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Psychological Consequences of Athletic Injury among High-Level

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DOI: 10.1080/02701367.1994.10607639 · Source: PubMed

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 Research Ouartsrly lor Exercise and Sport
@ 1994 by the American Alliance for Health,
Physical Education, Recreation and Dance
Vol.65, No. 4, pp. 347-354

Psychological Gonsequences of Athletic lniury

Among High-Level Competitors
Matthew H. Leddy, Michael J. Lambert, and Benjamin M. 1gtes
Iyurl prohibiting continued athtztic participation has been hypothcsized to haue a pred,ictablc emotional
impact on athlztes
(Rotella U HErnan, 19s5). Howeat the pslchol'ogtcal impaci of injury has not bisn
wett d,ocumznted.. This stud.y examined, the
pslchological reactions to injurl among 343 malz collcgiate athlztes participating in l0 sports.
Ail athlctcs uere assessed, using
TTteasures of depression, anxictl, and self<steem during praeason pttlsical
examiltations.^Injured, athl^etes along uith matchcd.
controk were later assessed ttithin one weeh of expytm1ing an athtetic injury and. 2 monthi tntn
A a x 3 eniury Status x Timt
of Tbsting) repeated measures multiaariate anal2sis of aariance (DM MANOVA) rnealed that injured,
atnUis e*h;O;ted great",
depraion and anxiety and hwn self-esteeern than ynbok immed,iatzly phlsicat injury and
foltowi.ng at 2 rnoittu
later Thzsefndings supported the general obsnration that physically ;iiurea oinLt t expoimcc a perioifoltou-up
of ernotional d,istress
that in som,e cases may be seaae enough to warrant crinicar-intcrumt;oi.

Kq words: athletic injury, elite athletes
ince 1965, investigators have studied the relation-
ship berween psychological facrors and athletic in-
jury. The earliest studies were conducted in an effort to
identify the personalityvariables and other factors, such
as life stress, that predisposed athletic competitors to in-
jurv or were related to the occurrence of injury (e.g.,
Andersen & Williams, 1988; Coddington & Troxell,
1980). Prediction and prevention of injury, however,
have proven elusive.
Because injuries appear to be increasing in fie-
quency (Meeuwisse & Fowler, 1988), the potential nega-
tive emotional effects of athletic injury have become in
increasing concern. Investigators have assumed that
athletes, following physical injury, experience predicr-
able psychological reacrions such as depression, anxiery
and impaired self-esteem, which may reach clinically
meaningful proportions (Crossman, 1985; Eldridge,
1983; Wiese & Weiss, 1987). As a result, a number of
studies have been conducted to idenrifr the emorional
changes that correlate with athletic injury.
Submitted: }ctober t9, 1993
Revision accepted: ,{ugust 17, lgg4
Matthew H. Leddy is director of psychotogical services at the
Northeast Mental Health Center of the Mental Heatth and Mental
Retardation Authority of Harris County in Houston, Texas. Michael
J. Lambert is a professor in the Department of Psychotogy at Brighan
Young University. Benjanin M. 0gles is an assistant professor in
the Departnent of Psychology at 0hio University, Athens.
Weiss and Troxel (1986) were the first to artempt to
identi$ the psychological responses of athletes to in-
jury. They interviewed 10 elite and collegiate competi-
tors who were injured and asked them to express their
most common difficulties in dealing with injuries.
Three males and seven females, who participated in five
different sports (nvo each from volleyball, basketball,
running, throwing, and wrestling), were interviewed.
Athletes' responses to injury included fear, tension,
fatigue, disbelief, depression, and somatic complaints
(e.g., insomnia, loss of appetite, and upset stomach).
Weiss and Troxel also found that many of the athletes
they interviewed expressed an inability to cope with
their injury, the long rehabilitation which followed, the
activity restriction, and the sense of being externally
controlled by the injury. Despite the lack of experimen-
tal controls and objective measures, Weiss and Troxel,s
work provided impetus for subsequent research in this
area.
Some studies have invesdgated the emorions and
self-perceptions of athleres following injuryr Chan and
Grossman (1988) found that injured runners exhibited
significantly more depression, anxiety, confusion, and
lower self-esteem rhan noninjured runners. Similarly,
Smith, Scott, O'Fallon, and Young (lgg0) artempted. to
determine the presence, noe, magnitude, and time
course of emotions, from onset of injurv until return to
competition, among arhleric competitors. The,v exam-
ined 72 recreational athletes, at 2-week intervals, from
the time their injury was sustained until their rerurn to
full participation in sports or 4 months, whichever came
first. Immediately following injury, the athletes experi-

