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Psychological Reactions to Exercise and Athletic Injuries

This is an excerpt from Foundations of Sport and Exercise Psychology 8th Edition With HKPropel Access by Robert S. Weinberg & Daniel S. Gould.

Despite taking physical and psychological precautions, many people engaged in vigorous physical activity sustain injuries. Even in the best-staffed, best-equipped, and best-supervised programs, injury is inherently a risk. Therefore, it is important to understand psychological reactions to activity injuries. Sport psychology specialists and athletic trainers have identified varied psychological reactions to injuries. Some people view an injury as a disaster. Others may view their injury as a relief—a way to get a break from tedious practices, save face if they are not playing well, or even have an acceptable excuse for quitting. Although many different reactions can occur, some are more common than others. Sport and fitness professionals must observe these responses.

Emotional Responses

As they began to examine the psychology of injury in athletes, sport psychologists first speculated that people’s reaction to athletic or exercise-related injury was similar to the response of people facing imminent death. According to this view, exercisers and athletes who have become injured often follow a five-stage grief response process (Hardy & Crace, 1990). These stages are

1. denial,
2. anger,
3. bargaining,
4. depression, and
5. acceptance and reorganization.

This grief reaction has been widely cited in early articles about the psychology of injury, but evidence shows that although individuals may exhibit many of these emotions in response to being injured, they do not follow a set, stereotypical pattern or necessarily feel each emotion in these five stages (Quinn & Fallon, 1999; Udry et al., 1997). Based on this research, sport psychologists recommend that we view typical responses to injury in a more flexible and general way—people do not move neatly through set stages in a predetermined order. Rather, many have more than one of these emotions and thoughts simultaneously or revert back to stages that they have experienced previously. Nevertheless, although emotional responses to being injured have not proved to be as fixed or orderly as sport psychologists once thought, you can expect injured individuals to exhibit three general categories of responses (Udry et al., 1997):

1. Injury-relevant information processing. The injured athlete focuses on information related to the pain of the injury, awareness of the extent of injury, and questions about how the injury happened, and the individual recognizes the negative consequences or inconvenience.
2. Emotional upheaval and reactive behavior. Once the athlete realizes that he is injured, he may become emotionally agitated; have vacillating emotions; feel emotionally depleted; feel isolated and disconnected; and feel shock, disbelief, denial, or self-pity.
3. Positive outlook and coping. The athlete accepts the injury and deals with it, initiates positive coping efforts, exhibits a good attitude and is optimistic, and is relieved to sense progress.

Most athletes move through these general patterns in reaction to injury, but the speed and ease with which they progress vary widely. One person may move through the process in a day or two; others may take weeks or even months to do so. One long-term study of 136 severely injured Australian athletes showed that the period immediately after the injury was characterized by the greatest negative emotions (Quinn & Fallon, 1999).

Psychological Relevance

Although a great deal of research has been done on psychological reactions to injury, one aspect that has been virtually neglected is the meaning or relevance of injuries to athletes; only a couple of researchers have addressed this topic. Grindstaff and associates (2010) interviewed intercollegiate athletes and found four primary meaning themes:

1. Perspective. Some athletes saw sport injury as an experience that challenged their perspectives on life and sport, such as what was to be learned from the purpose and timing of the injury.
2. Emotion. Some athletes discussed the dynamic, changing nature of emotions and their increasing willingness to share their feelings.
3. Coping. Some athletes thought about meanings concerning the importance of accepting injury challenges and overcoming them.
4. Relationships. Some athletes thought the relationships formed reflected the relevance of social connection and support to their recoveries.

Another example of psychological relevance or meaning of injuries was investigated by Samuel and colleagues (2015), who interviewed athletes who were recovering from severe injury, which allowed them to study athletes’ reactions to injury over a long period of time. Athletes discussed injury as disrupting their engagement with their sport and friendships with teammates, as well as creating emotional imbalance because they were losing their long-felt athletic identity. Athletes also talked about having to learn coping strategies to effectively deal with the changes caused by the severe injury.

Other Reactions

Athletes have additional psychological reactions to injury (Petitpas & Danish, 1995). Some of these other reactions may include the following:

1. Identity loss. Some athletes who can no longer participate because of an injury have a loss of personal identity; that is, an important part of themselves is lost, seriously affecting self-concept. Research has found that athletes had higher levels of intrinsic motivation when coaches provided a supportive environment during the rehabilitation process, which, in turn, helped them maintain an important part of their self-identity as athletes (Horn et al., 2013).
2. Fear and anxiety. When injured, many athletes have high levels of fear and anxiety. They worry about whether they will recover, whether reinjury will occur, and whether someone will replace them permanently in the lineup. Because the athlete cannot practice and compete, there’s plenty of time for worry.
3. Lack of confidence. Given the inability to practice and compete and their deteriorated physical status, athletes may lose confidence after an injury. Lowered confidence can result in decreased motivation, inferior performance, or even additional injury if the athlete overcompensates.
4. Performance decrements. Because of lowered confidence and missed practice time, athletes may have postinjury declines in performance. Many athletes have difficulty lowering their expectations after an injury and may expect to return to a preinjury level of performance.
5. Group processes. Injury to an athlete can affect group processes in a team either negatively or positively. For example, an injured basketball player who can’t play for two months might disrupt the smooth flow and teamwork that was developed through working together with the other four players. Conversely, sometimes when a high scorer gets injured, the other players rally around each other and contribute more effort, actually bringing the team closer together (see Benson et al., 2013).

The loss of personal identity is especially significant to athletes who define themselves solely through sport. People who sustain a career- or activity-ending injury may require special, often long-term, psychological care.

While the majority of effects of being injured are negative, positive growth can result. For example, injured players might realize how much they really love their sport and become reenergized after being injured and returning to play, or by having to deal with the adversity of being injured, athletes might learn more about themselves and develop new coping strategies.

Signs of Poor Adjustment to Injury

Most people work through their responses to injury, showing some negative emotions but not great difficulty in coping. One national survey of athletic trainers revealed that they refer 8% of their injured clients to psychological counseling (Larson et al., 1996). How can you tell whether an athlete or exerciser exhibits a normal injury response or is having serious difficulties that require special attention? The following are warning signs of poor adjustment to athletic injury (Petitpas & Danish, 1995):

• Feelings of anger and confusion
• Obsession with the question of when one can return to play
• Denial (e.g., “The injury is no big deal”)
• Repeatedly coming back too soon and becoming reinjured
• Exaggerated bragging about accomplishments
• Dwelling on minor physical complaints
• Guilt about letting the team down
• Withdrawal from significant others
• Rapid mood swings
• Statements indicating that recovery will not occur no matter what is done
  
  

A fitness instructor or coach who observes someone with these symptoms should discuss the situation with a sports medicine specialist and suggest the specialized help of a sport psychologist or counselor. Similarly, a certified athletic trainer who notices these abnormal emotional reactions to injuries should make a referral to a sport psychologist or another qualified mental health provider just as she should if an uninjured athlete exhibits general life issues (e.g., depression or severe generalized anxiety) of a clinical nature.

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