PREVENTION AND MANAGEMENT OF INJURY IN ......PREVENTION AND MANAGEMENT OF INJURY IN COMPETITIVE...

PREVENTION AND MANAGEMENT OF

INJURY IN COMPETITIVE SWIMMING

By

MsJulieHardt

MSc

SchoolofSportScienceExerciseandHealth

ThisthesisispresentedforthedegreeofDoctorofPhilosophyof

ScienceatTheUniversityofWesternAustralia

2012

ToKate

Youaremyrockandmysoul,mysisterandmybestfriend.Iamme

becauseofyou.

v

ABSTRACT

Threestudieswereconductedtoexaminecurrentcoach‐implementedinjury

preventionandmanagementpracticesinhigh‐performancecompetitive

swimming.Coachandswimmerperceptionsoftheuseofandimportanceofcoach‐

implementedinjurypreventionandmanagementbehaviourswerealso

investigated.

StudyOneemployedone‐on‐onesemi‐structuredinterviewstosurveyperceptions

ofelitecoaches(N=12),injuredswimmers(N=5),andsportsmedicine

professionals(N=6)fromtheUnitedStatesandAustraliaonwhatcoachesshould

dotopreventandmanageinjuries.Participantresponsesreflectedafour‐phase

cycleofinjurypreventionandmanagement,startingfromInjuryPreventionand

continuingthroughShort‐termInjuryManagement,Long‐termInjuryManagement,

andculminatinginReturntoFullTraining.Responsesalsorevealedthatthecoach

playsapivotalroleinthetechnicalcoachingaspectsofinjurypreventionand

management,andalsoperformsacriticalroleinthesocialsupportofinjured

athletesastheyrehabilitateandtransitionbacktofulltraining.

StudyTwoleveragedknowledgefromStudyOnetodevelopaprofilingtoolto

measurethedegreeofcoach‐implementedinjurypreventionandmanagement

behavioursaswellastheperceivedimportanceofthosebehaviours.TheInjury

PreventionandManagementProfileforSwimming(IPMP‐S),wascomprisedof

foursectionsoftheinjurypreventionandmanagementcyclefromStudyOneand

includedspecificbehavioursforinjurypreventionandmanagement.TheIPMP‐S

wasadministeredtohighperformancecoaches(N=18)andswimmers(N=135)

fromtheUnitedStatesandAustralia.Resultsofaseriesofrepeatedmeasures

AnalysesofVariance(ANOVA)revealedthatswimmersandcoachesratedthe

importanceofinjurypreventionandmanagementbehaviourssignificantlyhigher

thanthedegreetowhichtheyperceivedtheircoach(orthecoachself‐reported)to

enactthosebehaviours.One‐wayANOVAsalsorevealedthatswimmersperceived

theircoachestoimplementinjurypreventionandmanagementbehaviourstoa

significantlylesserdegreethancoachesreportedenactingbehaviours.

vi

InStudyThree,acoach‐implementedinjurypreventionandmanagement

interventionwasintroducedtoahighperformancenationalswimsquad

comprisedofmaleandfemaleadolescentagedswimmers(N=19swimmers,N=1

coach)andusingknowledgegainedfromthefirsttwostudies.Membersoftwo

othercomparableclubs(N=16swimmers,N=2coaches)actedascontrolsoverthe

durationofa3‐monthcompetitiveseason.Priortotheoutsetoftheseason,the

coachoftheinterventionsquadunderwentconsultationwiththeprimary

investigatortocreateaninjurypreventionandmanagementprogramfortheir

squad.Tomeasuretheeffectivenessoftheinjurypreventionandmanagement

program,allswimmers(N=35)andtheircoaches(N=3)completedtheIPMP‐Spre‐

andpost‐intervention.SwimmersalsocompletedtheLifeEventsSurveyfor

CollegiateAthletes(LESCA)andtheRecoveryStressQuestionnaireforathletes

(RESTQ‐76Sport).Thesemeasureswereusedtodeterminearelationshipbetween

lifestressandinjuryrateinswimming.Resultsrevealednorelationshipbetween

lifestressandinjuryoccurrenceincompetitiveswimming.WhileIPMP‐Sdata

showedthatswimmerswerenotexplicitlyawareofthechangesintheircoach’s

behaviours,thecoachfelttheinterventionhadapositiveresultoninjury

occurrenceandinjurymanagementwithinhersquad.Shealsoplannedtocontinue

enactingtheinjurypreventionandmanagementprotocolsinherdailyscheduling.

Resultsfromtheseriesofstudiessupporttheimportanceofcomprehensiveinjury

preventionandmanagementplanesincompetitiveswimming,andhighlightthe

importanceofthecoach’sroleinthisprocess.Futureresearchisrecommendedto

furtherinvestigatecoach‐implementedinjurypreventionandmanagement

programsacrossvaryingcompetitiveswimminglevelsandacrossvaryingtypesof

sports.

vii

TABLE OF CONTENTS

ABSTRACT.............................................................................................................................................................V

TABLEOFCONTENTS.....................................................................................................................................VII

LISTOFFIGURES...............................................................................................................................................XI

LISTOFTABLES................................................................................................................................................XII

STATEMENTOFCANDIDATECONTRIBUTION.....................................................................................XIII

CHAPTER1............................................................................................................................................................1

1 INTRODUCTION...........................................................................................................................................1

INTRODUCTIONANDSTATEMENTOFTHEPROBLEM...........................................................................................................1PURPOSEANDOVERVIEWOFRESEARCH...............................................................................................................................2

SIGNIFICANCEOFRESEARCH....................................................................................................................................................3

CHAPTER2............................................................................................................................................................5

2 REVIEWOFTHELITERATURE................................................................................................................5

INTRODUCTION...........................................................................................................................................................................5

INCIDENCEOFINJURYINCOMPETITIVESWIMMING.............................................................................................................5PSYCHOSOCIALANTECEDENTSOFSPORTINJURY.................................................................................................................72.0.1 Introduction............................................................................................................................................................72.0.2 PersonalityandInjuryOccurrence...............................................................................................................8

2.0.3 LifeEventStressandInjurySusceptibility................................................................................................82.0.4 AModelofLifeStress‐AthleticInjuryRelationships..........................................................................11

2.0.5 ModeratorVariablesintheLifeStress‐InjuryRelationship...........................................................11

2.0.6 PsychosocialInterventionstoPreventAthleticInjury......................................................................142.0.7 Summary................................................................................................................................................................16

RESPONSESTOANDREHABILITATIONFROMSPORTINJURY...........................................................................................17

2.0.8 Introduction.........................................................................................................................................................17

2.0.9 AthleteResponsestoInjury...........................................................................................................................182.0.10 StageModels,CognitiveAppraisalModels,andtheRisksModel...............................................19

2.0.11 AnIntegratedModelofPsychologicalResponsetotheSportInjuryandRehabilitation

Process 21

2.0.12 BiopsychosocialModelofResponsetoInjury.....................................................................................222.0.13 Rehabilitation...................................................................................................................................................23

2.0.14 PsychologicalInterventionsinRehabilitation...................................................................................24

2.0.15 Summary.............................................................................................................................................................26

viii

GENERALSUMMARYANDSTATEMENTOFTHEPROBLEM...............................................................................................26

CHAPTER3.........................................................................................................................................................28

3 STUDYONE–INJURYPREVENTIONANDMANAGEMENTINCOMPETITIVESWIMMING:

DISCOVERYOFCURRENTPRACTICES.......................................................................................................28

INTRODUCTION........................................................................................................................................................................28

METHOD...................................................................................................................................................................................29

3.0.1 Participants..........................................................................................................................................................29

3.0.2 InterviewGuideandProcedures.................................................................................................................303.0.3 Datacollectionandanalysis.........................................................................................................................31

RESULTSANDDISCUSSION.....................................................................................................................................................32

3.0.4 Coach‐implementedInjuryManagementPlans...................................................................................333.0.5 InjuryPrevention...............................................................................................................................................35

3.0.6 Communication..................................................................................................................................................39

3.0.7 Short‐termInjuryManagement..................................................................................................................423.0.8 ImmediateAction..............................................................................................................................................43

3.0.9 FirstAid..................................................................................................................................................................433.0.10 Communication................................................................................................................................................44

3.0.11 Long‐termInjuryManagement................................................................................................................463.0.12 ReturntoFullTraining................................................................................................................................55

CONCLUSIONS...........................................................................................................................................................................58

CHAPTER4.........................................................................................................................................................60

4 STUDYTWO–INJURYPREVENTIONANDMANAGEMENTINCOMPETITIVESWIMMING:

CONFIRMATIONOFCURRENTPRACTICES...............................................................................................60

INTRODUCTION........................................................................................................................................................................60METHODS.................................................................................................................................................................................61

4.0.1 ItemDevelopment.............................................................................................................................................614.0.2 ProfilingToolAdministration......................................................................................................................63

4.0.3 Procedure..............................................................................................................................................................64

4.0.4 StatisticalAnalyses...........................................................................................................................................65RESULTS....................................................................................................................................................................................65

4.0.5 Ratingsofcoach‐implementedbehaviourscomparedtoratingsofperceivedimportance

65

4.0.6 Coach‐implementedinjurypreventionandmanagementbehavioursandratingsof

perceivedimportance:Differencesbetweenswimmersandcoaches........................................................67

DISCUSSION..............................................................................................................................................................................70

4.0.7 Behaviourversusimportance......................................................................................................................704.0.8 Swimmersversuscoaches..............................................................................................................................72

CONCLUSIONS...........................................................................................................................................................................75

ix

CHAPTER5.........................................................................................................................................................77

5 STUDYTHREE–COACH‐IMPLEMENTEDINJURYPREVENTIONANDMANAGEMENTPLAN

INCOMPETITIVESWIMMING:IMPLEMENTATIONANDEVALUATION...........................................77

INTRODUCTION........................................................................................................................................................................77METHODS..................................................................................................................................................................................78

5.0.1 Participants..........................................................................................................................................................78

5.0.2 Measures................................................................................................................................................................80

5.0.3 InjuryPreventionandManagementPlanCondition.........................................................................825.0.4 Dataanalysis........................................................................................................................................................89

RESULTS....................................................................................................................................................................................90

5.0.5 Lifestress‐injuryrelationship.......................................................................................................................905.0.6 Interventionversuscontrol...........................................................................................................................91

5.0.7 Swimmersversuscoaches..............................................................................................................................93

5.0.8 Coachevaluation................................................................................................................................................98DISCUSSION..............................................................................................................................................................................98

5.0.9 Lifeeventstressandinjury............................................................................................................................985.0.10 Injurypreventionandmanagementplanintervention.................................................................99

5.0.11 Coachevaluation..........................................................................................................................................102CONCLUSIONS........................................................................................................................................................................104

CHAPTER6.......................................................................................................................................................106

6 SUMMARYANDCONCLUSIONS...........................................................................................................106

INTRODUCTION.....................................................................................................................................................................106SUMMARYOFRESULTS........................................................................................................................................................106

6.0.1 StudyOne–InjuryPreventionandManagementinCompetitiveSwimming:Discoveryof

CurrentPractices............................................................................................................................................................106

6.0.2 StudyTwo–InjuryPreventionandManagementinCompetitiveSwimming:

ConfirmationofCurrentPractices..........................................................................................................................1076.0.3 StudyThree–Coach‐ImplementedInjuryPreventionandManagementPlanin

CompetitiveSwimming:ImplementationandEvaluation...........................................................................108PRACTICALIMPLICATIONS..................................................................................................................................................109

RECOMMENDATIONSFORFUTURERESEARCH................................................................................................................111

APPENDIXA:STUDYONE............................................................................................................................123

APPENDIXB:STUDYTWO..........................................................................................................................130

APPENDIXC:STUDYTHREE.......................................................................................................................156

xi

LIST OF FIGURES

FIGURE3‐1:INJURYPREVENTIONANDMANAGEMENTCYCLEANDCOACH‐IMPLEMENTEDINJURYMANAGEMENT

BEHAVIOURS.......................................................................................................................................................................33

FIGURE5‐1:SUMMARYOFONE‐SAMPLET‐TESTSFORCHANGESINSCORESONTHEIPMP‐SFROMPRE‐TOPOST‐

INTERVENTIONFORINJURYPREVENTIONANDSHORT‐TERMINJURYMANAGEMENTBEHAVIOURS..................96

FIGURE5‐2:SUMMARYOFONE‐SAMPLET‐TESTSFORCHANGESINSCORESONTHEIPMP‐SFROMPRE‐TOPOST‐

INTERVENTIONFORLONG‐TERMINJURYMANAGEMENTANDRETURNTOFULLTRAININGBEHAVIOURS........97

xii

LIST OF TABLES

TABLE3‐1:COACHINTERVIEWGUIDE.....................................................................................................................................31

TABLE3‐2:INJURYPREVENTIONTACTICS..............................................................................................................................36

TABLE3‐3:SHORT‐TERMINJURYMANAGEMENTTACTICS.....................................................................................................42

TABLE3‐4:LONG‐TERMINJURYMANAGEMENTTACTICS.......................................................................................................48

TABLE3‐5:RETURNTOFULLTRAININGTACTICS...................................................................................................................56

TABLE4‐1:ITEMSECTIONSANDCATEGORIESFORTHEIPMP‐S........................................................................................62

TABLE4‐2:PARTICIPANTDEMOGRAPHICINFORMATION......................................................................................................64

TABLE4‐3:REPEATEDMEASURESANOVARESULTSFORSWIMMERS’RATINGSOFCOACH‐IMPLEMENTEDINJURY

MANAGEMENTBEHAVIOURSCOMPAREDTORATINGSOFBEHAVIOURIMPORTANCE..............................................66

TABLE4‐4:REPEATEDMEASURESANOVARESULTSFORCOACHSELF‐RATINGSOFINJURYMANAGEMENT

BEHAVIOURSCOMPAREDTORATINGSOFBEHAVIOURIMPORTANCE........................................................................67

TABLE4‐5:ONE‐WAYANOVARESULTSFORCOACH‐IMPLEMENTEDBEHAVIOURSCORESCOMPARINGSWIMMERS

ANDCOACHES.....................................................................................................................................................................68

TABLE4‐6:ONE‐WAYANOVARESULTSCOMPARINGSWIMMERS’ANDCOACHES’RATINGSOFPERCEIVED

IMPORTANCEFORINJURYPREVENTIONANDMANAGEMENTBEHAVIOURS..............................................................70

TABLE5‐1:SWIMMERDEMOGRAPHICINFORMATION............................................................................................................79

TABLE5‐2:INJURYPREVENTIONSTRATEGIES.........................................................................................................................83

TABLE5‐3:SHORT‐TERMINJURYMANAGEMENTSTRATEGIES.............................................................................................85

TABLE5‐4:LONG‐TERMINJURYMANAGEMENTSTRATEGIES...............................................................................................87

TABLE5‐5:RETURNTOFULLTRAININGSTRATEGIES............................................................................................................89

TABLE5‐6:SPANOVARESULTSCOMPARINGINTERVENTIONWITHCONTROLSWIMMERSONPRE‐ANDPOST‐

INTERVENTIONRESPONSESTOTHEIPMP‐S................................................................................................................93

TABLE5‐7:ONE‐SAMPLET‐TESTCOMPARISONSBETWEENINTERVENTIONSQUADSWIMMERS’CHANGESINRATINGS

ONTHEIPMP‐SFROMPRE‐TOPOST‐INTERVENTIONANDCOACHCHANGESINRATINGS...................................94

TABLE5‐8:ONE‐SAMPLET‐TESTCOMPARISONSBETWEENCONTROLSQUADSWIMMERS’CHANGESINRATINGSON

THEIPMP‐SFROMPRE‐TOPOST‐INTERVENTIONANDCOACHCHANGESINRATINGS.........................................95

xiii

STATEMENT OF CANDIDATE

CONTRIBUTION

TheworkinvolvedinthisresearchprogramwasperformedprimarilybyMs.Julie

Hardt(candidate).Allthreestudieswereplannedanddevelopedbythecandidate

undertheguidanceofProfessorSandyGordonandDr.NatBenjanuvatra,who

actedasthecandidate’ssupervisors.Participantrecruitment,datacollection,and

dataanalyseswereconductedsolelybythecandidate,exceptwhereindicatedfor

thepurposesofminimisingbiasandincreasingtrustworthiness.

Thecandidatedraftedthethesis,andProfessorSandyGordonandDr.Nat

Benjanuvatraprovidedfeedbackonthethesisdraft.

Signed:_______________________________________

JulieHardt(Candidate)

1

Chapter 1

1 Introduction

Introduction and Statement of the Problem

Whileswimmingisanon‐contactsport,athleteswhospendmanyhourstraining

andcompetingarestillsusceptibletoinjury.Giventhehighlyrepetitivenatureof

thesport,thereisaclearriskofoveruseinjury.Shoulderoveruseinjuriesare

reportedlythemostcommoncauseoflosttrainingtimeacrossallagesand

abilitiesofswimmer(Johnson,Gauvin,&Fredericson,2003)andespeciallyfor

eliteswimmers(Blanch,2004).Withthehighvolumeoftraininginherentinthe

sportofswimming,anyinjurywouldseverelylimitaninjuredswimmer’sabilityto

trainandcompete.

Inadditiontothephysicallimitationsthatinjuryincurs,injuryalsoresultsin

significantpsychologicalreactionssuchasanxiety,depression,anger,andlowered

self‐esteem(Gordon,Milios,&Grove,1991;Leddy,Lambert,&Ogles,1994;

Maniar,Curry,Sommers‐Flanagan,&Walsh,2001).Previousstudieshavesought

toidentifythebestwaytodealwiththepsychologicaleffectsofathleticinjury,and

commonfindingshaveshownthatcopingskillssuchasimageryandgoalsetting

(Driediger,Hall,&Callow,2006;Evans,Hardy,&Fleming,2000;R.E.Smith,Smoll,

&Ptacek,1990)aswellasincreasedsocialsupport(Manueletal.,2002;Podlog&

Eklund,2006;Udry,Gould,Bridges,&Tuffey,1997)areeffectivemeasuresfor

dealingwithinjury.Intimesofhardshipsuchasinjury,athletescommonlyturnto

theircoachasasourceofemotionalsupport(Thelwell,Weston,Greenlees,&

Hutchings,2008).

Consideringthepotentialforinjuryincompetitiveswimming,aswellasits

physicalandpsychologicalramifications,coachesshouldbepreparedtousetheir

uniquepositionofleadershipandsocialsupporttoeffectivelymanageinjury

amongswimmersintheirsquads.Whileresearchhasshownpositiveresults

throughpsychosocialinterventionsforinjurypreventionandinjuryrehabilitation,

2

itremainsunclearwhetherthisinformationhastrickleddownintocommon

coachingknowledgeandpractices.Specifically,notmuchisknownaboutthe

injurypreventionandmanagementstrategiescoachesactuallyemployin

competitiveswimming.

Purpose and Overview of Research

Thepurposeofthisresearchwastoexaminethecurrentcoach‐implemented

injurypreventionandmanagementpractisesinhigh‐performancecompetitive

swimmingaswellashowswimmersperceivetheircoaches’injurypreventionand

managementbehaviours.Thecurrentresearchprogramwasdesignedupona

modelofstressandathleticinjury(Andersen&Williams,1988)andtheintegrated

modelofresponsetosportinjury(Wiese‐Bjornstal,Smith,Shaffer,&Morrey,

1998).Thesemodelsrecognisethepsychosocialfactorsthatprecedeinjuryaswell

asaffectthepost‐injuryresponse.Withintheseframeworks,interventionsare

proposedtoaidpreventionofinjuryandinterventionstomanageresponseto

injuryinordertoincreaserecoveryoutcomes.

First,throughthisresearchtheauthorendeavouredtodiscovercurrentcoach‐

implementedinjurypreventionandmanagementbehavioursinswimming.

Second,theauthorcreatedaresearchprogramwhichattemptedtodevelopan

injurypreventionandmanagementprofilingtoolforcoachesandswimmers.

Third,theauthorattemptedtodesignandimplementaninjurypreventionand

managementprogramwithacompetitiveswimclub.Throughthisresearch,the

authoralsoexaminedhowtheathletesandcoachesrespondedtothe

implementationofastructuredandtargetedplanforinjurypreventionand

management.InChapter2,areviewoftheliteratureoutlininginjuryriskand

occurrenceinswimming,psychosocialantecedentstosportinjury,and

psychologicalresponsetosportinjurywillbepresented.Thereviewofthe

literatureformsthefoundationoftheresearchprogram.

Thecurrentresearchprogramwasdividedintothreephases.Inthefirstphase,

StudyOne(Chapter3),theresearchexploredthespecificinjurypreventionand

managementplansthatcoachesactuallyemploywiththeirswimmers.The

intentionofStudyOnewastotakeacomprehensivelookatthephenomenonof

3

injury,includinginjurypreventionstrategiesandplansdesignedtoaddressthe

psychologicalresponsestoinjuryandinjuryrehabilitation.Thiswasaccomplished

throughtheuseofinterviewswithelitecoaches,swimmers,andsportsmedicine

professionals.

Usingtheinformationgainedfromtheinterviewees,andbuildinguponextant

literature,StudyTwo(Chapter4)attemptedtodevelopanInjuryPreventionand

ManagementProfileforSwimming(IPMP‐S),whichwouldmeasurecoach‐

implementedinjurypreventionandmanagementbehavioursaswellasthe

perceptionoftheimportanceofthosebehaviours.

ThefinalphaseofthisresearchinStudyThree(Chapter5)involveddesigning,

implementing,andevaluatinganinjurypreventionandmanagementplanwitha

competitiveswimclubbasedontheinformationgatheredinthefirsttwostudies.

Whileitwasrecognisedthathavinganinjurypreventionandmanagementplan

wouldnotfullypreventinjuries,itwashopedthatitwouldhelpathletestobe

betterpreparedifinjuryweretohappenandthatseverityinjuriesandinjury

responsecouldbeminimised.

Significance of Research

Therewereanumberofsignificantcontributionstosportsinjurypreventionand

managementliteraturethattheauthorattemptedtomakethroughthisresearch.

Firstly,thisprojectaimedtoprovideanintegratedapproachtoinjuryresearchby

lookingatbothpre‐andpost‐injuryprotocols.Commonly,injuryresearchhas

focusedoneitherpre‐injuryfactorsorpost‐injuryfactors,butthisresearch

combinesbothintoaholisticinjurypreventionandmanagementframework.

Secondly,thisresearchapproachesinjurymanagementfromacombinationof

disciplinaryapproaches(e.g.,psychology,biomechanics)toprovideamore

comprehensiveapproachtoinjurypreventionandmanagementasopposedto

examiningtheinjurymanagementprocessthroughonedisciplinaryfilter.Third,

thisresearchmakesasignificantcontributiontotheliteraturebyexaminingthe

coach’sroleininjurypreventionandmanagementprocess.Whilecoacheshave

beenreportedtoplayanimportantrolewiththeirathletespre‐andpost‐injury,

literaturehastypicallyfocussedonotherserviceproviderssuchassports

4

medicinepractitioners(Arvinen‐Barrow,Penny,Hemmings,&Corr,2010;Podlog,

Dimmock,&Miller,2011;Wadey&Evans,2011).Byinvestigatingthecoach’srole

intheinjurymanagementprocess,thisthesishasimplicationsinregardsto

specificinjurypreventionandmanagementknowledgeandprotocolsforcoaches

tofollowintheirownclubs.ThewordsofaninjuredswimmerinStudyOne

underlinetheimportanceofacoach‐implementedplanforinjurypreventionand

managementofinjuredswimmers:

Iwishmycoachwouldhaveimplementedsomethingorhadsomethingin

place,orifsomebodydoesgetinjured,thenthisiswhatwe’regonnado,and

thisistheprotocolwe’regonnafollow.Whereasitwasjustgoanddo

whateveryouwanttodo,andthatwasn’tverysupportive.–USS02

5

Chapter 2

2 Review of the Literature

Introduction

Thepurposeofthischapteristooutlinetheliteratureonthepsychologyofsport

injuryandplanstoaddressthepsychosocialfactorsofinjury.Thechapteris

dividedintofourmajorsections:

1. IncidenceofInjuryinCompetitiveSwimming

2. PsychosocialAntecedentsofSportInjury

3. ResponsetoandRehabilitationfromSportInjury

4. InjuryManagementPlans

Incidence of Injury in Competitive Swimming

Sportisoneofthemajorcausesofinjuryamongstadolescents(Abernethy&

Bleakley,2007).Eventhoughswimmingisalow‐impact,non‐contactsport,itstill

carriesinherentrisksduetothehighvolumeoftrainingthatswimmersendure.

Competitiveswimmerscanbegintrainingasyoungas7yearsold,andthemajority

trainandcompeteyear‐round(Seinetal.,2010).Onceswimmersreachtheir

adolescentyears,itistypicaltotrainasmuchas20hoursaweeklogginginupto

50kminthattime(McMaster,1999).Withthisamountoftraining,swimmerscan

record2500ormoreshoulderrotationsperday,andtheycaneasilyrecordmore

thanamillionstrokecyclesinayear(McMaster,1999;Pink&Tibone,2000;Sein

etal.,2010).Giventherepetitivenatureoftheoverheadstrokecyclepairedwith

thehighvolumeoftraining,itisnotsurprisingthatthemostcommoninjuries

occurtotheshoulders(Ciullo&Stevens,1989;Kennedy&Hawkins,1974;

McMaster&Troup,1993;Wolf,Ebinger,Lawler,&Britton,2009).Ithasalsobeen

reportedthatswimmerscommonlyexperienceinjurytotheknees,lowerback,and

hips(Grote,Lincoln,&Gamble,2004;Kaneokaetal.,2007;O’Donnell,Bowen,&

Fossati,2005).

6

Ithasbeenreportedthat35‐91%ofsenior,elitelevelswimmersreportshoulder

paintoadegreethatlimitstheirabilitytotrainandcompeteeffectively(McMaster

&Troup,1993;Seinetal.,2010;Wolfetal.,2009).Intheirsurveyof80adolescent

agedswimmersfrom4differentswimclubs,Seinetal.(2010)found91%of

swimmersreportedshoulderpainwith84%showingpositiveimpingementsigns

uponclinicalexamination.Amongtheseswimmers,Seinetal.foundthatasweekly

traininghourswentup,thelikelihoodoftendinopathyalsowentup.Similarly,

tendinopathywentupwithanincreaseintrainingvolume.Whilenoinvasive

procedureswereperformed,theyspeculatedthatthehighlevelsofstressputon

thetendonsduetotrainingvolumehadaneffectonthestructuralstabilityofthe

tendons.Thesefindingssuggestthatthelongertheswimmerstaysintrainingand

competitionandthehigherthevolumeoftheirtraining,themorelikelytheyareto

sustainaninjury.Whileitseemslogicalthatinjuryratesarereportedlyhigher

amongeliteswimmerswhotrainhighervolumesandmorefrequently,these

injuriesarecommonacrossallagesandabilitiesofswimmers,including

adolescents(Blanch,2004;Johnson,Gauvin,&Fredericson,2003;Wolfetal.,

2009).

Inadditiontothehighvolumeandtrainingfrequencyreportedamongswimmers,

rapidchangesinvolumeandfrequencyhavebeenlinkedtoinjuryratesin

swimming.Ina5‐yearinvestigationofinjuriesinacollegiateprogram,Wolfetal.

