Psychological Effect of Lower Limb Injuries among Football Players

Hani Hamed*, Hamdy El- Kalupy**, Tamer Hifnawy***

*Assist. Prof. of Psychiatry- Beni-Sueif University

**Lecturer of Sport Medicine- El-Mansoura University

*** Assist. Prof. of Public Health and Community Medicine- Beni-Sueif University

 

Abstract:

Objective: The influence of psychological factors on sports injuries has been demonstrated in numerous empirical studies. Athletes experience significant mood changes throughout rehabilitation, which may hinder rehabilitation early in the process. Method: Descriptive analytical case control study which includes fifty professional football players with lower limb injuries & another group of professional football players without any injury at all will be selected. All participants were subjected to Semi structured interview, Familial Sociodeconomic Status Scale, Semi-Structured Pain Questionnaire, Beck Depression Inventory, Beck Anxiety Inventory, Life Satisfaction Scale, and Facing Daily Stressful Live Events Scale. Results: The group of football players with lower limb injuries shows statistically significant higher depression (p<.001), and higher anxiety (p<.001) compared to the other group of players. There was highly statistical significant difference regarding Life Satisfaction Scale (p<.001), and Facing Daily Stressful Live Events Scale. (p<.001). Conclusion: Depressive and anxiety disorders were more prevalent among football players with lower limb injuries. Also, among the same group there was higher degree of life dissatisfaction, and more stress caused by life events.      

 

Introduction:

 

Football is one of the most popular sports worldwide. The frequency of football injuries is estimated to be approximately 10 to 35 per 1000 playing hours. The majority of injuries occur in the lower extremities, mainly in the knees and ankles [1].

 

Injury is one of the unfortunate risks that collegiate athletes are faced with today. Even worse, is the possibility that some athletes experience re-injury or multiples injuries during their athletic careers. Athletes who experience multiple injuries are often labeled as injury prone and are treated numerous times for their physical injuries, but are never examined or treated for possible neural, behavioral or psychological deficits. For standard orthopedic injuries, it is assumed that the athlete is healthy once motor performance has reached pre-injury levels. Additionally, if injured athletes harbor any of these deficits during return to play, they may become more susceptible to re-injury [2].

Injuries among can be classified according to Bakry (1997) [3] to:

-Minor injuries: injuries need treatment for days, about 10 to 15days like muscle spasm and sprains.

-Major injuries: need treatment for weeks or months like fractures, serious ligament tears and dislocations.  

The influence of psychological factors on sports injuries has been demonstrated in numerous empirical studies. Almost all investigations have been based on stress theory or a personality-profile approach. Although the majority of studies have employed different methods, the results are in general agreement that "life events" can influence the risk of injury in athletes. In this context, social support appears to have a buffering effect. The influence of stress-coping strategies is still somewhat questionable. From the numerous psychological attributes that have been investigated in relation to sports injuries, only competitive anxiety has been shown to be associated with injury occurrence [4].

Athletes experience significant mood changes throughout rehabilitation, which may hinder the process of rehabilitation [5].

Over the last two and a half decades, researchers have tried to determine if psychological variables predispose or buffer athletes from injury. They have found that sport participants who experience many recent stressors, and who do not have the resources and skills to cope with the stress, seem most at risk for injury [6].

Psychosocial factors increasingly are becoming recognized as significant factors in sports performance, injury prevention, rehabilitation, and management. Whether considering an individual or team sport, however, the contribution of focused attention, concentration, stress management, and cognitive strategies is important. In most sports, athletes and coaches alike commonly refer to the “mental game” as equally important as physical abilities and talent to overall performance. Indeed, for the elite and professional athlete, the mental game often provides the competitive edge necessary for winning [7].

 

Aim of the Work:

This research attempts to attack the issue of the psychological effect of lower limb injuries among football players.

 

• To assess mood symptoms among football players.
• To investigate the effect of psychosocial factors as life satisfaction, different styles of facing stressful life events and subsequent lower limb injuries among football players.
• To detect the relationship between team position, site of injury, type of injury, severity of injury, and psychological profile among football players.

