50 Years of Research on the Psychology of Sport Injury: A Consensus Statement

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

The Athletic Identity Measurement Scale: A Systematic Review with Meta-Analysis from 1993 to 2021

Sport psychology embraced the study of athletic identity in the 1990s. The Athletic Identity Measurement Scale (AIMS) is at the forefront of athletic identity measurement. This quantitative review examined two hypotheses: individual who are most engaged in sports identify most as athletes and thus score higher on the AIMS, and athletic identity relates to positive (e.g., intrinsic motivation) and negative (negative emotions) factors. In addition to our two hypotheses, we explored whether the AIMS subscales influenced our two hypotheses. After completing a systematic search of SPORTDiscus, APA PsycINFO, ERIC, and Psychology and Behavioral Sciences Collection APA within the EBSCOhost platform along with some hand searching, 101 articles published between 1993 and our end date of August 2021 met the inclusion criteria. The included studies investigated 20,498 athletes competing in a variety of sports from the following continents: Australia, Asia, Europe, and North America. We based all analyses on random- and mixed-effects statistics. Higher-achieving athletes, as expected, self-reported a higher degree of athletic identity. The differences between athlete groups were significant (p < 0.001) and meaningful (g values ranged from 1.55 to 1.93). The AIMS total score correlations with positive and negative factors (correlates) were small in magnitude (r = 0.22 and 0.17). However, the relationships differed across correlate subcategories (e.g., intrinsic motivation/commitment, r = 0.51, and body issues, r = 0.14). Minimal AIMS subscale reporting occurred across the 101 studies; thus, we could not assess their importance with certainty. In conclusion, a higher degree of athletic identity related to valued sport correlates such as intrinsic motivation/commitment and the mastery goal orientation. These correlations were small in relation to negative or less desirable factors in sport such as body disorder issues and negative emotions. We recommend future research of greater complexity and the reporting of athletes’ competitive backgrounds to understand athletic identity. In addition, researchers should report AIMS subscale data.

A qualitative investigation into the individual injury burden of amateur rugby players

OBJECTIVE

To examine the individual experiences of injury burden in amateur Rugby players across the onset of injury, rehabilitation, and return to play.

DESIGN

Qualitative.

SETTING

Irish amateur Rugby clubs.

PARTICIPANTS

Three male and two female Rugby players who sustained a severe injury that resulted in a time loss of at least 28 days.

MAIN OUTCOME MEASURES

Semi-structured interviews were used to explore the injury burden experienced during the three phases of injury.

RESULTS

Hierarchical content analysis revealed 36 codes representing individual injury burden, which were clustered into seven themes across personal (emotional reaction; impact on performance or involvement; lack of knowledge; severity of injury and incapacitation) and situational (exposure to others playing; negative experiences with treatment or rehabilitation; societal burden) dimensions.

CONCLUSIONS

The findings indicate that individual injury experiences can affect a player's recovery and rehabilitation outcome, potentially extending the injury process and affecting player availability for the team. As such, injury management should focus on alleviating any injury-related burden experienced by players, as well as burden placed on the team, to maximise rehabilitation outcomes.

Investigating correlates of athletic identity and sport-related injury outcomes: a scoping review

OBJECTIVES

To conduct a scoping review that (1) describes what is known about the relationship between athletic identity and sport-related injury outcomes and (2) describes the relationship that an injury (as an exposure) has on athletic identity (as an outcome) in athletes.

DESIGN

Scoping review.

PARTICIPANTS

A total of n=1852 athletes from various sport backgrounds and levels of competition.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary measure used within the studies identified was the Athletic Identity Measurement Scale. Secondary outcome measures assessed demographic, psychosocial, behavioural, physical function and pain-related constructs.

