Drew Dickson, Erica French, Melissa Gonano, Brad Rasmus (Australian Catholic University

This study prospectively investigated the psychological effects from sports injuries and the factors that contributed to sports performance comeback in 27 male athletes from contact and non-contact sporting activities. The sample group was divided into two categories – fast healing (recovered in less than 12 weeks) and slow healing (recovery took longer than 12 weeks). A survey format was used to measure the psychosocial variables -attitude, outlook, stress levels, support, self talk, goal setting and imagery, and subsequent comparisons were made. 59% of participants were defined as fast healers while the remaining 41% were termed slow healers. Although the results showed differences between the two groups for imagery, outlook and social support (with fast healers using more mental strategies in the recovery process), the results were not significant enough to constitute any evidence. Both groups experienced comparably high levels of stress at the time of their injury

Key Words: Recovery, Attitude, Outlook, Stress, Support, Self-Talk, Healing Imagery, Goal Setting.

Sports injuries are a major concern to both coach and athlete and with an alarming 3 to 5 million adults and children injured each year in sport and exercise related activities (Weinburg & Gould, 1999), it has heightened interest into this area of investigation, with research delving into the nature of injuries and its increasing occurrence. It is hoped that through exploring the multifaceted nature of injuries that more knowledge will be obtained to help improve the rehabilitation process, and aid athletes to return sooner to their chosen sport.

The impact of athletic injury is dependent on a number of factors, including the nature and severity of the injury, the importance of sport in the athlete's life, and the reaction of the athlete's support network to the injury (Petitpas & Danish, 1995). To some, an injury can be seen as an escape from training or from fear of failing in competition.

Much of the original research into this area concentrated on the effects of physiological factors such as training methods eg. over training, biomechanical deficiencies and facilities, and equipment limitations. More recently however, professionals have become increasingly aware of the many psychological and social factors that may have a profound effect on the occurrence of injury. Crossman (1997) states that the psychological trauma following an injury is often more difficult for the affected athlete than the physical trauma.

The subjects were 27 physically active males who had sustained an injury in their chosen sporting activity and who ranged from 18 – 55 years of age (with a mean age of 26.5 years). The injury had to have occurred in the last five years in order to be eligible to participate in the research study and it had to have affected their participation in the activity for a minimum period of four weeks.

The survey chosen, the Sports Injury Survey, attempted to explore and identify the psychological factors affecting sports performance comeback post injury. More specifically, the survey intended to delineate the relationships between the following psychological factors and recovery time: attitude, outlook, self-talk, social support, mental imagery, levels of stress, and goal setting. The survey used a triangulation method (combination of quantitative and qualitative approaches) in order to assess participants psyche. Questions that required a numerical response were ranked on a scale of 1 – 10 and in most cases the subject was invited to expand on their numeric response.

The surveys were distributed to injured males via Health Clubs, Physiotherapists, Rehabilitation Clinics, Grade Cricket Clubs, NSW Kayak Institute of Sport, and NSW Swimmers. The cover sheet of the survey included a brief statement concerning the purpose of the study, ie to investigate the psychological effects of injury on sports performance comeback. It also assured participants that all medical and survey material would be kept confidential and that they were entitled to withdraw from the study at any time. The subjects were required to sign two consent forms (in which they were advised to keep one copy for record purposes). The surveys were then returned to the respective researcher in order to be analysed and correlated.

Quantative Results

What helped the most. The fast healing group appeared to rely more on external sources such as physiotherapists and the rehabilitation process than they did internal sources such as visualisation and personal responsibility. The slow healing group showed varying responses ranging from physiotherapy to mental attitude, social support, and rest.

Mental Strength. The consensus among the fast healing group was that a positive mental state will affect the speed of recovery. The slow healing group focused more on the physical side of recovery than the mental.

Levels of Stress. Responses indicated that the perception of stress is very individualised. Subjects within both groups provided copious amounts of varying responses.

Social Support. Subjects within both groups appeared to receive support from various sources with neither group showing consistent support from one particular outlet. Support came from family, team mates, physiotherapists, coaches, and some participants didn’t even receive any support at all.

Self-Talk. Participants in both the fast and slow recovery groups showed inconsistent feedback. Furthermore, responses from the slow healing showed just as much variability as the fast healing group.

Fear of Reinjury. Included planning to take preventative measures, very fearful of reinjury, to no worries about re-injury whatsoever. It was expected that fast healers would be generally less fearful or concerned about reinjury compared to the slow healers, however results indicate otherwise. In response most subjects stated that they thought constantly about reinjury.

Goal-Setting. Again, no conclusive results were found amongst either of the groups. It was expected that the fast healing group would be more involved in goal setting than the slow healing group, however results show inconclusive evidence to support this hypothesis.

Imagery. A high percentage of the participants did not practice imagery on any basis.

Although no significant differences was obtained from the present research study, it was discovered that those identified as fast healers had a better outlook towards their injury than those subjects identified as slow healers. This suggests and supports the findings of Iveleva & Orlick (1991) who stated that "The factors of attitude and outlook are considered to be critical in virtually all types of rehabilitation".

Although both categories displayed reasonably high levels of perceived social support, the fast healers tended to receive slightly more support from significant others (ie family, friends, coach, physiotherapist), than did the slow healers.

Weinberg et.al., (1999) concluded that people who develop psychological skills may deal better with stress, reducing both their chances of being injured and the stress of injury, should it occur.

Although previous research has concluded that high stress levels predispose athletes to injury (Petrie, 1993; McCullagh & Tonymon, 1992; Blackwell & McCullagh, 1990), the present study failed to find a significant difference between the time spent away from the activity and the amount of stress in the subject’s life at the time. However, both groups did show comparable levels of life stress supporting the fact that an accumulation of stress over a given period of time can significantly increase the likelihood of injury occurring (Petrie, 1993).

Although subjects could not change the fact that they were injured, they could control their thoughts about the injury and the recovery process. The results indicate that both categories experienced some sort of grieving in response to the injury before they were able to concentrate on the positive aspects of time away from competition.

Goal setting is said to be "… an important first step in indicating positive action toward a speedy recovery" (Iveleva & Orlick, 1991, p 27). The results indicate that both categories participated in some sort of goal setting, whether it was short term rehabilitation goals, or long term performance goals.

It may therefore be concluded that mental strategies can contribute to the overall healing process of an injured athlete. Furthermore, injured athletes should focus on mental strategies in order to decrease the potential life stress experienced by performing sports people. By successfully controlling the mental state, athletes can speed up the recovery process and achieve the desired sports performance comeback.

Several Possible limitations:

1. Small sample size of 27.

2. The type of injury was not a prerequisite to participate in the study.

3. The injury had to have occurred within the last five years.

Email correspondence: S.Burke@mackillop.acu.edu.au