Exercise-related injuries are common; in fact, one study found that up to 25% of people in their study had experienced one in the past year. It seems they are also more common in men and people aged 35-44 years of age. People also tend to be dissatisfied with the level of care they get as a result of their injury, reducing the likelihood that they will seek treatment for an injury (Grice et al., 2014). As a result, it can be particularly helpful to understand the psychological risk factors that contribute to exercise-related injuries to ideally prevent them from happening in the first place. This article will explore these psychological risk factors, the psychological impact of injury, how to prevent and recover from injury, and even some of the ways people can grow despite an injury. 

The vast majority of research in this domain is regarding injury within the context of elite sport and not necessarily the result of everyday exercise. However, many of the lessons learned from this research can still be helpful in understanding the psychological causes and impacts of injury under certain contexts. 

Psychological Risk Factors for Injury

As I write this, I am highly aware that this section could come across a little blame-y. I want to emphasize that the injury you are experiencing (or have or will experience) is not necessarily your fault. However, it is also important to recognize that there are common risk factors that increase the likelihood that one might experience an exercise-related injury in the future so as to prevent them in the first place. 

The first major risk factor is stress. People who have experienced major stressful life events and/or smaller but ongoing stressors in their life are more likely to experience an exercise-related injury. This is particularly true if the individual has relatively few coping mechanisms to manage that stress. Stress can cause attentional deficits as well as increases in muscle tension, two factors that can increase the risk of injury (Almeida et al., 2014). 

Additionally, there are certain personality traits that seem to be related to an increased risk for injury. In particular, people high in neuroticism (tendency toward negative emotions like anxiety, anger, etc.) and/or low in self-esteem are more susceptible to sport-related injury (Deroche et al., 2007). People who tend to be perfectionistic and high-achieving are more likely to engage in excessive training and experience an injury that way (Wiese-Bjornstal, 2010). Finally, those who tend to engage in more risk-taking behaviors are also more likely to develop a sport-related injury (Almeida et al., 2014). While you cannot necessarily change your personality, having awareness of these risk factors can help you to prevent future injury.

High levels of fatigue and low levels of vigor (low strength and excitement about exercise) also make it more likely that people will experience an injury due to training. The presence of particular health concerns also increases risk; namely, the presence of an eating disorder or a concussion have both been linked to further sport injury (Wiese-Bjornstal, 2010). 

Importantly, according to biopsychosocial models of sport- and exercise-related injury, these psychological factors do not work in isolation. Risk for injury is the result of a combination of biological factors (bone strength, age, previous injury), the aforementioned psychological factors, and social factors (role models, training environment, societal messaging). It is most likely that a combination of these factors puts you at greatest risk for an exercise-related injury. 

Psychological Impact of Injury

Unfortunately, stress is both a risk factor for and a consequence of an injury. For many people, experiencing a sport- or exercise-related injury only increases the stress they experience in their life, further perpetuating increased risk for injuries (Almeida et al., 2014). Additionally, stress decreases our ability for the physical wound to heal because of the impact of stress and the injury on the brain (Wiese-Bjornstal, 2010). 

After the injury, we go through a cognitive appraisal process, or the mental process in which we assess and evaluate the stressful situation (in this case, the injury) (Walker et al., 2007). This cognitive appraisal may change one’s sense of self and identity and it is common to feel a sense of loss, optimism, challenge, or burnout. Each of these feelings differently impacts our response to the injury (Wiese-Bjornstal, 2010) and even potentially the way we cope with the injury. 

For example, someone who appraises the injury as “the end of the world” and has extreme negative emotions like anger, sadness, guilt, and fear may be less likely to adhere to rehabilitation programs and seek out social support. There is no one right (or wrong) way to appraise an injury, but generally reframing the situation so that it leads to motivation for recovery — whatever that looks like for you — will promote the best outcomes. 

Additionally, when someone experiences a sport- or exercise-related injury, it is common to go through three experiential stages: distress, denial, and determined coping. However, social and emotional factors can disrupt the process at any of these three stages, leading the person to be “stuck” in one particular stage (Almeida et al., 2014). For example, if the person receives little social support and has a very negative attitude in the denial stage, they are less likely to move onto the determined coping stage. This can result in negative attitudes toward future rehabilitation and training and even giving up altogether. 

Using Psychology to Prevent Injury

Knowing all of these contributing factors to injury, here are a few tips that might help you prevent the injury from happening in the first place: 

• Ongoing Stress Reduction: Because stress is one of the most consistent predictors of injury, finding ways to manage your stress becomes increasingly important to prevent injury. While many people use exercise as their primary coping mechanism for stress (which is great), it is important to also have multiple stress-reduction strategies to turn to in times like this. For example, use various forms of meditation like imagery or square breathing to help you manage stress. Learn to set boundaries so that you reduce the amount of stress you experience altogether. Lean on your nutrition to help you feel well. Reduce any potential triggers for stress. Set realistic goals to work toward and have a sense of direction. Identify what works for you and prioritize stress reduction as a daily part of your life.
   
