Background: Psychological factors have been demonstrated to be associated with sports injuries and the recovery period (Ardern et al., 2012). This quantitative study aimed to investigate coping strategies used during recovery to improve confidence upon return to sport and identify if the implementation of a coping strategy had a significant impact on confidence levels. Research investigating coping strategies during recovery have not focused on supporting athletes but on theoretical models and on general implications as opposed to specific impacts such as confidence levels and their ability to return at a similar level prior to the injury. The life of an athlete is often altered negatively following a sports injury with feelings of sadness, anxiety, depression, and fear of re-injury all being common responses (Reese, Pittsinger and Yang, 2012). Nixdorf et al. (2020) have suggested that sports injury can be a temporal depression and anxiety predictor in German athletes, while Schinke (et al. (2017) suggests that injured athletes exhibit higher rates of depression and anxiety and low rates of self- esteem immediately post injury. Existing literature focuses on the efficacy of interventions as opposed to their effectiveness. Sports injuries are multifactorial and even the personality of an athlete can drastically impact the recovery process (Everhart et al., 2020) suggesting there is not a universally optimal approach.
Method: 114 athletes (86 males, 28 females) took part in an online survey distributed to athletes who met a specific criterion including questions around the athletes’ background and two questionnaires: 1) the Injury-Psychological Readiness to Return to Sport scale (I-PRRS) and 2) the ACL-Return to Sport after Injury scale (ACL-RSI) which was adapted to accommodate for all injuries in this study.
Results: Athletes who used a coping strategy within their recovery had significantly higher levels of confidence compared to those who did not. Males scored higher than females regardless of if a coping strategy was used. 90% of athletes felt that the implementation of a coping strategy would have been beneficial in their recovery from injury.
Conclusions: This study concludes that the use of a coping strategy appears to improve confidence in athletes when implemented in the recovery phase of an injury, with athletes themselves also perceiving that the inclusion of a coping strategy would enhance the recovery process. Additionally, more research is required around investigating the gender discrepancies that appear to be present with regards to confidence upon return to sport following a sports injury. Further research is required to determine the most effective interventions for each type of athlete as there are a number of factors that impede the process making some strategies more effective than others such as the personality of the athlete. Lastly, the findings from this study indicate that future education around providing support and implementing coping strategies is required for coaches and practitioners working with athletes as many are not aware of the important role they play in an athletes sporting career.
Sports injuries have been traditionally deemed as the result of biomechanical forces exerted on the body that were sustained during sporting activities where the athlete is considered as the container of a set of parts that have broken down and must be repaired, but the sport psychology approach aims to bring the athlete into a central active role when sustaining and recovering from an injury (Almeida et al., 2014). The implementation of psychological interventions reducing negative psychological consequences and improving coping during rehabilitation post-injury is well documented in the medical literature (Cummiskey, Lollgen and Zupet, 2016). The traditional recovery process places its attention on rehabilitating the injured area of an athlete. However, multiple studies (Bandura, 1990; Heil, 1993; Taylor and Taylor; 1997; Wiese-Bjornstal et al., 1998; cited by Magyar and Duda, 2000) have concluded that major cognitive decreases occur following injury in athletes’ self-efficacy and confidence about returning to sport. There is a growing body of evidence linking psychological measures to sport injury outcomes (Everhart et al., 2020). Therefore, the restoration of self-efficacy and confidence should be of paramount importance during the recovery phase to promote a more successful return to sport and can possibly be achieved by including coping strategies alongside traditional rehabilitation programmes. Coping refers to any strategies or interventions used to improve psychological, physical, and emotional stress related to an injury and the rehabilitation process (Everhart et al., 2020). A consequence or returning an athlete to sport before they are psychologically ready can lead to feelings of fear, anxiety, depression, and a decrease in performance (Glazer, 2009) making it imperative that the psychological aspect is investigated and implemented as common practice going forward.
A plethora of psychological factors can influence an athlete’s ability to rehabilitate and return to sport positively including high optimism, self-motivation, athletic self-identity, and perceived social support all proving to have a positive impact with kinesiophobia, pain catastrophizing, and depressive symptoms all negatively influencing treatment outcomes (Everhart et al., 2020). Physical and psychological components should both be included during the rehabilitation of an athletic injury (Hampson-Utley and Vazquez, 2008). The frequency of injuries in sport raises concern that athletes are being treated as athletes first, and people second. There is a large focus placed on rehabilitating the injury and a neglection of the athlete’s mental well-being which causes significant psychological stress. With emerging literature revealing psychological injury prevention programmes have a major impact in reducing the injury frequency in athletes (Tranaeus et al., 2015), the inclusion of these interventions needs to be garnered with the same importance as rehabilitation exercises and physio treatment during recovery. Unfortunately, whilst practitioners do appear to be aware of the benefits of implementing psychological interventions alongside traditional physiological and medical recovery protocols, they need more education on strategies/interventions and understanding the impact an injury has on an athlete psychologically (Heaney et al. 2015).