 

Subjects and Methods:

A descriptive analytical case control study including fifty professional football players with lower limb injuries - “ cases” & another group of professional football players without any injury - “Controls”.

Inclusion criteria:

• Male sex.
• Age between 19-25 years.
• Acceptance to participate in this study, by signing an informed consent form, after being reviewed by an Independent Research Ethical Committee

Exclusion criteria:

• Refusal to participate this study
• Current psychiatric disorder and other chronic medical condition
• Serious handicapping injuries

Methods:

  Both groups were subjected to the following:

• Semi Structured Interview:

Players were interviewed guided by a psychiatric history taking sheet designed at the Department of Psychiatry, Cairo University. It includes detailed developmental, family, educational and past history. Also it includes a mental state examination.

 

II - Beck Depression Inventory (BDI) [8]: 

 

         This inventory for measuring depression is a self-report scale designed to assess DSM-IV defined symptoms of depression such as sadness, guilt, loss of interest, social withdrawal, increase and decrease in appetite or sleep, suicidal ideation and other behavioral manifestations of depression over the previous 2 weeks. It can be used also over time to monitor symptoms and to assess response to therapeutic interventions.

 

         The inventory is composed of 21 groups of statements on a 4-point scale with the subject selecting the one that best matches his or her current state. Each statement group corresponds to a specific behavioral manifestation responses are scored 0-3, corresponding to no, mild, moderate or severe depressive symptomatology in the response. The score range varies from 0 to 63 where higher score indicate greater depression severity. According to (Beck et al., 1988) [8] score in range of:  (0 – 13) indicate no or minimal depression; (14 – 19) mild depression; (20 – 28) moderate depression; (29 – 63) severe depression.

 

III- Beck Anxiety Inventory (BAI) [9]:

 

         This inventory for measuring anxiety is a self-report scale designed to assess severity of anxiety symptoms over the past two week. Each item describes a common symptom of anxiety such as inability to relax and dizziness. The scale is designed to discriminate depression from anxiety and emphasizes the more somatic and panic-type symptoms of anxiety rather than symptoms of generalized anxiety such as worry, sleep disturbance and poor concentration. The BAI is a reliable and widely used screen for somatic anxiety symptoms that is sensitive to treatment response.

 

         The inventory is composed of 21 item and the items are scored on a 0 to 3 corresponding to no, mild, moderate or severe Anxiety symptomatology. The score range varies from 0 to 63 where higher score indicate greater anxiety severity. According to (Beck et al., 1988) [9] score in range of: (0 – 7) indicate no or minimal anxiety; (8 – 15) mild anxiety; (16 – 25) moderate anxiety; (26 – 63) severe anxiety.

 

IV-Life Satisfaction Scale [10]:

It is a 30-statements scale that includes 6 subscales to which the subject agrees disagrees or is equivocal. These subscales are the happiness, sociability, self assurance, stability, sociable acceptance, and satisfaction. It was designed to assess the level of satisfaction about life. The higher score indicates higher level of satisfaction and comfort about life.

 

 

 

V- Facing Daily Stressful Live Events Scale [11]:

It is a 30-statements scale that includes 3 subscales to which the subject agrees disagrees or is equivocal. It was designed to give an idea about different strategies can be used by the person to face and adapt different daily stressful life events (different coping skills). These subscales are the positive reaction (approach), negative reaction (avoidance), behavioral reaction. It was designed to assess the level of satisfaction about life. The higher score indicates higher level of satisfaction and comfort about life.

 

 

   All scales were applied in Arabic language after being back translated to English language and reviewed by the research team to ensure accuracy of the Arabic version.

Statistical Analysis:

data were collected coded and analyzed using SPSS software version 16 under Windows XP, The chi-square “X²” test was used for the analysis of categorical data. The Pearson product moment correlation coefficients “r” were calculated between the different investigated parameters. [12].

The level of significance was set at p <0.05.