• Know Yourself and Your Limits: Having self-awareness is incredibly important in the prevention of injuries. Identifying whether you have any of the personality traits that are linked with increased risk for injury (neuroticism, perfectionism, low self-esteem, high risk taker) can help you to take preventive steps. For example, if you have a tendency to be high achieving and perfectionistic, finding ways to manage that either on your own or with the help of a therapist will ultimately contribute to the prevention of injuries. Additionally, know whether you are feeling fatigued or low in vigor and identify ways to move your body that will promote overall well-being and decrease risk for injury until you feel refreshed and ready to give it your all. Finally, be sure to know the difference between good and bad pain, so that you can know when to push and when it might be a good idea to pull back and rest.
   
• Flexibility: I don’t necessarily mean the ability to touch your toes (though increased mobility probably doesn’t hurt in injury prevention, either) — I mean the ability to be mentally or psychologically flexible. It is important to be able to change your plan or goal for exercise based on how you are feeling physically, mentally, and emotionally on a given day. This also then involves not beating yourself up if you miss a strength or cardio session here or there. In fact, when you make a decision for your health because you are not feeling well, that is something to celebrate!
   
• Goal Setting: Finally, setting realistic and appropriate goals for your fitness will really help you in preventing injuries. I recommend doing this in conjunction with a certified personal trainer, physician, and/or physical therapist. The key here is that if you set a goal, you will know that pushing past pain or engaging in excessive exercise will actually get in the way of your ability to meet that goal. A good fitness plan will include rest and recovery so that you are able to consistently show up for yourself in healthy ways. Honestly, this goes for any goal, fitness-related or not. 

Using Psychology to Recover From Injury

Recovery from an injury is best promoted through adherence to rehabilitation plans, use of psychological skills (cognitive reframing, relaxation, and stress management techniques, etc.), leaning on social supports, reducing risk-taking behaviors, and setting goals for the self related to recovery (Walker et al., 2007). 

Therefore, it is important to find a doctor that you trust who can help provide you with a rehabilitation plan that is realistic and works for your needs, and create goals to help you stick to it. Additionally, be sure to really lean on the positive coping skills you have developed throughout your life. Implementing a variety of coping mechanisms will promote the best outcomes. If you struggle to identify any, it may be helpful to seek out counseling or other support in that process.

Finally, leaning on family and friends to help get you through this time is more important than ever. Whether that support means talking about your emotional response to the injury, the losses you have experienced due to the injury, or even just having meals and good conversation together, this social support becomes more important now than ever. 

Sport Injury Related Growth

While injuries are obviously best to be avoided, they can potentially lead to positive change within one’s life. Called sport-injury related growth (SIRG), people sometimes experience greater appreciation for their life, stronger relationships, increased personal strength, shifts in their priorities, and/or greater awareness of spiritual beliefs as the result of setbacks in sports and training (like an injury). SIRG is a process that is facilitated by evaluating and framing the setback in a way that promotes this level of growth (Wadey et al., 2019). In essence, if you experience an injury, it is important to first experience all the emotions and thoughts that naturally emerge, but then intentionally reframe the injury in a way that promotes personal growth. This is best done in collaboration with your social support structures and/or the help of a therapist. 

What are the things that have helped you prevent and/or recover from an injury? How did your mindset and emotions play a role in that? We would love to hear your experiences in the comments!

References

Almeida, P. L., Olmedilla, A., Rubio, V. J., & Palau, P. (2014). Psychology in the realm of sport injury: What it is all about. Revista de Psicología del Deporte, 23(2), 395-400. 

Deroche, T., Stephan, Y., Brewer, B. W., & Le Scanff, C. (2007). Predictors of perceived susceptibility to sport-related injury. Personality and Individual Differences, 43(8), 2218-2228.

Grice, A., Kingsbury, S. R., & Conaghan, P. G. (2014). Nonelite exercise-related injuries: Participant reported frequency, management and perceptions of their consequences. Scandinavian Journal of Medicine & Science in Sports, 24, 86-92.

Wadey, R., Roy-Davis, K., Evans, L., Howells, K., Salim, J., & Diss, C. (2019). Sport psychology consultants’ perspectives on facilitating sport injury-related growth. The Sport Psychologist, 33(3), 244-255.

Walker, N., Thatcher, J., & Lavallee, D. (2007). Psychological responses to injury in competitive sport: A critical review. The Journal of the Royal Society for the Promotion of Health, 127(4), 174-180. 

Wiese-Bjornstal, D. M. (2010). Psychology and sociocultural affect injury risk, response, and recovery in high-intensity athletes: A consensus statement. Scandinavian Journal of Medicine & Science in Sports, 20(2), 103-111.