1.2 Study Aims
The primary aim of this study is to identify if the implementation of a coping strategy during an athlete’s recovery would have a significant impact on improving confidence. The second aim is to discover if there would be any gender discrepancies in relation to confidence levels following sports injuries. Finally, the third aim of this study is to find out how the athlete’s themselves perceived coping strategies being beneficial in the recovery phase.
1.3 Rationale of this study
The research examining the success of employing psychological interventions with injured athletes is significantly lacking (Reese, Pittsinger and Yang, 2012). Whilst there is a lot of research coming out in the field of sport psychology, many of these studies investigate injury prevention, predictors of injury, and psychological factors as opposed to investigating strategies used during injury with the aim of improving confidence upon return to sport. This study will also give an insight as to how effective the athlete feels the implementation of a coping strategy would be in their recovery.
1.4 Limitations
Limitations are restrictions placed on the research proposal outside of the researchers’ control (Queirós, Faria and Almeida, 2017). In this study, the following limitations occurred:
- All surveys had to be collected online due to the current global Covid-19 pandemic. This also prevented face-to-face contact with the supervisor and prohibited use of the library for resources.
- This study was quantitative and relied heavily on the participants perceptions which may yield unreliable results.
- The inclusion criterion was exclusive to participants who experienced a serious injury (4+ weeks) at least 3 months ago to avoid any psychological distress and had to be over the age of 18.
- Soccer and Gaelic football players unintentionally made up a large percentage of this cohort (n=61%) which could skew results to the common injuries and experiences in these sports.
- Selecting the surveys to be used was a difficult process. Everhart et al. (2020) outlined 34 different assessment scales of psychological factors.
1.5 Delimitations
- The Covid-19 pandemic could have potentially made collecting data on injured athlete’s easier in this case as one of the criteria to be eligible included being at least 3-months post-injury. Sport had seized prior and for the duration results were being collected and could have prevented more players getting injured which could have possibly rendered their eligibility invalid.
- Morgan et al. (2020) described quantitative methods as being well suited to investigate psychological factors and have elucidated important factors influencing return to sport in a range of clinical scenarios.
- This study accommodated for all sports that played at a competitive level.
- Current literature focuses on confidence upon return to sport is heavily researched around ACL injuries. This study looked at all injuries over a wide range of injury lengths (1 month – 1+ year).
1.6 Research Hypotheses
The following hypotheses were postulated prior to investigation:
Hypothesis 1:
Ho: Athletes who used a coping strategy will have a higher level of confidence.
H1: Athletes who used a coping strategy will not have a higher level of confidence.
Hypothesis 2:
Ho: Athletes who used a coping strategy during their injury recovery will score higher in the I-PRRS Scale.
H1: Athletes who used a coping strategy during their injury recovery will not score higher in the I-PRRS Scale.
Hypothesis 3:
Ho: There will be no difference between confidence returning to sport following an injury among genders.
H1: There will be a difference between confidence returning to sport following an injury among genders.
The psychology of sports injuries is a comprehensive research area contributed to by numerous authors. This comes as no surprise given the fact that 17 million individuals suffer sports injuries in the United States alone every year (Clement and Shannon, 2011). In the United Kingdom, 33% of all injuries are sport and exercise related making it the leading cause of injury in the UK (Christakou and Lavalee, 2009). Sports injuries are perceived through solely physiological and medical research with the imperative role psychological factors play being overlooked until recently (Devantier, 2011). A low number of athletes report using psychological skills/strategies during rehabilitation and are underutilized in the recovery of injured athletes (Arvinen-Barrow et al., 2015). A growing amount of research is starting to suggest that psychological and social factors play a significant role in injury prevention and rehabilitation (Fernandes et al., 2014).
The life of an individual is usually altered following an injury, causing anger, depression, fear of reinjury and anxiety. This can cause the athlete to mentally adjust how they feel towards future injuries in a negative manner (Reese, Pittsinger and Yang, 2012). Other negative emotions include sadness, hostility, irritability, tension, and negative appraisals associated with returning to sport (ACSM et al., 2006). Between 5-19% of injured athletes report psychological distress levels comparable to individuals receiving treatment for mental health problems (Glazer, 2009). Furthermore, athletes who do not return to sport following an injury perceived their life three times more negatively than those who completed a rehabilitation programme and returned to sport (Ardern et al., 2012). Confidence in the injured body part is deemed as important by the athlete to be a key predictor of successful return to sport (Evans, Hardy and Fleming, 2000).
Sports injuries are multifactorial and one of the most common causes for an athlete to terminate their involvement in sport. On average, elite soccer players suffer two injuries per season with 75% of players (male and female) experiencing at least one injury every year (Santi and Pietrantoni, 2013). The result of an injury can cause both negative cognitive and emotional reactions that can impact a player’s wellbeing (Ivarsson et al., 2016). Bahr and Holme (2003) cited by Li et al., 2019) raised the issue that research around sport injury has largely been around biomechanical and physiological factors such as muscle strength, range of motion, posture, and joint instability. Other variables of sports injuries include weather conditions, playing surface, training overload and previous injury history (Boden et al., 2000) cited by Olmedilla-Zafra et al. (2017).
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