2 Psychological reactions to sports injury
If you have ever experienced a sports injury yourself, you will have first-hand experience of how having an injury can make people feel. Being involved in sport can become a significant part of people’s lives. In fact, some people have a very strong athletic identity, where their personal identity is strongly attached to being a sportsperson. When an injury occurs, and sports participation is consequently either restricted or stopped, it can lead to several psychological reactions. In this section we will examine some of these reactions and the models used to explain them.
The next activity looks at two common ways of understanding responses to injury. Read the following case study, which outlines the next stage in Jody’s case, and then try the activity.
Case study: Jody
When Jody first became injured she was extremely upset and angry because she felt that her world had fallen apart. Her whole life is centred on judo and her goal of becoming an Olympic champion. She was angry because she felt that the injury was taking her dreams away from her. Initially, she refused to accept the diagnosis and was adamant that she would return to training and competition long before her physiotherapist suggested.
Gradually, however, she has grown to accept that the injury will cause her to miss a long period of training/competition. She finds this very frustrating and feels jealous when she hears other judo athletes talking about training sessions or competitions they have undertaken. She is trying to focus her attention on her rehabilitation programme, but she is feeling very demotivated and down because she finds her rehabilitation programme very boring in comparison with judo training. She is also starting to experience doubts about her ability to recover from the injury and regain her pre-injury form when she does return. She is looking forward to returning to judo training eventually, but is worried about re-injuring the shoulder and occasionally experiences flashbacks of the moment when the injury occurred.
Activity 2 Psychological reactions to injury
Read the following extract from ‘Psychological reactions to exercise and athletic injury’.
Now complete these tasks:
- Using the information in the case study, try to match Jody’s reaction to the five grief response stages (denial, anger, bargaining, depression and acceptance/reorganisation) outlined in the extract. Consider how easy or difficult a task this might be.
- What do you think of the grief response model? Is it a good way to explain or describe how athletes react to a sports injury? What are the limitations of the model?
- Grief response (or stage) models assume that an athlete will react to an injury in a way similar to that in which an individual might respond to a significant loss, such as the death of a loved one. This suggests that injury constitutes a form of loss to the individual. The grief response model presented in the chapter stems from Kübler-Ross’s (1969) model, which was originally developed to explain reactions to terminal illness. When we examine Jody’s case study, we can probably see some evidence of all five stages of the model, although they do not necessarily occur in the specified order; for example, anger seems to come before denial.
- By trying to answer these questions you are developing your critical thinking skills. Critical thinking is an essential skill in undergraduate-level study. It is important that you do not accept everything that you read as being correct, but that you question and challenge what you read and look for evidence and examples to support your analyses. Although grief response models are an intuitively appealing way to describe reactions to sports injury, they do have limitations. The main limitation is their rigidity: they assume that every athlete is the same and that, consequently, all athletes will react to injury in the same stereotypical way. In practice, this is probably not the case – Jody may react in a completely different way to her injury than another judo athlete with the same injury may react. For example, an athlete who has been underperforming may see an injury as an escape from or an excuse for poor performance. Such an athlete is unlikely to demonstrate, for example, a period of depression, because they may be quite happy about being injured. Due to these limitations, cognitive appraisal models have come to be more widely accepted as models of psychological reaction to injury than grief response models, because they allow for individual differences. Cognitive appraisal models will be discussed next. If you are particularly interested in this area, a more detailed critique of grief response models can be found in Brewer (1994) and Evans and Hardy (1995).
In contrast to grief response models, cognitive appraisal models take individual differences into account. They do not assume that all athletes will react in the same way to injury. Instead, they suggest that how an individual interprets or appraises the injury (cognitive appraisal) will dictate their psychological reactions. This allows for Jody and another judo athlete to exhibit entirely different psychological reactions to the same injury. Therefore, it is the perception of an injury that affects psychological reactions, rather than the injury itself.
Figure 1 shows a cognitive appraisal model that suggests that how an individual interprets or appraises their injury is influenced by two variables – personal factors and situational factors. Personal factors include personality, age and previous experiences of injury. Situational factors include the stage of the competitive year and social influences (e.g. the coach’s reaction to the injury).
As mentioned above, the cognitive appraisal model suggests that how an individual appraises their injury (cognitive appraisal) dictates their psychological reactions or emotional response to the injury. The model further proposes that these emotional responses will affect the individual’s behaviour in relation to the injury; for example, whether or not they will adhere to their injury rehabilitation. This is shown in Figure 1 in the final stage of the cognitive appraisal model (behavioural response). We explore this further in Actvity 3.
Activity 3 Psychological reactions to injury
Watch the video below in which 2016 Olympic hockey gold medallist Helen Richardson-Walsh discusses the psychological impact of the various injuries she has experienced during her career. After you have watched the video, answer the questions below.
- What are some of the psychological reactions Helen has experienced in response to sports injury?
- What personal and situational factors might influence Helen’s cognitive appraisal of the injuries she has experienced?
1. Helen describes various psychological reactions to sports injury. These include feelings of fear, anxiety and hopelessness. She also discusses feeling a loss of identity when not being able to play hockey, which links to the concept of athletic identity discussed at the beginning of this section 1.3. As a full-time hockey player we would expect Helen to have a strong athletic identity and to see a large part of her identity as a hockey player.
2. There are various personal and situational factors that may have influenced Helen’s cognitive appraisal of each injury she has had. Helen’s previous experiences (personal factor) of injury are likely to have a had a significant impact. In the video Helen mentions that she has had several injuries. Therefore, her expectations of, for example, her likely return to full fitness and the time it will take, will probably be influenced by how quickly she achieved this for previous injuries. The timing of injury in relation to an important competition (situational factor) may also have affected her cognitive appraisal. For example, an injury experienced in the off-season, may evoke lesser feelings of anxiety and frustration than an injury sustained close to a major competition. In the video Helen describes the negative emotions attached to missing the World Cup due to a back injury.
It is important to note that the appraisal of an injury is not static, and neither are its consequences. Appraisals are likely to change as the injury progresses and possible setbacks are experienced. This is demonstrated in the case studies, where Jody’s reactions to her injury progressively changed over time.