qualitative methodology (see brief account in Chapter 1). Adopting this approach,
researchers have used such techniques as “in-depth” interviews and focus groups to
examine athletes’ emotional reactions to injuries over a given period of time (Hurley,
2003).
What findings have emerged from these parallel lines of inquiry? At least four trends
are evident. First, according to Brewer (200 Ib), higher levels of emotional disturbance
(e.g., depression, anger, frustration) have been detected in athletes suffering from injuries
than in control groups. To illustrate, Chan and Grossman (1988) discovered that injured
runners displayed significantly more depression, anxiety and confusion than did non-
injured counterparts. Also, according to Kishi, Robinson and Forrester (1994), patients
who had experienced amputations or spinal cord injuries became depressed and even
suicidal afterwards. Similarly, using a longitudinal research design, Leddy, Lambert and
Ogles (1994) found that injured athletes showed greater depression and anxiety than
athletes in control groups immediately after injury occurrence. Perhaps more
significantly, these authors discovered that this disparity in distress was still evident as
long as two months later. Overall, Brewer (1999) suggested that between 5 and 13 per
cent of injured athletes suffer emotional disturbance of clinically significant proportions.
A second general finding in the research literature is that physical trauma appears to be
associated with elevated levels of emotional distress. Indeed, such distress has been
reported in between 5 and 24 per cent of injured athletes who have been tested (ibid.).
Nevertheless, Brewer (2001b) urges caution as such evidence does not prove that injury
actually causes emotional disturbance. The third general finding in this field is that, not
surprisingly, the emotional reactions of injured athletes tend to change from negative to
positive during the course of their rehabilitation. For example, Quinn and Fallen (1999)
administered the POMS to 136 elite injured athletes and discovered that a variety of
initially negative emotional states (e.g., anger, depression) decreased significantly over
time. In a similar vein, Johnston and Carroll (2000) discovered that the degree of
emotional confusion precipitated by injury varied directly with athletes’ level of
involvement in their sport. Following up athletes at different stages of rehabilitation, they
found that those performers who had been more involved in sport and exercise before
incurring injury reported higher levels of confusion and lower perceptions of recovery
during rehabilitation than did colleagues who had been less involved in their sport. The
final general trend in the literature is the surprising discovery that occasionally, the
experience of injury may benefit the athletes afflicted (Udry, 1999). Among the common
benefits cited by athletes in this regard are opportunities for personal growth,
development of interests outside sport, and increased motivation (Brewer, 2001b). If
viewed con-structively, recuperation time from a serious injury may not only allow
athletes to learn more about themselves and how their bodies work but may also help
them to develop interests outside sport. For example, as indicated by the quote at the
beginning of this chapter, Roy Keane, the captain of Manchester United and former
captain of the Republic of Ireland, derived considerable benefit from the time he spent in
solitary reflection as he recovered from the cruciate knee ligament injury which he
experienced in 1998. Commonly, this type of injury is career-threatening as it usually
requires reconstruction of the knee and precludes the afflicted athlete from active
participation in the sport for up to a year afterwards. To illustrate the severity of this
injury, athletes who undergo reconstruction of their anterior cruciate ligament may lose
Helping athletes to cope with injury: from theory to practice 253