Introduction
Involvement in sport is often considered beneficial to increase a person’s physical and psychological health (Maffulli, Longo, Gougoulias, Caine & Denaro,2011). Although participation in sport is positive for health and well-being, it also sets high demands on athletes’ physical skills, thus increasing the risk of injury. For example, Bauer and Steiner (2009) estimated that over eight million sports injuries are medically treated each year in Europe alone. A number of studies indicate that a sports injury can be an extremely stressful and disruptive event for elite athletes, particularly in cases where the injury is severe and the athlete is heavily involved in sport (for a review see Brewer, 2007). Several studies have showed that, in a substantial number of cases, sports injuries will decrease an athletes’ physical (Drawer & Fuller, 2001) and psychological (Hagger, Chatzisarantis, Griffin & Thatcher, 2005) well-being over the long term.
Sports injury prediction research has mainly focused on physiological and demographical factors (Bahr & Krosshaug, 2005). However, the importance of specifically studying the psychological factors in order to understand the complex interaction of factors that impact injury susceptibility has been less highlighted (Wiese-Bjornstahl, 2010). Therefore, during the last few years, more and more studies have focused on psychosocial factors that could influence injury risk.
One of the first prediction models, and probably the most cited, is Williams and Andersen´s (1998) “stress injury model”. The multi-component theoretical model states that injury risk may be affected by the interplay between various psychosocial factors which are divided into three categories: personality factors, history of stressors and coping resources. The suggested psychosocial factors will influence the athlete’s appraisal of a potential stressful situation (e.g., a game/competition), and the athlete’s appraisal of the situation will have a bidirectional relationship with psychological and/or attentional changes. The strength of the stress response is suggested to be influenced by how threatening the athlete perceives the situation to be. The authors argue that an athlete that: (1) has experienced a great number of stressors has personality traits such as a high anxiety level, which increases stress susceptibility; and (2) exhibits poor coping resources, will appraise more situations as threatening. This cognitive appraisal will generate greater muscle tension and a narrowed peripheral view, which could lead to an elevated risk of injury.
Our research paper, published in Journal of Sport Rehabilitation (Ivarsson, Johnson & Podlog, 2013), prospectively examined whether personality variables, stress and coping styles can influence the risk of injury occurrence in an elite soccer population.
Method
The participants were 38 male and 18 female soccer players competing in four different teams in the Swedish Premier League (the highest level in Swedish soccer). The players were, at the beginning of the season, asked to complete three questionnaires (Swedish Universities Scales of Personality, Life Events Survey for Collegiate Athletes and Brief COPE) aimed to measure trait anxiety, negative life stress and coping abilities. Subsequent to the initial data collection, participants completed a stress questionnaire (Hassle and Uplift Scale), once a week for a 13 week period. Injury occurrence was registered by the team physiotherapist during the study time. A path analysis was used to test a hypothesized model, in what the psychological variables were hierarchical outlined in relation to each other as well as to injury occurrence. The design was approved by the regional ethical board.
Results and discussion
The results showed that the hypothesized model could predict 24 % of the injuries that occurred during the study. More specifically, players that reported high levels of trait anxiety were more likely to experience high levels of negative life event stress. Players experiencing a high level of negative life event stress were more predisposed to also experiencing high levels of hassle. These high levels of stress were then increasing the likelihood of becoming injured. To sum up, players with high level of trait anxiety and that experienced high levels of stress had more injuries than other players. The high level of stress could, in line with the suggestions from Williams and Andersen´s (1998) stress injury model, decrease the players’ abilities to recognize important cues during practice or a game. In turn, decreased perceptual abilities as well as motor skills could lead to poorer decisions since the player does not have all information that is required. Poor decision-making could lead to an increased injury risk for the player.
Practical implications
A few practical implications could be highlighted in relation to injury prevention.
Since stress is an important psychological variable in injury prediction, one recommendation could be to encourage players to take part in lifestyle interventions (such as mindfulness) in order to reflect on how they interpret specific situations. These types of interventions could perhaps educate the players in how to adjust their psychological state in order to decrease injury risk.
In preventing sports injuries, it is also important for clubs to offer support (e.g., social and instrumental) to the players in order to help them cope with stressful events that they are facing, both inside and outside the soccer context.
It is also recommended that coaches and medical staff have frequent dialogues with all players to be aware of the subjective psychological state of each player. This information could then be used to develop individual training programs for each player.
Authors’ note: This text is a summary of Ivarsson, A., Johnson, U., & Podlog, L. (2013), “Psychological predictors of injury occurrence: A prospective investigation of professional Swedish soccer players”, Journal of Sport Rehabilitation, 22, 19-26.