 

 

Results:

 

I- Sociodemographic and clinical Data:

 

• Age and Years of Experience:

 

Table 1: The age and Years of Experience

		Cases	Controls	P
Age	Mean	22.12	22.22	.825
	Std. Deviation	2.31	2.17
Years of Experiences in Years	Mean	7.34	7.30	.932
	Std. Deviation	2.33	2.36

 

 

• Education, Occupation, Marital Status, and Socioeconomic Status:

Table 2: Socio-demographic characteristics of the studied groups:

 

		Cases		Controls		P
		No.	Percent	No.	Percent
Education	School students	2	4	3	6	.370
	School Graduate	19	38	24	48
	University Students	14	28	7	14
	University Graduate	15	30	16	32
	Total	50	100	50	100
Occupation	Not Working	7	14	6	12	.886
	Skilled Worker	1	2	2	4
	Semi- Professional	31	62	29	58
	Professional	11	22	13	26
	Total	50	100	50	100
Marital Status	Single	40	80	42	84	.741
	Married	6	12	6	12
	Divorced	3	6	2	0
	Widow	1	2	4	0
	Total	50	100	50	100

 

• Team Position:

 

Table 3: Team Position in both Groups

		Cases (No= 50)	Controls    (No= 50)	P
Attacker	No.	9	9	.972
	%	18	18
Middle	No.	19	18
	%	38	36
Defender	No.	12	14
	%	24	28
Goal keeper	No.	10	9
	%	20	18
Total	No.	50	50
	%	100	100

 

• Description of Injury among cases (N= 50):

 

     Table 4: Description of Injury

	Min.	Max.	Mean	Std. Deviation
Number of Injuries	1.00	5.00	2.44	1.40
Periods of Rest in Weeks	2.00	23.00	4.98	4.87

 

• Type and Site of Injury among cases (N= 50):

 

Table 5: Type and Site of Injury

Type of Injury	Frequancy	Percent
Muscle Spasm	4	8
Ligament Tear	16	32
Sprain	9	18
Fracture	7	14
Multiple Injuries	14	28
Total	50	100
Site of Injury	Frequancy	Percent
Thigh Muscles	4	8
Knee Joint	16	32
Ankle Joint	30	60
Total	50	100

 

• Severity of Injury among cases (N= 50):

 

Table 6: Severity of Injury

	No. of Players	Percent
Mild	5	10
Moderate	19	38
Severe	26	52
Total	50	100

 

 

 

 

• Psychometric Data:

 

 

1 - Beck Depression Inventory:

 

Table 7: Beck Depression Inventory in both Groups

	Cases (No= 50)		Controls    (No= 50)		P
	No.	%	No.	%
No Depression	12	24	50	100.0	<.001
Mild Depression	21	42.0	0	0.0
Moderate Depression	15	30.0	0	0.0
Severe Depression	2	4.0	0	0.0
Total	50	100	50	100

 

 

 

• Beck Anxiety Inventory:

 

Table 8: Beck Anxiety Inventory in both Groups

	Cases (No= 50)		Controls    (No= 50)		P
	No.	%	No.	%
No Anxiety	6	12.0	46	92.0	<.001
Mild Anxiety	11	22.0	4	8.0
Moderate Anxiety	23	46.0	0	4.0
Severe Anxiety	10	20.0	0	0.0
Total	50	100	50	100

 

 

 

• Life Satisfaction Scale:

 

Table 9: Life Satisfaction Scale

Life Satisfaction Scale		Cases	Controls	P
Life Satisfaction Total	Mean	57.90	77.46	<.001
	Std. Deviation	7.35	8.52
Happiness	Mean	14.52	19.02	<.001
	Std. Deviation	1.96	2.22
Sociability	Mean	11.34	12.34	.004
	Std. Deviation	1.98	1.38
Self Assurance	Mean	10.58	14.60	<.001
	Std. Deviation	2.26	2.0
Stability	Mean	7.22	8.64	<.001
	Std. Deviation	.76	.65
Social Acceptance	Mean	7.80	14.42	<.001
	Std. Deviation	2.07	2.86
Satisfaction	Mean	6.66	8.66	<.001
	Std. Deviation	1.15	.75

