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stress and sports injuries, psychology of injury, personality and injury, psychological antecedents of injury, stress and injury

How much do psychological factors such as stress and personality contribute to the risk sports injuries?

The Sports Injury Doctor

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Physical factors are obviously the primary cause of injuries in sports and exercise – for instance, a poor tackle in football, an awkward landing in gymnastics or poor warm-ups in sprinting. However, psychological researchers are continuing to show that thoughts, perceptions and aspects of personality may be linked to the incidence of injury. Let me illustrate this argument with a sporting example.

Take the case of Gazza
In 1991, Paul Gascoigne was stretchered off the field in the F.A. Cup Final after committing a serious foul on Gary Charles of Nottingham Forest. Gascoigne suffered a complete rupture of the anterior cruciate ligament which threatened his £5m transfer to Lazio in Italy.

If you viewed the incident in isolation, it was quite clear the injury was sustained by a completely mistimed challenge. It might then be considered an accidental collision that happens from time to time in contact sports. However, when looking at the match prior to this point you are presented with an entirely different explanation. In subsequent interviews Gascoigne has admitted to being over-aroused (too psyched-up) and his actions on the field comply with a classic case of behavioural frenzy.

From the first minute, it was clear that he was pumped-up and intent on making his mark. However, this energy led to a number of impetuous challenges which culminated in a serious knee-injury. In this case it is likely that psychological dysfunction did contribute to the outcome.

Looking at the research literature, it is evident that personality factors, stress levels and attitudes have all received attention as possible psychological antecedents of injury(1). In trying to unravel the relationship between psychological factors and injury, investigators have often taken a similar approach to that of geneticists. Modern scientists will often search for patterns or trends that establish relationships between two variables, such as a mutated gene and a specific disease – although just because a relationship exists it does not follow that one causes the other. Similarly, psychologists have assessed the personalities of injured athletes to try to identify common factors that may be linked to incidents of injury.

Stress and athletic injury
Past research has seen the relationship between athletic injuries and psychological factors as essentially stress-related (1). In this sense, stress is predicted to produce increased state anxiety and consequently alterations in attentional focus and muscular tension. It is important to note that stress does not exist outside the individual – not all people respond negatively to potentially stressful situations; one person may view a championship match as exciting and exhilarating while another becomes anxious and chokes. This will usually depend on the individual's personality traits (perceptual bias) and the coping response present.

The importance of coping mechanisms will be discussed further towards the end of this article but at this point it is useful to point out that between stress and its consequences are positioned individual coping strategies. Learning to cope with stress can avoid such negative symptoms as attentional disruption and muscular tension.

In situations seen as stressful, athletes will often report attentional narrowing and excessive muscular tension, which are thought to increase the chances of sustaining an injury. Having a flexible attentional focus is an important attribute in many fast sporting activities that require both narrow (focusing on perhaps just one environmental cue) and broad focus (focusing on peripheral cues such as the positioning of other team members or opponents) at different times during play.

Stress can cause attentional narrowing which results in important peripheral cues being missed. For example, the football player that only attends to the ball may fail to withdraw from an unrealistic challenge (rather than stay on his feet) in which his opponent is obviously going to meet the ball first. This can result in a late tackle and/or injury. A significant body of past evidence also supports the notion that stress can cause increased muscular tension, which disrupts coordination and increases the risk of injury. A figure-skater who becomes tense during a difficult routine might lack coordination due to muscular tension and fall, injuring an ankle.

Threatening situations
One important model that highlighted the stress-injury relationship cited both situational factors (i.e. importance of situation) and personal characteristics (i.e. personality traits) as important determinants of outcome (2). This model cited the interaction between factors as crucial and provided an impetus for future research. An athlete who tends to view situations as threatening (high trait anxiety), who has a history of life stressors (major life-changing events and daily hassles) and has poor coping resources (lacks social support, etc.) is considered to be more likely to experience a negative stress response and consequently is more prone to athletic injury. Although the relationship between stress and injury is complex, one study that used a large sample size – 452 athletes (3) – showed that as predicted, athletes with more life stress, little social support and poor coping skills were associated with more days of non-participation due to athletic injury.

Personality research

Some researchers are quick to associate personality traits with athletic injury. In general, research concerning the measurement of personality in the sport and exercise field has been controversial, plagued by inappropriate and inconsistent methodologies and grossly over-generalised application of results.

Unfortunately, many psychologists have adopted one of two bi-polar stances that either ascribe great significance to the role of personality or virtually no significance at all. Many contemporary researchers, however, are beginning to take the middle ground and suggest that the truth lies somewhere between these two polarised positions. Despite this, the research findings to date are difficult to interpret due to inconsistencies, with the relationship between personality and injury remaining unclear. It would seem unlikely that a personality profile that characterises 'injury-prone' athletes actually exists (4), although some studies have identified patterns/trends that appear to warrant further investigation.

One recent study identified injured college gymnasts as possessing emotional instability, emotional disturbance, stress proneness and lack of self-control (5). This finding appears to support the stress-injury model previously discussed. Other research has shown a readiness to take risks (lack of caution, spirit of adventure) as characteristic of injured athletes, although this is not sufficient to establish a causal relationship between such traits and injury. The relationship between personality and injury should be viewed with caution. Some recent reviewers (6) emphasise that personality characteristics appear to either buffer or exacerbate the stress response – which is proposed to be the mechanism linked to injury. If personality is linked to injury (which is at present unclear) it is likely through indirect means.

