How are psychological consequences of long-term sport injuries among professional athletes influenced by dominant pre-injury personal and situational factors? 

 Marta Sveb
American International School of Zagreb 
International Baccalaureate 
Psychology
Contents
Contents	
Introduction	
Pre-injury personal and situational factors	
Psychological consequences influencing physical injuries	
Integration of pre-injury factors and psychological consequences	
Conclusion	
References	

Abstract

This essay examines the question “How are psychological consequences of long-term sport injuries among professional athletes influenced by dominant pre-injury personal and situational factors?”. It begins by introducing the relevance of the topic discussed and by defining the important terms such as athletic identity, professional athlete, and long-term injury. The essay then discusses an athlete’s dominant pre-injury personal and situational factors, especially intrinsic and extrinsic motivation, by providing relevant theories and studies. It further deals with the psychological consequences of long-term injuries, more specifically depression, stress and anxiety, anger, and shock and disbelief. Additionally, the essay analyses the influence of pre-injury personal and situational factors on psychological consequence. It comes to the conclusion which suggests that although sport injuries are physical, they seem to have a profound psychological impact which is greatly influenced by pre-injury factors, especially motivation. 

Word count: 138

Introduction 
Athletic champions are made by a dream, a desire, and a vision. Those components combined with the hard physical training enable them to fulfill their athletic potential. However, some distractions might occur along the way, such as sport injuries, which do not only test an athlete’s physical but also her/his psychological strength. Tiger Woods, Eduardo Da Silva and Bethany Hamilton are just a few who suffered severe injuries. It is estimated that 2/10 athletes suffer a long-term sports injury each year. For any professional athlete, sport is a major part of their life as well as an integral part of their identity providing them with a sense of identity, source of self-esteem and a constructive way to cope with stress. Athletic identity defines the degree to which an individual identifies with the athlete role and looks to others for the acknowledgement of that role (Brewer, Van Raalte, & Linder, 1993). Through participation in a sport, an athlete gives a social statement of who they are and how they wish to be viewed in or by society.
For the purpose of this essay a professional athlete is an individual who receives payment for his/her sports performance. Sports are by definition competitive and an athlete may be involved in a team based sport, like basketball, football, and handball, or in an individualistic sport such as tennis, skiing, and golfing. Professional athletes are required to reach, maintain and surpass high levels of physical conditionings in order to succeed in competitions and in their careers. Because of the constant pressure to improve, athletes tend to push their physical limits and thus may risk injuries. Sports injury occurs due to the repetitive overuse of muscles, a direct pressure or application of greater force than the body part can stand. However, it can also be caused through a physical contact with another athlete or in everyday life. Denial of seriousness of injury and its implications prolongs the recovery process. 
 In sports, injuries are a common occurrence. Although most of the time they are short rather than long-term, this research will deal with How are psychological consequences of long-term sport injuries among professional athletes influenced by dominant pre-injury personal and situational factors? and, therefore, it is vital to define the long-term injuries. For the purpose of this research, a long-term injury is defined in terms of an athlete’s inability to participate in games, practice and competitions for a period of not less than 21 days (Bianco, 2001; Podlog & Eklund, 2007; Thatcher et al., 2007). It is recognized that sport injuries have both physical and psychological implications and those combined make recovery a tremendously challenging experience for any professional athlete. Therefore the main thesis of this paper is that scientists have identified numerous psychological consequences as a result of sports injury: depression (Tracey, 2003), stress and anxiety (Clement, Granquist, & Arvinen-Barrow, 2013), anger (Udry, Gould, Bridges, & Beck, 1997) and shock and disbelief (Johnston & Carroll, 1998). This essay will further deal with the influence of pre-injury personal and situational factors on the mentioned psychological consequences of sport injuries. 