B0ES: Decenher 1994

347
Leddv, Lanbert, and 0gles
enced elevatecl lcvels of frustration, depressiort, lrncl :rn-
gcr. Thcse ch'.rnges in moocl remainecl trnchangecl for
:rbout ir month fbllowing injury lor the tnost seriottslv
injurecl athletes. Pearson ancl Jones (1992) estended
r.he previous sttrdies by exirmining the emotionlll itnpact
of sport injuries in a group of 6l injured rrthletes along
with a carefully matched group of noninjurecl athletes.
Injured athletes experienced significantly more ten-
sion, hostiliw, depression, riredness, and conftlsion
than the noninjured athletes.
Similar reactions have been identifiecl in athletes
who experience severe or career-endittg injtrries.
lvlcDonald and Hardy (1990) studied five severelv in-
jured collegiate athletes in the 4 weeks follorving injury.
These athletes had immediate increases in negative
mood, followed by gradual increases in positive mood
during rehabilitation. Interestingly, negative mood di-
minished and positive mood increased in relationship
to perceived rehabilitation. Using a unique sample of
athletes who experien ced career-endin g injuries, Klei ber
and Brock (1992) found that only those who had an in-
vestment in playing professional sport rvere likelv to
show lower self-esteem and life satisfaction 5 to l0 vears
Iater. This modified their earlier findings (Kleiber,
Greendorfer, Blinde, & Samdahl, i987), which had sug-
gested that any career-ending injury resulted in changes
in life satisfaction and self-esteem.
While these studies supported the idea that signifi-
cant alterations in mood and self-esteem can occur
among injured athletes, several problems limited the
strength and generalizability of their frndings: (a) all
studies used postinjury designs so the effects of selec-
tion bias could not be ruled out, (b) most of the studies
were limited in the number and rype of subjects erralu-
ated (nonelite or select sports), (c) none of the studies
attempred to document the severiry of pqvchological
distress experienced by athletes following injur,v, (d)
Smith et al. (1990) used college normarive data instead
of noninjured athletes for a comparison group, and (e)
the Chan and Grossman (i988) sampie was limited ro
"minor" foot and leg injuries.
One more recenl studv has actempted to improve
upon tJrese early attempts to document the psvchologi-
cal impact of injuri,. Smith et al. (i993) used a prosPec-
tive desiga to assess the impact of injurv on mood and
self-esteem. Athletes who were injured had significant
increases in depression and anger along rvith significant
decreases in vigor foilowing injurv. Unfortunately, the
athletes who were not injured were not assessed ag:ain
after the preinjurv tesring. As a resuit, a noninjured
control group was not avaiiabie for comparison.
Overall, the iiterature reviewed suggests that nega-
tive changes in mood and self-esteem mav accompany
athieric injurv. Injured athletes reported increases in
depression, anger, tension, and anxiery with concurrent
decreases in self-esteem and vigor. This research has
