What is sporting injury?
Injury is a common issue facing all sport performers (Ristolainen et al. 2012). Sporting injury can be defined as “loss or abnormality of bodily structure, or functioning, resulting from an isolated exposure to physical energy during sports training or competition, that following examination is diagnosed by a clinical professional as a medically recognized injury” (Timpka et al. 2014: p.425). There are two types of sports injury; acute and overuse (Fagher & Lexell 2014). Acute/traumatic injuries refer to the immediate, or first time, occurrence of an injury (Flint et al. 2014), caused by a specific event (Fuller et al. 2006), such as, the breaking of an ankle after a sliding tackle in football. While overuse/chronic injury is a reoccurring injury (Flint et al. 2014) caused by repeated micro trauma, with the source of the issue being unidentifiable (Fuller et al. 2006), such as tennis elbow. Acute and overuse injuries can be caused by physical factors, such as contact (Ivancic 2012), as well as psychological factors including stressors such as perfectionism (Masten et al. 2014). The sports injury response most commonly discussed is physical pain and discomfort however, psychological responses also play a role in the road to recovery (Walker et al. 2007). As injuries have the potential to be career ending (Fuller et al. 2006), the concept of injury is usually associated with negative emotions (Evans et al. 2008).
Numerous models and psychological emotions/responses to injury exist. However, it is beyond the scope of this paper to cover every response. Therefore, only several models and responses will be identified. Two models that have attempted to identify the psychological response process athletes enter post injury are the 5-stage grief response model (Kubler-Ross 1989), and the Integrated Model of Response to Injury (Weise-Bjornstal 1998). The 5-stage grief response model (Kubler-Ross 1989) is based on an athlete experiencing grief post injury. Despite limitations, such as a lack of individual differences, this model has been used to explain psychological responses to sports injury for years (Walker et al. 2007). The 5 stages include:
1 – Denial
2 – Anger
3 – Bargaining
4 – Depression
5 – Acceptance
However, Weise-Bjornstal et al. (1998) proposed another model; The Integrated Model of Response to Sports Injury, incorporating both grief and cognitive appraisal responses (Walker et al. 2007). The model views injury as a dynamic process, taking personal and situational factors into consideration, with regards to rehabilitation adherence, while also outlining cognitive, emotional, and behavioural responses to sports injury (Weise-Bjornstal et al. 1998). Both Kubler-Ross (1989) and Weise-Bjornstal et al. (1998) emphasize the importance of adhering to the rehabilitation program, without which recovery process time is increased. As both models are concerned with adherence to rehabilitation programs it is suggested both models are more applicable to long term/severe injuries (Levy et al. 2008).
Walker et al. (2007) identified self-motivation as the most important factor concerned with rehabilitation adherence. Therefore, it can be suggested with increased motivation, adherence is improved, resulting in positive health outcomes (Grindley & Zizzi 2005), in this instance recovery. A psychological intervention used to increased motivation is imagery; ‘an experience that mimics real experience’ (Wesch et al. 2012: p.695). Within sport, imagery serves two functions: cognitive, the rehearsal of skills (Milne et al. 2005), and motivational, imagining goals and the steps required to achieve them (Wesch et al. 2012). With regards to a rehabilitation program cognitive imagery can be used to rehearse strengthening exercises, such as pistol squats, while motivational imagery can be used to set a goal date for recovery.
Psychological emotions/responses to injury include body image; one’s thoughts and feelings about their own body (Grogan 1999). Performers with chronic/severe injuries may suffer from a loss of athleticism (Cassidy 2006b), whereby the performer loses muscle definition and/or skill ability during inactivity (Cassidy 2006a). A result of this can be an increase in anxiety prior to sporting return (Monsma et al. 2009). Increased anxiety is associated with re-injury concerns, not being able to achieve one’s goals, and a lack of competency (Podlog & Eklund 2006), all of which can have a negative impact upon performance. Consider a rugby performer’s goal was to achieve the same standard of performance prior to injury, but do not enter a tackle with 100% commitment due to re-injury concerns. Consequently, frustration may occur (Walker et al. 2007), as the player is not tackling to their full potential. This can lead to reduced competence, whereby the athlete is not sensing effectiveness in the activity they are undertaking, resulting in disinterest. To restore competence goal setting (GS) can be used (Podlog & Eklund 2006). However, it is crucial GS follows the SMART principles (specific, measureable, attainable, relevant, & timely) (Johnson et al. 2014), and allow the athlete to have a say in the goal being set (Podlog et al. 2011), thus ensuring the performer’s autonomy is preserved (Podlog & Eklund 2006).
Athletic identity (Madrigal & Gill 2014); “the extent to which a person identifies with the athlete role” (Horton & Mack 2000: p.102), is another response to injury weakened during situations where the sport-related outcome is unfavorable (Grove et al. 2004), such as injury. Consequently, the individual cannot train and/or compete. Therefore, the behaviours of the individual are not in line with those of an athlete (Perrier et al. 2014). Consider a rugby player who cannot train or compete due to injury, he/she may no longer identify as an athlete, as they are not carrying out the similar behaviours.
A reduction in athletic identity can lead to a state of depression (Madrigal & Gill 2014) through the loss of social support groups, such as team members, causing the injured individual to feel isolated (Cassidy 2006a). From which motivation towards the individual’s sport can change (Proios 2012). All of these factors can negatively impact performance. For example, a change in motivation from autonomous to controlled (Chan et al. 2011) can result in an attitude change, whereby the performer may no longer care about their performance (Martin & Horn 2013) and therefore, do not put 100% effort into training resulting in not being selected for the team. This can further reduce an individual’s athletic identity (Grove et al. 2004) and feeling of isolation, as the performer is pushed further away from team situations. To overcome motivational changes and a loss of social support Chan et al. (2011) suggests the trans-contextual model can be used to transfer motivation from coaches to the performer. For example, if coaches remained autonomously supportive of the injured performer throughout the recovery process, the performer will not lose their social support network (Cassidy 2006b) and may retain their own autonomous motivation from feeding off of the coach’s, which as previously identified is key to rehabilitation adherence (Walker et al. 2007).
Within the constraints of this paper the issues outlined above have highlighted several psychological responses to injury. A more extensive review would identify additional responses, including the perception of weakness.