In 1988, Andersen and Williams, through their research on "A Model of Stress and Athletic Injury: Prediction and Prevention" aimed at presenting a framework for the prediction and prevention of sport-related injuries. What they achieved was the provision of a broad theoretical foundation for future investigations in the subject, together with the presentation of the psychological variables that are relevant to the stress-injury relationship.
Further research has also pointed out a potential relationship between levels of stress and risk of injury. According to the multicomponent theoretical model of stress and injury most psychological variables, if they have an effect on injury, probably do so, through an association with stress and a resulting stress response (Andersen & Williams, 1988). According to the stress-injury model, when sport participants are put in a stressful situation such as a crucial game or competition, the athlete's history of personal stressors, cognitive stressors, perceptions, and coping resources contribute either interactively or in isolation to the stress response.
The central hypothesis of the model is that individuals with high personal stressors, cognitive stressors that tend to aggravate the stress response and few coping resources or social support, will, when placed in a stressful situation, be more likely to understand the situation as stressful and to manifest greater muscle tension and attention disruptions. The severity of this stress response is the mechanism proposed to cause the injury risk (Andersen & Williams, 1988). The central core of the model, which is the stress response, is a bi-directional relationship between the person's cognitive and emotional estimation of a potentially stressful situation and the physiological aspects of stress.
Causes of sport injury
According to the research of Wiese-Bjornstal et al., 1999, there are four main areas that could cause sport injury. These are:
- Physical - These include fatigue, muscle overuse, muscle strain, ligament sprain, poor training practices etc.
- Environmental - These factors are associated with athletic equipment, weather conditions, playing surfaces etc.
- Socio-cultural - These are the perceptions and beliefs of athletes that are based on cultural and societal norms. Some of these could be to demonstrate mental toughness and carry on playing despite the pain, the importance posed on victory and distinction, the "sport ethic" of pain as a reasonable sacrifice in professional sports.
- Psychological- Two main factors have been characterized as potential antecedents of a sport injury, stress and personality.
Psychological factors that can increase the risk of developing an injury
This part aims at explaining how the individual's response to a potentially stressful situation could impact the occurrence of injury. When an athlete enters a potentially stressful situation, such as a game with a difficult opponent or a demanding training, their perceptions, previous experiences and personality are those that will define their reaction.
At first, they will appraise the situation based on perceived capabilities and their understanding of demands. The relationship between demands and perceived capabilities will affect their levels of stress. The more they feel their strengths cannot meet the demands of the task, the more they are likely to experience stress.
Stress response includes two elements, the attentional and the physical. Attentional is related to peripheral vision, as stress affects the ability to detect signs in the peripheral environment. This narrowing of vision together with a focus only at things that are straight ahead could result to a player getting hurt, by accidentally clashing with their opponent. Another feature that could be noticed is distraction, stemming from an overflow of thoughts, which, again, inhibits proper focus and may have similar results to "tunnel vision".
From a physical standpoint, the bodily changes associated with stress response, such as muscle tightening, elevated heart rate, sweating, increased blood pressure could impair flexibility and co-ordination of movement, making someone more prone to injury.
The final response to the potentially stressful situation is also affected by personality factors, which will be discussed below, history of stressors or present life events that are considered significant lifestyle change and available coping resources. In addition, psychological interventions in the form of introduction of psychological skills' interventions like cognitive restructuring or mindfulness could alleviate the effect of the stress response.
Other mechanisms that could explain the connection between stress and injury are immunosuppression (in cases of chronic stress), sleep disturbance and its effects, altered self-care and disrupted tissue repair (due to increased secretion of cortisol).
As discussed in the previous part, personality is a factor that could act as a moderator of stress response.
- Competitive Trait Anxiety (CTA). Based on the research of Appaneal and Habif in 2013, more than twenty personality characteristics could be linked to sports injury. One of the most prominent is CTA. This is a behavioural predisposition to perceive competitive situations as threatening and then respond with state anxiety levels that are disproportionately higher to the actual levels of threat. People who demonstrate CTA are more likely to exhibit a stronger stress response, together with sleep disturbance, which are both factors that could contribute to a sport injury.
- Type D personality, also known as the distressed personality, refers to individuals that have high scores at the scales of negative affectivity and social inhibition. The latter is described as a tendency to inhibit the expression of emotions and behaviours in social interactions, while the former is a tendency to experience negative emotions across time and situations. Polman et al., in 2010 concluded that Type D Personality is positively correlated with perceived stress as well as negatively correlated with social support from family and friends.
Based on the above, one could easily understand that sport injury is a multi-dimensional matter, affected by a range of factors. Psychological mechanisms could potentially act as antecedents of sport injury, while development of coping skills could alleviate their effect.