348
procluced a valuable starting point tbr c()r'lLinued
investigarion of the consequences of injrrrv urcl has
resulted in a move torv'.rrcl developing interrr'nuons
for injured athletes iHeil, 1993; Pargnan, I !l!)ll: Rotella
& Hetrynan, 1986).
Despite these consistent findings, horr'ever, no pro-
spective studv has follorved both injured ancl non-
injured athletes. .\ a resuit, no definirive statements
about the causal relarionship between injtrrv and mood
changes can be macle. It may be rhat injurecl arhletes
are different in mood from noninjured athletes prior to
the injur,v. Another possibilitv is that all arhletes experi-
ence mood changes during the course of a season. re-
gardless of injury status. To further extend the inirial
findings regarding emodonal changes related to injurl',
the present study assesses the mood and self-esteem of
both injured and noninjured athletes using a ProsPec-
dve design.
Although mood and self-esteem changes have been
demonstrated to occur with athletic injurl', no attemPt
has been made to euluate the clinical severitv of this
mood disturbance. In fact, most studies use the Profile
of Mood States (PONIS; McNair, Lorr, & Droppleman,
1971) to assess the emodonal impact of injurv, vet make
no mention of the normative sample or ourPadent
sample reported in the POMS manual. While the POMS
is a widely used instrument in research setdngs, it is not
often used to assess disturbed mood in most clinicai set-
tings. As a result, this study includes two widely used
clinical measures of disturbed mood (depression and
anxiery). In addition, previous studies have included
measures of global self-esteem without considering the
mulripte dimensions of self-perceprion. In this studv, a
measure of athletes' perceptions and eraluarions of
their physical self Has included in addirion to a measure
of overall selfesteem.
The purpose of this study was to directlv investigate
the psychological effects of a phvsical injurv on eiite
level athletes while improving upon prerious related
studies by: (a) tesring athletes before and after phvsical
injury occurs. (b) testing athietes from 10 different
sports, (c) utilizinq a large subject sample rvith non-
injured athlete controls, (d) examining high-le"'el
athletic competitors, and (e) using reliable and valid
ciinical instruments that were appropriate for and spe-
cific to the phenomenon under invesrigarion and coulC
be used to examine the severiry of pwchologicai
svmptomatoiog,v. \\-e hvpothesized that injurv status
groups would nor differ in levels of depression, anxier';'
and self-esteem pnor ro injury. Following injurv, horv-
ever, rve hlpothesized that injured alhletes rr'ould repon
significanrly higher levels of depression and anxien'
along with significantly lower leveis of both phvsical anC
overall seif-esteem than noninjured arhietes. Similarir'.
we hypothesized that athletes who rvere injured at fol-
low-up would report significantiy higher levels of de-
BOES: Decenher 1994
 -e00v, LamDen. tnd 0gles