 

• Facing Stressful Life Event Scale:

 

Table 10: Facing Stressful Life Event Scale

Facing Stressful Life Event Scales		Cases	Controls	P
Positive Reaction	Mean	22.26	9.16	<.001
	Std. Deviation	6.27	2.11
Negative Reaction	Mean	21.82	4.12	<.001
	Std. Deviation	6.48	2.66
Behavioral Reaction	Mean	16.24	5.32	<.001
	Std. Deviation	9.31	2.42

 

 

• Correlation Studies:

1- Correlation between Type of Injuries and Beck Anxiety Inventory:

Table 11: Correlation between Type of Injuries and Beck Anxiety Inventory

		No Anxiety	Mild Anxiety	Moderate Anxiety	Severe Anxiety	P
Muscle Spasm	No.	1	1	1	1	.010
	%	16.7	9.1	4.3	10
Ligament Tear	No.	4	4	8	0
	%	66.7	36.4	34.8	0.0
Sprain	No.	0	4	4	1
	%	0.0	36.4	17.4	10
Fracture	No.	1	2	4	0
	%	16.7	18.2	17.4	0.0
Multiple	No.	0	0	6	8
	%	0.0	0.0	26.1	80

 

 

2- Correlation between Type of Injuries and Life Satisfaction Scale, Total:

 

Table 12: Correlation between Type of Injuries and Life Satisfaction Scale

	Mean	Std. Deviation	P
Muscle Spasm	64.75	2.06	.015
Ligament Tear	57.75	7.01
Sprain	62.44	6.77
Fracture	56.71	6.44
Multiple	53.78	7.12

 

 

3- Correlation between Severity of Injuries and Beck Anxiety Inventory:

 

Table 13: Correlation between Severity of Injuries and Beck Anxiety Inventory

		No Anxiety	Mild Anxiety	Moderate Anxiety	Severe Anxiety	P
Mild	No.	0	3	1	1	.036
	%	0.0	27.3	4.3	10
Moderate	No.	5	4	9	1
	%	83.3	36.4	39.1	10
Severe	No.	1	4	13	8
	%	16.7	36.4	56.5	80

 

 

 

 

 

 

4- Correlation between Severity of Injuries and Life Satisfaction Scale:

 

Table 14: Correlation between Severity of Injuries and Pain Questionnaire & Life Satisfaction Scale

		Life Satisfaction Scale, Total	Happiness	Sociability	Self Assurance	Stability	Social Acceptance	Satisfaction
Severity of Injuries	R	-.502	-.383	-.346	-.461	-.336	-.327	-.447
	P	<.001	.006	0.014	.001	.017	.021	.001
	N	50	50	50	50	50	50	50

 

5- Correlation between Beck Depression Inventory and Facing Stressful Life Event Sub-Scales:

 

Table 15: Correlation between Beck Depression Inventory and Facing Stressful Life Event Sub-Scales

		Mean	Std. Deviation	P
Negative Reaction	No Depression	21.42	6.97	.022
	Mild Depression	21.90	6.72
	Moderate Depression	20.27	3.67
	Severe Depression	35.00	7.07
Behavioral Reaction	No Depression	15.50	8.06	.010
	Mild Depression	15.90	9.01
	Moderate Depression	14.53	8.37
	Severe Depression	37.00	4.24

 

 

 

 

 

6-Correlation between Life Satisfaction Scale & it’s subscales and Facing Stressful Life Event Scale:

 

Table 16: Correlation between Life Satisfaction Scale and Facing Stressful Life Event Scale

