The Mental Impact of Sports Injury

Carly McKay, Carly D. McKay

• Editorial: Routledge
• Año: 2021
• ISBN:
  9781000512120
• Edición: 1
• Categoría: Psychology
• Categoría: Sports Psychology

Much is known about the physical strain that athletes' bodies are subjected to and the dangerous aspects of competition immediately spring to mind. But why do athletes train the way they do, and why do they push the limits? Why do some recover well from injury while others struggle? Despite decades of medical and sport science research, a piece has been missing from this picture.

Until recently, the role of psychological factors in risk and rehabilitation has been poorly understood. Thankfully, there is increasing awareness of just how crucial these factors can be for predicting injury, improving recovery, developing prevention strategies, and supporting athletes' long-term health. Yet, research in this area is still in its infancy and it can be difficult to synthesize an ever-growing body of knowledge into practical injury management approaches.

Using analogies from everyday life, The Mental Impact of Sports Injury bridges the gap between academic research and practical settings in an informative, yet easy to follow guide to the psychology of sports injury. Addressing risk, rehabilitation, and prevention, it outlines key considerations for researchers and practitioners across all levels of sport. Alongside the fundamentals of injury psychology, emerging areas of importance are also discussed, including training load monitoring and the technological advances that are shaping modern sport medicine. Targeted examples highlight the challenges of preventing and managing injury in grassroots, elite, and professional contexts, with chapters dedicated to the under-served communities of youth and Para sport athletes. Stepping away from traditional texts, this unique book presents the landmark literature, major concepts, and athlete insights into sports injury psychology from a totally new perspective.

1 INTRODUCTION: WHAT HAVE I GOTTEN MYSELF INTO?

Carly McKay

DOI: 10.4324/9781003088936-1

Setting the Scene

When you hear the term “sports injury,” what comes to mind? Athletes hobbling on crutches, maybe a doctor rushing onto a field, or a stretcher being wheeled off? Injury is ubiquitous in sport settings and whether we’ve experienced one personally or have only borne witness as a spectator, it's an inherent part of sports for many people. Yet, for such a commonplace event, an injury can leave an indelible mark on an athlete and those around them. There are the obvious physical consequences, sure, but injuries can also trigger a cascade of cognitive, emotional, and social responses with the potential to affect both immediate and longer-term outcomes. As we’re starting to better understand this and seek ways to minimize the risk of negative impacts on performance and health, sport injury psychology is emerging as a particularly hot topic in medical, coaching, and sport science circles. That's probably why you’ve picked up this book, right? Well, before we get into it, let's put this story into some firmer context as a starting point.

Historically, sport injury has been the domain of the medical professions, with a duty to assess the damage, repair it, and send athletes back out to compete again. To this end, Sport Medicine has developed as a distinct specialization and countless professional associations have evolved around the world to support its practitioners. This development rests upon the thousands of research studies devoted to identifying the best injury treatments, surgical techniques, and rehabilitation programmes, not to mention intense efforts toward injury prevention over the past several decades. Yet, despite all of this attention and resource, injury remains one of sport's biggest problems from grassroots levels right up through professional leagues. A narrow biomedical approach to injury management clearly doesn’t seem to be solving this, so we’re seeing increasing acknowledgement that injury isn’t a purely physical phenomenon. This is where sport psychologists enter the story.ⁱ

There's a small but growing body of evidence, from both research and experiential sources, that shows us just how important the psychological elements of injury risk and rehabilitation can be. We’ll take a journey through that information in the rest of the book, but first let's clear up one little issue that might be a barrier to anyone reading further. Without a doubt, “psychology” can be a little bit intimidating. For a lot of people, it comes across like a load of gibberish and made-up concepts that can’t be directly measured. It can seem complex and confusing, and there are plenty of misconceptions out there about why people feel and act in certain ways. So, if the idea of injury psychology is a little off-putting, that's not surprising. But just because someone doesn’t have a background in psychology, it doesn’t mean they aren’t intuitively aware of how athletes’ thoughts, emotions, and behaviors can shape their injury experiences. We can hear it in the way they speak, see it in their body language and sport performance, and recognize the effects on their wellbeing. I can reassure you that this book isn’t going to get into the esoteric debates that you might see in other branches of psychology, and you definitely don’t need to be an expert in the area to follow along. Instead, the aim is to help make some of those abstract theoretical ideas a little more tangible and to define terms that get tossed around in conversation around sport injury. It's about making things accessible and easier to implement in practice – hopefully that's what you’re here for.

