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Psychology of sport injury:
Prediction, prevention and rehabilitation
in Swedish team sport athletes
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Linnaeus University Dissertations
No 219/2015
PSYCHOLOGY OF SPORT INJURY:
PREDICTION, PREVENTION
AND REHABILITATION
IN SWEDISH TEAM SPORT ATHLETES
ANDREAS IVARSSON
LINNAEUS UNIVERSITY PRESS
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Psychology of sport injury: Prediction, prevention and rehabilitation in Swedish team sport athletes Doctoral dissertation, Department of Psychology, Linnaeus University, Växjö, Sweden, 2015 ISBN: 978-91-87925-57-3 Published by: Linnaeus University Press, 351 95 Växjö Printed by: Elanders Sverige AB, 2015
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Abstract Ivarsson, Andreas (2015). Psychology of sport injury: Prediction, prevention and rehabilitation in Swedish team sport athletes, Linnaeus University Dissertation No 219/2015, ISBN: 978-91-87925-58-0. Written in English. 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. In the result three themes of player experiences was identified: fatigue, life stress, and worry. The players interpreted these three themes as risk factors for ACL-injury.
The second study aimed to investigate whether personality, stress, and coping predicted injury occurrence in an elite soccer population. The result showed that an interaction between psychological variables (i.e. trait anxiety, negative life event stress and daily hassles, ineffective coping) could explain 24 % of the variance in injury occurrence. Moreover, the result showed that negative life event stress was found to have an indirect effect on injury occurrence through daily hassles.
In the third study the aim was to investigate whether individual level and changes in hassle and uplift levels over a 10-week period could predict injury outcome in an elite junior soccer population. The results showed that both initial level as well as change in hassle influenced injury risk. More specific, both high initial level as well as slow decrease in hassle was associated with an increased risk of injury.
The fourth study aimed to investigate the extent to which a mindfulness and acceptance based intervention program could reduce the number of sports injuries in a sample of soccer players. The result showed no statistically significant differences in injury rates between the two groups, but there was a medium effect size (adjusted Cohen´s d = - 0.59).
In the fifth study the aim was to investigate an athletic injury as a career transition through the narrative expression of successful and less successful injury experiences of a former elite handball player. The participant’s narratives made possible to identify four phases (i.e., pre-injury, injury and first reactions, diagnosis and treatment, rehabilitation and consequences) in the injury transition with distinct psychological content (e.g., demands, resources, barriers, and coping strategies) relevant to each phase. Key words: Athletic injury, prediction, prevention, psychology, rehabilitation
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SAMMANFATTNING
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ACKNOWLEDGEMENTS
for your encouragement and “open door policy” that for me h
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’
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LIST OF SCIENTIFIC A E SI
Female elite footballers’ recall of emotions, cognitions
II
III
I
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CONTENTS
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Rob’s Handball Career.
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INTRODUCTION
on the athlete’s career development both in a short term as well as a long
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an ACL injury had occurred as, “At that point it was extremely hard for me
showing emotions but this was one of the times in my life when I cried.”
in a substantial number of cases, will decrease the athlete’s perceived
negatively influence former athletes’ life satisfaction in comparison to former
—
athlete’s adjustment to the
(e.g., anger, fear) can negatively influence not only the person’s functioning,
ase, Ekstrand (2013) reported that one month’s time
cause a financial loss of approximately €500,000 for the club. Research has
€300 to €400 million per year.
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external/environmental factors may, in turn, influence the athlete’s behaviour
then be influenced by “controllable behaviours and uncontrollable risks
of the involved athlete” (Wiese
based intervention’s cap
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T
T
athlete’s stress responses that may are suggested to have a bidirectional relationship with the athlete’s appraisal of a potential stressful situationgame, competition). Both the magnitude of the stress reaction and the athlete’s
argued that an athlete’s history of stressors could influence the development of both an athlete’s traits and coping mechanisms, and,
injury rates. In several prediction studies, “the number of days missed due to injury” has been u
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T
T
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and the athlete’s coping resources and strategies, on the other hand. Crisis
I
for medical attention or time loss from football activities …
part in future football training or match play as a ‘‘time loss’’
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L
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suggested to influence both the athletes’ reactions to their situations and their emotional states. The athletes’ coping reso
psychological interventions could positively affect both athletes’ copi
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that these positive traits should decrease the strength of the athlete’s stress
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traits’ relationships with injuries is that that these factors do not seem to
stressors, directly influence human’s biological systems without any type of
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impact on injury rates was also shown in Ivarsson et al.’s (2015a) meta
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Summers, 1999). The effect estimate for hassles’ effect on injury risk has been
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Coping.
