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Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention

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Abstract

Background

Several studies have suggested that psychosocial variables can increase the risk of becoming injured during sport participation.

Objectives

The main objectives of these meta-analyses were to examine (i) the effect sizes of relationships between the psychosocial variables (suggested as injury predictors in the model of stress and athletic injury) and injury rates, and (ii) the effects of psychological interventions aimed at reducing injury occurrence (prevention).

Methods

Electronic databases as well as specific sport and exercise psychology journals were searched. The literature review resulted in 48 published studies containing 161 effect sizes for injury prediction and seven effect sizes for injury prevention.

Results

The results showed that stress responses (r = 0.27, 80 % CI [0.20, 0.33]) and history of stressors (r = 0.13, 80 % CI [0.11, 0.15]) had the strongest associations with injury rates. Also, the results from the path analysis showed that the stress response mediated the relationship between history of stressors and injury rates. For injury prevention studies, all studies included (N = 7) showed decreased injury rates in the treatment groups compared to control groups.

Conclusion

The results support the model’s suggestion that psychosocial variables, as well as psychologically, based interventions, can influence injury risk among athletes.

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Notes

  1. None of the studies in the meta-analyses had data that were normalized for exposure time or included specific calculations for specific types of injuries.

References

  1. Ekstrand J, Hägglund M, Waldén M. Injury incidence and injury patterns in professional football: the UEFA injury study. Br J Sports Med. 2011;45(7):553–8.

    Article  CAS  PubMed  Google Scholar 

  2. Drawer S, Fuller CW. Perceptions of retired professional soccer players about the provision of support services before and after retirement. Br J Sports Med. 2002;36(1):33–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Drawer S, Fuller CW. Propensity for osteoarthritis and lower limb joint pain in retired professional soccer players. Br J Sports Med. 2001;35(6):402–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Hagger MS, Chatzisarantis NLD, Griffin M, et al. Injury representations, coping, emotions, and functional outcomes in athletes with sports-related injuries: a test of self-regulation theory. J Appl Sport Psychol. 2005;35(11):2345–74.

    Google Scholar 

  5. Wiese-Bjornstal DM. Psychology and socioculture affect injury risk, response, and recovery in high-intensity athletes: a consensus statement. Scand J Med Sci Sports. 2010;20(Suppl 2):103–11.

    Article  PubMed  Google Scholar 

  6. Ekstrand J. Keeping your top players on the pitch: the key to football medicine at a professional level. Br J Sports Med. 2013;47(12):723–4.

    Article  Google Scholar 

  7. Hägglund M, Waldén M, Magnusson H, et al. Injuries affect team performance negatively in professional football: an 11-year follow-up of the UEFA Champions League injury study. Br J Sports Med. 2013;47(12):738–42.

    Article  PubMed  Google Scholar 

  8. Frisch A, Croisier JL, Urhausen A, et al. Injuries, risk factors and prevention initiatives in youth sport. Br Med Bull. 2009;92(1):95–121.

    Article  PubMed  Google Scholar 

  9. Physical activities and injuries-statistics and analysis (Swedish). Swedish Civil Contigencies Agency. https://www.msb.se/RibData/Filer/pdf/25550.pdf. 2010.

  10. Almeida PL, Olmedilla A, Rubio VJ, et al. Psychology in the realm of sport injury: what it is all about. Rev Psicol Deporte. 2014;23:395–400.

    Google Scholar 

  11. Johnson U, Tranaeus U, Ivarsson A. Current status and future challenges in psychological research of sport injury prediction and prevention: a methodological perspective. Rev Psicol Deporte. 2014;23(2):401–9.

    Google Scholar 

  12. Coddington RD, Troxell JR. The effect of emotional factors on football injury rates-a pilot study. J Hum Stress. 1980;6(4):3–5.

    Article  CAS  Google Scholar 

  13. Cryan PD, Alles WF. The relationship between stress and college football injuries. J Sport Med Phys Fit. 1983;23(1):52–8.

    CAS  Google Scholar 

  14. Bond J, Miller B, Chrisfield P. Psychological prediction of injury in elite swimmers. Int J Sports Med. 1988;9(5):345–8.

    Article  CAS  PubMed  Google Scholar 

  15. Williams J, Tonymon P, Wadsworth W. Relationship of life stress to injury in intercollegiate volleyball. J Hum Stress. 1986;12(1):38–43.