Getting Your Bearings

One of the things you’ll notice as you flip through the coming chapters is that this isn’t meant to be a textbook. There are already plenty of really excellent ones out there, so if you want to look into the finer theoretical details or read a comprehensive review of the research literature, I’d point you toward one of those instead.^1,2,3,4 This book approaches the topic of sport injury psychology from a slightly more oblique direction. Why? Well, for starters, the worlds of sport medicine and sport psychology have merged relatively recently. It was only in the 1970s when a clear body of literature began to appear with a focus on the psychological effects of injury in sport. The field has expanded quickly since then but, on the grander scale of psychology, there still aren’t all that many researchers or practitioners who are solely dedicated to this line of work. Of course, there are some very big names in the field (check out the authorship lists of the textbooks for a who's who), but many of us with a vested interest in the topic come at it from the medical end instead. In the sphere of injury prevention, for instance, the charge is mostly being led by epidemiologists, clinicians, and implementation scientists who are developing and delivering interventions in various sport contexts. This diversity brings to the conversation some interesting new perspectives and lessons learned that are valuable to understanding how research might be applied in practice, and that's where this book is coming from.

After personally spending more than a decade immersed in that world of sport injury prevention, a few things have become rather clear to me: foremost, psychological wellbeing is increasingly on the medical agenda as an important part of athlete health. Though it's still secondary to the physical aspects, the gap is narrowing and that's a good thing. But this also highlights that we have a long way to go before our understanding of injury psychology matches that of physiology, biomechanics, or medical science, and there are a few reasons why this presents an uphill challenge. Until now, researchers – and practitioners, to be fair – have largely operated in siloes, focusing on their particular area of expertise without fully integrating the disciplines in a way that mirrors the athlete's real-world context. After all, an athlete isn’t just a limb segment or a cardiovascular system, they’re a fully formed entity who lives within a particular social environment. We can’t truly understand one element without accounting for how it functions in the presence of the others. Sport injury psychology has suffered from this limitation in the same measure as other disciplines, exploring cognitions, emotions, and behaviors without a holistic consideration of the athlete and their surroundings. Though we’ve learned a lot about injuries from this single-minded approach, there's still much to be discovered by taking an interdisciplinary stance, and this can only improve our ability to support athletes through the injury process.⁵

The other consequence of this compartmentalized paradigm is that research to date has been undertaken in fits and starts. Unlike in more established fields of medicine, where there's been a systematic and strategic global effort to progress knowledge in a step-by-step fashion, sport injury psychology research hasn’t yet been a coordinated effort. Much of the underlying theory is still untested and there hasn’t been much consistency in the way studies have been designed.⁵ This means that the literature is a little bit piecemeal, and we don’t have the luxury of being able to compare between studies or pool their results together in the way we might have hoped. So, from a research perspective, there's a distance to go before we can be exceptionally confident that we have a good grasp of what's actually going on. This is a hurdle for evidence-informed practice, which is probably the bigger concern. Most of the theoretical models that we currently use in sport injury psychology are descriptive in nature, meaning that we have some hypotheses about the mechanisms that lead to injury (or not) and positive recovery experiences (or not), but there isn’t a set strategy for affecting those outcomes. Intervention is the ultimate goal if we hope to shape athletes’ trajectories through the injury process and for now, we’re relying on some fundamental psychological techniques that have been effective for enhancing sport performance but are largely untested for managing injury.⁶ Given these challenges, this book cannot provide a how-to guide for reducing injury risk or speeding up rehabilitation. It can, however, take stock of where we’re at and where we need to get to.

There's no doubt that meaningful progress will be made as research and practice develop further, but the first step in setting a direction of travel for the field is to speak openly about what we know and where the mysteries are. That's where this book comes in. It’ll provide an overview of some key concepts and explore what they mean in practical terms, but through a nontraditional lens. A danger in any narrative lies in the balance of perspectives that help contribute to the story. When it's told from just one point of view, the key messages can be narrow and it's easy to miss important details. It's a bit like seeing an image with forced perspective. Take Hagrid from the Harry Potter films, or the Hobbits from the Lord of the Rings trilogy. Those characters were played by humans of average size, but camera angles (and a few other tricks) make them appear to be larger or smaller on screen. It's much the same with sport injury psychology. If we only hear from one group of stakeholders, our perception of the situation will be limited, and we might not fully grasp the nature of the situation. By including multiple perspectives (i.e., from different stakeholders), we have a much better chance of getting the whole picture.

