Chapter 12

Injuries: The Psychology of Recovery and Rehab

By Charles Brown

Prevalence of Sports Injuries

17 million sports injuries occur in the USA each year.

Almost half of all collegiate football players lose playing time due to injury.

(continued)

Prevalence of Sports Injuries (cont)

A 1997 survey showed that 73% of all World Cup skiers had experienced a season-ending injury during their careers.

Women in college soccer or basketball have a 1 in 10 chance of sustaining an ACL injury (a rate 6 times greater than that of men).

Sports Injuries and Aging

Between 1991 and 1998, sport-related emergency room visits for 35- to 54-year-olds increased 33%.

From 1990 to 1996, sports injuries among those aged 65 years and older increased 54%.

Injuries and Psychological Effects

A 1996 survey indicated that 47% of certified athletic trainers believe that every athlete suffers negative psychological effects when injured.

Stress and Injury: Athletes at Risk

A research study of the University of Washington football team identified those with low and high life stresses. Just 9% of low-stress athletes experienced injuries that made them miss 3 days of practice or a game, whereas 50% of high-stress athletes did.

Elevated Stress Response

An elevated stress response can be caused by• a history of stress,• poor coping

resources, and• personality factors.

(continued)

Elevated Stress Response (cont)

Elevated stress response may lead to• muscle tension,• increased distractibility,• narrowing of attention, and• endocrine stress response and lower functioning

of immune system.

Athletes at Risk

Athletes with an elevated stress response are considered at risk for injury:• History of stress• Poor coping resources• Personality factors (e.g., high trait anxiety)

Emotional ResponseStage Model of Grief

Shock Denial Anger Bargaining Depression Acceptance

Cognitive-Appraisal Model of Reactions to Injury

Goal adjustment Rate of perceived

recovery Self-perceptions Belief and attributions Sense of loss or relief Cognitive coping

Research on Psychological Adjustment to Injury

Psychological stress involves fears of loss of dreams, fears of reinjury, reminders of injury (crash), worries about readiness to return.

Social concerns are isolation and distance from coaches and teammates.

Successful recovery was correlated with the amount of attention and empathy expressed toward them by teammates and coaches.

(Gould et al., 1997)

Strategies for Coping

Problem-focused coping involves managing or changing the problem.

Emotion-focused coping involves dealing with the emotions aroused by injury and its aftermath.

Avoidance strategies are also used: disengaging or distancing oneself from the situation. Usually effective only in the short term.

(Carver et al., 1989)

Social Support and Injury

Emotional support is the ability to turn to others for comfort and security.

Esteem support is rebuilding a sense of confidence.

Informational support is about the nature of the injury and what to expect from rehab.

Tangible support is concrete assistance that supports coping.

Goal Setting and Rehab

Athletes need help in setting attainable goals.

Ego-involved athletes are likely to approach rehabilitation by finding someone with a similar injury and attempting to outperform that person.

Task-involved athletes are more likely to focus on good effort and steady improvement.

Help athletes identify rehab models, and teach them mental skills for use in rehab.

Transtheoretical Model of Change

Rehab is dealt with in stages:• Precontemplation• Contemplation• Preparation• Action• Maintenance

There’s a potential relapse stage.

Health Belief Model

Adherence to rehab depends on these factors:• Perceived severity of the injury• The perceived balance between benefits of health-

enhancing behaviors and costs of participating in rehab

Adherence can be maximized by educating the athlete about the nature of the injury, the rationale for rehab, and the possible consequences of failure to complete rehab.

Protection Motivation Theory

Adherence to rehab is determined by these factors:• Severity of threat to health• Perceived susceptibility to threat• Perceived effectiveness of rehab• Self-efficacy toward rehab

Effective Recovery Methods

Goal setting

Imagery and relaxation

Positive self-talk

Tips for Avoiding Injury

Avoid introducing new high-risk routines or engaging in high-risk training during times of major life stress.

Teach stress-management techniques as a preventive measure.

Address the psychological aspects of injury rehabilitation before returning to play.

Future Directions

Dealing with injury integrated as part of being an athlete

Greater specificity of mental skills for rehab

Proactive plans and resources for anticipating injury

Support and exit plans for career-ending injuries

Greater emphasis on the aging athlete