Lecture 12: Injury

Question 1

What are the different types of injuries?

Answer 1

• can be acute vs overuse
• recurrent vs new
• severity: duration and impact
• substantial vs non-substantial

Question 2

Prevalence of injuries in NL

Answer 2

12,000 athletes getting injured every day so 8 per min, 104000 injuries in first aid in NL

Question 3

What are injury incidence rates for each category?

Answer 3

• first-year Physical Education Teacher Education (PETE) students: 11.7
  injuries per 1000 hours
• Dutch soccer players: 6.2 injuries per 1000 hours (time loss)
• Dutch female gymnasts: 5.2 injuries per 1000 hours
• Swedish talented athletes: 4.1 injuries per 1000 hours
• Circus arts students: 3.3 injuries per 1000 hours
• Dance students: 1.9 injuries per 1000 hours of dance

Question 4

Rugby head injuries

Answer 4

• can feel “punch drunk”
• chronic traumatic encephalopathy
• most sub-concussions are in training so there is a recommendation to limit contact training to 15 min a week
• significant differences with control group on neurodegenerative disease later in life

Question 5

What are the practical implications of prevalence rate studies?

Answer 5

• Sports & active recreation injuries are common, BUT non active people also get injured!
• Injuries may impact activities of daily living & limit future sport performance / participation
• Risk reduction efforts could be targeted towards Particular age
  sub groups and particular sport
  types & levels

Question 6

What are the psychological risk factors?

Answer 6

Anxiety/worry
Hypervigilance
Poor body image / low self esteem
Perfectionism
Limited coping resources
Life event stress
Risk taking behaviours
Low mood state

Question 7

What are the sociocultural risk factors?

Answer 7

Limited social resources
Lifetime history of abuse
Social pressures
Organisational stress
Stress due to negative self-appraisal of performance
Coaching quality
Culture of sport and teams

Question 8

What is the evidence for the stress and injury model?

Answer 8

• Positive association between life events, hassles, previous injury & injury
  (partly also for positive life
• Personality: Hardiness; Locus of control; Sense of coherence; Competitive trait anxiety; Achievement motivation; Sensation seeking
• Coping resources: Relaxation skills; Autogenic training / meditation;
  Imagery / mental rehearsal; Confidence; Social support ; Cognitive
  behavioural techniques
  High levels of stress due to negative life events and strong stress responsivity have the strongest relationship

Question 9

What are the consequences of neurological functioning??

Answer 9

Muscle tension
Coordination loss
Lack of focus
Increased self-consciousness
Poor decision-making

Question 10

Risk factors for injury in dance

Answer 10

• lower age
• higher BMI
• limited coping skills of dealing with stress and problems

Question 11

What are the important factors which result in stress responses?

Answer 11

Coping resources and potentially stressful athletic situations result in a stress response and thus injury-> research found that stress levels increased from injury-free to injury period

Question 12

What is the influence of culture?

Answer 12

Motivational climate (“If you’re injured, you’re worthless”)
Winning over health
External motivation
Sport identity
Poor coach athlete relationships
Lack of social support
Pain normalization

Question 13

How to prevent injuries?

Answer 13

Have open dialogues!
Form strong relationships with your athletes and colleagues
Screen athletes frequently for psychosocial stress and perceived recovery
Consider stakeholder education around
organisational injury risk factors.
Adopt mindfulness and acceptance-based practice and stress management approaches to reduce acute injury risk

Question 14

What are the injury prevention interventions?

Answer 14

by influencing the stress response: cognitive appraisal, physiological and attentional changes
Personality, history of stressors, coping
Training psychological skills
Interventions: goal setting, relaxation, imagery, self-talk, recognizing stressors, coping skills, CBT, mindfulness

Question 15

What are the injury prevention interventions outcomes?

Answer 15

• every study showed smaller number of injuries and shorter time-loss.
• effect sizes ranged from small to large
• important to integrate psychological prevention interventions within exercise-based programs for prevention
• high risk profile (higher stress response and negative life-events stress + low coping skills

Question 16

What is the psychological response to injury?

Answer 16

Impacts: rehabilitation behaviour and outcome, return to training and competition, future exercise adherence
The greater the severity, the higher the changes for negative emotional experience, but often sports medicine professionals do not know how to deal with psychological aspects of sport injury

Question 17

Positive factors affecting rehab outcomes

Answer 17

Hardiness, resilience and flourishing
High self-efficacy
Optimism, gratitude, self-compassion
Motivation
Coping
Social support
Locus of control
Psych. Reponses, coping & well-being, adherence, return to sport

Question 18

Negative factors affecting rehab outcomes

Answer 18

Severe pain catastrophizing
Strong ahletic identity
Perfectionism
Negative affectivity
Self-presentational concerns
Negative attitude to help
seeking
accessibility issues
Postinjury stress, coping, over-adherence, MH help-seeking

Question 19

Dance model of injury

Answer 19

Beliefs-> pressure-> injury which can lead to continuing dance or feeling better mentally

Question 20

How can positive psychology influence the response to injury?

Answer 20

→ Research needed which provides a more balanced, complete view of sport injury experience (rather than a negative event with negative consequences)
→ Insights towards alleviating the distress injured athletes experience
→ Growth (SRG), resilience, thriving
→ Promising results from Acceptance and Commitment Therapy for injuries

Question 21

What are the applied considerations of response to injury?

Answer 21

• Provide infrastructure to enable injured athletes to disclose their emotions
• Reinforce self- disclosure = Strength, not sign of weakness!
• Challenge injured athletes to see their injury from an alternative perspective
• Emphasize importance of & facilitate
  emotional/social support
• Be aware of impact culture
• enable practitioners to help athletes transform injury experience into an opportunity for growth and development

Question 22

Applied considerations for rehabilitation and return to sport?

Answer 22

• Encourage self awareness, reflection & learning, utilize strengths
• Focus on positive, challenge unrealistic performance beliefs
• (Re)consider logistics & schedule of (recreational) athletes; facilitate support & communication
• Progressively simulate the competitive
  environment

Question 23

How to build confidence?

Answer 23

Goal setting
Self- talk
Imagery
Emotional support
Informational support
Reflective practice
Simulation

Question 24

How to increase motivation?

Answer 24

• autonomy: athlete’s input in rehab journey, reduce pressure to return, provide choices in involvement
• relatedness: informational and emotional support, inclusion in team activities, 1-on-1 meetings, giving relevant tasks
• competence: goal setting, positive self-talk, imagery, reflective practice and talks, modifying activities, providing alternative activities

Question 25

What are the mental interventions to reduce risk?

Answer 25

• psychological skills training
• cognitive behaviour therapy
• mindfulness and acceptance
• imagery
• self-talk
• relaxation techniques
• goal-setting

Question 26

What are the mental interventions to improve rehabilitation?

Answer 26

Increasing knowledge( Athletes & Coaches)
Positive support
Actively listening & asking questions
Validating & reassuring
Motivation
Positive mindset
Optimism, gratitude, self-compassion
Individual counselling
Visualisation, relaxation, goal setting
Mindfulness and acceptance