		Positive Reaction	Negative  Reaction	Behavioral Reaction
Life Satisfaction Total	R	.329	.140	.152
	P	.02	.332	.291
	N	50	50	50
Happiness	R	.394	.227	.176
	P	.005	.112	.221
	N	50	50	50
Sociability	R	.329	-.008	.061
	P	.020	.957	.674
	N	50	50	50
Self Assurance	R	.326	.073	.086
	P	.021	.616	.551
	N	50	50	50
Stability	R	-.004	.033	.067
	P	.980	.980	.644
	N	50	50	50
Social Acceptance	R	-.079	.087	.095
	P	.584	.548	.513
	N	50	50	50
Satisfaction	R	.334	.177	.163
	P	.018	.218	.257
	N	50	50	50

 

Discussion:

Players among both groups were nearly from the same age group (the mean was 22.12 ± 2.31, 22.22 ± 2.17 for cases and controls respectively). Also, there was no statistical significant difference between players among the two groups regarding the years of experience (the mean was 7.34 ± 2.33, 7.30 ± 2.36 for cases and controls respectively) (table 1). There was no statistical significant difference between players in both groups regarding education, occupation, marital status, and team position (P= .370, P= .886, P=.741, P= .972 respectively) (table 2, 3). This highlight that  the two groups were cross matched.

   Among the group of injured players, the mean of number of injuries was 2.44 ± 1.40, and the mean of period of rest in weeks was 4.98 ± 4.87 (table 4).  The majority of players (32%) were with ligament tears and (28%) were with mixed injuries. Most of injuries were in the ankle joint (60%) and knee joint (32%) (table 5). The majority of injuries were of severe (52%) and moderate degree (38%) (table 6). Bailey et al., (2009) [13] found that most injuries were minor (class 1 severity), and none exceeded class 3 severity.  Knee and ankle injuries were the most common (27% and 47%, respectively), consisting mainly of sprains.

There was statistical significant difference between players in both groups regarding Beck Depression Inventory (P <.001) (table 7). Also, injured players showed higher degree of anxiety. There was statistical significant difference between players in both groups regarding Beck Anxiety Inventory (P <.001) (table 8). This was consistent with (Nor, 2006) [14] who stated that injuries may lead to emotional problems such as anxiety and depression. These negative moods and behaviours place the athlete at risk for prolonged rehabilitation and further behavioural problems.  Injury is often a traumatic event where emotional and psychological reactions are produced. Typically, these reactions are based on the individual’s perceptions of loss (e.g., mobility, playing time, career). Although this loss is perceived differently by different individuals, injuries can often prevent athletes from pursuing a self-defining activity. As a result, they are particularly vulnerable to psychological reactions such as anxiety, depression, fear, and loss of self-esteem [15]. Leddy, (1994) [16] found that injured athletes exhibited greater depression and anxiety and lower self-esteem than control groups immediately following physical injury and at follow-up sessions.

Players among the control group showed higher degree of satisfaction. They showed higher levels of happiness, sociability, self assurance, stability and social acceptance. There was statistical significant difference between players in both groups regarding Life Satisfaction Scale (P <.001) (table 9). The occurrence of injury among athletes may disrupt the emotional and psychological reactions, which are typically negative and affect the different aspects of their lives [17]. Again, dissatisfaction in different aspects of life among injured football athletes could be explained physiologically and psychologically by once an athlete becomes injured, both physiologic and psychological processes occur. Physiologically, a vicious pain-spasm-pain cycle will continue, causing further damage, if appropriate care is not provided. Furthermore, many physiologic changes that occur during psychological stress may impair recovery. Increased muscle tension, heart rate, bloodpressure, and skin conductance, all indicative of autonomic nervous system (ANS) activity, are present after injury. Also, attentional changes (ie, worry about self) that occur after athletic injury may cause further generalized muscle tension, which in turn may result in further musculoskeletal injuries from disturbances in fine motor coordination and reduced joint flexibility. Prolonged distress accompanying an injury may also lead to continual ANS arousal (eg, epinephrine, norepinephrine, and cortisol release) that may prolong recovery by impairing immune functioning and skeletal muscle repair [18].

