sport injury dissertation

• Tools and Resources
• Customer Services
• Affective Science
• Biological Foundations of Psychology
• Clinical Psychology: Disorders and Therapies
• Cognitive Psychology/Neuroscience
• Developmental Psychology
• Educational/School Psychology
• Forensic Psychology
• Health Psychology
• History and Systems of Psychology
• Individual Differences
• Methods and Approaches in Psychology
• Neuropsychology
• Organizational and Institutional Psychology
• Personality
• Psychology and Other Disciplines
• Social Psychology
• Sports Psychology
• Share This Facebook LinkedIn Twitter

Article contents

Psychological responses to sport injury.

• Britton W. Brewer Britton W. Brewer Springfield College
• https://doi.org/10.1093/acrefore/9780190236557.013.172
• Published online: 24 May 2017

In addition to the disruptive impact of sport injury on physical functioning, injury can have psychological effects on athletes. Consistent with contemporary models of psychological response to sport injury, aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, and behavior. Part of the fabric of sport and ubiquitous even among “healthy” athletes, pain is a common consequence of sport injury. Postinjury pain is typically of the acute variety and can be exacerbated, at least temporarily, by surgery and some rehabilitation activities. Cognitive responses to sport injury include appraising the implications of the injury for one’s well-being and ability to manage the injury, making attributions for injury occurrence, using cognitive coping strategies, perceiving benefits of injury, and experiencing intrusive injury-related thoughts and images, increased perception of injury risk, reduced self-esteem and self-confidence, and diminished neurocognitive performance. Emotional responses to sport injury tend to progress from a preponderance of negative emotions (e.g., anger, confusion, depression, disappointment, fear, frustration) shortly after injury occurrence to a more positive emotional profile over the course of rehabilitation. A wide variety of personal and situational factors have been found to predict postinjury emotions. In terms of postinjury behavior, athletes have reported initiating coping strategies such as living their lives as normally as possible, distracting themselves, seeking social support, isolating themselves from others, learning about their injuries, adhering to the rehabilitation program, pursuing interests outside sport, consuming alcohol, taking recreational and/or performance-enhancing substances, and, in rare cases, attempting suicide. Psychological readiness to return to sport after injury is an emerging concept that cuts across cognitive, emotional, and behavioral responses to sport injury.

• sport injury
• rehabilitation
• consequences
• psychological

Introduction

Inherent in sport participation is the risk of injury. Although the physical effects of sport injury (e.g., tissue damage, initiation of healing processes, increased body mass index and body fat percentage) are especially salient (Myer et al., 2014 ; Prentice, 2011 ), sport injury can also have psychological consequences. Aspects of psychological functioning that can be affected by sport injury include pain, cognition, emotion, behavior, and readiness to return to sport. These aspects can be considered in terms of theoretical, empirical, and practical perspectives.

Theoretical Perspectives

To describe and explain how athletes respond psychologically to injury, researchers have borrowed and, in some cases, adapted theories and models from other areas of psychology. For example, the most comprehensive attempt to represent psychological responses to sport injury and their antecedents conceptually—the integrated model of psychological response to sport injury (Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998 )—is based largely on principles from the literature on stress and coping (Lazarus & Folkman, 1984 ) and is an extension of several previously adapted models (e.g., Gordon, 1986 ; Weiss & Troxel, 1986 ). In the integrated model, sport injury is conceptualized as a stressor that athletes interpret (or “appraise”) in terms of its impact and their ability to deal with its effects. This cognitive appraisal process is thought to be influenced by a multitude of personal and situational factors. Personal factors include injury characteristics (e.g., severity, type) and individual difference variables in the psychological (e.g., personality, motivation, identity), demographic (e.g., age, gender), and physical (e.g., health status, eating behavior) domains. Situational factors pertain to aspects of the sport (e.g., level of competition, time of the competitive season), social (e.g., family dynamics, social support), and physical (accessibility to rehabilitation, comfort of rehabilitation sessions) environments. The resulting cognitive appraisals are posited to influence cognitive, emotional, and behavioral responses to sport injury, which are themselves proposed to be dynamic, reciprocally related, and potentially influential on injury recovery outcomes (Wiese-Bjornstal et al., 1998 ). Research has provided consistent support for predictions generated from the integrated model (for a review, see Brewer, 2007 ). Although the integrated model does not include pain and psychological readiness to return to sport, it could easily be expanded to do so.

Another group of models has adapted the widely known ideas of Kübler-Ross ( 1969 ) regarding adjustment to terminal illness to psychological responses to sport injury. Such grief-based “stage models” hold that athletes proceed through an invariant, predictable sequence of stages after injury. For example, several authors (Astle, 1986 ; Rotella, 1985 ) proposed that athletes display denial, anger, bargaining, depression, and, finally, acceptance after they become injured. Although athletes have exhibited grief-like reactions to serious injury (Macchi & Crossman, 1996 ) and tended to display more favorable psychological responses over time after injury (e.g., McDonald & Hardy, 1990 ; Smith, Scott, O’Fallon, & Young, 1990 ), the notion of an invariant series of psychological reactions to sport injury has not been supported by research (Brewer, 1994 ). As with the integrated model, stage models do not address pain and psychological readiness to return to sport.

Focused on the types of pain that athletes might encounter both before and after injury, Addison, Kremer, and Bell ( 1998 ) developed a model of sport-related pain that incorporates ideas from the gate control theory of pain (Melzack & Wall, 1965 ), the parallel processing model of pain (Leventhal & Everhart, 1979 ), and the literature on cognitive appraisal processes in stress and coping (Lazarus & Folkman, 1984 ). As specified in the model, which neatly dovetails with the integrated model of Wiese-Bjornstal et al. ( 1998 ), athletes experience postinjury pain when they interpret physiological sensations as indicating a threat to their health and ascribe the sensations to injury. Individual differences in age, attention to bodily symptoms, fitness, and physiology are thought to influence the detection of physiological sensations. Both intrinsic factors (e.g., affect, cognition, pain tolerance, personality) and extrinsic factors (e.g., culture, prior experience, social/situational context) are proposed to affect the appraisal process. The model holds that when athletes with injury appraise physiological sensations as pain due to their injury, their responses (e.g., reducing physical activity, seeking assistance, implementing a coping strategy) are subject to the influence of factors such as culture and motivation. Although the model is of potential utility in understanding pain after the occurrence of sport injury, research support for the model is scant.

One particular behavioral response to sport injury—adherence to sport injury rehabilitation—has been examined from a variety of theoretical perspectives. Because adherence to medical regimens has been a widely studied topic for many decades (Meichenbaum & Turk, 1987 ), investigators of adherence to sport injury rehabilitation have had numerous theories and models of adherence available to guide their research. Among the perspectives that have been applied in studies of sport injury rehabilitation are, in addition to the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., 1998 ), personal investment theory (Maehr & Braskamp, 1986 ), protection motivation theory (Prentice-Dunn & Rogers, 1986 ), self-determination theory (Ryan & Deci, 2000 ), the transtheoretical model (Prochaska & DiClemente, 1983 ), and an adaptation of the theory of planned behavior (Levy, Polman, & Clough, 2008 ). In general, the perspectives have strong cognitive and motivational components, which is not surprising given the effort and persistence that adherence to sport injury rehabilitation programs can require.

Although psychological readiness to return to sport is a concept that is still being defined, it has not been completely atheoretical. In particular, it has been suggested that self-determination theory (SDT; Ryan & Deci, 2000 ) offers a viable explanation for why athletes might or might not be psychologically ready to return to sport after injury. Podlog and his colleagues (e.g., Podlog & Eklund, 2005 , 2007 ; Podlog, Lochbaum, & Stevens, 2010 ) have provided empirical support for the contention that, consistent with SDT, athletes can be considered less psychologically ready to return to sport when their basic psychological needs for competence, relatedness, and autonomy are not being satisfied than when those needs are being met.

Empirical Perspectives

Although the first empirical study on psychological responses to sport injury was conducted by Little ( 1969 ) more than a half-century ago, it wasn’t until the 1990s that a steady stream of empirical investigations began to appear in the literature. Over the past quarter-century, a sizable body of research on the topic has accumulated. The primary foci of scientific studies have varied over time, but pain, cognition, emotion, behavior, and readiness to return to sport have all been examined by investigators.

Pain is ubiquitous in sport. It not only can signal the occurrence of sport injury and feature in its aftermath, but it also can be a central aspect of sport training and competition. Reflecting the prominent role of pain in sport, scholars have investigated multiple aspects of the phenomenon in the context of sport. Research has progressed along four main lines of inquiry. One line of research has examined pain from a sociological perspective, yielding the important finding that sport is a culture in which athletes can be reinforced (or even glorified) for ignoring, denying, and playing through pain and injury (e.g., Hughes & Coakley, 1991 ; Nixon, 1992 ). Pain, therefore, appears to be a socially charged psychological response to sport injury that athletes may be discouraged from expressing, even to those responsible for treating the conditions that precipitated it (Safai, 2003 ; Walk, 1997 ).

A second line of research has compared athletes and nonathletes on laboratory measures of pain tolerance and pain threshold. Results of a meta-analysis of 15 studies indicated that (1) athletes had higher pain tolerance than nonathletes for cold, electrical, heat, ischemic, and pressure stimul; and (2) athletes had higher pain threshold than nonathletes for cold and pressure stimuli (Tesarz, Schuster, Hartmann, Gerhardt, & Eidt, 2012 ). The relevance of these findings for pain in response to sport injury, however, is not clear.

A third line of research has focused on assessing the prevalence and identifying anthropometric, biomechanical, strength, training, and, in rare cases, psychological predictors of pain in athletes. Many of the studies in this area of inquiry have examined pain in particular parts or regions of the body experienced by athletes participating in sports in which such pain is likely. For example, investigators have studied shoulder pain in swimmers (Walker, Gabbe, Wajswelner, Blanch, & Bennell, 2012 ); leg pain in cross country runners (Reinking, Austin, & Hayes, 2010 ); wrist pain in gymnasts (DiFiori, Puffer, Aish, & Dorey, 2002 ); knee pain in athletes across a variety of sports (Hahn & Foldspang, 1998 ); patellofemoral pain in basketball, soccer, and volleyball players (Myer et al., 2015 ); low back pain in cross country skiers, orienteers, and rowers (Foss, Holme, & Bahr, 2012 ); and pain in various body locations in cyclists (Dahlquist, Leisz, & Finkelstein, 2015 ). Although the methods and criteria used to examine pain have varied considerably across studies, prevalence rates in excess of 80% for at least mild pain have been documented (e.g., DiFiori et al., 2002 ; Reinking et al., 2010 ). Overall, the findings in this area of research attest to the ubiquity of pain in sport, but they do not have clear implications for understanding pain as a psychological response to injury because many of the participants who reported experiencing pain were not necessarily injured per se and, even when injured, may have been training as much as those who were not injured (Dahlquist et al., 2015 ).

The fourth main line of research has explored pain experienced by athletes after anterior cruciate ligament (ACL) reconstruction. In addition to examining associations of factors such as surgical procedures (Beck et al., 2004 ; Benea et al., 2014 ; Niki et al., 2012 ), anesthesia (Ekmekci et al., 2013 ), clinical variables (Niki et al., 2012 ), and cryotherapy (Raynor, Pietrobon, Guller, & Higgins, 2005 ) with postoperative pain, researchers have obtained descriptive data on the quality of pain over the first 48 hours postsurgery (Tripp, Stanish, Coady, & Reardon, 2004 ) and the intensity of pain over the first 6 weeks postsurgery (Brewer et al., 2007 ; Oztekin, Boya, Ozcan, Zeren, & Pinar, 2008 Tripp et al., 2004 ; Tripp, Stanish, Reardon, Coady, & Sullivan, 2003 ). Athletes’ endorsement of adjectives to describe their pain (e.g., sharp, tender, throbbing, aching, tiring, pulling) seems to change slightly from 24 to 48 hours postsurgery (Tripp et al., 2004 ), and pain intensity tends to decrease steadily from 24 hours to 6 weeks postsurgery (Brewer et al., 2007 ; Oztekin et al., 2008 ; Tripp et al., 2004 ). Pain intensity is higher for adolescents than adults at 24 hours postsurgery (Tripp et al., 2003 ) but is higher for older individuals than younger individuals over the first 6 weeks postsurgery (Brewer et al., 2007 ). Pain intensity is positively associated with anxiety at 24 hours postsurgery (Tripp et al., 2004 ) and negative mood over the first 6 weeks postsurgery (Brewer et al., 2007 ). In general, research in this line of inquiry is more concentrated on pain as a psychological response than that in the other three lines, but the narrow focus on a single type of injury and approach to treatment limits its generalizability. Thus, although the four lines of research have been informative, limitations with each of them preclude a thorough understanding of pain responses to sport injury.

As noted in the general section on theoretical perspectives, the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., 1998 ) and earlier models emanating from the Lazarus and Folkman ( 1984 ) approach to stress and coping (e.g., Gordon, 1986 ; Weiss & Troxel, 1986 ) ascribe a temporally primary role to cognitive appraisals of the impact or personal relevance of sport injury in determining the cognitive, emotional, and behavioral responses that follow. In light of the physical damage induced by injury and the ramifications of that damage for subsequent sport participation, it is not surprising that interpretations of sport injury as threatening or involving harm or loss are common (Clement & Arvinen-Barrow, 2013 ; Ford & Gordon, 1999 ; Gould, Udry, Bridges, & Beck, 1997a ). Cognitive responses beyond the primary appraisals of the injury can be grouped into three potentially overlapping categories of cognitive content (i.e., injury-related, self-related, and coping-related) and one general category of cognitive processes.

Injury-related content

Given that sport injury is the kind of event that elicits the psychological responses addressed in this article, it is logical to expect the cognitive content of athletes with injuries to reflect their experiences and pertain at least partially to the injuries themselves. The unexpected nature of sport injuries may prompt athletes to engage in attributional thinking (Wong & Weiner, 1981 ) in which they attempt to identify the cause (or causes) of their injuries. A trio of studies identified behavioral factors (San José, 2003 ; Tedder & Biddle, 1998 ) and mechanical/technical factors (Brewer, 1999a ) as common explanations given by athletes for injury occurrence. In addition to cognitions about the causes(s) of their injuries, athletes have reported experiencing recurrent, distress-producing, recurrent, intrusive thoughts and images of the injury event (Newcomer & Perna, 2003 ; Shuer & Dietrich, 1997 ; Vergeer, 2006 ). Later, after the immediate impact of injury has passed, athletes have shown a propensity for experiencing more positively tinged cognitive content, reporting perceptions of benefits they have accrued as a result of their injuries (e.g., Ford & Gordon, 1999 ; Podlog & Eklund, 2006 ; Tracey, 2003 ; Udry, Gould, Bridges, & Beck, 1997 ; Wadey, Evans, Evans, & Mitchell, 2011 ). Common themes of the injury-related benefits identified by athletes include personal growth, psychologically based performance enhancement, and physical/technical development (Udry et al., 1997 ). After experiencing injury, athletes may also harbor negative cognitive content about their prospects with respect to future injury, reporting less confidence in their ability to avoid injury and higher levels of perceived risk of injury and worry about sustaining an injury than athletes without a recent injury (Reuter & Short, 2005 ; Short, Reuter, Brandt, Short, & Kontos, 2004 ).

Self-related content

For many athletes, injury threatens their involvement in a self-defining activity that serves as a significant source of self-worth (Brewer, Van Raalte, & Linder, 1993 ). Consequently, it is reasonable to expect that injury might have an impact on self-related cognitive content. Consistent with this notion, athletes have reported decreases in self-esteem after injury (Leddy, Lambert, & Ogles, 1994 ), increases in self-confidence and self-efficacy over the course of rehabilitation (Quinn & Fallon, 1999 ; Thomeé et al., 2007 ), and decreases in self-identification with the athlete role (Brewer, Cornelius, Stephan, & Van Raalte, 2010 ). Substantial changes in self-definition, which reflects how athletes think about themselves, have been reported by athletes with severe injuries (Vergeer, 2006 ).