pression and anxiety along with significantl,v lower lev- lnstrumentation

els of both physical and overall self-esteem than athletes
who had recovered from an earlier injurv or athletes In order [o assess the psvchological impact of in-
who were never injured. iurl', three widely used clinical instruments lvere admin-
istered to all subjects: the Beck Depression Inventorr',
the State-Trait Anxiew Inventorv-Form \', and the Ten-
nessee Self-Concept Scale. Clinical insruments \\'ere se-
Method lected, as opposed to sport-specific measures, in order
to investigate the clinical impact of injun' on athletes.
Subjects and Design Trait measures of anxieq'and self-esteem were included
to assess the potential impact of injur;.' on more disposi-
Ten male collegiate athletic teams from a large, pri- rional psychological characteristics of athletes. Since
vate NCAA Division IA universir,v participated in this sport participation ma1' be an important part of an
stud,v.l It should be noted that this universiry main- arhlete's idendry injury may'have an impact on more
tained a competitive and successful athletic Program, stable psvchological characterisrics. In addition, a de-
one which produced several nationally ranked teams mographic and training quesrionnaire was adminis-
and athletes. The number of individuals from each tered to all subjects.
team are shorm in Table 1. The 343 athletes ranged in Beck Depression Inaentml @DI). Tll.e Beck Depres-
age from 17 to 26 years (M = 20.42 years; S, = 2'06) . Of sion Inventory (Beck, Ward, Mendelson, Mock, &
these subjects, 205 (59.8Vo) received athletic scholar- Erbaugh, 1961) is a 21-item self-report inventory that
ships. The average competitor reported having been in- measures the intensity of common depressive symPtoms
volved in his sport for 8.i8 years (SD= 4.1) and invest- and attitudes. Each slrnptom is rated for intensity from
ing benveen 20 to 25 hr per week in his respective ath- 0 to 3. A total score is then calculated by summing the
letic activicy. ratings for each of the 21 items. Total scores range from
The study used a nonexperimental, prospective de- 0 to 63. Higher scores reflect the presence of more in-
sign to assess multiple variables over the duration of the tense depressive syrnptoms.
season. The independent variables included Injury Sta- Beck, Steer, and Garbin (1988) summarized the re-
tus with four levels: Injured (athletes injured at search regarding the reliability and validity of the BDI.
postinjury and injured at follow-up , n = 77); Recovered Internal consistencies for psychiatric populations range
(athletes injured at postinjury but fully recovered at fol- from .76 to .95, while nonpsychiatric populations' inter-
low-up, n = 68); Noninjured (athletes who were not in- nal consistencies range from .73 to .92. Correlations
jured at postinjury and not injured at follow-up, with other measures of depression range from .41 to .75
n = i10); and Late Injured (athletes who were not in- (e.g., Hamilton Psychiatric Rating Scale for Depression,
jured at postinjury but were injured at follow-up, Zung Self-Reported Depression Scale, MMPI Depres-
n = 58). Time of Testing comprised a within-subjects sion Scale, and Multiple Affect Adjective Checklist De-
factor and consisted of three levels: Pretest, Postinjury' pression Scale). The BDI also successfully differentiates
and Follow-Up. Athletes with Pretest injuries (n=30) psychiatric from nonpsychiatric groups.
were not included in the studY. 6fAD.The State Trait
Statc-Trait Anxiety In,aentorJ
Anxiety Inventory (Speilberger, Gorsuch, & Lushene,
Table 1. Number of athletes by iniury status and sport 1970) is a self-report instrument that differentiates be-
(rait anxietv; STN-T)
tween general feelings of anxiery
lniury status and current feelings of anxiew (state anxiet,v; STAf-S).
Late
This instrument is the most widelv used outcome mea-
Sport Pretest lnlured Recovered inlured Noninjured
sure for measuring changes occurring as a result of
12 38 40 5 19
reatment for anxiery.
Football
Wrestling 2 l0 9 4 IJ The STAI is a single-page, seif-report protocol con-
B aseball 07 10 21 23 sisring of two scales, The trait scale is on one side of the
Track and field 86 0 3 15 page and the state scale is on the reverse. Each scale is
Gymnastics 52 4 5 0 composed of 20 items, making a total of 40. Items are
Cross-country 31 4 E 4 rated on a scale ranging from 1 (not at all) to 4 (aery
Swimming 05 ,l
6 12
much so). A higher score reflects a greater level of anxi-
B asketball 04 0 13
ery for that particular scale.
Ten ni s 04 0 2 1

Speilberger et al. (1970) found internal consistency

Golf 00 0 0 10
estimates to range from '89 to .91 for the trait scale and
30 71 68 58 110 .86 to .95 for rhe state scale. Test-retest reliabiliry for the
Total
trait scale using a sample of high school and college stu-