    There was highly statistical significant difference between players in both groups regarding Facing Stressful Life Event Scale (P <.001) (table 10). This statistical significant difference included not only the negative reaction but also, the positive and behavioral reactions. Smith et al., (2001) [19] stated that athletes have difficulty coping with the changes that accompany injury, activity restriction, long rehabilitation, and feelings of being externally controlled by their injury. Also, (Newcomer, 2000) [20] found that physically recovered athletes with a recent injury history experience greater frequency and intensity of intrusive thoughts and avoidance behaviors when compared to athletes without a recent injury history. Injured athletes had higher scores on Impact of Event Scale which donate that they experienced a variety of stressful events.  Andersen & Williams, (1999) [21] stated that personality characteristics that tend to exacerbate the stress response, with a history of many stressors, and with few coping resources will be more likely, when placed in a stressful situation, to appraise the situation as stressful and thus exhibit greater physiological activation and attentional disruption. The muscle tension, distractibility, and perceptual narrowing that occur during the stress response appear to be the mechanisms behind increased injury risk.

There was statistical significant difference between type of injury and Beck Anxiety Inventory (P= .010) (table 11). Injured players with tear ligament showed lower degree of anxiety (66.7% no anxiety and 36.4% with mild anxiety). While the majority of players with multiple injuries showed higher degree of anxiety (80% with severe anxiety and 26.1% with moderate anxiety). This might be explained by Shuer (1997) [22] who stated that fear is another emotion prevalent among athletes with multiple injury. Athletes are fearful about re-injury and because of this fear, they may be reluctant to train with full intensity. Some athletes may be reluctant to return to training at all as a result of the fear. Wasley and Lox (1993) [23] suggested that the type of injury may determine differences in self-esteem and coping behavior.

Also, there was statistical significant difference between type of injury and Life Satisfaction Scale (P= .015) (table 12). Injured players with muscle spasm (64.75%) showed more satisfaction with life. While players with multiple injuries (53.78%) showed lower degree of life satisfaction. This was in line with Patterson et al., (1998) [24] who found a relationship of life stress, which affect the quality of life, to athletic injury. They found a positive relationship between injury and high life stress (daily hassles, and life changes). These findings suggest that preoccupation with life change may affect concentration on training and competition and increase the likelihood of further injury. Williams and Andersen (1998) [25] have proposed that physiologic (eg, increased muscle tension and narrowing of visual field) and attentional (eg, increased distractibility) aspects of the stress response are possible underlying manifestations of stress that increase susceptibility to injury.

Players with severe injuries showed higher degree of anxiety (80.% with severe anxiety and 56.5% with moderate anxiety). While the majority of players with mild injuries showed lower degree of anxiety (27.3% with mild anxiety). This difference reached statistical significant difference (P= .036) (table 13). The present study corroborates findings with Lavallee & Flint, (1996) [26] and Kolt & Roberts, (1998) [27] who revealed that such relationships are often found between injury outcome and risk factors such as competitive trait anxiety, low self-esteem and low mood state early in the season.

There was a highly significant negative correlation between severity of injury and Life Satisfaction Scale and it’s sub-tests (table 14). This means that the higher severity of injury is associated with less satisfaction of life and lower degree of happiness, sociability, self assurance, stability and social acceptance. This could be explained by Smith et al., (1990) [28] who found a relationship between negative life events and injury outcome among athletes, and such negative life events definitely affect different aspects of life satisfaction.

Regarding the correlation between Facing Stressful Life Event Scale and Beck Depression Inventory, there was statistical significant difference between severity of depression and negative & behavioral reactions (P= .022, P=.010 respectively). The negative and behavioral reactions were associated with higher means of severe depression (mean=35 ± 7.07, mean=37 ± 4.24) (table 15). Damage to self-esteem is a potential consequence of injury that has been neglected by researchers in favor of the closer examination of emotional reactions following injury. Certain components of self-esteem, physical self-efficacy, perceived physical competence, and higher are likely to be affected by the occurrence of injury. Some empirical evidence does exist that suggests that injury can lead to changes in how a person views him or herself which make them more vulnerable to psychological reactions such as anxiety, depression (Smith, 1996) [29].