Coping-related content

In taking an active role to deal with the adverse physical and psychological effects of injury, athletes have reported that they sometimes initiate cognitive coping strategies. Among the common themes of the cognitive content used by athletes to cope with injury are acceptance of injury, disengagement from injury, imagery, positive thoughts, and recovery (Bianco, Malo, & Orlick, 1999 ; Carson & Polman, 2008 , 2010 ; Gould, Udry, Bridges, & Beck, 1997b ; Ruddock-Hudson, O’Halloran, & Murphy, 2014 ; Tracey, 2003 ; Udry et al., 1997 ). It appears that the cognitive strategies deployed by athletes are at least in part influenced by the specific qualities of the injury-related stressors (e.g., physical symptoms, rehabilitation requirements) with which they are dealing, as the use of various coping strategies fluctuates over the course of rehabilitation (Johnston & Carroll, 2000 ; Udry, 1997 ) and differs as a function of whether athletes have chronic or acute injuries (Wasley & Lox, 1998 ).

The literature suggests that, in addition to affecting cognitive content, sport injury has an adverse effect on cognitive processes such as attention, memory, processing speed, and reaction time (Moser, 2007 ). Postinjury impairment of cognitive functioning has also been found for musculoskeletal injuries in one study (Hutchison, Comper, Mainwaring, & Richards, 2011 ), but not in another (Mrazik, Brooks, Jubinville, Meeuwisse, & Emery, 2016 ). Presumably, the intrusive images of injury occurrence (Shuer & Dietrich, 1997 ; Vergeer, 2006 ) noted in the section on injury-related content occupy some of the cognitive resources that would otherwise be devoted to processing other information and, along with postinjury emotional disturbance, may partially explain how musculoskeletal injuries might produce impaired cognitive functioning.

The largest share of research on the psychological consequences of sport injury has been devoted to emotional responses. Findings from an abundance of qualitative and quantitative studies have converged to produce a rich description of how athletes respond emotionally to injury and identify a variety of personal, situational, cognitive, and behavioral factors associated with those responses.

From a descriptive standpoint, athletes have tended to use a variety of negative terms (e.g., anger, bitterness, confusion, depression, fear, frustration, helplessness, shock) to characterize their emotions after injury (e.g., Bianco et al., 1999 ; Wadey, Evans, Hanton, & Neil, 2012a ). Although common, reports of negative emotions are not inevitable and may fluctuate widely over the course of the rehabilitation (Bianco et al., 1999 ; Carson & Polman, 2008 ; Johnston & Carroll, 1998 ). In general, however, there is evidence that athletes tend to report higher levels of emotional disturbance after sustaining an injury than they do before being injured (Appaneal, Levine, Perna, & Roh, 2009 ; Leddy, Lambert, & Ogles, 1994 ; Mainwaring et al., 2004 ; Mainwaring, Hutchinson, Biscchop, Comper, & Richards, 2010 ; Olmedilla, Ortega, & Goméz, 2014 ; Smith et al., 1993 ) and that athletes with injury tend to report higher levels of emotional disturbance than athletes without injury (Abenza, Olmedilla, & Ortega, 2010 ; Appaneal et al., 2009 ; Brewer & Petrie, 1995 ; Johnson, 1997 , 1998 ; Leddy et al., 1994 ; Mainwaring et al., 2004 ; Pearson & Jones, 1992 ; Smith et al., 1993 ). Estimates of the prevalence of athletes with injury who report clinically meaningful levels of emotional disturbance have ranged from 5 to 42% (Appaneal et al., 2009 ; Brewer, Linder, & Phelps, 1995 ; Brewer, Petitpas, Van Raalte, Sklar, & Ditmar, 1995 ; Brewer & Petrie, 1995 ; Garcia et al., 2015 ; Leddy et al., 1994 ; Manuel et al., 2002 ). Most of the psychological distress reported by athletes would be classified as “subclinical,” lacking the severity and/or duration to be considered a clinical condition.

In addition to the large body of research that has provided a thorough description of emotional responses to sport injury, numerous studies have investigated potential predictors of such responses. As proposed in the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., 1998 ), associations have been documented between postinjury emotional responses and a wide variety of personal and situational factors (which presumably affect emotional responses through cognitive appraisals), cognitive responses, and behavioral responses (the latter of which will be discussed in the section on behavior that follows). Regarding personal factors, positive associations have been obtained between postinjury emotional disturbance and pain (Brewer et al., 2007 ), pain catastrophizing (Baranoff, Hanrahan, & Connor, 2015 ), neuroticism (Brewer et al., 2007 ), impairment in performing daily activities (Crossman & Jamieson, 1985 ), injury acuteness (Alzate, Ramírez, & Artaza, 2004 ; Brewer, Linder, & Phelps, 1995 ), injury severity (Alzate et al., 2004 ; Manuel et al., 2002 ; Smith, Scott, O’Fallon, & Young, 1990 ), self-identification with the athlete role (Baranoff et al., 2015 ; Brewer, 1993 ; Manuel et al., 2002 ), and investment in playing sports professionally (Kleiber & Brock, 1992 ). Negative association has been documented between postinjury emotional disturbance and age (Brewer, Linder, & Phelps, 1995 ; Smith, Scott, O’Fallon, & Young, 1990 ), hardiness (Wadey, Evans, Hanton, & Neil, 2012b ), injury recovery (McDonald & Hardy, 1990 ; Smith, Young, & Scott, 1988 ), and acceptance of uncomfortable experiences (Baranoff et al., 2015 ).

With respect to situational factors, the variable most consistently associated with postinjury emotional responses is the amount of time that has passed since occurrence of the injury. With the exception of a possible increase in the intensity of negative emotions and a decrease in the intensity of positive emotions at the end of rehabilitation with a return to sport looming (Morrey, Stuart, Smith, & Wiese-Bjornstal, 1999 ), negative emotions tend to decrease in intensity, and positive emotions tend to increase in intensity as time passes after injury (Appaneal et al., 2009 ; Brewer et al., 2007 ; Garcia et al., 2015 ; Leddy et al., 1994 ; Macchi & Crossman, 1996 ; Mainwaring et al., 2004 , 2010 ; Manuel et al., 2002 ; McDonald & Hardy, 1990 ; Olmedilla et al., 2014 ; Quinn & Fallon, 1999 ; Smith, Scott, O’Fallon, & Young, 1990 ). Other situational factors for which associations with high levels of emotional disturbance have been documented in multiple studies include high levels of life stress (Albinson & Petrie, 2003 ; Brewer, 1993 ; Brewer et al., 2007 ; Manuel et al., 2002 ) and low levels of both social support for rehabilitation (Brewer, Linder, & Phelps, 1995 ; Rees, Mitchell, Evans, & Hardy, 2010 ) and satisfaction with social support (Green & Weinberg, 2001 ; Manuel et al., 2002 ).

Cognitive responses related to greater postinjury emotional disturbance in athletes include perceptions of being unable to cope with injury (Albinson & Petrie, 2003 ; Daly, Brewer, Van Raalte, Petitpas, & Sklar, 1995 ), high levels of avoidance-focused (Gallagher & Gardner, 2007 ) and low levels of instrumental coping strategies (Wadey, Clark, Podlog, & McCullough, 2013 ), and causal attributions for sport injury occurrence (Brewer, 1999a ; Tedder & Biddle, 1998 ). Emotional disturbance was positively associated with attributing the cause of injury to internal factors in one study (Tedder & Biddle, 1998 ) but negatively associated with attributing the cause of injury to internal and stable factors in a second study (Brewer, 1999a ). Behaviors associated with athletes’ emotional responses to injury are identified next.

Because pain, cognition, and emotion can be readily concealed from view, behavior is undeniably the most overt psychological response to sport injury. Further, even though the behavior of athletes may reflect or be a manifestation of their experience of pain, cognitive, or emotional responses to injury, it is behavioral responses that have the greatest potential to affect the rehabilitation process. Some of the behaviors that athletes have reported themselves as engaging in after injury can be interpreted as attempts to cope with the challenges of the situation. For example, such active, instrumental, “problem-focused” coping behaviors as pursuing rehabilitation vigorously, learning about the injury, trying alternative treatments, building physical strength, and cultivating or enlisting social resources (Bianco et al., 1999 ; Gould et al., 1997b ; Johnston & Carroll, 2000 ; Quinn & Fallon, 1999 ; Ruddock-Hudson et al., 2014 ; Wadey et al., 2012a , 2012b ) tend to be deployed under conditions of elevated stress and mood disturbance (Albinson & Petrie, 2003 ) and conceivably can be of utility in helping athletes to recover from their injury and return to sport. Even some avoidant or “emotion-focused” coping behaviors such as distracting oneself (e.g., keeping busy, watching television) and isolating oneself from others (Bianco et al., 1999 ; Carson & Polman, 2010 ; Gould et al., 1997b ; Ruddock-Hudson et al., 2014 ; Wadey et al., 2012a , 2012b ) may be useful in the regulation of postinjury emotions (Carson & Polman, 2010 ). Other behavioral responses to sport injury, however, such as attempting suicide (Smith & Milliner, 1994 ), engaging in disordered eating (Sundgot-Borgen, 1994 ), consuming banned substances (National Collegiate Athletic Association, 2012 ), and drinking alcohol (Martens, Dams-O’Connor, & Beck, 2006 ) may have less adaptive consequences.

The behavioral response to sport injury that has garnered the most attention from investigators is adherence to rehabilitation. Considered vital to the success of sport injury rehabilitation programs (Fisher, Domm, & Wuest, 1988 ), adherence in this context refers to the extent to which athletes follow the prescribed course of treatment. The specific behaviors involved in adhering to rehabilitation vary substantially across the range of injuries that athletes incur, but some of the more common behavioral requirements of sport injury rehabilitation programs include “attending and actively participating in clinic-based rehabilitation appointments, avoiding potentially harmful activities, wearing therapeutic devices (e.g., orthotics), consuming medications appropriately, and completing home rehabilitation activities (e.g., exercises, therapeutic modalities)” (Brewer, 2004 , pp. 39–40). Although athletes engage in some of the rehabilitation behaviors in supervised clinical settings, they complete other of the behaviors at home, away from the direct oversight of rehabilitation professionals. The considerable variation in average adherence levels reported in research investigations (ranging from 40 to 91%, as reported in a review of the literature [Brewer, 1999b ]) is not surprising in light of the vast array of injuries, rehabilitation programs, clinical settings, and methods of assessment (e.g., self-report, practitioner rating, attendance log) that have been examined. Further complicating the estimation of adherence in the context of sport injury rehabilitation is that some highly motivated athletes may “overadhere” to their rehabilitation program by engaging in rehabilitation activities to a greater extent than recommended by the sports health care professional treating them (Niven, 2007 ; Podlog, Gao et al., 2013 ). Although such behavior is technically nonadherent, it is fundamentally different from failing to complete one or more aspects of a rehabilitation program.

Given the potential importance of adherence in achieving desired sport injury rehabilitation outcomes, investigators have attempted to identify factors associated with adherence to sport injury rehabilitation. As in the general medical literature, in which literally hundreds of predictors of treatment adherence have been identified (Meichenbaum & Turk, 1987 ), research has documented numerous correlates of sport injury rehabilitation adherence that can be grouped into the main conceptual categories of the integrated model of psychological response to sport injury (Wiese-Bjornstal et al., 1998 ). Examples of personal factors for which positive associations with sport injury rehabilitation adherence have been found in multiple studies include (perceived) injury severity (Grindley, Zizzi, & Nasypany, 2008 ; Taylor & May, 1996 ), athletic identity (Brewer, Cornelius, Van Raalte, Petitpas, Sklar et al., 2003b ; Brewer, Cornelius, Van Raalte, Tennen, & Armeli, 2013 ), pain tolerance (Byerly, Worrell, Gahimer, & Domholdt, 1994 ; Fields, Murphey, Horodyski, & Stopka, 1995 ; Fisher et al., 1988 ), and self-motivation (Brewer, Van Raalte, Cornelius et al., 2000 ; Duda, Smart, & Tappe, 1989 ; Fields et al., 1995 ; Fisher et al., 1988 ; Levy et al., 2008 ). With respect to situational factors, findings from multiple investigations have shown that athletes display higher levels of adherence to sport injury rehabilitation programs when they consider themselves as receiving support from others for their rehabilitation (Byerly et al., 1994 ; Duda et al., 1989 ; Fisher et al., 1988 ; Johnston & Carroll, 2000 ; Levy et al., 2008 ), perceive the clinic setting in which they do their rehabilitation as comfortable, and view their clinic-based rehabilitation appointments as conveniently scheduled (Fields et al., 1995 ; Fisher et al., 1988 ).

Several cognitive and emotional responses have also been found to predict adherence to sport injury rehabilitation programs across multiple studies. From a cognitive standpoint, athletes have demonstrated higher levels of adherence to rehabilitation when they report believing that their treatment will be effective (Brewer, Cornelius, Van Raalte, Petitpas, Sklar et al., 2003a ; Duda et al., 1989 ; Taylor & May, 1996 ), profess a strong intention to adhere to rehabilitation (Bassett & Prapavessis, 2011 ; Levy et al., 2008 ), and indicate that they are confident that they can cope with their injuries (Daly et al., 1995 ; Levy et al., 2008 ) and complete their rehabilitation program (Brewer, Cornelius, Van Raalte, Petitpas, Sklar et al., 2003a ; Levy et al., 2008 ; Taylor & May, 1996 ; Wesch et al., 2012 ). In terms of emotional responses, negative associations have been documented between mood disturbance and sport injury rehabilitation adherence (Alzate et al., 2004 ; Daly et al., 1995 ).

Psychological Readiness to Return to Sport

The lack of a universally accepted definition of psychological readiness to return to sport after injury has not prevented researchers from investigating the topic through two main approaches. One approach involves comparing athletes who return to sport after injury with those who do not return to sport after injury on psychological variables measured during or after rehabilitation. The other approach involves asking athletes who have returned to sport after injury to describe their experience of returning. Reviews of research in which the two approaches have been implemented have yielded a consistent set of psychological factors associated with athletes’ return to sport after injury (Ardern, Taylor, Feller, & Webster, 2013 ; Czuppon, Racette, Klein, & Harris-Hayes, 2014 ; Podlog & Eklund, 2007 ). Specifically, the empirical findings of prospective and retrospective studies have dovetailed, suggesting that factors involved in psychological readiness to return to sport after injury include a lack of fear or anxiety regarding reinjury, confidence in the injured body part and in one’s ability to perform, and intrinsic motivation to return to sport.

The consequences of an absence of psychological readiness to return to sport are not fully understood. Beyond being less likely to return to sport in the first place, athletes who are not psychologically ready to return to sport but do so anyway may be at increased risk for such consequences as injury (or reinjury), poor sport performance, and a lower quality sport experience. Prospective longitudinal research is needed to investigate these possibilities.

Practical Perspectives

From an applied standpoint, numerous interventions have been implemented to affect athletes’ psychological responses to sport injury. Common treatment approaches for pain differ somewhat from those for problematic cognitive, emotional, and behavioral responses, and treatments designed to enhance psychological readiness to return to sport have not been evaluated explicitly. Consequently, interventions to treat pain and improve psychological readiness to return to sport are discussed separately from the other three main types of psychological response and from each other.