Attitudes and injury
In work with injured athletes, some sport and exercise psychologists have proposed that certain attitudes might predispose athletes to injury (7). According to this research, the attitudes that coaches often try to instil in their athletes can actually backfire with regard to injury risks. For example, the 'no pain, no gain', and 'give 110%' attitudes might unwittingly lead to athletes taking undue risks. In many sports, participants need to be assertive and play hard, but within safe limits, employing appropriate techniques and strategies. This doesn't just apply to contact sports since many other exercisers attempt to go through the pain barrier and as a result suffer overuse injuries or over-train.

A study cited by Weinberg and Gould (1995, p265) perfectly illustrates why giving 110% does not always produce the best performances. The study concerned 400m runners who were first asked to run all-out during a timed trial (giving 110% effort). A few days later the same runners were asked to complete a second run, this time at 95% of their capacity. Interestingly, runners' times were quickest in the 95% effort. The authors concluded that the result was due to increased muscular tensions in attempting to run beyond capacity which interfered with the necessary relaxed coordination of working muscles.

A second identified attitude associated with injury (especially in team situations) is the notion of 'worthlessness'. When an athlete sustains a minor injury that requires both treatment and rest, he/she may feel 'worthless' from not being able to contribute to winning. If the coach reinforces this feeling by unconsciously conveying the wrong message, the performer might easily decide to play through the injury to remain part of the team. There are times when the coach must insist on the player receiving treatment and sitting-out the competition for the benefit of all concerned. In such cases the coach can reassure the player that his/her contribution to the team will be greater with early treatment and quick recovery rather than with more lengthy rehabilitation periods caused by playing on through injury. Coping with stress

The most consistent psychological factor related to injury seems to be stress. It therefore follows that the ability to cope with stress can act as an essential buffer to reduce the likelihood of injury. Although the causes of stress can reside both inside and outside the sporting arena, and the coping mechanisms used by athletes appear to vary considerably(8), one of the fundamental and simplest buffers to stress appears to be social support from significant others. This can mean numerous sources such as coach, parents, partners, sport psychologist, etc. and can involve a variety of different approaches from formal counselling to simply being there to listen.

An in-depth review of coping and exploration of coping responses is beyond the scope of this article, but such approaches as stress-inoculation training, cognitive affective stress management, and systematic desensitisation, employing such applied techniques as progressive muscular relaxation, meditative relaxation, and cognitive restructuring are commonly cited in applied sport psychology texts. However, there are some simple approaches that can help athletes deal with stress at the competition site itself.

The actions and behaviour of coaches can psychologically impact on athletes so try to maintain consistent behaviour. The coach can actually transfer tension and nervousness to the athlete by behaving differently than when in practice situations.

The coach should try to help athletes embrace the challenge and see pressure situations as exciting and a chance to excel, rather than fearing the consequences of poor performance. To this end, it is important to promote focusing on the present and on what needs to be done (being instructional, not emotional) rather than on past events or on worrying about what might happen in the future – the 'what if...' scenario.

Setting-up simulated practice situations that incorporate pressure is a good way of familiarising the athlete with likely competitive conditions. Also, plan in advance the strategies and tactics to be employed as this can help reduce the uncertainty which is often a root cause of anxiety. When athletes feel stressed they often rush their actions. Try to encourage them to take their time. It is good to practise simple activities such as breathing control as a means of refocusing on the task in hand and remaining calm during breaks in play.

Lee Crust

References

(1) Weinberg, RS, & Gould, D (1995). Foundations of Sport and Exercise Psychology. Champaign, Ill. Human Kinetics.
(2) Andersen, MB, & Williams, JM (1988). 'A model of stress and athletic injury: Prediction and prevention'. Journal of Sport and Exercise Psychology, 10, 294-306.
(3) Smith, RE, Smoll, FL, & Ptacek, JT (1990). 'Conjunctive moderator variables in vulnerability and resilience research: Life stress, social support and coping skills and adolescent sport injuries'. Journal of Personality and Social Psychology, 58(2), 360-369.
(4) Junge, A (2002). 'The influence of psychological factors on sports injuries: review of the literature'. American Journal of Sports Medicine, 28 (5 supp), S10-S15.
(5) Yan, J (1997). 'Personality of injured college students majoring in gymnastics'. Journal of Shanghai Physical Education Institute, 21(1), 37-41.
(6) Williams, JM, & Andersen, MB (1998). 'Psychological antecedents of sport injury: review and critique of the stress and injury model'. Journal of Applied Sport Psychology, 10 (1), 5-25.
(7) Rotella, RJ, & Heyman, SR (1986). 'Stress, injury and the psychological rehabilitation of athletes'. In JM Williams (Ed), Applied Sport Psychology: Personal growth to peak performance (pp. 343-364). Palo Alto, CA. Mayfield.
(8) Gould, D, Finch, LM, & Jackson, A (1993). 'Coping strategies used by national champion figure skaters'. Research Quarterly for Exercise and Sport, 64(4), 453-468.

stress and sports injuries, psychology of injury, personality and injury, psychological antecedents of injury, stress and injury

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