There was a highly significant positive correlation between positive reaction in Facing Stressful Life Event Scale and Life satisfaction Scale total, Happiness Sub-scale, Sociability Sub-scale, Self Assurance Sub-scale & Satisfaction Sub-scale (P= .02, P=.005, P=.020, P=.021, P=.018 respectively) (table 16). Ford et al., (2000) [30] stated that injured athletes with more optimism, hardiness, global self-esteem or better coping strategies may adapt more effectively with life change stress, resulting in reduced injury vulnerability and recovery rates which is associated with higher satisfaction.

 

Overall, besides the improvement of physical performance, technical and tactical skills and injury prevention, psychological state of the players in a team will be essential for team success and should be addressed. Beyond the physical pain of the injury, it also contributes to exclusion from team activities, stresses about losing abilities, and considerations of surgery, prolonged recovery and rehabilitation. Also, fears about regaining previous functioning are also present. These stressors can cause a great deal of psychological angst and disturbance, and produce symptoms of depression, anxiety, and low self-esteem

 

 

Conclusion:

• Depressive and anxiety disorders were more prevalent among football players with lower limb  injuries. Among the same group there was a higher degree of life dissatisfaction.

• Football players with lower limb injuries had more difficulties facing stressful life events.

• Football players with multiple and severe lower limb injuries showed higher anxiety symptoms and a lower level of life satisfaction

• Approaching strategies in facing stressful life events  are associated with higher level of life satisfaction. 

 

Recommendations:

• Physiotherapists should always be alert to a concomitant psychiatric disturbance that could associated with lower limb                   

     injuries among football  players.

• It is also important to study in depth characters of the personality and coping strategies of injured football players which highly colour their psychological condition.  

• We recommend including a psychiatrist among the medical team to facilitate injury prevention, better adaptation and promote rehabilitation.

•  The psychiatrist can play an influential role in the “mental game” which  is equally important as physical abilities and talent to overall performance.
• Psychological profiles of the players could enable coaches to choose players who are truly worthy, good, and have the thirst for success to improve the name and reputation of the team.

  

 

References:

1- Dvorak, J and Junge, A (2000): Football injuries and physical symptoms. Am J Sports Med September vol. 28 no. suppl 5: 3-9.

2- Moss^, R. A. and Slobounov S (2006): Neural, behavioral and psychological effects of injury in athletes. Foundations of Sport-Related Brain Injuries. Springer US. Part 5: 407-430.

3- Bakry M.K. (1997): Sport Injuries and Rehabilitation. Cairo, 36-58.

4- Junge A. (2000): The influence of psychological factors on sports injuries. Am J Sports Med. 28(5 Suppl):10-5.

5- Morrey M. A., Stuart M. J., Smith A. M., and Wiese-Bjornstal D. M. (1999): A longitudinal examination of athletes' emotional and cognitive responses to anterior cruciate ligament injury. Clin J Sport Med. Apr; (2):63-9.

6- Williams J. M.(1996): Stress, coping resources, and injury risk. International Journal of Stress Management. Springer Netherlands volume 3 number4. 209-221.

7- Ahern D.K. and Lohr  B.A. (1997): Psychological factors in sports injury rehabilitaion. Clinics in Sports Medicine. Volume 16, Issue 4, Pages 569-768.

8- Beck A.T., Steer R.A., and Garbin M.G. (1988): Psychometric properties of the Beck depression Inventory: Twenty five years of evaluation. Clin Psych rev, 8:77.

9- Beck A.T., Epstien N., Brown G., and Steer R.A. (1988): An inventory for measuring clinical anxiety: psychometric properties. J consult clin Psycho, 56(6):893 – 7.

10- Dessoki M.M. (2003): Life Satisfaction Scale. Egyptian Anglo Library.

11- Poon L.W. (2003): Facing Daily Stress Live Event Scale. Egyptian Elnahda Library.

