- E233_1Sport and exercise psychology: a case study approach
The psychological aspects of sports injury
About this free course
This free course is an adapted extract from the Open University course Sport and exercise psychology: a case study approach www.open.ac.uk/courses/modules/e233.This version of the content may include video, images and interactive content that may not be optimised for your device. You can experience this free course as it was originally designed on OpenLearn, the home of free learning from The Open University: www.open.edu/openlearn/health-sports-psychology/health/sport-and-fitness/the-psychological-aspects-sports-injury/content-section-0.There you’ll also be able to track your progress via your activity record, which you can use to demonstrate your learning.The Open UniversityWalton Hall, Milton KeynesMK7 6AACopyright © 2016 The Open University
Intellectual property
Unless otherwise stated, this resource is released under the terms of the Creative Commons Licence v4.0 http://creativecommons.org/licenses/by-nc-sa/4.0/deed.en_GB. Within that The Open University interprets this licence in the following way: www.open.edu/openlearn/about-openlearn/frequently-asked-questions-on-openlearn. Copyright and rights falling outside the terms of the Creative Commons Licence are retained or controlled by The Open University. Please read the full text before using any of the content. We believe the primary barrier to accessing high-quality educational experiences is cost, which is why we aim to publish as much free content as possible under an open licence. If it proves difficult to release content under our preferred Creative Commons licence (e.g. because we can’t afford or gain the clearances or find suitable alternatives), we will still release the materials for free under a personal end-user licence. This is because the learning experience will always be the same high quality offering and that should always be seen as positive – even if at times the licensing is different to Creative Commons. When using the content you must attribute us (The Open University) (the OU) and any identified author in accordance with the terms of the Creative Commons Licence.The Acknowledgements section is used to list, amongst other things, third party (Proprietary), licensed content which is not subject to Creative Commons licensing. Proprietary content must be used (retained) intact and in context to the content at all times.The Acknowledgements section is also used to bring to your attention any other Special Restrictions which may apply to the content. For example there may be times when the Creative Commons Non-Commercial Sharealike licence does not apply to any of the content even if owned by us (The Open University). In these instances, unless stated otherwise, the content may be used for personal and non-commercial use.We have also identified as Proprietary other material included in the content which is not subject to Creative Commons Licence. These are OU logos, trading names and may extend to certain photographic and video images and sound recordings and any other material as may be brought to your attention.Unauthorised use of any of the content may constitute a breach of the terms and conditions and/or intellectual property laws.We reserve the right to alter, amend or bring to an end any terms and conditions provided here without notice.All rights falling outside the terms of the Creative Commons licence are retained or controlled by The Open University.Head of Intellectual Property, The Open University978 1 47300 042 1 (.kdl)
978 1 47300 137 4 (.epub)IntroductionSports injury is relatively common among sport and exercise participants, but what role does psychology play in it? To answer this question, this free course, The psychological aspects of sports injury, will examine two areas: firstly, it will consider the psychological factors that may increase the likelihood of sustaining a sports injury, and secondly, it will consider psychological reactions to the incidence of a sports injury. The course will also examine how sport psychology can be used both to help minimise the risk of injury and to help people cope better with sports injury rehabilitation.This OpenLearn course is an adapted extract from the Open University course E233 Sport and exercise psychology: a case study approach. After studying this course, you should be able to:recognise the psychological factors that may potentially lead to a sports injuryunderstand psychological responses to sports injuryappreciate the role the sport psychology intervention can play in rehabilitation from injury.1 Psychological factors and the risk of sports injuryUnfortunately, injury is a relatively common occurrence among sports participants (Timpka et al., 2005). It was estimated in the 1990s that 29.7 million sports injuries occur each year in the UK (Nicholl et al., 1995). That figure may well have now increased. Traditionally, the study of sports injury has focused on the physical aspects of injury. More recently, however, the psychological aspects of sports injury have also been considered.The psychological aspects of sports injury can be split into two broad categories: psychological factors that may increase an athlete’s risk of developing an injury, and psychological reactions to sports injury and their impact. You will consider both of these, as well as examining the role that sport psychology can play in the prevention and treatment of sports injuries.We will begin exploring these topics by using the case study of Jody.Case study: JodyJudo is, and always has been, the main focus of Jody’s life. She is a full-time athlete receiving National Lottery funding and is dedicated to achieving her goal of winning an Olympic gold medal. However, prior to becoming injured, Jody had a