Psychologic Stress Related to Injury and Impact on Sport Performance

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Injury rates are high among children and adolescent athletes. Psychosocial stressors, such as personality, history of stressors, and life event stress can influence injury occurrence. After injury, those same factors plus athletic identity, self-esteem, and significant others—such as parents, coaches, and teammates—can affect injury response, recovery and subsequent sport performance. Goal setting, positive self-talk, attribution theory, and relaxation or mental imagery are psychologic interventions that can help injured athletes cope with psychosocial stressors. Medical professionals should be aware of the potential influence that psychosocial stressors and psychologic interventions can have on injury occurrence, injury recovery, and sport performance.

Section snippets

Athletic injury prediction models

Over the last two decades, two pivotal, empiric sport injury models (Fig. 1) have evolved to investigate psychosocial factors that may influence the risk of obtaining a sport injury and recovery following injury. The Andersen and Williams model (see top portion of Fig. 1) provided a framework to examine psychologic precursors, such as personality, history of stressors, and coping resources in relation to sport injury [4]. The main premise of this model is that a psychophysiologic response is

Psychologic stressors before injury

As postulated by Andersen and Williams (see top portion of Fig. 1) [4], history of stressors (ie, life event stress, daily hassles, and previous injury history), personality characteristics (ie, hardiness, locus of control, and competitive trait anxiety), and coping resources (ie, general coping behaviors, social support, stress management, and psychologic skills training) directly elicit a stress response, while indirectly influencing injury occurrence. Early research in this domain focused on

Athletic identity, self-esteem, total mood disturbance

Athletic identity refers to “the degree to which an individual identifies with their athletic role” [19]. Athletes with high athletic identity identify primarily with sport, whereas athletes with a low athletic identity tend to participate in multiple activities, with sport being one of many activities. One benefit of strongly identifying with the athletic role is an increase in self-esteem. For older children and adolescents, high self-esteem helps mediate the continuous physical, psychologic,

Sociologic stressors following injury

Along with personal factors, situational factors such as level of competition (eg, varsity versus junior varsity), time in season (eg, beginning versus end of season), playing status (eg, starter versus nonstarter), and perceived role on the team may also affect injured athletes' cognitive appraisal and emotional response to injury. If athletes perceive the injury to be a threat to their position and status on the team or to their ability to compete in upcoming competitions, they may ignore

Psychosocial stressors affecting sport performance

When injured, athletes have two viable options: stop sport participation and complete procedures, treatment, and rehabilitation in entirety, or return to sport prematurely. Research has demonstrated the role of psychosocial stressors on young athletes as they contemplate injury response. Risk factors for early return to sport include long-term physical pain, which consequently may affect performance, and long-term exercise participation following retirement from sports.

Wadley and Albright [58]

Psychologic interventions

Abraham Maslow theorized that individuals seek to satisfy fundamental basic human needs. Needs are based on a hierarchal pyramid, with physiologic needs having the highest priority, followed by safety, love and belonging, self-esteem, and self-actualization. When injury occurs, the basic needs of safety, love and belonging, and self-esteem are threatened. Psychologic interventions can help injured athletes reclaim their basic needs, while simultaneously increasing self-esteem and dealing with

Summary

This article addressed the impact psychosocial stressors have on injury recovery and the sport performance of young injured athletes. Medical professionals aware of psychosocial stressors unique to young athletes that may contribute to injury occurrence and influence rehabilitation, may help counter the negative effects and unhealthy behavioral responses that sometimes occur post-injury. Through awareness and appropriate interventions, medical professionals can help facilitate an optimal

Acknowledgment

The authors thank Dr. Eric Milliner, an adolescent sport psychiatrist from the Mayo Clinic, for his years of experience working with adolescent athletes. Dr. Milliner uses medication only when needed. Thankfully, most patients leave his office feeling better about themselves and their sports.

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