focused strategies direct the person’s
nce the athlete’s
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review. This finding indicates that athletes’ attempts to cope with different
It may, therefore, be difficult to generalize the athlete’s answer from a questionnaire that, for example, asks the athlete to “
” By using many
S pon .
del, the athlete’s interpretation and cognitive evaluation of inter
In n ion i .
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average Cohen’s
o ogi i no in in o o n iin .
Con p M o o ogi n S i i i in p in.
Con p i .
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M o o ogi i .
defined as “snap shot” investigations, the researcher takes just one picture and
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S i i i .
value “is
obtained conditionally on H0 being true p ( H0)” ( ickerson, 2000, p.
o ogi o in n ing i i ion p opo in i .
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factors are suggested to influence the athlete’s cognitive appraisal of the situation (e.g., coping, attributions). The athlete’s appraisal of the situation
treatment, effort, intensity). All responses together with the athlete’s cognitive
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S n i o i ionp o
the athletes’ etherefore, to investigate female elite soccer players’ experiences of the time
curve analysis framework, whether athletes’ individual levels and changes in
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and III), it is likely that by reducing the athletes’ stress levels, the injury risk
isolated event and seldom as a specific transition process within the athlete’s
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METHOD
S ud I
Female elite footballers’ recall of emotions, cognitions
P r icip n .
the Swedish women’s elite
In er ie .
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Procedure.
D n i .
(e.g., Richardson, 2000). Creative nonfiction “offers a story using factors
ys” (Smith, 2013, p. 135). In line with this definition, some examples of the
analysis were used together with the participants’ real words, phrases, and
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S ud II
P r icip n .
–
In ru en .
S edi ni er i ie Sc e o Per on i SSP .
Li e E en Sur e or Co egi e A e e LESCA .
The LESCA (Petrie, 1992) was used to measure athletes’ history of life
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–
T e e nd p i c e.
used to measure athletes’ levels of daily hassles and uplifts. The inventory
h’s alpha for the
rie COPE.
used to measure athletes’ coping
). Carver (1997) found Cronbach’s alphas
In ur recording.
Procedure.
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team’s physiotherapists. As daily hassles are a variable that is fluid in nature,
D n i .
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Baron and Kenny’s (
by the following sentence: “bootstrapping generates an empirical
as a representation of the population in miniature”
“probability of selection for any given case remains equal over every random
S ud III
P r icip n .
In ru en .
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In ur recording.
resulted in restriction of the player’s participation
Procedure.
assistance of each school’s coach. Because daily hassles is a dyn
assessment of athletes’ perceptions and stressors than using just one single
D n i .
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baseline model contained one latent factor of level (i.e., the athlete’s initial
athlete’s change trajectories i
——
indicators’ influence on growth factors (Muth
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S ud I
P r icip n .
In ru en .
In ur recording.
resulted in a restriction of the player’s participation
Procedure.
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sessions took place in classrooms at the soccer team’s high school. Between January and June, all injuries that occurred were recorded by the high school’s
Inter ention progra .
Treat ent group ind u ne and acceptance practice .
Mindfulness has been described as “openhearted, mjudgmental awareness” (Kabat
ce can positively influence both individuals’ apprai
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exercise) that was sent electronically to each player’s e
Contro group port p c o og or op .
Data ana i .
// (1
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Stud V
Participant.
handball career due to multiple knee (ACL) injuries. During Rob’s handball
Inter ie .
requests for information concerning Rob’s handball career was used. After he
omes. Rob’s thoughts and emotions
questions were: “Can you recall the time prior to when the injury occurred?” “What were your thoughts, and how did you feel in the beginning of yourehabilitation?”, and “What kind of support did you receive during the first weeks of your rehabilitation?” Additional questions and probes were added to
Procedure.