    Article  CAS  Google Scholar 

  16. Williams JM, Andersen MB. Psychosocial antecedents of sport injury and interventions for risk reduction. In: Tenenbaum G, Eklund R, editors. Handbook of sport psychology. 3rd ed. New York: Wiley; 2007. p. 379–403.

    Google Scholar 

  17. Williams JM, Andersen MB. Psychosocial antecedents of sport injury: review and critique of the stress and injury model. J Appl Sport Psychol. 1998;10(1):5–25.

    Article  Google Scholar 

  18. Andersen MB, Williams JM. A model of stress and athletic injury—prediction and prevention. J Sport Exerc Psychol. 1988;10(3):294–306.

    Article  Google Scholar 

  19. Wilkerson GB. Neurocognitive reaction time predicts lower extremity sprains and strains. Int J Athl Ther Train. 2012;17:4–9.

    Article  Google Scholar 

  20. Swanik CB, Covassin T, Stearne DJ, et al. The relationship between neurocognitive function and noncontact anterior cruciate ligament injuries. Am J Sports Med. 2007;35:943–8.

    Article  PubMed  Google Scholar 

  21. Appaneal RN, Perna FM. Biopsychosocial model of injury. In: Eklund R, Tenenbaum G, editors. Encyclopedia of sport and exercise psychology. Thousand Oaks: SAGE Publications, Inc.; 2014. p. 74–7.

    Google Scholar 

  22. Liederbach, Compagno J M. Psychological aspects of fatigue-related injuries in dancers. J Dance Med Sci. 2001;5:116–120.

  23. Richardson SO, Andersen MB, Morris T. Overtraining athletes: personal journeys in sport. Champaign: Human Kinetics; 2008.

    Google Scholar 

  24. Hackfort D, Kleinert J. Research on sport injury development: former and future approaches from an action theory perspective. Int J Sport Exerc Psychol. 2007;5(4):324–39.

    Article  Google Scholar 

  25. Ng JYY, Ntoumanis N, Thogersen-Ntoumani C, et al. Self-determination theory applied to health contexts: a meta-analysis. Perspect Psychol Sci. 2012;7(4):325–40.

    Article  PubMed  Google Scholar 

  26. Olsen OE, Myklebust G, Engebretsen L, et al. Exercises to prevent lower limb injuries in youth sports: cluster randomised controlled trial. BMJ. 2005;330:449.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Card NA. Applied meta-analysis for social science research. Guilford Press: New York; 2011.

  28. Cohen J, Cohen P. Applied multiple regression/correlation analysis for the behavioural sciences. Hillsdale: Erlbaum; 1983.

    Google Scholar 

  29. Borenstein M, Hedges L, Higgins J, et al. Comprehensive meta-analysis. Englewood: Biostat; 2009.

  30. Higgins JPT, Thompson SG, Deeks JJ, et al. Measuring inconsistency in meta-analyses. BMJ. 2003;327(7414):557–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Rosenberg MS. The file-drawer problem revisited: a general weighted method for calculating fail-safe numbers in meta-analysis. Evolution. 2005;59:464–8.

    Article  PubMed  Google Scholar 

  32. Cohen J. Things I have learned (so far). Am Psychol. 1990;45(12):1304–12.

    Article  Google Scholar 

  33. Landis RS. Successfully combining meta-analysis and structural equation modeling: recommendations and strategies. J Bus Psychol. 2013;28(3):251–61.

    Article  Google Scholar 

  34. Valentine JC, Pigott TD, Rothstein HR. How many studies do you need? A primer on statistical power for meta-analysis. J Educ Behav Stat. 2010;35(2):215–47.

    Article  Google Scholar 

  35. Byron K, Khazanchi S. A meta-analytic investigation of the relationship of state and trait anxiety to performance on figural and verbal creative tasks. Pers Soc Psychol Bull. 2011;37(2):269–83.

    Article  PubMed  Google Scholar 

  36. Kato T. Frequently used coping scales: a meta-analysis. Stress Health. 2015;31:315–23.

    Article  PubMed  Google Scholar 

  37. Williams JM, Tonymon P, Andersen MB. The effects of stressors and coping resources on anxiety and peripheral narrowing. J Appl Sport Psychol. 1991;3(2):126–41.

    Article  Google Scholar 

  38. Williams JM, Tonymon P, Andersen MB. Effects of life-event stress on anxiety and peripheral narrowing. Behav Med. 1990;16(4):174–81.