349
B&ES: Decemher 1994
Leddy, Lanberl and 1gles
rients ranged ttom .ti5 to .86' The STAI measures the
theoretical constrtlcts of state and trait anxiew and can
adequately cliscriminate benveen a normal and psvchi-
atric sample (Chaplin, 1984).
' The Tennessee
Tennessee Setf-Concept Scalz (TSCS)'
Self-Concept Scale (Roid & Fitts, 1988) is a 100-item
measure oi various asPects of individuals' self-percep
tions. Each item is rated on a | (complztcly fake) to 5
(cornptetzty true) scale' A variery of scales can be scored
using *re subjecs' resPonses' of which the total
(TSC$T) is the most frequently used in research' The
TSCST rePresents the individuals' "overall level of self-
esteem" (Roid & Fitts, 1988, p' 3)' In this study' the
physical self-score (TSCSP), which rePresents the sub-
jects' ,riew of their body, state of health, physical appear-
-ance,
skills, and sexuality' was also included' Adequate
test-retest reliabilities have been reported for both
scales (r=.92 and r= .87 for the TSC$T and TSCSR
respectively; Roid & Fitts, 1988). The scales of the TSCS
have been shown to discriminate patient from non-
patient samples as well as concurrent validity with other
measures of distress or personality characteristics (e'g''
the MMPI, the Edwards Personal Preference Schedule;
Fits, 1965). The TSC$T does a particularly goodjob of
discriminating clinical from nonclinical samples and is
frequently used in research (Walsh, 1984) '
Demographic and, traini.ng questi'onnaire' A deme
-
graphic and uaining questionnaire was developed by
ihe'investigators to gather several pieces of informa-
don, including age, sport, scholarship status, Pretest in-
jury status, number of years spent participating in a par-
icrrlar sport, and weekly time commitment to a particu-
lar sport.
Procedure
Subjects (N= 343) initially completed an informed
consent document, the BDI, the STAI, the TSCS, and
the demographic questionnaire before official practice
o. .o*p"ition got-underway as part of preseason physi
cal exa^minations (pretest). Athletes who were injured
after the pretest (injury was defined as phvsiologicai
damage oi Uoay pain that required medical attendon
and ciused an athlete lo miss a game, pracdce session'
or subsequent game play because athleric participation
rvas impeded) iompieted, for a second ume, the BDI'
the STAI, and the TSCS within one week after injury
(postinjury). The instruments were administered by the
tiam rrainer. Each time an injured athlete was tested' a
noninjured athlete was selected at random from a pool
of injury-free athleles and asked to complete the BDI'
the 5T.{, and the TSCS for a second rime' The injured
athlete and the randomly selected control subject then
complered, for a third and final rime (follow-up) ' the
BDI, the STAI, and the TSCS 2 months after each
athlete's second test completion. This procedure was
350
tbllowed unril ail athletes had completed the sequence
of assessments either as an injured or control subje ct'
Results
Preliminary Analyses
Initial analyses were conducted to determine injury
rates for the overall sample; 30 (8.770) of the 343 ath-
letes were injured at Pretest, and 145 of the remaining
313 competitors sustained at least one injury during the
course of the season and were assessed at posrinjury, re-
sulting in a 47.8Vo injury rate. Addirional information
."gutJi.tg the distribution of injuries across teams is dis-
played in Table 1.
The most corunon injuries were to the knee, which
accounted for 19.6Vo of all injuries, followed by the shoul-
der (16.9%), ankle (17.3Vo),leg $.a%), arm (8'37o)'
hand, (7.9%), back (6.0Vo), head/neck/face (5'7Vo)'
wrist (4.9%), pelvis/groin,/hiP $'4%)' chest/riblabdo-
men (3.0% ), ioot (2 -3Vo), and other (1'LVo)' In regard to
specific diagnoses, the ankle sprain * 9t most com-
monly diagnosed injury (9.9Vo), followed by knee connr-
sions' (4.5%), fractured finger (4'2Vo), knee sprain
(3.8Vo), back strain (3'4Vo), hamstring strain (3'47o)'
ioulder bursitis/ tendinitis (3.0Vo), shoulder contusion
(3.0Vo), elbow bursitis/ tendinitis (3'0Vo), pelvis,/ groin /
hip (3.0%), and knee cartilage damage (3'07o) '
lnjury Status by line of Testing Analysis
Correlations among the dependent measures
ranged from .20 to .70' The correlation berween the
STAf-T and STAI-S was .70. As a result of this redun-
dancy, the STAI-T was removed from the analysis' A
test of the assumption of sphericiry indicated violation
(GG epsilon =.i+7), and therefore a DM MAIIOVA
was conducted.
The interaction of Injury Status and Time of Test-
ing was significant, Wilks's l, = 'i89, F (24,876) = 28'32'
pi.OOr. ilI.uttt and standard deviations for the Injury
'S*trx
grouPs at each assessment point are presented in
Table i. To further explore the meaning of the signifi-
cant interaction effect, one-way NI.fu\OVAs comparing
the four injury grouPs within each rime period were
conducted. The muidvariate and univariate tests at Pre-
test were not significant, indicating that the injury
groups *"re ttot tigttificantly differenr in levels of de-
ir.r.io.r, ,ttt" utt*i.ty, physical self, and total
self-es-
teem prior to the beginning of lhe season'
The multivariate test at Postinjurv assessment was
significant, Wiiks' ). = .516, F (12, 809) = 19'I7 ' p < '001'
Aiproximat ely 48Vo of the variance in the linear combi-
nuiiott of dependenc variables was accounted for by
RAES: December 1994
 Leddy, Lambert and 7gles

