Runners Psychosocial Response to Overuse Injury

NewsBot · Jul 31, 2015

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Narratives of Psychosocial Response to Microtrauma Injury among Long-Distance Runners
Hayley C. Russell and Diane M. Wiese-Bjornstal
Sports 2015, 3(3), 159-177

Athletes with microtrauma or overuse injuries resulting from an accumulation of repeated small forces may differ from athletes with macrotrauma or acute injuries in their psychosocial responses because of the unique challenges presented by these insidious-onset and often chronic injuries. Our purpose was to use narrative inquiry to examine the psychosocial experiences and responses of 10 long-distance runners who had experienced microtrauma injuries. Qualitative data analysis of interview data led to a chronological timeline of the injury experience and an assessment of the meaning attributed to these injury experiences using a variation of Mishler?s core-narrative approach. Participants reported distinct thoughts, feelings, and behaviors during each phase of the injury?pre-injury, injury onset, and outcome. In the pre-injury period, participants indicated specific running-related goals and attributed their injuries to overtraining or a change in training. During the injury onset phase, participants consistently indicated two themes: self-diagnosis and treatment, and not taking time off. Within the outcome phase of injury, participants acknowledged changed training because of the injury, and lessons learned from their injury experiences. The narratives of microtrauma-injured runners revealed psychosocial distress and behavioral tendencies post-injury that have important implications for runners, coaches, and healthcare professionals.
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NewsBot · Feb 18, 2016

Psychosocial factors associated with outcomes of sports injury rehabilitation in competitive athletes: a mixed studies systematic review
Dale Forsdyke, Andy Smith, Michelle Jones, Adam Gledhill
Br J Sports Med doi:10.1136/bjsports-2015-094850

Background The prime focus of research on sports injury has been on physical factors. This is despite our understanding that when an athlete sustains an injury it has psychosocial as well as physical impacts. Psychosocial factors have been suggested as prognostic influences on the outcomes of rehabilitation. The aim of this work was to address the question: are psychosocial factors associated with sports injury rehabilitation outcomes in competitive athletes?

Study design Mixed studies systematic review (PROSPERO reg.CRD42014008667).

Method Electronic database and bibliographic searching was undertaken from the earliest entry until 1 June 2015. Studies that included injured competitive athletes, psychosocial factors and a sports injury rehabilitation outcome were reviewed by the authors. A quality appraisal of the studies was undertaken to establish the risk of reporting bias.

Results 25 studies were evaluated that included 942 injured competitive athletes were appraised and synthesised. Twenty studies had not been included in previous reviews. The mean methodological quality of the studies was 59% (moderate risk of reporting bias). Convergent thematic analysis uncovered three core themes across the studies: (1) emotion associated with rehabilitation outcomes; (2) cognitions associated with rehabilitation outcomes; and (3) behaviours associated with rehabilitation outcomes. Injury and performance-related fears, anxiety and confidence were associated with rehabilitation outcomes. There is gender-related, age-related and injury-related bias in the reviewed literature.

Conclusions Psychosocial factors were associated with a range of sports injury rehabilitation outcomes. Practitioners need to recognise that an injured athlete's thoughts, feelings and actions may influence the outcome of rehabilitation.
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NewsBot · Apr 11, 2016

Injury Risk Is Increased by Changes in Perceived Recovery of Team Sport Players.
van der Does HT et al
Clin J Sport Med. 2016 Mar 3.

OBJECTIVE:
The aim of this study is to investigate if changes in perceived stress and recovery over the course of a season are risk factors for acute and overuse injuries.
DESIGN:
A prospective nonexperimental cohort design.
SETTING:
Data were gathered at the SportsFieldLab Groningen and at the facilities of the participating teams.
PARTICIPANTS:
Eighty-six male and female basketball, volleyball, and korfball players aged 21.9 ? 3.5 years.
INTERVENTIONS:
In this 10-month observational study, the independent variables are the changes in perceived stress and recovery.
MAIN OUTCOME MEASURES:
The Recovery-Stress Questionnaire for Athletes (RESTQ-Sport) was filled out every 3 weeks throughout the season to assess changes in perceived stress and recovery. Acute and overuse injuries were registered by the teams' physical therapists. Odds ratios and 95% confidence intervals were calculated.
RESULTS:
During one season, 66 acute and 62 overuse injuries were registered. Multinomial regression analysis showed that perceived General Recovery, shown in the scales Social Recovery and General Well-Being, decreased in the 6-week period before an acute injury (OR 0.59 and 0.61, respectively, P ≤ 0.05) compared with healthy periods. Risk of overuse injuries increased when perceived Sport Recovery, shown in the Personal Accomplishment scale, decreased in the 3-week period before the injury (OR 0.59, P ≤ 0.05) compared with healthy periods.
CONCLUSIONS:
Therefore, decreased perceived recovery can indicate an increased injury risk. General Recovery affects acute injury risk and Sport Recovery affects the risk of an overuse injury. Monitoring perceived recovery over the course of a season could give guidance for recovery enhancing practices to prevent injuries.
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NewsBot · Jul 14, 2016

