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The Psychology of Injuries in Sport

Coach and Athlete Welfare S5524204

What this presentation will cover

In this presentation, the topic of the psychology of injuries within sport will be explored. This resource will cover: - The prevalence of injuries within sport - Psychological antecedents of injuries - Psychological responses to injuries - Rehabilitation and recommendations This presentation is aimed at managers of sports teams to provide them with insights on the psychological affects that injuries have on the athletes within their team.

The Prevalence of Injuries within Sport

What is an injury and how they occur

Types of injuries

Prevalence of injuries

Psychological Antecedents

The stress-injury model

There are three antecedents shown in the stress-injury model. 1. Personality 2. History of stressors 3. Coping resources

Psychological responses to injury

This section will look at the psychological responses that individuals may have after receiving an injury. Athletes respond to injuries in a variety of different ways and extremes, exhibiting a wide range of cognitive, behavioural, and emotional responses (Crossman 1998). There is an estimated 5-13% of athletes who suffer levels of psychological distress following an injury (Masten, Strazar, Zilavee, Tusak, Kandare 2014). There are big differences in the severity of distress in athletes in relation to the severity of their injury, athletes with more serious injuries show to have higher levels of anger, depression, and frustration than those with more acute injuries (Crossman 1998).

Many athletes, especially at elite level, tend have extremely high levels of motivation and determination and therefore when they face an injury to themselves, many indivduals respond in a positive manner and show their determination in the rehabilitation process. The study by Masten, Strazar, Zilavee, Tusak, and Kandare (2014) found that athletes who had more severe injuries were found to cope with the aftermath of their injury better than those with more acute injuries. This could show that many athletes, once faced with task of a long-term rehabilitation after an injury, have higher levels of motivation to complete the rehabilitation process as efficiently as they can meaning they are more positive in their abilities to cope with pain. However, the study also suggests that the reason for athletes coping better with severe injuries could be because of the long period of time they have to rehabilitate, whereas athletes with acute injuries will be expected to recover in a shorter period which could lead to stress levels rising.

However, research has shown that injuries can drastically affect an athlete’s wellbeing in a negative way. Injuries can be a huge influence on how successful and athlete’s career is. Many injuries can lead to athlete’s never returning to their peak level of performance or potentially never returning to their sport at all (Ivarsson, Tranaeus, Johnson, Stenling 2017). This can affect an athlete’s mental health drastically potentially causing them to be unable to go through the rehabilitation process in the best way possible.

Rehabilitation and Recommendations

Rehabilitation process


There are 3 stages before full recovery after an individual sustains an injuryInjury phase Rehabilitation phase Return to play phase


- Wong, P., Hong, Y., 2005. Soccer injury in the lower extremities. Journal of Sports Med. 39. Pp. 473-482. - Berritto, D., Lacobellis, F., Mazzei, M.A., Volterrani, L., Guglielmi, G., Brunese, L., Grassi, R., 2016. MDCT in ischaemic colitis: how to define the aetiology and acute, subacute, and chronic phase of damage in the emergency setting. British Journal of Radiology. 89(1061). - Beuno, A.M., Pilgaard, M., Hulme, A., Forsberg, P., Ramskov, D., Nielsen, R.O., 2018. Injury prevalence across sports: a descriptive analysis on a representative sample of the Danish population. Injury Epidemiology. 5(6). - Johnson, U. (2007). Psychosocial antecedents to sport injury, prevention, and i ntervention: An overview on theoretical approaches and empirical findings. International Journal of Sport and Exercise Psychology, 5, 352-369. - Andersen, M.B., Williams, J.M., 1988. A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psychology. 10. Pp. 294-306 - Barrow, M.A., Walker, N., 2013. The psychology of sport injury and rehabilitation. The Psychology of Sport Injury and Rehabilitation. London: Routledge. - Crossman, J. 1998. The psychology of athletic injury. The sport scientists: Research adevntures. Pp.179-192. New York. Addison Wesley Longman.- Masten, R., Strazar, K., Zilavee, I., Tusak, M., Kandare, M., 2014. Pschological response of athletes to injury. Kinesiology. 46(1). Pp. 127-134. - Crossman, J., 1997. Psychological rehabilitation from sports injuries. Sports Medicine. 23(5). Pp. 333-339.- Reese, L.M.S., Pittsinger, R., Yang, J., 2012. Effectiveness of psychological intervention following sport injury. Journal of Sport and Health Science. 1(2). Pp. 71-79

There are 3 stages of damage of injuries. The first is acute injuries which is present for anywhere up to 2 weeks. The second is subacute injuries which last between 2 and 7 weeks. The final stage is chronic injuries which is an injury that lasts more than 7 weeks (Berritto, Lacobellis, Mazzei, Volterrani, Guglielmi, Brunese, Grassi 2016).

