The psychological aspects of sports
injury
About this free course
This free course is an adapted extract from the Open University course Sport and exercise psychology: a
case study approach www.open.ac.uk/courses/modules/e233.
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Contents
Introduction 4
Learning Outcomes 5
1 Psychological factors and the risk of sports injury 6
2 Psychological reactions to sports injury 8
3 The role of sport psychology intervention 12
Conclusion 14
Keep on learning 15
References 16
Acknowledgements 17
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Introduction
Introduction
Sports injury is relatively common among sport and exercise participants, but what role
does psychology play in it? To answer this question, this free course, The psychological
aspects of sports injury, will examine two areas: firstly, it will consider the psychological
factors that may increase the likelihood of sustaining a sports injury, and secondly, it will
consider psychological reactions to the incidence of a sports injury. The course will also
examine how sport psychology can be used both to help minimise the risk of injury and to
help people cope better with sports injury rehabilitation.
This OpenLearn course is an adapted extract from the Open University course
E233 Sport and exercise psychology: a case study approach.
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Learning Outcomes
After studying this course, you should be able to:
l recognise the psychological factors that may potentially lead to a sports injury
l understand psychological responses to sports injury
l appreciate the role the sport psychology intervention can play in rehabilitation from injury.
1 Psychological factors and the risk of sports injury
1 Psychological factors and the risk of
sports injury
Unfortunately, injury is a relatively common occurrence among sports participants
(Timpka et al., 2005). It was estimated in the 1990s that 29.7 million sports injuries occur
each year in the UK (Nicholl et al., 1995). That figure may well have now increased.
Traditionally, the study of sports injury has focused on the physical aspects of injury. More
recently, however, the psychological aspects of sports injury have also been considered.
The psychological aspects of sports injury can be split into two broad categories:
psychological factors that may increase an athlete’s risk of developing an injury, and
psychological reactions to sports injury and their impact. You will consider both of these,
as well as examining the role that sport psychology can play in the prevention and
treatment of sports injuries.
We will begin exploring these topics by using the case study of Jody.
Case study: Jody
Judo is, and always has been, the main focus of Jody’s life. She is a full-time athlete
receiving National Lottery funding and is dedicated to achieving her goal of winning an
Olympic gold medal. However, prior to becoming injured, Jody had a lot to deal with – her
nephew had been hospitalised with a serious illness and she had recently moved house,
having split up with her long-term partner. Jody has always found it hard to relax and ‘switch
off’ and had been planning to book a session with a sport psychologist to help address this.
However, she never got round to booking an appointment.
Sports injuries can be caused by a wide variety of factors. These factors can be grouped
into four main areas: physical, environmental, socio-cultural and psychological (Wiese-
Bjornstal and Shaffer, 1999). Physical (e.g. fatigue, overuse, muscle imbalances) and
environmental (e.g. slippery surfaces, unsafe equipment) factors are perhaps more
obviously associated with injury, but the links between socio-cultural and psychological
factors and injury are less obvious.
Socio-cultural factors relate to the culture and attitudes that are often adopted within
sports teams that could encourage the development of a sports injury. Some examples of
the attitudes that could increase the risk of injury include:
l the belief that pain tolerance demonstrates strength and toughness
l an acceptance that pain and injury are part of sport – ‘no pain, no gain’
l an unwillingness to seek medical treatment for fear of appearing weak
l role and monetary pressures to continue to play sport while injured (e.g. pressure
from management or sponsors).
(Adapted from Wiese-Bjornstal and Shaffer, 1999, pp. 24–5)
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1 Psychological factors and the risk of sports injury
For the remainder of this section we will focus on the psychological factors that can
increase an athlete’s susceptibility to sports injury. You will begin by reading some
literature on this topic and linking it to Jody’s case study.
Activity 1 Psychological factors that may lead to injury
Allow about 40 minutes
Reread Jody’s case study and consider which psychological factors might have led to
her injury and how these factors could have contributed to her injury.
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2 Psychological reactions to sports injury
Comment
There are two potential psychological causes of sports injury – personality and stress.
Research examining the link between personality factors and risk of injury remains
inconclusive. To date, stress appears to have received the most research attention,
with Andersen and Williams’ (1988) model of stress and injury underpinning most of
the research in this area. Williams and Andersen (1998) later revisited this model and
made a few minor changes.
The risk of injury is thought to increase in proportion to the level of stress. Prior to her
injury Jody seemed to be experiencing some very stressful situations. Dealing with the
illness of a loved one, a relationship breakdown and moving house are all considered
to be significant life stress events. According to Andersen and Williams’s (1988)
model, this stress could have contributed to the development of her injury by:
l acting as a distraction, preventing her from focusing on her judo techniques
l narrowing her attention, causing her to miss important cues/stimuli
l increasing her muscle tension, inhibiting the coordination of her movement when
performing her judo skills.
