During the past 3 decades, a growing body of research has documented the psychological antecedents and consequences of sport injury. Psychological factors have been found to play important roles in the occurrence of, and recovery from, sport injury.1,2 Psychological interventions to prevent sport injuries and facilitate sport-injury rehabilitation have been developed, implemented, and evaluated.3
With regard to the psychological antecedents of sport injury, researchers have documented a consistent positive association between life stress and sport injury. Factors moderating the stress-injury relationship include social support, coping skills, and personality.2 Preliminary studies suggest that modifying the stress response can reduce injury risk.4,5 Presumably, stress-management interventions lower the risk of injury by decreasing muscular tension, reducing stress-induced narrowing of the peripheral visual field, and enhancing concentration on the task at hand.6
Research on the psychological consequences of sport injury has been guided by theoretic perspectives positing that personal factors (eg, personality, demographic characteristics) and situational factors (eg, social support, environment) influence cognitive responses to injury, which are thought to be interrelated with emotional and behavioral responses to injury.7 Ultimately, psychological responses to injury are thought to contribute to sport-injury rehabilitation outcomes.7,8 Major topics of inquiry on the psychological consequences of sport injury include self-perceptions after injury, strategies for coping with injury, emotional reactions to injury, adherence to rehabilitation, psychological factors affecting rehabilitation outcomes, social support in rehabilitation, and patient-practitioner interactions.1 Several of these topics are considered in the articles that constitute this special section of the Journal of Athletic Training.
Although age is one of several demographic factors thought to influence psychological responses to sport injury, age analyses have been reported in relatively few studies of the psychological consequences of sport injury. There are, however, compelling reasons for adopting a developmental perspective in examining psychological issues associated with sport-injury rehabilitation. First, the risk for sport injury varies across the life span.9 Second, negative emotional reactions to sport injury tend to diminish with age.10,11 Third, given the popularity of sport and recreational activities across the life span, it is necessary to investigate the generalizability of research findings across different age groups. Fourth, developmental differences in athletic identity12 and other factors may influence how athletes respond to injury.
The purpose of the collection of articles that follows is to examine the developmental effects on various aspects of sport-injury rehabilitation. Three of the articles pertain to issues associated with surgery and rehabilitation after an acute tear of the anterior cruciate ligament (ACL), one of the more prevalent and debilitating sport injuries.13,14
In “Psychological readiness for anterior cruciate ligament surgery: describing and comparing the adolescent and adult experiences,” the transtheoretic model of behavior change,15 which has been applied extensively in studies of smoking cessation and exercise initiation, is used to examine the extent to which adolescent and adult recreational athletes are mentally prepared for reconstructive surgery. Several key differences between adults and adolescents in presurgical cognitive, emotional, and behavioral variables are highlighted.
“Comparing postoperative pain experiences of the adolescent and adult athlete after anterior cruciate ligament surgery” describes the short-term postoperative responses of adolescents and adults, comparing pain, affective distress, and catastrophizing after ACL reconstructive surgery. Adolescents reported significantly more pain, state anxiety, and catastrophizing than adults at 24 hours postsurgery.
“Age-related differences in predictors of adherence to rehabilitation after anterior cruciate ligament reconstruction” further extends the temporal sequence of the treatment of ACL tears, examining age-related differences in predictors of adherence to rehabilitation after ACL reconstructive surgery. Age is shown to moderate the relationship between psychological factors and 2 kinds of adherence (home exercise completion and home cryotherapy completion). Older patients were more adherent when they were self-motivated and perceived high levels of social support, whereas younger patients were more adherent when they were highly invested in the athlete role as a source of self-worth.
In contrast to these articles, which examine age effects in psychological responses to a single type of sport injury, “Features of posttraumatic distress among adolescent athletes” explores postinjury psychological distress in athletes of a single age group (ie, adolescents) who have experienced a variety of serious sport injuries. The findings support previous research with adults indicating that athletes commonly experience features of posttraumatic distress after sport injury. The results are discussed in terms of the course of posttraumatic distress after medical trauma and the potential impact of the sport environment on athletes' posttraumatic distress.
The last article, “Psychological aspects of sport-injury rehabilitation: a developmental perspective,” serves as a critique of the previous articles. Suggestions for future directions in developmental research and practice in the psychological aspects of sport-injury rehabilitation are presented.
Together, the articles demonstrate the potential advantages of examining developmental differences when investigating psychological responses to sport injury. Not only may individuals differ in postinjury cognition, emotion, and behavior as a function of their age, but the relationships among psychological and other rehabilitation variables may also vary by age. Just as maturation is a common consideration when evaluating the physical ramifications of sport injury, so, too, should it be considered when evaluating the psychological ramifications of sport injury. I hope that this collection of articles will serve as a springboard for further developmental inquiry on the psychological aspects of sport injury and will stimulate the development, evaluation, and eventual implementation of age-appropriate psychological interventions to facilitate the recovery and enhance the experience of athletes with injuries.
ACKNOWLEDGMENTS
This article was supported in part by grant R15 AR42087-01 from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Its contents are solely the responsibility of the author and do not represent the official views of the National Institute of Arthritis and Musculoskeletal and Skin Diseases. I thank Allen Cornelius, Renee Newcomer, and Judy Van Raalte for their helpful comments on an earlier draft of the manuscript.
Editor's Note:
Britton W. Brewer, PhD, is from the Center for Performance Enhancement and Applied Research, Department of Psychology, Springfield College, Springfield, MA.
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