Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement.

This consensus statement summarizes key contemporary research themes relevant to understanding the psychology and socioculture of sport injury. Special consideration is given toward high-intensity sport in which elite athlete training and performance efforts are characterized by explosive physical speed and strength, mental fortitude to push physical limits, and maximum effort and commitment to highly challenging goals associated with achieving exceptional performance. Sport injury occurrence in high-intensity sport is an adverse and stressful health event associated with a complex multitude of risks, consequences and outcomes. A biopsychosocial (Engel, 1980) view is advocated which contextualizes an understanding of the psychological aspects of sport injury in light of influential sociocultural, ethical, and biomedical issues. Outcomes related to athlete health and performance excellence are of equal importance in considering how psychological scholarship, expertise and services can be used to improve efforts focused on the prevention and management of sport injury among high-intensity athletes. The consensus view is that psychology and socioculture do affect sport injury risk, response and recovery in high-intensity athletes, and that continued efforts in psychological research and professional practice are needed to protect athlete physical and mental health and contribute toward performance excellence and career longevity.

A longitudinal examination of athletes' emotional and cognitive responses to anterior cruciate ligament injury.

OBJECTIVE: To determine the emotional and cognitive impact of injury and surgery on physical recovery in injured athletes. DESIGN: A prospective longitudinal study comparing the psychosocial and physical recovery of competitive and recreational athletes. SETTING: Tertiary-care sports medicine center. PARTICIPANTS: Twenty-seven athletes (15 men and 12 women) who required anterior cruciate ligament (ACL) reconstruction surgery. INTERVENTIONS: A repeated-measures design used to compare the psychosocial and physical changes for 6 months after ACL surgery. MAIN OUTCOME MEASURES: Emotional (mood) and cognitive (coping) functions and physical recovery (range of motion, physician-rated level of recovery, and physician permission to return to sport). RESULTS: There was a significant time-effect difference in mood, with a greater mood disturbance and recovery rate for competitive athletes than recreational athletes. Differences in mood and pain coping were significant at 2 weeks and 2 months after surgery. CONCLUSION: Athletes experience significant mood changes throughout rehabilitation, which may hinder rehabilitation early in the process. Longer-term rehabilitation was not impacted by mood or pain coping. Future studies might focus on examining the process over a longer time period (1-2 years after surgery). Physicians should be aware of these findings and appropriately counsel and motivate athletes toward more favorable positive psychological and physical outcomes.

Predictors of injury in ice hockey players. A multivariate, multidisciplinary approach.

Eighty-six male high school ice hockey players participated in this prospective study to determine both the incidence of injury in high school ice hockey and the influence of physical, situational, and psychosocial factors. Physical factors included height, weight, vision, previous injuries, musculoskeletal abnormalities, and injuries present at the time of screening evaluations. Situational factors examined were level of participation, playing time, player position, and games versus practices. Psychosocial factors such as confidence, stress, social support, positive states of mind, and mood states were also examined to determine their influences on injury. Twenty-seven injuries occurred during the 1994 to 1995 season. As hypothesized, the overall incidence of injury in high school hockey games (34.4 per 1000 player-game hours) was less than the incidence of injury in Junior A hockey (96.1 per 1000 player-game hours) and was more than previously reported for Bantam youth hockey (10.9 per 1000 player-game hours). Injuries occurred more often in games than in practices, usually as a result of collisions. Physical factors such as player position and previous injuries did not significantly predict injuries, but players in the high playing time group were more likely to be injured. Psychosocial factors of low vigor and high fatigue as measured by the Incredibly Short Profile of Mood States (ISPOMS) significantly predicted high school ice hockey injuries.

Competitive athletes: preinjury and postinjury mood state and self-esteem.

In a prospective study, we determined whether preinjury and postinjury differences existed in the mood state and self-esteem of competitive athletes. The influence of severity of injury, gender, level of participation in sports, and type of sport on these dependent variables was also measured. Among 238 male and 38 female athletes from hockey, basketball, baseball, and volleyball teams, 36 sustained 43 injuries. Significant postinjury increases were noted for depression (P < 0.0001) and anger (P = 0.0012), whereas vigor (P < 0.0001) was significantly less after injury. When the 36 injuries were classified, 27 were minor or moderate (nonparticipation in sports for only one or two weekly assessments), and 9 were severe (nonparticipation for three or more weekly assessments). When a stepwise multiple regression equation was used to predict the scores for postinjury depression, the only significant predictor was the severity of injury (F = 8.48 [1, 34]; R2 = 0.30; P = 0.0063). Of the following physical and psychosocial variables--level of participation, type of sport, age, previous injury, preinjury stress, gender, mood state scales, and self-esteem--only level of participation (P < 0.0001) and type of sport (P = 0.0004) were predictors of injury. The significant preinjury and postinjury differences in mood state suggest that postinjury mood disturbances reported in previous studies are likely attributable to the occurrence of injury, are related to the severity of injury, and do not merely reflect a disturbed preinjury mood.

Modeling effects on children's form kinematics, performance outcome, and cognitive recognition of a sport skill: an integrated perspective.

This study examined the effectiveness of visual and verbal models during the initial phase of complex sport skill acquisition in children. Thirty-six girls between the ages of 7-0 and 8-11 years were randomly assigned to one of three experimental conditions in a 3 x 4 (Model Type x Trial Block) factorial design. A visual model performing an underhand modified softball pitch was viewed prior to each of four blocks of five practice trials. Verbal performance cues were added to the model at the second, third, or fourth trial block, according to the experimental condition. A multivariate repeated measures analysis of variance revealed a significant trial block main effect, with subjects showing improved matching of form kinematics to the model with increasing trials but no differences in performance outcome. More dramatic changes coincident with the addition of verbal cues were observed for some kinematic variables. Children exhibited better cognitive recognition of correct form as a function of increased exposure to the visual model.