2 Psychological reactions to sports injury
If you have ever experienced a sports injury yourself, you will have first-hand experience
of how having an injury can make people feel. Being involved in sport can become a
significant part of people’s lives. In fact, some people have a very strong athletic identity,
where their personal identity is strongly attached to being a sportsperson. When an injury
occurs, and sports participation is consequently either restricted or stopped, it can lead to
several psychological reactions. In this section we will examine some of these reactions
and the models used to explain them.
The next activity looks at two common ways of understanding responses to injury. Read
the following case study, which outlines the next stage in Jody’s case, and then try the
activity.
Case study: Jody
When Jody first became injured she was extremely upset and angry because she felt that
her world had fallen apart. Her whole life is centred on judo and her goal of becoming an
Olympic champion. She was angry because she felt that the injury was taking her dreams
away from her. Initially, she refused to accept the diagnosis and was adamant that she
would return to training and competition long before her physiotherapist suggested.
Gradually, however, she has grown to accept that the injury will cause her to miss a long
period of training/competition. She finds this very frustrating and feels jealous when she
hears other judo athletes talking about training sessions or competitions they have
undertaken. She is trying to focus her attention on her rehabilitation programme, but she is
feeling very demotivated and down because she finds her rehabilitation programme very
boring in comparison with judo training. She is also starting to experience doubts about her
ability to recover from the injury and regain her pre-injury form when she does return. She is
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2 Psychological reactions to sports injury
looking forward to returning to judo training eventually, but is worried about re-injuring the
shoulder and occasionally experiences flashbacks of the moment when the injury occurred.
Activity 2 Psychological reactions to injury
Allow about 45 minutes
Read the following extract from ‘Psychological reactions to exercise and athletic
injury’.
Reading 1
Now complete these tasks:
1 Using the information in the case study, try to match Jody’s reaction to the five
grief response stages (denial, anger, bargaining, depression and acceptance/
reorganisation) outlined in the extract. Consider how easy or difficult a task this
might be.
2 What do you think of the grief response model? Is it a good way to explain or
describe how athletes react to a sports injury? What are the limitations of the
model?
Comment
1 Grief response (or stage) models assume that an athlete will react to an injury in a
way similar to that in which an individual might respond to a significant loss, such
as the death of a loved one. This suggests that injury constitutes a form of loss to
the individual. The grief response model presented in the chapter stems from
Kübler-Ross’s (1969) model, which was originally developed to explain reactions
to terminal illness. When we examine Jody’s case study, we can probably see
some evidence of all five stages of the model, although they do not necessarily
occur in the specified order; for example, anger seems to come before denial.
2 By trying to answer these questions you are developing your critical thinking
skills. Critical thinking is an essential skill in undergraduate-level study. It is
important that you do not accept everything that you read as being correct, but
that you question and challenge what you read and look for evidence and
examples to support your analyses. Although grief response models are an
intuitively appealing way to describe reactions to sports injury, they do have
limitations. The main limitation is their rigidity: they assume that every athlete is
the same and that, consequently, all athletes will react to injury in the same
stereotypical way. In practice, this is probably not the case – Jody may react in a
completely different way to her injury than another judo athlete with the same
injury may react. For example, an athlete who has been underperforming may
see an injury as an escape from or an excuse for poor performance. Such an
athlete is unlikely to demonstrate, for example, a period of depression, because
they may be quite happy about being injured. Due to these limitations, cognitive
appraisal models have come to be more widely accepted as models of
psychological reaction to injury than grief response models, because they allow
for individual differences. Cognitive appraisal models will be discussed next. If
you are particularly interested in this area, a more detailed critique of grief
response models can be found in Brewer (1994) and Evans and Hardy (1995).
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2 Psychological reactions to sports injury
In contrast to grief response models, cognitive appraisal models take individual
differences into account. They do not assume that all athletes will react in the same way to
injury. Instead, they suggest that how an individual interprets or appraises the injury
(cognitive appraisal) will dictate their psychological reactions. This allows for Jody and
another judo athlete to exhibit entirely different psychological reactions to the same injury.
Therefore, it is the perception of an injury that affects psychological reactions, rather than
the injury itself.
Figure 1 An example of a cognitive appraisal model of psychological adjustment to athletic
injury. Cognitive appraisal models explain why two athletes can respond very differently to
the same situation.
