Articles & Resources

Injury Prevention: Psychology and Intervention

Posted by Boston Sports Medicine and Performance Group on Sep 21, 2010 6:23:00 PM

A review by Art Horne

Some kids just always seem to get hurt, year after year they show up in your athletic training room like clockwork, even for injuries sustained outside of their sport.  How many times can the same athlete get hit by a car while riding their bike on campus? Or what about the other athlete that just seems to always be in for a new injury evaluation every Monday whether they had a game on the weekend or not.  But is it just bad luck, or does their psychological profile lend them to behaviors that clearly puts them in harm’s way at a much greater rate than their teammates?

The following serves as a brief review from Urban Johnson’s article, Sport Injury, Psychology and Intervention: An overview of empirical findings, from the Centre for Research in Sport and Health, Halmstad University.

From this article, Johnson reviews psychosocial antecedents to sport injury, “the most influential stress-injury model aimed at predicting the occurrence of sport injury was developed by Andersen and Williams, 1988, and modified by Williams and Andersen, 1998.  It posits that individuals with personality characteristics that tend to exacerbate the stress response, with a history of many stressors, and with few coping resources will be more likely, when placed in a stressful situation, to appraise the situation as stressful and thus exhibit greater physiological activation and attentional disruption.  The muscle tension, distractibility, and perceptual narrowing that occur during the stress response appear to be the mechanisms behind increased injury risk (Andersen & Williams, 1999)”

Risk Factors

Personality: “relationships are often found between injury outcome and risk factors such as internal or external locus of control, competitive trait anxiety, low self-esteem and low mood state early in the season.”

History of Stressors: “the vast majority of these studies have found a positive relationship between injury and high life stress, daily hassles, and life changes.  These findings suggest that preoccupation with life change may affect concentration on training and competition and increase the likelihood of injury.”

Coping Resources:  Several studies, “report a relationship between athletes low in coping resources and prediction of injury. Hanson et al (1992) found the coping resources were the best discriminator of both severity and number of injuries.”   Some other studies, “have shown a direct effect, with athletes low in social support exhibiting more injuries”, while other studies, “have found a relationship between negative life events and injury outcome only for athletes low in both social support and coping skills.”

Intervention Studies

Although there is some research to suggest that relaxation techniques, counseling, imagery, and team building are affecting in limiting the number of reported injuries “the implementation and assessment of controlled intervention that might lessen the stress response and reduce injury vulnerability is sparsely documented.”

Where do we go from here? Implications for practice

  1. Major Life Stressors: “major life event stress and daily hassles seem to have a direct or indirect effect on injury resiliency and vulnerability.” So where do we go from here? In a recent article I posted the “Mood Questionnaire” that we use prior to training and/or practice.  This gives me at least some talking points if an athlete scores low under, “Joy of Competition & Training”, “Focus” or “Sharpness” and allows me to pull that athlete aside and have an additional conversation and follow up as needed.  “Because of their close relationships with athletes, coaches and therapists are in a unique position to recognize athletes at-risk and help them. They are in a position to teach athletes how to expand their range of coping skills and thus to meet troublesome life events and daily hassles.”


  1. Recognize Effect of Personality Variables on Injury Outcome:  “People with high competitive trait anxiety, an external locus of control, pessimistic lifestyles, chronically low moods, and aggressive behavior seem to be at greatest risk of injury.”   With this said, Johnson suggests and we have simply added a “psychosocial risk assessment” as part of our general screening examination at the beginning of the season.  This can be as simple as:


ANXIETY SCORE:  Please rate yourself.

Prior to competition, how would you rate your anxiety level?  10 being the highest, and 0 being the lowest. ­­­____


  1. Prevention Techniques and Skills: “Relaxation techniques, including somatic relaxation techniques focusing on breathing and/or progressive muscle relaxation show promise. So does the practice of having athletes keep daily or weekly notes during the season.” Again, by tracking athletes at least once a week with a simple mood score/questionnaire, you are able to see trends develop with noticeable spikes in mood or fatigue becoming talking points for all of those involved including the sports medicine and strength & conditioning.  “Coaches and sport psychologists should consider implementing intervention programmes for athletes with a high injury-risk profile.”

Topics: Art Horne, Health & Wellness