(2009)revealedthatmorethan72%ofthemaleswimmers(32of44males)and

70%offemaleswimmers(35of50females)sustainedaninjurythatresultedin

missedtrainingorcompetitiontime.Injuryrateswerehighestamongstthefirst

yearswimmerswhohadtransitionedfromtheirhighschoolprogram,andas

swimmersprogressedthroughtheprogram,injuryratesdecreased.Theauthors

speculatedthatthispatternofinjurywasaresultofthevastincreaseinvolume

andfrequencyofbothwatertrainingandlandbasedtrainingtheswimmers

experiencedintheadjustmentfromhighschooltouniversitylevelswimming.In

factnearly40%ofreportedinjurieswerearesultofdry‐landtraining.Their

findingswerecontrarytosomestudiesthatrecommenddry‐landactivitiessuchas

strengthandconditioningtoincreasestrengthofstabilizingmusclesandthereby

lowerinjuryrisk(Abernethy&Bleakley,2007;Emery,Meeuwisse,&Hartmann,

2005).However,thisfindingwasinlinewithpreviousstudiesonswimming

7

injuriesstatingthatweighttrainingcanactuallybeacausativefactorininjuries

(Greipp,1985;Hall,1980).

Whilethemajorityofreportedinjuriesinswimmingarenotimpactrelated,the

long‐termnatureoftendinopathiescanmeanalengthyrehabilitationprocessfor

injuredswimmers.Giventhevolumeoftrainingswimmerslogin,aninjurythat

limitstheirabilitytotrainforlongperiodsoftimecanbedevastatingtoa

competitiveseason.

Psychosocial Antecedents of Sport Injury

2.0.1 Introduction

Basedonthehighvolumeoftrainingthatswimmersendure,itisclearthatthe

physicaldemandsoftrainingputswimmersatinjuryrisk.Aswasdiscussedearlier,

thehigherthevolumeandfrequencyoftraining,themorelikelyaswimmeristo

experienceshoulderpain.Also,thedrasticchangeinvolumefromahighschool

programtoacollegiateprogramhasbeenspeculatedtoincreaseriskforinjuryin

swimmingbecauseofthesuddenincreaseinphysicalstressputonthebody(Wolf

etal.,2009).Indeed,researchhasshownthatmanysportsincurhighamountsof

differenttypesofstress,whichincludenotonlythephysiologicaldemandsof

trainingbutalsopsychologicalandsocialdemandsthroughoutacompetitive

season(Santomier,1983).Itstandstoreasonthatathletesneedbothphysicaland

psychologicalskillstomanagestressfulsituationsthatmaybepresentedtothem

(Maddison&Prapavessis,2007).

Researchtypicallyseparatesinjuryriskfactorsbetweentwocategories:intrinsic

factorsandextrinsicfactors.Extrinsicfactorsarerelatedtothingsliketheuseof

protectiveequipment,thetypeofsportplayed,andthetrainingregimen.Intrinsic

factorsconcernfactorsrelatedtothespecificathlete,includingphysiologicaland

psychologicalfactors(Caine,Maffulli,&Caine,2008).Thelinkbetween

physiologicalandbiomechanicalfactorsandinjuryriskhasbeenheavily

researched(Cowley,Ford,Myer,Kernozek,&Hewett,2006;Knapik,Bauman,

Jones,Harris,&Vaughan,1991;Krosshaug,Slauterbeck,Engebretsen,&Bahr,

2007;Surve,Schwellnus,Noakes,&Lombard,1994;Tropp,Askling,&Gillquist,

8

1985).Inrecentliterature,therehasalsobeenagreaterunderstandingofthe

psychologicalfactorsthataffectinjuryriskinathletes.

2.0.2 Personality and Injury Occurrence

Personalitytraitscanbedefinedaspsychologicalvariablesthatapersoncanbe

characterizedby,andwhicharesituationindependent.Earlystudiesinvestigating

theaffectofpsychosocialfactorsonathleticinjuryfocusedonpersonalityvariables

(Brown,1971;D.W.Jacksonetal.,1978;Valiant,1981).Theseinitialinvestigations

werecompletedbasedontheideathatcertainathleteswouldhavea

predispositiontoinjurybasedontheirpersonalitytraits.Resultsfromthese

studiesyieldedequivocalresults.Somestudiesshowedarelationshipbetween

particularpersonalitymeasuresandinjury;however,othersshowedno

relationship.Inconsistentfindingscontinuedwithlaterstudiesincludingthoseinto

competitivetraitanxiety(Lavallee&Flint,1996;Passer&Seese,1983;Petrie,

1993)andglobalself‐esteem(Ford,Eklund,&Gordon,2000;Kelley,1990;Seff,

Gecas,&Ray,1992).Consideringthecontradictoryresultsofavarietyofstudieson

therelationshipbetweenpersonalitytraitsandinjury,Junge(2000)suggestedthat

noonecharacteristicprofilecouldbedrawnthatwouldrevealanathletewhowas

predisposedtoinjury.Lifeeventstressisonepsychosocialfactorwhichhasa

historyoffindingssupportingapositiverelationshipwithinjury.

2.0.3 Life Event Stress and Injury Susceptibility

Initialresearchintostressandinjuryfocusedontherelationshipbetweenlife

eventstressandinjurysusceptibilityforAmericanfootballers.Bramwell,Masuda,

Wagner,andHolmes(1975)usedamodifiedversionoftheSocialandAthletic

ReadjustmentRatingScaledevelopedbyHolmesandRahe(1967),whichthey

namedtheSocialandAthleticReadjustmentScale(SARRS).Theyfoundthatamong

the82footballplayersintheirstudy,thosewhosufferedmajorinjuriesreported

significantlyhigherscoresontheSARRSthantheirnon‐injuredcounterparts.This

findingrevealedastrongrelationshipbetweenlifestressandinjuryrisk:asmore

challenginglifeeventswereexperienced,injuryriskseemedtoincrease.Cryanand

Alles(1983)furtheredthisresearchusingamorerobustdesignwhenreplicating

Bramwelletal.’sstudy.Theyusedalargersampleoffootballers(N=115),andthey

9

sampledfrom3separateuniversities.Whiletheyfoundthathigherlevelsoflife

changedidnotincreaseriskformajorinjuries,therelationshipwasupheldfor

generalinjuryrisk.CryanandAllesalsofoundthatathleteswhoexperiencedhigh

levelsoflifechangeweremorelikelytosuffermultipleinjuriesincomparisonwith

teammateswhoreportedlowlevelsoflifechange.

Followingtheseinitialstudies,researchintotherelationshipbetweenlifeevents

andinjuryriskcontinuedwiththedevelopmentofnewmeasures.Coddingtonand

Troxell(1980)usedtheLifeEventScaleforAdolescents(LESA)tomeasurelife

stressamonghighschoolfootballplayers.Theyfoundthatathleteswhoreported

higherscoresforfamilyinstabilityorobjectlossweresignificantlymorelikelyto

sufferaninjury.PasserandSeese(1983)usedamodifiedversionoftheLife

ExperiencesSurvey(LES)originallydevelopedbySarason,Johnson,andSegal

(Sarason,Johnson,&Siegal,1978).Thismodifiedversion,theAthleticLife

ExperiencesSurvey(ALES),allowedforrespondentstorecordnotonlywhether

theyexperiencedanevent,butalsothedesirabilityoftheexperienceandthe

magnitudeoftheimpactontheirlife.UsingtheALES,PasserandSeese(1983)

reportedasignificantpositiverelationshipbetweennegativelifeeventsandinjury

ratesamongDivisionIIfootballplayers,buttheyfoundnorelationshipbetween

injuryandpositivelifeeventstress.Theyalsofoundnosignificantrelationship

betweenlifeeventstressandinjuryfortheDivisionIfootballplayers.

Ratherthanmodifyingapreviousmeasurecreatedforthegeneralpopulation,

Petrie(1992)createdameasureoflifeeventstressspecificallyforusewithsport

populations,namedtheLifeEventSurveyforCollegiateAthletes(LESCA).Inhis

studyofcollegiategymnasts,Petriefoundthatinjuredgymnastsreportedhigher

levelsoflifeeventstressthanthosegymnastswhoremaineduninjured,

particularlyfornegativelifeevents.Negativelifeeventstressaccountedfor6‐11%

oftheinjuryvariancereported.

Alongwiththeincreaseinavailablemeasuresofthelifestress‐injuryrelationship,

researchalsoexpandedtoinvestigateothersportingpopulations.Throughout

subsequentyears,lifeeventstresshasbeenshowntobeasignificantpredictorof

injuryinavarietyofteamandindividualsportsincludinggymnastics(Kerr&

Minden,1988;Petrie,1992),soccer(Ivarsson&Johnson,2010;Rogers&Landers,

10

2005),rugby(Maddison&Prapavessis,2005),alpineskiing(May,Veach,Reed,&

Griffey,1985),andavarietyofothersportsincludingbaseball,cross‐country,

softball,tennis,andtrackandfield(Dunn,Smith,&Smoll,2001;Hardy,Richman,&

Rosenfeld,1991;Hardy&Riehl,1988).

Theonlystudylinkingstressandinjuryincompetitiveswimmerswasconducted

byDavis(1991).Davissuggestedthatareductionofstressmayleadtoareduction

ininjuryrate.InhisstudyofaDivisionIIcollegiateswimmingprogram,he

implementedasportpsychologyprogramemphasisingrelaxationtechniques.At

theconclusionoftheseason,therewasa52%reductionintheincidenceofinjury

incomparisontoreportsgatheredfromthepreviousseason.WhileDaviswasnot

abletomakeaconclusivestatementofcausation,sinceotherfactorsmayhave

affectedtherelationship,hesuggestedthatthereductionofstressdueto

relaxationcontributedtoasubsequentreductionininjuryoccurrence.

Whilethemajorityofstudiesfoundsomerelationshipbetweenlifeeventstress

andinjury,researchintobasketball(Rider&Hicks,1995)andvolleyball(Williams

etal.,1986)foundnosignificantrelationship.RiderandHicks(1995)speculated

thatthelackofsignificancewasaresultofthelowlevelsofreportedstressforall

athletesintheirstudy.Williams,Tonyman,andWadsworth(1986)positedthatthe

non‐contactnatureofvolleyballmayhavemadeitdifficulttorevealasignificant

relationshipbetweenlifestressandinjury.

Despiteavarietyofdifferentmeasures,amongdifferentsports,anddiffering

abilitylevels,themajorityofstudiesintothelifestress‐injuryrelationshiphave

upheldthefindingthataslifeeventstressgoesupinjuryriskalsoincreases

(Williams&Andersen,1998).Eventhoughtheevidenceispredominantlyin

supportofthelifestress‐injuryrelationship,earlyresearchwasinconsistent

mainlyduetolimitationsarisingfromsimplisticresearchdesigns,inadequate

measurementtools,andalackoftheoreticalunderpinnings.Andersenand

Williams(1988)addressedtheseconceptualproblemsbyproposingan

interactionalmodelofstressandathleticinjury,whichtheyupdatedtenyears

later(seeWilliams&Andersen,1998).(Gunnoe,Horodyski,Tennant,&Murphey,

2001;Maddison&Prapavessis,2005;R.E.Smithetal.,1990)

11

2.0.4 A Model of Life Stress‐Athletic Injury Relationships

InthetheoreticalmodelproposedbyWilliamsandAnderson(1998),they

identifiedvariouspsychosocialpredictorvariablesofinjury,potentialmechanisms

forthestress‐injuryrelationship,andpossibleinterventionsforpreventinginjury.

Atthecoreoftheirmodelisthestressresponse,whichisapresentedasa

bidirectionalrelationshipbetweenthecognitiveappraisal(e.g.evaluationof

demands,resources,andconsequences)ofapotentiallystressfulathleticsituation

andthephysiologicalreactions(e.g.,increasedmuscletension)andattentional

responses(e.g.narrowingofthevisualfield)tothesituation.Thesevariables

interactwithoneanother,andtheymayincreaseinjuryvulnerabilitybyaffecting

anathlete’sabilitytoappropriatelydetectandreacttoenvironmentalcues.

WilliamsandAndersen(1998)alsoproposedthreefactorsabovethestress

responsethatmayworksolelyorincombinationtoaffectthestressresponseand

injuryrisk.Thesethreepsychosocialconstructsincludedpersonality

characteristics(e.g.,hardiness,locusofcontrol,competitivetraitanxiety),history

ofstressors(e.g.,lifeevents,dailyhassles,previousinjuries),andcopingresources

(e.g.,copingbehaviours,socialsupport,mentalskills).Thismodelsuggeststhat

thesepsychosocialvariablesinfluencehowanathleterespondstostressful

situations,andthepresenceorabsenceofthesevariablescanincreaseordecrease

injuryriskthroughtheireffectonthestressresponse.Ithasbeenhypothesised

thatathletesatthehighestriskofinjurywouldbethosewhohavepoorcoping

resources,manylifestressors,andcertainpersonalitycharacteristics,whilethose

withtheoppositeprofilewouldbetheleastatrisk(Andersen&Williams,1988;

Maddison&Prapavessis,2007;Williams&Andersen,1998).

2.0.5 Moderator Variables in the Life Stress‐Injury Relationship

Whilelifeeventstresshasbeenshowntobeasignificantpredictorofinjury,

previousfindingshavealsosuggestedthatathleteswithpoorcopingskillsorlow

socialsupportmayalsobemorevulnerabletoinjury(Blackwell&McCullagh,

1990;Devantier,2011;Gunnoeetal.,2001;Hanson,McCullagh,&Tonymon,1992;

Steffen,Pensgaard,&Bahr,2009;Williamsetal.,1986).Furthermore,coping

resources,includingsocialsupportandindividualcopingskills,mightmoderate

12

thelifestress‐injuryrelationship.AsdefinedbyBaronandKenny(1986),a

moderatorvariableaffectsthenature,direction,orstrengthoftherelationship

betweenanindependentvariableandadependentvariable.Inthecontextofthe

lifestress‐injuryrelationship,itispossiblethatthepresenceofsituationalor

individualdifferencevariablescouldmoderatethevulnerabilityofanathleteto

injury.

PasserandSeese(1983)acknowledgedaneedtoexaminemoderatorvariablesin

theirresearchonlifestressandathleticinjuryamongcollegefootballers;however,

theyfoundnosignificanteffectsamongthethreedispositionalvariablesexamined.

Followingthis,Williamsetal.(1986)examinedcopingresourcesasapotential

moderatorvariable.Fortheirstudy,copingresourcesweremadeupofa

combinationofsocialsupportandgeneralcopingbehavioursenactedbythe

volleyballplayers.Whilecopingresourcesfailedtomoderatethestress‐injury

relationship,theydidexhibitasmall,butdirectinfluenceoninjuryoccurrence

whereinjuredplayersreportedlowercopingresourcesthanuninjuredplayers.

Intheirstudyofmaleandfemalehighschoolathletes,Smith,Smoll,andPtacek

(1990)foundthatpsychologicalcopingskillsactedasamoderatorvariableinthe

lifestress‐injuryrelationship.Theirresultsshowedthatthestress‐injury

relationshipwashighestamongathleteswhoreportedbothlowcopingsupport

andlowsocialsupportalongwithhighlifestress,accountingformorethan20%of

theinjuryvariance.ThisfindingwasalsoconsistentwithresultsinPetrie’s(1992)

studyongymnasts.Asmentionedearlier,Petriefoundthatgymnastswhoreported

higherlifeeventstress(particularlyfornegativelifeevents)weremorelikelytobe

injuredthangymnastswithlowlifeeventstress,accountingfor6‐11%ofthe

injuryvariance.Thisrelationshipbecamemorepronouncedwhenincludingthe

moderatingvariableofsocialsupport,with11‐22%ofinjuriesbeingpredictedby

lifeeventstress.Specifically,thoseathleteswhoexperiencedhighlevelsoflife

eventstressandlowlevelsofsocialsupportweremorelikelytobecomeinjured.

WhilePetriefoundlowsocialsupporttoincreaseinjuryrisk,hesuggestedthat

highsocialsupportmightactasabufferforlifestressandprotectagainsttherisk

ofinjury.

13

Intherealmofsports,coacheshavebeenfoundtobeavitalsourceofsocial

supportfortheirathletes(Bianco,2007;Malinauskas,2008;Robbins&Rosenfeld,

2001).Indeed,inhisstudyofcollegiateathletes,Malinauskas(2008)suggested

thatsocialsupportfromcoachescontributedpositivelytotheoverallphysical

well‐beingoftheathletesandprovidedabufferagainstfeelingsofstressboth

priortoinjuryandduringrehabilitation.However,hestatedthatinorderforthere

tobeapositiveeffectofsocialsupport,thereneedstobeamatchbetweenthetype

ofsupporttheathleteneedsandthetypeofsupportthatthecoachgives.In

addition,theathleteneedstoperceivethatthecoachisactuallyprovidingthe

support.InapreviousstudybyRobbinsandRosenfeld(2001),theyfoundsimilar

results.Collegiateathletesintheirstudycitedheadcoachesandassistantcoaches

asimportantprovidersofsocialsupportpre‐andpost‐injury,particularlyfortask

appreciation,taskchallenge,andemotionalchallengesupport.

Inadditiontosocialsupport,RogersandLanders(2005)havealsosuggestedthat

highamountsofcopingskillsmayactasabufferagainsttheeffectoflifeevent

stressoninjuryrisk.Theydefinedcopingskillsastheabilitytothinkclearlyunder

stressandcontrolarousal,setspecificgoalsanduseproblemsolvingstrategies,

andalsopayattentiontoandbenefitfromconstructivefeedback.Forthemaleand

femalehighschoolsoccerplayersintheirstudy,morethan27%ofinjuriescould

bepredictedbytheinteractionbetweennegativelifeeventstressandlowcoping

skills.Furthermore,theyfoundthathighamountsofcopingskillsloweredthe

effectofnegativelifestressoninjury.Theypositedthatifanathletepossessed

sufficientmentalskillstomanagestress,lifeeventstresswouldhavelessofan

impactonraisingtheirinjuryrisk.

Alongwithsocialsupportandcopingskills,personalitycharacteristicshavealso

beenfoundtohaveamoderatinginfluenceonthelifestress‐injuryrelationship.In

astudyof121athletesfromavarietyofteamsports,Ford,Eklund,andGordon

(2000)foundthatglobalself‐esteem,hardiness,anddispositionaloptimism

moderatedtherelationshipbetweenmeasuresofpositive,negative,andtotallife

changeandinjurytime‐loss.Theyalsofoundatrendtowardsamoderating

influenceontherelationshipforcompetitivetraitanxiety,physicalabilityself‐

esteem,andnumberofsocialsupportprovidersandqualityofsocialsupport.

14

Wadey,Evans,Hanton,andNeil(2011)alsofoundathathardinesshada

moderatingeffectonnegativelifeeventstressandinjury.Ashardinessincreased,

resultsshowedthatinjuryriskdecreased.Theysuggestedthatwhileathletesmay

experiencesimilarlevelsofnegativelifeeventstress,thoseathleteswhohadhigh

hardinessscoreswerebetterabletoappraiseandreappraisestressfuleventsso

thattheseeventsdidnothavesuchdeleteriouseffectsontheirinjuryrisk.Given

thefindingsthatnegativelifeeventsalongwiththemoderatingeffectsofcoping

resourcesandpersonalitycharacteristicsincreaseinjuryrisk,itfollowsthatthe

nextstepwouldbetotestpsychosocialinterventionstopreventinjury.

2.0.6 Psychosocial Interventions to Prevent Athletic Injury

Intheprogressionofresearchintothepsychosocialantecedentstoathleticinjury,

veryfewstudieshavespecificallyexaminedinjurypreventionbasedon

psychologicallybasedinterventions.Inanearlyreview,Cupal(1998)pointedout

thattherewasapaucityofempiricalstudies.Furthermore,thesestudieslacked

controlgroupsandstandardizedpreventionandrehabilitationprotocols,soit

madeitdifficulttodeterminethedegreetowhichthepsychologicalinterventions

contributedtothepreventionofinjuryamongpotentialconfoundingfactors.

However,thesestudiesdidprovideapreliminaryunderstandingofthiscomplex

relationship.

Initialstudiesimplementedpsychologicalskillsbasedinterventionsforgeneral

performance,butfoundthatinjuryrateswentdownasanaddedbenefit.DeWitt

(1980)investigatedtheeffectsofacognitiveandbiofeedbackinterventiononthe

performanceofmalebasketballplayers.Notonlydidtheperformanceofthe

interventiongroupimprove,theyalsoself‐reportednoticeabledecreasesinminor

injuries.MayandBrown(1989)alsoinvestigatedtheeffectsofamentalskills

interventiononperformanceofskiersimplementingavarietyofdifferentmental

skills(e.g.,attentioncontrol,imagery)aswellasteambuildingactivities,

relationshiporientations,communication,andcrisisinterventions.Atthe

conclusionofthestudy,athletesassociatedtheinterventionwithareductionin

injuriesaswellasincreasedself‐confidenceandself‐control.

15

Davis(1991)wasoneofthefirsttodirectlyinvestigatetheeffectofamentalskills

programoninjuryrate.Asmentionedpreviously,Davisimplementedastress

reductioninterventiononagroupofswimmers,andhefounda52%reductionin

injuryrateascomparedtoinjuryreportsfromthepreviousseason.Healsofounda

33%reductioninseriousinjuriesinacohortoffootballplayers.Whilethese

studiessupportedtheroleofpsychologicalskillsusageandtraininginthe

reductionofinjury,theylackedrandomizedcontrolleddesigns,andmeasurement

ofinjurywasnotprospective.Onlyahandfulofstudieshaveaddressedthese

factorsintheirresearchdesignsinvestigatingtheeffectsofpsychologicallybased

interventionstopreventinjury(Johnson,Ekengren,&Andersen,2005;Kerr&

Goss,1996;Maddison&Prapavessis,2005;Perna,Antoni,Baum,Gordon,&

Schneiderman,2003)

Oneofthefirsttousearandomizedcontrolleddesigninthislineofresearch,Kerr

andGoss(1996)examinedtheeffectofacognitivebehaviouralstressmanagement

(CBSM)interventiononinjuryratesamongnationalandinternationallevel

gymnasts.Participantsattendedbimonthlysessionsoveran8‐monthperiod,

whichcoveredmultiplepsychologicalskills(e.g.,cognitiverestructuring,

relaxation,imagery).Althoughtherewasasignificanttreatmenteffectfor

decreasedlifestress,resultsindicatedanon‐significantreductionininjuryrate.

KerrandGoss(1996)explainedthelackofasignificancetothelateinclusionof

relaxationanddistractionskillsintotheprogram.Pernaetal.(2003)also

investigatedtheeffectsofaCBSMinterventiononinjuryrates,andtheyfoundthat

comparedtoacontrolgroup,therowersintheCBSMconditionexperienced

significantreductionsininjuryandillnessdays.

Twostudieswentfurtherwiththeirinterventionswheretheyspecificallytargeted

athleteswithahigh‐riskprofileforinjury(i.e.,highlifestressandlowcoping

resources).Johnsonetal.(2005)examinedtheeffectofapsychologicallybased

injurypreventionprogramwithSwedishsoccerplayers.Attheconclusionofthe

study,thetreatmentgrouphadsignificantlyfewerinjuriesthanthecontrolgroup.

MaddisonandPrapavessis(2005)alsoexaminedtheeffectsofaCBSM

interventiononinjuryratesamonghigh‐riskrugbyplayers.Theyfoundthatthe

playersinthetreatmentconditionmissedfewerdaysoftrainingandcompetition

duetoinjuryincomparisontothecontrolgroup.Whiletherewasatrendforfewer

16

injuriesoverall,thedifferencewasnotfoundtobesignificant.Thetreatmentgroup

alsoreportedasignificantincreaseincopingresourcesandadecreaseinworry

followingtheintervention.

2.0.7 Summary

Inrecentliterature,therehasbeenanincreasedinterestintothepsychosocial

antecedentsthataffectathleticinjuryandpsychologicalinterventionsdesignedto

addressthesefactorsinordertopreventinjuries.Byfarthemostwidely

researchedfactorinthisareaisthatoflifeeventstressanditsrelationshipto

injuryoccurrence.Whileearlyresearchwaslackingintheoreticalunderpinnings

andalsosufferedfromweakexperimentaldesigns,morerecentresearchhas

benefittedfromtheframeworkputforwardbyWilliamsandAndersen(Williams&

Andersen,1998).Mostfindingsindicatethatthereisapositiverelationship

betweenlifeeventstressandinjuryoccurrence,andthisrelationshipisfurther

moderatedbyfactorssuchascopingskills,socialsupport,andpersonalityfactors

(e.g.,hardiness,globalself‐esteem).

Giventherelationshipbetweenlifeeventstressandotherpsychosocialfactors

withinjuryrisk,researchhasalsobeguntoaddresstheeffectofpsychologically

basedinterventionsforthepreventionofinjury.Whilethereiscurrentlyapaucity

ofresearchinthisarea,preliminaryresultsindicatethatpsychologicallybased

interventionsworkasaplausiblemechanismtoreducetherateofinjury,

particularlyamongthoseathleteswhohaveahigh‐riskprofileforinjury.

Inordertoincreaseknowledgeintothisareaandalsobeabletobettergeneralize

theresultstominimizeinjury,moreresearchmustbedonewithavarietyof

differentsports,agegroups,abilitylevels,cultures,andgenders.Inparticular,

researchshouldcontinuetoassesstheimpactofinjurypreventionprogramsbased

onpsychosocialinterventions.Futureresearchshouldalsolookintothe

knowledgeandimplementationofthesetypesofstrategiesbycoachesinreal

worldsettings:Arerealworldcoachesandathletesawareofthepsychosocial

impactoninjuryoccurrence?Whatarecoachesandteamsdoingtoaddressthese

issues?

17

MaddisonandPrapavessis(2007)suggesttheneedforcoaches,trainers,and

athletestobeawareofthepsychosocialfactorsofinjury,andthataddressingthose

riskfactorscanreduceinjuries.Ataminimum,theyrecommendthateducation

intothisareaisthefirststepforcoachesandathletestopreventinjuries.Other

factorstoincludewouldbeanincreaseinsocialsupport,anintroductiontocoping

skillsuse,andanincreaseintheuseofmentalskillssuchasgoalsetting,stress

management,imageryuseinathleticprograms.Notonlymaythesefactorshelpto

preventinjury,buttheymayalsohelpathletescopemoreeffectivelyiftheydo

becomeinjured.

Responses to and Rehabilitation from Sport Injury

2.0.8 Introduction

Sometimeswhenaninjuryandabadlifeeventhappentogether,itkindof

bringsyoudowntoanotherlevelbecausenotonlyareyouhurtphysically,but

you’rehurtemotionallyandyou’rehurtsocially.So,andallaspectsofyourlife

arejustoutofcontrolandspinningoutward,andso,yeah,sometimeswhen

somethingtraumatichappens,itcanmakeaninjuryalotworseandhowto

handletheinjuryalotworse.–Injuredcollegiateswimmer(Study1)

Whileresearchhasshownthatlifeeventstressisasignificantpredictorofsports

injury,theinjuryinitselfcanalsobeastressortoanathlete(Nicholls&Polman,

2007).Thenegativeemotionalresponsesthatarecommonamonginjuredathletes

reflectthisideathatinjuryincursasignificantamountofdisturbance.Injured

athletescanexperiencearangeofnegativeemotionssuchasanger,depression,

andanxietyaswellasexhibitinglowerself‐esteemandfeelingisolatedfromothers

(Goldsmith,2007;Leddyetal.,1994;Thelwelletal.,2008).Agrowingbodyof

researchisaddressingthesereactionstoathleticinjury,particularlyconcerning

strategiestofacilitaterecoveryfrominjury.Thissectionsummarisestheliterature

onthecognitive,emotional,andbehaviouralconsequencesofathleticinjury,and

theeffectsofinterventionsontherehabilitationphaseofinjurymanagement.