    Article  CAS  PubMed  Google Scholar 

  39. Rogers TJ, Alderman BL, Landers DM. Effects on life-event stress and hardiness on peripheral vision in a real-life stress situation. Behav Med. 2003;29(1):21–6.

    Article  PubMed  Google Scholar 

  40. Muthén L, Muthén B. Mplus user’s guide (Vol. 6). Los Angeles: Muthén & Muthén; 1998.

  41. Viswesvaran C, Ones DS. Theory testing: combining psychometric meta-analysis and structural equations modeling. Pers Psychol. 1995;48(4):865–85.

    Article  Google Scholar 

  42. MacKinnon DP. Introduction to statistical mediation analysis. New York: Routledge; 2008.

    Google Scholar 

  43. Marsh HW. Application of confirmatory factor analysis and structural equation modeling in sport and exercise psychology. In: Tenenbaum G, Eklund R, editors. Handbook of sport psychology. 3rd ed. Hoboken: Wiley; 2007. p. 774–98.

    Google Scholar 

  44. Fuchs E, Flugge G. Chronic social stress: effects on limbic brain structures. Physiol Behav. 2003;79(3):417–27.

    Article  CAS  PubMed  Google Scholar 

  45. McEwen BS. The neurobiology of stress: from serendipity to clinical relevance. Brain Res. 2000;886(1–2):172–89.

    Article  CAS  PubMed  Google Scholar 

  46. McEwen BS. Central effects of stress hormones in health and disease: understanding the protective and damaging effects of stress and stress mediators. Eur J Pharmacol. 2008;583(2–3):174–85.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Cozolino L. The neuroscience of psychotherapy: healing the social brain (Norton Series on Interpersonal Neurobiology). New York: WW Norton & Company; 2010.

    Google Scholar 

  48. Gabbett TJ, Ullah S, Jenkins D, et al. Skill qualities as risk factors for contact injury in professional rugby league players. J Sports Sci. 2012;30(13):1421–7.

    Article  PubMed  Google Scholar 

  49. Baumeister R, Bratslavsky E, Finkenauer C, et al. Bad is stronger than good. Rev Gen Psychol. 2001;5(4):323–70.

    Article  Google Scholar 

  50. Berntsen D, Rubin DC, Siegler IC. Two versions of life: emotionally negative and positive life events have different roles in the organization of life story and identity. Emotion. 2011;11(5):1190–201.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Rogers T, Landers D. Mediating effects of peripheral vision in the life event stress/athletic injury relationship. J Sport Exerc Psychol. 2005;27(3):271–88.

    Article  Google Scholar 

  52. Soares JM, Sampaio A, Ferreira LM, et al. Stress-induced changes in human decision-making are reversible. Transl Psychiatry. 2012;2:e131.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Davis M. Neurobiology of fear responses: the role of the amygdala. J Neuropsychiatry Clin Neurosci. 1997;9(3):382–402.

    Article  CAS  PubMed  Google Scholar 

  54. Ivarsson A, Johnson U, Andersen MB, et al. It pays to pay attention: a mindfulness-based program for injury prevention with soccer players. J Appl Sport Psychol. 2015;27(3):319–34.

    Article  Google Scholar 

  55. Andersen MB, Ivarsson A. A methodology of loving kindness: how interpersonal neurobiology, compassion and transference can inform researcher-participant encounters and storytelling. Qual Res Sport Exerc Health. 2016;8(1):1–20.

    Article  Google Scholar 

  56. Johnson U, Ekengren J, Andersen MB. Injury prevention in Sweden: helping soccer players at risk. J Sport Exerc Psychol. 2005;27(1):32–8.

    Article  Google Scholar 

  57. Kerr G, Goss J. The effects of a stress management program on injuries and stress levels. J Appl Sport Psychol. 1996;8(1):109–17.

    Article  Google Scholar 

  58. Maddison R, Prapavessis H. A psychological approach to the prediction and prevention of athletic injury. J Sport Exerc Psychol. 2005;27(3):289–310.

    Article  Google Scholar 

  59. Tranaeus U, Johnson U, Engström B, et al. A psychological injury prevention group intervention in Swedish floorball. Knee Surg Sports Traumatol Arthrosc. 2015;23(11):3414–20.

