot of her identity tied to being a runner. Overall, the athlete has a positive view of life, demonstrates remarkable resilience, both currently and during past hardships, and has decent coping and stress management skills. Some of these coping skills include daily meditation, yoga, breathing practices, and understanding how to access and use resources and support. Daily life stressors involve raising a family, managing a professional life, caring for her aging parents, and figuring out how to balance her personal and professional life. No significant trauma background but does have a history of much loss.
Timing of Services
Given that this athlete is seeking services from an SPP at the onset of her injury, knowing that information helps direct the role and direction of assessment. However, before beginning, a foundation piece must be laid. Research has demonstrated that a connection exists between psychological factors and a return to play after a musculoskeletal sports injury, and that psychosocial intervention may help facilitate post-injury recovery in athletes through the promotion a positive emotional state and rehabilitation adherence (Gennarelli et al., 2020). There is a role for an SPP to help this athlete. An injured athlete can experience stress across three phases of injury, onset, rehabilitation, and return-to-play (Evans et al., 2012). During the onset phase, athletes tend to experience incapacitation and isolation, and during rehabilitation, experiences may include a lack of rehabilitation progress and setbacks (Evans et al., 2012). While chances of the athlete being in the onset phase are high, given the timing, it is necessary to evaluate if that truly is the case or if there is an overlap to begin understanding the athlete's needs.
Assessment
Another place for assessment and exploration with the athlete is their emotional state and psychological distress. Research has identified some common responses to injury. These responses include sadness, isolation, irritation, lack of motivation, frustration, anger, alterations in appetite, sleep disturbance, and disengagement (Hooi & Wah, 2018). Some of these symptoms mirror those of grief which, given this athlete's history of grief and loss, needs to be assessed in relation to emotional state and the potential for triggering past grief. Additional research has shown that athletes may experience psychological impacts similar to Kubler-Ross's stages of grief (Hooi & Wah, 2018). Even more reason to be attuned to assessing a grief process. One method for assessment may be to use the Six Needs of Mourning model (Wolfelt, 2006). While the model was developed around death loss, there is still relevance to other types of losses. For example, the first need of mourning is acknowledging the loss's reality. Is the athlete able to acknowledge the reality of the injury and what that means? Finally, a psychological distress assessment is necessary to evaluate potential adherence to rehabilitation protocols. While the athlete has demonstrated remarkable resiliency, it would be foolish to rule out distress, especially as this athlete has a high athlete identity. Hooi and Wah (2018) have found that athletes respond in two ways to psychological distress. The first response is attempting to hasten recovery to return to their role as a sports person quickly. The second response is avoidance of rehabilitation protocols because of the uncomfortable or painful physical and psychological sensations. Both limit adherence to rehabilitation protocols which risks injury recovery (Hooi & Wah, 2018). Given the potential amount of stress in the athlete's life, there is a chance that stress may be impacting how she is able to handle the distress of being injured.
Adherence to Rehabilitation
Adhering to a rehabilitation plan is crucial. Goddard et al. (2021) found two categories of factors influencing adherence to rehabilitation: person and situational. The person-specific factors are the impact of the injury, justification for adherence, motivation, confidence/self-efficacy, coping, social support, locus of control, cognitive appraisal, coping, and psychological skills. In contrast, situation factors include the physical therapist's characteristics, strategies, and effectiveness, and treatment efficacy. Knowing that these two factors are at play, refines the assessment process and opens the door to understanding the athlete on a deeper level. For example, this athlete has coping skills and social support, but what about her cognitive appraisal? This brings the assessment back to the model that was introduced in the previous post and how factors and concepts are interconnected. Finally, it speaks to being able to collaborate as an SPP so that all professionals supporting the athlete are providing superior services to the athlete.
A person with a ponytail sitting down drinking water. There is a knee brace on their left and a basketball next them.
take action today moment:
There is so much to consider whether you are an SPP, athlete, coach, etc. when it comes to injury recovery. Take some time to assess what you need to be successful in your role whether you are an athlete or someone who helps athletes. Consider the level of complexity and nuance. Even if you are not an athlete and are just living life, take the time to understand nuance and complexity so that you can make informed decisions.
Learn More About psychological factors and injuries:
References
Andersen, M. B., & Williams, J. M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology, 10(3), 294-306. https://doi.org/10.1123/jsep.10.3.294
Bolling, C., Van Mechelen, W., Pasman, H. R., & Verhagen, E. (2018). Context matters: Revisiting the first step of the ‘sequence of prevention’of sports injuries. Sports Medicine, 48(10), 2227-2234.
Evans, L., Wadey, R., Hanton, S., & Mitchell, I. (2012). Stressors experienced by injured athletes. Journal of Sports Sciences, 30(9), 917-927. https://doi.org/10.1080/02640414.2012.682078
Gennarelli, S. M., Brown, S. M., & Mulcahey, M. K. (2020). Psychosocial interventions help facilitate recovery following musculoskeletal sports injuries: A systematic review. The Physician and Sportsmedicine, 48(4), 370-377. https://doi.org/10.1080/00913847.2020.1744486
Gledhill, A., Forsdyke, D., & Murray, E. (2018). Psychological interventions used to reduce sports injuries: A systematic review of real-world effectiveness. British Journal of Sports Medicine, 52(15), 967-971.
Goddard, K., Roberts, C. M., Byron-Daniel, J., & Woodford, L. (2021). Psychological factors involved in adherence to sport injury rehabilitation: A systematic review. International Review of Sport and Exercise Psychology, 14(1), 51-73. https://doi.org/10.1080/1750984X.2020.1744179
Hooi, L. B., & Wah, T. E. (2018). Injured athletes and a new invention of relaxation techniques. International Research Journal of Pharmacy and Medical Sciences, 1(4), 78-81.
Petushek, E. J., Sugimoto, D., Stoolmiller, M., Smith, G., & Myer, G. D. (2019). Evidence-based best-practice guidelines for preventing anterior cruciate ligament injuries in young female athletes: A systematic review and meta-analysis. The American Journal of Sports Medicine, 47(7), 1744-1753. https://doi.org/10.1177/0363546518782460
Wolfelt, A. (2006). Companioning the bereaved: A soulful guide for caregivers. Companion Press.