18

2.0.9 Athlete Responses to Injury

Followingamajorinjury,anathletemustcopewitharangeofpotentiallystressful

andunpleasantsituations,includinglargeamountsofmedicalinformationonthe

injury,thelossoftheirphysicalcapabilities,dependencyonothers,andthe

emotionsofwithdrawalfromtheirsport(Flint,2007).Whereoncetheirsport

providedasenseofaccomplishmentandprideandwasasourceofself‐esteem,

theirinjuryhasnowcreatedapotentialthreattotheirfuture.Ithasbeenfound

thatinjuredathletescanexperiencenotonlydecreasedphysicalhealthorcapacity

duetotheirinjury,butalsodecreasedsenseofachievement,financialconcerns,

lossofidentity,andloweredself‐perception(Ford&Gordon,1999).Athletes’

responsestoinjurywillvaryaccordingtotheindividual,dependingontheir

characteristics,anddependingonthecontextoftheinjury.Whilesomeresearch

hassuggestedtheremaybepositiveoradaptiveresponsestoinjury,themajority

ofresearchfocusesonthenegativeresponsestoathleticinjury(Brewer,Linder,&

Phelps,1995;Leddyetal.,1994;Udry,Gould,Bridges,&Beck,1997;Udry,1999).

Numerousstudieshavedocumentedtheadverseeffectsinjurycanhaveonan

athlete’semotionalstate.Inaretrospectivestudyoffootballplayers,Brewerand

Petrie(1995),foundthatinjuredfootballplayersreportedsignificantlyhigher

levelsofdepressioncomparedtonon‐injuredcounterparts.Mooddisturbancewas

alsoreportedinaprospectivestudyexaminingthedifferencesbetweenpre‐and

post‐injurymoodstatesamongathletes.Smithetal.(1993)foundthatinjured

athletesexperiencedasignificantmooddisturbancecomparedtoratingspriorto

sustainingtheinjury.

Furthermore,thesenegativeresponsescancontinuelongaftertheinitialinjury.In

astudyofmaleathletesfrom10differentsports,Leddy(1994)foundthatinjured

athletesreportedgreaterlevelsofdepressionandanxietyimmediatelyfollowing

theirinjurycomparedtonon‐injuredathletes.Thisdisparitywasalsostillseenat

thefollow‐upobservationtwomonthslater.Overhalf(51%)oftheinjured

participantsexhibiteddepressionsymptomsofatleastmildseverity,and12%

exhibitedsymptomssimilartotheseveritylevelsofadultsinoutpatienttreatment

forclinicaldepression.Similarly,Appaneal,Levine,Perna,andRoh(2009)found

thatinjuredmaleandfemaleathletesshowedhigherlevelsofclinician‐based

19

depressionthannon‐injuredathletesoneweekpost‐injury,andtheselevels

remainedsignificantlyhigheronemonthlater.Thesefindingssuggestthatinjury

canresultinseverelevelsofmooddisturbanceanddepressioninathletes.In

recentliterature,researchershavesoughttoinvestigatetheunderlying

mechanismsoftheseeffectsinanattempttoexplainathletes’psychological

responsestoinjury.

2.0.10 Stage Models, Cognitive Appraisal Models, and the Risks Model

Earlytheoreticalframeworkswereproposedtoexplainthepathwayof

psychologicalresponsetoinjury,includingstagemodels(Gordon,Milios,&Grove,

1991;Lynch,1988;Nideffer,1989),cognitiveappraisalmodels(Weiss&Troxel,

1986),andthe“risksmodel”(Rose&Jevne,1993).Themostcommonstagemodel

referredtointheathleticinjuryresponseliteratureispossiblyKubler‐Ross’s

(1969)griefresponse.Whilethisframeworkwasoriginallydevelopedwith

terminallyillcancerpatients,itdescribesthestagesofemotionalreactionsin

responsetothelossofsomethingdesiredorhighlyvalued(Wehlage,1980).Given

thescopeofnegativeemotionalresponsestoinjuryoutlinedearlier,itseemsthat

anathlete’sabilitytotrainandcompeteisahighlyvaluedelementoftheirlives.

Themodelproposedacycleof5stagesofgriefstartingfromdisbelief,denial,and

isolationandprogressingtoanger,bargaining,depression,andfinallyacceptance

(Kubler‐Ross,1969).Inastudyinvolvingsportphysiotherapists,Gordon,Milios,

andGrove(1991),thephysiotherapistsreportedthatinjuredathletesexperienced

symptomssuggestingdenial,anger,bargaining,anddepressionthroughoutthe

courseoftheirrehabilitation.Whilethereisevidencethatinjuredathletesdo

experiencethesetypesofemotions,stagemodelshavebeencriticizedasbeingtoo

simplistic(Evans&Hardy,1995).Furthermore,ithasbeensuggestedthatnotall

athletesexperienceallthestages,andtheydonotnecessarilygothroughthe

stagessequentially(Grove&Gordon,1995).Consequently,stagemodelscannot

reliablybeusedtopredictbehaviour,sotheyarenotsufficientasanoverarching

theoreticalframeworkforresponsetoathleticinjury.

Giventheselimitations,cognitiveappraisalmodelsevolvedoutoftheliteratureon

stressandcoping.WeissandTroxel(1986)explainedathleteresponsetoinjury

throughamodeladaptedfromPasser’s(1982)modelofthestressprocess.Intheir

20

proposedmodel,theyoutlinedfourcomponents:thesituation,cognitiveappraisal

ofthesituation,emotionalresponse,andconsequencesofthisresponse.Weissand

Troxel(1986)proposedthatthestressfulnatureofinjurywouldputsignificant

physicalandpsychologicaldemandsontheathlete.Asaresultofthesestressors,

theathletewouldmakeacognitiveappraisaloftheirabilitytocopewiththe

situation.Dependingontheathlete’savailableresources,theymayexhibita

negativestressresponsethatwouldsubsequentlyresultinnegativeemotions,

includinganxiety,anger,anddepression.Followingtheiremotionalresponse,the

consequencescouldincludebehavioural,psychological,andphysicaloutcomes.

Anumberstudieshaveexploredavarietyofvariablesrelatingtoanathlete’s

psychosocialandphysicalenvironment,includingcurrentinjurystatus,social

support,lifestress,severityofinjury(Breweretal.,1995;Brewer,1993;D.

Pargman&Lunt,1989).Theresultsfromthesestudiesseemconsistentwiththe

cognitiveappraisalframeworkofpsychologicalresponsetoathleticinjurythat

numerousenvironmentalandindividualfactorswouldaffectanathlete’s

evaluationoftheirinjury.

Nearthesametimeastheemergenceofstagemodelsandcognitiveappraisal

models,RoseandJevne(1993)developedthefour‐phasecyclical“risksmodel”

basedonqualitativedata,whichemergedfrominterviewsofsevenathletesand

theirexperienceswithmoderateormajorinjury.Afterthefirstphaseofgetting

injured,theathletethencyclesthroughacknowledgingtheinjury,dealingwiththe

impactoftheinjury,andachievingaphysicalorpsychosocialoutcome.Inaddition

tothefourphases,RoseandJevneincludedtwoothercategoriesintheirmodel

thatcharacterizedtheinjuryprocess:“ignoringthelessons”(relapsing)and

“actingonthelessons”(attemptingtopreventinjuriesinthefuture).Theirmodel

exhibitedaspectsofboththestagemodelsandthecognitiveappraisalmodels.The

cyclicalmovementissuggestiveofthestagemodelwherethereisnosetperiodof

timethatanathletewouldstayinaparticularstage,andtheymayalsosufferfrom

relapsesandrevertbacktootherstages.Theirmodelalsoaddressesthecognitive

appraisalthatoccursintheinjuryrecoveryprocess,particularlywheretheathlete

willacknowledgetheirinjury(ornot),andtheirsubsequentactionstodealwith

theirinjurywillbeaffectedbytheirappraisal.

21

Whilethesemodelsalladdressthewayinwhichanathleterespondstotheir

injuryinaprocessfrominjurytorehabilitation,theyallpresentedalimitedscope

oftheinjuryprocess.Followingtheseinitialattemptsatatheoreticalframework

forathleticresponsetoinjury,Wiese‐Bjornstal,Smith,Shaffer,andMorrey(1998)

createdamorecomprehensivemodelbasedonpreviousresearchandliterature

whichincorporatedaspectsofpreviousmodels.

2.0.11 An Integrated Model of Psychological Response to the Sport Injury and

Rehabilitation Process

Themostsupportedmodelofathleteresponsetoinjuryistheintegrated

frameworkputforwardbyWiese‐Bjornstaletal.(1998),whichwasextendedfrom

AndersenandWilliams’(1988)existingmodelofstressandathleticinjury.As

discussedearlier,thestressresponseleadstoinjuryandisaffectedbyfactorssuch

ascopingskills,personality,andhistoryofstressors.Followinginjury,Wiese‐

Bjornstaletal.’s(1998)modelproposedthatanathletemakesacognitive

appraisalofthesituationthatisinfluencedbypersonalandsituationalfactors.

Personalfactorsincludeinjurycharacteristics(e.g.,history,severity),individual

differences(e.g.,paintolerance,self‐esteem,athleticidentity),demographicfactors

(e.g.,gender,age,ethnicity),andphysicalvariables(e.g.,healthstatus,disordered

eating,useofergogenicaids).Situationalfactorsincludesportcharacteristics(e.g.,

type,playingstatus,levelofcompetition),socialvariables(e.g.,teammate

influences,coachinfluences,socialsupportprovision),andenvironmental

variables(e.g.,accesstorehabilitation,rehabilitationenvironment).Asindicated

bythedirectionalarrowsintheirmodel,cognitiveappraisalsleadtoemotional

responses(e.g.fear,anxiety,positiveoutlook/attitude)andsubsequent

behaviouralresponses(e.g.adherencetorehabilitation,use/disuseofsocial

support,effort).Thesethreefactorscyclingthrougheachotherarelinkedto

eventualphysicalandpsychosocialrecoveryoutcomes.

Giventhecyclicalnatureofinjuryresponseandrehabilitation,ithasbeen

suggestedthatifathletesapproachtheirrehabilitationwithpositiveappraisals,

makeuseofavailablecopingresources,andadheretotheirrehabilitation,theyare

likelytohavemorepositiverecoveryoutcomesandhealmorequickly(Petrie&

Hamson‐Utley,2011).Conversely,iftheyapproachtheirrehabilitationwith

22

extremelynegativeappraisals,ortheydonotadheretorehabilitationoruse

maladaptivecopingstrategies,theyarelikelytoprolongtheirrecovery.Atany

pointintheinjuryprocess,copingbehavioursandsocialsupportcanactasbuffers

againstnegativeemotionsandbehaviours,andathletescanthenreactmore

positivelyfortheirrecovery.

2.0.12 Biopsychosocial Model of Response to Injury

WhileWiese‐Bjornstaletal.’s(1998)modeloutlinesaframeworkforthe

psychosocialresponsetoinjury,ithasbeennotedinrecentliteraturethat

physiologicalfactorsalsoaffecttheinjuryresponseandrehabilitationprocess.

Brewer,Andersen,andVanRaalte(2002),addressedthislimitationwiththe

proposalofabiopsychosocialmodelofinjuryresponse.Thepremiseofa

biopsychosocialmodelpositsthatphysiologicaldemandsinteractwith

psychologicalstresstoaffectdisruptionsinattention,affect,behaviour,and

recovery.Ithasbeenshownthatathleteswithhighnegativelifeeventstress

exhibitextendedperiodsofelevatedcortisolincomparisontoathleteswithlow

levelsoflifeeventstress,andelevatedcortisolmayhinderrecoverybyslowing

downthehealingprocessorcausingsecondaryillnesses(Perna&McDowell,

1995).Ithasbeensuggestedthatnegativepost‐injuryresponses(e.g.,anger,

depression)couldactivatethecortisolstressresponse,andtherebyhinderingtheir

abilitytorecoverquickly(Petrie&Hamson‐Utley,2011).Assuch,Breweretal.

(2002)suggestedthatsuccessfulrehabilitationwouldmakethemostof

psychosocialelementsandencourageinjuredathletestophysicallytakecareof

themselvesthroughpropersleepandnutrition,aswellasensurethatthey

maintainthehealthoftheirimmunesystem.

BothWiese‐Bjornstaletal.’s(1998)integratedmodelandBreweretal.’s(2002)

biopsychosocialmodelcenteronthecognitiveappraisalprocess.However,the

biopsychosocialmodelrecognizestheimportanceofunderstandingtheeffectof

physiologicalfactorsonaninjuredathlete’scognitive,emotional,andbehavioural

responsestoinjuryandrehabilitation.

23

2.0.13 Rehabilitation

Asmentionedearlier,negativeemotionalreactionstoinjurycancontinuelong

aftertheinitialinjury,andsometimesuptoonetotwomonthslater(Appanealet

al.,2009;Leddyetal.,1994).Notonlydoinjuredathletesexperiencenegative

emotions,buttheirmoodscanfluctuatedramaticallythroughthecourseoftheir

rehabilitation.Morrey,Stewart,Smith,andWiese‐Bjornstal(1999),foundathletes’

moodscanbequitenegativeintheinitialphaseofinjury,butastheirrehabilitation

progresses,theirmoodstatebecomesmorepositive.Astheathletebeginstheir

transitionbacktosport,theymayagainexperienceaspikeinnegativereactionsin

relationtotheanxietyandfearofpotentialre‐injuryassociatedwiththeirreturn.

Sportsmedicinephysiciansreportcommonlydiscussingpsychologicalissueswith

theirathletesrelatingtofearaboutsurgery,impatiencewiththespeedofrecovery,

andfearofre‐injury(Mann,Grana,Indelicato,O’Neill,&George,2007).

Sportsphysiotherapistsandathletictrainershavealsorecognizedtheseresponses

intheirathletes,andtheyhaveidentifiedavarietyofimportantpsychological

skillsthatwouldfacilitaterehabilitation,includinggoalsettingandmotivation

techniques,arousalcontrol,anxietymanagement,communicationandcounselling

skills,painmanagement,relaxation,andprovidingsocialsupport(Ford&Gordon,

1998;Hamson‐Utley,Martin,&Walters,2008;Larson,Starkey,&Zaichowsky,

1996;Wiese,Weiss,&Yukelson,1991).Theseskillscanallbeusedtohelp

decreasethenegativeemotionsthatcangoalongwithinjury,andthatcan

decreaseanathlete’sadherencetothenecessaryrehabilitationfortheirinjury.

Certainly,coachesstandinauniquepositiontoprovidesomeofthismuchneeded

socialsupportforinjuredathletes.Studieshavefoundthatathletesvaluethesocial

supporttheyreceivefromtheircoachesnotonlypriortoinjury,butalsoduring

theirrehabilitation(Bianco,2007;Malinauskas,2008;Podlog&Dionigi,2010;

Robbins&Rosenfeld,2001).Inastudyofhighperformancecoaches,Podlogand

Dionigi(Podlog&Dionigi,2010)foundthatcoachesreportedusingseveral

strategiestohelptheirathletesmanagethepsychosocialissuestheyfacedin

rehabilitatingfromtheirinjuries.Specifically,theylistedprovidingsocialsupport,

fosteringopencommunicationandteamworkamongtherehabilitationteam

(coach,athlete,sportsmedicineprovider),andworkingongoalsettingand

24

positivethinkingascorestrategies.Workingasateamunit,thecoach,athlete,and

sportsmedicineprovidercouldworktogethertobringaboutasuccessful

rehabilitationandreturntosport.

Rehabilitationadherencehasbeenidentifiedasanecessaryfactorforpositive

recoveryoutcomes,anditcanbeaffectedbypersonalfactorssuchasemotions

(Fields,Murphey,Horodyski,&Stopka,1995;Niven,2007).Accordingtothe

integratedmodelofinjuryresponse,negativeemotionalresponsescanresultin

negativerehabilitationbehavioursandmaypredictreducedrecoveryoutcomes

andfurthernegativecognitiveappraisalsinadownwardcycle(Wiese‐Bjornstalet

al.,1998).Certainly,researchindicatesthatifanathletehassnegativereactionto

theirinjuryandrehabilitation,theyaremorelikelytoexhibitpooradherenceto

rehabilitationprotocols(Niven,2007).Ithasalsobeensuggestedthataperception

ofslowrecoverymaycauseanincreaseinnegativeaffect,non‐adherenceto

rehabilitationexercises,andlackofuseofcopingresources(A.M.Smith,1996).

Alternatively,anathletewithapositiveattitudeandoutlooktotheirrehabilitation

willbemorelikelytoadheretotheirrecoveryplanandachieverehabilitation

goals,thusspeedinguptherecoveryprocess(Scherzeretal.,2001).

2.0.14 Psychological Interventions in Rehabilitation

Giventhatapositiverehabilitationprocesscanspeeduprecovery,factorsthat

facilitateadherenceshouldbemaximisedtocreateamorepositiverehabilitation

experience.TaylorandTaylor(1997)suggestthatadequatesocialsupportaswell

asuseofpsychologicalskillscanhelptoensurethattherehabilitationprocessruns

smoothlyforamoretimelyrecovery.Indeed,Udry(1997)foundthatsocial

supporthelpedtoincreaseadherencetorehabilitationwhenitwaspairedwith

positivecognitivecoping.Goalsettinginterventionshavealsobeenshowntohave

apositiveeffectonrehabilitationoutcomes(Evans&Hardy,2002).Brewer,Jeffers,

Petitpas,andVanRaalte(1994)conductedastudywith20injuredathletes

undergoingphysicaltherapy.Theseathletesweregivenintroductorysessionson

goalsetting,imagery,andcounselling.Immediatelyfollowingeachintervention,

theathleteswereaskedtoratetheirperceptions,andtheyindicatedapreference

forgoalsetting.Whilegoalsettingwasthemostpreferred,allthreeinterventions

wereperceivedpositivelyforsportrehabilitation.

25

Inadditiontopositiveperceptions,ithasbeensuggestedthatpsychological

interventionsforusewithinjuryrehabilitationbetailoredtotheparticularphase

ofrehabilitationandinjuredathletemaybegoingthrough(Petrie&Hamson‐Utley,

2011).PetrieandHamson‐Utleysuggestthatinterventionshelpingathletesrelax,

focusonhealing,andmanagingdistressmaybethemostbeneficialinthefirstfew

weeksofrehabilitationwhenpainlevelsarethehighest.Attheotherendofthe

rehabilitationspectrum,athletesmayneedmoreskillstoincreaseconfidence,cope

withfearofre‐injury,andreduceanxietyintheirprocesstoreturntosport.Hare

andEvans(Hare&Evans,2008)foundevidencesupportingthevariedusageof

imageryatdifferenttimephasesofrehabilitationintheircasestudyofaninjured

Olympicathlete.Intheearlyphaseofrehabilitation,theathleteusedimagery

contenttoincreasemotivation,relaxation,andself‐confidence.Duringthemid‐

phaseofrehabilitation,theathletereportedusingimagerytorehearseandpractice

specificrehabilitationskillsaswellasperformanceskills.Contentimagerywas

alsousedatthispointtomaintainself‐confidence,motivation,andpositive

attitude.Astheathletebegantransitioningbackintofulltraining,hisimagerywas

exclusivelyusedforperformance.Herehearsedperformanceskillsandworkedto

maintainapositiveattitude,controlanxiety,andreducefrustrationwithhislevel

ofperformance.Healsousedimagerytoincreasehisconfidencelevelsashe

returnedbacktocompetition.

Researchhasalsorevealedthepositiveeffectsofpairingimageryusagewith

relaxationskillsforrehabilitationandrecovery.Duetothenatureofinjury,painis

inevitableintherehabilitation,andrelaxationskillsandimagerycanbeusedto

copewithpainduringtherecoveryprocess(Law,Driediger,Hall,&Forwell,2006).

Inastudyinvestigatingtheeffectsofrelaxationandguidedimagery,Cupaland

Brewer(2001)foundthatathleteswhoreceivedtheinterventionexperiencedless

pain,lessanxiety,andgreaterstrengthgainsthanacontrolgroupat24weeks.

Rehabilitationpresentsanumberofchallenges,butresearchfindingssupportthe

useofpsychologicalskillstoimprovethelikelihoodofpositiverehabilitation

outcomeswithinjuredathletes.

26

2.0.15 Summary

Inadditiontopsychosocialantecedentsofinjury,researchershavealso

demonstratedthatathletescanexperiencenegativeemotionalreactionsin

responsetotheirinjuries,includinganxiety,depression,andanger(Goldsmith,

2007;Leddyetal.,1994;Thelwelletal.,2008).Similartoinjuryprevention

studies,researchershaveendeavouredtofacilitateinjuryrecoverythrough

psychosocialinterventionsaimedatreducingstress,increasingconfidence,and

increasingmotivationandrehabilitationadherence,andthisresearchhasshown

positiveresults(Cupal&Brewer,2001;Driedigeretal.,2006;Evans&Hardy,

2002).

General Summary and Statement of the Problem

Thischapteraddressedinjuryriskandoccurrenceincompetitiveswimming,

psychosocialantecedentstosportsinjury,andpsychologicalresponsestosports

injury.Eventhoughswimmingisanon‐contactsport,thereisstillaninherentrisk

ofinjury,particularlyforlong‐termoveruseinjuries.Indiscussingpsychosocial

antecedentstoinjury,AndersenandWilliams’(Andersen&Williams,1988)model

ofthestress‐injuryresponsewaspresentedasaframeworkforinjury

susceptibility.Inthecontextofthisframework,interventionstopreventinjuryor

reduceanathlete’sinjuryriskwerealsodiscussed.Inthediscussionofpost‐injury

response,WieseBjornstaletal.’s(1998)integratedmodelofinjuryresponsewas

usedtoexplainhowpsychosocialfactorsaffectanathlete’scognitiveappraisalsof

theirinjury,andhowthoseappraisalsaffectemotionalresponsesandsubsequent

behaviouralresponses.Appraisals,emotions,andbehaviourscyclethroughone

anothertoaffectrecoveryoutcomes,suchasadherencetorehabilitationprotocols.

Psychosocialinterventionsforthiscyclewerediscussedtoincreasepositive

rehabilitationoutcomes.

Whileresearchhasdevelopedabaseofknowledgeconcerningpsychosocial

antecedentsandpost‐injuryresponsesandtheireffectontheinjuryprevention

andmanagementprocess,additionalresearchisneededtodetermineprotocolsfor

managingthesefactors.Preliminarystudieshavebeendonetoimplement

interventionstoreduceinjuryriskandmanagepost‐injuryresponses,butthe

27

specificmechanismsoftheseinterventionsandthemostefficaciouswayto

implementtheseinterventionsneedtobefurtherexplored.Specifically,littleis

knownabouttherolethecoachplaysintheinjurypreventionandmanagement

process.

Thisresearchprogramaimstoaddresssomeofthesefactorsintherealmof

competitiveswimming.Whilemostresearchhasfocussedoninjurybylookingat

eitherpre‐injuryprotocolsorpost‐injuryprotocols,thecurrentprogramwill

combinethesetwofacetsintoaholisticinjurymanagementapproach.

Furthermore,manystudieshaveresearchedinjurymanagementfromthe

perspectiveofathletesorsportsmedicineprofessionals,thecurrentresearchwill

alsofocusontheroleofcoachesintheinjurymanagementprocess.StudyOnewill

investigatetheparticularbehaviourselitecoachesareimplementingtoprevent

andmanageinjuryinswimming.Equippedwiththisknowledgeaswellas

theoreticalframeworksforantecedentstoinjuryandinjuryresponse,StudyTwo

aimstodevelopaninjurypreventionandmanagementprofilingtoolforusewith

competitiveswimmingprograms.Finally,StudyThreeaimstodesign,implement,

andevaluateacoach‐implementedinjurypreventionandmanagementprogram

withacompetitiveswimclub.

28

Chapter 3

3 Study One – Injury Prevention and Management in

Competitive Swimming: Discovery of Current Practices

Introduction

“Ihaven’tmetaneliteathletewhohasn’thadaninjuryatsomepointyet.”

–UnitedStatesCollegiateSwimCoach

Whileswimmingisanon‐contactsport,athleteswhospendmanyhourstraining

andcompetingarestillsusceptibletoinjury.Eliteswimmerstrainanaverageof20

hoursperweek,loggingin50kilometresormoreinthatperiodoftime,anditis

estimatedthatswimmerscompletemorethanonemillionstrokecyclesayear

(McMaster,1999).Giventhehighlyrepetitivenatureofthesport,thereisaclear

riskofoveruseinjury.Shoulderoveruseinjuriesarereportedlythemostcommon

causeoflosttrainingtimeacrossallagesandabilitiesofswimmer(Johnson,

Gauvin,&Fredericson,2003)andespeciallyforeliteswimmers(Blanch,2004).It

hasbeenreportedthatupto35%ofseniorlevel,eliteswimmersexperience

significantshoulderpaintoadegreethatinterfereswiththeirabilitytotrainand

competeeffectively(McMaster&Troup,1993).Othercommoninjuriesin

swimmingoccurtotheknees,lowerback,andhips(Groteetal.,2004;Kaneokaet

al.,2007;O’Donnelletal.,2005).Withthehighvolumeoftraininginherentinthe

sportofswimming,anyinjurywouldseverelylimitaninjuredswimmer’sabilityto

trainandcompete.

Inadditiontothephysicallimitationsthatinjuryincurs,injuryalsoresultsin

significantpsychologicalreactions.Whilebeinginjured,itisnotuncommonforan

athletetoexhibitemotionssuchasanxiety,depression,anger,andloweredself‐

esteem(Gordonetal.,1991;Leddyetal.,1994;Maniaretal.,2001).Previous

studieshavesoughttoidentifythebestwaytodealwiththepsychologicaleffects

ofathleticinjury,andcommonfindingshaveshownthatcopingskillssuchas

imageryandgoalsetting(Driedigeretal.,2006;Evansetal.,2000;R.E.Smithetal.,

29

1990)aswellasincreasedsocialsupport(Manueletal.,2002;Podlog&Eklund,

2006;Udry,Gould,Bridges,&Tuffey,1997)areeffectivemeasuresfordealingwith

injury.Intimesofhardshipsuchasinjury,athletescommonlyturntotheircoach

asasourceofemotionalsupport(Thelwelletal.,2008).

Consideringthepotentialforinjuryincompetitiveswimming,aswellasits

physicalandpsychologicalramifications,coachesshouldbepreparedtousetheir

uniquepositionofleadershipandsocialsupporttoeffectivelymanageinjury

amongswimmersintheirsquads.Currently,however,notmuchisknownabout

theinjurypreventionandmanagementstrategiescoachesactuallyemployin

competitiveswimming.Therefore,thisstudysoughttoinvestigatetheexistence

anduseofinjurypreventionandmanagementprogramsincompetitiveswimming

throughinterviewswithcoaches,swimmers,andsportsmedicineprofessionals.