    Article  PubMed  Google Scholar 

  60. Noh YE, Morris T, Andersen MB. Psychological intervention programs for reduction of injury in ballet dancers. Res Sports Med. 2007;15(1):13–32.

    Article  PubMed  Google Scholar 

  61. Edvardsson A, Ivarsson A, Johnson U. Is a cognitive-behavioural biofeedback intervention useful to reduce injury risk in junior football players? J Sci Med Sport. 2012;11(2):331–8.

    Google Scholar 

  62. Chan DKC, Hagger M. Theoretical integration and the psychology of sport injury prevention. Sports Med. 2012;42(9):725–32.

    PubMed  Google Scholar 

  63. Bahr R, Krosshaug T. Understanding injury mechanisms: a key component of preventing injuries in sport. Br J Sports Med. 2005;39:324–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  64. Shrier I, Raglin JS, Levitan EB, et al. Procedures for assessing psychological predictors of injuries in circus artists: a pilot prospective study. BMC Med Res Methodol. 2014;14:77.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Fawkner HJ, McMurrary NE, Summers JJ. Athletic injury and minor life events: a prospective study. J Sci Med Sport. 1999;2(2):117–24.

    Article  CAS  PubMed  Google Scholar 

  66. Ivarsson A, Johnson U, Lindwall M, et al. Psychosocial stress as a predictor of injury in elite junior soccer: a latent growth curve analysis. J Sci Med Sport. 2014;17(4):366–70.

    Article  PubMed  Google Scholar 

  67. Wang P, Shen W, Boye ME. Joint modeling of longitudinal outcomes and survival using latent growth modeling approach in a mesothelioma trial. Health Serv Outcomes Res Methodol. 2012;12(2–3):182–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Andersen M, Williams J. Athletic injury, psychosocial factors and perceptual changes during stress. J Sports Sci. 1999;17(9):735–41.

    Article  CAS  PubMed  Google Scholar 

  69. Blackwell B, McCullagh P. The relationship of athletic injury to life stress, competitive anxiety and coping resources. Athl Train. 1990;25(1):23–7.

    Google Scholar 

  70. Brink MS, Visscher C, Arends S, et al. Monitoring stress and recovery: new insights for the prevention of injuries and illnesses in elite youth soccer players. Br J Sports Med. 2010;44(11):809–15.

    Article  PubMed  Google Scholar 

  71. Bum D. Stress, attention and sports injury [Doctoral dissertation]: Victoria University of Technology; 1998.

  72. Byrd B. The relationship of history of stressors, personality, and coping resources, with the incidence of athletic injuries [Master’s thesis]: University of Colorado at Boulder; 1993.

  73. Devantier C. Psychological predictors of injury among professional soccer players. Sport Sci Rev. 2011;20(5–6):5–36.

    Google Scholar 

  74. Fields KB, Delaney M, Hinkle JS. A Prospective-study of type—a behavior and running injuries. J Fam Pract. 1990;30(4):425–9.

    CAS  PubMed  Google Scholar 

  75. Galambos S, Terry P, Moyle G, et al. Psychological predictors of injury among elite athletes. Br J Sports Med. 2005;39(6):351–4 (discussion 4).

  76. Gunnoe AJ, Horodyski M, Tennant LK, et al. The effect of life events on incidence of injury in high school football players. J Athl Train. 2001;36(2):150.

    PubMed  PubMed Central  Google Scholar 

  77. Hanson SJ, McCullagh P, Tonymon P. The relationship of personality-characteristics, life stress, and coping resources to athletic injury. J Sport Exerc Psychol. 1992;14(3):262–72.

    Article  Google Scholar 

  78. Hardy C, Riehl R. An examination of the life stress-injury relationship among noncontact sport participants. Behav Med. 1988;14(3):113–8.

    Article  CAS  PubMed  Google Scholar 

  79. Ivarsson A, Johnson U. Psychological factors as predictors of injuries among senior soccer players. A prospective study. J Sci Med Sport. 2010;9(2):347–52.

    Google Scholar 

  80. Ivarsson A, Johnson U, Podlog L. Psychological predictors of injury occurrence: a prospective investigation of professional Swedish soccer players. J Sport Rehabil. 2013;22:8.

    Article  Google Scholar 

  81. Johnson U, Ivarsson A. Psychological predictors of sport injuries among junior soccer players. Scand J Med Sci Sports. 2011;21(1):129–36.