Pre-injury personal and situational factors
An athlete’s personal and situational factors influence how athletes respond to injury and behave after the injury (Weise-Bjornstal, Smith & LaMott, 1995). At the young age, when most of the athletes are choosing to practice sport professionally, the main factor that contributes to that decision is motivation.
Motivation can be defined as an internal state or condition that activates behavior and gives it direction (Kleinginna and Kleinginna, 1981). People can be motivated by external factors (extrinsic motivation) and internal factors (intrinsic motivation). Comparison between people who are externally motivated and those who are internally motivated shows that those with intrinsic motivation have more interest, excitement, and confidence, which in turn enhances performance, persistence, and creativity (Deci & Ryan, 1991; Sheldon, Ryan, Rawsthorne, Ilardi, 1997). Therefore, some professional athletes could be motivated by money, fame or fear of disappointing their family and thus have extrinsic motivation, while others could be motivated by genuine love and natural inclination toward sport and success (Ryan, 1995).
 Intrinsic motivation describes the natural (innate) inclination toward assimilation, mastery, spontaneous interest, and exploration, which are essential for cognitive and social development and represent a principal source of enjoyment in an individual’s life (Csikszentmihalyi & Rathunde, 1993; Ryan 1995). People will be intrinsically motivated only for the activities or behaviors that have an appeal of novelty, challenge or aesthetic value. The activities or behaviors, which do not appeal as such but are still performed, are due to the extrinsic motivation. Deci and Ryan proposed a theory of Self-Determination (SDT), which is a theory of human motivation and personality. SDT mainly focuses on the intrinsic factors (intrinsic motivation) that motivate individuals to gain knowledge or independence. The theory addresses three innate needs: competence, relatedness and autonomy (Ryan, Kuhl, & Deci, 1997); that is people have a need to master different tasks (competence), a need to feel connection with other people (relatedness) and a need to feel in control of their behaviors (autonomy). If these three universal needs are met, human beings can psychologically grow and their wellbeing is promoted. Thus they become self-determined and are able to perform the behavior in which they are intrinsically interested. In order for the psychological growth potential to be at the optimal level, human beings require social environments that support them (Albrecht and Adelman, 1987). In sport, support provided by mentors and/or parents for autonomy and competence incite more intrinsic motivation (Frederick & Ryan, 1995). Furthermore, demonstrations of positive outcomes in sport are associated with more intrinsic motivation than the extrinsic motivation (Chatzisarantis, Biddle & Meek, 1997).
 In almost any situation or society, certain values and behaviors are prescribed and expected from an individual and thus people tend to perform activities that aren’t necessarily interesting due to the social pressure (Ryan & La Guardia, in press). For example, parents of an individual might expect them or even pressure them to become an athlete while one might not intrinsically find that appealing. The child’s motivation can range from amotivation, to passive compliance, to active commitment (Ryan et al., 1997). Such extrinsically motivated behaviors are performed in order to satisfy an external demand (in mentioned case, parents’ demand) or reward contingency. This type of extrinsic motivation is referred to as externally regulated (Deci & Ryan, 1985). A second type of extrinsic motivation is introjected regulation. Both types are a part of a subtheory of Self-Determination theory (SDT), called Organismic integration theory (OIT). Introjected regulation refers to accepting a regulation (that is, becoming an athlete) but not fully embracing it. Therefore, an individual becomes an athlete to avoid guilt or anxiety or to attain ego enhancements such as pride. When ego is involved, people are motivated to demonstrate ability, or avoid failure, in order to maintain feelings of worth (deCharms, 1968; Nicholls, 1984; Ryan, 1982).  Although extrinsically motivated behaviors aren’t usually interesting, the primary reason people perform them is because behaviors are prompted, modeled, or valued by significant others (Ryan, Stiller, and Lynch, 1994).  
Extrinsically motivated behaviors are hence greatly influenced and fostered by the social environment of an individual. Therefore, an athlete’s social environment has an important impact on their motivation and performance. In 1979 Henry Tajfel proposed the Social Identity Theory (SIT). Human beings do not have only the individual identity but also a collective, social one. Social identity is the individual’s self-concept derived from perceived membership of social groups (Hogg & Vaughan, 2002). SIT is based upon the assumption that people tend to identify themselves with the group they belong to (in-group) and thus favor it at the expense of their out-group. People tend to use social categories such as ethnicity, religion, occupation and eye color to categorize themselves and they strive to increase their self esteem through social comparison. In other words, in team-based sports, a player identifies with his club and through positive comparison with the opponent club his self-esteem increases. The process is called positive distinctiveness and it is a source of pride and self-esteem (Tajfel, 1979). SIT helps define sport as a source of self-esteem for a professional athlete. When athletes suffer a long-term injury, they are unable to practice nor compete and thus they are unable to identify themselves with the club, team or sport. This results in the loss of social identity and, therefore, loss of positive distinctiveness. Athletes are no longer able to compare to their outgroups and hence unable to use comparison to increase their self-esteem.  
 The findings of Tajfel’s study are further supported by the idea of athletic identity. Athletes develop a unique athletic identity, which is the degree to which an individual identifies with the athletic role and requires acknowledgement from their society for that role (Brewer et al., 1993). Sport becomes a social statement of who they are and how they wished to be seen by society. Athletic identity is one of the primary techniques athletes use to evaluate their worth and competence. The amount of worth and competence an athlete places on identity may influence self-esteem, affect, and motivation (Brewer et al., 1993). The benefits of strong athletic identity include higher self-esteem, confidence and discipline, strong sense of self, and it may affect the performance positively. However, there are certain risks of having a strong athletic identity. Some researchers have found that athletes may neglect other aspects of their life in order to fulfill their athlete role. Athletes with strong athletic identity have a more difficult time coping with sports injuries and thus lose confidence. The sport becomes their primary source of self-worth and thus when they have to retire or when they get injured athletes tend to have difficulties adjusting to a life without “their” sport. Athletic identity generally seems to be a positive concept, which is present in most of professional athletes.