lot to deal with – her nephew had been hospitalised with a serious illness and she had recently moved house, having split up with her long-term partner. Jody has always found it hard to relax and ‘switch off’ and had been planning to book a session with a sport psychologist to help address this. However, she never got round to booking an appointment.Sports injuries can be caused by a wide variety of factors. These factors can be grouped into four main areas: physical, environmental, socio-cultural and psychological (Wiese-Bjornstal and Shaffer, 1999). Physical (e.g. fatigue, overuse, muscle imbalances) and environmental (e.g. slippery surfaces, unsafe equipment) factors are perhaps more obviously associated with injury, but the links between socio-cultural and psychological factors and injury are less obvious.Socio-cultural factors relate to the culture and attitudes that are often adopted within sports teams that could encourage the development of a sports injury. Some examples of the attitudes that could increase the risk of injury include:the belief that pain tolerance demonstrates strength and toughnessan acceptance that pain and injury are part of sport – ‘no pain, no gain’an unwillingness to seek medical treatment for fear of appearing weakrole and monetary pressures to continue to play sport while injured (e.g. pressure from management or sponsors).(Adapted from Wiese-Bjornstal and Shaffer, 1999, pp. 24–5)For the remainder of this section we will focus on the psychological factors that can increase an athlete’s susceptibility to sports injury. You will begin by reading some literature on this topic and linking it to Jody’s case study.Activity 1 Psychological factors that may lead to injuryAllow about 40 minutesReread Jody’s case study and consider which psychological factors might have led to her injury and how these factors could have contributed to her injury.There are two potential psychological causes of sports injury – personality and stress. Research examining the link between personality factors and risk of injury remains inconclusive. To date, stress appears to have received the most research attention, with Andersen and Williams’ (1988) model of stress and injury underpinning most of the research in this area. Williams and Andersen (1998) later revisited this model and made a few minor changes. The risk of injury is thought to increase in proportion to the level of stress. Prior to her injury Jody seemed to be experiencing some very stressful situations. Dealing with the illness of a loved one, a relationship breakdown and moving house are all considered to be significant life stress events. According to Andersen and Williams’s (1988) model, this stress could have contributed to the development of her injury by:acting as a distraction, preventing her from focusing on her judo techniquesnarrowing her attention, causing her to miss important cues/stimuliincreasing her muscle tension, inhibiting the coordination of her movement when performing her judo skills.2 Psychological reactions to sports injuryIf 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: JodyWhen 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 injuryAllow about 45 minutesRead the following extract from ‘Psychological reactions to exercise and athletic injury’.Reading 1Now 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 injuryAllow about 40 minutesWatch 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.3 The role of sport psychology interventionThe use of sport psychology techniques can be helpful in both the prevention and the treatment of sports injuries. The next activity considers how sport psychology can assist in both of these areas. Activity 4 Sport psychology intervention and sports injuryAllow about 20 minutesBased on what you learned in Section 1, how do you think sport psychology can be used to prevent injury?Based on what you learned in Section 2, how do you think sport psychology can be used to aid rehabilitation from injury?Watch the video below of 2016 Olympic hockey champion Helen Richardson-Walsh and make a list of some of the psychological strategies she used to aid her recovery from injury.As much of what was discussed in Section 1.2 focused on the links between stress and injury risk, it would seem logical that the use of stress management techniques could help to reduce the risk of injury. This has been supported by various research studies. For example, Johnson et al. (2005) found that a stress management programme significantly reduced the number of injuries that developed among a group of soccer players. It is plausible to suggest, then, that Jody’s risk of injury may have been reduced had she utilised stress management techniques.If certain psychological reactions to injury can have a negative effect on rehabilitation and rehabilitation outcomes, any intervention designed to reduce such reactions could potentially be of benefit. The specific interventions that can be used are shown in Box 1.Helen describes three key strategies that she used, all of which are discussed in Box 1. Firstly, she used goal-setting to help her focus. Secondly, she visualised herself achieving her goal of becoming Olympic champion (imagery), and finally she used a blog as a way of sharing her experience and talking to other people (social support).Box 1 Sport psychology interventionsImagery Imagery, the process of creating or recreating a scenario in the mind’s eye, can be used in several different ways during injury. It can be used to practise physical skills when physical practice is not possible, to reduce stress and anxiety, and to help manage pain (e.g. by acting as a distraction during painful treatments). There is also some evidence to suggest that imagining the injured tissues healing can actually speed up the healing process.Goal