You are on page 1of 16

Epstein 1!

Epstein, Ryan
Professor Leslie Wolcott
ENC 1102-0M03
7 December 2015
The Psychological Effects of Sports Injuries
Every day, athletes are faced with their biggest fear, getting injured. Being injured can be a
very difficult and stressful process for an athlete, since they are taken away from the sport they
love for what can be a few weeks or unfortunately forever. This bibliography explores the
question of how athletes mentally cope with sports injuries, and also how they are affected.
Throughout my research, I have found that through multiple studies dating back to 2002,
involving questionnaires, interviews, discussions, and personal experiences, there is proof that
sports injuries produce negative effects on an athlete. These negative effects can range anywhere
from a sense of loss, confusion, and frustration (Frank), to significant depression and suicidal
ideation (Putukian).
In this bibliography, there are numerous web and journal articles. I mainly aimed for
sources containing research studies because they provide scientific proof involving the overall
question of this bibliography as mentioned above. For example, Jessica Taverniti Hornbrook
concludes that self-talk is an effective coping strategy for injured athletes by reviewing
psychologically approved questionnaires that were completed by injured collegiate student
athletes with results showing that positive self-talk post-injury can help with the grieving
process. With guides on how to cope with a sports injury, and the effects that the injury has on

Epstein 2!
the athlete, this bibliography would be ideal to anyone who has suffered or is currently dealing
with a sports injury, an aspiring sports psychologist, or an aspiring physical therapist.
Ball, Daniel R. "A Pain in the Brain: The Psychology of Sport and Exercise Injury." IDEA Health
& Fitness Association. 1 Mar. 2002. Web. 18 Oct. 2015. In this scholarly web article,
Daniel R. Ball, a doctor in sport psychology and physical therapy, discusses what a
psychologist/therapist can do to help in a certain situation. For example, he starts off the
article with attentional disruption, or when an athletes focus is disrupted by stressors not
related to the activity at hand, injury can occur because the athlete is not aware of
peripheral activities or misses adjustment cues (Williams et al. 1991). In this situation,
Ball provides examples, and also what the instructor can do to help this client. The
example he provides is about a participant in a step class who is shaken up about her
mothers illness, misses a step in the routine, and sprains her ankle. For what the instructor
can do, Ball says that Exercisers need constant reminding to focus and attend fully to
the activity at hand.Its good to have casual conversation while exercising, but cue your
clients firmly when it is time to focus on a new movement or exercise. Throughout the
article, there are many sections including this one, containing all different scenarios of
sports injuries. This article could be helpful to anyone who has had a sports injury, is
currently going through a sports injury, or someone who is aspiring to be a sport
psychologist or therapist.
Belger, Allison. Coping with Injury: The Psychology of Being Sidelined. Invictus
Redefining Fitness. 08 July 13. Web. 11 Oct 15. In this scholarly web article, Allison
Belger, a psychologist and co-owner of TJs Gyms in North Carolina, talks about a

Epstein 3!
personal experience with being sidelined in a sport due to an injury, the negative effects
that can come following an injury, and strategies for helping cope with the injury. Belger
was in a womens soccer league and played in her first game since college, which was
twenty years ago. She played pretty much the whole game until the final minutes, she was
accelerating towards the ball and felt a sharp pain in her hamstring. She was able to finish
the game successfully, but a few days later, she went for a morning run and couldnt make
her hamstring work. Eight weeks after that, she was still sidelined from playing soccer.
Belger discusses the negative effects that can come following an injury, and these are
isolation: feeling lonely when injured, anxiety: regarding their sense of identity and
capacity for healing and recovery, fear of re-injury: athletes experience a phase of
vulnerability, depression: mood changing, and low self-esteem. Some specific strategies
that Belger discusses that have been shown to be helpful for athletes who are injured are
imagery: visualizing the body healing and seeing oneself back on the field or court,
journaling: writing down emotional content related to the injury, and goal-setting: writing
down goals can increase positivity and motivation for the athlete.
Campigotto, Jesse. "The Pain Game: How Athletes Deal with Injuries - CBC Sports - Sporting
News, Opinion, Scores, Standings, Schedules." CBCnews. 01 Dec.
2010. Web. 11 Oct. 2015. In this scholarly web article, Jesse Campigotto, a columnist for
CBC Sports, provides a storyline about the injuries and recovery of these injuries with
Christine Nesbitt, an Olympic speed skating gold medalist, Heather Moyse, a bobsleigh
gold medalist, and Kelly VanderBeek, an alpine skier. Campigotto divides this story up
into four parts: Part I: The Injury, Part II: The Rehab, Part III: The Help, and Part IV: The

