2 Which psychological factors increase injury risk?

In the previous section you identified that there are various factors that can increase the risk of developing a sport injury, including psychological factors. In this section you will begin to explore what these psychological factors are and how they can potentially increase the risk of injury. There are two main psychological factors that have been identified as potential antecedents of sport injury – stress and personality. These both feature in a key model in this field – the Stress and Injury model (Williams and Andersen, 1998).

The Stress and Injury model (Figure 2) can be used to explain how psychological factors increase the risk of sport injury. When exposed to a potentially stressful situation the individual’s stress response will dictate whether or not an injury occurs. This stress response is influenced by three key things – personality, history of stressors and coping resources – and can be mediated through the use of interventions.

Maximise

Figure 2 The Stress and Injury model (Williams and Andersen, 1998)

The next activity will help you to understand the model and its application.

Activity 1 Applying the Stress and Injury model

Timing: Allow about 35 minutes

Watch Video 2 in which Lesley Podlog, a key researcher in the psychological aspects of sport injury, describes the components of the Stress and Injury model.

Download this video clip.Video player: Video 2

Show transcript|Hide transcript

Transcript: Video 2

LESLEY PODLOG

So looking at the model, the first thing that Williams and Andersen suggests occurs is that the athlete enters into a potentially stressful athletic situation. So this can be an important competition. It could be a demanding training session. It could be a physical test of strength or endurance. But the key is that the situation is only potentially stressful. Why?

One of the things that George mentioned at the end of his talk is this idea of perception. The key to the model is how athletes appraise or interpret the meaning of the situations that they enter into. So as individuals, when we enter into a competition or really any situation, one of the things that we do is we make an assessment of the demands of the situation. So the athlete assesses what's being required of me in this particular situation.

They also make an assessment of what are their abilities, their resources, or capabilities for meeting the demands of the situation. If they believe that they have the capabilities to meet the demands, they're likely to interpret this situation as a challenge, one that they can successfully meet and do well at.

On the other hand, if they perceive the situation, if they believe that the demands are greater than their ability to meet those demands, they're more likely to appraise the situation as threatening. In this case, it's suggested that athletes experience what Williams and Andersen call the stress response.

The stress response is characterised by two key features. There is an attentional component, and there's a physical component. From an attentional standpoint, it's suggested that a couple things happen to athletes under stress conditions.

First of all, the athlete has a greater inability to detect cues in the peripheral environment. So they become less sensitive to cues in the periphery, and they experience what we call tunnel vision or a narrowing of the peripheral vision. So for instance-- the football player who's really stressed might only be able to see straight ahead, and they fail to see that defender who's coming in for the slide tackle. And under these conditions, the athlete is more susceptible to getting hurt.

From an attentional standpoint, there are other consequences from stress. Another consequence is that individuals tend to become distracted. So they have task-irrelevant types of thoughts.

So maybe the athlete is thinking oh, why did I miss that last pass? Or my coach is not particularly impressed with how I'm performing right now. In other words, they're not absorbed in the task at hand. So under these conditions when the athlete is not fully immersed in the process of what they're doing, when they're distracted, they're also more susceptible to getting hurt.

From a physical standpoint, it's also been suggested that there are also a number of changes that occur during stress. So for instance, heart rate may increase. Timing and coordination may be impaired. And one of the factors that George mentioned-- fatigue may also be related to or is suggested to be related to increased likelihood of injury.

So there's a few other factors that I just want to briefly mention in the model before highlighting the empirical work that's tested it. It's also contended that three categories of factors-- one's personality so the traits that make up the individual or how they typically respond from one situation to the next.

Their history of stress, and the here, there's two main categories. One are major negative life events so significant changes in the person's life, things like moving to a new country, or getting a new job, or relationship issues. But also more chronic daily hassles or even uplifting events can be challenging for an individual to deal with.

So these history of stresses combined with how athletes cope, how they manage situations, how they deal with stress and challenges, along with their personality all come to bear on how they appraise discrete situations. So again, these factors are suggested to either increase or decrease the likelihood that athletes interpret the situation as threatening, and the subsequent stress response and injury likelihood.

Just finally, in the model, it's also suggested that psychological skill interventions-- things like the ability to try and breathe, or regulate one's heart rate, or somatic tension; giving athletes skills to help them think about how they talk to themselves, or how they interpret situations. Mindfulness techniques that help the athlete to be more attentive in the moment and absorbed in what they're doing can mitigate or reduce the stress response and the subsequent likelihood of injury.

End transcript: Video 2

Download

Video 2

Interactive feature not available in single page view (see it in standard view).

Now read the next instalment of Travis’s case study in the box below and try to apply the model to Travis. Alternatively, you may prefer to apply the model to yourself or someone you know who has experienced sport injury.

Case study: Applying the Stress and Injury model to Travis’s injury

In the weeks leading up to his injury Travis had been under a lot of pressure at work as he had been promoted into a new role and was in charge of bidding for a new contract for his company. This led him to feel very stressed and he didn’t feel that he was coping very well with the stress of his new job role. Travis has always found it difficult to cope with high pressure situations. He has been finding it hard to switch off from work and was consequently feeling very tense. He had been experiencing muscle tension in his shoulders and had been short tempered at home in the days leading up to his injury. He came to the gym following an argument with his husband Trevor on the day that he sustained his rotator cuff injury during a heavy weight lifting session. When talking to his physiotherapist Lydia, he said that he had been quite distracted thinking about both the argument and the contract he was bidding on at work (the main source of his work-related stress). He felt that this caused him to use poor technique when lifting the bar which may have led to the injury.

Discussion

If you apply the Stress and Injury model to Travis’s case study, you can see that Travis’s new job and being in charge of bidding for a new contract at work is a potentially stressful situation that Travis has cognitively appraised as being stressful. This appraisal has caused attentional changes (Travis was distracted when lifting weights as a result of thinking about the argument and the contract) and physiological changes (muscle tension in his shoulders) that could have led to his injury.

As the model shows, Travis’s cognitive appraisal and stress response has been influenced by personality factors (it seems that Travis is prone to finding it difficult to cope with high pressure situations), history of stressors (e.g. the change in job, argument with his husband) and a perceived lack of coping resources (he doesn’t feel he was coping well with the stress of his new job). The model suggests that interventions (strategies or techniques to help him manage stress) may have reduced his risk of developing an injury. As Travis didn’t use any such interventions the injury was more likely to occur. You will explore interventions to help reduce injury in Session 4.

Having explored the Stress and Injury model, you’ll now examine some of the mechanisms to explain how stress can lead to injury.