(Source: Brewer, 1994, p. 91, Figure 1)
Figure 1 shows a cognitive appraisal model that suggests that how an individual interprets
or appraises their injury is influenced by two variables – personal factors and situational
factors. Personal factors include personality, age and previous experiences of injury.
Situational factors include the stage of the competitive year and social influences (e.g. the
coach’s reaction to the injury).
As mentioned above, the cognitive appraisal model suggests that how an individual
appraises their injury (cognitive appraisal) dictates their psychological reactions or
emotional response to the injury. The model further proposes that these emotional
responses will affect the individual’s behaviour in relation to the injury; for example,
whether or not they will adhere to their injury rehabilitation. This is shown in Figure 1 in the
final stage of the cognitive appraisal model (behavioural response). We explore this
further in Actvity 3.
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2 Psychological reactions to sports injury
Activity 3 Psychological reactions to injury
Allow about 40 minutes
Watch the video below in which 2016 Olympic hockey gold medallist Helen
Richardson-Walsh discusses the psychological impact of the various injuries she has
experienced during her career. After you have watched the video, answer the
questions below.
Video content is not available in this format.
1 What are some of the psychological reactions Helen has experienced in response
to sports injury?
2 What personal and situational factors might influence Helen’s cognitive appraisal
of the injuries she has experienced?
Comment
1. Helen describes various psychological reactions to sports injury. These include
feelings of fear, anxiety and hopelessness. She also discusses feeling a loss of identity
when not being able to play hockey, which links to the concept of athletic identity
discussed at the beginning of this section 1.3. As a full-time hockey player we would
expect Helen to have a strong athletic identity and to see a large part of her identity as
a hockey player.
2. There are various personal and situational factors that may have influenced Helen’s
cognitive appraisal of each injury she has had. Helen’s previous experiences (personal
factor) of injury are likely to have a had a significant impact. In the video Helen
mentions that she has had several injuries. Therefore, her expectations of, for
example, her likely return to full fitness and the time it will take, will probably be
influenced by how quickly she achieved this for previous injuries. The timing of injury in
relation to an important competition (situational factor) may also have affected her
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3 The role of sport psychology intervention
cognitive appraisal. For example, an injury experienced in the off-season, may evoke
lesser feelings of anxiety and frustration than an injury sustained close to a major
competition. In the video Helen describes the negative emotions attached to missing
the World Cup due to a back injury.
It is important to note that the appraisal of an injury is not static, and neither are its
consequences. Appraisals are likely to change as the injury progresses and possible
setbacks are experienced. This is demonstrated in the case studies, where Jody’s
reactions to her injury progressively changed over time.
3 The role of sport psychology intervention
The use of sport psychology techniques can be helpful in both the prevention and the
treatment of sports injuries. The next activity considers how sport psychology can assist in
both of these areas.
Activity 4 Sport psychology intervention and sports injury
Allow about 20 minutes
1 Based on what you learned in Section 1, how do you think sport psychology can
be used to prevent injury?
2 Based on what you learned in Section 2, how do you think sport psychology can
be used to aid rehabilitation from injury?
3 Watch the video below of 2016 Olympic hockey champion Helen Richardson-
Walsh and make a list of some of the psychological strategies she used to aid her
recovery from injury.
Video content is not available in this format.
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3 The role of sport psychology intervention
Comment
1 As much of what was discussed in Section 1.2 focused on the links between
stress and injury risk, it would seem logical that the use of stress management
techniques could help to reduce the risk of injury. This has been supported by
various research studies. For example, Johnson et al. (2005) found that a stress
management programme significantly reduced the number of injuries that
developed among a group of soccer players. It is plausible to suggest, then, that
Jody’s risk of injury may have been reduced had she utilised stress management
techniques.
2 If certain psychological reactions to injury can have a negative effect on
rehabilitation and rehabilitation outcomes, any intervention designed to reduce
such reactions could potentially be of benefit. The specific interventions that can
be used are shown in Box 1.
3 Helen describes three key strategies that she used, all of which are discussed in
Box 1. Firstly, she used goal-setting to help her focus. Secondly, she visualised
herself achieving her goal of becoming Olympic champion (imagery), and finally
she used a blog as a way of sharing her experience and talking to other people
(social support).
Box 1 Sport psychology interventions
Imagery
Imagery, the process of creating or recreating a scenario in the mind’s eye, can be used in
several different ways during injury. It can be used to practise physical skills when physical
practice is not possible, to reduce stress and anxiety, and to help manage pain (e.g. by
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Conclusion
acting as a distraction during painful treatments). There is also some evidence to suggest
that imagining the injured tissues healing can actually speed up the healing process.