Epstein 4!
Comeback. In Part I: The Injury, Campigotto talks about how these athletes got their
injuries. Heather Moyse got her injury while she was playing rugby, a totally different
sport than bob sleighing, and she tore ligaments in her right ankle and foot after being
tackled. Christine Nesbitt also got injured while not playing her sport; she was riding her
bike home from a workout, and she was broadsided by a car while going through a
crosswalk. She crashed into the hood of the car and suffered a small fracture in her right
elbow. Kelly VanderBeek got injured while racing down a hill in France practicing for an
upcoming event. She caught an edge, knocking her off balance, and she suffered two torn
ligaments, a fracture in the tibial plateau, and a chunk of bone ripped from the outside part
of the joint. In Part II: The Rehab, Campigotto talks about the beginning of the recovery
process for each athlete. VanderBeek was the only athlete that required surgery, and it was
successful. Moyse avoided surgery, and she loaded up on exercise. She was in a bad
situation because her right calf and quad shrunk in size and strength, so she was trying to
be in the gym as much as possible, and she would eventually get back to her normal
strength. Nesbitts recovery was the least problematic, since she is a speed skater and arms
arent an important factor in skating. In Part III: The Help, Campigotto talks about the
athletes supporters and how they helped them through this recovery. Nesbitt credited the
Candian speed skating teams exceptional medical and training staff, "the day after [the
injury] happened, I was in physio. They got me in right away, even though I couldn't do
anything, just to start trying to reduce the inflammation said Nesbitt. Moyse credited her
trainer, Matt Nichol. Moyse said "he's the best, in my books, at modifying workouts and
training not only for the individual person, but also for individual injuries.

Epstein 5!
VanderBeeks no. 1 person was her husband, who helped her get up the stairs, helped
her with her workouts, and she said he was really amazing to have in my corner to help
get through it emotionally and physically. In Part IV: The Comeback, Campigotto talks
about how far these athletes have come since first getting injured. VanderBeek achieved a
major milestone, hitting the slopes a few months after her first injury, and it was a
successful run. Moyse wouldnt return to the bob sleighing season until later on, she
wanted to take baby steps and begin by running. Nebitt is currently destroying the best
middle-distance skaters in the world, and is off to a phenomenal start.
Christos, Galazoulas. "Psychological Aspects of Rehabilitation following Serious Athletic
Injuries with Special Reference to Goal Setting: A Review Study." SDK Supplies. Jan.
2007. Web. 14 Oct. 2015. In this scholarly web article, Dr. Calazoulas Christos, who
works for the Department of Physical Education and Sports Science at Aristotle University
of Thessaloniki in Greece, discusses the benefits of intervention strategies and how they
can aid to the rehabilitation process. Some examples of these strategies that he discusses
are education (accurate information gathering and effective communication skills), social
support (family, team, coaches), psychological skill training (imagery training, cognitive
techniques, relaxation), and goal setting. After reading this article, one can conclude that
the use of these intervention techniques and specifically the goal setting process in the
rehabilitation process is prominent and seems to have positive results according to
Christos.
Cohn, Patrick. "How Athletes Mentally Cope With Injury (New Research)." Peak Performance