settingSetting short- and long-term goals for recovery, return to training/competition and day-to-day rehabilitation can help focus athletes’ attention, keep them motivated and increase their adherence.Positive self-talkThe occurrence of an injury can lead to negative thoughts. The use of positive self-talk can help to develop a positive attitude towards rehabilitation.Relaxation techniquesRelaxation techniques can help to ease the stress and anxiety that may be a consequence of injury. They can also help to relieve tension in the injured area.Social supportSocial support can mediate some of the psychological stresses of being injured. For example, some of the negative consequences of injury, such as loneliness and loss of identity, occur because contact is lost with team-mates and/or coaches when an athlete is injured. This could be alleviated by maintaining contact, by, for example, an athlete undertaking their rehabilitation exercises alongside team practice sessions.ConclusionThis free course, The psychological aspects of sports injury, examined the effect that psychological factors can have on the development of a sports injury and rehabilitation from sports injury. It also considered how sport psychology techniques can be used to prevent sports injury and enhance rehabilitation. The main learning points are:Psychological factors that may predispose an athlete to injury include stress and certain personality characteristics.The model of stress and injury (Andersen and Williams, 1988; Williams and Andersen, 1998) has been used to examine the links between stress and injury risk.The occurrence of a sports injury can lead to several negative psychological reactions, which can impact on rehabilitation.Grief response models and cognitive appraisal models have been used to describe psychological reactions to injury. Cognitive appraisal models have received more support because they allow for individual differences.Sport psychology intervention can greatly benefit the injury rehabilitation process.The psychological aspects of sports injury provided an introduction to studying Sport and Fitness Qualifications. It took you through a series of exercises designed to develop your approach to study and learning at a distance and helped to improve your confidence as an independent learner.This OpenLearn course is an adapted extract from the Open University course Sport and exercise psychology: a case study approach. If you enjoyed The psychological aspects of sports injury you may be interested in the Badged Open Course E233 Exploring sport coaching and psychology.Keep on learning Study another free courseThere are more than 800 courses on OpenLearn for you to choose from on a range of subjects. Find out more about all our free courses. Take your studies furtherFind out more about studying with The Open University by visiting our online prospectus. If you are new to university study, you may be interested in our Access Courses or Certificates. What’s new from OpenLearn?
Sign up to our newsletter or view a sample. For reference, full URLs to pages listed above:OpenLearn – www.open.edu/openlearn/free-courses
Visiting our online prospectus – www.open.ac.uk/courses
Access Courses – www.open.ac.uk/courses/do-it/access
Certificates – www.open.ac.uk/courses/certificates-he
Newsletter – www.open.edu/openlearn/about-openlearn/subscribe-the-openlearn-newsletter
Andersen, M.B. and Williams, J.M. (1988) ‘A model of stress and athletic injury: prediction and prevention’, Journal of Sport and Exercise Psychology, vol. 10, no. 3, pp. 294–306.Brewer, B.W. (1994) ‘Review and critique of models of psychological adjustment to athletic injury’, Journal of Applied Sport Psychology, vol. 6,
no. 1, pp. 87–100.Evans, L. and Hardy, L. (1995) ‘Sport injury and grief responses: a review’, Journal of Sport and Exercise Psychology, vol. 17, no. 3, pp. 227–45.Galambos, S.A., Terry, P.C., Moyle, G.M. and Locke, S.A. (2005) ‘Psychological predictors of injury among elite athletes’, British Journal of Sports Medicine, vol. 39, no. 6, pp. 351–4. Johnson, U., Ekengren, J. and Andersen, M.B. (2005) ‘Injury prevention in Sweden: helping soccer players at risk’, Journal of Sport and Exercise Psychology, vol. 27, no. 1, pp. 32–8.Kübler-Ross, E. (1969) On Death and Dying, Toronto, Macmillan.Nicholl, J.P., Coleman, P. and Williams, B.T. (1995) ‘The epidemiology of sports and exercise related injury in the United Kingdom’, British Journal of Sports Medicine, vol. 29, no. 4, pp. 232–8.Timpka, T., Lindqvist, K., Ekstrand, J. and Karlsson, N. (2005) ‘Impact of social standing on sports injury prevention in a WHO safe community: intervention outcome by household employment contract and type of sport’, British Journal of Sports Medicine, vol. 39, no. 7, pp. 453–7.Wiese-Bjornstal, D.M. and Shaffer, S.M. (1999) ‘Psychosocial dimensions of sports injury’ in Ray, R. and Wiese-Bjornstal, D.M. (eds) Counseling in Sports Medicine, Champaign, IL and Leeds, Human Kinetics.Williams, J.M. and Andersen, M.B. (1998) ‘Psychosocial antecedents of sport injury: review and critique of the stress and injury model’, Journal of Applied Sport Psychology, vol. 10, no. 1, pp. 5–25.The material acknowledged below is Proprietary and used under licence (not subject to Creative Commons Licence). See Terms and Conditions.Course image: Groman123 in Flickr made available under Creative Commons Attribution-ShareAlike 2.0 Licence.Figure 1: Brewer, B.W. (1994) ‘Review and Critique of Models of Psychological Adjustment to Athletic Injury’ (pp. 87-100)Don't miss out:If reading this text has inspired you to learn more, you may be interested in joining the millions of people who discover our free learning resources and qualifications by visiting The Open University - www.open.edu/openlearn/free-courses
Discussion
2019012600