The operationalised definition of sports injury differs within the existing sport psychology literature often owing to the differing severities and durations of injury (Nicholl et al, 1995), this variation in definition can therefore result in discrepancies regarding empirical results (Pargman, 2007). However, despite this debate regarding operationalisation, there is no debate that sports injuries can have a significant psychological effect upon elite athletes, especially young, elite athletes. Studies that investigate the temporary psychological mentality of injured and uninjured performers have consistently found injured athletes as having a lower psychological affect than uninjured athletes as well as lower self-esteem, higher levels of depression and more incidences of negative thoughts (Chan & Grossman, 1988; Johnston & Carroll, 1998; Leddy et al, 1994; McGowan et al, 1994; Pearson & Jones, 1992). The effects of injury are not limited to one aspect of the athlete’s life, and consequences can impact athletes’ psychological, social and biological domains (Wiese-Bjornstal et al, 2008).
These negative effects cause understandably significant psychological issues for adult athletes, however, for a young elite athlete trying to improve and excel in their sport only to be knocked back by an injury, it can be catastrophic (Weiss, 2003). For example, Newcomer and Perna (2003) stated that adolescent athletes suffer from injury related distress long after the injury has been recovered from. Moreover, Manuel et al (2003) found that depressive symptoms in injured adolescent athletes showed a negative correlation with the age of the athlete, further supporting the theory that younger athletes experience a greater negative psychological response to injury. This article will examine the psychological effects of sports injuries on elite athletes, why these effects may occur, and attempt to explain why these effects can be magnified in specifically elite, young athletes.
There are differing models that attempt to explain the psychological impact that sports injuries can have upon young athletes. Some models are based upon existing theories relating to negative mood and depression, an example of this would be the Grief Model which centres itself upon the idea that the injured athlete will feel as though they have lost a major part of their ‘self’, potentially leading to the onset of negative thoughts and beliefs. The Grief Model of injury uses the Kuhbler-Ross Model of Bereavement (from the 1969 book ‘On Death and Dying’) to try and explain the effects of this loss of ‘self’. This model sets out five stages that will occur for a person dealing with loss; Disbelief and Denial, Anger, Bargaining, Depression and, Acceptance and Resignation, and it has been argued that an athlete experiences each of these stages in some form whilst recovering from injury. A young professional football player from Premier League team Bournemouth FC, showed a clear example of the Disbelief and Denial stage during a recent interview following a severe cruciate ligament injury. The player was quoted as saying ‘I can make a return before the end of the season’ despite the club doctor informing him that he wouldn’t be physically fit enough to play again until the following campaign. This denial of the seriousness of his injury could cause psychological issues and potentially prolong his rehabilitation. If the Grief Model of injury is to be believed, then it is clear as to why young athletes can react so much worse psychologically to injury. It has already been discussed that injured adult athletes can respond poorly to their ‘loss’, therefore, with their greater immaturity and their inability to express and identify their grief as coherently (Moody & Moody, 2007), a child or adolescent’s psychological response can be disastrous. When going through grief and loss, a child can also develop depression and anxiety both at the time and throughout later life (Koblenz, 2016), implying that the effects can continue to affect a young athlete’s career long after they have physically recovered.
Limitations of the Grief Model of Injury (Heil, 1993; Udry et al, 1997) led Brewer (1994) to propose the ‘Cognitive Appraisal Model of Psychological Adjustment from Athletic Injury’, which argues that an athlete’s response to injury is based upon how they cognitively appraise their situation. The theory builds upon the Stress and Coping Models of Lazarus and Folkman (1984), with the athlete having to assess the stress that the injury is causing them and then evaluate the severity of that stress, whilst also understanding the effect it could have upon them. It is these cognitive appraisals that will determine the athletes’ emotional response to the situation. For example, Brewer (1994) argues that an athlete’s fear of re-injury can cause anger and depression, a finding also supported by researchers such as Leddy et al (1994) and McGowan et al (1994). This fearful emotional response can in turn affect the behaviour that athletes show, such as their adherence to a rehabilitation programme, leading to an increase in recovery time. The inability for children and adolescents to respond to stress in a calm and reasoned manner (Varni et al, 1991) is a factor that could explain the increased negative effect that sports injuries can have upon them. The negative stressors that an injured young athlete experiences can also lead to an increase in negative emotional responses such as depression (Masten et al, 1988), which as Brewer states, can then affect behavioural responses and ultimately recovery time.
With injured athletes suffering the psychological effects discussed above, there is no doubt that psychological support is needed to help them not only recover from injury physically, but mentally too. However, in adult sport this support is not always delivered effectively or timely, arguably often due to the negative stigma attached to mental health, throughout youth sport on the other hand, there should be no such excuse for this provision not being promoted and encouraged. A positive sustainable attitude from coaches and parents alike regarding psychological support during injury could direct elite young athletes onto a sensible path towards recognising when to use the psychological support at their disposal. Psychologists working with coaches to institute measures that can aid youngsters in their psychological recovery and development is therefore a necessity for youth sport. This support could simply take the form of teaching young athletes basic stress reduction and relaxation techniques (Smoll & Smith, 1990) to reduce their negative emotional responses (Schwab-Reese et al, 2012) and help them to cope better with the heightened stress caused by injury. The interventions introduced by sport psychologists must be utilised, as their importance with regards to both young athletes’ physical and mental health is patent. More must be done to encourage young athletes to seek help and to ensure they receive the help that they require and deserve. Injury for an elite athlete is a major cause for worry and concern, but for elite young athletes who are still developing psychologically and still trying to grow and mature, the effects can be disastrous.