3 Are psychological interventions effective?
Various studies have indicated that psychological interventions are effective in reducing the risk of sport injury. For example:
- In their systematic review of psychological interventions to reduce sport injury Gledhill et al. (2018) reviewed thirteen papers and found that 93% reported a reduction in injury rates. These studies predominantly involved stress management related interventions and used the Stress and Injury model as a framework.
- Similarly, a meta-analysis (a study which statistically combines the results from multiple research studies) of fifteen studies by Tranaeus et al. (2015) concluded that psychological interventions have a large effect on injury reduction.
- A further meta-analysis by Ivarsson et al. (2017) revealed decreased rates of injury in the treatment groups (those who used interventions) compared to the control groups (those who didn’t use interventions) in the seven injury prevention studies they examined.
In the next activity you will explore one particular study in more detail by reading the box below.
Box 1 Research: The effectiveness of a stress management intervention
To measure the effectiveness of a three-month stress management programme designed to reduce the incidence of sport injury.
63 male youth football players aged 17–19 years from four Spanish national youth league teams. 35 of these participated in a stress management programme (intervention group) and 28 did not (control group).
Stress management programme intervention:
The stress management programme was designed to teach the players to cope with stress. It required the players to attend a weekly one-hour session for three months and included the following modules:
linking thoughts and emotions
- progressive muscle relaxation, breathing, imagery, passive and differential muscle relaxation
- self-instructional and attention-focus training
- stress inoculation training
It was based on a method called Stress Inoculation Therapy (SIT) which aims to teach people about stress and how to manage it. SIT aims to progressively expose the individual to stressful situations, gradually ‘inoculating’ the events that might trigger a stress response in order to increase the participant’s ‘resistance’ to stress.
The average number of sport injuries experienced per month was recorded before and after the stress management programme intervention. Before the intervention the number of injuries was similar for the intervention and control groups, but following the stress management programme the intervention group experienced significantly fewer injuries than the control group.
(Olmedilla-Zafra et al., 2017)
Activity 2 An injury prevention programme
Read Box 1 which outlines a study undertaken by Olmedilla-Zafra et al. (2017) examining the effectiveness of a stress management intervention on injury prevention in football (soccer) players. Then complete the following tasks:
- Visit the
webpage and find out more about one of the following techniques included in the stress management programme:
- Progressive muscle relaxation (also known as muscle relaxation)
- Breathing strategies
- Imagery (also known as visualisation).
- Reflect on whether you think our case study Travis, who was experiencing a lot of stress before his injury (see Activity 1 of Session 3), would have benefited from using a stress management package such as this and why.
- Progressive muscle relaxation (PMR), breathing techniques and imagery are all examples of techniques that have been used to increase relaxation and reduce stress. The Athletes Connected page will have shown you some practical examples of your chosen technique.
All of these techniques have received research support for use in the prevention of sport injury, but there has been some wider debate about the effectiveness of PMR. This is because a systematic review (Pelka et al., 2016) concluded that PMR was ineffective in enhancing performance. It should be noted, however, that this review was specifically investigating the direct effect of PMR on measures of sports performance (e.g. tennis strokes, reaction time, muscle strength, aerobic performance), while the benefits of PMR in relation to sport injury are likely to be more indirect. For example, PMR has been shown to improve sleep, which could indirectly reduce injury risk (e.g. improved recovery from training, reduced stress/anxiety) (McCloughan et al., 2016). Additionally, as you have just seen, studies such as Olmedilla-Zafra et al. (2017) have found support for PMR in sport injury prevention.
- The study undertaken by Olmedilla-Zafra et al. (2017) shows that the stress management programme was effective in reducing the incidence of sport injury in youth footballers. As you saw in Activity 1 (Session 3) Travis was experiencing a large amount of stress before his injury. It is possible that, had he had access to a stress management programme like this, he may not have become injured. To help prevent future injuries it would be beneficial for him to learn stress management strategies such as those in the study.
You will look at psychological interventions in more depth in Sessions 7 and 8 when you explore their use in rehabilitation from sport injury.