Method

3.0.1 Participants

Participantsincludedatotalof12elite‐levelswimcoaches,5swimmers,and6

sportsmedicineprofessionals.Overthecourseof6months,apurposefulsampleof

swimcoacheswerecontactedviatelephoneoremailfromtheUnitedStates(N=8,

USC01‐USC08)andAustralia(N=4,AUC09‐AUC12)andrepresentingeither

university(7)orclub(5)teams.Thesecoacheswerechosenbasedontheir

experiencecoachinghighperformanceswimmerstotheNationalChampionships

intheirrespectivecountry.Becauseoftheiraffiliationswithuniversitysports

departmentsincludingsportsphysiotherapists,universitycoacheswereincluded

inadditiontoclubcoachesbecausetheiraccesstoresourcesforinjury

managementcouldaffecttheirinjurymanagementprotocols.Allbuttwoofthe

coachesweremale,andtheyhadanaverageof22yearsexperience(range10‐31).

Fivelong‐terminjured(i.e.atleast3monthsrehabilitation)orpreviouslyinjured

swimmerswereidentifiedbyparticipatingcoachesandweresubsequently

recruitedforthestudy.Giventheirlong‐termrehabilitationforinjury,these

swimmerswererecruitedfortheirfirst‐handknowledgeofprotocolsthathelped

themmanagetheirinjuries.Notwoswimmerswererecruitedfromthesameteam.

Swimmersincludedbothmales(2)andfemales(3)ranginginagefrom15‐20who

hadachievedaminimumqualificationattheUnitedStatesJuniorNationalslevel

30

(N=3,USS01‐USS03)orAustralianNationalAgelevel(N=2,AUS04‐AUS05).These

swimmerswereadvisedthattheywerenotobligatedtoparticipateinthestudy

andthatparticipationornon‐participationwouldnotaffecttheirtreatmenton

theirteaminanyway.Asafinaltriangulatingdatasource,6sportsmedicine

professionals(foursportsphysiotherapists/athletictrainers,asportpsychologist,

andasportsphysician)wereinterviewed.Aswiththecoachesandswimmers,the

sportsmedicineprofessionalswererecruitedfromtheUnitedStates(N=2,USM01‐

USM02)andAustralia(N=4,AUM03‐AUM06),andtheywereallchosenfortheir

experiencewithtreatinginjuredswimmers.Giventheirexpertknowledgeininjury

managementpairedwiththeirexperiencedealingwithswimmers,thesesports

medicineprofessionalswerethoughttohaveauniqueperspectiveoninjury

preventionandmanagementprotocolsthatcouldbeimplementedwithswimming

squads.

FollowingHumanEthicsapproval,allparticipantsweregiveninformation

regardingthetestingprotocolaswellasanyrisksorbenefitsofthestudy.Signed

consentwasobtainedpriortocommencementoftheinterview.Intheeventthat

theparticipantwasyoungerthan18yearsold,parentalconsentwasalsoobtained.

3.0.2 Interview Guide and Procedures

Asemi‐structuredinterviewformatwasimplementedtodeterminethenatureof

coach‐implementedinjurymanagementpracticesincompetitiveswimming.Once

theinterviewguidewaswritten,theprimaryresearcherconductedtwopilot

interviewswithamastersswimcoachandawaterpolocoach.Followingfeedback

oninterviewtechniqueandinterviewcontent,revisionsweremadetothe

interviewguide.

Allinterviewswereconductedone‐on‐oneinaquietlocationcomfortableforthe

participant.Inadditiontotimetakentogatherdemographicinformationand

establisharapportwiththeparticipant,theinterviewsrangedinlengthfrom18‐

45minutes.Theinterviewformat,illustratedinTable1,wasmodelledafterHolt

andDunn(2004)andincludedoneclosedquestionandanumberofopen‐ended

questions.Follow‐upprobeswereusedtoallowtheparticipantstoclarifytheir

responsesandtoensurethateachtopicwasadequatelycovered.Theoneclosed

questionwasdeemednecessaryinordertoclearlyassesstheparticipants’

31

awarenessorimplementationofaninjurymanagementprogram(seeTable3‐1).

Questionswereslightlymodifiedforswimmersandsportsmedicineprofessionals

toreflectimpressionsofwhattheircoaches(orcoachestheyworkedwith)

implemented.

Table3‐1:CoachInterviewGuide

CoachQuestions

1. Doyouknowofany injurymanagementprograms in swimming,ordoyouactivelyuseaninjurymanagementprogram?

2. Whatspecificallydoyoudoorthinkshouldbedonetopreventinjuriesinswimming?3. Whatspecificallydoyoudoorthinkshouldbedonewhenaswimmergetsinjured?4. What specifically do you do or think should be done during an injured swimmer’s

rehabilitation?5. How specifically do you determine or how should you determinewhen an injured

swimmerisreadytoreturntofulltrainingandcompetition?6. Whattypesofissuessurfacewhenmanaginginjuredswimmers,andhowdoyoudeal

withtheseissues?

3.0.3 Data collection and analysis

Agroundedtheoryapproachwasusedtopursuethetopicofinjurymanagementin

swimming.Thisprocessinvolvedgatheringandanalyzingdataandcomingupwith

atheorybasedontheresults.Itwasaninductiveprocessinwhichthetheorywas

discoveredandallowedtoformthroughempiricalobservationsandparticipant

experiencesasopposedtotestingahypothesis.

Withthepermissionoftheparticipant,allinterviewsweredigitallyvoicerecorded

andtranscribedverbatim.Theauthorconductedallinterviewsduetoherabilityto

establisharapportwiththeparticipantsgivenher20yearscombinedexperience

asaswimmerandswimcoach.Interviewswerethencodedandanalyzed

inductivelyusingopen,axial,andselectivecodingproceduresputforwardby

StraussandCorbin(1998)andaidedusingNVIVOqualitativeanalysissoftware.

Keyquoteswereisolatedandthengroupedintoahierarchyofcategories.Usinga

constantcomparativeapproach,codedcategorieswerecomparedtopreviously

definedcategories,whichallowedfortheconfirmationandrefinementof

hierarchies.Astheanalysisprogressed,relationshipsweredeterminedbetween

thecategoriesandsubcategoriestoformahierarchyofinjurymanagement

32

behaviours.Followingthisprocedureofcoding,twoseparateresearchers(one

whowasnotinvolvedinthestudy)wererecruitedtoensuretheefficacyofthe

codingandplacementofkeyquotesintocategories,andtheyeachwere

responsibleforhalfthedata.Datawasrevieweduntiltherewasagreement

betweentheresearchers.Furthermore,interviewtranscriptsweresenttothe

participantstovalidatetheiraccuracyandrepresentativeness.

Results and Discussion

Thedatathatemergedfromtheinterviewssupportedafour‐phasecycleofinjury

preventionandmanagement(seeFigure3‐1).InjuryPreventionwasthefirst

phase,whichreflectedactionsandbehavioursenactedinordertopreventan

injuryfromoccurringinswimming.Thethreesubsequentphasesregardactions

enactedafteraninjurytakesplace.Short‐termInjuryManagementreferstothe

periodoftimeinthefirstcoupleofdaysfollowinginjuryoccurrence.These

behavioursweredistinctfromthebehavioursregardingrehabilitationand

managementoverthecourseofaninjury.Theyreflectedtheneedtoidentifythe

injuryanditscauseaswellasimmediatelymodifytheactivitylevelofthe

swimmeruntilmoreinformationabouttheinjurycouldbecomeknown.Thethird

phaseofthecycleisLong‐termInjuryManagement,whichbeginsaftertheinjury

hasbeendiagnosedandarehabilitationplanhasbeenenactedandculminates

whentheswimmerbeginstheirtransitionbackintofullparticipationinswimming

activities.Thefinalphaseoftheinjurypreventionandmanagementcycleisthe

ReturntoFullTraining.Thisphasereflectsthosebehavioursspecificallyenactedin

thegoaloftransitioninganathletefrominjuredtohealthy,wheretheyare

participatingfullyintrainingandcompetition.

33

Figure3‐1:Injurypreventionandmanagementcycleandcoach‐implementedinjurymanagementbehaviours

Tofulfilthepurposeofreportingontheinjurymanagementpracticesofcoachesin

competitiveswimming,theresultsanddiscussionsectionhasbeendividedinto5

sections:Coach‐implementedInjuryManagementPlans,InjuryPrevention,Short‐

termInjuryManagement,Long‐termInjuryManagement,andReturntoFull

Training.

3.0.4 Coach‐implemented Injury Management Plans

Whileinjurymanagementhasbeenresearchedextensivelyoverthepast25years,

littleinformationexistsaboutwhetherproposedprogramsareactuallybeing

adoptedbycoacheswiththeirathletes.Onlyinrecentliteraturehavetherebeen

attemptsatdeterminingtheeffectofcoachesimplementinginjurymanagement

programs,andtheyhavefocusedoninjurypreventiontechniquesonly(seeCaine,

Maffulli,&Caine,2008;Gianotti,Hume,&Tunstall,2010).Furthermore,noneof

thesestudiesinvestigatedinjurypreventionormanagementprotocolusagesthat

includedpsychosocialelements,andnoneinvestigatedswimming.

•Socialsupport(training,socialintegration,esteem,emotional,educational,network)•Communication•Mentalskillstraining

•Trainingconsiderations•Swimmerfeedback•Medicalfeedback•Confidenceconsiderations

• Immediateactions•Firstaid•Communication

•Trainingconsiderations•Healthconsiderations•Preventioneducation•Communication•Mentalskillstraining

InjuryPrevention

Short‐TermManagement

Long‐TermManagement

ReturntoFullTraining

34

Oneoftheprimarypurposesofthisresearchwastogetapictureofwhatelite

coachesarecurrentlydoingincompetitiveswimmingtopreventandmanage

injuriesintheirsquads.Therefore,oneofthemainquestionswaswhethercoaches

wereawareofanyinjurymanagementprogramsincompetitiveswimming,and

whethertheypersonallyimplementedinjurymanagementplanswiththeirsquads.

Despitedecadesofexperiencecoachingswimming,thecoachesinthecurrent

studyrevealedvagueplanstomanageinjuries.Outofthe12coaches,5responded

withplansforinjurypreventionintheirsquad,2citedonlyhavingplansforafter

aninjuryhappened,and4coacheshadnoplanforinjurymanagement(1coach

mentionedawarenessofinjurymanagementinformationdisseminatedbytheir

nationalswimminggoverningbody).

Onepointthatwasevidentfromthecoaches’responseswasthelackofawareness

ofinjurymanagementplansdrivenbyresearchintothisarea.Onecoach,whohad

beencoachingfor28years,revealedhewasunawareofanyspecificprogramsfor

injurymanagement,butinstead,hehadworkedoutwhatwassuccessfulforhis

ownathletesthroughyearsofpersonalexperience.Whenaskedabouthis

awarenessandimplementationofaninjurymanagementprogram,hestated,“I’ve

neverreadone.I’vegotmyown,throughtrialanderror,Ihavemyownprogram”

(USC05).

Whilehe’slearnedforhimselftechniquesthatwork,othercoacheswithless

experiencemaybelackingknowledgeanddirectionasitappliestoinjury

management.Thisfeelingwasreflectedinthecommentsofonecoachwhohas

beencoachingfor10years:

Imean,IsupposeIgottoflybythewire,youknow.Ireallydon’tknowif

thereisanyrealprotocolsthere,orkindofanyschemesthatareavailable

thatyoucansayalrightwell,thisisAtoZorwhateverintheprocess.Are

there?–AUC12

Evenatthehighestlevel,somecoacheshaveabsolutelynoplanforinjuries.

ConsiderthesentimentsofthisOlympiccoachwhohasbeencoachingfor30years:

35

Theonlymanagementthatwehavehereisthat,wehavebasicallyit’s

almostlikeanon‐managementthinguntilsomethinghappens.–USC01

It’sonethingforcoachestofeeltheydon’thaveaplan,butattheendoftheday,

theinjuredswimmerandtheirwell‐beingshouldbeanimportantconsideration.In

atimewhentheymayfeelcutofffromtheirsocialnetworkandlostastohow

thingsaregoingtoprogress,injurymanagementplansmayreducetheanxietyof

injury.Thisviewisreflectedinthethoughtsofthisinjuredswimmer:

Iwishmycoachwouldhaveimplementedsomethingorhadsomethingin

place,orifsomebodydoesgetinjured,thenthisiswhatwe’regonnado,and

thisistheprotocolwe’regonnafollow.Whereasitwasjustgoanddo

whateveryouwanttodo,andthatwasn’tverysupportive.–USS02

3.0.5 Injury Prevention

Whilesomecoachesdidnotciteinjurypreventionaspartofaninjurymanagement

plan,itbecameclearinthesubsequentinterviewquestionsthattheydidinfact

employinjurypreventiontactics.Table3‐2summarizestheresultsofthequestion:

Whatspecificallydoyoudoorthinkshouldbedonetopreventinjury?Outofthe

22interviews,39rawdatathemesemergedconcerninginjuryprevention

behaviours.Theserawdatathemeswerethenfurthercombinedtoform18sub‐

dimensionsand5generaldimensions.

36

Table3‐2:InjuryPreventionTactics

1stOrder 2ndOrder RawDataTheme

TrainingConsiderations

Trainingintensity

MonitoringintensityIncorporatingrecoveryMonitoringvolumeMonitoringload

Warmup/down WarmingupWarmingdown

EquipmentuseMonitoringequipmentuse(paddles,

etc.)

Stroketechnique IncorporatingskillsanddrillsMonitoringtechnique

Dry‐landactivities

CorestabilisationStrengthandconditioningDry‐landexercisesStretchingroutines

HealthConsiderations

Diet EatinghealthyHydration HydratingSleep Gettingenoughsleep

BodyawarenessListeningtotheirbodiesKnowingdifferencebetweeninjuryand

sorenessPre‐seasonclinicalassessment Pre‐seasonscreeningprocess

InjuryPreventionEducation

Parenteducation Educatingtheparents

Squadeducation

EducatingtheteamMakingteamawareofinjury

managementprocessInjurypreventionclinics

CoacheducationResearchingforpersonalknowledgeGettinginformationfromgoverning

body(e.g.USASwimming)

Communication

Swimmercommunication

EncouragingcommunicationBeingapproachableInteractingwithswimmersDevelopingcoachtoswimmer

relationships

StaffcommunicationCommunicatingwithstaffabout

protocolsDeveloprelationshipwithasports

medicineprofessionalforreferrals

Developingarelationshipwithasportsphysiotherapist

Mentalskills

Generalmentalskills ImplementingamentalskillsprogramGoalsetting Implementinggoalsetting

Stressmanagement TeachinghowtomanageanxietyTeachinghowtodealwithstress

3.0.5.1 Training Considerations

Giventhatinjuriesarephysicaloccurrences,itfollowsthatmanyofthe

participantscitedphysicaltrainingfactorswhendiscussinginjuryprevention

behaviours.Commonamongthesebehaviourswasattentiontotheduration,

intensity,andvolumeoftrainingthatswimmerstypicallycomplete.Participants

alsoreferredtotheimportanceofgeneralstrengthandstabilitythatdry‐land

37

activitiesprovide.Inaddressingtrainingasafactorininjuryoccurrence,Coach

USC02stated,“Well,it’snotsuddenlyincreasingyardage,asudden,arealbig

increaseintheworkloadthatthey’redoing.Trytograduallydothings.“A

swimmerraisedthesamesentiment.

“Ithinkthatcoachesgetsometimesveryambitiouswithwhattheywantto

do,andbecausetheyget,Imean,it’saverygoodthingthattheywantto

stretchthelimits,butthere’sapointwhereitbecomesmorehurtfultothe

athletethanitdoesbeingproductiveforthem.”–USS01

Thesecommentsarereflectedintheswimminginjuryliterature,whereithasbeen

foundthatlargetrainingvolumesaswellassuddenincreasesintrainingloadsputs

athletesatgreaterriskforinjury(McMaster,1999;Wolfetal.,2009).Inadditionto

theconsiderationstowardstrainingintensityinordertopreventinjury,

preventionthroughdry‐landactivitieswasalsoseenasessential.Ithasbeen

suggestedintheliteraturethatdry‐landactivitiessuchasweightliftingor

stretchingprogramscanlowerinjuryoccurrence(Ciullo,1986;Stavrianeas,2009).

Certainly,theparticipantsinthisstudywereoftheopinionthatdry‐landactivities

helpedtoreduceinjuryrisk,andtheywouldbeanimportantpartoftheirprogram.

“Ithinkthere’ssomeresponsibilityinthesensethatyouhavetomakesure

thatyouhavetheappropriatemechanismsinplacetohelpthemprevent

theinjuries,whetherit’sstrengthening,somekindofprogramlikethat.“–

USC08

Coaches,swimmers,andsportsmedicineprofessionalsseemedtoagreethat

trainingfactorswereamajorpartofinjuryprevention.

3.0.5.2 Health Considerations

Alongwithphysicalconsiderationswithinthetrainingenvironment,participants

madeconnectionsbetweenmonitoringpersonalhealthandinjuryprevention.This

processrangedfrommaintaininggeneralhealththroughproperdietandsleepto

gettingapre‐seasonscreeningofphysicalhealthtopickuponpotentialrisk

factors.

38

Accordingtothestress‐injurymodelputforthbyWilliamsandAndersen(1998),

anathlete’suseofcopingresourcescanaffecttheirvulnerabilitytoinjury.These

resourcesincludegeneralcopingbehaviourssuchasgoodsleepingpatternsand

nutritionalhabits.InWadey,Evans,Hanton,andNeil’s(2012)studyonhardiness

andthesportinjuryprocess,theysuggestedthatathleteshighinhardinesswere

morelikelytoemploypositivehealthpractices,andthiscouldlowertheirinjury

susceptibility.Thesentimentofgeneralhealthbeinglinkedtoinjurywasmirrored

inthethoughtsofsomeoftheparticipants.

“Weeventalkabout,bytheway,nutritionandhowthat’sakeycomponent

becausearecoveredathleteandanathletethatfeelsgoodisprobablygoing

tobelesssusceptibletoinjury.”–USC06

“Ifyourimmunesystemisshattered,yourunamuchhigherriskofbeing

sickorgettinginjuredeasierorstufflikethat.”–USS02

Giventhenatureoftheirprofessionandtheinjuriesthattheyseeonadailybasis,

thesportsmedicineprofessionalparticipantsfoundanobviouslinkbetweenpre‐

seasontestingandinjuryprevention.Thissportsphysiotherapist(AUM03)

reportedthatiswasimportantforallswimmers“tobescreenedbysomeone

beforetheygetintoatrainingprogramandidentify,forinstanceintheshoulder,

muscleimbalancesaroundthearea”.Pre‐seasonscreeningissuggestedforuse

withallsportssothatthoseathleteswhoareatahigherphysicalrisktoinjurycan

beidentifiedattheoutsetinanefforttopreventinjuries(Caineetal.,2008;

Courson,Navitskis,&Patel,2005;Hudson,2010;Parkkari,Kujala,&Kannus,

2001).Pre‐seasonpsychosocialscreeninghasalsobeensuggestedtoidentify

athletesatahigherriskforinjury(U.Johnsonetal.,2005;Steffenetal.,2009;

Wiese‐Bjornstal,2009).However,noneoftheparticipantsinthisstudyidentified

thisasapreventionstrategy.

3.0.5.3 Injury Prevention Education

Inadditiontotrainingandhealthconsiderationsforthepreventionofinjury,

participantscitededucationasanimportantfactorinpreventinginjury.Indeed,it

hasbeensuggestedthatcoachesfulfilanimportantrolewiththeirathletesby

communicatinginjurypreventioninformationandsettingattitudesforplayer

39

safety,suchasemphasizinglongterm‐healthovershort‐termsuccess(Gianotti,

Quarrie,&Hume,2009;Wiese‐Bjornstal,2002).Researchalsosuggeststhatinjury

preventionprogramsincludeeducationfortheathletes,suchasincreasinggeneral

injuryawarenessamongtheteam(Abernethy&Bleakley,2007;Cupal,1998).

Somecoachesinthisstudyfoundthisroletobecrucialforinjuryprevention,and

theyendeavouredtoholdperiodicalmeetingsdiscussinginjurypreventionand

managementstrategiessothattheirswimmerswouldbewellinformedaboutthe

process.

Oh,wegooverthatstuff.Youbetterbelievewedo.Infact,Iusuallytrytosit

themdownquarterly,andwehavelikeameeting.Andthat’soneofthe

meetingswegooverisinjuryprevention.–USC04

Similarly,participantscitedtheimportanceofkeepingtheparentsinformedabout

injurypreventionandmanagementprotocols.Particularlyforagegroup

swimmers,onecoach(AUC09)remarked“theideawasnotsomuchtoaim

[education]atthekidsbecauseit’ssohard,butit’stoaimitattheparentstobe

abletogetthroughtothechildthatyou’vegottodothis”.Parentscanofferan

extrasupportsystemforthecoach,andtheyarealsotheoneswhowillbein

chargeofmakingsuretheirchildseesasportsmedicineprofessionaliftheyget

injuredorcompletestheirrehabilitationexercises.

3.0.6 Communication

Forcoaches,educatingtheirswimmersisthefirststepinestablishinga

communicationavenueforinjurypreventionandmanagement.Mostparticipants

feltthatcommunicationwasthekeytoallaspectsoftheinjurymanagementcycle.

Atthefrontendofinjuryprevention,participantsfeltitwasimportantforthe

swimmerstocommunicatepaintotheircoachorsportsmedicineprofessionalso

thattheycouldtakethenecessarystepstopreventsmallpainsfrombecomingfull‐

blowninjuries.Richman,Hardy,Rosenfeld,andCallanan(1989)suggestedthatit

wasimportantforcoachestohaveanopendoorpolicyfortheirathletesinregards

toinjuryespeciallyconsideringsportingculturecommonlyreinforcestheattitude

of“toughingitout”andnottellingthecoachaboutpain.

40

Andthecoachbeingabletobetalkedtoaswell.…Quiteoften,theathlete

wantstotellthemsomethingbuttheyallworryaboutthecoachperception

thatthey’retryingtoslackoff.It’satoughrelationship.–AUM06

Firstofall,Ihavethepeoplewhoareinintensepain,andwillonlytellme

twoweekslater,aftertheirpainstarts.…Ifyou’dtoldmeaweekandahalf

earlier,wecouldhavefixedit,youknow.–USM01

Inadditiontothecoachandswimmercommunication,otherstaffcommunication

wasdeemedimportantforinjurypreventionaswell.Thisaspectwasseenas

particularlyimportantforuniversityprogramsthattendedtohavegreaterstaff

numbersthatincludemultipleswimcoaches,strengthandconditioningcoaches,

andsportsmedicineprofessionals.Oneuniversitycitedcommunicationand

teamworkwithstaffasamainreasonforareductionininjuryoccurrenceoverthe

previousyear.

Idon’tknowrightnowifit’sbecausewehaveaverygoodsysteminplace

withourathletictraining,withourstrength.Weareworkingtogetherso

wellasateamthatwaythatwereallyaren’tseeingtheshoulderinjuries

andstuffthatweusedtohave.–USC07

Understandably,havingaccesstoasportsmedicineprofessionalondeckatevery

trainingsessionisseentoincreasetheabilityofateamtomanageinjury.However,

justbecauseclubcoachesdonottendtohavethisdailyaccesstotreatment,that

doesnotmeantheyshouldbefloatingaloneontheirown.Manyparticipantscited

theimportanceofcreatinganetworkofsupport.Byfosteringarelationshipwitha

localsportsmedicineprofessional,coachescouldhaveaconsistentandreliable

contacttosendalltheirswimmers,andtheseswimmerscouldthenbecomemore

comfortablewiththistypeofcontact.Also,asthecoachandspecificsports

medicineprofessionalworktogethermoreoften,theirrelationshipcangrowwith

trusttomoreeasilymonitortheprogressaninjuredswimmermakesintheir

rehabilitation.

Onewaythecoachcanstartdevelopingnetworksistocheckoutthe

nearestsportsmedicineclinicandfindoutwhatservicesareoffered.Then

theycanhaveareferralsystemfortheirathletesandcanbuilda

41

relationshipwithaparticularphysioorclinicthatcanbedevelopedover

time.–AUM04

3.0.6.1 Mental Skills

Thefinalaspectthatparticipantscitedasimportantinthepreventionofinjuryin

swimmingwashelpingtheathletesdeveloptheiruseofmentalskills.Inparticular,

goalsettingwasmentionedmostoften.Thereisstrongsupportinpsychosocial

literaturethatlinksmentalskillsdevelopmentandusagetoinjuryrisk(Cupal,

1998;Fordetal.,2000;U.Johnsonetal.,2005;Williams&Andersen,1998).While

participantsfeltitwasimportanttodevelopthementalskillsoftheirathletesin

ordertohelppreventinjuries,themainhurdletoprovidingthisservicewasseen

asbeingtootimeintensiveortoohardtoimplement.

Onesportsmedicineprofessionalputitthisway:

Thereisn’tmuchasfaraspreventionofinjury.Whilesomecoachesmay

recognizehighlyanxiousorperfectionisticathletes,theydon’tnecessarily

workwiththementalskillsofthesepotentiallyatriskindividuals.It’s

somethingthatcoachesmaywishtheycoulddo,butitendsupbeinglowon

thelistofpriorities,andcoachesjustrunoutoftimetoimplementanything.

–AUM04

Well,Imean,Ialwaysdogoalsetting.Imean,andIthinkpartofitisthe

processtogettothegoals,youknow.Sopartoftheprocessisstayinginjury

free,oriftheyhaveahistoryofit,tryingtobeproactiveinitsothatit

doesn’tbotheryouandstufflikethat.…Andthat’spartofthegoal,notjust

havingthetimes,buthavingtheprocesstogettothetimes.–USC02

Forinjurymanagement,participantsmentionedanumberofdifferenttypesof

behaviourstotrytopreventinjury.Thesebehavioursincludedtraining

considerations,healthconsiderations,injurypreventioneducation,

communication,andmentalskills.Throughtheuseofawell‐roundedapproach,

mostparticipantsfeltmostinjuriescouldbeprevented.

42

3.0.7 Short‐term Injury Management

Whiletheidealsportsituationwouldbetopreventinjuriesfromoccurring,the

realityisthattherewillstillbeinjuriestomanage.Onceaninjurydoesoccur,the

firstfewdayscanbequitecriticaltowardstheongoingrehabilitationoftheinjury

(Almquistetal.,2008).Short‐terminjurymanagementreferstothebehaviours

enactedinthesmallperiodoftimeimmediatelyfollowinginjuryoccurrence

throughthefirst3dayspost‐injury.Thiswindowoftimewaschosenbecauseit

wasthephaseofinjurymanagementwheretheinjuryhasoccurredandan

assessmentwillbemadewithapotentialprognosis,butinjuryrehabilitationhas

notyetbegun.

Table3‐3:Short‐termInjuryManagementTactics

1stOrder 2nd Order RawDataTheme

ImmediateAction

DeterminenatureofinjuryDeterminewhatisinjuredDeterminehowtheinjuryhappenedDetermineifitispainorjustsoreness

Adjustswimming

GetthemoutofthewaterSeeiftheycanswimitoutChangeequipmentuse(e.g.pullbuoy,

flippers)Changestroke

FirstAidR.I.C.E.R.