Psychological consequences influencing physical injuries 
One of the significant psychological consequences of physical injuries among professional athletes is depression (Tracey, 2003). Tracey examined the emotional responses of injured athletes during the rehabilitation process and in order to enable practitioners and researchers to develop a more effective recovery method. The participants were 10 university student-athletes from U.S. suffering a moderate to severe sports injury. The participants were interviewed about their emotional experience of injury three times: following the injury, 1 week post-injury and 3 weeks post-injury. The prevailing emotions that they identified included loss, decreased self-esteem, frustration and anger. Through discussion, athletes’ thoughts changed to perceive the injury as a challenge and even beneficial for their self-development. Their thoughts and perception became positive. Because all the participants were U.S. university athletes, generalization is limited due to cultural and social factors. Furthermore, there is a significant difference between professional athletes and university athletes. That is university athletes do not get paid for their participation and hard work. For that reason, the extent of emotions among professional athletes might be wider and/or different. University athletes tend to depend on sport mostly for the purposes of scholarships for education, while professional athletes devote their lives to sport and base their self-esteem, confidence, worth, and identity on their success.  However, Tracey aimed for understanding of psychological consequences of sports injury and, as a result, researchers gained new knowledge and perception which helped them model new recovery methods which will in future help other injured athletes. Additional studies that follow support Tracey’s findings.
 Moreover, research has also found that stress and anxiety are a common consequence of sports injuries (Clement et al., 2013). The purpose of the study was to determine psychological responses and coping behaviors athletic trainers notice that their athletes display and the psychosocial strategies athletic trainers use on athletes or wish to use. The method used in this study was an online survey containing qualitative and quantitative items. There were 215 participants, all athletic trainers (86 male, 129 female). The results of the study showed that stress, anxiety and anger were rated as primary psychological responses that athletes might display after a sports injury. The primary focus of this study weren’t the psychological consequences of sports injury on athletes but rather the perception of them by the athletic trainers. Thus, the study doesn’t provide an explanation for the occurrence of stress and anxiety. Random sample in the study is not large enough to represent the total population of athletic trainers of every sport. However, the findings can be generalized to all the sports because athletic trainers who participated in the study came from various areas of sport. Therefore, it is possible to perceive stress and anxiety as universal emotions which can occur as a consequence of sports injuries in a majority of sports. 
 In addition to mentioned factors anger seems to play a significant role among the professional athletes (Udry et al., 1997). The study aimed to examine the role of coping strategies and social support among injured athletes during rehabilitation from knee surgery and involved twenty five athletes with severe knee injury who were assessed five times: that is presurgery, and 3, 6, 9 and 12 weeks post-surgery. The researchers used descriptive statistics to analyze their results, and the statistics showed that instrumental coping was the most used coping strategy. Instrumental coping (problem-solving) focuses on techniques to tackle the issue in order to reduce stress around a given situation, in this case a knee injury and surgery. Such instrumental coping was a significant predictor of an athlete adhering to the rehabilitation process at ninth week of post-surgery. Although the study proposes that instrumental coping is most widely used as a technique among athletes during the process of rehabilitation from an injury, all the participants of this study had a knee injury and had to undergo a surgery. Thus, the generalization is affected because it might be that knee injury influences athletes to have different emotional responses than other body part injury would. It also depends upon the sport an athlete practices because the importance of the knee, and leg itself, varies between different sports. Even though the study suggests that anger plays a significant role during rehabilitation it doesn’t expand on its significance. However, the injured athletes were assessed five times during the rehabilitation and thus researchers were able to follow the gradual changes in emotional responses as well as the coping techniques. 
Shock and disbelief are also psychological consequences of sports injury (Johnston et al.,1998). Emotional responses of athletes were measured after an injury and in their situational and temporal contexts. Researches used interviews as a method of research and thus sixteen severely injured athletes participated in the study. Furthermore, the results such as emotional responses, appraisals, events, and behaviors that researchers obtained from the analysis were presented using diagrams. Throughout the rehabilitation process the main emotions athletes dealt with were depression and frustration. However, causes of the emotional response differed as the athletes went through the different stages of the rehabilitation. Thus, in the early stages of the rehabilitation, depression and frustration were caused by inability to continue participating in a sport. In the middle stage they were influenced by a negative appraisal of rehabilitation process, while at the end of rehabilitation the primary cause was eagerness to return to sport. Even though sixteen interviewed athletes displayed a common pattern of emotions and their causes, the sample was small. The random sample, sixteen randomly chosen severely injured athletes, is inadequate to use it as a representation of all the injured athletes. It is also important to take into consideration that researchers interviewed severely injured athletes who might not ever return to sport (due to injury or retirement) and thus the results of this study should not be used to predict or describe the emotional responses of professional athletes following a sport injury who might be able to go back to sport. Different factors such as pre-injury personal and situation factors, social support and motivation might have influenced the results. However, the study gives a general idea of what psychological consequences long-term, severe, sport injuries have among professional athletes especially because the analysis of the data was precise due to usage of the NUD*IST (Nonnumerical Unstructured Data Indexing Searching and Theorizing) computer program. Researchers followed the emotional processes that happened among athletes during the entire rehabilitation process and thus provided a descriptive report of the gradual psychological change during the process. 

