“Put me back in, Coach!” – Psychological responses to sports injury

Jan 21, 14 “Put me back in, Coach!” – Psychological responses to sports injury

Psychological Response to Injury


Anyone who’s ever been injured will be able to tell you about the range of moods and emotions that they experienced, both immediately after the injury, and in the following weeks or months.

Here Dr Peter Olusoga who is a Sport Psychology Lecturer and consultant, based at Sheffield Hallam University in the UK discusses the “Psychological Response to Injury”. 

Researchers have investigated psychological responses to injury from a couple of different perspectives.  Some suggest that the response to injury follows a similar pattern to a grief response.  Kubler-Ross’ (1969) identified five discrete stages that people go through when faced with impending loss (denial, anger, bargaining, depression, and acceptance), and this model seems intuitively appealing when applied to injury.  In a sense, athletes who are injured have suffered a loss of sorts and might go through denial (“I’ll just put some ice on it, it’ll be fine”), anger (“This is bulls**t”), bargaining (“What if I got a second opinion?), depression (“This sucks – I hate my life”), and acceptance (“Right, let’s get on with rehab”).  Now the actual evidence for these stages applying to injury is somewhat mixed.  Personally, I recognise all of these stages from my own injuries (especially the “I’ll just put some ice on it, it’ll be fine” stage), and depression, as well as anger and frustration, are all easily observable in many injured athletes.  However, research has also suggested that the denial and bargaining stages don’t really apply to athletic injury.  Moreover, people are very different, so we can’t really say that everyone will go through the same five stages in the same order every time they get injured!


Rugby - no stretcher required.



The second perspective addresses these problems, and views the injury response as a cognitive appraisal process.  Essentially, this means that athletes experience injury as a stressful event.  When a potentially stressful situation occurs (in this case, injury) a person evaluates the nature of the stressful event against their ability to cope.  This process is called appraisal and consists of two parts: Primary appraisal is concerned with what’s at stake (is this thing a threat to my goals, my self-esteem, my values?), while secondary appraisal is concerned with whether or not a person has the ability and resources to cope.  The appraisal process therefore influences the way that a person responds emotionally to injury and the ways in which they might behave.  So because different people will have different cognitive appraisals, they will respond differently to athletic injuries.


An integrated perspective

One model that attempted to integrate these two perspectives was developed by Wiese-bjornstal and her colleagues.  This Integrated Model of Psychological Response to Sport Injury suggests that emotions associated with grief are a result the cognitive appraisal process, and are just some of the emotions that athletes can experience after suffering an injury.   The diagram below is an abridged version of Wiese-bjornstal et al.’s model and shows some of the emotional responses (e.g., fear, anger, depression, frustration, boredom) and some of the behavioural responses (e.g., sticking or not sticking to rehab, using social support, effort and intensity, and using psychological skills) that athletes might exhibit.  The cognitive appraisal process drives the emotional and behavioural responses to injury, which in turn drive further cognitive appraisals (the arrows in the diagram), and the appraisal process itself is influenced by a range of personal and situational factors.


Weiss model


While there are a number of emotional and behavioural responses that are perhaps missing from the model (e.g. ,fear of re-injury, or withdrawal from the sport environment), having an understanding of the ways in which athletes respond to injury, and the factors that can influence that response, can help us to help athletes through what can be an immensely difficult period.


How can we help?

The other day, I was talking to a colleague of mine, a Strength and Conditioning coach, who’s doing some work with a football team.  He was telling me about one of the coaches whose attitude towards injured players was something along the lines of: “Injured players aren’t any use to me.  I don’t even want to see them until they’re ready to play.”  Now first of all, this kind of attitude is going to lead to athletes playing through injury and pain.  Most people have played or trained through pain and discomfort before, it’s part of being a mentally tough athlete, but it’s important to recognise the difference between pain and an actual injury.  Athlete’s might make injuries worse, or return too quickly and re-injure themselves because they don’t want to fall out of favour with the coach.  According to Wiese-bjornstal et al.’s model, coaches contribute to the situational factors that influence cognitive appraisals, so it’s vital that coaches have an understanding of the psychological impact of injuries, and are able to provide the emotional support that their athletes require.  Young athletes in particular have described the need for encouragement from coaches to get through the challenges associated with rehabilitation.


"Put me back in, Coach. I can play!"
      “Put me back in, Coach. I can play!…Unless this guy’s sick on me, in which case I’m done”

Psych in the treatment room


To increase the chances of successful recovery outcomes, athletes need to have positive cognitive appraisals of the situation.  That is, they need to have realistic goals (i.e., not feel the pressure to return too quickly), and believe that they have the coping resources to handle the situation (support from coaches, teammates, parents, friends is vital here).  In the initial stages of injury, sports medicine professionals can help by making sure that athletes have an understanding of their injury, are clear on the implications of their injury, and have realistic timescales for return (minimising their fear of the unknown).  During the rehabilitation phase, athletes can use strategies such as relaxation and imagery (reducing tension, depression, frustration), as well as goal setting (increasing adherence behaviours), to increase the chances of them responding positively to their situation.



So we know that athletes experience a range of emotions and exhibit varying behaviours when they get injured.  Some of these emotions and behaviours can be negative and harm the recovery process, while others  can be adaptive and lead tobe more positive outcomes.  Wiese-bjornstal et al.’s integrated model also suggests that athletes’ cognitive appraisals of the situation influence their emotional and behavioural responses (and vice versa) and, importantly, there are a number of personal and situational factors that influence those appraisals.  To help athletes deal with the trauma and stress of injury, and to increase the chances of positive recovery outcomes, coaches and sports medicine professionals need to have an understanding of psychological responses to injury and appreciate how they might be able to influence an athlete’s cognitive appraisals by becoming an effective part of the support network.


To view this article by Dr Perer Olusoga and to view his website please (CLICK HERE)


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