Epstein 6!
Sports. 2015. Web. 13 Oct. 2015. In this scholarly web article, Patrick Cohn, a doctor in
psychology, provides a type of research involving how Australian Football League Players
cope with injury, and this research was done by Mandy Ruddock-Hudson et al. Their
research identified four factors: your emotional reaction to injury, the support you receive
by others, how well you meet the challenges of rehabilitation, and your psychological
readiness to return to play. After conducting the research, the psychologists learned that
successful athletes who maintained their mental toughness, were motivated to return to
action and renewed their hunger to compete. Cohn goes on by including Mentally
tough players adopted a positive mindset that enabled them to regain a sense of selfcontrol during the course of their injury. These athletes sought to develop other aspects of
their game (physical strength, diet, mental game). The study concluded that an athletes
approach to injury significantly influences how well you cope with an injury and the
rehabilitation process.
Frank, Monica A. Assessing and Coping With Injuries. Excel At Life, LLC. 2002. Web. 7 Oct
15. In this scholarly web article, Monica Frank, a doctor in psychology, discusses the
application of sport psychology to martial arts training and coping with injuries. She
begins by talking about how an injury can prevent the self-satisfaction and
accomplishment they (the athlete) experience through their sport. She then goes on by
saying that the result of this can be a sense of loss, confusion, and frustration. She talks
about how the martial artists can set mental goals to be achieved, and this helps keep the
athlete motivated and positively focused, and also helps in reducing physical recovery
time. Frank has done research on how these martial artists use certain strategies to cope

Epstein 7!
with these injuries. Martial artists have trouble accepting and handling injuries; they are
frequently taught to simply ignore the pain. This could lead to problems of not recognizing
the seriousness of the injury. The martial artist should allow the normal emotions of grief
to occur. After the research, she concludes that the martial artist needs to recognize that
the martial arts and/or physical activities aren't the only source of satisfaction,
competence, and excitement in life.
Galland, Mark. "Dealing with the Unexpected." Orthopaedic Specialists
North Carolina. Jan. 2011. Web. 12 Oct. 2015. In this scholarly web article, Mark
Galland, a doctor in orthopedic surgery and sports medicine at Tulane University, provides
a familiar scenario to any athlete in their senior year with a season-ending injury. He
discusses the process to recovery including the steps that are needed to be taken. He starts
off by saying to set personal goals for recovery: What is it that you are trying to do after
you heal? The next step he says is to divide your recovery into smaller periods. For
example, if you strain your bicep, make a goal to go to the gym and stretch and gradually
start strengthening your bicep to the point where you can get a full range of motion.
Galland then goes on to say as you progress with your therapy and are able to perform
more activities, you may be able to assist in drills and practices. For example, a
volleyball player can start feeding balls to their coach. Also, they can help direct drills
and encourage teammates on the proper techniques. Galland concludes this article by
saying that the key to a successful recovery is staying motivated.
Hornbrook, Jessica Taverniti. "Self-Talk During Sport Injury Recovery." (2012): n. pag.
ProQuest, UMI Dissertations Publishing, 2012. Web. 26 Oct. 2015. In this research study

Epstein 8!
by Jessica Taverniti Hornbrook, Doctor of Psychology at Alliant International University,
attempts to look into the concept of self-talk and how it impacts psychological recovery of
a sports injury. The participants in this study were 82 pre injury student-athletes from four
year universities competing at the NCAA and NAIA levels. They were only eligible to
complete this study if they had been injured and out of their sport for at least a week or
more. Hornbrook writes that Self-Talk was quantified pre and post injury using the Self
Talk Use Questionnaire (STUQ) (Hardy, 2004). An example of a question on the STUQ is
I believe that my positive thoughts really help me to concentrate on a task. Along with
this statement, the athlete would be required to choose a number 0-5, 0 meaning strongly
disagree and 5 meaning strongly agree. The student athletes were also required to complete
the COPE Inventory, which is similar to the STUQ, it asks to indicate what the athlete
generally feels, when they experience stressful events. 23 of the student athletes completed
the post injury STUQ and the COPE Inventory. The findings show that there was
increased use of self-talk pre-injury and that females used increased negative self-talk pre
injury and higher positive self-talk post injury compared to male student athletes. A rather
interesting result was that athletes that injured their ankles and were treated with a cast
reported the highest rates of self-talk during post injury. Student athletes with severe
injuries also reported the most frequent endorsement of 12 of the subscales of coping
including seeking social support, planning and acceptance of the injury Hornbrook stated.
To conclude, self-talk can can be incorporated as a coping strategy for psychological
interventions, and offers great insight into the athletes experience of being injured.
Kontos, Anthony P., R. J. Elbin, Renee N. Appaneal, and Tracey Covassin. "Coping Responses