group membership, era squared .4g4.

Follow_up uni_
variareI tests and Scheffe posr_hoc= tests indicat"j tr,ui, mood disturbance in the mild range,
several athleres
following injury rhe Injuied and Recovered reporr experiencing several ry-p,ol,
athleres of
'Cti.-," . sufficient in_
displayed significandy higher levels tensity to warrant treafnenr
."1!ril:,,?''i -_
of depression and m€ n r ro r a p..,, i o,.,
srare anxien'rhan rhe Noninjured
and Late Injured ath_ BDI scores "of about 22 (Nieuel, n,rrr"tl,
T.::l i::":'f"J:;:
letes. At Lhe same time, tlie Injured ff.rnmings, &
and Recovered Gretter, 1997) Using 20 as a cutoff, tZi"'
arhleres exhibited significantly lolwer OZI of the I45
total and physical Injured and Recovered athletes traue
seif-esteem scores following injury nOf s.ores thar re_
than the Noninjured
and Late Injured arhletes (see fatte depressive qnnpto_, Jrnifu,
Z). L"::1":."ttries.of to those
crt:1ts receiving outpatient featment
The MANOVA
1^th_elollow_Up was also significant, lr for depression.
In addirion, their scores reflect sufficient intensirv
Wilks's-2, = .467, r(i2, 809) = 22.iS,p< .00l.ipproxi_ to
marely 53Vo of the variance in the linear warrant further evaluation and potendal
combination of FeatmenL'
dependent variables was accounred for
by group mem-
l.:.liq, eta squared =.533. Univariate -F rests and
Scheff6 post-hoc tests indicated that
the Injured and Discussion
Lare Injured arhletes had significantly
higher levels of
depression than either the -Noninjured
or Recovered The present investigation extends
athleres ar rhe final evaluation. Hlwever, previous findings
only the In_ of negadve emodonal reacdons u*o.rf
jured group exhibited significantly utt t.t", follow-
higher levels of stare ing physical injury (Chan & Grossmani,lbas,
A::?_1 l"ft"y-yo than t}le otirer"three groups. rn- al., 1990) to high-level compedtors..Evijences*i,}, ",
Jured and I ate Injured athletes exhibited significantly is pro_
lower vided to. suggesr that high-revel athletes
and physical self-esteem scores than the are vutnerabte
.total
l.lonrn;ured or Recovered athletes. In to emodonal reactions following injury, including
addirion, the Late in_
creased depression and anxiety- u.r"d
Injured arhletes had significantly lower physical
selfes_
..drr."d selfes_
teem scores than the other three teem, and that in some instances, these
cao,.ro.. emodonal re_
sponses reach similar levels of intensities
. Regarding rhe clinical -."iing+.rrtness of rhese ceilnq outparient psychotherapy. The results
to clients re_
data, Table 3 details the frequencies
Jf in;ured athletes study further serve to remind us tfrut
of this
exhibiting normal, mild, mild_moderate,' athletes are not
moderate_se- inoculated from emotional disrurb"";"
vere, and severe levels of depression
based on clinical ;y virtue
their talent and ourstanding physical conditioning, of
cur-off scores for t}re BDI (Bick et al., as
1961). As can be previ^ously believed (Crossmin-, I gg5)
seen,57Vo Q! of the injured athleres (Injured .
and Re_ Given the current findings, one might
covered) had at least mild sFnproms raise the
of iepression at question of how and why athlJtc injury
postinjury. While many of ths injured
athletes have adons in psychological funcdo"i"g.it'.
Lds to
^lte._
fredominant
Table 2' Means and standard deviations
for the BDl, sTAl-s, Tscs-T, and rSCS-p pretest,
at p.stinjury, and follow-up