RestaffectedareaIceaffectedareaCompressaffectedareaElevateaffectedareaRefertoasportsmedicineprofessional

fordiagnosisNSAID TakeibuprofenStretching Stretchaffectedarea

Communication

Beliefinathlete Believeinathlete

SwimmercommunicationCommunicatewithswimmerEncourageswimmertocommunicate

withcoachParentcommunication CommunicatewithparentsSportsmedicineprofessional

communicationCommunicatewithsportsmedicine

professional

Insuchasmallwindowoftime,participantswererelativelyagreedaboutthe

actionsthatshouldoccurimmediatelyfollowinganinjury.Thesebehaviours

includedimmediateactions,applyingfirstaid,andcommunicatingaboutthe

injury.

43

3.0.8 Immediate Action

Uponbeingtoldofaninjury,participantscitedparticularpoolsideactionsthat

shouldbetakenimmediately.Theseactionsincludeddeterminingthenatureofthe

injuryandalsoadjustingtheactivityleveloftheswimmerbasedonthenatureof

theinjury.

Firstandforemost,participantsfeltcoachesshouldgetagraspoftheinjury

includingthelocation,thecause,andtheseverityoftheinjuryinordertomakea

moreinformeddecisionaboutsubsequentaction.Throughparticipantresponses,

thiswaslistedassomethingofa“basicpoolsideanalysis”wherethecoachgoes

“throughaQ&A”to“determinewhatsortoflevelweneedtochasethisup”

(AUC11).Swimmersrespondedsimilarlysayingthatthey“thinkthatthecoach

needstoknowwhattypeofinjuryitis,whathurtsthem[theinjuredathlete]the

most,andthenworkaroundthat”(USS01).

Oncethenatureoftheinjuryisdetermined,thenextstepparticipantsfeltwas

importantwasadjustingtheactivityleveloftheswimmer.Thisrangedfromseeing

iftheathletecould“getbackinthewaterandseeiftheycanswimitout”(AUC12)

to“pull[ing]themoutstraightaway”(AUM05).Typicallyhowever,coacheswould

prefertokeeptheswimmerinthewaterbutonanadjustedload.

3.0.9 First Aid

Alongwithdeterminingthenatureoftheinjuryandadjustingtheactivitylevels,

participantsmentionedacommonthemerelatingtofirstaidwherethecoach

wouldeitherrecommendorapplybasictreatmentorrefertheinjuredswimmerto

asportsmedicineprofessionalformoreextensivetreatment.Basictreatment

includedsimpleactionstypicallyreflectingknowledgeoftheRICERorRICEM

principleofinjurytreatment:Rest,Ice,Compression,Elevation,andReferraltoa

sportsmedicineprofessionalorMedication(Gaunt&Maffulli,2011).

Theyneedtostop,andtheyneedtoadheretotheR.I.C.E.M.,whateveryou

wanttocallit:rest,ice,compression,elevation,andmedication.–AUM05

Referraltoasportsmedicineprofessionalwasseenascriticalinthegoalof

managinganinjurywell.Byfindingouttheextentoftheinjury,theswimmercould

44

hopefullyshortenrehabilitationtimebytakingearlyaction,andthecoachcould

makemoreinformeddecisionsabouttheswimmer’sinjurymanagement.

Ialwaysadvisethemstraightaway,goseethespecialist.–AUC12

Assoonastheygetinjured,theyneedtoseeasportsphysicianfora

diagnosisoraphysioorsomeoneinvolvedforacorrectdiagnosis.Andonce

one’sgotacorrectdiagnosis,thenonecanmanageitasappropriate.–

AUM03

Whilethisstepofreferringanathletetoasportsmedicineprofessionalwasseen

ascriticalinmanagingtheinjury,thecoachdoesnotalwayshavecontroloverthe

complianceofthisadvice.Itwasclearforsomeparticipantsthatnon‐adherenceto

thisadvicecouldleadtolongerrehabilitationsdownthetrack.

We’vegotgoodexamplesjustthisyearwithverygoodswimmerswhohad

nigglesanddidn’treallytreatitlikethat,andthen,sortofitturnedinto

morethananiggle.Itturnedintopain,andtheywereadvisedtoseek

medicalattention,andtheydelayedthat,andallofasuddenthey’reoutof

thewaterfor4weeks.…Andthenasaresult,4weeksouthascosttheman

opportunityatworldchampionshiptrials.–AUC11

3.0.10 Communication

Aswithinjuryprevention,communicationwasseenasakeyingredienttoeffective

short‐terminjurymanagement.Atthestartofthiscommunication,participantsfelt

itwasimportantforthecoachtobelieveintheathlete.Withoutthisbeliefand

trust,afurtherrelationshipofcommunicationforinjurymanagementcouldnotgo

forward.Whiletherewasaconcernthatathletesmightmakefalseclaimsofinjury

forthepurposeofanexcusefromhardwork,coachesiteratedaneedto“relyon

theirhonesty”(AUC10)orto“givetheswimmerthebenefitofthedoubt”(AUC09).

Eveninthosefirstfewdaysofinjury,participantsdrewattentiontotheneedfor

communication.Andthiscommunicationneededtoinvolveallpartiesinvolved:

injuredswimmer,coach,parent(s),andsportsmedicineprofessionals.Starting

withtheswimmer,thecoachcannothelptreataninjuryifs/hedoesnotknowit

exists.Theswimmerneedsto“havetheactuallyballstosaythatitactuallyhurts

45

insteadofmakingittwiceasworse”(AUM05).Butontheotherhand,thecoach

needstobeapproachableaswell.

Andherthingwasshewasafraidtocommunicatewith[thecoaches]

becauseshedidn’twanttobeseenasslackingoff,thatshewastryingtoget

outofsomething.–USM01

WellthebiggestissuethatIthinkthatthereis,iscommunication.Sooncea

kidcomestomeandtellsmethatthey’reinjured,theyneedto

communicateallthetime.AndItellthemthat.Andthenweconstantlytalk

aboutwhereyou’reat.–USC04

Communicationbetweenthecoachandtheparentsoftheinjuredswimmerwas

alsoseenascriticalforshort‐terminjurymanagement,particularlyforagegroup

swimmerswhoarestillunderthecareoftheirparents.

Letmumordadknowandjustsaylook,she’sgotabitofaniggle,orhe’sgot

abitofaniggle.Handoverthecard[forthephysiotherapist]andifthey

wanttogothere,it’suptothem.–AUC09

Tocompletethecommunicationcircuit,itwasfeltthatthecoachandthesports

medicineprofessionalneededtocommunicateinordertoassesstheinjured

swimmer’ssituationmoreeffectively.

We’lljust,I’llliaisedirectlywiththephysio,doctor,orwhoeveris,the

pilatesinstructororgyminstructor.Thefirstthingiswejustidentify

medically,identifyexactlywhattheinjuryis.AndthenI’llspeaktothose

guysandfindoutwhatrangeofmotionandwhatsortofabilitytheathlete’s

gonnahaveinthepool.–AUC11

Accordingtotheparticipantsinthisstudy,short‐terminjurymanagementseems

toberelativelystraightforward.Firstthecoachneedstofigureoutwhattheinjury

is,thens/heneedstoadjusttheactivityleveloftheinjuredathleteaccordingly.At

thesametime,thecoachwillgenerallyrecommendsomebasicfirstaidaccording

totheRICEprinciple,andtheywillrefertheinjuredswimmertoasportsmedicine

professional.Finally,thecoachwillcommunicatewithallpartiesinvolved:the

injuredswimmer,theparents,andthesportsmedicineprofessional.Forone

46

injuredswimmer,herteamhadanefficientplaninplacethatcoveredallthese

basesofshort‐terminjurymanagement:

Imean,thefirstpersonwetalktoisthetrainersafterwetalktothe

coaches,andthentheyassesswhetherornotwecanswimornot.Andthen,

theyfileaninjuryreportandthatgoesuptothecoachesandthestrength

staff,andthenthey,it’saprettyorganizedplan,whenyougetinjured.–

USS02

Theseactionsmentionedbytheparticipantsallfallunderaseriesofguidelines

andrecommendationsfortheappropriatemedicalcareofadolescentathletes

publishedbytheNationalAthleticTrainersAssociation(NATA)(Almquistetal.,

2008).Intheirguidelines,theyrecommendthatimmediateinjuryevaluationand

treatmentcouldenhancehealingtimesandreducetheriskofre‐injury.Whilethey

pointedouttheimportanceofprofessionalassessment,theyrecognizedthatthe

coachisfrequentlytheonlypersononsiteduringtraining,andthattheyshould

usetheirknowledgeandscopeofsafetytraining(e.g.,firstaid,CPR)intheinitial

assessmentoftheinjury.Followingthis,theathletewouldneedtobe

professionallyassessedbyacertifiedsportsmedicineprofessional.Byadheringto

theseguidelines,coachesandsportsprogramscouldlessenrecoverytimethrough

promptandproperevaluation.

3.0.11 Long‐term Injury Management

Whilethethemesthatemergedforshort‐terminjurymanagementweremostly

discrete,immediateactions,thethemesthatemergedforlong‐terminjury

managementweremorecomplex,reflectingitscomplexnature.Long‐term

managementwasdelineatedastheperiodoftimestartingfromafewdaysafter

injuryoccurrenceandfollowingthroughtothepointwhentheinjuredathlete

beginstheirreturntofulltrainingandcompetition.

Threemajorthemesforcoach‐implementedlong‐terminjurymanagementwere

identifiedthroughthedataanalysis:socialsupport,communication,andmental

skillstraining.Socialsupportcouldbefurtherbrokendownintothefollowing6

sub‐categories:trainingsupport,socialintegration,esteemsupport,emotional

support,supportnetwork,andeducational/informationalsupport.

47

3.0.11.1 Social Support

Thecoachstandsinauniquepositionwiththeirathletestoprovidenotonly

traininginstructionbutalsosocialsupport,asathletescommonlyreachoutto

theircoachwhentheyfacedifficultiessuchasinjury(Thelwelletal.,2008).Yang,

Peek‐Asa,Lowe,Heiden,andFoster(2010)suggestedthatcoachesareacritical

partofaninjuredathlete’ssupportnetwork,astheycanofferspecific

understandingoftheinjuredathlete’ssituationandexperience.Theparticipantsin

thecurrentstudyidentifiedavarietyofsocialsupportbehaviourswhichcoaches

implementorshouldimplementtomanageinjuredswimmers.

Intheirinvestigationofsocialsupportresearch,CutronaandRussell(1990)

derivedfivebasicsocialsupportdimensions:tangibleaid(instrumental

assistance),socialintegration(thefeelingofbelongingtoagroup),emotional

support(turningtoothersforcomfortandsecurity),esteemsupport(bolsteringa

person’scompetenceorself‐esteem),andinformationalsupport(adviceor

guidanceforsolutionstoproblems).Thesedimensionsweredirectlyreflectedin

theresponsesoftheparticipantsinthisstudy.Oneotherdimensionemergedfrom

thedatainthisstudy,andthatreflectedtheneedforthecoachtorelyonanetwork

ofsupport,includingfamily,friends,andsportsmedicinesupporters,tohelpthe

injuredswimmerintheirrecovery.

48

Table3‐4:Long‐termInjuryManagementTactics

1stOrder 2ndOrder 3rdOrder RawDataTheme

SocialSupport

TrainingSupport Techniqueassessment - Techniqueassessment

Trainingplan- Makeatrainingrehabilitationplan- Makedailytrainingplans

Providechallenges- Challengetheswimmertoworkharddespiteinjury

- Providemodifiedtestsets

SocialIntegration Sociallyconnectedtoteam

- Keeptheminvolvedinthesquad- Havethemstartorendthetrainingsessionatsametimeasteammates

Modifiedtrainingwithinsquad

- Designthingsthattheycandoonthesameintervals

Createsocialgroupofinjuredswimmers

- Makealanefortheinjuredswimmers

Assistondeckactivities - GettheswimmerondecktoassistSocialevents - Createsocialeventsoutsideoftraining

Esteem

Support

Encouragement- Helptheswimmerfocusoncapabilities- Encouragetheswimmer- Motivatetheswimmer

Belief - Believeintheswimmer’shealthyreturn

Inspiration- Giveexamplesofathletesovercomingsimilarinjuries

Emotional

Support

Emotionalsupport - SupporttheswimmeronanemotionallevelListeningsupport - Supporttheswimmerasa‘soundingboard’Managenegativeemotions - HelptheswimmerworkthroughfrustrationsPositiveattitude - Trytostaypositivewiththeswimmer

Patientwithswimmer - Bepatient

EducationalSupport

Educateaboutrehabilitationprocess

- Educateimportanceoffollowingrehabilitationplan

- Convinceabouttheneedtodecreaseorstopswimming

Educateabouthealth - Educateabouthealthanddiet

Educateparents- Educateparentsabouttherehabilitationprocess

Educateteamaboutinjuredswimmer’sprocess

- Educateteamaboutinjuredswimmer’smodifiedtraining

Support

Network

Sportpsychologistsupport - RefertheswimmertoasportpsychologistFriendsupport - Encouragesupportfromfriends/confidantsParentalsupport - EncouragesupportfromparentsTeammatesupport - EncouragesupportfromteammatesSportsmedicineprofessionalsupport

- Relyonsupportfromthephysiotherapist/athletictrainer

Communication

Communication Communicatewithparents - Communicatewiththeparents

Communicatewithsportsmedicineprofessional

- Communicatewithphysiotherapist/athletictrainer

Communicationwithswimmer

- Communicationfromswimmertocoach- Communicationfromcoachtoswimmer

MentalSkills

Mentalskills

Goalsetting- Haveswimmersetperformancegoals- Haveswimmersetrehabilitationgoals

Imagery- Haveswimmervisualiseswimmingwithgoodtechnique

- HaveswimmerfocusonpositivefutureStressmanagement - Teachswimmerstressreleasetechniques

49

TrainingSupport

Acoach’snumberonejobwiththeirathletesistotrainthemforcompetition.Not

surprisingly,swimmers,coaches,andsportsmedicineprofessionalsallidentified

trainingsupportasacriticaldimensionofsocialsupportforanathletewhilstthey

rehabilitatefrominjury.Inthecontextofasportingenvironment,tangibleaid

givenbyacoachreflectstheinstrumentalassistanceprovidedthroughcreating

andmonitoringtrainingprograms.Thus,CutronaandRussell’s(1990)social

supportdimension,tangibleaid,wasrenamedtrainingsupportforthisstudy.

Inthecontextofinjury,competitiveswimmingisuniquetoothersportsinthat

injuryrarelyresultsintotalabsencefromtraining.Ifaswimmerinjurestheir

shoulder,forexample,theycanstilldomodifiedtrainingthroughacombinationof

kicking,drillingordry‐landactivitieswiththeirteammates(Blanch,2004).

AccordingtoBlanch,totalrestis“veryrarelywarranted(nortoleratedby

swimmersandcoaches)”(pg.119).Inthistypeofenvironment,thecoach’s

challengeistokeeptheswimmeractivewithcreative,modifiedtrainingplans.

Indeed,participantsinthisstudyrecognizedthisroleasanimportantaspectof

socialsupportforinjuredswimmers.Thisinjuredswimmerrecognizedthathis

coach“hadtosortofadaptthetrainingsettochangeabit,orshewoulduseher

initiativeandchangethesetslightlysothatIcouldstilldoit”(AUS04).One

representativecoachrespondedsimilarlyinregardstotrainingsupportforinjured

swimmers.

Justalwayshavingtocomeupwithsomethingalternativethattheycando

andstillgetoutoftheworkoutwhatyouwantbutwithinthelimitations

thattheyhave.Thecreativityofgettingthespeed,gettingaerobic

conditioning,justgettingdonewhatyouneedtogetdone.–USC07

Whilecoacheswouldhelptheinjuredswimmersbydevelopingamodifiedtraining

plan,somefeltitwasalsoimportanttoinvolvetheinjuredswimmerinthetraining

andrehabilitationprocess.Itwasfeltthatbykeepingtheswimmerinvolved,they

wouldbemoreactiveintheirownrecovery,andtherewouldbelesspressureon

thecoachtocompletelymonitortheirrehabilitationbacktohealth.

50

SoIaskeachathletetokeepanote,alogbook,orwhateveronwhere

they’reat,andhowtheymightbetryingtoincreasetheirnumberof

sessionswithashoulderinjuryorabackinjurysothattheyknowthey’ve

gonefromtwosessionsaweektothreetofour,andtheirkm’shave

graduallyincreased.Sobasicallyputitbackontheathlete’sshoulders,again

withmeasasupportersotospeak.–AUC10

SocialIntegration

Thesecondsocialsupportthemeparticipantsfeltwasimportantforcoachesto

implementwassocialintegrationoftheinjuredswimmer.TaylorandTaylor

(1997)suggestedthatoneofthemostdifficultaspectsofinjuryisthefactthatan

athletecanfeelseparatedfromtheirtraininggroupbecausetheirinjuryprecludes

themfromfullyparticipating.

Onecoachmentionedthathis“biggestfearisforthemtofeelseparatedfromthe

team,isolation”(USC05).Particularlyforeliteathleteswhobasetheiridentityon

theirathleticabilityandperformance,aninjurycandrasticallyaffecttheirability

tostayconnected.Aninjuredswimmerconfirmedthissentimentsayingthatoneof

thedifficultpartsofmanagingherinjurywas“beingonanindividualplanandnot

withtheteam”(USS01).Shewentonfurthertosay:

IknowmanytimesthatIhadtoswiminalanebymyselfjustbecausemy

practicewouldbedifferent.Sojustgettingthroughtheindividualaspect,

andyoudon’thaveyourteamtorelyonmuchbecauseyouhavesuchan

individualplan.–USS01

Participantsinthisstudymentionedanumberofdifferentstrategiestokeep

injuredathletessociallyconnectedand“pluggedintotheteam”(USC03).One

approachforsocialintegrationwastohavetheinjuredathletesdoingthesame

setsasthemainsquadbutwithslightmodifications.Notonlywouldtheybe

gettingaphysicaltrainingbenefit,butonecoachfeltthat“psychologically,Ithink

theystillfeelthatthey’repartofthesquad”(AUC11).

Otherstrategiesincludedhaving“socialeventsoutsideoftrainingtomakesure

everyonestayssociallyconnected”(AUM04)orgettingtheminvolvedwithon‐

51

deckactivitiessuchasassistingwithcoaching.Thisswimmerrespondedpositively

tothisstrategy,saying,“thatreallyhelpedalot,andIgotalotofencouragement

throughthem,throughmebeingacoach”(USS02).

EsteemSupport

Inadditiontotheisolationinjuredathletestendtofeel,self‐confidenceand

motivationlevelscanalsosufferduringlong‐termrehabilitation(Taylor&Taylor,

1997).Asmentionedearlier,esteemsupportrepresentssupportthatisenactedto

boostaperson’ssenseofcompetenceortoconveyabeliefintheirabilityto

overcometheirsituation.Consequently,participantspointedoutthevalueof

receivingthistypeofsupportfromthecoachtowardshelpinganinjuredathlete

managetheirinjuryandrehabilitation.

IthinkthebiggestroleIhaveintherehabprocessisjustconstant

reassurancethatwhatwe’redoingistherightthing,andwe’regonnaget

throughthis.It’sgonnabefine,youknow.IfeellikeI’mdoingmuchmoreof

thatthananythingelse.–USC06

[Mycoach]hasbeentheonlypersonoutofeveryonethatI’vecomein

contactto,contactwithabout,whohasbelievedthatI’llgetoveritandthat

IcangetbackfromtheinjuryandgetbacktobeingbetterthanIwasbefore.

…That’sprobablythebiggestpositivethat’scomeaboutit,fromhim

anyway.–AUS05

EmotionalSupport

ThenextdimensionofsocialsupportdelineatedbyCutronaandRussell(1990)is

emotionalsupport.Thistypeofsupportincludesactionsandbehavioursenacted

tocomfortothersandtoleadpeopletofeeltheyarecaredforbyothers.Inastudy

investigatingsupportnetworksforathletes,Rosenfeld,Richman,andHardy(1989)

foundthatwhilecoachesprovidetechnicalsupport,theyofferedlittleemotional

supportorlisteningsupport.Itwasthoughtthattheyneededtomaintaina

positionofauthoritywiththeirteamandfosterthecompetitivenesswiththe

athletes.However,theseresultswerefoundwithhealthyathletes,sothecoach’s

rolemaybedifferentforinjuredathletes.Morerecently,Yangetal.(2010)found

52

thatforinjuredathletes,coachescanofferadistinctunderstandingoftheinjured

athlete’sexperience.Assuch,theystandinapositiontoprovideashared

perspectivewiththeathlete,particularlywithregardstoemotionalsupport.

Certainly,participantsinthisstudycitedcoach‐enactedemotionalsupportas

importantforlong‐terminjurymanagement.

Somearebetterthanothers,butlots,Ithinkwhenyou’reflyinghigh,andall

ofasuddenyougetinjuredandyoucan’tdowhatyouknowyou’recapable

ofdoing.Itrytosupportthememotionallyandpsychologicallythroughthat

processaswell.–AUC11

Whenacoachcansitdownandtalktomeoneonone,Ifeellikethat’sbeen

mosthelpful.Ijust,sometimesI’mlikehey,Ineedtositdown,Ihaveallthis

frustration,Ihaveallthisemotioncomingon,andI’mjustfrustratedatthis

point.Ifsomeonecanjustsitdownandtalktome,Ithinkthatisthemost

beneficialthingandsaying,likeit’sok,I’mgoingtoworkthroughit,we’re

goingtoworkthroughit,andI’mgoingtohelpyouworkthroughit.Ifeel

likethatmeansthemosttome.–USS01

EducationalSupport

EducationalsupportwasrenamedfromCutronaandRussell’s(Cutrona&Russell,

1990)dimension,informationalsupport.Inthecontextoflong‐terminjury

managementforthisstudy,coachinformationsupportreflectedthebehaviourof

educatingtheinjuredswimmerintherehabilitationandrecoveryprocess.These

actionsrangedfromeducatingtheinjuredswimmerabouttheirinjuryandthe

timeitwouldtaketorecovertoeducatingthemaboutmaintaininggeneralhealth

toaidtheirrecovery.

Andtalkingtothemabouttheimportanceofincreasingitgraduallyand

slowly,andtheimportanceoffollowinginstructionsfromthephysioor

doctoranddoingtheirsetexercisesorwhateveritisthey’vebeenadvised

todo.–AUC10

53

IthinkIneedtoeducatethemofhowwe’regonnaadjusttheirtraining

program,andhowthattrainingprogrameventhoughthey’reinjuredis

gonnamakethembeabletogoforward,andmakethembelieveit.–USC05

Whilemanyoftheaspectsofinjuryoccurrencereflectnegativeresponsesandhow

tomanagethem,ithasbeenproposedthatinjuriescanresultinbenefits,aswell.

Indeed,knowledgegainedfromeducationaboutanatomyandinjuryriskfactors

hasbeenshowntobeaperceivedbenefitoftheinjuryprocess(Wadey,Evans,

Evans,&Mitchell,2011).Wadeyetal.proposedthatinjuredathletesmayhave

manyquestionsabouthowtheygotinjured,whetherthey’llbeabletocompete

again,orhowtheycanrecover.Thesequestionscanthenleadtheathleteto

approachknowledgeableothers,suchastheircoach,togainanswers.Thisfinding

wasreflectedintheobservationsofthecoaches,sportsmedicineprofessionals,

andinjuredswimmersinthisstudy,whofeltthateducationalsupportwasan

importantroleofthecoachduringlong‐terminjurymanagement.

SupportNetwork

Thefinalaspectofsocialsupportthatemergedforcoach‐implementedlong‐term

injurymanagementwastheconceptofrelyingonanetworkofsupportiveothers.

Certainly,itisunreasonabletosuggestthatonepersonbethesolesourceofsocial

supportforanother(Taylor&Taylor,1997).Injuredathletesdomuchbetterwith

anetworkofsupportersincludingcoaches,friendsandfamily,sportsmedicine

professionals,andteammates(Nippert&Smith,2008;Rosenfeld&Richman,1997;

Wieseetal.,1991).Inthecurrentstudy,participantsrecognizedthevalueofa

strongsupportnetworkandtheneedforthecoachtoencouragetheinjured

swimmertoreachouttootherstohelpthemmanagetheirrecovery.

Thecoachshoulddevelopnetworks.Thesenetworksshouldinclude

parents,physios,andothersportsmedicineprofessionals.Toooften,

coachesfeeltheymustmanageeverythingontheirown.However,theyare

muchmoreeffectiveiftheysourceouttheirwork.Alotofthesupportfor

injuredathletescouldandshouldbeprovidedbysportsphysios.–AUM04

Andit’snotalwaysasportpsych.Itmightbesomeonelikeanex‐swimmer

oraconfidantwithinourprogram,ateammanager,orsomethingwhere

54

they,oftentheyjustwanttogetitallout,andbydoingthat,theyfeelbetter.

…Sowereallytryanddirectthemtocommunicateifnotwithus,then

somebodyelse.–AUC11

But,Ialsothinkthattheteamiswhathelpsyouputitbacktogether.Ifyou

haveasupportiveteam,andthattheyweretheonesthatare“okC___,no

matterwhat,you’regonnacomeback.Maybeyou’renotgonnabegreat,but

you’restillgoingtoplayarole”.Sothat’swhat’sgottenmethroughtheups

anddowns.–USS02

Byencouragingthesupportfromothersources,thecoachdoesnothaveto

shoulderalltheresponsibilityofsupportinganinjuredathlete.Also,by

encouragingexpansionofsocialsupport,thecoachhelpsstrengthentheperceived

socialsupportoftheathlete.Withadequatesocialsupport,theathleteismore

likelytohaveamorepositiverecoveryexperience(Clement&Shannon,2011;

Niven,2007;Rosenfeld&Richman,1997).

3.0.11.2 Communication

Inadditiontosocialsupport,communicationemergedasamajorthemeforlong‐

terminjurymanagement.Aswithinjurypreventionandshort‐terminjury

management,communicationforlong‐terminjurymanagementwasseenasakey

componentofcoordinationandunderstandingbetweenathletes,coaches,and

sportsmedicineprofessionals.Withpropercommunication,theeffectedparties

couldstayapprisedofprogresswiththeinjury,andtheathletewouldfeelmore

connectedtotheinjuryrehabilitationprocess.

Ijusthadaconferencecalltwodaysagowithhermom,dad,anddoctor.…

Youjusthavetostayincommunicationwitheveryone.Soeveryone’sonthe

samepage.–USC01

Opencommunicationisbothways:swimmertotrainer,trainerto

swimmer,coachtoeverybody.–USC03

ButIjustthinkstayingintunewithwherepeopleareatandhavingan,I

meanasanathlete,youcanalwaystrytoconnectthatcoach‐athlete

55

relationshipandopenupthecommunication.Butitreallyalldependson

whetherthecoachwantstolistenornot.–USS01

3.0.11.3 Mental Skills Training

Thefinalmajorthemethatemergedforlong‐terminjurymanagementwasmental

skillstraining.Injuredathletesfrequentlyexperiencenegativereactionsafter

sustaininganinjuryandthroughouttherehabilitationprocess.Commonfindings

haveshownthatpsychologicalskillssuchasimageryandgoalsettinghavebeen

effectivemeasurestoaddressthesenegativeresponses(Driedigeretal.,2006;

Evansetal.,2000;R.E.Smithetal.,1990).Theseresearchfindingsweresupported

inthecommentsoftheparticipantsinthecurrentstudy.Throughtheirresponses,

theyrecognizedthatincreasingmentalskillsusagecouldhelpwithsomeofthe

negativeaspectsofinjuryandrehabilitation,anditcouldhelpfocusanathletes’

energytowardsrecovery.