Epstein 9!
Among Athletes With Concussion, Orthopaedic Injuries, and Healthy Controls."
PsycEXTRA Dataset 21.4 (2012): n. pag. Web. 26 Oct. 2015. In this scholarly web journal
article, the four authors mentioned in the above citation who are all professors/doctors at
well-respected universities, conducted a research comparing the coping responses of
concussed athletes with those with an orthopedic injury and healthy controls and
observed sex differences in coping behaviors following sports injury. 68 participants with
a concussion, 42 athletes with an orthopedic injury, and 33 healthy controls completed the
brief COPE Inventory about one week after their sports injury. The group of participants
with a concussion reported lower active, planning, acceptance, religion, self-distraction,
venting, and self-blame coping than the group of participants with an orthopedic injury.
The group of participants with an orthopedic injury reported lower acceptance, venting,
and substance use coping than the healthy control group. Furthermore, females reported
higher levels of humor, planning, venting, and instrumental support than males. The
conclusion of this study is that athletes with a concussion may not engage in coping to
the same extent as athletes with other injuries.
McDermott, Melony L. "Stress, Coping, and Injury in High School and Collegiate Basketball
Players." (2013): 1-32. Central College, 12 Apr. 2013. Web. 21 Oct. 2015. In this research
experiment, Melony McDermott, the primary investigator, aimed to answer the question of
whether there is a difference between high school and college student-athletes due to
differences in coping mechanisms. This experiment involved eight high school and sixteen
college basketball players, and these players were surveyed based on their seasons. The
surveys that were used were the LESCA (Life Events Stress for Collegiate Athletes) for

Epstein 1! 0
stress, and the ACSI (Athletic Coping Skills Inventory) for coping mechanisms. After
reviewing all of the surveys, the final results showed that injured athletes had lower stress
scores than those who were not injured. The results also showed that high school athletes
had higher coping skills than collegiate athletes.
Noadi, Airi, and Ostrow, Andy. "The Effects of Cognitive and Relaxation Interventions on
Injured Athletes Mood and Pain during Rehabilitation." Athletic Insight. 2008. Web. 13
Oct. 2015. In this research experiment, Doctors Airi Noadi and Andy Ostrow, demonstrate
how cognitive intervention, or a set of techniques and therapies practiced in counseling,
and how relaxation intervention, or activities that relieve muscle tension, induce a quiet
body response, and rebuild energy resources; this may include deep breathing exercises,
imagery, meditation, and other techniques, improved an injured athletes mood and pain.
The purpose of the experiment was to see how effective cognitive and relaxation
interventions are on pain and mood for a sample of athletes who have experienced injury
recovery periods of over twelve weeks. There were five total participants. For this
experiment, an A-B-C-A method was used, meaning that the participants were exposed to
a baseline period (A), the two interventions (B and C), and the return baseline period (A2).
Overall, after a series of these interventions, the results of the analyses showed that three
participants out of the five total showed improvements in mood during the cognitive
intervention, but it also appeared that three participants showed improvements in either
mood or pain during the relaxation intervention.
OConnor, John William, Sr. Emotional Trauma in Athletic Injury and the Relationship among
Coping Skills, Injury Severity, and Post Traumatic Stress. Ann Arbor: ProQuest, 2010.