The first antecedent that is looked at is personality characteristics. The model says that individuals with certain personality characteristics tend to exacerbate the stress response. Some of these characteristics include excessive effort, locus of control, resilience, competition anxiety, and fear of injury or reinjury (Johnson 2007). Personality traits of an individual can be a big factor into why some people are more exposed to getting injured as certain traits may put individuals into more risky situations. For example, a study by Masten, Strazar, Zilavee, Tusak, and Kandare (2014) found that athletes who are more extroverted seem to be more prone to getting injured then athletes who are more introverted. They suggest the reason for this could be that more introverted athletes are more likely to expose themselves to risky situations and more like to not overestimate their physical abilities. Whereas extroverted athletes may have a higher drive to success and high levels of confidence which could lead to finding themselves in higher injury risk situations.

Figure 1 The stress-injury model (Anderson and Williams 1988)

The stress-injury model developed by Andersen and Williams (1988), shown in figure 1, shows the potential psychological antecedents to injuries that individuals may possess causing them to be more prone to injury.

The final antecedent of the stress-injury model explored is coping resources. Coping resources is defined as an individual’s ability to manage their emotions and focus as well as external factors that are available to an individual such as social support (Barrow, Walker 2013). The book by Barrow and Walker (2013) found that athletes who are low in coping skills and external resources were the most venerable to be injured. However, there was studies that found athletes with low stress and high social support have an increased chance of injury suggesting high amounts of social support may encourage athletes to take more risks thus making them more venerable to injury. Individuals who have a history of stressors who have not been exposed to adequate coping methods and resources are likely to assess their situation as stressful and therefore are more prone to exposure of greater physiological activation and attentional disruption (Johnson 2007).

The stress-injury model says that stress responses may involve disruptions to an individual athlete’s cognitive, attentional, and physiological function (Barrow, Walker 2013). The book by Barrow and Walker (2013) found, from several studies, that factors contributing to a poor stress response that may increase the risk of sport injury include low perceptions of health, slower reaction time, and peripheral narrowing. These factors can all increase the chances of athletes being unable to avoid injuries. The same book also explores the idea that different mental and emotional states an individual can be in can increase the chances of injuries. For example, if an athlete is in an angry mood state, then they are more likely to become injured whilst participating in physical activity.

An injury is defined as any condition an athlete is in that forces them to be unable to participate in physical activity, removing them from competition (Wong, Hong 2005).

Injuries are mainly caused by overuse of muscles, direct impact that the affected body part cannot withstand or over stretched muscles. Common injuries include bruises, sprains, strains, bone brakes, joint and ligament injuries, and concussions.

Figure 2The five stages of the Kübler-Ross Grief Cycle. Figure from blog.digitalnexa.com.

Majority of athletes will have spent time unable to part take in physical activity due to injuries. A study of injury prevalence of a sample of the Danish found that, over the 12 months prior to the study, 18.4% of adults and 19.3% of children sustained an injury that either prevented them from part taking in physical activity or required contact to the health care system (Beuno, Pilgaard, Hulme, Forsberg, Ramskov, Damsted, Nielsen 2018). Another study by Johnson 2007 highlights the increased chance of injury in elite sport, the study shows that in elite football in Finland and the United Kingdom 65% of athletes sustain an injury throughout one season and in Sweden it is as high as 75%. These Study highlights the prevalence of injuries occurring within sports and physical activity.

The second antecedent looked at is history of stressors. A book by Barrow and Walker (2013) found that 80% of the studies measuring stress history reported a significant relationship between stress history and injury. Examples of history of stressors include major life events, prior/ reoccurring injury history and daily hassles.

The first stage is the initial aftermath of the sustained injury. This where the athlete is not deemed fit to begin the physical rehabilitation of their injury and should therefore be supported mentally to aid with any emotional distress the athlete may have.

The second phase is where there is a rehabilitation programme in place for the athlete to begin to start to recover physically from their injury. There should be motivational support on offer to ensure the athlete completes their programme as effectively as possible.

The final phase is ensuring the athlete is fully recovered from their injury and brought back to match fitness for them to begin competing or participating again. The importance of ensuring they are fully recovered from their injury is stressed as returning too soon may cause the injury to grow worse.

As mentioned previously in this presentation, the prevalence of injuries within sport is great and is not likely to decrease. These recommendations will therefore be focused on what managers can do to aid the rehabilitation process for their athletes to ensure they minimalised their stress and anxiety. A study by (Crossman 1997) highlights several important factors on how a manager/coach could provide support for injuries athletes. The first suggestions are that the athlete is provided support on how they can manage their spare time out of their normally training routine. Once injured, athletes may find themselves with excessive spare time that they may not be used to. Providing support on how they fill this time can prevent them from developing mental health issues such as depression. The second is for managers/coaches to attempt to get an understanding of the emotional responses of the athlete to their injury. The three primary emotions to injuries are frustration, depression, and anger. If a manager can understand the athlete’s emotion, then they look to provide support to help deal with those emotions. The final recommendation is that managers should look to offer their injured athletes interventions. A study by (Reese, Pittsinger, Yang 2012) showed that interventions using techniques such as guided imagery, goal setting, and relaxation decreased negative psychological emotions, improved coping, and reduced re injury anxiety.

Figure 2 Psychological strategies for making rehabilitation from sport injury work.Jane Crossman 1997