Injury

Martin I. JonesBSc MSc PhD CPsychol CSci AFBPsS SFHEABASES accredited Sport and Exercise Scientist (Psychology)HCPC registered Sport and Exercise Psychologist

Intended Learning Outcomes On successfully completing this week’s study you will be able to...

Discuss how stress influences injury risk

Describe Williams and Andersen’s model of injury

Understand the psychological consequences of injury

Manage self-learning, set and meet targets, manage time, and read extensively for information

Justine Henin has likened her emotions after ending her playing career to being in mourning.

Justine Henin in 'mourning' after ending her career

Source: BBC website

"I regard ending my career more like a sentence that's been handed down than a decision I've made

"The will is there, but physically I can't [carry on]. Now I have to mourn the end of my career

A. 20 million

C. 2 million

B. 200 million

D. 200,000

A. B. C. D.

25% 25%25%25%

How many (youth) sport injuries in USA?

2 million injuries per year that require

medical attention. 20 million sports participants

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).

29.7 million sports

injuries per year

Source: Nicholl et al., 1995)

A. £99.7 million

C. 997 million

B. £9997 million

D. 9.7 million

A. B. C. D.

25% 25%25%25%

How much do injuries cost in the UK?

£997 million£643 million new injuries £354 million recurrent injuries

Source: Nicholl et al., (1993)

Sport hurts

What “causes” injury?

Culture of the sport?

The collarbone was still together; it had a v-fracture but he said it was relatively stable. If I didn't crash again, it was probably going to stay together. He said if I could handle the pain, then maybe it was possible to continue

Women football players 'tough it out' through injury

Why?

Sport ethic which advocates personal sacrifice, risk taking, playing with playing with pain in the face of injury, and the unwillingness to seek out medical treatment

Although these factors are not the cause of injury per se, these attitudes can create a climate that discourages individuals from reporting injuries early or from seeking treatment

Williams and Andersen (1998)Williams, J. M., & Andersen, M. B. (1998). Psychosocial antecedents of sport injury: Review and critique of the stress and injury model'. Journal of applied sport psychology, 10(1), 5-25.

Stressful event

History of stressors Personality Culture of

sport

Stress response

Injury No injury

Coping

History of

stressors

History of Stressors• An individual’s personal stress factors, including:

• Previous experience with injuries

• Life stress

• Chronic daily problems

PersonalityHardinessOptimism / pessimismExplanatory style

Personality• Optimism-Pessimism• Explanatory Style

• The way individuals account for events in their lives. It is a relatively permanent tendency to explain things in a certain way.

• Psychological Hardiness• A personality characteristic that acts as a

resistance resource. This disposition consists of three components: commitment, challenge, and control.

CopingPersonal coping and social support

The stress response

Narrowed peripheral

and central vision

Muscle tension

bracing

Endocrine stress response and lower functioning of immune system

Result: injury

!

Why should we study the psychology of

pain in relation to injury

?

Acute pain is the primary reason why people seek medical attention and the major complaint that they describe on initial evaluation

Of all the components of the injury response, none is less consistent or less understood than an individuals response to pain

Is pain a purely physiological phenomenon?

Pain vs. nociception

Psychological factorsact indirectly on pain and injury by reducing physical activity, muscle flexibility, tone, and strength, and physical endurance

Biopsychosocial model of pain

Moving beyond the biological aspects of pain  

Complex inter-relationship of biology with psychological processes and

social environments.

All three areas are of considerable importance in the

overall pain experience

Pain as a psychological

constructWhich variables

predict pain threshold and pain

tolerance?Pain threshold is the point at

which pain begins to be felt

Pain tolerance is the maximum level of pain that a person is able

to tolerate

Pain catastrophizingAn exaggerated negative mental set brought to bear during actual or anticipated painful experience

(Sullivan et al., 2001).

A false alarm to an otherwise benign stimulus

(Beck, 1989)

RuminationRepetitive thinking about the negative sensations associated with noxious stimuli

"I can´t stop thinking about how much training hurts"

Magnification Elevation of the threat value of pain

“This is the worst pain I’ve ever experienced, I’m afraid that something serious might happen"

HelplessnessA belief that nothing can be done to extricate oneself from the pain experience

“There is nothing I can do to reduce the intensity of my pain"

Individuals who score high on measures of pain catastrophizingReport more intense pain (Sullivan et al., 1995, 2006)

Report more severe depression and anxiety (Keefe et al., 1989; Martin et al., 1996),

Show higher levels of pain behaviour and disability (Sullivan et al., 1998, 2000,2006; Keefe et al., 2000; Sullivan and Stanish, 2003),

Consume more analgesic medication (Bedard et al., 1997; Jacobsen and Butler, 1996)

Have more prolonged stays when hospitalized (Gil et al., 1992).

