How Athletes Cope With Injury

By Bobby Weisenberger, MS, ATC, PES

Athletes at all levels will likely experience some sort of injury over the course of a playing career. As hard as we try to prevent them, and as much as we would like them to go away, injuries will continue to happen. Injuries not only affect the athletes physically, but mentally as well. How an athlete chooses to cope with injuries can affect how long they remain out of competition.

Athletes who are better at coping with their injuries are more likely to take an active role in rehabilitation, have fewer negative thoughts, and have less anxiety about the possibility of never returning to play. Medical professionals who understand how athletes cope with injury are better equipped to assist athletes. These professionals adjust or implement coping strategies that could ultimately return the athlete to competition quicker.

According to Kildal, Willebrand, Anderson, Gerdin, & Ekselius (2005) “Coping refers to a person’s cognitive and behavioral efforts to manage stressful situations and accompanying negative emotions. The use of certain coping strategies is proposed to have beneficial effect of health by affecting the stress response as well as unhealthy or health-promoting behaviors”. Individuals cope with stress in different ways and those choices can differ based on severity of injury, mental toughness, hardiness, and gender. How the athlete chooses to cope with the stress of an injury can ultimately determine what type of outcome they have with respect to return to play.

Coping strategies can be grouped into three main categories: problem-focused coping, emotion-focused coping, and avoidance coping.

Problem-focused coping is seen as a more positive coping strategy in which the athlete either takes a more active role in their rehabilitation, or actively displays more problem-solving actions. A component of problem-focused coping is goal setting. Athletes often set specific and obtainable goals that focus on rehabilitation goals, dates for return to play, and being stronger and better than they were before injury.

Emotion-focused coping strategies consist of individuals using other stimulus to diminish negative emotions due to stress. Some of the techniques of emotion-focused coping are watching television, playing video games, venting alone or to others, and reaching out to friends, family, teammates, coaches, and medical staff.

Avoidance coping is a strategy that an athlete may use in an attempt to separate themselves from a stressful event. The avoidance coping strategy is widely seen as a negative strategy and often related to maladaptive behavior and poor rehabilitation outcomes. According to Allen et al. (2011) avoidance coping was the least desirable strategy and that athletes who were less open to new experiences were more likely to try and cope by avoiding the problem. Allen et al. also found that avoidance coping was used more by emotionally unstable athletes and that there was a strong link between disengagement/avoidance coping and neuroticism. Kildal, et al. (2005) found that extensive use of avoidant coping and low use of emotional support related to bad outcomes. While avoidance is widely seen as negative, a Carson & Polman (2010) study found that the athletes all expressed the need to remove themselves from the situation (i.e. Staying at parent’s house after surgery so to not dwell on being injured, refusing to watch games, and changing training times to avoid seeing the team). Carson & Polman concluded that avoidance coping can be beneficial to the rehabilitation process and while it is important to control short-term emotional states, avoidance coping can have long-term benefits that last well after return to play.

Factors that can affect coping strategy

Athletes who were high in hardiness and or mental toughness were more likely to use the more positive problem-focused coping strategy and a much less likely to use avoidance. According to Madrigal & Gill (2014) an athlete who is mentally tough may consider an injury like an ankle sprain to be minor or manageable and follow through with rehabilitation protocol, while an athlete who is a highly anxious may cope with the exact same injury using an avoidant strategy.

When considering gender differences, Dollen et al. (2015) found that Australian and Dutch male and female athletes in individual sports made comparable use of emotion-focused coping however, in the team sports, female athletes used more emotion-focused coping than males. Wadey, et al. (2012) found that two of their participants reported their initial coping strategy was to vent their responses either by themselves or with others. According to Wadey, et al. This cognitive emotion-focused strategy was reported to lower intensity and frequency of their psychological and behavioral responses. Athletes expressed the importance of social support from parents, teammates, coaches, medical professionals and other role models.

What does all this mean for our athletes?