Psychosocial Factors and Sport Injuries: Meta-analyses for Prediction and Prevention
Andreas Ivarsson , Urban Johnson, Mark B. Andersen, Ulrika Tranaeus, Andreas Stenling, Magnus Lindwall
Sports Medicine 12 July 2016

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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NewsBot · Nov 17, 2016

Association of psychological variables and outcome in tendinopathy: a systematic review
Adrian Mallows, James Debenham, Tom Walker, Chris Littlewood
Br J Sports Med doi:10.1136/bjsports-2016-096154

Objective Fear, anxiety, depression, distress and catastrophisation are all factors known to affect pain and disability levels. To date, the association of such psychological factors has yet to be established in tendinopathy. Therefore, the purpose of this paper was to determine if psychological variables are associated with tendinopathy and whether any such variables may be associated with pain and disability outcomes in conservative management of tendinopathy.

Design A systematic review was undertaken and included studies were appraised for risk of bias using the Newcastle-Ottawa Scale. Owing to heterogeneity of studies, a qualitative synthesis was undertaken.

Data sources An electronic search of MEDLINE, CiNAHL, SPORTDiscus, PsycINFO, EMBASE and PsycARTICLES was undertaken from their inception to April 2016.

Eligibility criteria for selecting studies Any study design that incorporated psychological measures and clinical outcomes using participants with tendinopathy.

Results Ten articles describing nine studies and 1108 participants were included. Conflicting evidence exists regarding the association of anxiety, depression and lateral epicondylalgia (LE). Strong evidence suggests LE is not associated with kinesiophobia. Moderate evidence links catastrophisation and distress with LE. Moderate evidence suggests distress is not associated with rotator cuff tendinopathy, but kinesiophobia and catastrophisation are. Limited evidence suggests patellar tendinopathy is not associated with anxiety or depression and kinesiophobia may be linked with suboptimal outcomes in Achilles tendinopathy.

Summary/conclusions Tendinopathy requires an individualised approach to management. Clinicians should consider using validated screening tools for the presence of psychological variables as a part of their holistic management.
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NewsBot · Dec 7, 2016

BJSM Blog post:
AchillesAl part 3: pyschosocial considerations in achilles pain

NewsBot · Feb 2, 2017

WHAT CHARACTERISES CHAMPION RUNNERS' MANAGEMENT OF INJURY AND ILLNESS? QUALITATIVE STUDY AT IAAF ATHLETICS WORLD CHAMPIONSHIPS
Toomas Timpka et al
Br J Sports Med 2017;51:396 doi:10.1136/bjsports-2016-097372.285

Background International sports bodies are increasingly on the lookout to balance the excitement of elite sport with the risk that is inevitable. For further understanding of these risks, athletes' reports on how sensations of pain, discomfort, and loss of functioning are interpreted and acted upon are vital.

Objective To explore what characterizes injury and illness management among champion runners.

Design Qualitative study using in-depth interviews for data collection.

Setting Middle- and long-distance runners at IAAF World Athletics Championships.

Participants 12 international runners competing for championships medals.

Assessment of Risk Factors Thematic analysis to generate understanding reasoning about injury and illness.

Main Outcome Measurements Qualitative model describing champion runners' injury and illness management over time.

Results The athletes' behaviours and decisions-making procedures were summarised in the main themes resilience and exigency. Resilience behaviour was constituted of ordinary rather than extraordinary actions and is characterised by a proneness for learning, dynamic adaptations to unforeseen circumstances, and focusing on long-term objectives. The theme prompting and learning describes intense information-seeking performed when experiencing symptoms of injury or illness in order to understand causes and guide responses. This quest for information and knowledge comprised early consultation with clinicians and execution of diagnostic tests, dialogue with coaches, and discussions with peers. The themes effects and consequences describe the short-term outcomes of the athletes' decision-making and their standpoints on how their injury and illness management impacts their overall career, respectively.

Conclusions A model of injury and illness management among champion runners has been developed. The model offers a positive outlook on progress in sports where overuse injuries are common, and a direction for policies aimed at protection of top-level athletes. Resilience behaviour arises from dynamic adaptations of normal functions, meaning that the greatest threats to health maintenance in this group of athletes are those that compromise such adaptations.
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NewsBot · Mar 25, 2017

Beyond the tendon: Experiences and perceptions of people with persistent Achilles tendinopathy
Sean Mc Auliffe et al
Musculoskeletal Science & Practice; Article in Press

Highlights
•Research in tendinopathy has focused on the physical impairments utilising quantitative means.
•No study has qualitatively investigated the psychosocial aspects of Achilles tendinopathy.
•Persistent Achilles tendinopathy is associated with a significant psychosocial burden.
•Understanding experiences and personal impact of Achilles tendinopathy may enhance management.
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Background
Achilles tendinopathy (AT) is associated with persistent pain leading to a significant physical and psychological burden. Psychosocial factors are considered to be important mediators following exercise interventions. Despite the recognition of the importance of psychosocial variables in persistent MSK disorders, there is a distinct lack of qualitative research investigating psychosocial factors in AT.