With that in mind, this book isn’t written from an entirely psychological standpoint. Instead, I’ve invited colleagues, friends, and subject-matter experts from a wide range of disciplines to weigh in on some of the big topics in injury psychology today. Some of them are leading academics in the field (to help keep the story grounded in evidence), but others are practitioners, clinicians, and policy makers who have unique views to share. Most importantly, we’ll also hear from some athletes themselves, who can give us firsthand insight into their injury experiences. Together, we’ll explore our current state of understanding with a critical eye, considering emerging issues in contemporary sport medicine that have the potential to shape injury risk and rehabilitation moving forward. We’ll borrow from other fields of psychology here and there to explore some “what if?” scenarios, too. Oftentimes, having a fresh set of eyes on a problem will yield different solutions, so that's the approach I’m taking. With any luck, it’ll be the starting point for some new research directions or practical approaches; if not, it’ll be an interesting conversation to have anyway.

All in all, my hope is that this book will help to clarify some things if you’re new to sport injury psychology, but mostly I want to share a few new ideas that might spark interest in the topic. There are so many potential avenues of research to be pursued and all kinds of opportunities to develop applied practice, but neither can happen without a wider community of invested stakeholders. Ideally, by the time you reach the last page, we can count you as part of the group. Wait, that sounds a little too serious, doesn’t it? Reading in your spare time shouldn’t feel like work or a commitment to something bigger, and it most certainly shouldn’t be painful (though my sense of humour might be, in places). So, please, kick back, work your way through the story, and take from it what you can. With all of the growing attention on mental health in sport, psychology is filtering into a lot of what we do and we’re not all experts in it. I hope this book is a friendly starting point and, at the very least, I hope you enjoy it.

Note

1. That might be a little reductionist. Sport psychologists are certainly leading the charge, but sport sociologists, behavioural epidemiologists, implementation scientists, neuroscientists, and a whole host of mental skills coaches, counsellors, and other allied professionals are involved, too. This is a sport psychology book, though, so the psychologists get pride of place.

References

1. Wadey R. (ed.). Sport injury psychology: cultural, relational, methodological, and applied considerations. New York: Routledge 2020.
2. Arvinen-Barrow M, Walker N. (eds.). The psychology of sport injury and rehabilitation. New York: Routledge 2013.
3. Brewer BW, Redmond C. Psychology of sport injury. Champaign, IL: Human Kinetics 2016.
4. Gledhill A, Forsdyke D. The psychology of sports injury: from risk to retirement. London: Routledge 2021.
5. Almeida PL, Olmedilla A, Rubio VJ, et al. Psychology in the realm of sport injury: what it is all about. Revista de Psicologia del Deporte 2014; 32: 395–400.
6. Hall C, Duncan L, McKay C. Psychological interventions in sport, exercise & injury rehabilitation. Dubuque, IA: Kendall Hunt 2014.

2 THEORETICAL MODELS AND HOW TO READ THEIR INSTRUCTIONS: FLAT PACK PSYCHOLOGY

Carly McKay

DOI: 10.4324/9781003088936-2

We’ve all been there. We’ve come home with an innocent looking, brown cardboard box full of furniture parts and we’re confident that they should be simple enough to assemble. After all, you only need a single screwdriver to do it! Then we open the box, find the incomprehensible pictures that pass as instructions, and spend the rest of the day cursing and looking for pieces that we swear are missing. Does that sound familiar? Well, for a lot of people, trying to understand a complex psychological theory results in much the same experience. There are all kinds of diagrams and, somehow, you’re expected to figure out how everything fits together. Sometimes you’re not even sure how to use it once you’ve figured it out!

Fear not. We’re going to take a little tour through the prominent psychological theories of sport injury in a step-by-step way. For the nonpsychologists in the room, we’ll start with the basics and go from there. If you do happen to have a background in the field, then you might be able to skip ahead a bit, but don’t go too far! We’ll end up referring back to this chapter throughout the rest of the book.

Who Follows the Directions Anyway?

People say things like “in theory, this should work” all the time. It usually means they’re guessing about what might happen based on a rough idea or their own personal experience in a similar situation. That's perfectly fine for casual conversation but, in scientific circles, the term is used much more precisely. For researchers, a theory is developed based on evidence gathered over time. It provides a conceptual map of how variables are related to each other, and it's repeatedly confirmed through observation and/or experiment. So, it's not a collection of hunches and speculation, it's a substantiated explanation of some phenomenon in the world. Theories are used to help us understand associations between specific concepts and they allow us to make predictions about events based on those associations. Take the legend of Newton sitting under an apple tree, for example. As he observed fruit falling to the ground, he wondered why objects would always descend perpendicularly to the ...