Research shows that athletes use each of the three strategies (i.e. Problem-focused, emotion-focused, and avoidance) to cope with injury. Problem-focused coping has been shown to be a desirable coping strategy because the athlete actually takes a mental part in the rehabilitation process. Athletes using problem-focused coping often set strong, measurable, rehabilitation goals, and place their focus on the rehabilitation process in order to return to play stronger or better than they were before injury. Athletes are able to alleviate the post injury stress by focusing on and resolving their injury. Emotion-focused coping has been shown to be considered a positive style of coping but there are elements that can lead to negative outcomes. The positive sides of emotion-focused coping are reaching out to friends, family, teammates, coaches, medical staff, or other role models for support. The emotional support of others is important to helping an injured athlete cope with injury. Other ways of using emotion-focused coping involves using outside distractions like television, playing video games, or venting alone or to others. These examples can be negative if used in extremes as they can lead to a full disconnect. It is one thing to take some time to let go, relax, and forget about the injury for a while, but not to the point that the distractions are consuming all of the athlete’s time. Use of the avoidance coping strategy is widely looked at as negative. Majority of the research corelated the use of avoidance coping with maladaptive behaviors and negative outcomes. When an excessive amount of avoidance coping is used early in the rehabilitation process, it is more likely to be used late in the process and could ultimately lead to a bad outcome. However, there are instances when avoidance could also be positive in small amounts. Carson & Polman (2010) explained that by taking up a new hobby or job gave the athletes a positive distraction to help take their mind off of being injured. Carson & Polman (2010) also noted that the athletes used this time to work on personal or career development, and those benefits lasted long after return to play.

What does this mean for Sports Medicine Professionals, Parents, or Coaches?

Sports medicine professionals, parents, and even coaches should be aware of the different types of coping strategies, and be able to identify which strategy athletes are using. By having a good understanding of the different coping mechanisms and how athletes may use them, trained sports medicine professionals can intervene if an athlete is observed trending in a negative direction. Parents and coaches who observe an athlete trending in a negative direction could refer that athlete to an appropriate medical professional for evaluation. Athletes who fall into a negative coping behavior could be more likely to completely disengage and fail to adhere to set rehabilitation plans, delay return to play, or worse case, never return to play. By keeping the athletes on a positive trend with regards to coping, they can also keep them on a strict rehabilitation plan so they meet their goals and successfully return them to play in an appropriate time frame.

References

Allen, M. S., Greenlees, I., & Jones, M. (2011). An investigation of the five-factor model of personality and coping behavior in sport. Journal of Sport Sciences, 29(8), 841-850. doi:10.1080/02640414.2011.565064

Carson, F., & Polman, R. C. J. (2010). The facilitative nature of avoidance coping within sports injury rehabilitation. Scandinavian Journal of Medicine & Science in Sports. 20, 235-240. doi:10.1111/j.1600-0838.2009.00890.x

Dollen, M., Grove, R. J., & Pepping, G., (2015). A comparison of coping-styles of individual and team athletes of Australia and the Netherlands. International Sports Studies, 37, 36-48. retrieved from https://www.logos-verlag.de/

Kildal, M., Willebrand, M., Andersson, G., Gerdin, B., & Ekselius, L. (2005). Coping strategies, injury characteristics and long-term outcome after burn injury. Injury, International Journal of the Care of the Injured, 36, 511-518. doi:10.1016/j.injury.2004.06.013

Madrigal, L., & Gill, D. L. (2014). Psychological responses of division 1 female athletes throughout injury recovery: A case study approach. Journal of Clinical Sport Psychology, 8, 276-298. http://dx.doi.org/10.1123/jcsp.2014-0034

Wadey, R., Evans, L., Hanton, S., & Neil, R. (2012). An examination of hardiness throughout the sport-injury process: a qualitative follow-up study. British Journal of Health Psychology, 17, 872-893. doi:10.1111/j.2044-8287.2012.02084.x