Purpose
To qualitatively explore the perceptions and experiences of people with AT prior to an intervention study.

Methodology
A qualitative, interpretive description design was performed using semi-structured telephone interviews. The questioning route covered history of AT, perceived cause of AT, effect of AT pain, experience in managing AT, and perspective on prognosis of AT pain. Interviews were transcribed verbatim. The study has been reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist. To facilitate the rigor of methodology and the transparency of the research process an audit trail was created.

Results
Eight participant's (Five male and three female). Four main themes were identified in the data: (i) pain as a feature of everyday life; (ii) experience with the management process; (iii) identifying with and self-managing AT, and (iv) looking to the future.

Conclusions
This study suggests that persistent AT is associated with a significant psychosocial impact, particularly in terms of participation in daily life and valued activities. Better understanding the experiences and personal impacts of AT may enhance management of this persistent disorder, and facilitate individuals with AT complying with evidence-based approaches including exercise and pain reconceptualization.
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NewsBot · Sep 6, 2017

Do Exercisers With Musculoskeletal Injuries Report Symptoms of Depression and Stress?
Lichtenstein MB et
Sport Rehabil. 2017 Sep 5:1-22. doi: 10.1123/jsr.2017-0103.

CONTEXT:
Sports injuries in athletes can lead to negative emotional responses in terms of anger, anxiety, confusion, and sadness. Severe injuries can be understood as a stressful life event with increased levels of psychological distress, but injury assessment and rehabilitation typically focuses on somatic symptoms.
OBJECTIVE:
The primary aim of this study was to estimate the prevalence of depression and emotional stress, and measure self-rated health in regular exercisers presenting to a sports medicine clinic with musculoskeletal injury. The secondary aim was to identify psychosocial factors associated with depression in injured exercisers and the potential need for psychological counselling.
DESIGN:
A cross-sectional survey study.
SETTING:
A sports medicine clinic for injuries of the foot, knee, or shoulder.
PARTICIPANTS:
Regular exercisers with present injuries (n=694) and exercisers without injuries (n=494). Regular exercisers were defined as those undertaking moderate exercise at least once a week.
INTERVENTION:
A questionnaire survey completed on paper by patients in a sports medicine clinic and a web-based version completed by online sports communities.
MAIN OUTCOME MEASURES:
Participants completed the Major Depression Inventory (MDI), Perceived Stress Scale (PSS), health-related quality of life (EQ-5D-5L), and questions on sociodemographics, exercise habits, and injury history.
RESULTS:
Symptoms of depression were reported by 12% of injured exercisers and 5% of non-injured controls (p<0.001). Clinical stress was found in 30% of injured exercisers and 22% of controls (p=0.002), and EQ-5D-5L VAS score was lower for injured (69±19) than non-injured exercisers (87±13, p<0.001). Injured exercisers with symptoms of depression reported high stress levels and impaired daily functioning, were younger, and more likely to have over 10 days injury-related work absence.
CONCLUSIONS:
We recommend psychological assessment of exercisers attending a sports medicine clinic for musculoskeletal injury, and supplemental clinical psychological interview for suspected depression or stress-related psychopathology.
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NewsBot · Feb 18, 2021

Psychosocial Impacts of Sports-related Injuries in Adolescent Athletes
Haraldsdottir, Kristin PhD; Watson, Andrew M. MD, MS
Current Sports Medicine Reports: February 2021 - Volume 20 - Issue 2 - p 104-108

Adolescence represents a time of tremendous physical, social, and emotional growth, and sport participation can provide significant mental health benefits for young athletes. Injuries are unfortunately common in sports and represent a threat to the short- and long-term health of athletes. While injury management has typically revolved around the minimization of pain and the restoration of physical function, emerging evidence suggests that the psychological consequences of injury may be significant, potentially jeopardizing return to play, increasing subsequent reinjury risk, and even leading to the development of mental health disorders. The majority of this research has been conducted in adult athletes and less is known about outcomes in youth athletes following injury. This review examines what is known about the psychosocial impact of sports injuries in youth athletes to identify areas of future research and to aid clinicians in the management of this population.
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NewsBot · May 4, 2021

Psychological risk profile for overuse injuries in sport: An exploratory study
Simon Martinet al
Journal of Sports Sciences: 31 Mar 2021