lnjured Recovered
Dependent Tjme of (n =77lr
Late injured Noninjured
variable testing M (SDI
{n = 68} (n = 58) (n= tto)
M (SDI M (SDI M (SDI
8Dr Pretest 2.66 (3.2) 3.09 (4.0)
Postinjury 2.86 (3.2) 2.86 {3.4)
10.r0 (7.1 )
10.65 (7.3)
Follow-up 1.64 (2.1) l.e3 (3.5)
8.58 (6.7) 3.39 (s.3) e.e3 (6.2) 1.51 {2.3)
STAI.S Pretest 33.79 (9.6) 34.47 (9.71
Postinjury 3l.45 (9.s) 34.s9 (9.2)
42.70 (1L9) 41.31 (11.0)
Follow-up 27.78 (9.71
30.98 (8.1)
39.20 (12.9) 32.19 (9.7) 32.74 112.41 30.48 (7.8)
JU5- I Pretest 346.10 (43.9) 356.04 (45.s) 360.48 (43.2)
Postinjury 278.83 (6e.5) 354.62 (41.8)
288.97 (60.0) 350.66 (s2.6)
Follow-up 281 .36 (67.s) 357.63 (56.s)
353.77 (56.6) 291.85 (85.7) 361.62 (42.3)
ISCS.P Pretest 69.44 {8,7} 71 .00 (s.3)
Postinjury 71.48 (8.e) 71 .06 (s.3)
58.09 (14.3) s6,09 (r3.2)
Follow-up 67.60 (18.2) 69.78 (12,11
58.31 (13.61 7r.99 (e.7) 51.64 (1 7.8) 71 .03 {e.8}
Vore. BDI= 8eckDepressionlnventory;sT|l.S.=stateanxietyscaleonthestate.Traitnn,
-e
nn essee Self-concept Scare; TSCS-p
= physicar rrri-r..rr rr the Tennessee serf-concept
scare.
70ES: Decemher tgg4
35t
Leddy, Lanben, and 1gles

moclel lAnclersen & Williams, 1988; Smirh et al., 1990;
Weiss & Troxel, l98ti) to explain reactions to :rthletic
injtrry combines the interaction of cognitive forces,
stress, and physiological experiences. Others (e.g.'
Chan & Grossntan, 1988) have implicated the role of
endorphins as a precipitant of mood disturbances
among injured athletes. A more psychodynamic but
equallv plausible explanarion for rhis relationship was
offered by Eldridge ( 1983), who views athletic injury as
a narcissistic insult, one that alters the injured athletes'
body image and, in the process, threatens their selG
image. Finally, Rotella and Heyman (1986) suggest that
emolional resPonses occur in part because medical
techniques have decreased the duration of time needed
for adequate physical rehabilitation, thereby reducing
the time period available to the athlete for appropriate
psychological adjustment. Just as more work is needed
to replicate and extend the findings of studies aimed
at identifing athletes' emotional responses to injury'
further attempts to delineate the specific reasons why
athletic injury leads to alterations in psychological
functioning need to be conducted as well.
Finally, the findings of the Present study suggest
that, in order to safely and responsibly return the ath-
lete to competition, a more comprehensive rehabilita-
tion program should be employed (Wiese-Bjornstal &
Smith, 1993). In fact, a number of researchers and prac-
titioners (e.g., Eldridge, 1983; Heil, 1993; Nideffer,
1983; Rotella & Heyman, 1986; Weiss & Troxel, 1986;
Wiese-Bjornstal & Smith, 1993) have outlined specific
treatment Programs for dealing with both the physical
and psychological concomitants of injury. It should be
noted, however, that there is little empirical evidence
that psychological treatment strategies for injured ath-
letes are eflective (Wiese, Weiss, & Yukelson, 199 l), bttt
the findings o[ this sttrclv clo qtrestion the appropriate-
ness of using techniques airned onlv at phvsical rehabili-
radon with the athlete rvho develops psvchological
svTnPtoms.
Until more data become available, those charged
with the welfare of the injured comPetitor are advised
to adopt a more conservative approach' including the
following guidelines: (a) be acutely aware of and par-
ticularly sensitive to the fact that athletic injury can re-
sult in psychological consequences, leaving some com-
petitors feeling depressed, anxious, confused, frus-
trated, angry, and uncertain about themselves; (b) edu-
cate the athlete about the psychological effects of in-
jury; (c) ascertain an athlete's previous injury history as
well as his or her prior emotional reacdons to injury,
and aim specific educational interventions accordingly;
(d) use empirically validated psychological measures to
identif athletes who are experiencing psychological
fauma after athletic injury (ensure that assessments are
obtained by professionals with appropriate training);
and (e) offer the injured athlete alternadves for chan-
neling physical energies, such as swimming' weight lift-
ing, rycling, etc.
While this and previous studies document that ath-
letic injuries may be accompanied by psychological re-
actions, more research is needed to clarif the emo-
tional impact of injury. Future research should address
the psychological consequences of athletic injury in a
variety of additional samPles, including women, older
athletes, differing levels of competitiveness, and a
greater variety of sports. Perhaps these studies can iso
iate the injury-based emotional resPonses of a variety of
different athletes (both male and female and rePresent-