Thecoachcanalsohelptheirinjuredswimmerworkontheirmentalskills.

–AUM04

Butifyoucansetthesegoals,andifsomeonecanhelpsetthegoalswiththe

athlete,Ithinkthattheywouldhaveamorepositiverehabbingthan

someonewhodoesn’thavethosegoalsandkindofgoeswithoutany

direction.–USS01

Ithink,probablydoingmorelike,imageryandstuffoutsideofthepool,and

justfocusonwheretheywereorwheretheycouldseethemselvesbeingin

apositivelight.–USM02

3.0.12 Return to Full Training

Theinjurypreventionandmanagementcycleconcludeswithareturntofull

trainingandcompetition.Thisphaseofinjurymanagementreflectsthefinalphase

ofrecoverywhentheinjuredathletetransitionsfrommodifiedtrainingtothe

abilitytofullyparticipateintrainingandcompetition.Aswithshort‐terminjury

management,participantresponsesreflectedthediscretenatureofthephaseof

injurymanagementconcerningthereturntofulltrainingandcompetition.Four

majorthemesemergedforthisprocess,includingtrainingconsiderations,

swimmerconsiderations,medicalconsiderations,andconfidenceconsiderations.

56

Table3‐5:ReturntoFullTrainingTactics

1stOrder 2ndOrder RawDataTheme

Trainingconsiderations

Progressivelyincreasetraining

- Progressivelyincreaseload- Increasestrengthandendurance

Monitorprogress - Monitorrehabilitationandtrainingprogress

SwimmerConsiderations

Increaseloadbasedonswimmerfeedback

- Relyonfeedbackfrominjuredswimmer- Communicatewithswimmeronhowtheirinjury’sfeeling

Allowswimmertodecidepaceofreturn

- Leaveituptotheswimmertodecidereturnrate

- Lettheswimmerrecoverintheircomfortzone

Increaseloadbasedonpainlevels

- Increasetrainingbasedontolerablepainlevels

- Increasetrainingonlywhenpainfreeforsustainedtime

MedicalconsiderationsIncreaseloadbasedonsportsmedicineprofessionalfeedback

- Increasetraininguponclearancefromphysiotherapist

- Increasetrainingafterpassingorthopaedictests

Confidenceconsiderations

Manageanxiety- Reassuretheswimmer- Manageanxietylevels

Buildconfidence- Buildtheswimmer’sconfidence- Gettheswimmertobelieveinwhattheycanaccomplish

3.0.12.1 Training Considerations

TaylorandTaylor(1997)suggestedthatintheinitialreturntotraining,athletes

canbecomeoverexcitedwiththeconclusionoftheirrehabilitationthatthey

attempttocomebacktooquickly,ortheydotoomuchtoosoon.Byspeeding

throughtheprocess,theythencanputthemselvesatfurtherriskofre‐injury.

TaylorandTaylorrecommendedthatthecoachandtheathleteshouldcollaborate

withaplanforreturnthatreadjuststotrainingdemandsslowlyandsafely.

Participantsinthecurrentstudyrevealedsimilarconclusionsaboutthisphaseof

injurymanagement.Theyfeltcoachesshouldpayparticularattentiontothe

volumeandtypeoftrainingintroducedandhowquicklytrainingvolumewas

increasedtomatchtherestofthesquad.

I’lldoarecoveryplan.Soeventhough,thelastweekmightbefullload,

we’restillverycautiousthatwe’reinthatrecoveryperiod.Soifitcomes

downtoachoicemaybeintrainingbetweenmaxeffortand90%,we’lltake

the90%option,justincase.Ifwemakeitthroughthe4thweekwithoutany

hiccups,thenwe’rebackreadytogo.–AUC11

57

It’sgonnabesillytogostraightbackinanddo9two‐hoursessionsandsort

of70kmaweekstraightaway.It’sjustgonna,morethanlikely,I’mjust

gonnagetinjuredagain.Very,veryslowbutprecisesortoftransitioninto

trainingagain.–AUS05

3.0.12.2 Swimmer Considerations

AsmentionedbyTaylorandTaylor(1997),thereturntofulltrainingshouldbea

collaborativeprocessbetweentheinjuredathleteandthecoach.Participantsfelt

thatintheprocessofincreasingtrainingatanappropriatelevel,thecoachneeded

toencourageandrelyonfeedbackfromtheswimmer.Coachespointedoutthat

theyneededto“makesurethatthey[injuredswimmers]comebackpainfree,and

ifthereispain,wegobacktorestingthem”(USC05).Inorderforthisprocessto

workproperly,coachesandswimmersalikestressedtheneedforcommunication

fromtheswimmer.

Theyhavetocommunicatetomehowtheirinjury’sfeeling,andthenwe

tendtosortoftentativelyreturntofulltrainingandthencompetition.–

AUC10

It’smyjobtolethimknowwhat’stoomuch,andwhetherIcangoabit

harderorthingslikethat.–AUS05

3.0.12.3 Medical Considerations

Particularlyininjurieswhereasportsmedicineprofessionalisinvolvedinthe

diagnosisandrehabilitation,thecoach,athlete,andsportsmedicineprofessional

needtoworktogethertodetermineanathlete’sreadinesstoreturntofull

participationintheirsport(Clover&Wall,2010;Taylor&Taylor,1997).Certainly,

giventhemedicalnatureofinjury,ifanathletehasamedicaldiagnosisatinjury

outset,theyshouldrequireamedicalclearancetodeterminetheirhealthyreturn.

Furthermore,CloverandWall(2010)suggestedthatanathletictrainermayhavea

bettergraspontheathlete’sphysical,cognitive,andemotionalreadinesstoreturn

thanacoachduetotheirone‐on‐oneworkwiththeathleteinarehabilitation

setting.Theyalsosuggestedwhilethecoachmaybetemptedtodeclareanathlete

readytoreturn,itwasimportantforthecoachtodefertomedicaladviceforthe

ultimatehealthoftheathlete.Thisattitudewasreflectedintheresponsesofthe

58

participantswhofeltthatreturntofulltrainingis“uptothedoctor”(USC02),or

that“everythinghastobeokayedthroughtheathletictrainingstaff,andwhatever

theysaygoes”(USC07).Thissentimentwasalsoreflectedintheresponsesofthis

swimmerwhosaid,“myphysicaltherapisttoldmewhenhethoughtI’dbereadyto

goback”(USS03).

3.0.12.4 Confidence considerations

Whilethehealthyreturntotrainingandcompetitionfollowinginjuryisgenerally

theultimategoalofarehabilitationprogram,thistransitionalphasecanelicita

varietyofnegativeemotionalresponses,suchasfear,anxiety,anddepression

(Bianco,Malo,&Orlick,1999;Glazer,2009;Podlog&Eklund,2007,2009).Ithas

beensuggestedthatthemostcommonsourcesofanxietyinvolveafearofre‐injury

bycomingbacktoosoonandanxietyaboutbeingunabletoreachpre‐injury

performancelevels(Bianco,2001;Taylor&Taylor,1997).ParticipantsinBianco’s

(2001)studyofeliteskierscitedcoachsupportasapivotalaspectthathelped

themmaintainmotivationlevelsandcopewithanydifficultiesthataroseinthe

processofreturningfrominjury.Participantsinthecurrentstudybroughtup

similarobservations,saying,“thedoctormayhaveclearedthemphysically,but

theymightnotbementallyready”(AUS04).Theircommentssuggestedthatcoach

supportcouldhelpaswimmermanagetheiranxietylevelsandhelpthembuild

confidence.Considerthecommentsofthefollowingcoach.

Thosekids,you’vejustgottostartbuildingtheirconfidencebackup.And

getthemtobelieveinwhattheycanaccomplishagain.Ithinkagood

exampleofthatwasD___.Shegotinjuredandthenwentthroughahuge

slumpandjuststoppedbelievinginherabilitytobefast.Iremembersitting

downwithheronthebenchat[thepool]andsaying,listen,it’sgonna

happen.Youjustgottabelieveinit.Yougottakeepbelieving.Anditdid.

Whatd’yaknow!Shegotfastagain.–USC04

Conclusions

Thepresentstudyofferedvaluableinsightintotheinjurypreventionand

managementbehavioursofswimcoachesinelite,competitiveswimming.By

lookingattheobservationsofcoaches,injuredswimmers,andsportsmedicine

59

professionals,amorecomprehensivepictureofthecurrentinjurypreventionand

managementpracticesinswimmingemerged.Responsesreflectedafour‐phase

cycleofinjurypreventionandmanagement,startingfrominjurypreventionand

continuingthroughshort‐termandlong‐terminjurymanagementandculminating

inreturntofulltrainingandcompetition.Throughoutthiscycle,itisclearthe

coachplaysapivotalrolenotonlyinthetechnicalcoachingaspectsofsport,but

theyofferacriticalsourceofsocialsupporttoathletes,particularlyduringthe

injurymanagementandreturntosportprocess.

Oneotherthemethatemergedwasalackofknowledgeofliteratureandresearch

intotheareaofinjurypreventionandmanagementforcoaches.Therewasalsoa

lackofspecificplanningforthisprocess.Whiletheseelitecoacheshavecomeup

withstrategiesthatworkforthemafteryearsofexperiencewithinjuredathletes,

newcoachescomingintothesportarenotyetexposedtothisknowledge.Further

disseminationofinformationneedstobemadeintotheactualsporting

communitiestomakesurecoachesandathleteshaveaccesstothisknowledge.

Nowthatweknowwhatcoachesaredoingtopreventandmanageinjuriesin

swimming,thenextstepistoseeifthesebehavioursarecommonwithalarger

sampleofcoachesandswimmers.Wecanalsoseeifswimmerperceptionsmatch

coachbehaviours.Areswimmersawareofinjurypreventionandmanagement

plans,anddotheymatchwhatcoachesfeelareimportant?Fromthere,thestep

willbetodevelopapreventionandmanagementplanincompetitiveswimming

encompassingbehavioursforinjuryprevention,short‐terminjurymanagement,

long‐terminjurymanagement,andreturntofulltrainingandmeasureits

effectiveness.

60

Chapter 4

4 Study Two – Injury Prevention and Management in

Competitive Swimming: Confirmation of Current Practices

Introduction

Researchintoinjurypreventionhasidentifiedavarietyoffactorsaffectinginjury

risk,includingphysiologicalandbiomechanicalfactors(Cowleyetal.,2006;Knapik

etal.,1991;Krosshaugetal.,2007).Recently,psychosocialantecedentshavealso

beenrecognisedassignificantpredictorsofinjury.Oneantecedentthathas

receivedparticularattentionisthelifestress‐injuryrelationship(Andersen&

Williams,1988;Petrie,1992;Rogers&Landers,2005).Theincreasing

understandingofthelifestress‐injuryrelationshiphasledresearchersto

implementanumberofinterventionstoreducelifestressinordertoreduceinjury

riskandoccurrence,withpositiveresults(Davis,1991;U.Johnsonetal.,2005;

Pernaetal.,2003).

Inadditiontothepsychosocialantecedentsofinjury,researchershavealso

examinednegativeemotionalreactionsmanyathletesexperienceinresponseto

theirinjuries,includinganxiety,depression,andanger(Goldsmith,2007;Leddyet

al.,1994;Thelwelletal.,2008).Similartoinjurypreventionstudies,researchers

haveendeavouredtofacilitateinjuryrecoverythroughpsychosocialinterventions

aimedatreducingstress,increasingconfidence,andincreasingmotivationand

rehabilitationadherence(Cupal&Brewer,2001;Driedigeretal.,2006;Evans&

Hardy,2002).

Whileresearchhasshownpositiveresultsthroughpsychosocialinterventionsfor

injurypreventionandinjuryrehabilitation,itremainsunclearwhetherthis

informationhastrickleddownintocommoncoachingknowledgeandpractices.

MaddisonandPrapavessis(2007)suggestedthatcoaches,trainers,andathletes

shouldbemadeawareofthepsychosocialfactorsaffectinginjurysothattheycan

minimizeinjuryriskfactorsandthereforeinjuryoccurrence.Specifically,they

61

statethatthefirststeptoreducinginjuriesistoincreaseeducationamongcoaches

andathletes.Inthepreviousstudy(Chapter3),aqualitativeexaminationof

currentcoach‐implementedinjurypreventionandmanagementpracticesin

competitiveswimmingwasconducted.Twokeyimportantissuesemergedfrom

thisstudy.First,coaches,evenatelitelevels,donothaveclearandinformedinjury

preventionandmanagementplans.Additionally,theroleofthecoachasasource

ofsocialandemotionalsupport,particularlyduringinjurymanagementand

recovery,isundervalued.

Basedontheinformationobtained,thisstudysoughttocreateaprofilingtoolnot

onlytoconfirmthebehavioursdelineatedinthefirststudy,butthatalsocanbe

usedtoprofiletrainingsquadsquicklyandefficiently.Informationfromthis

profilingtoolcouldbeusedtoraiseawarenessofinjurymanagementprotocols

andtoinformcoachingpracticetopromotepreventionandrecoveryfrominjuryin

competitiveswimmers.Thisprofilingtoolwasdesignedforadministrationto

coachesforself‐reportmeasuresintotheirinjurypreventionandmanagement

practicesandtheimportancetheyattachedtothosebehaviours.Byslightly

changingthewording,itwasalsodesignedtoassessswimmerperceptionsof

coach‐implementedbehavioursandtheirperceptionofimportanceforthose

behavioursastheyrelatedtoinjurypreventionandmanagement.

Methods

4.0.1 Item Development

TheinitialstepforcreatingtheInjuryPreventionandManagementProfilefor

Swimming(IPMP‐S)wastoassembleapoolofitemsthatreflectedcoach‐

implementedinjurypreventionandmanagementbehaviours.Themajorityof

itemswerederivedfrominterviewsconcerninginjurypreventionand

managementwithcoaches(12),injuredswimmers(5),andsportsmedicine

professionals(6)whowerefamiliarwithtreatinginjuredswimmers(seeStudy1,

inChapter3).Rootquestionsfortheseinterviewsincludedthefollowing:

1. Whatspecificallydoyoudoorthinkshouldbedonetopreventinjuries

inswimming?

62

2. Whatspecificallydoyoudoorthinkshouldbedonewhenaswimmer

getsinjured?

3. Whatspecificallydoyoudoorthinkshouldbedoneduringaninjured

swimmer’srehabilitation?

4. Howspecificallyshoulditbedeterminedorhowdoyoudetermine

whenaninjuredswimmerisreadytoreturntofulltrainingand

competition?

Followingdeductiveandinductivedataanalysisoftheseinterviews,4sections

weredrawnfromemergedhierarchies,includingbehavioursforInjuryPrevention,

Short‐termInjuryManagement,Long‐termInjuryManagement,andReturntoFull

Training.Withinthesesections,categoriesemergedfromthedata.SeeTable4‐1

forthehierarchyofsectionsandcategories.

Table4‐1:ItemsectionsandcategoriesfortheIPMP‐S

InjuryPreventionShort‐TermInjuryManagement

Long‐TermInjuryManagement



Healthconsiderations

Preventioneducation

Communication

Mentalskillstraining

Immediateactions

Firstaid

Communication

SocialSupport

Trainingsupport

Socialintegration

Esteemsupport

Emotionalsupport

Educationalsupport

Networksupport

Communication

Mentalskillstraining


Swimmerfeedback

Medicalfeedback

Confidenceconsiderations

Aftertheinitialpoolofitemswascreated,3sportscientistswererecruitedto

evaluatethecontentrelevanceofthepoolofitems.Thesereviewerswereselected

basedontheiracademicexperienceaswellastheirknowledgeincompetitive

swimming.Thefirstreviewerwasanactiveresearcherwithadoctorateinsport

psychologyandarecordofpeer‐reviewedpublishedresearchinsportsinjury.The

secondreviewerhadadoctorateinsportpsychologywithahistoryofpeer‐

reviewedpublicationincoach‐athleteinteractions.Thefinalreviewerwasasport

scientistwithadoctorateinmotorcontrolanda20‐yearpersonalbackgroundin

swimming,includingcompetition,coaching,andpeer‐reviewedresearch.These

reviewerswereaskedtolookoverthelistofitemsandcommentonthesuitability

63

oftheseitemstotheexistingcategories.Theywereaskedtoindicateitemsthatdid

notbelongtoacertaincategoryorbelongedtomorethanonecategory.Theywere

alsoaskedtoindicateanyotherissueswithitems(e.g.itemlength,readinglevel,

clarity,etc.).Inaconstantcomparativetechnique,theprofilingtoolwaseditedand

refinedforusewithapilot‐testinggroup.

Inthefinalstageofpilotingitemdevelopment,theinitialIPMP‐Swasadministered

to13swimcoachesand7swimmers.ThepilotcoachesallheldanAustralianSwim

CoachesandTeachersAssociation(ASCTA)GreenLicense(orequivalent)or

higher.Therewere7malecoachesand6femalecoacheswithanaverageof5.2

yearsexperience(range=1‐16).Theswimmerswhowererecruitedforthepilot

testincluded4malesand3femalesbetweentheagesof13and21(mean=18.7).

Theseparticipantsweregiventhequestionnairetocomplete,andtheywerealso

askedtoprovideanyfeedbackonitemsifnecessary.Theywereaskedtoindicate

anyconfusionwithitemsorwhethertheyfeltanyitemswerenotappropriately

allocatedtocategories.

Therecommendationsfromthecoachesandswimmersweretakenintoaccount,

andtheIPMP‐Swaseditedanddeemedreadyforusewithalargerpopulation.

4.0.2 Profiling Tool Administration

4.0.2.1 Participants

Forthisstudy,apurposivesampleofswimmers(N=135)andcoaches(N=18)from

theUnitedStates(N=56swimmers,N=7coaches)andAustralia(N=79swimmers,

N=11coaches)wererecruitedtocompletetheIPMP‐S.Swimmersincludedmales

(N=63)andfemales(N=72)whorangedinexperiencefromschoolswimming

competitionsuptointernationalcompetitions,withthehighestlevelofexperience

attheOlympics.Theyrangedinagefrom12to30years(M=16.6,SD=3.54).

Coacheswerecomprisedequallyofmales(N=9)andfemales(N=9)andhadat

leasttheequivalentofanASCTABronzeLicense(Australia)orAmericanSwim

CoachesAssociation(ASCA)Level2license(USA).Allofthecoacheswerechosen

forparticipationbecauseoftheirexperiencecoachinghigh‐performanceteen‐aged

orcollegiateswimmers,whoaremorelikelythanyoungerswimmerstosustainan

64

injuryduetothehigherdemandsoftrainingatthislevel(Blanch,2004)(seeTable

4‐2fordemographicinformation).

Table4‐2:Participantdemographicinformation

Swimmers CoachesVariable N % Variable N %

Age=16.6 3.54 Age=37.0 15.2Gender Gender

Male 63 46.7% Male 9 50.0%Female 72 53.3% Female 9 50.0%

Country CountryAustralia 79 58.5% Australia 11 61.1%

USA 56 41.5% USA 7 38.9%CompetitionLevel Experience(years)

School 7 5.2% 1‐5 3 16.7%State 52 38.5% 6‐10 8 44.4%

Nationalagegroup 53 39.3% 11‐15 2 11.1%Nationalopen 17 12.6% 16‐20 1 5.6%International 6 4.4% ≥21 4 22.2%

License Level Bronze/2 8 44.4% Silver/3 7 38.9% Gold/4 3 16.7%

4.0.3 Procedure

FollowingHumanEthicsapproval,allparticipantsweregiveninformation

regardingthetestingprotocolaswellasanyrisksorbenefitsofthestudy.Initial

recruitmentforparticipationinvolvedcontactingspecificcoachesandtheirclubs.

Twelveclubs(N=12coaches,N=120swimmers)wererecruitedinthismanner

including5fromtheUnitedStatesand7fromAustralia.Uponagreementfor

participation,swimmersandtheirparentsweregivenaccesstoinformationabout

thestudyincludingrisksandbenefitsofparticipation.Swimmerswerevisitedat

theirnormaltrainingtimeandinaquietlocationattheirtrainingfacilityto

completetheIPMP‐S.Participantsweretoldthatcompletionofthequestionnaire

representedtheirinformedconsentandthattheywerefreetowithdrawfromthe

studyatanytimewithnopenalty.Measuresweretakentoensureswimmer

confidentiality,includingspecificmeasurestoensurethatcoacheswouldnothave

accesstospecificswimmerinformation.Furthermore,coacheswereprohibited

frombeingpresentwhiletheswimmerscompletedtheIPMP‐S,andtheywerealso

nottoldwhichswimmersdidordidnotcompletetheprofilingtool.These

measuresweretakensoswimmersdidnotfeelunnecessarypressureto

65

participate.Coachesweregivenaccesstoaweb‐enabledversionoftheIPMP‐Sto

completeontheirowntimeseparatefromtheirswimmers.

Inadditiontothepersonalvisitationprocedure,theIPMP‐Swasweb‐enabledfor

bothcoachesandswimmerstocomplete.Initialrecruitmentwentoutviae‐mail,

butthisprocessyieldedpoorresults.Subsequentrecruitmentwasenabledviaa

Facebookgrouppagethatincludedaninformationsheetandanelectroniclinkto

theweb‐enabledversionoftheIPMP‐S.Coach(33)andswimmer(54)contacts

wereinvitedtoparticipateandinturntoinviteotherstoparticipate.Thisprocess

yielded6morecoachesand15moreswimmersasparticipants.

4.0.4 Statistical Analyses

ItemsontheIPMP‐Swereorganisedintocategorieswithin4majorsections(see

Table4‐1).Inordertomakecomparisonsbetweenresponsesfromswimmersand

coaches,categoryscoresfortheIPMP‐Swereobtained.Thisprocessinvolved

calculatinganaveragecategoryscorefromtheindividualitemscorestoenable

comparisonsacrosscategories.Oncecategoryscoreswereestablished,the

followingcomparisonsweremadeusingrepeatedmeasuresAnalysisofVariance

(ANOVA):thedifferencebetweenswimmers’ratingsofcoach‐implemented

behavioursandratingsofimportanceforthosebehaviours,andthedifferences

betweencoaches’self‐ratedbehavioursandratingsofimportanceforthose

behaviours.Additionally,aseriesofone‐wayANOVAswerealsoperformedto

determinethedifferencesbetweencoaches’andswimmers’perceptionsofcoach‐

implementedbehavioursandtheimportanceofthosebehaviours.

Results

4.0.5 Ratings of coach‐implemented behaviours compared to ratings of perceived

importance

AseriesofrepeatedmeasuresANOVAswereperformedcomparingswimmers’

ratingsofimportanceforinjurymanagementbehaviourstotheirperceptionofthe

degreeofcoachenactmentforthosesamebehaviours.TheIPMP‐Scategoryscores

andtheresultsoftherepeatedmeasuresANOVAsforswimmersaresummarised

inTable4‐3.Foreverycategory,swimmersratedtheimportanceofinjury

66

preventionandmanagementbehaviourssignificantlyhigherthanthedegreeto

whichtheyperceivedtheircoachtoenactthosebehaviours(p<.001).

Table4‐3:RepeatedmeasuresANOVAresultsforswimmers’ratingsofcoach‐implementedinjurymanagementbehaviourscomparedtoratingsofbehaviourimportance

IPMPcategory Behaviour ImportanceFvalue(df=134) Sig.

InjuryPrevention Mean SD Mean SD Trainingconsiderations 3.50 .54 4.29 .56 245.65 p<.001Healthconsiderations 3.16 .98 4.12 .64 153.03 p<.001Preventioneducation 2.93 .98 3.85 .82 152.07 p<.001

Communication 3.82 .80 4.10 .69 16.42 p<.001Mentalskillstraining 3.08 1.03 3.45 1.04 16.23 p<.001

Short‐TermInjuryManagement Immediateactions 3.62 .67 4.16 .52 110.25 p<.001

Firstaid 3.35 .81 3.97 .64 101.21 p<.001Communication 3.18 .74 3.85 .65 133.45 p<.001

Long‐TermInjuryManagement Trainingsupport 3.52 .73 4.06 .60 81.05 p<.001Socialintegration 3.01 .70 3.28 .73 17.70 p<.001Esteemsupport 3.57 .90 4.03 .76 39.94 p<.001

Emotionalsupport 3.53 .96 4.09 .74 50.91 p<.001Educationalsupport 3.04 1.03 3.57 .87 58.70 p<.001

Networksupport 2.88 1.05 3.55 .91 74.85 p<.001Communication 3.34 .94 3.90 .71 63.87 p<.001

Mentalskillstraining 3.09 1.03 3.60 .92 49.08 p<.001

ReturntoFullTraining Trainingconsiderations 3.60 .78 3.98 .73 46.78 p<.001Swimmerconsiderations 3.52 .73 3.93 .65 53.34 p<.001Medicalconsiderations 2.92 1.20 3.66 1.09 69.45 p<.001

Confidenceconsiderations 3.57 1.08 3.99 .88 27.41 p<.001

Behaviourratingswereona5‐pointLikert‐typescale(1=notatall,2=alittle,3=somewhat,4=alot,5=toagreatextent).Importanceratingswerealsoona5‐pointscale(1=unimportant,2=oflittleimportance,3=moderatelyimportant,4=important,5=veryimportant).

AsillustratedinTable4‐4,therepeatedmeasuresANOVAsforcoachesrevealeda

significantlyhigherratingfortheimportanceofbehavioursthantheratingsfor

implementationofthosebehavioursinallcategoriesunderInjuryPrevention,

Short‐termInjuryManagement,andLong‐termInjuryManagement(p<.05).For

ReturntoFullTraining,coaches’ratingsofimportanceweresignificantlyhigher

thanbehaviourenactmentforswimmerconsiderations,medicalconsiderations,

andconfidenceconsiderations(p<.05),however,trainingconsiderationswerenot

significantlydifferent(p=.08).

67

Table4‐4:RepeatedmeasuresANOVAresults forcoachself‐ratingsof injurymanagementbehaviourscomparedtoratingsofbehaviourimportance

IPMPcategory Behaviour ImportanceFvalue(df=17)

Sig.