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220) and “acted as an active listener in an attempt to assist the participant to tell his life story in his own way with his own words.” Both interviews were
Data ana i .( I Hiles ermak, 200 ) was
––
participant’s stories.
tory together into a core narrative describing Rob’s career ). Themes permeating Rob’s career
Two groups of segments related to Rob’s injury experiences
better interpret the participant’s meanings.
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Et ica con ideration or a tudie
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Swed
ish
wom
en’s
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RESULTS
Stud Iplayers’
players’ experiences prior to the occurrence of the ACL injury (Malin’s and Sara’s). the players’
In Malin’s tale, she expresses that she was cognitively, emotionally and
tors prior to the ACL injury. Sara’s perceived pressure for a quick
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Stud II
Stud III
curve analysis framework, whether athletes’ individual levels and changes in
ignorable dropout) showed acceptable fit, 2 (
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dropout indicators’ infldemonstrated a very good fit with data 2 (
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Leve
l dai
ly h
assl
e
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Stud IV
Stud VThe aims of the study were: (1) to explore the athlete’s career
detail the athlete’s injury experiences.
Rob’s Handball Career.In Rob’s early career, he was highly motivated and serious when it came to
ecovery Rob’s knee and back started to
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T e in ur proce e .
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DISCUSSION
Sport in urie a a te ic p eno enon
within an athlete’
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that exposure to stress may change the brain’s neurological networks (e.g.,
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fluence the brain’s abilities to suppress irrelevant information (Chaudhuri &
). Also, Sara’s story
picture of the player’s actual coping strategy in a specific situation. Because
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other researchers’ (e.g., Cohen, 1994; Gigerenzer, 2004; Loftus, 1996)
Cohen’s
been related to functional changes in the brain’s attention systems (Fox et al.,
and executive functions are closely related with humans’ abilities to select
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’
Rob’s story, it is clear that he had a positive attitude towards both injuries.
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aspect when it comes to Rob’s emotions during this phase was that they were related to the perceived status of his knee. Because an athlete’s
(described in both Rob’s injury narratives), is essential in this phase. To stay
2008). Another challenge that also interferes with an athlete’s
other than the injury. In Rob’s case, he ended his relationship with his
fast. Also, in Rob’s story similar experiences are present. Being both mentally
Met odo ogica re ection
is possible to “draw from the strengths and minimize the weaknesses”
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Studie I V.
Stud II.
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Stud III.
Stud IV.
n light of the study’s context, and the context
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) this process could be highly influenced by the researcher’s
“true” effectiveness of the intervention
Practica i p ications
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T eoretica i p ications for future researc
the athlete’s cognitiv
activation of the brain’s various subsystems (e.g., amygdala; Cozolino, 2010).
“ scales”, “linear dynamic systems”, and that “
es”
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Conc usions and future studies
the athlete’s career, but also, to co
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References
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–
–
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“You want to measure coping but your protocol’s too long: Consider the Brief COPE.”
–
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–
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–
J.,…Meeuwisse, W. H. (200
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–
–
–
–
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Things we still haven’t learned (so far).
––
–Johnson, U. (2011). Athletes’ experiences of psychosocial risk factors
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–
:
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–
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–
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–
–
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Park, S., Lavallee, D., & Tod, D. (2013). Athletes’
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Stambulova, N. & Wylleman, P. (2014). Athletes’ career development and
–
–
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’
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). “Magnitude based inference”: A
:
–
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Appendi
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Des
crip
tion
of th
e To
pics
for t
he In
terv
entio
n an
d C
ontr
ol G
roup
s’ S
essio
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rela
ted
to th
e pa
rtici
pant
s’ b
est a
nd w
orst
Appendi
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Dis
cuss
ion
abou
t the
par
ticip
ants
’
abou
t the
par
ticip
ants
’
Dis
cuss
ion
abou
t the
par
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’
Dis
cuss
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abou
t the
par
ticip
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’
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ipan
ts’
–
Dis
cuss
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abou
t the
par
ticip
ants
’
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Dis
cuss
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abou
t the
par
ticip
ants
’
min
dful
ness
into
the
parti
cipa
nts’
socc
er