Depression lnventory (BDl)

Table 3. Frequency of iniured athletes experiencing distress at pretest, post injury and follow-up on the Beck

Severitya
Time of
Normal Mitd Mild-Moderate Moderate-Severe Severe
testin g lnjury status
,, 0 0
P retest I ured
nj 13 1

4 2 0 0
Recovered 62
2 0 0 0
Late injured 55
5 0 0
Noninlured 104 1

22 10 0
Postiniury lnjured 40
20 10 0
Rec overed 31
0 0 0
Late injured 57 1

106
I 0 1 0
Noninjured

Follow-up lnjured 42 28 4 0

Recovered 63 J 0 2 0

Late inlured 23 7 2 0
26
Noninlured 110 0 0 0 0

arhe following values represent B0l scores for each of the severity levels: normal s 9, mild = 10-15, mild-moderate = 16-19, moderate-
severe = 20-29, and severe 2 30.

352 frAES: Decemher 1994


ing a broad age range), including top amateur, masters,
Oh'mpic, and professional competitors. Similarll', orher
variables such as social support and coaching influences
mav contribute to the understanding of athletic injurv
(Hardv & Crace, 1993). It will be interesring to see how
athletes who invest considerabiy more dme than recre-
ationai or collegiate athletes, and who depend upon
sport participation for their livelihood, reacl to phvsical
injur,v, especially when those injuries are season or ca-
reer ending.
Besides continuing the invesrigation into th. Pty-
chological consequences of athletic injury, efforts to
evaluate the effectiveness of counseling strategies used
with injured athletes should be undertaken. \Arhile ser'
eral models for intervening with injured athletes have
been proposed, no supporting empirical er"idence has
d.emonstrated the utiligv of these methods. Neverthe-
iess, this study demonstrates the need for continued fo-
cus on the psychological consequences of injury.
While the full psychological effects of injury remain
to be uncovered, further research may ascertain the
specific risk factors and consequences of injury. Simi-
Iarly, specific assessment and intervention strategies can
be developed to assist athletes at all levels to cope with
the physical and emotional consequences of athleric in-
jury. Athletes in all sPorts experience the painful effects
of injury; perhaps the continued efforts of researchers
in sport psychology may directly contribute to establish-
ing empirically validated methods for helping to ease
their discomfort.
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Authors'Note

Address correspondence to Matthew H. Leddy' PhD'

Clinical Director, Northeast Mental Health Center,
Mental Health and Mental Retardation Authority of
Harris Counry 7200 North Loop East' Houston, TX
77028.

B1ES: Decemher 1994

354

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