InjuryPrevention Mean SD Mean SD Trainingconsiderations 3.92 .36 4.54 .32 66.27 p<.001Healthconsiderations 3.91 .61 4.51 .38 13.50 p<.01Preventioneducation 3.36 1.12 4.39 .54 21.81 p<.001

Communication 4.46 .32 4.70 .29 8.33 p<.05Mentalskillstraining 3.73 .85 4.29 .57 10.88 p<.01


Firstaid 3.61 .59 4.01 .58 9.14 p<.01Communication 3.81 .54 4.13 .64 9.89 p<.01


Emotionalsupport 4.32 .55 4.53 .47 5.09 p<.05Educationalsupport 3.74 .77 4.21 .65 13.66 p<.01

Networksupport 3.87 .77 4.37 .69 14.12 p<.01Communication 4.35 .50 4.60 .45 12.75 p<.01

Mentalskillstraining 3.64 1.00 4.19 .65 17.77 p<.01

ReturntoFullTraining Trainingconsiderations 3.85 .72 4.26 .56 3.57 p=.076Swimmerconsiderations 3.47 .52 4.00 .59 10.67 p<.01Medicalconsiderations 4.11 .88 4.47 .63 5.39 p<.05

Confidenceconsiderations 4.19 .67 4.47 .61 6.54 p<.05

Behaviourratingswereona5‐pointLikert‐typescale(1=notatall,2=alittle,3=somewhat,4=alot,5=toagreatextent).Importanceratingswerealsoona5‐pointscale(1=unimportant,2=oflittleimportance,3=moderatelyimportant,4=important,5=veryimportant).

4.0.6 Coach‐implemented injury prevention and management behaviours and

ratings of perceived importance: Differences between swimmers and coaches

Aseriesofone‐wayANOVAswereperformedcomparingcoaches’self‐reported

ratingsofinjurypreventionandmanagementbehaviourstoswimmers’ratingsof

coach‐implementedbehaviours.AsillustratedinTable4‐5,swimmersratedtheir

perceptionofcoach‐enactedbehaviourslowerthantheratingcoachesassessed

themselvesforthesamebehaviours.For15outof20variables,thisdifference

reachedstatisticalsignificance(p<.05).

68

Table 4‐5: One‐way ANOVA results for coach‐implemented behaviour scores comparingswimmersandcoaches

IPMPcategory Swimmers CoachesFvalue(df=151)

Sig.

InjuryPrevention Mean SD Mean SD Trainingconsiderations 3.50 .54 3.92 .36 10.15 p<.01Healthconsiderations 3.16 .98 3.91 .61 10.09 p<.01Preventioneducation 2.93 .98 3.36 1.12 2.93 p=.089

Communication 3.82 .80 4.46 .32 11.44 p<.01Mentalskillstraining 3.08 1.03 3.73 .85 6.60 p<.05


Firstaid 3.35 .81 3.61 .59 1.87 p=.174Communication 3.18 .74 3.81 .54 12.28 p<.01

Long‐TermInjuryManagement Trainingsupport 3.52 .73 4.03 .32 8.52 p<.01Socialintegration 3.01 .70 3.28 .50 2.53 p=.114Esteemsupport 3.57 .90 4.66 .46 25.62 p<.001

Emotionalsupport 3.53 .96 4.32 .55 11.63 p<.01Educationalsupport 3.04 1.03 3.74 .77 7.91 p<.01

Networksupport 2.88 1.05 3.87 .77 14.80 p<.001Communication 3.34 .94 4.35 .50 19.49 p<.001

Mentalskillstraining 3.09 1.03 3.64 1.00 16.73 p<.001

ReturntoFullTraining Trainingconsiderations 3.60 .78 3.85 .72 1.65 p=.201Swimmerconsiderations 3.52 .73 3.47 .52 .063 p=.803Medicalconsiderations 2.92 1.20 4.11 .88 16.32 p<.001

Confidenceconsiderations 3.57 1.08 4.19 .67 5.75 p<.05

Behaviourratingswereona5‐pointLikert‐typescale(1=notatall,2=alittle,3=somewhat,4=alot,5=toagreatextent).

UndertheInjuryPreventioncategory,swimmers’ratingsweresignificantlylower

thancoaches’ratings(p<.05)fortrainingconsiderations,healthconsiderations,

communication,andmentalskillstraining.Therewasnosignificantdifference

betweenswimmers’andcoaches’ratingsofbehaviourforinjuryprevention

education.ForShort‐termInjuryManagement,swimmers’ratingsforimmediate

actionandcommunicationweresignificantlylowerthancoaches’ratings(p<.05).

Firstaidbehaviourswerenotsignificantlydifferentbetweenswimmersand

coaches.SixoutofsevenbehavioursunderLong‐termInjuryManagementwere

ratedsignificantlylowerbyswimmersthanbycoaches(p<.05),andtheseincluded

trainingsupport,esteemsupport,emotionalsupport,educationalsupport,

networksupport,communication,andmentalskillstraining.Swimmers’ratings

forsocialintegrationwerenotsignificantlydifferentthancoaches’responses.

Finally,fortheReturntoFullTrainingcategory,swimmers’ratingswere

69

significantlylowerthancoaches’ratingsformedicalconsiderationsandconfidence

considerations(p<.05).Trainingconsiderationsandswimmerconsiderationswere

notsignificantlydifferent.

Whencoaches’ratingsofperceivedimportanceforinjurypreventionand

managementbehaviourswerecomparedtoswimmers’perceptionsofimportance,

swimmers’ratingsofperceivedimportanceweresignificantlylowerthancoaches’

ratingsofimportancein14outof20variables(p<.05)(seeTable4‐6).

ForbehavioursintheInjuryPreventioncategory,healthconsiderations,injury

preventioneducation,communication,andmentalskillswereratedsignificantly

lessimportantbyswimmersthanbycoaches.Trainingconsiderationswerenot

significantlydifferentbetweencoachesandswimmers.Coachesandswimmersdid

notdiffersignificantlyonperceivedimportanceforallthreevariablesunderShort‐

termInjuryManagement:immediateactions,firstaid,andcommunication.All

variablesunderLong‐termInjuryManagementwereratedsignificantlyless

importantbyswimmerswhencomparedtocoaches’ratingsofperceived

importance(p<.05).UnderReturntoFullTraining,swimmers’perceptionsof

importanceweresignificantlylowerthancoaches’ratingsformedical

considerationsandconfidenceconsiderations,butcoachesandswimmersdidnot

differsignificantlyfortrainingconsiderationsorswimmerconsiderations.

70

Table4‐6:One‐wayANOVAresultscomparingswimmers’andcoaches’ratingsofperceivedimportanceforinjurypreventionandmanagementbehaviours

IPMPcategory Swimmers CoachesFvalue(df=151)

Sig.

InjuryPrevention Mean SD Mean SD Trainingconsiderations 4.29 .56 4.54 .32 3.45 p=.065Healthconsiderations 4.12 .64 4.51 .38 6.36 p<.05Preventioneducation 3.85 .82 4.39 .54 7.48 p<.01

Communication 4.10 .69 4.70 .29 13.37 p<.001Mentalskillstraining 3.45 1.04 4.29 .57 11.34 p<.01

Short‐TermInjuryManagement Immediateactions 4.16 .52 4.33 .52 1.71 p=.193

Firstaid 3.97 .64 4.01 .58 .065 p=.800Communication 3.85 .65 4.13 .64 2.97 p=.087


Emotionalsupport 4.09 .74 4.53 .47 5.97 p<.05Educationalsupport 3.57 .87 4.21 .65 8.97 p<.01

Networksupport 3.55 .91 4.37 .69 13.46 p<.001Communication 3.90 .71 4.60 .45 16.73 p<.001

Mentalskillstraining 3.60 .92 4.19 .65 4.65 p<.05

ReturntoFullTraining Trainingconsiderations 3.98 .73 4.26 .56 2.55 p=.112Swimmerconsiderations 3.93 .65 4.00 .59 .169 p=.682Medicalconsiderations 3.66 1.09 4.47 .63 9.54 p<.01

Confidenceconsiderations 3.99 .88 4.47 .61 5.16 p<.05

Importanceratingswereona5‐pointLIkert‐typescale(1=unimportant,2=oflittleimportance,3=moderatelyimportant,4=important,5=veryimportant).

Discussion

4.0.7 Behaviour versus importance

TheresultsfromtheIPMP‐Sindicateagapbetweentheperceivedimportanceand

thereportedimplementationofinjurypreventionandmanagementbehaviours.

Coachesandswimmersalikeconsistentlyratedimportancesignificantlyhigher

thantheobservedimplementationofinjurypreventionandmanagement

behaviours.Whileadefinitiveexplanationcannotbegivenonthereasonsforthis

gap,theremaybeobstaclespreventingtheimplementationofinjuryprevention

andmanagementbehaviours.

Onesuchobstaclecouldbetheperceivedtimethesetaskstakeincomparisonto

thetimeacoachhasavailabletothemweighedagainsttheperceivedoutcome.In

Study1,onesportsmedicineprofessionalsummedupthedilemmacoachesface.

71

[Coaches]don’tnecessarilyworkwiththementalskillsofthesepotentially

atriskindividuals.It’ssomethingthatcoachesmaywishtheycoulddo,but

itendsupbeinglowonthelistofpriorities,andcoachesjustrunoutoftime

toimplementanything.–AUM04

Socialsupportisalsoseenasafactorthatrequiresextratimeforimplementation.

Yangetal.(2010)suggestedthatathleteshaveaneedforemotionalsupport

followinginjury,andtheyfrequentlyturntotheircoachforthissupport.They

mentionedthatathletesfeltitwasespeciallyimportantforasupportertotakethe

timetositdownandlistentothemandofferunderstandingfortheirsituation.

Thistypeofsupportrequirestimeoutsideoftraininginadditiontothemanyother

tasksrequiredofcoaching.Duetotheincreaseddemandoutsideoftrainingtimes,

coachesmayperceivethisasanobstacletoimplementingsocialsupporttotheir

injuredathletes.

Anotherobstacletoimplementinginjurypreventionandmanagementbehaviours

maybelackofknowledgeofhowtoproperlyimplementstrategies.Particularlyfor

InjuryPrevention,educationwasoneofthelowestratedimplementedbehaviours,

despitehavingamuchhigherimportancerating.AsnotedinStudy1,evenamong

eliteswimmingcoaches,theydidnothaveexplicitknowledgeofinjury

managementprogramsinswimming.Manyhadcomeattheirownstrategiesfrom

yearsofpersonalexperience.Forcoacheswhoarerathernewintothefield,they

maynothavetherequisiteknowledgetoimplementtechniques.Iftheydon’thave

personalknowledgeofinjurypreventionandmanagementtechniques,theyareill

equippedtoeducatetheirswimmers.

Personalknowledgealsopertainstomentalskillsuseforpreventionandlong‐

termmanagementofinjury.Arvinen‐Barrow,Penny,Hemmings,andCorr(2010)

investigatedphysiotherapists’useofpsychologicalskillsintheirtreatmentof

injuredathletes,andparallelsfromtheirresultscanbemadetocoaching.Arvinen‐

Barrowetal.reportedthatparticipantsseemedcomfortableusingcommon

proceduressuchasgoalsettingandsocialsupport,buttheywerelesslikelytouse

techniquessuchasimagery,relaxation,orself‐talkduetoalackofexperienceor

knowledgeinthoseareas.Theyalsotendedtorelyon‘gut‐feelings’andexperience

inusingpsychologyintheirpractices.Coachesmayalsoexhibitsimilargapsin

72

knowledgeandexperience,particularlyconsideringthatauniversitydegreeisnot

apre‐requisitetoacquiringcoachingqualifications.Coaches’potentiallylimited

knowledgemaypreventthemfromimplementingpsychologicalskillswiththeir

swimmers,despiteassigningimportancetothosetechniques.

Furthermore,psychologyofinjurycanstillbeglaringlyabsentfromcoachingtexts.

Asrecentlyas2008,onecanfindtextbooksdedicatedtopsychologicalskillsfor

coachingthathavenomentionofinjuryatall(Burton&Raedeke,2008).In

contrast,therehavebeenentirebooksdedicatedtothepsychologyofinjury,

coveringtopicsrangingfrominjurypreventionallthewaythroughrehabilitation

andreturningtosport(Crossman,2001;Heil,1993;DavidPargman,1993).By

omittingpsychologyofinjuryfromcoachingtexts,thereisanimplicitmessagesent

thatthisparadigmisnotimportantforcoaches.Certainly,acoachcannotbe

expectedtohaveasolidgraspofpsychologicalskillsuseforinjurywhenitisnot

includedineducationalmaterialsintendedtoguidetheircoaching.

4.0.8 Swimmers versus coaches

Resultsfromthedataanalysisrevealedthatswimmersratingsofcoach‐

implementedbehaviourswerelowerthantheself‐reportedratingsfromthe

coaches.Onthesurface,thisresultsuggestsoneoftwopossibilities.First,the

swimmershavemadeanaccurateassessmentofcoach‐implementedbehaviours,

andthecoacheshaveover‐reportedthedegreetowhichthey’veenacted

behaviours.Second,perhaps,isthatcoacheshaveaccuratelyassessedtheirown

behaviours,andswimmershavenotrecognisedcoacheffortsininjuryprevention

andmanagement.

Itispossiblethatcoaches’self‐reportsareoverestimated,andswimmer

perceptionsandrecallofcoachbehavioursaremoreaccurate.Inastudy

conductedbySmithandSmoll(1991),theyusedamulti‐methodapproachto

assesscoach‐athleteinteractionswhereintheycomparedobservercodingsof

overtbehaviourswithmeasuresofplayerperceptionandcoachself‐reports.They

foundthatchildren’s(aged6‐18yearsold)ratingsofperceivedcoachbehaviour

werehighlycorrelatedtotheobservedbehaviours.However,coaches’self‐reports

weregenerallylowlycorrelatedornon‐significant.Theysuggestedthatcoaches

maynothaveacomprehensiveawarenessoftheirownbehaviours,andthat

73

athletesmaypossessmuchmoreaccurateperceptionsoftheircoaches.This

relationshipmayalsoholdtrueforresultsofthecurrentstudyofadolescentaged

swimmers(M=16.6,SD=3.54),however,onecannotdrawadefinitiveconclusion

withoutdirect,observationaldata.Whileitiscertainlytemptingtobelievethe

swimmers’data,onemusttakeintoaccounttheevaluativenatureofperception.

Cumming,Smith,andSmoll(2006)suggestthatathletesformperceptionsof

behaviourwithinacontextofexperiences,andpositiveornegativeevaluationsof

thecoachmaypositivelyornegativelyaffectperceivedcoachbehaviours.

Thealternativeexplanationtowhyswimmerperceptionsofcoachbehaviours

weresignificantlylowerthancoachself‐ratingsmaybethatcoachesweremore

accurateintheirself‐reporting,buttheathleteswerenotfullyawareofthe

coaches’behaviour.Fromthisperspective,theresultssuggestthatcoachesmaybe

performinginjurypreventionandmanagementbehaviours,butswimmersarenot

recognisingtheimplementationofthesebehaviours.Particularlyforbehaviours

underLong‐termInjuryManagementandReturntoFullTraining,thisexplanation

seemsplausiblegiventhatmanyoftheswimmersmaynothavesustainedany

long‐terminjuriesatanypoint.Fornon‐injuredswimmers,theIPMP‐Sinstructed

themtoreportonwhattheysawtheircoachdoingforinjuredathletes.Without

first‐handexperience,swimmersmightnotbeabletomakeaclearjudgementof

coach‐implementedbehaviour.Asmentionedearlier,socialsupportbehaviours

mayoccuroutsideoftrainingtimes,andthus,theymaybeoutsideofthe

experienceofnon‐injuredathletes.Similarly,iftheyhaveneverneededto

communicatewithbothasportsmedicineprofessionalandtheircoachinaplanto

returntofulltraining,theymightnotbeabletomakeanaccurateassessmentof

coachbehaviour.Sincethisperceptionisnotbasedonactualexperience,they

mightunderestimatethedegreetowhichtheircoachenactsthosebehaviours.

Whileadefinitiveanswercannotbegivenregardingthedifferencebetween

swimmerperceptionsandcoachself‐reports,itmightbethatbothpossibilitiesare

actingtogether.Coachesmaybeoverestimatingthedegreetowhichtheyenact

behaviours,andswimmersmaybeunderestimatingcoach‐enactedbehavioursdue

toinexperiencewithlong‐terminjury.Fromtheperspectiveoftheathletes,a

perceptionofthelackofinjurymanagementmaybejustasproblematicasifa

coachhasnoplanforinjurypreventionandmanagement.Certainlyconcerning

74

socialsupportofferedbycoachestoinjuredathletes,ithasbeensuggestedthat

regardlessoftheactualsupportgiven,itistheathlete’sperceptionofthatsupport

thathasthegreatesteffectontheirrehabilitationexperience(Clement&Shannon,

2011).Ifacoachhasstrategiestoprovidesocialsupport,buttheirswimmersdon’t

perceivethats/hedoes,theswimmersmaynottrusttheircoachtosupportthemif

theybecomeinjured.Inthissense,itisimportantforthecoachtonotonly

implementinjurypreventionandmanagementbehaviours,buts/healsoneedsto

raiseswimmers’awarenessaboutinjurypreventionandmanagementprotocols.

Alongwithalowerratingforcoach‐implementedbehaviours,swimmersratedthe

importanceofinjurypreventionandmanagementbehaviourssignificantlylower

thancoachesdidfor14outof20variables.Thisisalsothoughttobeduetoalack

ofexperience.Specifically,allvariablesunderLong‐termInjuryManagementwere

ratedassignificantlylessimportantbyswimmersthanbycoaches.Foranadult

coachworkingwithadolescentagedswimmers,thecoachwouldhavemuchmore

personallifeexperienceandmuchmoreswimmingexperiencethantheyouththey

coach.Theywouldhaveabetterunderstandingoftheinherentneedforsocial

supportduringtimesofhardship,andthustheywouldattachmoreimportanceto

thosevariablesthantheirswimmerswould.

WhilecoachesandswimmersdifferedintheirassessmentofimportanceforLong‐

termInjuryManagement,theyrespondedsimilarlyforallthreevariablesunder

Short‐termInjuryManagement:immediateaction,firstaid,andcommunication.

ForShort‐termInjuryManagement,itisthoughtthatthisdiscreteprocesshasonly

asmallnumberofactionpossibilities.Duetothediscretenatureandlimitedscope

ofbehavioursforShort‐termInjuryManagement,itisunderstandablethatcoaches

andswimmerswouldassignsimilarimportancetotheseactions.

Theothervariableswhereswimmersandcoachesreportedsimilarlevelsof

importancewerefortrainingconsiderationsintheInjuryPreventionprocessand

theReturntoFullTrainingprocessandalsoswimmerconsiderationsintheReturn

toFullTraining.Giventhatthecoach’sfirstjobwiththeirathletesistotrainthem

inpreparationforcompetition,itfollowsthattrainingconsiderationsforinjury

preventionandreturntotrainingwouldberatedsimilarlybyswimmersand

75

coaches.Italsofollowsthatbothswimmersandcoacheswouldvalueswimmer

considerationsandfeedbackintheprocesstoreturntotrainingfollowinginjury.

Conclusions

Whilethecurrentstudyhaditslimitations,itoffersinsightintothe

implementationandperceivedimportanceofinjurypreventionandmanagement

behavioursincompetitiveswimming.ResultsoftheIPMP‐Ssuggestagapbetween

perceivedimportanceandreportedimplementationofinjurypreventionand

managementbehaviours.Howdowe,asresearchers,helpcoachesbridgingthe

gapbetweenimplementationandimportance?Futureresearchneedstobedone

toinvestigatestrategiesaimedtoincreasingcoach‐implementationofinjury

preventionandmanagementbehaviours.Thehopewouldbethatbyincreasing

thesebehaviours,coachescanbothpreventmoreinjuriesintheirsquads,andthey

canalsohelpinjuredathletesmanagetheirinjurieswithlesspsychologicaldistress

foraquicker,healthyreturntosport.

Inadditiontothegapbetweenimportanceandbehaviour,thisstudyrevealeda

discrepancybetweencoachself‐reportsandswimmerperceptionsofcoach‐

implementedbehaviours.Whiletheresultscannotdefinitivelydeterminewhether

coachorswimmerreportsweremoreaccurate,futureresearchmayreveal

strategiesforclosingthisgap.Specifically,researchcanintroducecoach

interventionstocreateandimplementinjurypreventionandmanagementplans

withtheirtrainingsquads.Byintroducingacomprehensiveplanforinjury

preventionandmanagement,theguessworkcanberemovedfromtheprocess.

Withgreaterknowledgeofinjurypreventionandmanagementprotocols,

swimmersandcoachescanworktogethertobemoreproactiveaboutpreventing

injuriesandworkmoreeffectivelytomanageinjuryduringtherehabilitation

process.

TheIPMP‐Sisapreliminaryprofilingtoolforcoachesandswimmerstomeasure

theirinjurypreventionandmanagementbehaviours.Anopportunityexistsfor

athleticclubstomeasuretheclimateofinjurypreventionandmanagementwithin

theirclubs.Bymeasuringcoachbehavioursandattitudesandcomparingthemto

76

swimmerperceptionsandattitudes,clubscantakestepstowardscreatinginjury

preventionandmanagementplanswiththeirorganisations.

Inherentintheprocessofresearchinginjurypreventionandmanagement

interventionsisthegreaterdisseminationofknowledgefromresearchtopractice.

Whilethepsychosocialaspectsofinjurypreventionandrehabilitationarewell

supportedinacademicresearch,theseadvancesarenotyetcommonknowledgein

coachingliterature.Howcancoachesbeexpectedtoknowaboutandimplement

injurypreventionandinjurymanagementstrategiesiftextbooksaimedattheir

educationfailtoevenmentionthepsychologyofinjury?Futureresearchcanaim

todesignpracticalstrategiesforcoachestoimplementwiththeirownsquads.

77

Chapter 5

5 Study Three – Coach‐Implemented Injury Prevention and

Management Plan in Competitive Swimming:

Implementation and Evaluation

Introduction

Numerousstudieshavedemonstratedthepositiveeffectsofpsychosocial

protocolsoninjuryprevention(Abernethy&Bleakley,2007;Davis,1991;Pernaet

al.,2003)andinjuryrehabilitationadherence(Evans&Hardy,2002;Scherzeret

al.,2001;Worrell,1992)amongathleticpopulations.Despitefindingssupporting

theefficacyofinterventionstopreventinjuriesandinterventionstomanage

injury,researchhasnotinvestigatedtheefficacyofacomprehensiveprogramthat

worksbothtopreventinjuriesandtomanageinjuriesoncetheyoccur.Ithasbeen

suggestedthatinterventionsneedtobeeffective,buttheyalsoneedtobeeasyto

employ(Hamson‐Utleyetal.,2008).Inaddition,thesestudieshavebeen

implementedandrunbyresearcherswhoworktointervenewithathleticsquads,

buttheroleofthecoachasafacilitatorofinjurypreventionandmanagementhas

notbeeninvestigatedinresearch,thusfar.

Thefirststudy(seeChapter3)inthisthesisinvestigatedwhatleadingcoaches

reportedtheyweredoingtopreventandmanageinjuryincompetitiveswimming,

andthesecondstudy(seeChapter4)wentfurthertoinvestigateperceptionsof

importanceforinjurypreventionandmanagementbehavioursfrombothcoach

andswimmerperspectives.Strikingly,resultsrevealedthatmanyathletesfeelthat

havinganexplicitandinformedinjurypreventionandmanagementplanisthe

responsibilityofthecoachastheyarethe‘go‐to’personwhenanincidenthappens.

Whilstbothcoachesandswimmersvaluetheimportanceofinjurypreventionand

management,theactualimplementationofinjurypreventionandmanagement

plansislacking.Resultsalsorevealedamismatchbetweenswimmerperceptions

oftheircoachesandwhatcoachesreportastheiractionsforinjurypreventionand

78

management.Thedifferencesincoach‐athleteperceptionsareofaconcern

becauseevenifthecoachhasacomprehensiveplan,itcannotbefullyemployedif

itisnotcommunicatedtotheathletes.

Atthispoint,itisunclearwhetheranathlete’sperceptionisanaccuratebarometer

forcoach‐implementedinjurypreventionandmanagementbehaviours.Inorderto

addressthegapsbetweenimportanceandbehaviour,andalsotoaddressgapsin

research,theaimofthecurrentstudywastoimplementandevaluatethe

effectivenessofacoach‐implementedinjurypreventionandmanagementplan.Itis

recognisedthathavinganinjurypreventionandmanagementplandoesnotfully

preventinjuries,butitcanhelptheathletestobebetterpreparedwheninjury

doeshappenandcanminimisetheseverityoftheinjuryandinjuryresponse.

Therefore,thisstudyplacedlessfocusontheactualratesofinjury,butmoreonthe

swimmers’andcoaches’perceptionsoftheirpreparednessindealingwithinjuries

whentheyoccur.Thespecifichypothesesofthisstudywereasfollows:

a. Life event stress would have a positive relationship with injury for both

controlandinterventionclubs.

b. Swimmers in the intervention club will perceive greater implementation

anduseofaninjurymanagementprogramthanswimmersincomparisonto

controlclubs.

Methods

5.0.1 Participants

Onerepresentativeswimclub(N=19swimmers,1coach)fromthePerth

metropolitanareawaschosenasacasestudyforintervention,withtwoadditional

clubs(N=16swimmers,2coaches)actingascontrolcases(seeTable5‐1for

swimmerdemographicinformation).Thelengthoftheinterventionlastedthe

durationofa3‐monthcompetitiveshort‐courseseason.

79

Table5‐1:Swimmerdemographicinformation

Swimmers

Variable Intervention Control

Age(mean SD) 14.63 1.42 17.56 3.85

Gender

male 5 8

female 14 8

CompetitionLevel

state 10 2

nationalage 8 6

nationalopen 1 4

international 0 4

Injuryinpast2years

yes 7 12

no 12 4

Theclubswerechosenfortheirstatusashigh‐performanceclubsinPerth.The

coachesallheldatleastaSilverASCTAcoachinglicense,andtheyhadbeen

coachingfor10yearsormorewiththelastthreeyearsattheircurrentclub.Itwas

importantthatthecoachhadanestablishedsocialconnectionwiththeswimmers

intheirsquadandhadanestablishedmethod(ornon‐method)forpreventionand

managementofinjuries.Theirsquadscontainedmultiplehigh‐performance

adolescentswimmerswhohadcompetedattheNationalAgeChampionshipslevel

orhigher.Theseclubsalsohadsimilartrainingroutinesandvolumestoensurea

moreequivalentcomparisonbetweentheinterventionclubandthecontrolclubs.

Thisleveloftrainingandcompetitionwaschosenbecausethehighertraining

demandsatthislevelofcompetitionputsthematagreaterriskforinjuryand

thereforegreaterneedforinjurypreventionandmanagementstrategies.Currently

injuredswimmerswereexcludedfromparticipationinordertoprevent

discrepanciesinmeasurementreportingiftheircoachchangedinjury

managementprotocolshalfwaythroughrehabilitation.

80

5.0.2 Measures

InjuryReporting

Theprimaryresearchermadeweeklyvisitstothecoachesinvolvedinthestudyto

obtainreportsofinjury.Aninjurywasdefinedasaphysicalproblemthatoccurred

asaresultoftrainingorcompetitionthatlimitedtheswimmerfromtrainingatfull

capacity(e.g.,restedfromtrainingsessions,avoidedcertainstrokesormotions,

usedequipmentaidssuchasakickboardinsteadoffullswimming)formorethan

onedaybeyondtheinjury.Thenatureofcompetitiveswimmingissuchthatifone

sustainsaninjury,thereisalmostalwaysamodifiedactivitythatcanbedoneto

stilltrain.Forexample,ifaswimmersuffersfromongoingshoulderpainto

tendonitis,thatswimmercanmodifytheirtrainingbysupplementingwithfinsuse

ordomorekickingactivitiestoavoidtheoverheadmotionsrequiredoffull

strokes.InjurieswereclassifiedaccordingtoguidelinessetoutbyPowelland

Barber‐Foss(1999)basedoncalendardayslostduetoinjurybutmodifiedto

accountfortheabilityofswimmerstocontinuetotrainwhileinjured,albeitina

modifiedcapacity.Aminorinjurywasonethataffectedtraininglessthan8days,a

moderateinjuryaffectedtrainingbetween8and21days,andamajorinjury

affectedtrainingformorethan21days.