Have you ever been injured? What was your immediate reaction to injury?Feelings ThoughtsBehaviour?

ShockDenial AngerBargaining DepressionAcceptance

Greif response model

Cognitiv

e appraisal

model

“the fact that the injury has occurred is considered less critical to understanding emotional reactions than is the way in which the injury is perceived”

(Brewer, 1994)

Appraisal

Age Personal control

Personality Explanatory style

History of stressors

Severity of injury

Athletic identityTime of seasonMagnitude of informational

support

Duration of injury

Mood disturbance

Level of activity disruption

Perceived social support

Recovery process

Coping skills Personality

Psychological Response to

Injury

P e r so na lityO p tim ism -P ess im ism

E x p la n a to ry S ty leH a rd in e ss

H isto r y o f S tr e sso r sP rev io u s E x p e rie n c e w ith In ju r ie s

L ife S tre ssC h ro n ic D a ily P ro b lem s

C o p ing R e so ur c e sS o c ia l S u p p o r t

P e rso n a l C o p in g S k ills

R esp o n se to S p o rt In ju ry

Individuals with a strong and exclusive athletic identity can see an injury as a threat to their core identity and self-worth.

COPINGA wide variety of behaviours and social networks that help individuals deal with life, including:

Personal coping skills (e.g., keeping a positive attitude, ability to control anxiety, etc.)Social support

COPINGCoping is the process of constantly changing cognitive and behavioural efforts to manage specific external and/or internal demands or conflicts appraised as taxing or exceeding one’s resources

(Lazarus & Folkman, 1984).

Problem-focused coping

Emotion-focused copingAvoidance coping: Preference to reduce the importance of attention toward a stressorSpecific vs. Global Coping Strategies

An exchange of resourcesbetween at least two

individualsperceived by the provider or

recipient to enhance the wellbeing of the recipient.

TYPES OF SOCIALSUPPORT

Emotional SupportListening Support

Emotional ChallengeEmotional Comfort

Informational SupportTechnical Appreciation

Technical ChallengeShared Social Reality

Tangible SupportMaterial AssistancePersonal Assistance

Listening Support

Schedule longer treatment times

Establish closer therapists/athlete relationships

Convey an understanding of skills required by the athlete in his/her sport

Emotional Comfort

Allow time to talk during each rehabilitation session

Provide reassurance regarding progress through goal-setting

Facilitate communication between the medical practitioner/specialist and the athlete

Emotional Challenge

Set achievable early goals

Set long and short term goals that are checked regularly

Consider referrals to other health professionals (e.g. GP or Sport Psychologist)

Technical Appreciation

Measure and record objective changes

Provide the athlete with a sense of self-achievement

Use schedules of positive reinforcement to reward effort

Technical Challenge

Have an understanding of the particular sport

Set, reinforce and regularly monitor short and long-term goals

Devise strategies to counter set-backs or unrealistic expectations

Shared Social Reality

Foster communication with the coach

Make available relevant literature and documentary evidence of successful treatment

Personal Assistance

Act as a human resource base by providing information on the services available to the athlete

Material Assistance

Suggest further facilities and means of rehabilitation

Provide therapeutic aids and equipment for loan or at cost

Coach /therapist behaviour

Perceived social

support

Athlete physical

and emotional well being

Athlete’s willingness to accept and ask for social support is important for effective recovery and rehabilitation

Pain behavior as communal coping?

efficacypersonalizeeducationprogression

Competence

Control

coping with paincoping with emotionscoping with thoughts

Commitment

goal settingthreat vs. challenge

social support

Transtheoretical Model of Change and injury• Rehab is dealt with in stages:

• Pre-contemplation• Contemplation• Preparation• Action• Maintenance

How could you integrate your knowledge of goal setting and imagery in the rehabilitation of injury?

Martin I. JonesBSc MSc PhD CPsychol CSci AFBPsS SFHEA

BASES accredited Sport and Exercise Scientist (Psychology)HCPC registered Sport and Exercise Psychologist

E: m.i.jones@exeter Tw: @drmijones