Epstein 1! 1
Print. In this research study by Dr. John William OConnor, there was a question regarding
the possibility of emotional trauma symptoms occurring in athletic injury and the extent to
which coping skills and injury severity affect levels of post traumatic stress. In some
previous findings, they revealed that anxiety, stress, and depression in athletes were
elevated after the athletes were injured. But the purpose of this study was to explore how
injured, elite athletes were affected by post traumatic stress. This research consisted of a
quantitative survey which was grounded in a framework. This was administered to thirtyfive injured athletes from the northeastern United States, and it was administered to see if
trauma symptoms were present post-injury and if there was any connection between
coping strategies and trauma. OConnor writes A one-sample t-test analysis was
conducted to test for reported levels of elevated traumatic symptoms. Two independent
sample t-tests were conducted to compare the trauma levels of athletes with avoidant
coping skills versus active coping skills as well as those with severe injuries versus
moderate or mild injuries. After reviewing each of the thirty-five surveys, the results of
this study proved that post traumatic stress symptoms were present in a significant
number of injured athletes, however, coping strategies and severity of the injuries were
not related in anyway to how intense the post traumatic symptoms were to the injured
athletes.
Podlog, Leslie, and Robert C. Eklund. "Return to Sport After Serious Injury: A Retrospective
Examination of Motivation and Psychological Outcomes." Journal of Sports
Rehabilitation 15 (2005): 20-34. Human Kinetics Publishers, Inc. Web. 25 Oct. 2015. In
this scholarly web journal article, doctors Leslie Podlog and Robert C. Eklund from the

Epstein 1! 2
University of Western Australia, conduct a research on experiences of competitive athletes
returning to sports following a serious injury. The participants in this experiment were
elite and sub-elite athletes requiring a minimum 2-moth absence from sport participation.
The participants were required to complete the SMS, or, the Sport Motivation Scale,
which is a 28-item inventory designed to evaluate motivation for sports participation.
After this, the participants were required to take the RSSIQ, or, the Return to Sport After
Serious Injury Questionnaire, to assess injured athletes perceived psychological outcomes
of returning to the sport. The items in this questionnaire assessed cognitive, affective, and
behavioral aspects of the athletes post-injury return outcomes. Responses were recorded
on a 7-point Likert scale with anchor statements 1 (does not correspond at all) to 7
(corresponds exactly). An example of a question on the RSSIQ is Within my first season
since returning to sport after injurymy confidence in performing challenging skills and
techniques has been lower. After thorough analysis of the questionnaires, the results show
that intrinsic motivations for returning to competition were associated with a positive
renewed perspective on sport participation. Conversely, extrinsic motivations for returning
to sport were associated with increased worry and concern. The study concludes that
motivation involving return to a sport may play an important role in return-to-sport
perceptions among elite and sub-elite athletes.
Putukian, Margot. "Mind, Body and Sport: How Being Injured Affects Mental Health." NCAA.
05 Nov. 2014. Web. 11 Oct. 2015. In this scholarly web article, Margot Putukian, the
director of athletic medicine and head team physician at Princeton University, provides an
excerpt from the Sport Science Institute, containing information about how a sports injury

Epstein 1! 3
can affect the mental health of an athlete. She starts off with some emotional responses
that are followed by an injury, including lack of motivation, frustration, isolation, and
sadness in no particular order. Putukian then goes on by saying that injury can trigger
significant depression and suicidal ideation. Some examples are provided involving these
scenarios. The first example is about Olympic skier Picabo Street. She sustained serious
knee and leg injuries in March of 1998 and battled severe depression during the recovery.
She stated: I went all the way to rock bottom. I never thought I would ever experience
anything like that in my life. It was a combination of the atrophying of my legs, the new
scars, and feeling like a caged animal. Fortunately, she received treatment and returned to
skiing before she retired later on. The other example Putukian provided is about Kenny
Mckinley, a wide receiver for the Denver Broncos. He was found dead from a selfinflicted gunshot wound in September of 2010 after growing depressed following a knee
injury. He was expected to be sidelined after surgery, and he previously made statements
about how he had no idea what he would do without the sport of football, and began
hinting signs of suicide. To conclude, athletes with sports injuries can be greatly affected
mentally, and should seek treatment as soon as possible.
Quinn, Elizabeth. Coping with the Emotional Stress of a Sports Injury." About.com Health. 16
Dec 2014. Web. 12 Oct. 2015. In this short scholarly web article, Elizabeth Quinn, a sports
medicine expert, provides some very helpful information regarding how to cope with the
negative psychological effects following a sports injury. She starts off with talking about
the athlete learning about their injury. For example, the athlete may think to themselves:
How long will recovery take? or What should I expect during rehab? By

