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 Chapter 22 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Stress-Injury Model Hypothesis Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Personality History of Stressors Coping Resources Potentially Stressful Athletic Situation Injury Interventions Stress Response Cognitive Appraisals Physiological /Attentional Changes Stress-Injury Model Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

“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 Stress Response Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 low- risk individuals Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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.) Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Interventions to Reduce Injury Vulnerability Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the 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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

Cognitive Appraisal Models Personal Factors Cognitive Appraisal Emotional Response Behavioral Response Situational Factors Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 & situations Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Potentially Dangerous Attitudes Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.

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 Teaching Psychological Rehabilitation Strategies Copyright © 2015 McGraw-Hill Education. All rights reserved. No reproduction or distribution without the prior written consent of McGraw-Hill Education.