Chapter 22
Injury Risk and Rehabilitation:
Psychological Considerations
Jean M. Williams and Carrie B. Scherzer
“I knew I was in trouble when I heard snap, crackle and
pop, and I wasn’t having a bowl of cereal.”
Nick Kypreos, ice hockey, Toronto Maple Leafs
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Thinking about Injury
• Although many of the causes for injury are physical (e.g., level
of conditioning, equipment failure, poor playing surface,
faulty biomechanics) or just plain bad luck, psychosocial
factors also play a role
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How Psychosocial Factors Influence
Injury
• Certain psychosocial factors predispose individuals to injury
– other psychosocial factors help protect from injury
• The difference = stress and a resulting stress response
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Stress-Injury Model Hypothesis
• Individuals with a history of many stressors, personality
characteristics that exacerbate the stress response, and few
coping resources will, when placed in a stressful situation such
as a demanding practice or crucial competition, be more likely
to appraise the situation as stressful and exhibit greater
physiological activation and attentional disruptions.
• Severity of the resulting stress response is what
predisposes the individual to injury
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Stress-Injury Model
History of
Stressors
Personality
Potentially Stressful
Athletic Situation
Stress Response
Cognitive
Appraisals
Physiological
/Attentional
Changes
Interventions
Coping
Resources
Injury
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Stress Response
• “Good” stress = stress
• Occurs when athlete views a
competitive situation as
challenging, exciting, and fun
• Helps the athlete stay
focused and his/her play to
successfully “flow”
• “Bad” stress = distress
• Occurs when athletes
perceive they lack resources
to meet the demands of the
situation and it is important
to succeed because dire
consequences if fail
• Manifests physiologically,
attentionally, and anxiety
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Stress Response (cont.)
• Stress-injury model proposes that primary culprits
in injury risk are increased muscle tension,
narrowing of the auditory and visual field, and
increased distractibility
• SO when high-risk psychosocial profile performs
under stress, they experience higher anxiety and
greater peripheral narrowing and delayed or missed
responding to central vision cues compared to lowrisk individuals
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History of Stressors
• Major life events – from a breakup, change in residence,
death of a loved one to eligibility difficulties, trouble with
coaches, and change in playing status
• Daily hassles - minor daily problems, irritations, or changes
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Personality and Coping Resources
• Trait anxiety
• A general disposition or tendency to perceive situations as
threatening and to react with an anxiety response
• Dispositional optimism and hardiness
• Mood states
• Quantity and quality of relationships with supportive people
(family, friends, coaches, etc.)
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Interventions to Reduce Injury
Vulnerability
• It is possible to reduce sports injuries through psychological
skills training
• Must strengthen coping skills and control emotional states
• Two-pronged approach
• Change cognitive appraisal
• Decrease physiological arousal and enhance attention
control
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Reducing Injury
Cognitive Appraisal
•  Negative self-talk
• Foster realistic
expectations
• Develop a sense of
belonging
• Optimal coach-athlete
communication
Physiological/Attention
• Relaxation skills
• Distractibility
• Keep an appropriate
attention focus
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prior written consent of McGraw-Hill Education.
Implications for Coaches, Sport
Psychologists, and ATs
• Implement interventions with athletes predisposed to
injury due to psychosocial factors
• Target specific interventions to those most likely to
benefit from them
• Reduce exposure to high-risk activities if the athlete has
recently experienced many stressors or appears to be in a
high-stress or distracted state
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Athletes Psychological Reactions to Injury
•
•
•
•
•
•
•
View as disaster
Opportunity to display courage
Uncertainty regarding recovery
Negative mood states
Identity loss
Treatment compliance problems
Relief from practice drudgery and/or poor
performance
• Opportunity to focus on other aspects of life
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Athletes Psychological Reactions to
Injury (cont.)
• Following concussion, some athletes experience depression,
confusion, and total mood disturbance
• Mood changes might be due to the injury itself and not just
the removal from sport
• Some athlete’s experience resembles the stages of grief
• Postinjury emotions (tension, depression, anger) improve as
rehabilitation progresses
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Cognitive Appraisal Models
• Cognitive Appraisal Models
• Derived from stress and coping theory
• Accounts for individual differences in response to
athletic injury
• How does the athlete perceive the injury?
• Cognitive appraisal determines the emotional response,
which determines the behavioral response to injury
rehabilitation
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Cognitive Appraisal Models
Personal
Factors
Situational
Factors
Cognitive Appraisal
Emotional Response
Behavioral Response
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Grief Stage Model
• Incorporated when an injured athlete is facing termination of
participation in sport
• Injury constitutes a loss of self, and that psychological
responses to injury follow a predictable sequence
• Denial
• Anger
• Bargaining
• Depression
• Acceptance and resignation
• Minimal support within area of injury due to variability across
individuals & Copyright
situations
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Self-Regulation Theory
•
People form a representation of their injury on the basis of
1. General information available about the injury
2. Information obtained from expert sources (e.g., athletic
trainer, physician)
3. Current and past experiences with injury
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Potentially Dangerous Attitudes
• Act Tough and Always Give 110%
• Giving 110% is impossible
• Creating image of invulnerability to injury
• Trying to give 110% can lead to performing at 50% of
optimal ability
• Injured Athletes are Worthless
• Coaches may isolate, cease communication, or criticize
injured athletes
• Communicates that athlete is only useful as a performer
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Whole-Person Philosophy
•
•
Respond to athletes as people, not just injuries
They need social support
• Critical in the rehabilitation phase
• Help ensure that normal contacts are maintained and be as
optimistically reassuring as possible
• Teammates, coaches, sport psychologists, and athletic
trainers
• As soon as athletes can rejoin a team—even if on crutches or
bandaged—they should
• Peer mentors and injury support groups
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Double-Edged Crutch
• Social support and the reintegration of the injured athlete are
important parts of the rehabilitation process, there are two
problems:
1. An injured athlete may present a conscious or unconscious
threat to others
2. An athlete’s injury may present an opportunity to another
person
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Teaching Psychological
Rehabilitation Strategies
• Important to learn about the injury itself and the
rehabilitation process - knowledge is power!
• Results in faster recovery and reduction in pain, state
anxiety, and fear of re-injury
•
•
•
•
•
Thought stoppage
Cognitive restructuring
Imagery
Goal-setting
Relaxation
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