Pages from Psychology of Sport Injury Course 1_Part2.pdf

20 Psychology of Sport Injury As Alex was unfortunate enough to learn, injury is a common by-product of sport participation; as a result, sport health care professionals have long sought strategies for preventing (or at least minimizing) the occurrence of injury among athletes. In order to develop...

20 Psychology of Sport Injury As Alex was unfortunate enough to learn, injury is a common by-product of sport participation; as a result, sport health care professionals have long sought strategies for preventing (or at least minimizing) the occurrence of injury among athletes. In order to develop such interventions, professionals must thoroughly understand the processes by which athletes become injured (W. van Mechelen, Hlobil, & Kemper, 1992). Knowing the etiology of sport injury helps professionals determine when, where, and how to intervene in order to achieve maximal prevention. To that end, this chapter addresses models of sport injury occurrence, psychosocial predictors of sport injury, and mechanisms of psychosocial influence on sport injury occurrence. Models of Sport Injury Occurrence At first glance, explaining Alex’s injury would seem to be a simple task. He collided with another player, fell to the ground, and dislocated his shoulder as a result of the impacts he sustained. End of story, right? Not necessarily. Contemporary models of sport injury occurrence suggest that although the physical forces Alex absorbed may have delivered the final blows, other culprits may have contributed to his injury. More specifically, models of sport injury occurrence have been proposed by two schools of thought—the multifactorial model of sport injury etiology, which is based primarily in sports medicine and epidemiology, and the stress–injury model, which is based predominantly in sport psychology. Despite a shared recognition that multiple biological, psychological, and social factors may contribute to sport injury occurrence, these two models have evolved in large part independently of each other. Both models have made important contributions to contemporary understandings of the etiology of sport injury and therefore warrant further exploration. Multifactorial Model of Sport Injury Etiology Developed over the past four decades, the multifactorial model is less a single, unified con- ceptualization of the causes of sport injury than a series of related representations of the processes by which sport injury is thought to occur. As described by W. van Mechelen et al. (1992), the earliest versions of the model focused on identifying both internal (i.e., intrinsic or personal) factors and external (i.e., extrinsic or environmental) factors that contribute to the occurrence of sport injury. These early versions of the model posited that internal factors determined an athlete’s capacity to deal with the stress produced by environmental factors and that injury was most likely to occur when stress exceeded the individual’s capacity. Among the internal factors thought to affect this capacity were biological variables (e.g., previous injury, physical defect, height, weight, joint stability, body fat, age, sex), psychological variables (e.g., self-concept, locus of control, risk acceptance, personality), and physical fitness variables reflecting the interaction between psychological states (e.g., motivation, behavior) and physiological parameters (e.g., aerobic endurance, strength, speed, sport skill, coordination, flexibility). External factors thought to confer stress (and, ultimately, injury risk) on athletes included sport-related variables (e.g., type of sport, exposure, nature of event, opponent and teammate behavior [a social factor!], rules, referees’ application of rules), venue (e.g., state of floor or ground, lighting, safety features), equipment (e.g., sport implements, protective gear, shoes, clothing), and weather conditions (e.g., temperature, relative humidity, wind). Limitations were noted in this stresscapacity conceptualization of sport injury etiology by W. van Mechelen et al. (1992). As a result, they added a dynamic element, introduced the concept of strain, and incorporated an active role for the athlete into the process in order to explain the occurrence of acute and overuse injuries. Specifically, they suggested that • stress from external factors produces strain, which, if substantial enough in relation to capacity, produces acute injury; • repetitive and accumulated strain over time results in overuse injury; B.W. Brewer and C.J. Redmond, Psychology of Sport Injury, Champaign, IL: Human Kinetics, 2017). For use only in Psychology of Sport Injury Course 1–Sport Medics. Antecedents of Sport Injury   21 • capacity can change over time and can be affected by external stress, such as when fatigue impairs motor skills; and • athletes can reduce external stress by altering their involvement in the sport activity. events that incite acute injury (e.g., colliding with another athlete) may differ in nature from those that incite overuse injury (e.g., excessive training volume). More recently, the multifactorial model has been further modified in important ways by Bahr and Krosshaug (2005) and by Meeuwisse, Tyreman, Hagel, and Emery (2007). Bahr and Krosshaug focused their efforts on the incitingevent portion of the model, with an eye toward describing more fully the mechanisms of sport injury. Specifically, they proposed that descriptions of inciting events should address The multifactorial model was next expanded by Meeuwisse (1994), who made several key modifications. As shown in figure 2.1, he retained the temporal component added by W. van Mechelen et al. (1992), as well as the concepts of internal and external risk, but abandoned the stress–strain–capacity terminology and introduced in its place the concepts of predisposed athlete, susceptible athlete, and inciting event. In this iteration of the model, an athlete is predisposed to injury if her or his vulnerability is increased by one or more internal risk factors that are necessary, but typically not sufficient, to produce injury. Such an athlete is susceptible to injury when exposed to external risk factors. This susceptible athlete is considered more vulnerable to injury than a predisposed athlete, but generally not so vulnerable that injury happens without an inciting event. Meeuwisse (1994) described the inciting event as “the straw that breaks the proverbial camel’s back” (p. 169), in that it is not sufficient to cause an injury on its own but wreaks havoc on a susceptible athlete and tips the balance from susceptibility to injury. Inciting events