This is an excerpt from Core Concepts in Athletic Training and Therapy With Web Resource by Susan Kay Hillman.
Sport Injury Risk
Why does sport injury happen, and what places one person more at risk for sport injury than another? The Sport Injury Risk Profile (SIRP; Wiese-Bjornstal 2009) view of the many factors affecting sport injury risk gives athletic trainers a means of understanding how psychological and sociocultural factors operate interactively with physical and environmental factors within the larger context of sport injury risk (see figure 22.1). Interventions directed at better managing these aspects have the potential to reduce risk of sport injury in the same way in which other more common athletic training interventions, such as changes in training and conditioning protocols or the use of protective equipment, reduce risks. In order to design and implement effective psychological and sociocultural interventions, athletic trainers must first understand the complex combination of influences on sport injury risk for individual participants on their teams and must recognize the ways in which psychological and sociocultural factors contribute to the risk.
The SIRP identifies specific examples of elements within each major contributor to the profiles that have been linked to sport injury risk. Participants all have their own unique profiles—combinations or constellations of risk factors that influence their personal risks for sport injury. There are likely both cumulative and interactive effects of these risk factors; in other words, the factors work together and in combination. Two broad categories of risk in figure 22.1 are personal and environmental. Personal influences represent individual internal biological and psychological characteristics unique to each participant, while environmental influences encompass those arising from the physical and sociocultural external contexts in which that participant trains and competes.
Within each of these two broad categories of risk are two subcategories. Biological factors are internal; they represent the physical and physiological characteristics of individual participants and include such elements as physical condition, age, and existing muscular imbalances. Psychological factors represent internal mental characteristics of individual participants, including mood state, life stress, and risk taking. Physical factors encompass the external physical environments surrounding participation; environments precipitating injury occurrence might include things such as uneven surfaces, slippery conditions, and unsafe equipment. Sociocultural factors represent external sociocultural influences such as the quality and rigor of officiating, the quality and style of coaching, and the social pressure to play when one is hurt or fatigued. These risk factors influence sport injuries through their effects on participant exposures to potentially injurious situations, behavioral choices made, and hazards encountered.
Among all four subcategories, the role of participant developmental or life span level is apparent. Biological factors, for example, encompass developmental factors such as the physical vulnerabilities associated with growth (e.g., incomplete epiphyseal closure and risk of growth plate injuries in young active people; deterioration of joints in older individuals). Examples of psychological factors related to growth and development across the life span are the less diverse coping skills and capabilities of children, or the increased mental distress associated with chronic health conditions in the elderly. Examples of developmental level-related physical factors are the improperly sized or fitted equipment often used by young participants, or the reduced balance abilities of older patients leading to increased risk of a fall on slippery surfaces. Examples of sociocultural and age-related factors are the untrained volunteer coaches often working with young people, or the reduction in social interaction and support experienced by many older persons.
Another way of looking at psychological and sociocultural risk factors is through the conceptual model of stress and athletic injury (Andersen and Williams 1988). This model has guided much of the research on psychological and social influences on vulnerability to sport injury. The central psychological influence on the occurrence of sport injury, according to this model, is the stress response. Essentially, the more “stress” participants perceive, the more vulnerable they are to injury, particularly if they do not have sufficient coping resources for managing the stress. Stress-related changes that occur in patient attention and cognition (e.g., tunnel vision, attention turning inward toward personal thoughts rather than focusing outward on the risks in the sporting environment) and physiology (such as increased muscle tension and increased heart rate) can negatively affect individual behaviors and performance, which in turn increase the risk of injury.
Of all of the factors outlined in the model of stress and athletic injury, the most consistently supported finding is that individuals who report feeling significant stress from major life events (both sport and nonsport events, such as moving, death of a family member, divorce of parents, or starting a new school) are more likely to sustain a sport injury than those who report feeling less major life event stress. This seems to be particularly true if participants with high life event stress also report that they have limited coping resources to help them manage the stress. One can imagine a football quarterback, for example, so distracted by thoughts of his parents' impending divorce that he fails to see and prepare for the tackler about to hit him, leading to a macrotrauma injury that might have been prevented had he been “paying attention.” Or, picture the swimmer with no one to talk to, training excessively to distract herself, whose neck and shoulder muscles are overly tense because she is worried about the health of her ill grandmother, thus altering her normal stroke mechanics and leading to microtrauma injury. These examples provide brief snapshots of how psychological and social factors contribute to sport injury risk.
It is clear that understanding why sport injuries happen requires an understanding of the complexity of the risk factors involved, including psychological and sociocultural factors. From the standpoint of the injury prevention role so important to the work of athletic trainers, it is imperative to understand the many risk factors so that the athletic trainer might design important risk reduction interventions, again including those that address potentially harmful sociocultural and psychological influences.