An important aspect of postinjury pain among athletes is that it often can be escaped or reduced by ceasing, reducing, or modifying involvement in activities that produce or exacerbate the pain. For postinjury pain that is especially intense or long-lasting, formal pain management interventions can be initiated. Such interventions are likely to involve a combination of analgesic medications and physical therapies (Kolt, 2004 ). Aspirin, ibuprofen, and paracetamol (acetaminophen) are the analgesic medications most likely to be recommended, with opioids (e.g., codeine) and corticosteroids prescribed less frequently (Garnham, 2007 ). Physical therapies used to treat postinjury pain in athletes include electrophysical agents (e.g., transcutaneous electrical nerve stimulation [TENS], interferential electrical stimulation, ultrasound), manual techniques (e.g., massage, chiropractic manipulation), exercise, cryotherapy, heat, and acupuncture (Kolt, 2007 ; Snyder-Mackler, Schmitt, Rudolph, & Farquhar, 2007 ; Wadsworth, 2006 ). Although a wide variety of psychological techniques have been recommended to help athletes cope with postinjury pain (Kolt, 2004 , 2007 ), the effectiveness of such techniques in the context of sport injury has been evaluated in very few controlled experimental studies (Cupal & Brewer, 2001 ; Ross & Berger, 1996 ). The lack of research on psychological pain management techniques in sport injury rehabilitation suggests that the techniques are not implemented on a widespread basis in clinical settings.

Cognitive, Emotional, and Behavioral Responses

As for postinjury pain, many psychological interventions have been advocated to affect cognitive, emotional, and behavioral responses to sport injury. Only a few of the interventions, however, have received experimental support for influencing cognitive, emotional, and/or behavioral responses in sport injury rehabilitation. Interventions found effective relative to a control condition include goal setting (Evans & Hardy, 2002 ; Penpraze & Mutrie, 1999 ), imagery (Cupal & Brewer, 2001 ), modeling (Maddison, Prapavessis, & Clatworthy, 2006 ), and multimodal interventions (Johnson, 2000 ; Ross & Berger, 1996 ). These interventions (Christakou, Zervas, & Lavallee, 2007 ; Cupal & Brewer, 2001 ; Maddison et al., 2006 , 2012 ; Newsom, Knight, & Balnave, 2003 ; Ross & Berger, 1996 ; Theodorakis, Beneca, Malliou, & Goudas, 1997 ; Theodorakis, Malliou, Papaioannou, Beneca, & Filactakidou, 1996 ) and others, including biofeedback (Silkman & McKeon, 2010 ) and self-talk (Beneka et al., 2013 ), have been found to influence physical outcomes in sport injury rehabilitation.

As an emerging construct, psychological readiness to return to sport after injury has received minimal attention from researchers attempting to evaluate the effectiveness of interventions designed explicitly to foster psychological readiness in athletes resuming sport participation after injury. Nevertheless, interventions that have produced increases in confidence (e.g., Maddison et al., 2006 ) and decreases in anxiety (e.g., Cupal & Brewer, 2001 ; Ross & Berger, 1996 ), for example, may have enhanced the readiness of the athletes receiving the interventions to return to sport with or without the intention of actually doing so. As a fuller understanding of the composition of what it means to be psychologically ready to return to sport emerges, inquiry into the effects of interventions developed to enhance readiness is likely to ensue.

Conclusions

Sport injury can affect athletes both physically and psychologically. Pain, cognition, emotion, and behavior are primary areas of psychological functioning affected by injury. Psychological responses to sport injury tend to be strongest in close temporal proximity to injury occurrence and fluctuate over the course of rehabilitation. Psychological readiness to return to sport after injury is an emerging concept that incorporates aspects of cognition, emotion, and behavior, including anxiety, confidence, motivation, and postreturn expectations. A variety of theoretical perspectives have been used to guide a body of research on psychological responses to sport injury. Relatively few controlled investigations of interventions designed to influence psychological responses to sport injury have been conducted.