Goal setting
Setting short- and long-term goals for recovery, return to training/competition and day-to-
day rehabilitation can help focus athletes’ attention, keep them motivated and increase their
adherence.
Positive self-talk
The occurrence of an injury can lead to negative thoughts. The use of positive self-talk can
help to develop a positive attitude towards rehabilitation.
Relaxation techniques
Relaxation techniques can help to ease the stress and anxiety that may be a consequence
of injury. They can also help to relieve tension in the injured area.
Social support
Social support can mediate some of the psychological stresses of being injured. For
example, some of the negative consequences of injury, such as loneliness and loss of
identity, occur because contact is lost with team-mates and/or coaches when an athlete is
injured. This could be alleviated by maintaining contact, by, for example, an athlete
undertaking their rehabilitation exercises alongside team practice sessions.
Conclusion
This free course, The psychological aspects of sports injury, examined the effect that
psychological factors can have on the development of a sports injury and rehabilitation
from sports injury. It also considered how sport psychology techniques can be used to
prevent sports injury and enhance rehabilitation. The main learning points are:
l Psychological factors that may predispose an athlete to injury include stress and
certain personality characteristics.
l The model of stress and injury (Andersen and Williams, 1988; Williams and
Andersen, 1998) has been used to examine the links between stress and injury risk.
l The occurrence of a sports injury can lead to several negative psychological
reactions, which can impact on rehabilitation.
l Grief response models and cognitive appraisal models have been used to describe
psychological reactions to injury.
l Cognitive appraisal models have received more support because they allow for
individual differences.
l Sport psychology intervention can greatly benefit the injury rehabilitation process.
The psychological aspects of sports injury provided an introduction to studying Sport and
Fitness Qualifications. It took you through a series of exercises designed to develop your
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Keep on learning
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Sport and exercise psychology: a case study approach.
If you enjoyed The psychological aspects of sports injury you may be interested in the
Badged Open Course E233 Exploring sport coaching and psychology.
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References
Andersen, M.B. and Williams, J.M. (1988) ‘A model of stress and athletic injury: prediction
and prevention’, Journal of Sport and Exercise Psychology, vol. 10, no. 3, pp. 294–306.
Brewer, B.W. (1994) ‘Review and critique of models of psychological adjustment to
athletic injury’, Journal of Applied Sport Psychology, vol. 6,
no. 1, pp. 87–100.
Evans, L. and Hardy, L. (1995) ‘Sport injury and grief responses: a review’, Journal of
Sport and Exercise Psychology, vol. 17, no. 3, pp. 227–45.
Galambos, S.A., Terry, P.C., Moyle, G.M. and Locke, S.A. (2005) ‘Psychological
predictors of injury among elite athletes’, British Journal of Sports Medicine, vol. 39, no. 6,
pp. 351–4.
Johnson, U., Ekengren, J. and Andersen, M.B. (2005) ‘Injury prevention in Sweden:
helping soccer players at risk’, Journal of Sport and Exercise Psychology, vol. 27, no. 1,
pp. 32–8.
Kübler-Ross, E. (1969) On Death and Dying, Toronto, Macmillan.
Nicholl, J.P., Coleman, P. and Williams, B.T. (1995) ‘The epidemiology of sports and
exercise related injury in the United Kingdom’, British Journal of Sports Medicine, vol. 29,
no. 4, pp. 232–8.
Timpka, T., Lindqvist, K., Ekstrand, J. and Karlsson, N. (2005) ‘Impact of social standing
on sports injury prevention in a WHO safe community: intervention outcome by household
employment contract and type of sport’, British Journal of Sports Medicine, vol. 39, no. 7,
pp. 453–7.
Wiese-Bjornstal, D.M. and Shaffer, S.M. (1999) ‘Psychosocial dimensions of sports injury’
in Ray, R. and Wiese-Bjornstal, D.M. (eds) Counseling in Sports Medicine, Champaign, IL
and Leeds, Human Kinetics.
Williams, J.M. and Andersen, M.B. (1998) ‘Psychosocial antecedents of sport injury:
review and critique of the stress and injury model’, Journal of Applied Sport
Psychology, vol. 10, no. 1, pp. 5–25.
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Acknowledgements
Acknowledgements
The material acknowledged below is Proprietary and used under licence (not subject to
Creative Commons Licence). See Terms and Conditions.
Course image: Groman123 in Flickr made available under
Creative Commons Attribution-ShareAlike 2.0 Licence.
Figure 1: Brewer, B.W. (1994) ‘Review and Critique of Models of Psychological
Adjustment to Athletic Injury’ (pp. 87-100)
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