    Article  CAS  PubMed  Google Scholar 

  82. Keller B, Braga AM, Coelho RW. Relationship between personality trait and muscle injuries in tennis players. Rev Bras Med Esporte. 2013;19(2):120–2.

    Article  Google Scholar 

  83. Kerr G, Minden H. Psychological-factors related to the occurrence of athletic injuries. J Sport Exerc Psychol. 1988;10(2):167–73.

    Article  Google Scholar 

  84. Kolt G, Kirkby R. Injury in Australian female competitive gymnasts: a psychological perspective. J Physiother. 1996;42(2):121–6.

    Article  Google Scholar 

  85. Kontos A. Perceived risk, risk taking, estimation of ability and injury among adolescent sport participants. J Pediatr Psychol. 2004;29(6):447–55.

    Article  PubMed  Google Scholar 

  86. Krasnow D, Mainwaring LM, Kerr G. Injury, stress, and perfectionism in young dancers and gymnasts. J Dance Med Sci. 1999;3(2):51–8.

    Google Scholar 

  87. Lavallee L, Flint F. The relationship of stress, competitive anxiety, mood state, and social support to athletic injury. J Athl Train. 1996;31(4):296–9.

    CAS  PubMed  PubMed Central  Google Scholar 

  88. Lysens R, Vanden Auweele Y, Ostyn M. The relationship between psychosocial factors and sports injuries. J Sports Med Phys Fit. 1986;26(1):77–84.

    CAS  Google Scholar 

  89. Nigorikawa T, Oishi K, Yasukawa M, et al. Type A behavior pattern and sports injuries. Jpn J Phys Fit Sport Med. 2003;52(4):359–67.

    Article  Google Scholar 

  90. Noh YE, Morris T, Andersen MB. Psychosocial factors and ballet injuries. Int J Sport Exerc Psychol. 2005;3(1):79–90.

    Article  Google Scholar 

  91. Osborn ZH, Blanton PD, Schwebel DC. Personality and injury risk among professional hockey players. J Inj Violence Res. 2009;1(1):15–9.

    Article  PubMed  PubMed Central  Google Scholar 

  92. Passer M, Seese M. Life stress and athletic injury: examination of positive versus negative events and three moderator variables. J Hum Stress. 1983;9(4):11–6.

    Article  CAS  Google Scholar 

  93. Patterson EL, Smith RE, Everett JJ, et al. Psychosocial factors as predictors of ballet injuries: Interactive effects of life stress and social support. J Sport Behav. 1998;21(1):101.

    Google Scholar 

  94. Quarrie KL, Alsop JC, Waller AE, et al. The New Zealand rugby injury and performance project. VI. A prospective cohort study of risk factors for injury in rugby union football. Br J Sports Med. 2001;35(3):157–66.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Steffen K, Pensgaard AM, Bahr R. Self-reported psychological characteristics as risk factors for injuries in female youth football. Scand J Med Sci Sports. 2009;19(3):442–51.

    Article  CAS  PubMed  Google Scholar 

  96. Horst N. Risk factors for recurrent injuries in male amateur soccer players: a prospective cohort study. [Master’s thesis]: Utrecht University, Utrecht, Netherlands; 2012.

  97. van Mechelen W, Twisk J, Molendijk A, et al. Subject-related risk factors for sports injuries: a 1-yr prospective study in young adults. Med Sci Sport Exerc. 1996;28(9):1171–9.

    Article  Google Scholar 

  98. Vassos MV. An exploration of the psychometric properties of the Test of Attentional and Interpersonal Style 2 and its ability to predict athletic injury [Doctoral dissertation]: RMIT University; 2009.

  99. Wadey R, Evans L, Hanton S, et al. An examination of hardiness throughout the sport injury process. Br J Health Psychol. 2012;17(1):103–28.

    Article  PubMed  Google Scholar 

  100. Wadey R, Evans L, Hanton S, et al. Effect of dispositional optimism before and after injury. Med Sci Sport Exerc. 2013;45(2):387–94.

    Article  Google Scholar 

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Correspondence to Andreas Ivarsson.

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Andreas Ivarsson, Urban Johnson, Mark Andersen, Ulrika Tranaeus, Andreas Stenling, and Magnus Lindwall declare that they have no conflicts of interest relevant to the content of this review.

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Ivarsson, A., Johnson, U., Andersen, M.B. et al. Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention. Sports Med 47, 353–365 (2017). https://doi.org/10.1007/s40279-016-0578-x

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