are applicable to both acute and overuse injuries, but • the playing situation, • the behavior of athletes and their opponents, • gross biomechanical characteristics, and • detailed biomechanical characteristics. In this version of the model, both internal and external risk factors were considered as potentially interacting with the characteristics of inciting events to make injury more or less likely. For example, a volleyball player with poor neuromuscular control (an internal risk factor) who collides with a teammate (an inciting event) is more vulnerable to an ankle injury than an athlete who experiences a similar collision but possesses better neuromuscular control. Meeuwisse et al. (2007) advanced the model even further by building on an elaboration Exposure to external risk factors Intrinsic risk factors Predisposed athlete Inciting event Susceptible athlete Risk factors for injury (distant from outcome) Injury Mechanism of injury (proximal to outcome) Figure 2.1 Multifactorial model of sport injury etiology. Meeuwisse, 1994 B.W. Brewer and C.J. Redmond,E5665/Brewer/F02.01/541446/MattH-R2 Psychology of Sport Injury, Champaign, IL: Human Kinetics, 2017). For use only in Psychology of Sport Injury Course 1–Sport Medics. 22 Psychology of Sport Injury of the inciting event proposed by Bahr and Krosshaug (2005) and on the following suggestions by Gissane, White, Kerr, and Jennings (2001): • Internal risk factors can vary over time. • The model should address what takes place after the occurrence of injury. • The process by which athletes sustain injuries is not linear, as posited in an earlier version of the model (figure 2.1), but cyclical. As displayed in figure 2.2, this updated model contains a number of modifications of the version shown in figure 2.1. First, among the sample intrinsic factors, it replaces flexibility and somatotype with neuromuscular control and strength; this change is mostly cosmetic. Second, this version depicts the possibility that susceptible athletes may encounter potentially injurious situations and not get injured. For example, injury may be averted due to tissue adaptation, use of protective equipment, or another factor (internal or external) that modifies the athlete’s injury risk. Third, the updated version incorporates the possibility that athletes who sustain an injury may not recover sufficiently to return to sport participation. Fourth, and perhaps most important, the “dynamic, recursive” nature of the model is highlighted by the arrows indicating the continuance of sport participation after noninjury or the return to sport after recovery from injury. When an athlete continues or returns to sport participation, he or she does so with the strong possibility that internal or external risk factors have changed since the athlete last progressed through the cycle. For example, as noted by Meeuwisse et al. (2007), fatigue that lingers to the next day of sport participation can alter an athlete’s neuromuscular control and therefore constitutes a change in the athlete’s Repeat participation Adaptation? Exposure to extrinsic risk factors (e.g., equipment, environment, etc.) Events (e.g.) Age Intrinsic risk factors Neuromuscular control Previous injury Predisposed athlete No injury Susceptible athlete Strength Recovery Inciting event Injury No recovery Removed from participation Risk factors for injury (distant from outcome) Mechanism of injury (proximal to outcome) Figure 2.2 Updated multifactorial model of sport injury etiology. Based on Meeuwisse et al. 2007 E5665/Brewer/F02.02/541455/MattH-R2 B.W. Brewer and C.J. Redmond, Psychology of Sport Injury, Champaign, IL: Human Kinetics, 2017). For use only in Psychology of Sport Injury Course 1–Sport Medics. Antecedents of Sport Injury   23 internal risk profile entering the second day of participation. Therefore, if all other factors in the model remain the same as they were on the first day of participation, the athlete’s risk of injury is greater on the second day than it was on the first day. Stress–Injury Model In response to the proliferation of research on psychological and social predictors of sport injury in the 1960s, 1970s, and early 1980s, M.B. Andersen and Williams (1988) proposed a model of sport injury occurrence that incorporated the accumulated research findings and provided a framework to guide subsequent research. As shown in figure 2.3, the central thesis of their model posits that the stress response is a proximal cause of sport injury. Furthermore, the model hypothesizes that contributors to the stress response include three broad categories of psychosocial factors—personality, history of stressors, and coping resources—each of which acts either directly or through its relations with the other two categories. (The same investigators later updated the model [J.M. Williams & Andersen, 1998] by making the Personality arrows between the three categories bidirectional.) Interventions directed at the stress response are thought to alter the likelihood of injury occurrence. The centerpiece of the stress–injury model is the stress response, a process in which people cognitively appraise the environmental demands placed on them in potentially stressful situations (i.e., stressors), the resources they possess to manage those demands, and the consequences of succeeding or failing at managing the demands. These cognitive appraisals are thought to influence and be influenced by physiological and attentional changes (e.g., general muscle tension, narrowing of visual field, distractibility) that place athletes at increased risk for injury. Thus, according to the model, athletes who perceive themselves as overwhelmed and helpless in the face of a stressful sport situation may experience tense muscles, “tunnel vision,” or inattention to the sport environment—all of which make them more susceptible to injury. On the other hand, athletes who perceive themselves as possessing the resources necessary to manage the demands of a potentially stressful sport situation are considered less likely to experience History of stressors Coping resources Stress response Potentially stressful athletic situation Cognitive appraisals Physiological or attentional changes Injury Interventions Figure 2.3 The stress–injury model. Adapted, by permission, from M.B. Andersen and J.M. Williams, 1988, "A model of stress and athletic injury: Prediction and prevenE5665/Brewer/F02.03/541461/MattH-R2 tion," Journal of Sport & Exercise Psychology 10: 294-306. B.W. Brewer and C.J. Redmond, Psychology of Sport Injury, Champaign, IL: Human Kinetics, 2017). For use only in Psychology of Sport Injury Course 1–Sport Medics.