• Abenza, L. , Olmedilla, A. , & Ortega, E. (2010). Efectos de las lesiónes sobre las variables psicológicas en fubolistas juveniles [Effect of injuries on psychological variables among under-19 soccer players.]. Revista Latinoamericana de Psicología , 42 , 265–277.
• Addison, T. , Kremer, J. , & Bell, R. (1998). Understanding the psychology of pain in sport. Irish Journal of Psychology , 19 , 486–503.
• Albinson, C. B. , & Petrie, T. (2003). Cognitive appraisals, stress, and coping: Preinjury and postinjury factors influencing psychological adjustment to athletic injury. Journal of Sport Rehabilitation , 12 , 306–322.
• Alzate, R. , Ramírez, A. , & Artaza, J. L. (2004). The effect of psychological response on recovery of sport injury . Research in Sports Medicine , 12 , 15–31.
• Appaneal, R. N. , Levine, B. R. , Perna, F. M. , & Roh, J. L. (2009). Measuring postinjury depression among male and female competitive athletes. Journal of Sport and Exercise Psychology , 31 , 60–76.
• Ardern, C. L. , Taylor, N. F. , Feller, J. A. , & Webster, K. E. (2013). A systematic review of the psychological factors associated with returning to sport following injury . British Journal of Sports Medicine , 47 , 1120–1126.
• Astle, S. J. (1986). The experience of loss in athletes. Journal of Sports Medicine and Physical Fitness , 26 , 279–284.
• Baranoff, J. , Hanrahan, S. J. , & Connor, J. P. (2015). The roles of acceptance and catastrophizing in rehabilitation following anterior cruciate ligament reconstruction . Journal of Science and Medicine in Sport , 18 , 250–254.
• Bassett, S. F. , & Prapavessis, H. (2011). A test of an adherence-enhancing adjunct to physiotherapy steeped in the protection motivation theory . Physiotherapy Theory and Practice , 27 , 360–372.
• Beck, P. R. , Nho, S. J. , Balin, J. , Badnrinath, S. K. , Bush-Joseph, C. A. , Bach, B. R., Jr. , et al. (2004). Postoperative pain management after anterior cruciate ligament reconstruction. Journal of Knee Surgery , 17 , 18–23.
• Benea, H. , d’Astorg, H. , Klouche, S. , Bauer, T. , Tomoaia, G. , & Hardy, P. (2014). Pain evaluation after all-inside anterior cruciate ligament reconstruction and short term functional results of a prospective randomized study . The Knee , 21 , 102–106.
• Beneka, A. , Malliou, P. , Gioftsidou, A. , Kofotolis, N. , Rokka, S. , Mavromoustakos, S. , et al. (2013). Effects of instructional and motivational self-talk on balance performance in knee injured . European Journal of Physiotherapy , 15 , 56–63.
• Bianco, T. , Malo, S. , & Orlick, T. (1999). Sport injury and illness: Elite skiers describe their experiences. Research Quarterly for Exercise and Sport , 70 , 157–169.
• Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed mood. Journal of Personality , 61 , 343–364.
• Brewer, B. W. (1994). Review and critique of models of psychological adjustment to athletic injury. Journal of Applied Sport Psychology , 6 , 87–100.
• Brewer, B. W. (1999a). Causal attribution dimensions and adjustment to sport injury. Journal of Personal and Interpersonal Loss , 4 , 215–224.
• Brewer, B. W. (1999b). Adherence to sport injury rehabilitation regimens. In S. J. Bull (Ed.), Adherence issues in sport and exercise (pp. 145–168). Chichester, U.K.: Wiley.
• Brewer, B. W. (2004). Psychological aspects of rehabilitation. In G. S. Kolt & M. B. Andersen (Eds.), Psychology in the physical and manual therapies (pp. 39–53). Edinburgh: Churchill Livingstone.
• Brewer, B. W. (2007). Psychology of sport injury rehabilitation. In G. Tenenbaum & R. C. Eklund (Eds.), Handbook of sport psychology (3d ed., pp. 404–424). New York: Wiley.
• Brewer, B. W. , Cornelius, A. E. , Sklar, J. H. , Van Raalte, J. L. , Tennen, H. , Armeli, S. , et al. (2007). Pain and negative mood during rehabilitation after anterior cruciate ligament reconstruction: A daily process analysis . Scandinavian Journal of Medicine and Science in Sports , 17 , 520–529.
• Brewer, B. W. , Cornelius, A. E. , Stephan, Y. , & Van Raalte, J. L. (2010). Self-protective changes in athletic identity following ACL reconstruction. Psychology of Sport and Exercise , 11 , 1–5.
• Brewer, B. W. , Cornelius, A. E. , Van Raalte, J. L. , Petitpas, A. J. , Sklar, J. H. , Pohlman, M. H. , et al. (2003a). Protection motivation theory and sport injury rehabilitation adherence revisited. The Sport Psychologist , 17 , 95–103.
• Brewer, B. W. , Cornelius, A. E. , Van Raalte, J. L. , Petitpas, A. J. , Sklar, J. H. , Pohlman, M. H. , et al. (2003b). Age-related differences in predictors of adherence to rehabilitation after anterior cruciate ligament reconstruction. Journal of Athletic Training , 38 , 158–162.
• Brewer, B. W. , Cornelius, A. E. , Van Raalte, J. L. , Tennen, H. , & Armeli, S. (2013). Predictors of adherence to home rehabilitation exercises following anterior cruciate ligament reconstruction. Rehabilitation Psychology , 58 , 64–72.
• Brewer, B. W. , Linder, D. E. , & Phelps, C. M. (1995). Situational correlates of emotional adjustment to athletic injury. Clinical Journal of Sport Medicine , 5 , 241–245.
• Brewer, B. W. , Petitpas, A. J. , Van Raalte, J. L. , Sklar, J. H. , & Ditmar, T. D. (1995). Prevalence of psychological distress among patients at a physical therapy clinic specializing in sports medicine . Sports Medicine, Training and Rehabilitation , 6 , 139–145.
• Brewer, B. W. , & Petrie, T. A. (1995). A comparison between injured and uninjured football players on selected psychosocial variables. Academic Athletic Journal , 10 , 11–18.
• Brewer, B. W. , Van Raalte, J. L. , Cornelius, A. E. , Petitpas, A. J. , Sklar, J. H. , Pohlman, M. H. , et al. (2000). Psychological factors, rehabilitation adherence, and rehabilitation outcome after anterior cruciate ligament reconstruction . Rehabilitation Psychology , 45 , 20–37.
• Brewer, B. W. , Van Raalte, J. L. , & Linder, D. E. (1993). Athletic identity: Hercules’ muscles or Achilles heel? International Journal of Sport Psychology , 24 , 237–254.
• Byerly, P. N. , Worrell, T. , Gahimer, J. , & Domholdt, E. (1994). Rehabilitation compliance in an athletic training environment. Journal of Athletic Training , 29 , 352–355.
• Carson, F. , & Polman, R. (2010). The facilitative nature of avoidance coping within sports injury rehabilitation . Scandinavian Journal of Medicine & Science in Sports , 20 , 235–240.
• Carson, F. , & Polman, R. C. J. (2008). ACL injury rehabilitation: A psychological case study of a professional rugby union player. Journal of Clinical Sport Psychology , 2 , 71–90.
• Christakou, A. , Zervas, Y. , & Lavallee, D. (2007). The adjunctive role of imagery on the functional rehabilitation of a grade II ankle sprain . Journal of Human Movement , 26 , 141–154.
• Clement, D. , & Arvinen-Barrow, M. (2013, October). Psychosocial responses during different phase of sport injury rehabilitation: A qualitative study . Paper presented at the annual meeting of the Association for Applied Psychology, New Orleans, LA.
• Crossman, J. , & Jamieson, J. (1985). Differences in perceptions of seriousness and disrupting effects of athletic injury as viewed by athletes and their trainer. Perceptual and Motor Skills , 61 , 1131–1134.
• Cupal, D. D. , & Brewer, B. W. (2001). Effects of relaxation and guided imagery on knee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction . Rehabilitation Psychology , 46 , 28–43.
• Czuppon, S. , Racette, B. A. , Klein, S. E. , & Harris-Hayes, M. (2014). Variables associated with return to sport following anterior cruciate ligament reconstruction: A systematic review . British Journal of Sports Medicine , 48 , 356–364.
• Dahlquist M. , Leisz, M. C. , & Finkelstein, M. (2015). The club-level road cyclist: Injury, pain, and performance . Clinical Journal of Sport Medicine , 25 , 88–94.
• Daly, J. M. , Brewer, B. W. , Van Raalte, J. L. , Petitpas, A. J. , & Sklar, J. H. (1995). Cognitive appraisal, emotional adjustment, and adherence to rehabilitation following knee surgery. Journal of Sport Rehabilitation , 4 , 23–30.
• DiFiori, J. P. , Puffer, J. C. , Aish, B. , & Dorey, F. (2002). Wrist pain, distal radial physical injury, and ulnar variance in young gymnasts: Does a relationship exist? American Journal of Sports Medicine , 30 , 879–885.
• Duda, J. L. , Smart, A. E. , & Tappe, M. K. (1989). Predictors of adherence in rehabilitation of athletic injuries: An application of personal investment theory. Journal of Sport and Exercise Psychology , 11 , 367–381.
• Ekmekci, P. , Bengisun, Z. K. , Akan, B. , Kazbek, B. K. , Ozkan, K. S. , & Suer, A. H. (2013). The effect of magnesium added to levobupivacaine for femoral nerve block on postoperative analgesia in patients undergoing ACL reconstruction . Knee Surgery, Sports Traumatology, Arthroscopy , 21 , 1119–1124.
• Evans, L. , & Hardy, L. (2002). Injury rehabilitation: A goal-setting intervention study. Research Quarterly for Exercise and Sport , 73 , 310–319.
• Fields, J. , Murphey, M. , Horodyski, M. , & Stopka, C. (1995). Factors associated with adherence to sport injury rehabilitation in college-age recreational athletes. Journal of Sport Rehabilitation , 4 , 172–180.
• Fisher, A. C. , Domm, M. A. , & Wuest, D. A. (1988). Adherence to sports-injury rehabilitation programs. The Physician and Sportsmedicine , 16 (7), 47–52.
• Ford, I. W. , & Gordon, S. (1999). Coping with sport injury: Resource loss and the role of social support. Journal of Personal and Interpersonal Loss , 4 , 243–256.
• Foss, I. S. , Holme, I. M. K. , & Bahr, R. (2012). The prevalence of low back pain among form erelite cross-country skiers, rowers, orienteerers, and nonathletes: A 10-year cohort study . American Journal of Sports Medicine , 40 , 2610–2616.
• Gallagher, B. V. , & Gardner, F. L. (2007). An examination of the relationship between early maladaptive schemas, coping, and emotional response to athletic injury. Journal of Clinical Sport Psychology , 1 , 47–67.
• Garcia, G. H. , Wu, H. H. , Park, M. J. , Tjoumakaris, F. P. , Tucker, B. S. , Kelly, J. D. 4th , et al. (2015). Depression symptomatology and anterior cruciate ligament injury: Incidence and effect on functional outcome—A prospective cohort study . American Journal of Sports Medicine , 44 , 572–579.
• Garnham, A. (2007). Pharmacological agents in sport and exercise. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 541–557). Edinburgh: Churchill Livingstone.
• Gordon, S. (1986, March). Sport psychology and the injured athlete: A cognitive-behavioral approach to injury response and injury rehabilitation. Science Periodical on Research and Technology in Sport , 1–10.
• Gould, D. , Udry, E. , Bridges, D. , & Beck, L. (1997a). Stress sources encountered when rehabilitating from season-ending ski injuries. The Sport Psychologist , 11 , 361–378.
• Gould, D. , Udry, E. , Bridges, D. , & Beck, L. (1997b). Coping with season-ending injuries. The Sport Psychologist , 11 , 379–399.
• Green, S. L. , & Weinberg, R. S. (2001). Relationships among athletic identity, coping skills, social support, and the psychological impact of injury in recreational participants. Journal of Applied Sport Psychology , 13 , 40–59.
• Grindley, E. J. , Zizzi, S. J. , & Nasypany, A. M. (2008). Use of protection motivation theory, affect and barriers to understand and predict adherence to outpatient rehabilitation . Physical Therapy , 88 , 1529–1540.
• Hahn, T. , & Foldspang, A. (1998). Prevalent knee pain and sport. Scandinavian Journal of Social Medicine , 26 , 44–52.
• Hughes, R. H. , & Coakley, J. (1991). Positive deviance among athletes: The implications of overconformity to the sport ethic. Sociology of Sport Journal , 8 , 307–325.
• Hutchison, M. , Comper, P. , Mainwaring, L. , & Richards, D. (2011). The influence of musculoskeletal injury on cognition: Implications for concussion research . American Journal of Sports Medicine , 39 , 2331–2337.
• Hutchison, M. , Comper, P. , Mainwaring, L. , Richards, D. , & Bisschop, S. M. (2009). Differential emotional responses of varsity athletes to concussion and musculoskeletal injuries . Clinical Journal of Sport Medicine , 19 , 13–19.
• Johnson, U. (1997). Coping strategies among long-term injured competitive athletes. A study of 81 men and women in team and individual sports . Scandinavian Journal of Medicine Science in Sports , 7 , 367–372.
• Johnson, U. (1998). Psychological risk factors during the rehabilitation of competitive male soccer players with serious knee injuries [Abstract]. Journal of Sports Sciences , 16 , 391–392.
• Johnson, U. (2000). Short-term psychological intervention: A study of long-term-injured competitive athletes. Journal of Sport Rehabilitation , 9 , 207–218.
• Johnston, L. H. , & Carroll, D. (1998). The context of emotional responses to athletic injury: A qualitative analysis. Journal of Sport Rehabilitation , 7 , 206–220.
• Johnston, L. H. , & Carroll, D. (2000). Coping, social support, and injury: Changes over time and the effects of level of sports involvement. Journal of Sport Rehabilitation , 9 , 290–303.
• Kleiber, D. A. , & Brock, S. C. (1992). The effect of career-ending injuries on the subsequent well-being of elite college athletes. Sociology of Sport Journal , 9 , 70–75.
• Kolt, G. S. (2004). Pain and its management. In G. S. Kolt & M. B. Andersen (Eds.), Psychology in the physical and manual therapies (pp. 141–161). Edinburgh: Churchill Livingstone.
• Kolt, G. S. (2007). Pain. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 133–148). Edinburgh: Churchill Livingstone.
• Kübler-Ross, E. (1969). On death and dying . New York: Macmillan.
• Lazarus, R. S. , & Folkman, S. (1984). Stress, appraisal, and coping . NewYork: Springer.
• Leddy, M. H. , Lambert, M. J. , & Ogles, B. M. (1994). Psychological consequences of athletic injury among high-level competitors. Research Quarterly for Exercise and Sport , 65 , 347–354.
• Leventhal, H. , & Everhart, D. (1979). Emotion, pain, and physical illness. In C. E. Izard (Ed.), Emotions in personality and psychopathology (pp. 263–299). New York: Plenum.
• Levy, A. R. , Polman, R. C. J. , & Clough, P. J. (2008). Adherence to sport injury rehabilitation programs: An integrated psycho-social approach . Scandinavian Journal of Medicine and Science in Sport , 18 , 798–809.
• Little, J. C. (1969). The athlete’s neurosis—A deprivation crisis. Acta Psychiatrica Scandinavia , 45 , 187–197.
• Macchi, R. , & Crossman, J. (1996). After the fall: Reflections of injured classical ballet dancers. Journal of Sport Behavior , 19 , 221–234.
• Maddison, R. , Prapavessis, H. , & Clatworthy, M. (2006). Modeling and rehabilitation following anterior cruciate ligament reconstruction . Annals of Behavior Medicine , 31 , 89–98.
• Maddison, R. , Prapavessis, H. , Clatworthy, M. , Hall, C. , Foley, L. , Harper, T. , et al. (2012). Guided imagery to improve functional outcomes post-anterior cruciate ligament repair: Randomized-controlled pilot trial. Scandinavian Journal of Medicine and Science in Sports , 22 , 816–821.
• Maehr, M. , & Braskamp, L. (1986). The motivation factor: A theory of personal investment . Lexington, MA: Lexington Books.
• Mainwaring, L. M. , Bisschop, S. M. , Green, R. E. A. , Antoniazzi, M. , Comper, P. , Kristman, V et al. (2004). Emotional reaction of varsity athletes to sport-related concussion. Journal of Sport and Exercise Psychology , 26 , 119–135.
• Mainwaring, L. M. , Hutchison, M. , Bisschop, S. M. , Comper, P. , & Richards, D. W. (2010). Emotional response to sport concussion compared to ACL injury . Brain Injury , 24 , 589–597.
• Manuel, J. C. , Shilt, J. S. , Curl, W. W. , Smith, J. A. , DuRant, R. H. , Lester, L. , et al. (2002). Coping with sports injuries: An examination of the adolescent athlete. Journal of Adolescent Health , 31 , 391–393.
• Martens, M. P. , Dams-O’Connor, K. , & Beck, N. C. (2006). A systematic review of college student-athlete drinking: Prevalence rates, sport-related factors, and interventions. Journal of Substance Abuse Treatment , 31 , 305–316.
• McDonald, S. A. , & Hardy, C. J. (1990). Affective response patterns of the injured athlete: An exploratory analysis. The Sport Psychologist , 4 , 261–274.
• Meichenbaum, D. , & Turk, D. C. (1987). Facilitating treatment adherence . New York: Plenum.
• Melzack, R. , & Wall, P. D. (1965). Pain mechanisms: A new theory. Science , 150 , 971–979.
• Morrey, M. A. , Stuart, M. J. , Smith, A. M. , & Wiese-Bjornstal, D. M. (1999). A longitudinal examination of athletes’ emotional and cognitive responses to anterior cruciate ligament injury. Clinical Journal of Sport Medicine , 9 , 63–69.
• Moser, R. S. (2007). The growing public health concern of sports concussion: The new psychology practice frontier . Professional Psychology: Research and Practice , 38 , 699–704.
• Mrazik, M. , Brooks, B. L. , Jubinville, A. , Meeuwisse, W. H. , & Emery, C. A. (2016). Psychosocial outcomes of sport concussions in youth hockey players . Archives of Clinical Neuropsychology , 31 , 297–304.
• Myer, G. D. , Faigenbaum, A. D. , Foss, K. B. , Xu, Y. , Khoury, J. , Dolan, L. M. , et al. (2014). Injury initiates unfavourable weight gain and obesity markers in youth . British Journal of Sports Medicine , 48 , 1477–1481.
• Myer G. D. , Ford, K. R , Di Stasi, S. L. , Foss, K. D. , Micheli, L. J. , & Hewett, T. E. (2015). High knee abduction moments are common risk factors for patellofemoral pain (PFP) and anterior cruciate ligament (ACL) injury in girls: Is PFP itself a predictor for subsequent ACL injury? . British Journal of Sports Medicine , 49 , 118–122.
• National Collegiate Athletic Association . (2012). National study of substance abuse trends among NCAA college student-athletes . Retrieved from http://ncaapublications.com/p-4266-research-substance-use-national-study-of-substance-use-trends-among-ncaa-college-student-athletes.aspx .
• Newcomer, R. R. , & Perna, F. M. (2003). Features of posttraumatic stress among adolescent athletes. Journal of Athletic Training , 38 , 163–166.
• Newsom, J. , Knight, P. , & Balnave, R. (2003). Use of mental imagery to limit strength loss after immobilization. Journal of Sport Rehabilitation , 12 , 249–258.
• Niki, Y. , Hakozaki A. , Iwamoto W. , Kanagawa H. , Matsumoto H. , Toyama Y. , et al. (2012). Factors affecting anterior knee pain following anatomic double-bundle anterior cruciate ligament reconstruction . Knee Surgery Sports Traumatology Arthroscopy , 20 , 1543–1549.
• Niven, A. (2007). Rehabilitation adherence in sport injury: Sport physiotherapists’ perceptions. Journal of Sport Rehabilitation , 16 , 93–110.
• Nixon, H. L., II. (1992). A social network analysis of influences on athletes to play with pain and injuries . Journal of Sport and Social Issues , 16 , 127–135.
• Olmedilla, A. , Ortega, E. , & Gómez, J. M. (2014). Influencia de la lesión deportiva en los cambios del estado de ánimo y de la ansiedad precompetitiva en futbolistas [Influence of sports injury changes in mood and precompetitive anxiety in soccer players]. Cuadernos de Psicología Del Deporte , 14 , 55–61.
• Oztekin, H. H. , Boya, H. , Ozcan, O. , Zeren, B. , & Pinar, P. (2008). Pain and affective distress before and after ACL surgery: A comparison of amateur and professional male soccer players in the early postoperative period . The Knee , 15 , 368–372.
• Pearson, L. , & Jones, G. (1992). Emotional effects of sports injuries: Implications for physiotherapists. Physiotherapy , 78 , 762–770.
• Penpraze, V. , & Mutrie, N. (1999). Effectiveness of goal setting in an injury rehabilitation programme for increasing patient understanding and compliance [Abstract]. British Journal of Sports Medicine , 33 , 60.
• Podlog, L. , & Eklund, R. C. (2005). Return to sport after serious injury: A retrospective examination of motivation and psychological outcomes. Journal of Sport Rehabilitation , 14 , 20–34.
• Podlog, L. , & Eklund, R. C. (2006). A longitudinal investigation of competitive athletes’ return to sport following serious injury . Journal of Applied Sport Psychology , 18 , 44–68.
• Podlog, L. , & Eklund, R. C. (2007). The psychosocial aspects of a return to sport following serious injury: A review of the literature from a self-determination perspective . Psychology of Sport and Exercise , 10 , 535–544.
• Podlog, L. , Gao, Z. , Kenow, L. , Kleinert, J. , Granquist, M. , Newton, M. , et al. (2013). Injury rehabilitation overadherence: Preliminary scale validation and relationships with athletic identity and self-presentation concerns . Journal of Athletic Training , 48 , 372–381.
• Podlog, L. , Lochbaum, M. , & Stevens, T. (2010). Need satisfaction, well-being, and perceived return-to-sport outcomes among injured athletes . Journal of Applied Sport Psychology , 22 , 167–182.
• Prentice, W. E. (2011). Principles of athletic training: A competency-based approach (14th ed.). New York: McGraw-Hill.
• Prentice-Dunn, S. , & Rogers, R. W. (1986). Protection motivation theory and preventive health: Beyond the health belief model. Health Education Research , 1 , 153–161.
• Prochaska, J. O. , & DiClemente, C. C. (1983). Stages and processes of self-change of smoking: Toward an integrated model of change. Journal of Consulting and Clinical Psychology , 51 , 390–395.
• Quinn, A. M. , & Fallon, B. J. (1999). The changes in psychological characteristics and reactions of elite athletes from injury onset until full recovery . Journal of Applied Sport Psychology , 11 , 210–229.
• Raynor, M. C. , Pietrobon, R. , Guller, U. , & Higgins, L. D. (2005). Cryotherapy after ACL reconstruction: A meta-analysis. Journal of Knee Surgery , 18 , 123–129.
• Rees, T. , Mitchell, I. , Evans, L. , & Hardy, L. (2010). Stressors, social support and psychological responses to sport injury in high- and low-performance standard participants . Psychology of Sport and Exercise , 11 , 505–512.
• Reinking, M. F. , Austin, T. M. , & Hayes, A. M. (2010). Risk factors for self-reported exercise related leg pain in high school cross-country athletes. Journal of Athletic Training , 45 , 51–57.
• Reuter, J. M. , & Short, S. E. (2005). The relationship among three components of perceived risk of injury, previous injuries and gender in non-contact/limited contact sport athletes. Athletic Insight: The Online Journal of Sport Psychology , 7 , 20–42.
• Ross, M. J. , & Berger, R. S. (1996). Effects of stress inoculation on athletes’ postsurgical pain and rehabilitation after orthopedic injury. Journal of Consulting and Clinical Psychology , 64 , 406–410.
• Rotella, B. (1985). The psychological care of the injured athlete. In L. K. Bunker , R. J. Rotella , & A. S. Reilly (Eds.), Sport psychology: Psychological considerations in maximizing sport performance (pp. 273–287). Ann Arbor, MI: Mouvement.
• Ruddock-Hudson, M. , O’Halloran, P. , & Murphy, G. (2014). Long-term athletic injury: The psychological impact on Australian Football League (AFL) players . Journal of Applied Sport Psychology , 26 , 377–394.
• Ryan, R. M. , & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist , 55 , 68–78.
• Safai, P. (2003). Healing the body in the “culture of risk”: Examining the negotiation of treatment between sport medicine clinicians and injured athletes in Canadian intercollegiate sport. Sociology of Sport Journal , 20 , 127–146.
• San José, A. (2003). Injury of elite athletes: Sport- and gender- related representations. International Journal of Sport and Exercise Psychology , 1 , 434–459.
• Short, S. E. , Reuter, J. , Brandt, J. , Short M. W. , & Kontos, A. P. (2004). The relationships among three components of perceived risk of injury, previous injuries and gender in contact sport athletes. Athletic Insight , 6 , 38–46.
• Shuer, M. L. , & Dietrich, M. S. (1997). Psychological effects of chronic injury in elite athletes. Western Journal of Medicine , 166 , 104–109.
• Silkman, C. , & McKeon, J. (2010). The effectiveness of electromyographic biofeedback supplementation during knee rehabilitation after injury. Journal of Sport Rehabilitation , 19 , 343–351.
• Smith, A. M. , & Milliner, E. K. (1994). Injured athletes and the risk of suicide. Journal of Athletic Training , 29 , 337–341.
• Smith, A. M. , Scott, S. G. , O’Fallon, W. M. , & Young, M. L. (1990). Emotional responses of athletes to injury. Mayo Clinic Proceedings , 65 , 38–50.
• Smith, A. M. , Stuart, M. J. , Wiese-Bjornstal, D. M. , Milliner, E. K. , O’Fallon, W. M. , & Crowson, C. S. (1993). Competitive athletes: Preinjury and postinjury mood state and self-esteem. Mayo Clinic Proceedings , 68 , 939–947.
• Smith, A. M. , Young, M. L. , & Scott, S. G. (1988). The emotional responses of athletes to injury. Canadian Journal of Sport Sciences , 13 (Suppl.), 84P–85P.
• Snyder-Mackler, L. , Schmitt, L. A. , Rudolph, K. , & Farquhar, S. (2007). Electrophysical agents in sport and exercise injury management. In G. S. Kolt & L. Snyder-Mackler (Eds.), Physical therapies in sport and exercise (pp. 220–235). Edinburgh: Churchill Livingstone.
• Sundgot-Borgen, J. (1994). Risk and trigger factors for the development of eating disorders in female elite athletes. Medicine and Science in Sports and Exercise , 26 , 414–419.
• Taylor, A. H. , & May, S. (1996). Threat and coping appraisal as determinants of compliance to sports injury rehabilitation: An application of protection motivation theory . Journal of Sports Sciences , 14 , 471–482.
• Tedder, S. , & Biddle, S. J. H. (1998). Psychological processes involved during sports injury rehabilitation: An attribution-emotion investigation [Abstract]. Journal of Sports Sciences , 16 , 106–107.
• Tesarz, J. , Schuster, A. K. , Hartmann, M. , Gerhardt, A. , & Eich, W. (2012). Pain perception in athletes compared to normally active controls: A systematic review with meta-analysis . Pain , 153 , 1253–1262.
• Theodorakis, Y. , Beneca, A. , Malliou, P. , & Goudas, M. (1997). Examining psychological factors during injury rehabilitation. Journal of Sport Rehabilitation , 6 , 355–363.
• Theodorakis, Y. , Malliou, P. , Papaioannou, A. , Beneca, A. , & Filactakidou, A. (1996). The effect of personal goals, self-efficacy, and self-satisfaction on injury rehabilitation. Journal of Sport Rehabilitation , 5 , 214–223.
• Thomeé, P. , Wahrborg, M. , Börjesson, R. , Thomeé, R. , Eriksson, B. I. , & Karlsson, J. (2007). Self-efficacy, symptoms and physical activity in patients with an anterior cruciate ligament injury: A prospective study . Scandinavian Journal of Medicine & Science in Sports , 17 , 238–245.
• Tracey, J. (2003). The emotional response to the injury and rehabilitation process . Journal of Applied Sport Psychology , 15 , 279–293.
• Tripp, D. A. , Stanish, W. D. , Coady, C. , & Reardon, G. (2004). The subjective pain experience of athletes following anterior cruciate ligament surgery. Psychology of Sport and Exercise , 5 , 339–354.
• Tripp, D. A. , Stanish, W. D. , Reardon, G. , Coady, C. , & Sullivan, M. J. L. (2003). Comparing postoperative pain experiences of the adolescent and adult athlete after anterior cruciate ligament surgery. Journal of Athletic Training , 38 , 154–157.
• Udry, E. (1997). Coping and social support among injured athletes following surgery. Journal of Sport and Exercise Psychology , 19 , 71–90.
• Udry, E. , Gould, D. , Bridges, D. , & Beck, L. (1997). Down but not out: Athlete responses to season-ending injuries. Journal of Sport and Exercise Psychology , 19 , 229–248.
• Vergeer, I. (2006). Exploring the mental representation of athletic injury: A longitudinal study . Psychology of Sport and Exercise , 7 , 99–114.
• Wadey, R. , Clark, S. , Podlog, L. , & McCullough, D. (2013). Coaches’ perceptions of athletes’ stress-related growth following sport injury . Psychology of Sport and Exercise , 14 , 125–135.
• Wadey, R. , Evans, L. , Evans, K. , & Mitchell, I. (2011). Perceived benefits following sport injury: A qualitative examination of their antecedents and underlying mechanisms . Journal of Applied Sport Psychology , 23 , 142–158.
• Wadey, R. , Evans, L. , Hanton, S. , & Neil, R. (2012a). An examination of hardiness throughout the sport-injury process: A qualitative follow-up study . British Journal of Health Psychology , 17 , 872–893.
• Wadey, R. , Evans, L. , Hanton, S. , & Neil, R. (2012b). An examination of hardiness throughout the sport injury process . British Journal of Health Psychology , 17 , 103–128.
• Wadsworth, L. T. (2006). Acupuncture in sports medicine. Current Sports Medicine Reports , 5 , 1–3.
• Walk, S. R. (1997). Peers in pain: The experiences of student athletic trainers. Sociology of Sport Journal , 14 , 22–56.
• Walker, H. , Gabbe, B. , Wajswelner, H. , Blanch, P. , & Bennell, K. (2012). Shoulder pain in swimmers: A 12-month prospective cohort study of incidence and risk factors. Physical Therapy in Sport , 13 , 243–249.
• Wasley, D. , & Lox, C. L. (1998). Self-esteem and coping responses of athletes with acute versus chronic injuries. Perceptual and Motor Skills , 86 , 1402.
• Weiss, M. R. , & Troxel, R. K. (1986). Psychology of the injured athlete. Athletic Training , 21 , 104–109, 154.
• Wesch, N. , Hall, C. , Prapavessis, H. , Maddison, R. , Bassett, S. , Foley, L. , et al. (2012). Self-efficacy, imagery use, and adherence during injury rehabilitation. Scandinavian Journal of Medicine and Science in Sports , 22 , 695–703.
• Wiese-Bjornstal, D. M. , Smith, A. M. , Shaffer, S. M. , & Morrey, M. A. (1998). An integrated model of response to sport injury: Psychological and sociological dimensions . Journal of Applied Sport Psychology , 10 , 46–69.
• Wong, P. T. P. , & Weiner, B. (1981). When people ask “why” questions, and the heuristics of attributional search . Journal of Personality and Social Psychology , 40 , 650–663.

