One of the most overlooked factors of injury is stress. First, let's define what I mean by "stress". Stress is created by stressors. Stressors can be broken simply into mental and physical categories. Mental stressors include things like: final exam week, trouble in a relationship, uncertainty with the future, and financial instability. Physical stressors are more easy to quantify. This includes things such as increasing your workout routine quickly, trying a new activity, having longer practices, and competing more months out of the year. The brain does not differ in response to physical vs mental stressors.
Physical stressors+mental stressors=cumulative stress.
With that being said, it is important for coaches, healthcare providers, parents, and the individual to be cognizant of this relationship. For instance, if its finals week at university, you probably don't want to try to run twice as much as normal that week. If you are having a relationship spat with your wife, its not the best time to go do intense manual labor or a hard workout. We need to respect that as mental stressors go up, we need to look at lowering physical stressors and vice versa.
For this article, I want to mainly touch on mental stressors. The American Academy of Family Physicians put out a consensus statement on this subject. Their paper states "It is essential the team physician: Recognize psychological factors play a role in injury rehabilitation." They left no doubt in their statement, that psychological factors influence injury rates, recovery times, and performance outcomes. It is fairly intuitive why stress increases these risks, but let's look into how we identify stress in our athletes, children, and ourselves.
Behavioral: trouble sleeping, difficulty focusing, substance abuse, performs better in practice than in games, and changes in normal personality
Physical: feeling ill, headaches, increased muscle tension, increase or decrease in appetite, and general fatigue
Psychological: inability to concentrate, negative self talk, rumination on negative events, lack of motivation, and self doubt
Armed with this education, what can we do as healthcare providers, parents, and athletes to tackle this dirty duo of physical and mental stress? On the mental side, one science backed technique is cognitive behavioral techniques. Usually, a psychologist or mental health counselor can help guide you through the techniques, but as a self admitted non-expert on the science, here is the low down. CBT is based on the theory that its not the events themselves that upset or stress us, its the meaning we give to the events. Essentially, the goal is to train the mind to understand that we cannot control the events in our life, but we can control how we interpret them. One hallmark of CBT, is combatting negative thoughts. Easier said than done, CBT teaches us to examine the evidence essentially. Here's an example. Jan is convinced that airplanes are dangerous and if she were to get on one, she would surely die. This fear comes to a tipping point, when Jan learns she has to fly for her work meeting or she will be fired. Jan begins catastrophizing the trip. Her stress goes through the roof, and she may even begin to feel physically ill. What Jan could do, is try to approach her fear from an objective standpoint. She could consider than airplanes are on of the safest methods of travel available, and that it is wildly unlikely anything bad could happen and she will be safe.
This is just an illustration. But, replace airplane with back pain, a chemistry exam, the playoff game, a presentation at work, or talking in front of a crowd and you quickly can see the impact your outlook can have on your stress levels. If we know stress creates a higher likelihood of negative outcome, be it poor performance, a negative experience or physical injury, then it is paramount that we address this negative outlook component. We have to look at combatting our negative thoughts with likely realities. Yes, I know that there a quite literally thousands of wise sayings that
This article will serve as an introduction to the psychology side of injuries, recovery, and performance. I don't want to go on and on, but I do want to give you a sneak peak of whats coming next. In this article, I reference physical and mental stress, but only cover the mental component. In the future, I want to talk about the physical stress side, namely load management and how we can do better at not running our young athletes into the ground with year round sports. Another topic that did not come up on the mental stress side of things that I would like to touch on in time, goal setting. Goal setting is an effective life strategy in general, but it can also be a good way to put CBT to practice and see real life outcomes. Until next time, keep up with what I am learning on instagram @athletedocrehab.
Dr. Trey
References:
AMERICAN COLLEGE OF SPORTS MEDICINE. Sideline preparedness for the team physician: a consensus statement. Med. Sci. Sports Exerc. 33:846–849, 2001.
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