RESULTS

Twenty-two studies were identified for inclusion. Samples were dominated by male, Caucasian athletes. The majority of studies captured musculoskeletal injuries, while only three studies included sport-related concussion. Athletic identity was significantly and positively associated with depressive symptom severity, sport performance traits (eg, ego-orientation and mastery-orientation), social network size, physical self-worth, motivation, rehabilitation overadherence, mental toughness and playing through pain, as well as injury severity and functional recovery outcomes. Findings pertaining to the association that an injury (as an exposure) had on athletic identity (as an outcome) were inconsistent and limited.

CONCLUSIONS

Athletic identity was most frequently associated with psychosocial, behavioural and injury-specific outcomes. Future research should seek to include diverse athlete samples (eg, women, athletes of different races, para-athletes) and should continue to reference theoretical injury models to inform study methodologies and to specify variables of interest for further exploration.

“Be Mindful Even Though It Hurts”: A Single-Case Study Testing the Effects of a Mindfulness- and Acceptance-Based Intervention on Injured Athletes’ Mental Health

Injury is a serious setback for athletes and might jeopardize mental health. The aim of this study is to investigate if a mindfulness- and acceptance-based intervention can improve mindfulness (nonreactivity and acting with awareness), acceptance, and well-being, and decrease the level of symptoms of anxiety and depression. A single-case design with multiple, staggered, and nonconcurrent baselines was used. Six seriously injured athletes took part in an 8-week intervention and repeatedly completed questionnaires on all variables for the duration of the study. The results showed that, on average, there were significant clinical changes between phases in nonreactivity, well-being, and acceptance. No effect was seen in the two remaining scales. On an individual level, two participants showed effects in all scales, two participants in some of the scales, and two participants in the scale nonreactivity. Results are discussed in light of existing research, and implications for practitioners’ clinical methods are presented.

Injury and Disordered Eating Behaviors: What is the Connection for Female Professional Dancers?

Dancers, like athletes, frequently endure injuries and disordered eating as a result of performance-specific demands. The purpose of this study was to explore the relationship between severe injuries and disordered eating from the perspectives of female professional dancers. In-depth, semi-structured interviews were conducted with 13 female professional dancers ages 18–38 (M = 23; SD = 6.2) whose dance participation was suspended for 4–36 weeks (M = 12.69; SD = 10.09) due to a dance-related injury. We adopted a social constructivist stance to view the experiences of dancers through the lens of a phenomenon highly influenced by environmental and cultural factors. A thematic analysis yielded five themes including negative emotions associated with injury, anxiety and uncertainty around future involvement, modifications in nutritional intake (e.g., reduction of calories), coping with injury, and the need for an effective and holistic injury rehabilitation program.

Preliminary investigation into sport and exercise psychology consultants' views and experiences of an interprofessional care team approach to sport injury rehabilitation

Sport injury rehabilitation has moved from predominately physical treatment to a more holistic care. However, limited research has explored the views and experiences of those involved in such an approach. The purpose of this study was to preliminarily investigate sport psychology consultants' (SPCs') views and experiences of an interprofessional team approach to sport injury rehabilitation. A cross-sectional online survey previously used with athletic trainers was distributed via a US-based sport/exercise psychology list-serve (N = 1245). A total of 62 (27 men, 35 women, M age 38.2 years, age range: 22-73 years) participants with 10.6 (SD = 9.8) years of experience as an SPC were included in the final analyses. On average, SPCs felt that it was very important (M = 6.6; SD = 0.6) for athletes to have access to an interprofessional care team. Of the sample, 64.5% (n = 40) typically worked as part of an interprofessional care team 44.7% of the time. The SPCs (n = 28; 45.2%) also indicated that the primary treatment providers (e.g., athletic trainer, physical therapist) were typically serving as the primary point person for such teams. Since gaining entry to sport medicine can be an area SPCs struggle with, building effective working relationships with treatment providers can help promote and increase SPCs involvement in providing holistic, interprofessional care to athletes with injuries. To ensure athletes' successful biopsychosocial return to sport, different individuals and professionals should work together for the benefit of the athlete by adopting holistic care during sports injury rehabilitation.