Related Articles

• Bullying in Sport and Performance Psychology
• Burnout in Sport and Performance
• Injury Prevention in Sport and Performance Psychology
• Psychological Aspects of Athletic Training
• Sociocultural Aspects of Sport Injury and Recovery

Printed from Oxford Research Encyclopedias, Psychology. Under the terms of the licence agreement, an individual user may print out a single article for personal use (for details see Privacy Policy and Legal Notice).

date: 22 April 2024

• Cookie Policy
• Privacy Policy
• Legal Notice
• Accessibility
• [66.249.64.20|185.66.15.189]
• 185.66.15.189

Character limit 500 /500

• Help & FAQ

The Mental Impact of Sports Injury

• Centre for Motivation and Health Behaviour Change
• Department for Health
• Centre for Health and Injury and Illness Prevention in Sport
• Auckland University of Technology
• Western University
• Queens University
• Stellenbosch University
• University of the West of England
• Swedish School of Sport and Health Sciences
• Irish Rugby Football Union
• University of Calgary
• Vrije Universiteit Amsterdam
• Amsterdam UMC
• IOC Research Centre
• Cardiff Metropolitan University

Research output : Book/Report › Book

Access to Document

• https://www.routledge.com/The-Mental-Impact-of-Sports-Injury/McKay/p/book/9780367370206

Fingerprint

• Athletic Injuries Medicine & Life Sciences 100%
• Athletes Medicine & Life Sciences 58%
• Sports Medicine & Life Sciences 42%
• Wounds and Injuries Medicine & Life Sciences 39%
• Psychology Medicine & Life Sciences 32%
• Para-Athletes Medicine & Life Sciences 26%
• Sports Psychology Medicine & Life Sciences 25%
• Rehabilitation Medicine & Life Sciences 24%

T1 - The Mental Impact of Sports Injury

AU - McKay, Carly

AU - Badenhorst, Marelise

AU - Bolling, Caroline

AU - Callaghan, Lisa

AU - Derman, Elton Wayne

AU - Dillon, Kirsten

AU - Herbison, Jordan

AU - Martin, Luc

AU - Mellalieu, Stephen

AU - Moore, Lee

AU - Prapavessis, Harry

AU - Raymond, Mason

AU - Rollo, Scott

AU - Runciman, Phoebe

AU - Tabor, Abby

AU - Tranaeus, Ulrika

AU - van Dyk, Nicol

AU - West, Stephen

PY - 2021/12/31

Y1 - 2021/12/31

N2 - 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.

AB - 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.

SN - 9780367370206

BT - The Mental Impact of Sports Injury

PB - Routledge

Log in using your username and password

• Search More Search for this keyword Advanced search
• Latest content
• Current issue
• For authors
• New editors
• BMJ Journals More You are viewing from: Google Indexer

You are here

• Volume 34, Issue 2
• Sports injury incidence
• Article Text
• Article info
• Citation Tools
• Rapid Responses
• Article metrics

• Lisa Hodgson Phillips
• Centre for Sports Medicine, Department of Orthopaedic and Accident Surgery, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, United Kingdom
• Correspondence to: L Hodgson Phillips

https://doi.org/10.1136/bjsm.34.2.133

Statistics from Altmetric.com

Request permissions.

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

The aim of this paper is to give a “medical” viewpoint on sports injury data collection and analysis, and to emphasise the importance of epidemiological sports data collection with regard to incidence rates and exposure risk hours and highlight the need for uniform definitions within and across sport. It is designed not as a statistical or epidemiological paper but as a resource to be used by those involved in sports injury research so that they may confidently analyse, evaluate, and compare existing research and to enable them to collect accurate sports injury data in their own field.

Introduction

Sports injuries occur when athletes are exposed to their given sport and they occur under specific conditions, at a known time and place.

The last point should relate to time missed in training days as well as competitive participation and may also consider time lost to work in the case of a semiprofessional athlete. The knowledge gained from asking these questions may help us to predict and thus prevent injury.

In sports medicine, we are thus all epidemiologists “concerned with quantifying injury occurrence with respect to who is affected by injury, where and when injuries occur and what is their outcome—for the purposes of explaining why and how injuries occur and identifying strategies to control and prevent them”. 1

To interpret the literature, we must be able to discern good studies from bad, to verify whether conclusions of a particular study are valid, and to understand the limitations of a study. 2 Many studies are limited because the data collection is for injured athletes alone or risk factors alone, which does not allow the use of the epidemiological concept of athletes being at risk. There is no common operational definition of sports injury in existence at present and furthermore no set definition of severity. Some studies classify a severe injury as one that results in five games being missed, whereas others classify a severe injury as one that requires five weeks out of competition to heal; these clearly are not compatible for comparisons of sports for which more than one game is played each week. 3, 4 There is currently no set format for data collection across sports, and the size of the samples vary: some studies refer to only one team and others use multiple teams. 3, 5– 7 Therefore methodological factors alter the perception and interpretation of incidence rates.

When examining sports injury data the questions typically asked are:

is there a greater risk in one certain sport?

is there a common site and type of injury in a given sport?

who is at most risk in a team sport?

what is the participation time missed as the result of that specific injury?

The fundamental unit of measurement is rate. To calculate a valid injury rate, the number of injuries experienced (numerator data) is linked to a suitable denominator measure of the amount of athletic exposure to the risk of injury. Thus a rate consists of a denominator and a numerator over a period of time. Denominator data can be a number of different things; they could be the number of athletes in a club or team, the number of games played, the number of minutes played, or the number of player appearances. The choice of the denominator affects the numerical value of the derived data and also their interpretation. For example, injuries can be expressed as the number of injuries per game, an injury every so many minutes of play, or the number of injuries per ( x ) player appearances. 8

Incidence rates

Incidence is the most basic expression of risk. Incidence rates pertain to the number of new injuries that occur in a population at risk over a specified time period or the number of new injuries during a period divided by the total number of sportspeople at that period. Thus the epidemiological concept of athletic exposure in games or training is multiplied by the number of players participating. Incidence rates that do not consider exposure do not reliably indicate the problem and cannot be used to compare injury incidence.

Determining incidence rates

Accurate and consistent medical diagnosis is imperative. Diagnoses may be made by the doctor or physiotherapist but must be consistent throughout, with the use of set codes for site, nature, and severity of injury. All injuries should be recorded, including transient injuries—that is, those that require medical attention but result in no time lost to training or playing. Time lost from participation must be recorded accurately, using both training and game/competitive participation data, in days lost as well as games and weeks lost. Many studies exclude training injuries and training time lost, using only those injuries that occur in a game or that require a competitive game to be missed. 3, 9 These studies lose valuable data and fail to portray the true injury picture of the sport. If training information is excluded, then the data only represent the tip of the iceberg—submerged missed data may include the effects of training injuries or, more importantly, the training time lost on the player, his/her fitness, and ultimately his/her career. The same argument can be used to show the importance of including transient injuries in the data analysis. Excluding these injuries gives a false picture of the injuries sustained in a given sport.

Coding of injury diagnosis

Coding and recording of injuries should be through the consistent use of a set of established definitions of injury, which are expansive and descriptive to avoid subjectivity. Standard classifications of diagnoses are in existence such as the International Classification of Diseases; however, these are often not specific enough and thus not of any use for sports injury data collection. In contrast, there is the Orchard Codes system, which is very descriptive and expansive and may be used in this type of research. A single person should record the information where possible to achieve greatest intra-rater reliability. Time lost from sport participation must be considered an objective measure that is not sensitive to the concept of returning to play when the athlete is not fully healed and must always be referred to as a filter when conclusions on sports injury data are drawn. Athletes are often paid professionals and as such do not wish to miss a training or competitive/playing session, which could result in loss of their team place in the next game or their wage at the end of the week. Athletes are eager to participate and thus always challenge the healing process as they almost always aim to return to competition much sooner than the lay person. 10 We do not have any reliable criteria on return to sport.

Study design

The US Preventative Services Task Force in 1989 established a hierarchy of evidence in which greater weight was given to study designs in decreasing order of importance. 11 Random control trials were rated first; these expose some subjects, but not others, to an intervention—for example, risk of injury. Therefore this type of research is more clinical in nature and not typically appropriate for the study of injury patterns. Cohort studies were rated next; this type of study monitors both injured and non-injured athletes, thereby providing results on the effects of participation, and are ideally prospective in nature. Case-control was the third type of study, monitoring only those athletes who suffered an injury and are typically more retrospective in nature. These make up the vast majority of sports injury studies at present; however, we should recognise that multiple anecdotes do not add up to an evidence base.

Weaknesses in sports injury epidemiology research

Retrospective data are used which may lead to bias.

Multiple injury recorders leading to a lower inter-rater reliability.

Single or part season's data analysed.

Single team analysed.

Injury cases documented are not adjusted for exposure risk hours of training or playing.

Comparisons made with other studies that have not used the same injury coding or methodology (may not even be of the same sport).

Studies should have validity and reliability. The former is defined as the extent to which you measure what you intended to measure and is usually compared against a yardstick. Sports injury incidence at present has no yardstick against which comparisons can be made. Reliability is the ability to produce the same results on more than one occasion and is dependent on inter-rater or intra-rater data collection. For accurate injury incidence, reliability is imperative. 12

Sample size influences results. It is impossible to compare studies in which various sample sizes—that is, one team or many—have been used, unless adjustments for exposure have been made and this is clearly stated in the methods. Studies on one particular sports team, however, can be powerful if the number of injuries incurred is large enough to show statistical significance. 13

The type of statistical analysis is directly related to the methodology of the study. For example, the χ 2 test can be used to assess the differences between observed and expected injuries in a season or number of seasons. Multiple regression and multiple variate analyses may be chosen to assess the influence of independent factors on the injuries incurred—for example, the player position or the hardness of the ground. The calculation of incidence rates has been identified as a critical feature of sound epidemiological sports injury studies. 14

As a footnote, it should be mentioned that any patient injury information collected must always be confidential.

Exposure risk hours and rates per 1000 hours

The way in which incidence is expressed has also been shown to affect the calculation/interpretation of incidence rates. Increasingly, incidence rates in all sports are being expressed as rates per 1000 hours. This is a good approach and allows some comparison across sports. However, a further refinement of the calculation of incidence rates is to measure the actual exposure time at risk. Thus expected injuries are calculated using player exposure/risk hours. These risk hours should ideally include training time as well as competitive participation. 13, 15

The following is an example of how exposure/risk hours are calculated in a team sport, specifically rugby league. There are 13 players of one team on the field at any one time. The duration of the game is 80 minutes (1.33 hours). Thus there are 17.33 player exposure/risk hours per team per game of rugby league (13 × 1.33). Over an average season—for example, 30 games—there may be 520 player exposure/risk hours (13 × 1.33 × 30).

To calculate the incidence in relation to these exposure hours, the total number of injuries recorded over a period is divided by the total exposure for that period, and the result multiplied by 1000 to obtain the rate per 1000 hours. This period could be one game, several games, or a whole season or number of seasons. To see if there are significant differences across games or seasons, observed and expected injuries can be used. Observed injuries are those recorded over the period under consideration. Expected injuries are calculated by dividing the total injuries—for example, over four seasons—by the total exposure—for example, for the same four seasons—and multiplying the result by the exposure for the period under consideration—for example, one season only—giving an expected injury case for that one season. Significance tests may then be applied.

The relevance of recording and analysing data in this way is shown below taking data from a previous study. 13 Figure 1 shows the number of injury cases recorded over four rugby league seasons at one British professional rugby league club (1993–1996 inclusive). On initial observation, there does not appear to be a significant difference across the four seasons, and the observer may even say that the injuries were in fact lower over the last two seasons. However, in fig 2, which is for the same four seasons but the data are adjusted for exposure/risk hours and presented as rates per 1000 hours, the true picture is disclosed. An obvious increase in injury incidence is seen. In truth, in the 1996 season, the incidence of injury was almost double that of the first season recorded (1993/1994). Excluding exposure time at risk prevents the true picture from being seen. This can be highlighted by the fact that, during the 1993/1994 season, there were 35 games played (605.15 exposure hours) and in 1996 only 21 games were played (363.09 exposure hours); however, observe the difference in injury incidence again. Not adjusting for exposure/risk hours but only commenting on total injury cases is a fatal flaw in sports injury data presentation.

