Sport And Exercise Psychology: A Critical Introduction

indirect loss of production through the resultant problem of “time off work” (Rahnama,
Reilly and Lees, 2002). Leaving aside the medical and economic issues, however, how do
athletes react to, and cope with, the injuries that they experience? Is there a psychological
dimension to injury rehabilitation as the quotations from Steffi Graf and Roy Keane at the
start of this chapter suggest? In addressing these questions, our objectives in this chapter
are two-fold. First, we shall try to summarise what is known about current theory and
research on the psychological factors involved in athletic injuries. In addition, we shall
try to provide some practical insights into the strategies used by sport psychologists to
facilitate rapid and effective injury rehabilitation in athletes.
The chapter is organised as follows. To begin with, I shall trace the shift from a
physical to a psychological perspective on injuries in sport. Next, a brief analysis of the
nature, prevalence and causes of sports injuries will be presented. The third part of the
chapter will outline and evaluate two theoretical models which purport to describe how
athletes react psychologically to injuries: the “grief stages” theory and the “cognitive
appraisal” model. Next, I shall sketch some practical strategies used by sport
psychologists in the rehabilitation of injured athletes. After that, some new directions for
research on the psychological aspects of injury will be examined. Finally, suggestions
will be provided for possible research projects in this field.

The psychological approach to injuries in athletes

Until the 1980s, most sports medicine specialists believed that as injuries had physical
causes, they required only physical forms of treatment. Furthermore, it was assumed that
athletes who had attained minimal levels of physical rehabilitation were “fully prepared
for a safe and successful return to competition” (Williams, Rotella and Heyman, 1998, p.
410). Within a decade, however, at least three strands of evidence combined to challenge
this purely physical approach to injury management.
To begin with, interviews with many injured athletes (e.g., see the quote from the
former Wimbledon tennis champion Steffi Graf at the beginning of this chapter) revealed
the emotional consequences of their physical problems. For example, anger and
depression are common reactions to the discovery that one is prevented from pursuing
one’s hobby or livelihood. Unfortunately, not all coaches or managers are sensitive to the
mental repercussions of sports injuries. For example, consider the way in which injured
soccer players used to be treated at Liverpool Football Club during the managerial reign
of Bill Shankley. Apparently, Shankley believed that the best way to hasten the
rehabilitation of such players was to ignore them completely until they had recovered
(Bent et al. 2000)! This curious practice of scapegoating injured athletes was revealed by
the former Liverpool team captain, Tommy Smith, who recalled that his manager used to
speak to him via a third party (the club trainer) whenever he was injured. Fortunately, this
situation has changed with the advent of specialist medical staff and sophisticated
treatment facilities in leading Premiership clubs. A second sign of a psychological
approach to injury management comes from surveys of the opinions and experiences of
treatment specialists in this field. By way of background, in the mid-1990s several
surveys of athletic trainers revealed a growing awareness of the significance of the
“mental side” of injuries. For example, 47 per cent of a large (almost 500) sample of

Sport and exercise psychology: A critical introduction 244