Injury Martin I. Jones BSc MSc PhD CPsychol CSci AFBPsS SFHEA BASES accredited Sport and Exercise Scientist (Psychology) HCPC registered Sport and Exercise Psychologist
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