• Download figure
• Open in new tab
• Download powerpoint

Game injury statistics showing number of injury cases per season.

Game injury statistics showing rates per 1000 hours per season.

Strengths in sports injury epidemiology research

Using one recorder to diagnose and document injuries gives a high intra-rater reliability.

Incidence rates are used and adjusted for exposure.

Training injuries are included.

Time lost to competitive participation plus time lost to training and work also documented.

Prospective studies conducted using descriptive set injury coding definitions and methodology.

Filters recognised and referred to.

Comparisons made with similar studies but acknowledging the differences in diagnostic coding and definitions of severity.

Acknowledging where professional sport is compared with amateur sport.

Using more than one team where possible: improved generalisability.

If we apply the above to what we already know clinically, we may help to predict and prevent future injury occurrence. Thus accurate data collection could be essential in the prevention of injuries. If specific influences are identified as a contributing factor to the risk of injury and supported by scientific data collection, then the rules of the sport may be changed to prevent this happening again. This will have the effect of making our athletes as injury free as possible and may even help to lengthen their time in competitive participation.

Ideal study

Cohort design (injured and non-injured athletes observed).

Conducted over several teams.

Longitudinal prospective data collection.

One recorder where possible (high intra-rater reliability).

Uniformity of injury definition across sports.

Specific definitions of injury severity so comparisons between studies can be made accurately.

Exposure hours used to express incidence rates for competitive participation and training.

Acknowledgement of existing filters.

Acknowledgments

I would like to thank Dr Mark E Batt for his help and advice on preparing this paper.

• ↵ Caine CG, Caine DJ, Lindner KJ. The epidemiological approach to sports injuries. In: Caine DJ, Caine CG, Lindner KJ, eds. Epidemiology of sports injuries. Champaign, IL: Human Kinetics, 1996:1–13.
• ↵ Campbell M, Machin D. Medical statistics . Chichester: John Wiley & Sons, 1990:1.
• ↵ Gibbs N. Injuries in professional rugby league. A 3 year prospective study. Am J Sports Med 1993 ; 21 : 696 –700. OpenUrl Abstract / FREE Full Text
• ↵ Estell J, Shenstone B, Barnsley L. Frequency of injuries in different age groups in an elite rugby league club. Aust J Sci Med Sport 1995 ; 27 : 95 –7. OpenUrl PubMed
• ↵ Walker RD. Sports injuries: rugby league may be less dangerous than rugby union. The Practitioner 1985 ; 229 : 205 –6. OpenUrl PubMed Web of Science
• Garraway M, Macleod D. Epidemiology of rugby football injuries. Lancet 1995 ; 345 : 1485 –7. OpenUrl CrossRef PubMed Web of Science
• ↵ Norton R, Wilson MA. Rugby league injuries and patterns. New Zealand Journal of Sports Medicine 1995 ; 22 : 37 –8. OpenUrl
• ↵ Schootman M, Powell JW, Torner JC. Study designs and potential biases in sports injury research: the case control study. Sports Med 1994 ; 18 : 22 –37. OpenUrl CrossRef PubMed Web of Science
• ↵ Alexander D, Kennedy M, Kennedy J. Injuries in rugby league football. Med J Aust 1979 ; 2 : 341 –2. OpenUrl PubMed Web of Science
• ↵ Schootman M, Powell JW, Albright JP. Statistics in sports injury research. In: Delee JC, Drez D, eds. Orthopaedic sports medicine. London: WB Saunders, 1994.
• ↵ US Preventative Services Task Force. Guide to clinical preventative services: an assessment of the effectiveness of 169 interventions. Report of the US Preventative Services Task Force. Sydney: Williams & Wilkins, 1989.
• ↵ Lower T. Injury data collection in the rugby codes. Aust J Sci Med Sport 1995 ; 27 : 43 –7. OpenUrl PubMed
• ↵ Hodgson Phillips L, Standen P, Batt ME. Effects of seasonal change in rugby league on the incidence of injury. Br J Sports Med 1998 ; 32 : 144 –8. OpenUrl Abstract / FREE Full Text
• ↵ Wallace RB. The numerator, denominator and the population at risk. Am J Sports Med 1988 ; 15 : 55 –6. OpenUrl
• ↵ Hodgson Phillips L. The effects of seasonal change in rugby league on the incidence of injury. MSc thesis, 1996.

Read the full text or download the PDF:

How to Overcome Depression After a Sports Injury

Ouch – that pain is more than just physical.

If you've ever experienced a sports injury, you’re probably familiar with that sinking feeling after hearing a pop followed by a sharp pain. Your mind races as you consider recovery time and the impact it will have on your game. But if the stress and frustration turns into long-term feelings of hopelessness, being upset about your injury could escalate to depression.

Whether you’re a professional hockey player, a college gymnast or a recreational basketball player, an injury certainly has the potential to impact your psychological well-being. It’s important to recognize why you’re feeling down and pay attention to your emotional health, experts say.

John Murray, a clinical sports psychologist based in Palm Beach, Florida, focused his doctoral dissertation on how an injury – and subsequent social support – affects an athlete's identity.

[Read: Is Your Therapist a Good Fit? ]

Murray’s patients range from junior to professional athletes, and he's seen patients from all levels on the athletic spectrum experience depressive symptoms. Anyone can be affected psychologically, but the more success an athlete has achieved, the more likely he or she might experience depression or feel a lack of self-worth. In other words, an Olympian would be more affected psychologically by an injury than someone who plays pick-up basketball on Saturdays

“The more elite the athlete is, the more identity is ... wrapped up in the athlete role,” Murray says. “When they get injured, it’s a more devastating blow to them because they're losing something more valuable than a recreational athlete, who might just be doing it for weekend fun.”

Professional athletes also might be forced to face issues such as financial stress or the realization that the career they had planned on could be over.

Rebecca Symes​, a sports psychologist ​​who runs the sports consultancy Sporting Success in Britain​ ,  says the more time and effort the athlete spends on a sport, the greater the psychological impact. “Athletes with a strong athletic identity will define themselves on the basis of their sport – that is, their sense of worth and self-esteem is wrapped up in their sport, and being successful and associated with being an athlete,” she says.

[Read:  10 Ways to Break a Bad Mood .]

Depressive symptoms may also stem from the loss of a physical outlet and a change in exercise schedule. Especially for professional athletes, who spent hours every day focused on training and preparation, living with an injury that changes their daily routine is an adjustment. 

William Wiener​, a sports psychologist in New York City, says athletes who participate in sports with an individual focus, such as tennis or gymnastics, are more at risk psychologically. “Injured athletes on teams can at times be very much a part of the team​ and remain integrated socially, and feel engaged and invested in their team’s success,” he says. Meanwhile, athletes in individual sports often have to cope with their injury alone and may be cut from their sport completely while they're recuperating.

Olympic skier Hannah Kearney , who won a gold medal in 2010 and a bronze medal in 2014, has been seriously injured twice during her athletic career. After tearing her ACL in 2007, and suffering internal injuries after a ​crash while training in Switzerland in 2012, Kearney was able to rebound from her injuries.

“Every single athlete has some sort of physical obstacle in their career, so it’s really just a part of the identity. In fact, it sort of solidifies it,” she says.

While injuries can be difficult psychologically, Kearney says, there are some benefits to being taken out of the game or off the slopes.

“The fact that I had been doing this sport for the majority of my life, and this was the first time I had had it taken away from me, it made me realize how much I loved the sport, and that was valuable in making me a better athlete, too," Kearney says. "If you’re more grateful then you’re more likely to enjoy it and appreciate it and work harder.”

She advises athletes to focus on other aspects of their life while they are healing.

“I had never put up a Christmas tree, I had not gone to see my brother play hockey very often, so I did both of those things during that time period when I was stuck at home not able to ski. It’s up to you how you view the injury and what you make of it,” she says. “If you can’t get better at your sport at a certain time, then try to get better at other parts of your life.”

Strategies for Coping

If you feel like you might be spiraling into a depressed state following an injury, it's crucial to recognize and address the problem. Coping mechanisms should be tailored to the athlete, but experts says there are ways for all athletes to maintain good mental health during the recovery process. 

First, both recreational and ​professional athletes need to follow a regular sleep schedule, eat healthy and adhere to all medical instructions. Murray says a lot of post-injury anxiety stems from fear of re-injury. A medical professional can help ease that anxiety by ​ensuring the healing process is progressing on schedule.

[Read:  What's Causing Your Bad Mood – And How to Overcome It .]

To overcome depressive symptoms, it's important for professional athletes to establish a sense of greater self-worth and purpose. If the injury was career-ending, recognize that you have other favorable qualities besides being good at your sport. “That's why it's important for athletes to give consideration to post-playing career planning and to have other things in their life aside from their sport,” Symes says.

Picking up another sport after the injury might also be an option. Murray says participating in another athletic activity can be a great idea, and trying a different sport has offered some of his patients a competitive and physical outlet. “Golf is a lot less taxing on the body, so if you’re playing football and you get a serious knee injury, you might be able to play golf,” Murray suggests.

Wiener also says golf can be a great outlet for recreational athletes to cope with losing a sport, though professionals may find it challenging. If someone is accustomed to being the best, starting from scratch can be frustrating – especially in a less-than-perfect physical state. “That can be very hard for people who are always used to pushing the limit,” Wiener says. “Sometimes channeling athletic energy in another direction can be really helpful, and other times, athletes will be too ambitious and sort of force the process.” Psychologists agree that seeking help from athletic peers who have had similar experiences, especially if they've overcome the psychological effects, can be helpful for athletes at all skill levels. And communicating your anxieties to other athletes – who can assure you that "life goes on" – can be encouraging.

[See: ​ How to Find the Best Mental Health Professional for You .] Like with any kind of emotional distress, it's essential to see a professional who can address your psychological needs with a coping plan. As a sports psychologist, Murray says because he understands the athletic mentality, he can better address his client's needs.

“It’s really important, I think that [psychologists] understand the athlete and understand what they're experiencing,” Murray says. “That’s one of the biggest things that helps being a sports psychologist, as a person who has played sports, who’s coached sports, who knows sports, as opposed to somebody else who might not be as sensitive to the potential impact of an injury.” 

Tags: sports , depression , mental health , exercise and fitness

Most Popular

Best Hospitals

health disclaimer »

Disclaimer and a note about your health ».

Your Health

A guide to nutrition and wellness from the health team at U.S. News & World Report.

You May Also Like

Atlantic diet.

Janet Helm April 18, 2024

Routine Health Screenings Everyone Needs

Elaine K. Howley April 17, 2024

The Afterburn Effect to Burn Calories

Cedric X. Bryant April 16, 2024

How to Fix Bad Posture

Paul Wynn April 11, 2024

Time Blindness ADHD Productivity Tools

Claire Wolters April 11, 2024

The Best Supplements to Build Muscle

David Levine and Elaine K. Howley April 11, 2024

10 Ways to Calm Yourself Down

Stacey Colino April 10, 2024

D-Mannose for UTI: Is It a Cure?

Claire Wolters April 10, 2024

Hot Yoga for Depression

Jake Panasevich April 4, 2024

Should Kids Take Multivitamins?

Elaine K. Howley April 2, 2024

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List

Sport injury prevention in-school and out-of-school? A qualitative investigation of the trans-contextual model

Alfred s. y. lee.

1 School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China

Martyn Standage

2 Department for Health, University of Bath, Bath, United Kingdom

Martin S. Hagger

3 Department of Psychological Sciences, University of California, Merced, California, United States of America

Derwin K. C. Chan

4 Faculty of Education and Human Development, The Education University of Hong Kong, Hong Kong Special Administrative Region, China

5 School of Psychology, Curtin University, Perth, Australia

Associated Data

All relevant data are within the paper and its Supporting Information files.

To investigate junior secondary school students’ experiences and perspectives of in-school and out-of-school sport-safety, with a particular focus on the meaning and content that they applied to the motivational and social cognitive factors of sport injury prevention.

Focus-group interview.

Participants were 128 junior secondary school students (Form 1 to Form 3) aged between 12 and 16 years from two secondary schools. We organised focus-group interviews by class (group size = six to nine students). Seventeen groups completed semi-structured interviews regarding their experience, beliefs, and motives for injury prevention in-school and out-of-school. We analysed data by thematic content analysis using a typological approach.

Higher order themes (N = 7) including in-school and out-of-school motives and social cognitive factors and associated lower-order themes (N = 16), emerged from the analysis corresponding to constructs from trans-contextual model tenets.

Conclusions

The current study is the first qualitative study to explore junior secondary school students’ experience and perspectives on sport injury prevention, using trans-contextual model as a framework for investigation. The findings contribute to a better understanding on their motivational and social cognitive factors in adopting sport injury prevention. The content of the theme behavior also indicated the inadequacy of students’ knowledge of effective sport injury prevention techniques, and underscored the importance of sport safety education.

Introduction

Sport injury is one of the leading causes of injury in young people [ 1 – 3 ]. Not only may injury lead to temporary impairment of sport performance and absence from sport and school, but it could also result in prolonged pain, higher risk of re-injury, early retirement from competitive sport, and lower future commitment to physical activity for health [ 4 – 6 ]. Emery and Tyreman [ 1 ] reported that over 60% junior high school students (aged 12–15 years) suffered at least one sport injury in the past year. They also found that few injuries occurred during physical education (PE) classes. Most occurred in a game (39.3%) or recreational setting (26.9%), such as informal sport play in community parks. It therefore appears that sport injuries occur most often in out-of-school contexts.

Sport injury prevention includes static stretching, warm-up before and cool down after exercise, strength and conditioning [ 7 ], landing technique [ 8 ], and correct application of protective equipment (e.g., helmet) [ 9 ]. Sport injury prevention programs are provided for youth both in-school [ 10 ] and out-of-school [ 11 ]. Yet, the prevention of sport injury is a behavior that requires motivation and perseverance to maintain [ 12 – 14 ], particularly when students are unsupervised in out-of-school contexts (e.g., playing physically active games, leisure sport events). It is therefore important to understand why and how students learn sport safety in-school (PE lessons) and apply sport injury prevention in out-of-school contexts. In the current study, we employed a qualitative investigation guided by the trans-contextual model (TCM) [ 15 – 17 ] to explore and gain a rich understanding of the psychological processes underpinning students’ learning and application of sport safety principles. For the in-school context, we are referring to the PE lesson; out-of-school refers to both supervised and unsupervised physical activities.

The TCM integrates three important social psychological theories: including self-determination theory (SDT) [ 18 , 19 ], the theory of planned behavior (TPB) [ 20 ], and the hierarchical model of intrinsic and extrinsic motivation (HMIEM) [ 21 ]. The pattern of motivation posited in TCM is classified generally by three forms of motivation and their sub-types defined by SDT [ 18 , 19 ]. Autonomous form of motivation is an inherent drive to engage particular behaviors. Individuals are autonomously motivated when they are performing behaviors under intrinsic (e.g., acting for fun and pleasure), integrated (e.g., acting for behavior that is synthesis with own self) and identified (e.g., acting for achieving personally valued goal) motivation. In contrast, behaviors driven by externally-referenced reasons are known as controlled motivation which comprises introjected (e.g., acting to satisfy pride and ego, and avoid shame and guilt) and external (e.g., acting for compliance and to avoid punishment) regulation. Last but not least, amotivation refers to the absence of the motivation (e.g. acting for behaviors without any reason). The fundamental premise within the TCM is that the quality and quantity of motivation (i.e., autonomous, controlled motivation, and amotivation) based on tenets within SDT can be transferred from one context (e.g., taking PE lesson) to another related context (e.g., leisure-time physical activity), leading to changes in the social cognitive factors (i.e., attitude, subjective norm, perceived behavioral control (PBC), and intention from the TPB) that relate to intention, and actual behavioral participation. The proposition of TCM regarding the transferability of motivation is built on the assumption derived from the HMIEM [ 21 ]. The HMIEM proposes that forms of motivation from SDT operate at the three levels of generality (i.e., specific, contextual, and global) and are hierarchically related to each other. The motivational and behavioral patterns in one context are then expected to activate similar motivational patterns in allied behaviors in related contexts [ 22 ].

