Problems in SportStress, Injury, PED’s and Burnout

Stress and Injury

– Stress is leading cause of injury, misuse of PED’s and burnout

– Finch et al (1998): 20-30% of total injuries in a given population are sports related

– Research: increased stress in life = increased injury in sports• Smith et al (1990): 452 m/f high school athletes,

assessed stress, social support, coping skills and # of days off related to injury– Results showed a correlation between stressors and injury,

other factors included low social support and low coping skills

Explaining the Relationship Between Stress and Injury

•Williams et al (1991); stress disrupts attention, reduces peripheral awareness• Anderson & Williams (1999): negative

life event stressors were the only significant predictor of injury in 196 college athletes• Smith et al (2000): muscle tension

caused by stress interferes with normal coordination, thus increasing rick of injury

Stress and Recovery

–Cramer et al (2000): natural healing disrupted by high glucocorticoids, impairing the immune response and inhibiting production of growth hormones»Cortisol inhibits recovery of damaged

tissues–Perna et al (2003): stress caused impaired

sleep patterns and protein synthesis-essential for recovery process

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Responding To Injury Grief Response Model (Hardy, Crace, 1990)

• Coping with 3 stressors (Physical, Psychological and Social) essential to rehab process takes one of 2 forms

• Denial: injured players pushes it and make it worse• Anger: about injury’s impact on ability/career• Bargaining: deal making to mitigate the injury• Depression: reality of injury • Acceptance/reorganization: coping can begin

• Similar to Kubler-Ross 5 Stages of Grief• Petitpas & Danish (1995): Identity Loss—injury low self –efficacydepressionlow self confidencelow status and motivationidentity loss

Cognitive Appraisal Model (Urdy et al, 1997)

• “Information Processing” About Injury (Urdy et al)– Stage 1: Amount/type of pain, how/why it

happened, consequences and rehab options– Stage 2: emotional upheaval, reactive behaviors

—anger, frustration– Stage 3: Developing, outlook and coping

Cognitive Appraisal Model(Wiese, Bjornstal, 1998)

• Primary Appraisal: what is at stake, challenge, threat, benefit or loss

• Secondary Appraisal: how can you cope, options available

PED use in last 20 Years– Physical considerations• Strength, endurance, alertness, aggression, fatigue,

anxiety, wt. gain/loss all can be impacted by PED’s

– Psychological considerations• Coping w/stress, self esteem, confidence, respond to

external pressures

•

– Social considerations• Social learning theory: see model (Bonds, Canseco,

Ben Johnson) do it without getting caught (Bandura; Anshel, 1998)• Conformity, coercion, peer pressure• “Game Theory” (Axelrod, 1984): if you don’t use you

will be left behind by the using competition (e.g. EPO doping in the Tour de France, roids in MLB), leads to cognitive rationalization that the rewards outweigh the risks of getting caught

•

Physical Effects of Steriods

• synthetic derivatives of testosterone, anabolic effects retention of protein to build muscle• “stacking”: combo of different types can be permanent• Injections increase risk of Hepatitis B, HIV• Damage may take years to see (Lyle Alzado)• Feminization Effect in men• Women have “Masculinization Effect” • Acne, wt. gain, liver damage, heart attack, stroke,

increased cholesterol, weak tendons (see Bo Carrol), permanent growth halt in teens in both males and females

Psychological Effects of Steroids

• Mood swings, extreme irritability/aggression (“roid rage”), addiction and withdrawal issues

Effects of Other PED’s

• Beta blockers: reduce anxiety, blood pressure, heart rate, depresses CNS• Diuretics: wt. loss, dehydration, cramping,

kidney stones, increased cholesterol• EPO (erythropoietin): increased oxygen

and stamina, risks for blood clots, heart attack, stroke• Narcotics: mask pain, failure to feel injury,

overdose threat

Causes of Burnout– Cognitive-Affective Stress Model

(Smith 1986) how thoughts and feelings influence athlete’s burnout• Stage 1: Situation Demands: demands exceed

resources = stress• Stage 2: Cognitive Appraisal: threat vs. challenge

appraisal of situation = anxious or excited• Stage 3: Physiological Responses: fight or flight due to

appraisal• Stage 4: Behavioral Response: performance issues,

cohesion problems, withdrawal

– Hardiness (Kobasa, 1986) is the key factor to overcoming stressors and resisting burnout; based on 3 factors• Control: person’s ability to influence events• Commitment: person’s refusal to give up• Challenge: person’s willingness to change

• Mental Toughness Model (Clough and Earle, 2001)• Mental toughness questionnaire resulted in a group

of mentally tough subjects and non mentally tough who then did 3 30 minute cycling trials at 30, 50 and 70% max; oxygen uptake and reactions of subjects was recorded• Results showed MT subjects reported lower perceived

exertion, even at 70% suggesting MT helps withstand stress/burnout

• Self Determination Theory (Raedeke, 1997)• Burnout results from lack of intrinsic

motivation or control over participation; “have to” rather than “get to” attitude • Factors include: identity = sport,

entrapment, social support/demands

Preventing Burnout

– Cognitive Affective Stress Management (Smith, 1980)• Mental/physical coping strategies designed to prevent

burnout in 4 steps– Pre-treatment Assessment: interviews to assess the athlete’s

stress response and appraisal– Treatment Rationale: athlete analyzes and gains

understanding of personal stress reactions– Skill Acquisition: athlete learns relaxation, cognitive

restructuring and self talk– Skill Rehearsal: stress is induced to allow athlete to practice

new stress reducing skills

– Stress Inoculation Theory (SIT) Meichenbaum, 1985• Athlete is exposed to increasing levels of stress in 3

stages, thereby enhancing his/her immunity “Learned Resourcefulness”– Stage 1: Conceptualization: athlete becomes aware of +/--

thoughts, self talk, imagery– Stage 2: Rehearsal: practice– Stage 3: Application: athlete encounters low stress and then

moves up to moderate then high and applies what was rehearsed in stage 2

– Prepare--control--cope--evaluate--overcome