Overuse injuries account for a substantial part of sport injury incidence among athletes of various sports and levels. Despite the gradual onset of symptoms, athletes often persevere in training and competing. The present exploratory study aimed to identify a psychological risk profile for overuse injury. One hundred and forty-nine athletes competing in various sports responded to a range of questionnaires measuring the following psychological variables: negative life stress, perfectionistic concerns, perfectionistic strivings, athletic identity, and the coach-athlete relationship. Participants subsequently answered the OSTRC Overuse Injury Questionnaire on a weekly basis during a 10-week period. Using a latent profile analysis, athletes were classified into three latent profiles regarding their psychological characteristics. Athletes in the second profile, characterized by a combination of high athletic identity, perfectionistic concerns and negative life stress and poor coach-athlete relationship, were found to be significantly more often affected by overuse injuries (74% of the time) than individuals in the two other profiles (52% and 48% of the time, respectively). In conclusion, psychological factors may contribute to the risk of overuse injuries through complex interactions (i.e. accounting for interdependencies within a specific configuration of variables) rather than through their independent influences.
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NewsBot · Jan 27, 2022

Injury-related psychological distress and the association with perceived running ability in injured runners
BenjaminMaschke et al
Physical Therapy in Sport; Volume 54, March 2022, Pages 36-43

Highlights
•Injured runners exhibit psychological distress at the start of rehabilitation.
•Negative mood and athletic fear-avoidance beliefs may persist in some injured runners.
•Higher athletic fear-avoidance is associated with lower perceived running ability.
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Objective
Examine injury-related psychological distress and association with perceived running ability in injured runners.

Design
Prospective longitudinal study.

Participants
Forty-three patients with a running-related injury.

Main outcome measures
Data collection at initial physical therapy visit and 12–16 weeks later included Optimal Screening for Prediction of Referral and Outcome - Yellow Flag (OSPRO-YF) and Athlete Fear Avoidance Questionnaire (AFAQ) for injury-related psychological distress, and University of Wisconsin Running and Recovery Index (UWRI) for perceived running ability. OSPRO-YF composite score, total yellow flags, and yellow flags in each domain (negative mood, fear-avoidance, positive affect/coping) were calculated.

Results
UWRI score and OSPRO-YF composite score and yellow flags significantly improved over time, while AFAQ score and yellow flags in OSPRO-YF negative mood domain did not. AFAQ scores were significantly correlated with UWRI score at baseline, follow-up and change over time, while OSPRO-YF composite score and yellow flags were not. Baseline OSPRO-YF composite score and AFAQ score were not correlated with follow-up UWRI score.

Conclusions
Injury-related psychological distress is elevated when injured runners start rehabilitation, and generally improves; however, negative mood and athletic fear-avoidance may persist. Higher athletic fear-avoidance is associated with lower perceived running ability at the same time point or interval.
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NewsBot · Feb 1, 2022

Psychosocial Risk Factors for Overuse Injuries in Competitive Athletes: A Mixed-Studies Systematic Review
Ulrika Tranaeus, Simon Martin & Andreas Ivarsson
Sports Medicine (2021)

Background
While the psychosocial risk factors for traumatic injuries have been comprehensively investigated, less is known about psychosocial factors predisposing athletes to overuse injuries.

Objective
The aim of this review was to systematically identify studies and synthesise data that examined psychosocial risk factors for overuse injuries in athletes.

Design
Systematic review.

Data Sources
MEDLINE, Web of Science and PsycINFO databases, supplemented by hand searching of journals and reference lists.

Eligibility Criteria for Selecting Studies
Quantitative and qualitative studies involving competitive athletes, published prior to July 2021, and reporting the relationship between psychosocial variables and overuse injury as an outcome were reviewed. This was limited to academic peer-reviewed journals in Swedish, English, German, Spanish and French. An assessment of the risk of bias was performed using modified versions of the RoBANS and SBU Quality Assessment Scale for Qualitative Studies.

Results
Nine quantitative and five qualitative studies evaluating 1061 athletes and 27 psychosocial factors were included for review. Intra-personal factors, inter-personal factors and sociocultural factors were found to be related to the risk of overuse injury when synthesised and reported according to a narrative synthesis approach. Importantly, these psychosocial factors, and the potential mechanisms describing how they might contribute to overuse injury development, appeared to be different compared with those already known for traumatic injuries.

Conclusions
There is preliminary evidence that overuse injuries are likely to partially result from complex interactions between psychosocial factors. Coaches and supporting staff are encouraged to acknowledge the similarities and differences between traumatic and overuse injury aetiology.
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NewsBot · Oct 10, 2022

PSYCHOSOCIAL RISK FACTORS FOR OVERUSE INJURIES IN COMPETITIVE ATHLETES

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