The original application of the TCM lies within transferring motivation between PE and leisure-time physical activity [ 15 ]. It was found that when students endorsed autonomous forms of motivation (i.e., identified regulation, and intrinsic motivation) rather than controlled forms of motivation (i.e., introjection and external regulation) in PE, they were more likely to be autonomously motivated toward leisure-time physical activity. Autonomous forms of motivation in leisure-time physical activity then predicted intention and self-reported physical activity via the mediation of the social cognitive factors. This pattern of results has been shown to be consistent across 12 countries, supporting the cross-cultural invariance of the original application of the TCM in PE and physical activity contexts [ 16 , 17 ]. Therefore, promoting autonomous motivation of students in PE (e.g., PE teachers who support the psychological needs of students and their volitional engagement with PE activities; [ 16 , 17 ] might be meaningful not only to the motivational pattern in an in-school context, but also to the motivational and social cognitive process associated with the behaviors in an out-of-school context.

Researchers have extended the potential of the TCM model to other behaviors, including rehabilitation [ 23 ], occupational injury prevention and rehabilitation [ 24 ], in-school and after-school learning [ 25 ], anti-doping in sport [ 26 ] and elite athletes’ sport injury prevention [ 27 ]. The trans-contextual process of motivation tested in these studies explains how motivation at work, school, or sport can be transferred into motivational, social cognitive and behavioral patterns of a related behavior in an allied context (e.g., rehabilitation for occupational injury, learning in out-of-school, sport injury prevention). In support of the tenets within TCM in the context of sport injury prevention, Chan and Hagger [ 27 ] found that elite athletes who possessed high autonomous motivation in sport tended to hold higher autonomous motivation for sport injury prevention. Autonomous motivation for sport injury prevention is a predictor of a wide range of behavioral outcomes of sport safety or injury prevention, such as adherence and commitment to injury prevention, prioritization and fatalism towards safety, and communication barrier and worry towards sport injury [ 27 , 28 ]. Aligned with TCM predictions, the relationship between autonomous motivation for sport injury prevention and intention has been shown to be mediated by social cognitive variables [ 28 , 29 ]. The TCM has been used to explain motivation and social cognitive process of human behaviors, including sport injury prevention, yet research has predominantly used quantitative methods to test the model. To date, extant work has not formally examined if the model is well-placed to explain students’ learning and application of sport safety in-school and out-of-school contexts. Somehow, it would not be comprehensive to understand students’ experience and perspectives in learning sport safety by using quantitative data only [ 30 ]. Hence, we proposed to adopt qualitative methodology to supplement existing research findings predominantly based on quantitative data.

In the present study, we employed qualitative methods to investigate junior secondary school students’ experiences and perspectives of in-school and out-of-school sport-safety, with a particular focus on the meaning and content that they applied to the motivational and social cognitive factors of sport injury prevention. The purpose of the present study was to explore the applicability and provide a holistic view of the TCM in secondary school students learning sport safety. Our study targeted junior secondary school students (Secondary 1 to Secondary 3, typically aged 12 to 16 years) because it is the beginning stage of secondary school education, a time in which sport safety is especially important for reducing the risk of sport injury in the later stages of PE [ 31 , 32 ]. We conducted semi-structured focus group interviews with students to explore the content of the psychological variables in the TCM. We also examined number of codes identified respectively for autonomous motivation, controlled motivation, and amotivation. We were particularly interested to explore 1) the applicability of adopting TCM to explain secondary school students’ psychological factors underpinning sport safety; and 2) what are the realistic psychological processes of students learning sport injury prevention (e.g. particular reasons of adopting sport injury prevention, feelings or beliefs toward the prevention exercises) in-school and out-of-school. These analyses led to the first qualitative investigation of the TCM on sport safety in a junior secondary school setting. The results that obtained from the qualitative study would be useful to advance the understanding of TCM constructs in the context of sport safety for secondary school students, and the findings might inform the development of theory-driven interventions for sport injury prevention in school settings.

Participants

Upon ethical approval from the first author’s institution [approval number = EA1604014], we conducted 17 focus-group interviews (6 to 9 participants per group) corresponding to a total number of 128 junior (Form 1 to Form 3 which are equivalent to 7 th to 9 th grade in US) secondary school students (69 males and 59 females; age = 12 to 16 years old; mean-age = 13.76, SD = 1.50) from two secondary schools in Hong Kong. Participants attended two mandatory PE lessons per teaching week. Most participants reported a history of sport injury (52.80%) such as a scrapes, sprained ankle, strained muscle, ligament rupture, or bone fractures. Some participants had experienced a sport injury in the last 6 months (18.75%). The variation in participants’ background in terms of age, gender, sport participation and injury experience enabled diverse perspectives of sport safety for enriching interview conversation [ 33 ]. The characteristics of each focus group are shown in Table 1 .

Note. The two local schools are marked as A and B to protect confidentiality and anonymity. M = mean; SD = standard deviation.

Secondary school students (Form 1 to Form 3) aged between 12 to 16 who attend regular PE lessons were invited to the study. Eligible students and their parents/guardians provide informed consent before the study. Students were asked to complete a short demographic questionnaire (e.g., age, gender, sport and sport injury experience) before joining the focus group interview. To foster a friendly environment in which students would freely interact with their peers, each focus group interview was formed by students within the same class, used the mother language of participants (i.e., Cantonese, the primary Chinese dialect in Hong Kong) as the medium of communication, and was moderated by one of the five Cantonese-speaking interviewers, including the first and second author, and three research assistants trained to follow the study protocol and moderate the interview according to the interview schedules. To enhance the quality and consistency of interview delivery, five interviewers ran 2 practice trials among themselves before the data collection.

At the beginning of the focus groups, interviewers raised questions about sports experience and motivation to play sports to establish rapport with the participants. Interviewers then provided a clear definition of sport injury (i.e., ‘any unintentional or intentional damage to the body resulting from participation in sport [ 34 ] and examples (e.g., abrasion, sprain, dislocation, or bone fracture), before leading the main topic of discussion to sport injury. Interviewers would then explore students’ sport safety knowledge by asking “What do you normally do to prevent sport injury in-school/out-of-school?”. The main part of the interview centered on questions about students’ motivation and social cognitive factors of sport injury prevention in-school and out-of-school. Examples of questions included “Why do you prevent sport injury in-school/out-of-school?”, “What are the pros and cons of doing sport injury prevention?” and “Under what circumstances, is sport injury prevention more difficult/ easy?”. The whole interview schedule is presented in S1 Appendix . The interviewers facilitated the discussion by (1) encouraging every group member to be active in contributing to, but not dominating, the interview, (2) asking for clarification and elaboration on certain points, (3) providing probing questions (e.g., “How do you feel”, “What do you think?”) to stimulate reflection of thoughts and feelings. At the end of the interview, participants were asked to discuss any additional issues that came to their mind about safety and injury prevention in sport. The focus group interviews lasted for 35 to 50 minutes with audio recordings transcribed verbatim.

Data analysis

We adopted and followed Keegan and colleagues’ key analytical procedures [ 35 , 36 ] in our qualitative data analysis, including (1) transcribing of interview content into 65 pages of single-lined text with 11 font size; (2) reading the transcript and listening to the interview recordings multiple times to increase familiarity; (3) conducting a thematic content analysis with typological approach [ 37 ] using ThematiCoder version 1.0 [ 38 ], and quotes could be coded into multiple themes; (4) checking consistency of all the coding with agreement of 96% between two coders; (5) paraphrasing and restating participants’ responses to ensure correct understanding and precise transcription of the data; (6) adopting a ‘critical friend’ approach to allow the two coders to critically review and challenge each other’s coding, categorization, organization, reflection, and interpretation of qualitative findings [ 39 , 40 ], and (7) conducting a peer debriefing session among the research team members about the analysis. The essence of the thematic content analysis in this study was to systematically organize the lower-order themes that emerged inductively into higher order themes based on motivational and social cognitive factors of the TCM, so deductive data analysis would progressively take place until theoretical saturation was reached. Chi-square tests of independence examine if the frequency (i.e., the code counts) of the three forms of motivations were consistent or different between in-school and out-of-school contexts.

The theoretical components within the TCM, including motivation in-school and out-of-school contexts, the three social cognitive factors (attitude, subjective norm, PBC), and intention, emerged as higher-order themes in the thematic analysis. In general, most of the students understood sport injury prevention as doing warm-up, such as running laps and stretching. Few students mentioned cool down as a preventive measure. The details and English translations of quotations of the higher-order themes and their corresponding lower-order themes are presented in Table 2 . Where quotations are provided, the participants’ reference is presented for gender (F = female and M = male) and group (G1-G17 = Group 1—Group 17).

Motivation in-school

This theme refers to the motivation that students endorsed toward in-school sport injury prevention measures. The three main emergent subthemes were autonomous motivation , controlled motivation , and amotivation . Students reported being autonomously motivated to prevent in-school sport injuries when they self-endorsed the values or benefits of warm-up activities or exercises. They viewed warm-up exercises as preventing muscle pain, stiffness, sprain, sport injury or enhancing sport performance: “I want to protect myself” (M, G16), “(Why will you do sport injury prevention?) It is good to my body” (M, G11). Controlled motivation refers to the external demands, pressure, and pride satisfaction of doing sport injury prevention. Many students reported that they experienced controlled motivated to carry out the preventive measures in-school: “I do it (warm-up) only when teachers ask us to do it” (M, G9), “Sometimes it (warm-up) is compulsory, and so you need to do some to avoid being scolded (by teachers)” (F, G1). Sometimes, students did not know the reasons they engaged in sport injury prevention in-school. These quotes are under the themes of amotivation: “(What are the reasons that you do injury prevention in PE lesson?) No reason we just do it” (M, G17), “I do it (warm-up) because I have nothing else to do” (F, G4).

Motivation out-of-school

This theme specifically represents students’ motives to prevent sport injury in out-of-school context. A utonomous motivation , controlled motivation , and amotivation emerged as sub-themes. For the autonomous motivation, similar responses could be found in-school and out-of-school contexts. “I really want to do better in the competition” (F, G1), “(I want) to prevent cramping (in swimming)” (F, G5). Outside of school, students also attempted to prevent sport injury because of external reasons (controlled motivated): “Yes, I will do (preventive measures), I have training during summer, I do it when coach asks me to do it” (M, G13), “When my father is around I definitely need to do (a warm-up)” (F, G2). For amotivation, some of the students’ responses showed absence of motivation towards sport injury prevention out-of-school: “(So do you know why you do sport injury prevention?) I really don’t know” (M, G6).

Social cognitive factors

Attitude refers to the personal evaluation of sport injury prevention. This theme encompasses two sub-themes, affective attitude and instrumental attitude . Affective attitude represents whether the students enjoy performing the preventive measures. It is further subdivided into positive and negative affective attitude. Students used “Refreshing”, “Relaxing” (M, G6) and “Comfortable” (M, G16) to describe the positive feelings of warming-up. However, other students had different ideas: “(Doing a warm-up is) very boring” (M, G3), “That was very annoying is doing leg split” (F, G1).

Instrumental attitude refers to students’ assessment of the benefits of doing sport injury prevention. Many students did not consider preventive measures to be beneficial to them: “It is the same whether you do it (warm-up) or not” (M, G15), other terms like “Waste of time”, “Waste of energy” and “Useless” (M, G16) were also reported. In other cases, students believed injury prevention can “Reduce (muscle) pain”, “Reduce the chance of injury” and “Relax your muscle” (F, G5). A handful of students highlighted warm-up exercises can enhance their sport performance: “You will be more concentrated after warming-up”, “Improve competition performance” (M, G12).

Subjective norms

This theme refers to the perception of social appropriateness of sport injury prevention. Injunctive norm and descriptive norm emerged as lower-order themes. Injunctive norms referred to the perception of others’ approval or encouragement on preventing sport injury. Most students could not determine whether their significant others cared about their injury preventive behaviors (i.e., “No idea”): “My family members have no opinion (on whether I do warm-up)” (F, G2). Some felt that teachers, coaches and family members approved their behaviors: “If you do a lot (of warm-up exercises), people think that you are professional” (F, G9). Only a small number of students reported their social groups disapproved them to do sport injury prevention. They perceived others viewed them as “Pretending to be professional”, “Very weird” (M, G14), when they carried out the safety measures. Descriptive norms represented whether students’ significant others prevented sport injury or not. Both positive and negative descriptive norms were reported by the students: “Yes, they (parents) are the one to lead (the warm-up)” (F, G2), “Family members don’t do (warm-up exercises)” (M, G11).

This theme refers to students’ perceived ease or difficulty of adopting sport injury prevention. The two main emergent sub-themes were positive PBC and negative PBC . The majority of the students were confident in doing preventive measures: “It (doing warm-up exercises) is always easy” (M, G17). However, some students found it more difficult, “Very difficult, we need to do leg split” (F, G1). Environment was also reported to be a determinant of PBC, “It is easier to do if we have a mat”, “(It is easier to do), if we can turn on air conditioner” (F, G1). Students had negative PBC on injury prevention when the “Weather is hot”, “Not enough space” (M, G9).

Intention emerged as a higher order theme that refers to the students’ intention to engage in sport injury prevention. This theme was further divided into intention and no intention . Some students reported they are intended to participate in sport injury prevention: “Yes I will do some stretching after exercises” (M, G12), “I will do it in the training session in coming Thursday” (M, G5). For students who had no intention, they said “I will not do it” (F, G1), “No, why will I do it?” (F, G8).

Behavior was a higher-order theme that referred to the adoption of sport injury prevention in-school and out-of-school. All of the groups reported they needed to do warm-up exercises before PE class and a few students highlighted they do cool-down exercises. The warm-up in-school normally consisted of “standard stretching” (F, G2) and “Jogging for few laps” (M, G4). Besides doing warm-up exercises, PE teachers also taught “the correct techniques” (F, G6) and asked students to use safety equipment: “Knee pad” (M, G13) and “Shin guard” (M, G3). When students were out-of-school, approximately half of them said they would engage in sport injury prevention: “I do it (stretching) before swimming” (F, G5) and “Bring helmet and do warm-up before skating” (M, G6). The other half of the sample reported they would not do injury prevention out-of-school: “I jump right into to the swimming pool to swim” (M, G12), “I don’t think of putting on a helmet before cycling” (M, G4).

Pattern of motivation between in-school and out-of-school

The code counts for in-school autonomous motivation, controlled motivation, and amotivation were respectively 40, 83, and 6; that for out-of-school were respectively 44, 20, and 8 respectively. A 2 x 3 chi-square test of independence ( χ 2 = 28.84, p < .01) indicated that patterns of motivation were different between the in-school and out-of-school contexts. Follow-up 2x2 chi-square tests indicated that controlled motivation was mentioned more often regarding in-school than out-of-school contexts (controlled and autonomous motivation x contexts: χ 2 = 22.33, p < .01, odds ratio = 4.57; controlled motivation and amotivation x contexts: χ 2 = 9.64, p < .01, odd ratio = 5.53). However, the frequency of autonomous motivation and amotivation were relatively consistent between the two contexts (autonomous motivation and amotivation x contexts: χ 2 = .11, p = .74, odds ratio = 1.21).