12- Altman G.A. (1991): In Altman,G.A.(ed.): Practical statistics for Medical Research; Chapman & Hall, London.

13- Bailey R., Erasmus L., and Lüttich L., (2009): Incidence of injuries among male soccer players in the first team of the University of the Free State in the Coca Cola League – 2007/2008 season. South African Journal of Sports Medicine, Vol 21 No. 1: 1015-5163.

14- Nor M. A. (2006): Psychological predictors of injury among Malasysian professional football players. Degree of Doctor of Philosophy: 20-39.

15- McDonald S. A., and Hardy C. J. (1990): Affective response patterns of the injured athlete: An exploratory analysis. The Sport Psychologist, 4, 261–274.

16- Leddy M.H., Lambert M.J., and Ogles B.M. (1994): Psychological consequences of athletic injury among high-level competitors. Abstract retrieved on January 12, 2005 from PubMed database.

17- Rotella, R. J., and Heyman, S. R. (1993): Stress, injury, and the psychological rehabilitation of athletes. In J. M. Williams (Ed.), Applied sport psychology: Personal growth to peak performance, 2nd ed. 338–355. 

18- Nideffer R. M. (1983): Psychological aspects of sports injuries: issues in prevention and treatment. Int J Sport Psychol. 1983;20:241-255.

19- Smith A.M., Hartman A.D., and Detling N.J. (2001): Assessment of the injured athlete. In J.Crossman, Coping with sports injuries: Psychological strategies for rehabilitation. New York: Oxford University Press, 20-50.

20- Newcomer R. R. (2000):  Cognitive- affective, bahvioral, and psychological response to injury among competitive athletes. Degree of Doctor of Sport Psychology: 30-59.

21- Andersen. M. B., and Williams, J. M. (1999): Athletic injury, psychosocial factors, and perceptual changes during stress. Journal of Sport Sciences, 17, 735–741.

22- Shuer M. L., and Dietrich M. S. (1997): Psychological effects of chronic injury in elite athletes. Western Journal of Medicine, 166 (2), 104-109.

23- Wasley D., and Lox C.L. (1993): Self-esteem and coping responses of athletes with acute versus chronic injuries. Abstract retrieved on February 20, 2006 from PubMed database.

24- Patterson, E. L., Smith, R. E., and Everett, J. J. (1990): Psychosocial factors as predictors of ballet injuries: Interactive effects of life stress and social support. Journal of Sport Behavior, 21, 101–112.

25- Williams J. M. , and Andersen M. B. (1998): Psychosocial antecedents of sport injury: review and critique of the stress and injury model. J Sport Psychol, 10:5-25.

26- Lavallee L., and Flint F. (1996): The relationship of stress, competitive anxiety, mood state, and social support to athletic injury. Journal of Athletic Training, 31, 296–299.

27- Kolt G., and Roberts P. D. T. (1998): Self-esteem and injury in competitive field hockey players. Perceptual and Motor Skills, 87(1), 353–354.

28- Smith R. E., Smoll F. L., and Ptacek J. T. (1990): Conjunctive moderator variables in vulnerability and resiliency research: Life stress, social support and coping skills, and adolescent sport injuries. Journal of Personality and Social Psychology, 58, 360–369.

29- Smith A. M. (1996): Psychological impact of injuries in athletes. Sports Medicine, 22, 391–405.

30- Ford I. W., Eklund R. C., and Gordon S. (2000): An examination of psychosocial variables moderating the relationship between life stress and injury time-loss among athletes of a high standard. Journal of Sports Sciences, Volume 18, Issue 5, 301 – 312.

All pages in this site copyright ©Priory Lodge Education Ltd 1994-

Online Journals

Vet On-Line

Pharmacy On-Line

Anaesthesia On-Line

General Practice On-Line

History of Medicine On-Line

Psychiatry On-Line

Medicine On-Line

Family Medicine On-Line

Chest Medicine On-Line

Dentistry On-Line

Surgery On-Line