Integration of pre-injury factors and psychological consequences 
As demonstrated above some of the most prominent consequences of sport injury among professional athletes are depression, stress and anxiety, anger, shock and disbelief. Further research will demonstrate the interaction between them and the pre-injury personal and situational factors. Based on the reviewed studies it is reasonable to state there is a complex interplay between the consequences and pre-injury personal and situational factors. In particular, the type of motivation (intrinsic vs. extrinsic) an athlete demonstrates prior to injury could affect the onset of depression. If an athlete is intrinsically motivated by factors such as love for the sport, their athletic identity is lost due to the injury and this causes an athlete to lose self-esteem and feel the loss of worth and thus develop depression. On the other hand, if an athlete is externally motivated by factors such as fame and money, they might suffer a decrease in their popularity and consequently lose the self-esteem and feel worthless. Those feelings cause an athlete to be stressed and anxious about their future. Moreover, athlete’s motivation might change post-injury. While they were once motivated by fame and fortune, after suffering a severe and long-term injury they might become intrinsically motivated to succeed in the sport they practice. However, it could also occur that an athlete’s motivation changes from the intrinsic to the extrinsic because if they once loved the sport, they might start developing feelings of hatred or anger but continue to be motivated in order to attain the prior to injury level of self-esteem. 
Social and athletic identities are also significant factors which may influence the post-injury onset of negative emotions. An athlete loses their identity and the source of self-confidence resulting in frustration and depression. In addition to that, an athlete is excluded from the team during their rehabilitation and that might influence the emotions of stress and anxiety because one might become anxious about their place within the team. For those of single athlete sports, the loss of social identity includes the loss of national/club identification. That is, an athlete no longer represents his nation/club and thus feels as a disappointment. This again could give a rise to a range of emotions such as depression, anger, and anxiety. Some athletes with strong athletic identity might become anxious after an injury due to the lack of opportunities in the fields excluding their athletic experience. Furthermore, because sport is the imperative in any professional athlete’s life and a great extent of their psychological well being depends on it, when they are forced to quit they are shocked and in a disbelief. 

Conclusion 
There is a clear connection of psychological consequences of physical long-term injuries among professional athletes with their pre-injury personal and situational factors. Due to their dependence on sport as a source of self-esteem, worth, confidence, and identity once athletes suffer a long-term injury emotions such as depression, anger, stress and anxiety, and shock and disbelief may arise. Studies demonstrated in this research paper advocate the mentioned emotions as universal among professional athletes, regardless the sport they practice. Although sport injuries are physical, they seem to have a profound negative psychological impact on athletes’ lives and may cause a psychological disturbance, which sabotages the fulfillment of athletic potential. Therefore, in order to return to sport an athlete should devote time to tackling both the physical and psychological consequences of sport injuries. 

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