The purpose of the current study was to explore junior secondary school students’ experience and perspectives of sport safety in-school and out-of-school context, with a particular focus on the meaning and content they applied to the psychological factors of sport injury prevention under the TCM [ 15 – 17 ]. The higher-order and lower-order themes emerged from thematic content analysis generally aligned with the motivational and social cognitive constructs of the model, but the pattern of motivation in-school and out-of-school context did not entirely support the proposition of the TCM as the patterns of controlled motivation did not appear to be consistent (or transferrable) between the two contexts. These results yet may provide information about the mechanisms underlying the process of trans-contextual transfer of motivation [ 12 , 27 – 29 ].

The current data are supportive the presence of autonomous and controlled motivation, and amotivation for sport injury prevention among junior secondary school students [ 24 , 27 , 29 ]. However, when investigating the content of the quotes for autonomous motivation, we did not observe intrinsic motivation for sport injury prevention in either in-school or out-of-school contexts. This phenomenon may indicate that autonomously motivated students may participate in sport injury prevention because they think that it is useful or beneficial, rather than because it is fun. While “Having fun” has been regarded as an important factor that determines individuals’ adherence to sport injury prevention [ 14 ], and researchers also proposed that injury prevention programs should be more game-like [ 41 ] our current data suggest that students are not intrinsically motivated to participate in injury preventive measures. Although the absence of intrinsic motives for sport injury prevention is somewhat in line with the operationalization of autonomous motivation in the sport injury prevention version [ 24 , 29 ] of treatment self-regulation questionnaire [ 42 ], our findings may raise further questions about the necessity, applicability, effectiveness, and practicality of promoting intrinsic motivation for sport injury prevention. Nevertheless, workshops and interventions can be provided to PE teachers and coaches, introducing ways to develop enjoyable sport injury prevention programme (e.g. jogging with a football, rotating leadership in leading dynamic stretching). Another effective strategy would be to enhance other autonomous forms of motivation, such as identified regulation. This would mean a focus on identifying the internally valued outcomes of injury prevention (e.g., being able to continue participating in exercise, avoiding lengthy rehab or visits to the physiotherapist), rather than promoting enjoyment of the exercises themselves.

Another noteworthy finding in this study concerns about content of amotivation for sport injury prevention. Amotivation, compared to autonomous and controlled motivation, was a theme that received less mention (expressed via codes), but its expressions in the quotations did not always appear to be maladaptive as it was described within SDT [ 19 ]. In this study, amotivated students were not aware of the reasons behind why they sported injury prevention, and they did not feel pressured to do so. However, follow-up questions about why indicated that (1) some students believed that it was easier to follow what it was told or what everyone else was doing, (2) or they just did it automatically or habitually when time allowed. The former case was more prevalent for in-school amotivation, and might reflect lack of true intention towards sport injury prevention, thus more vulnerable to dropout and low-awareness to sport injury prevention in some circumstances (e.g., unsupervised out-of-school conditions). It might also explain why the latter case (i.e., automaticity and habit) was more commonly found out-of-school amotivation. Such content related to amotivation might somewhat reflect concepts such as implicit attitude, implicit motivation, and habit, that growing amount of research have used them for the explanation of health behaviors [ 43 – 46 ]. Existing literature regarding the role of amotivation on sport injury prevention has been scarce, so it would be worthwhile for future studies to incorporate amotivation, and even other related factors (e.g., habit, implicit attitude) into the TCM [ 47 ].

The role of controlled motivation is another interesting observation. Our data indicated that students felt obliged to participate in safety measures, and felt that sport injury prevention was compulsory because they had to follow significant others’ (e.g., PE teachers in-school context, and coaches and parents in out-of-school context) instructions or comply with safety regulations. It seemed that students may not necessarily know the rationale behind performing sport injury prevention activities. Such a scenario is not ideal for behavioral adherence because in the absence of external demands or social pressure, individuals driven by controlled motivation are less likely than autonomous motivated individuals to adhere to sport injury prevention [ 19 , 48 ], making them more vulnerable to behavioral dropout in out-of-school context. In the focus-group interview, there were several students who possessed in-school controlled motivation, but not out-of-school controlled motivation, and they also reported behavioral non-compliance in out-of-school context “I don’t do warm-up [outside school]”. This might be why the students were less likely to report controlled motivation for out-of-school injury prevention compared to in-school injury prevention.

Rates of autonomous motivation and amotivation (but not controlled motivation) for injury prevention were highly comparable between in-school and out-of-school contexts. These findings were in line with the tenets of TCM [ 15 – 17 ], it might provide implications for the trans-contextual transfer of motivation in the injury prevention context [ 23 , 27 , 28 , 49 ]. Autonomous motivation and amotivation appeared to be more prevalent by participants than controlled motivation in the out-of-school context, so that might suggest that the transferability of autonomous motivation and amotivation is more effective than controlled motivation. Our data might, therefore, offer an explanation as to why some previous studies adopting the TCM reported non-significant [ 26 ] or relatively weaker association between controlled forms of motivation across contexts, as compared to that of autonomous forms of motivation [ 15 , 50 ]. Yet, the answer has not been fully revealed as majority of the studies applying the TCM often use a composite score for motivation types from SDT (e.g., the relative autonomy index) rather than differentiated constructs [ 16 , 51 ]. It might be important for future studies to examine the independent transferability of each type of motivation from SDT.

Our findings were consistent with previous studies examining the TCM in injury prevention regarding the transferability of autonomous motivation across contexts [ 23 , 27 ]. According to SDT [ 18 , 19 ] and prior studies in injury management [ 23 , 27 ], autonomous motivation could be facilitated by satisfying individuals’ psychological needs of autonomy (feeling of choices and freedom), competence (feeling of being able to do what you want) and relatedness (feeling of being accepted, connected and cared for) [ 28 , 52 , 53 ]. However, questions remain on how PE teachers can provide the best support for satisfying students’ psychological needs in the injury prevention contexts, and answering this question require further analysis of PE teachers’ behaviors.

The current study provided evidence on students’ beliefs in sport injury prevention with themes consistent with the theoretical concepts of the social cognitive variables from the TCM, including attitude, subjective norms, and PBC [ 24 , 29 ]. The sub-themes indicated there were positive and negative beliefs that governed students’ decision-making process for sport injury prevention. Our findings may be useful for understanding or even modifying the salient beliefs associated with students’ commitment to sport safety guidelines. Researchers and sport medicine practitioners should try to alter negative beliefs, such as affective (e.g., “painful feeling”) and instrumental (e.g., “waste of time”) attitudes, injunctive (e.g., “it makes me look weird in front of others”), descriptive norms (e.g., “None of my friends do it”), and PBC (e.g., “no time and space”) to try to draw students’ attention to the positive ones. For example, one common negative instrumental attitude is about the effectiveness of sport injury prevention. It refers to a misconception that sport injury is inevitable regardless of prevention, and previous studies have reported this belief was negatively related to self-determined (i.e., more autonomous, less controlled) motivation of injury prevention [ 27 , 28 ]. Resolve this maladaptive belief by restating the evidence about the effectiveness of sport injury prevention on reducing the risk and severity of sport injuries [ 54 ]. A prior study in promoting helmet use among school-aged cyclists disseminated leaflets with persuasive messages constructed based on the TPB [ 20 ]successfully enhanced future helmet use by promoting change in the social cognitive variables [ 55 ]. Besides the three social cognitive variables, intention emerged as an independent theme in the present study, but the content regarding students’ future engagement in sport injury prevention rarely specified specific injury preventive behaviors, and when and how they would be performed. This finding might be due to the well-documented intention-behavior ‘gap’ in which intentions cannot fully predict behaviors because people do not act according to their intentions [ 56 , 57 ]. Our data may imply that enriching the specification of intention that students formed for sport injury prevention might bridge the intention-behavior gap, and this could be done by fostering better action control, implementation planning, action/recovery self-efficacy [ 56 – 59 ]. Several behavioral change strategies have been proposed by the literature to tackle these variables, for example the “if, then” approach proposed by Chapman, Armitage [ 60 ]. Future studies could investigate the feasibility of applying these evidence-based behavioral change strategies in sport injury prevention contexts.

Injury preventive behavior reported by junior secondary school students reported many strategies related to sport safety. However, pre-exercise warm-up and stretching dominated the content of this theme. Stretching during pre-exercise warm-up might not necessarily be the most appropriate method for sport injury prevention [ 61 ]. Some studies even suggested stretching could have negative effects on performance [ 62 ], and might have a non-significant impact on injury prevention [ 63 ]. Other types of preventive methods, such as neuromuscular training (e.g. FIFA 11+, iSPRINT) [ 54 , 64 , 65 ], eccentric strength training [ 66 ], resistance training [ 67 ] received increasing amount of evidence in supportive to their effectiveness on sport injury prevention. Our findings may imply that besides fostering better behavioral adherence, enhancing the knowledge of sport injury prevention among students and PE teachers (e.g., sport safety workshop, education seminar) might be critical to reducing the risk of sport injury, particularly in out-of-school unsupervised situations [ 10 , 68 ].

Limitations and future directions

A few limitations of the current study should be addressed to identify the boundaries of the study and stimulate further research. Our study adopted a qualitative approach focusing on the content of the psychological factors of TCM, and the frequency salient themes [ 69 ]. The cross-sectional nature of the study and qualitative data mean that we cannot draw causal inference on transfer of motivation, and the change in psychological variables within the TCM. A longitudinal study with cross-lagged panel design could examine the temporal relationship by testing the changes of TCM variables over time [ 70 ]. Another noteworthy limitation is related to the study sample. Although our study sample was recruited from only two local secondary schools in Hong Kong, the variation of participants’ personal backgrounds, school environment, sport culture, and region of residence could be restricted, so it might affect the generalizability of the findings to other populations. Future studies should replicate this line of work with diverse samples with participants from different backgrounds, and more importantly, in other behavioral contexts (e.g., physical activity, occupational injury prevention, rehabilitation, and education) where qualitative studies of the TCM have yet to be employed.

The current study is the first qualitative study to explore junior secondary school students’ experience and perspectives on sport injury prevention, using TCM as a framework for investigation. Themes emerged from 17 focus group interviews were consonant with the constructs of the TCM, including in-school motivations, and out-of-school motivations, social cognitive factors, intention, and behavior regarding sport injury prevention. The frequency of codes for motivation could be explained by the tenets of the TCM’s regarding the transferability of motivation across contexts. The frequency of autonomous motivation and amotivation was highly consistent across the two contexts, but that of controlled motivation was significantly reduced in out-of-school context. The content of behavior also indicated the inadequacy of students’ knowledge of effective sport injury prevention techniques, and underscored the importance of sport safety education. Based on the findings of prior studies on the TCM in other behavioral contexts (e.g., occupational injury prevention), making goal-oriented safety objectives, promoting the pros of preventing sport injury, encouraging everyone to participate in injury prevention (including students’ family) and removing students’ barriers to do sport injury prevention (e.g. uneven surface, hot weather and time limit), might be possible solutions to enhance students’ adherence to engage in sport injury prevention [ 12 , 28 ]. Future quantitative research is warrant to test the effectiveness of these strategies on students’ behavioral adherence towards sport injury prevention.

Supporting information

S1 appendix, funding statement.

The project is funded by Hong Kong Research Grant Council [27106016] awarded to Derwin K. C. Chan, Martin S. Hagger, and Martyn Standage. The funder website: https://www.ugc.edu.hk/eng/rgc/ . The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Data Availability

Do a more advanced search »

Search for dissertations about: "sport injuries dissertation"

Showing result 1 - 5 of 6 swedish dissertations containing the words sport injuries dissertation .

1. Sports-related injuries and illnesses in Paralympic athletes

Author : Kristina Fagher ; Rehabiliteringsmedicin ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; Sports medicine ; Epidemiology ; eHealth ; Qualitative research ; Paralympic sports medicine ; Athletic injuries ; Prevention ; Sports for persons with disabilities ;

Abstract : .... READ MORE

2. Motor Imagery to Facilitate Sensorimotor Re-Learning (MOTIFS): Integrating Dynamic Motor Imagery in Current Treatment of Knee Injury

Author : Niklas Cederström ; Idrottsvetenskap ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; SAMHÄLLSVETENSKAP ; SOCIAL SCIENCES ; MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; knee injury ; Sport medicine ; Exercise therapy ; Sport psychology ;

Abstract : Traumatic knee injury is common in physical activity that includes jumping and cutting movements, and most commonly include anterior cruciate ligament (ACL) or meniscus injuries. Surgical or non-surgical intervention strategies may be chosen, but treatment will include a physical-therapist led physical training program. READ MORE

3. Psychology of Sport Injury : Prediction, Prevention and Rehabilitation in Swedish Team Sport Athletes

Author : Andreas Ivarsson ; Urban Johnson ; Judy van Raalte ; Linnéuniversitetet ; [] Keywords : SAMHÄLLSVETENSKAP ; SOCIAL SCIENCES ; Athletic injury ; prediction ; prevention ; psychology ; rehabilitation ;

Abstract : The dissertation consists of five separate studies that all have focused on different aspects of the relationship between psychological factors and sport injuries.In the first study the aim was to investigate female elite soccer players’ experiences of the time prior to the occurrence of an ACL injury. READ MORE

4. Running-related injuries among recreational runners. How many, who, and why?

Author : Jonatan Jungmalm ; Göteborgs universitet ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; biomechanics ; causality ; description ; injury epidemiology ; prediction ; training load ;

Abstract : Background. It is important for improving and maintaining general health to engage in regular physical activity. A major barrier to retain in regular physical activity is quitting because of an injury. In running, one of the most practiced leisure-time physical activities on a global scale, injuries are unfortunately common. READ MORE

5. Scaphoid Fractures - epidemiology, diagnosis and treatment

Author : Peter Jörgsholm ; Malmö Handkirurgi ; [] Keywords : MEDICIN OCH HÄLSOVETENSKAP ; MEDICAL AND HEALTH SCIENCES ; Scaphoid fracture ; carpal fracture ; paediatric ; radiography ; CT ; MRI ; arthroscopy ; scapholunate ligament injury ; radial comminution ; surgical treatment ; conservative treatment ; fracture union ;

Abstract : Abstract The scaphoid is the most commonly fractured carpal bone. The diagnosis is difficult and untreated the long-term results are poor. Approximately 10% do not unite even if they are treated properly. The aim of this thesis was to study scaphoid fracture epidemiology, diagnosis and treatment. READ MORE

Searchphrases right now

• Self excited
• high voltage protection system
• in-situ characterization
• Sarah-jayne Reilly
• Elzbieta Plaza
• information behaviour
• immunological processes

Popular searches

• Filosofiska fakulteten
• Up-Regulation
• high energy physics
• risk and quality

Popular dissertations yesterday (2024-04-21)

• Capability for broader cost-effectiveness in public health and social welfare : developing, valuing, and applyingcapability-adjusted life years Sweden (CALY-SWE)
• Noun Phrases in British Travel Texts : A Corpus-Based Study
• Understanding Media Accountability : Media Accountability in Relation to Media Criticism and Media Governance in Sweden 1940-2010
• Dividing the Indivisible : Algorithms, Empirical Advances, and Complexity Results for Value-Maximizing Combinatorial Assignment Problems
• Individually Tailored Treatment in the Management of Musculoskeletal Pain : Development and Evaluation of a Behavioural Medicine Intervention in Primary Health Care
• Towards a grammar of spoken South Saami
• Mast cells and their progenitors in respiratory diseases : Understanding their connection to lung function and airway inflammation
• Prefabricated composite bridges : a study of dry deck joints
• Essays in empirical finance
• Resource Lean and Portable Automatic Text Summarization
• Popular complementary terms: essays, phd thesis, master thesis, papers, importance, trend, impact, advantages, disadvantages, role of, example, case study.

See yesterday's most popular searches here . Dissertations.se is the english language version of Avhandlingar.se .