Epstein 1! 4
understanding the injury and knowing what to expect during the rehabilitation process,
according to Quinn, you will feel less anxiety and a greater sense of control. Quinn then
talks about maintaining a positive attitude, so the athlete can be committed to overcoming
the injury by showing up for treatments and working hard. Some other strategies Quinn
talks about that can help cope with the negative effects are imagery, getting support,
setting goals, and maintaining fitness while injured. To conclude, with the right
knowledge, support and patience, any injury can be conquered without too much stress.
Secrest, Mallory. "Narratives of Collegiate Female Athletes Who Sustained Multiple
Injuries." (2010): 1-150. Mallory Secrest, May 2010. Web. 26 Oct. 2015. In this online
research study, Mallory Secrest, a graduate student in the School of Human Movement,
Sport & Leisure Studies at Bowling Green State University, attempts to observe athletes
psychological response to multiple injuries by interviewing four collegiate athlete females
twice, who were multiply injured. The first interview was unstructured and focused on
their injury experiences. The second interview was somewhat structured and expanded
more on issues raised in the prior interview. Secrest states that Composite
monologues and individual narratives were constructed from athletes direct quotes and
layered with theoretical and research discussion. These narratives included multiple
themes, such as responses to injuries and rehabilitations, coping strategies, social support,
and so on. According to the narratives, the athletes experienced to their injuries such as
shock, anger, and frustration. They also experienced distrust in their body. Overtime,
Secrest states all four athletes did learn to cope with their injuries. Social support from

Epstein 1! 5
their coaches, teammates, and trainers helped them cope with their injuries. The
conclusion of this experiment is that overall, the athletes narratives provide an in-depth
understanding of their psychological responses to multiple injuries and have practical
implications for sports medicine professionals, coaches, and multiply injured athletes.
Wilson, Lindsey. "Coping With Injuries From A Mental Perspective." Great American Media
Services and Coach and AD. 28 Dec. 2011. Web. 11 Oct. 2015. In this scholarly web
article, Lindsey Wilson, the owner and lead presenter of Positive Performance Consulting
in Seattle, Washington, discusses some research that she did on a friend who hurt her knee
while playing college basketball. She was a tough player and new that the rehab process
would be long, but after figuring out she would need multiple surgeries, the psychological
impact hit her hard. Wilson would be by her side throughout this process, and even 10
years later, says that her friend is still haunted by this psychological impact, and mourns
that she couldnt finish her college career. Today, her friend is still worried when
participating in physical activities and remembers the horrible injury she came across.
Many athletes are currently going through this and psychologists are constantly trying to
find ways to make the coping process easier.
Winsberg, Mimi. "The Psychology of the Injured Athlete." EnduranceCorner. n.d. Web. 11
Oct. 2015. In this short scholarly web article, Mimi Winsberg, a doctor in psychology and
a psychiatrist, discusses the struggles of an injured athlete, including the stages of grief,
and methods to cope with these injuries. Injury is psychologically tough for an athlete. She
provides a list of struggles; a loss of identity: identifying through a sport, a void in their
schedule: may be harder to maintain structure and social life, lack of self-esteem: struggle

Epstein 1! 6
to find new areas of life that reinforce self-esteem, their physical health: force the athlete
to confront issues of vulnerability and dependence, and their stress management: life can
start to feel more challenging and chaotic. These are all great struggles for the athlete and
the following coping methods provided by Winsberg are how the athletes overcome these
struggles; grieving: will allow the athlete to move on to the next steps of coping,
accepting: come to terms with what has happened and not live with constant regret,
resetting goals: key to a healthy healing approach, maintaining a routine: helps maintain
neuro-muscular connections, taking responsibility, being patient: faster return to normal
intensity workouts will not necessarily translate into faster recovery, and the most
important, seeking support: will help mitigate feelings of isolation and depression.