InjuryPreventionandManagementProfileforSwimming(IPMP‐S)

TheIPMP‐SdevelopedinStudy2wasadministeredtwotimestobothswimmers

andcoaches:attheoutsetofthecompetitiveseasonjustpriortothe

commencementoftheinterventionandimmediatelyaftertheinterventionperiod

concluded3monthslater.Thisprofilingtoolenabledtheeffectivenessofthecoach

traininginterventiontobeassessedfortheinterventionsquad.Also,comparisons

weremadebetweentheinterventionsquadandthecontrolsquadstoensurethat

coachchangeswerearesultofthetraininginterventionandnottheresultofother

potentiallyconfoundingvariables.

Long‐termLifeStress

TheLifeEventsSurveyforCollegiateAthletes(LESCA)wasdevelopedbyPetrie

(1992),anditwasadministeredattheoutsetofthecompetitiveseasonasa

baselinelong‐termmeasureoflifestressforathletes.TheLESCAconsistsof69

81

itemswhereathletesareaskedtoindicatewhetheranitemhasoccurredinthelast

12months.Foreacheventthathasoccurred,theyarealsoaskedtoratetheimpact

ofthatlifeeventonan8‐pointLikertscale,from‐4(extremelynegative)to+4

(extremelypositive).ThescoresfromtheLESCAarethendividedintototallife

eventstress,positivelifeeventstress,andnegativelifeeventstress.This

procedurehasbeenusedinseveralotherstudiesincludingusewithadolescent

athletes(Gunnoeetal.,2001).LESCAhasatest‐retestreliabilityrangingfrom0.76‐

0.84(Petrie,1992).

Short‐termLifeStress

TheRecovery‐StressQuestionnaireforathletes(RESTQ‐76Sport)wasdeveloped

byKellmanandKallus(2001)tomeasurethefrequencyofstressorsandrecovery

activitiesofathletesovershorttimeperiods.TheRESTQ‐76Sportwas

administeredat3timepoints:theoutsetoftheseason,halfwaythroughthe

season,andattheconclusionoftheseason.WhiletheLESCAwasadministeredasa

long‐termmeasureoflifeeventstress,thismeasurewasusedtogetanindication

ofshort‐termstressoverthecourseoftheseason.TheRESTQ‐76Sportindicates

thedegreetowhichathletesarephysicallyand/ormentallystressedandwhether

ornottheyareusingindividualstrategiesforrecovery.Participantsrespondto

itemsona7‐pointLikert‐typescaleanchoredfrom0(never)to6(always)

indicatinghowoftentherespondentparticipatedinvariousactivitiesduringthe

pastfewweeks.Nineteensubscalescoreswerederived,whicharefurthergrouped

intofourmajorsubscalegroups:

1. General Stress Subscale (General Stress, Emotional Stress, Social Stress,

Conflicts/Pressure,Fatigue,LackofEnergy,andPhysicalComplaints)

2. General Recovery Activity Subscale (Success, Social Recovery, Physical

Recovery,GeneralWell‐Being,andSleepQuality)

3. Sport‐specific Stress Subscale (Disturbed Breaks, Burnout/Emotional

Exhaustion,andFitness/Injury)

4. Sport‐specific Recovery Subscale (Fitness/Being in Shape, Personal

Accomplishments,Self‐efficacy,andSelf‐regulation)

TheRESTQ‐76sporthasbeenusedwithadolescentathleticpopulationsasa

measureofshort‐termlifestress,andthesubscaleshaveareliabilityrating

82

rangingfrom.67‐.86).(Grobbelaar,Malan,Steyn,&Ellis,2010).Thismeasurewas

administeredpriortotheintervention,halfwaythroughtheintervention,andat

theconclusionoftheinterventioninordertoassessshort‐termstressthroughout

theseason.

SocialSupport

TheSocialSupportSurvey(SSS)(Richman,Rosenfeld,&Hardy,1993)assessesthe

typesanddegreeofsocialsupportthatapersonperceivesaswellasthesourcesof

thissupport,anditwasadministeredattheoutsetofthecompetitiveseasonandat

theconclusion.Forthepurposeofthepresentstudy,aslightlymodifiedversionof

theSSSimplementedbyRees,Hardy,andEvans(2007)thatencouragedathletes

toconsidersupportfromallsources,includingfromtheirsport(e.g.,teammates,

coaches,sportpsychologists).Thismodifiedversiononlychangedthe

introduction,withthewordingforthesupportcontentfactorsremaining

unchangedfromtheoriginal.Foreachsupportcontentfactor,theSSSmeasures

thenumberofpeoplewhoprovidesupportfortheathlete,anditalsomeasures

howsatisfiedtheyarewiththequalityofthatsupportandhowdifficultitwouldbe

toobtainmore.

Interview

Followingtheconclusionofthestudy,apost‐interventioninterviewwas

conductedwiththecoachoftheinterventionsquadtoassessandevaluateher

perceptionoftheeffectivenessofprogram.Thisintervieweewasaskedthe

followingquestions:

1. Whatweresomeofthestrengthsoftheinjurypreventionandmanagement

program?

2. Whatkindsofinjurypatternsdidyounoticewithyourswimmersthrough

theimplementationofyourinjurypreventionandmanagementprogram?

3. Whatcouldbedonetomaketheprogramevenmoreeffective?

5.0.3 Injury Prevention and Management Plan Condition

Priortothecompetitiveseason,theprimaryresearchermetwiththeintervention

coachandcreatedacomprehensiveplantopreventinjuriesandtomanageinjuries

83

if/whentheydidoccur.Thisplanfollowedthecategoricalbehavioursthat

emergedfrompreviousresearch(seeChapters3&4).Specifically,theprimary

researcherandthecoachdiscussedstrategiesrelatedtoInjuryPrevention,Short‐

termInjuryManagement,Long‐termInjuryManagement,andReturntoFull

Training.Whiletheprimaryresearcheraidedthecoachincreatingtheinjury

managementplan,thecoachimplementedallprotocolswithherswimmers.Once

theseasonhadbegun,theprimaryresearchermadeweeklyvisitsinordertocheck

inwiththecoachandadministermeasurementprotocols.Theseweeklyvisits

occurredfortheinterventionsquadaswellasforthecontrols.

InjuryPrevention

Priortothebeginningoftheseason,theprimaryresearcherandtheintervention

coachmetandcreatedaseason‐longplanforinjuryprevention.ThisInjury

Preventionplantookintoaccounttrainingconsiderations,healthconsiderations,

injurypreventioneducation,communication,andmentalskillstraining(seeTable5‐

2).

Table5‐2:Injurypreventionstrategies

Category CoachStrategies

TrainingConsiderations

- Trainingperiodisationplan

- Strengthandconditioningexercises

- Warm‐upandwarm‐downprocedures

- Stroketechniquework

HealthConsiderations

- Pre‐seasonteammeetingondiet,hydration,andsleeppractices

- Dailyemphasisonproperdiet,hydration,andsleep

- Recommendedpre‐seasonhealthassessmentwithasportsphysiotherapist

InjuryPreventionEducation- Pre‐seasonteammeetingdiscussinginjurypreventionandmanagementprotocolswithswimmersandparents

Communication

- Emphasisonopencommunicationwithswimmers

- Initiatedarelationshipwithasportsmedicineprofessionalforreferralofinjuredswimmers

84

MentalSkills

- Goalsetting

- Relaxationtechniques

- Imagery

Fortrainingconsiderations,shecontinuedtoimplementherdry‐landsystemof

lightstrengthandconditioningandjointstabilisationexercisesbasedon

recommendationsputforwardbySwimmingAustralia.Shealsomonitoredstroke

techniqueandequipmentuseinthewater.Usingtheconceptofperiodisation

taughtthroughtheSilverLicenseaccreditationfromtheAustralianSwimCoaches

andTeachersAssociation(ASCTA),wemappedoutaseason‐longtrainingplan

startingfromagradualincreaseintrainingintensityattheseasonoutsetandalso

incorporatingperiodsoflessintensetrainingduringpotentiallystressfultime

pointssuchasschoolexams.

Attheoutsetoftheseason,thecoachhadaneducationalteammeetingwith

swimmersandparents.Thismeetingcoveredinjurypreventioneducationand

healthconsiderations(seeAppendix).Specifically,thismeetingcoveredthe

importanceofdiet,hydration,andpropersleephabits.Italsoincludedspecific

educationastotheprocessofinjurypreventionandmanagement:theimportance

ofconsistentattendancetotraining,aswellastimemanagement,stress

management,andconstantcommunicationwiththecoach.

Aspartofthecommunicationprocess,thecoachwasintroducedtoaleading

swimming‐specificsportsphysiotherapistinhercitywithwhomshecould

communicateandstartaprofessionalrelationship.Thiswasdevelopedsothather

swimmerswouldhaveaconsistentphysiotherapisttovisitandwithwhomshe

couldworkcloselyifanyofherswimmerssustainedaninjury.Swimmers(and

theirparents)weregiventhecontactdetailsofthissportsphysiotherapistinorder

toseehimforapre‐seasonhealthassessment.Becauseofthemonetary

requirementofthisrecommendation,itwasnotcompulsoryforswimmersto

makeanappointmentwiththephysiotherapist,butitwasstronglyencouraged.

Finally,theinterventioncoachcontinuedtooffermentalskillstrainingwithher

swimmers,butsheexpandedfromusingprimarilygoalsettingtoincluding

sessionsonrelaxationtechniquesandimageryinordertodevelopstress

85

managementandcopingskillswithherswimmers.Specificproceduresfollowed

thoseoutlinedinHogg’sbook,MentalSkillsforSwimCoaches(1995).

Short‐termInjuryManagement

ForShort‐TermInjuryManagement,theprimaryresearcherandthecoachcreated

aninjuryactionplanforthefirst3daysfollowinginjury.Thisprocessincluded

immediateactions,firstaid,andcommunication,asillustratedinTable5‐3.

Table5‐3:Short‐terminjurymanagementstrategies

Category Strategies

ImmediateAction

- Determinenatureandcauseofinjury

- Adjustswimmingaccordingtoinjuryparameters

- Filloutinjuryreportformwithswimmer

FirstAid

- AdheretoRICEprinciple(rest,ice,compression,elevation)

- Referinjuredswimmertosportsmedicineprofessional(ifnecessary)

Communication

- Communicatewithswimmeraboutshort‐terminjurymanagementprotocol

- Communicatetoparent(s)aboutinjury

- Communicatewithsportsmedicineprofessional(ifswimmerwasreferred)

Immediateactionsaccountforthefirstactionstakenuponawarenessofaninjury,

suchasdeterminingthenatureoftheinjuryandadjustingtrainingaccordingly.

Alongwithdeterminingthenatureoftheinjury(e.g.,whatisinjured,howdidthe

injuryoccur)andadjustingtraining(e.g.,stoppingtraining,adjustingtraining,

implementingequipmentuselikeakickboard),thecoachwasinstructedto

documenttheinjury.Inordertokeeptrackofallinjuriesthroughouttheseason

andtotracktreatmentgivenandrecommendedfollow‐upswithinjured

86

swimmers,thecoachwasgivenastandardinjuryreportformofferedbySports

MedicineAustralia(SMA)(seeAppendix),whichshefilledoutwiththeswimmer.

Thesecondstepintheshort‐terminjurymanagementplanwastoapplyfirstaid,

whichgenerallymeantadheringtotheR.I.C.E.R.principle(rest,ice,compression,

elevation,andreferraltoasportsmedicineprofessional).Dependingonthe

severityoftheinjury,thecoachwouldrecommendtheappropriateleveloffollow‐

up.Forsomeminorinjuries,R.I.C.E.R.wasnotnecessary.However,forsome

injuries,referraltoasportsmedicineprofessionalwasbothencouragedand

necessary.

Inherentinthisprocess,wasaneedforthecoachandathletetobecommunicating

together.Forplanningpurposes,theprimaryresearcherinstructedthecoachto

createanenvironmentcharacterisedbyopencommunicationwiththeir

swimmers,andencouragementtoswimmerstoopenlycommunicatewiththem

(Udry,1997).Communicationalsoincludedcommunicatingwithparentsviadirect

personalconversationsorthroughemailastothedetailsoftheirchild’sinjury

reportandthetreatmentrecommendedforthatinjury.

Long‐terminjurymanagement

ForLong‐termInjuryManagement,theinterventioncoachwasinstructedinthe

differentlevelsofsocialsupportandhowtoappropriatelyadministerthemfor

injurymanagement,asdelineatedinStudy1andStudy2(seeTable5‐4).

Thefirsttwolevelsofsupportweretrainingsupportandsocialintegration.In

otherwords,thecoachwouldcreateamodifiedtrainingplanfortheswimmerthat

wouldtakeintoaccountinjurylimitationsandalsoaimtokeeptheswimmer

sociallyconnectedtotheirtrainingsquad(e.g.,modifiedsetsinthesamelanesas

theirteammates,opportunitiesforon‐deckassistance).Wereaswimmerto

sustainaninjury,thisprocesswouldalsorequireinvolvementoftheathletein

creatingthemodifiedtrainingplanandcomingupwithstrategiestostay

connectedwiththeirteammates.

Thesecondtwolevelsofsocialsupportwereesteemsupportandemotionalsupport

fortheinjuredswimmer.Thecoachwasinstructedintheimportanceofmotivating

87

theswimmerandofferingthemencouragementintheirrecoveryprocess.In

additiontoencouragement,thecoachwasavailabletoofferbasicemotional

supportbyofferingalisteningearorconveyinganunderstandingthattheathlete

mighthavenegativeemotions.Thisdidnotmeanfixingtheproblemnecessarily,

butacknowledgingthattheswimmermightbehavingadifficultemotionaltime.

Thenexttypeofsupportthecoachprovidedwasbasiceducationalsupport.

Particularlyforathleteswhohaveneversustainedaninjury,theymayneedtobe

taughttheprocessofinjuryrehabilitation,maintaininghealth,andtrainingwhile

injured.Byeducatingthemabouttheprocess,injuredathletesmayexperienceless

anxietythaniftheyhavenoknowledgeorcontrolovertheirinjury(Heil,1993).

Table5‐4:Long‐terminjurymanagementstrategies

Category Strategies

TrainingSupport

- Providedtechniqueassessments

- Createdamodifiedtrainingplanincorporatinginjurylimitations

SocialIntegration

- Keptswimmerattachedtotrainingsquad

- Encouragedswimmertocontinuetoattendtrainingtostayincontactwithteammates

- Hadswimmerassistwithon‐deckactivities

- Organisedsocialeventsoutsideoftraining

EsteemSupport

- Offeredencouragement

- Motivatedswimmer

- Believedinswimmer

EmotionalSupport

- Providedemotionalsupport

- Providedlisteningsupport

- Keptapositiveattitude

- Remainedpatientwithswimmer

EducationalSupport- Educatedswimmeraboutrehabilitationprocess

- Educatedswimmeraboutmaintaininghealth

SupportNetwork

- Referredtosportpsychologist(ifnecessary)

- Encouragednetworksupport(friends,teammates,family)

- Encouragedtrustinsupportfromsportsmedicineprofessional

88

Communication

- Encouragedopencommunicationwithswimmer

- Communicatedwithparentsaboutinjuryandprogress

- Communicatedwithsportsmedicineprofessionalaboutinjuryandprogress

MentalSkillsTraining

- Implementedgoalsetting

- Implementedimagerytechniques

- Implementedrelaxationtechniques

Finally,whilethecoachwasabletoprovidesomesocialsupport,shecouldnotand

shouldnotbethesoleproviderofsupportforaninjuredathlete.Assuch,thecoach

encouragedtheathletestoextendtheirnetworksofsupporttoincludefriends,

teammates,and/orfamily.Theywerealsoencouragedtotrustthesupportoffered

bytheirsportsphysiotherapist(orothermedicalprovider).Thecoachinthisstudy

wasalsogivencontactdetailsofasportpsychologistsothattheyhadaready

contactreferralfortheinjuredswimmer.Withtheabovestrategiesinplace,the

coachdidnotfeelshehadtodoeverythingorbeeverybodyfortheathlete.She

activelyencouragedtheathletestoproactivelyhelpthemselvestoincreasetheir

ownsocialsupportnetworks.

Followingfromthedifferentlevelsofsocialsupport,thecoachwasencouragedto

keepanopenlineofcommunicationwiththeswimmerandtheirsportsmedicine

provider.Also,ifappropriate,thecoachwasencouragedtokeepanopenlineof

communicationwithparents,particularlyiftheathletewasstilllivingathome.

Thecoachwasalsoinstructedtocontinuethementalskillstrainingofferedaspart

ofinjuryprevention.Thesementalskills,includinggoalsetting,relaxation

techniques,andimagery,weremodifiedtoaddressthenewdemandsofinjury

rehabilitation.Inthisway,injuredswimmerswereencouragedtobeactiveintheir

ownrecoveryundercoachsupport.


Theinterventioncoachwasinstructedinaprocessfortransitioninganinjured

swimmertofulltrainingfollowinglong‐termrehabilitation.AsillustratedinTable

5‐5,thefirstconsiderationwastotraining:thecoachprogressivelyincreasedthe

89

trainingloadandcontinuallymonitoredtheprogressoftheathlete.Nextinthis

processwastotakeintoaccountswimmerconsiderations,includingincreasing

trainingbasedonswimmers’reportsofpainlevelsandswimmerfeedback.

Intuitively,thecoachalsoreliedonfeedbackfromthesportsmedicineprofessional

treatingtheinjuredathlete.Forexample,trainingwasnotbroughtbacktopre‐

injurylevelswithoutclearancefromthesportsmedicineprofessional.Finally,

giventhatinjuriesmaycauseanxietyanddistress,thecoachmonitoredthe

confidencelevelsoftheirinjuredswimmer,andonlyincreasedtrainingwhenthey

andtheirathletefeltcomfortablewiththeincrease.Mentalskillsusedforlong‐

terminjurymanagementwerecontinuedasapartofthisprocess.

Table5‐5:Returntofulltrainingstrategies

Category Strategies

Trainingconsiderations- Progressivelyincreasedtrainingload

- Continuallymonitoredtrainingprogress

SwimmerConsiderations

- Increasedtrainingbasedonswimmerpain

levels

- Increasedtrainingbasedonswimmer

feedback

Medicalconsiderations

- Increasedtrainingonlywhenmedically

cleared

- Increasedtrainingbasedonsportsmedicine

professionalfeedback

Confidenceconsiderations- Helpedswimmermanageanxiety

- Helpedswimmerbuildconfidence

5.0.4 Data analysis

Inordertodeterminetheexistenceofapredictiverelationshipbetweenlifestress

andinjury,alogisticalregressionanalysiswasperformedusingfactorsfromthe

LESCAandfromtheRESTQ‐76Sport.WhiletheSSSwasintendedforinclusionin

90

thisanalysis,therewereparticipanterrorsincompletingthequestionnairetothe

degreethatitwasnotpossibletousethedata.

TheIPMP‐Swascompletedbyswimmerspriortotheinterventionandatthe

conclusionofthestudytoassesstheirperceptionsofcoach‐implementedinjury

preventionandmanagementbehaviours.Inordertodeterminetheeffectsofthe

interventiononswimmerperceptions,aseriesofsplitplotanalysisofvariance

(SPANOVA)testswereperformed.

Finally,thecoachoftheinterventionsquadwasinterviewedattheconclusionof

thestudyforherperceptionsoftheintervention’seffectiveness.Asummaryofher

responseshasbeenincludedinthediscussionsectionforasubjectiveviewonthe

effectivenessoftheinjurypreventionandmanagementintervention.

Results

5.0.5 Life stress‐injury relationship

Throughoutthecourseoftheintervention,therewerefewinjuriesreported

amongtheinterventiongroupandthecontrolgroup.Theinterventiongroup

reportedfiveinjuriesfromfiveseparateswimmersoutofthe19participants.Four

oftheseinjurieswereminor,andoneinjurywasclassifiedasmoderate(see

section5.1.2forinjuryclassifications).Outof16participantsinthecontrolgroup,

sixswimmerssustainedatotalofseveninjuries.Twoathletessustainedmajor

injuries,threeathletessustainedminorinjuries,andoneathletesustainedtwo

differentminorinjuriesatdifferenttimesduringtheseason.Oftheminorinjuries,

fourwereforshoulderjointpain,twowereforkneejointpain,andonewasfor

lowerbackpain.Theseinjuriesweremanagedwithmodifiedtrainingforlessthan

oneweekanddidnotrequirereferraltoasportsmedicineprofessional.Theonly

injurythatresultedintimeawayfromtrainingwasalaceratedcheekrequiring

stitchesasaresultofaheadoncollisionwithanotherswimmer.Themoderate

injurywasshoulderpainclassedasminortendonitisbythephysiotherapist,and

thepainwasresolvedafterthreeweeksofmodifiedswimmingandinjury

management.Thetwomajorinjurieswerebothclassedasshouldertendonitis,and

bothswimmerswereinvolvedinongoingtreatmentwithphysiotherapistsand

ongoingmodifiedtrainingwithintheirsquads.

91

Becauseofthesmallnumberofinjuries,alogisticalregressionwasdoneforall35

swimmersasawholetodetermineiftherewasapredictiverelationshipbetween

lifestressandinjuryoccurrence.Similarly,allinjuriesweregroupedtogetherfor

analysis.Inotherwords,swimmerswereeitherclassifiedashavingsustainedan

injuryornotsustaininganinjury,buttheywerenotclassifiedaccordingtothe

severityofinjury.Atotalofeightfactorswereenteredintothelogisticalregression

analysis,includingthreefactorsfromtheLESCA:totallifeeventstress,positivelife

eventstress,andnegativelifeeventstress.Theremainingfivefactorswerefrom

theRESTQ‐76Sport,includingtotalstress,generalstress,generalrecovery

activity,sport‐specificstress,andsport‐specificrecovery.Allinjuriesbutone

occurredinthefirsthalfoftheseason,soresultsfromtheRESTQ‐76atthemiddle

oftheseasonandattheendoftheseasonwerenotincludedinanalysissince

stressafterinjurycouldnotbeapredictorofinjury.Atestofthefullmodelagainst

theconstantmodelwasnotstatisticallysignificant,indicatingthatlifestressdid

notreliablydistinguishbetweenswimmerswhosustainedaninjuryandthosewho

didnot(chi‐square=11.397,p=.122,withdf=7).

5.0.6 Intervention versus control

SPANOVAresultsaresummarisedinTable5‐6.Forthemajorityofitemstherewas

nosignificantmaineffectfortime(pre‐versuspost‐intervention),nomaineffect

fortreatmentlevel(interventionversuscontrol),andnointeractioneffectfortime

andtreatmentlevel.UnderShort‐termInjuryManagement,therewasasignificant

maineffectfortreatmentlevel[F(1,33)=4.590,p<.05]forfirstaidbehavioursand

aninteractioneffectbetweentimeandtreatment[F(1,33)=4.653,p<.05].Follow‐

upt‐testsandrevealedtheinterventiongrouphadasignificantlylowerresponse

thanthecontrolgrouponthepost‐interventionresponseforfirstaidbehaviours

[t(33)=‐3.193,p<.01].UnderLong‐termInjuryManagement,therewasasignificant

maineffectfortime[F(1,33)=5.950,p<.05]fortrainingconsiderations.Follow‐up

t‐testsrevealedthecontrolgroupresponsestotrainingconsiderationswere

significantlyhigherpost‐interventionthantheywerepre‐intervention

[t(33)=4.865,p<.05].UnderReturntoFullTraining,therewasasignificant

interactioneffect[F(1.33)=9.098,p<.01]formedicalconsiderations.Follow‐upt‐

testsrevealedtheinterventiongroupswimmersrespondedsignificantlylower

92

thancontrolgroupswimmersonthepre‐interventionresponsesformedical

considerations[t(33)=‐3.617,p<.01].

93

Table 5‐6: SPANOVA results comparing interventionwith control swimmers on pre‐ andpost‐interventionresponsestotheIPMP‐S

InterventionSwimmers ControlSwimmers

Pre‐

interventionPost‐

intervention Pre‐

interventionPost‐

intervention

IPMPcategory Mean SD Mean SD Mean SD Mean SDInjuryPrevention

Trainingconsiderations 4.06.60 4.16.44 4.20.57 4.27.48Healthconsiderations 3.59.87 3.46.90 3.30.93 3.41.78Preventioneducation 3.04.76 3.07.94 3.131.00 3.45.75

Communication 4.10.61 3.86.65 4.06.86 4.06.57Mentalskillstraining 3.761.07 3.381.05 3.261.04 2.93.83

Short‐TermInjuryManagement

Immediateactions 3.89.51 3.76.52 3.76.46 3.71.62Firstaid 3.51.85 3.09.70** 3.60.63 3.83.66**

Communication 3.45.70 3.37.63 3.34.61 3.38.72Long‐TermInjuryManagement

Trainingsupport 3.49.76 3.66.63 3.55.68* 3.84.59*Socialintegration 3.29.65 3.26.54 3.31.63 3.45.41Esteemsupport 3.91.74 3.98.52 4.02.74 3.99.61

Emotionalsupport 3.86.75 3.91.66 3.83.89 3.91.44Educationalsupport 3.34.83 3.37.69 3.41.93 3.34.73

Networksupport 3.42.84 3.45.90 3.38.87 3.391.06Communication 3.54.77 3.61.56 3.55.84 3.53.83

Mentalskillstraining 3.75.98 3.461.03 3.55.89 3.24.82ReturntoFullTraining

Trainingconsiderations 3.64.77 3.78.56 3.70.76 3.64.61Swimmerconsiderations 3.82.90 3.64.83 3.58.58 3.75.52Medicalconsiderations 2.681.04** 3.131.27 3.84.81** 3.881.02

Confidenceconsiderations 3.821.02 3.711.00 4.13.74 4.00.63*denotesp<.05,**denotesp<.01

5.0.7 Swimmers versus coaches

Tocompareswimmers’perceptionsofchangepre‐topost‐interventiontocoach

self‐reports,differencescoreswerecalculatedbysubtractingthepre‐intervention

responseontheIPMP‐Sfromthepost‐interventionresponseforeachbehaviour.

Onceadifferencescorewasobtained,aseriesofone‐samplet‐testswererunusing

coachresponsesasthenullvalueforcomparisontoswimmerresponsesforthe

interventiongroupandforthecontrolgroup.Resultsfortheinterventiongroup

aresummarisedinTable5‐7.Swimmersratingsofchangeweresignificantly

differentfromcoachratingsfor11outof20variables.Resultsforthecontrol

94

grouparesummarisedinTable5‐8.Inthecontrolgroup,swimmers’ratingswere

significantlydifferentthancoachratingsfor5outof20variables.Agraphical

representationoftheresultsforInjuryPreventionandShort‐termInjury

ManagementcanbeseeninFigure5‐1,andLong‐termInjuryManagementand

ReturntoFullTrainingcanbeseeninFigure5‐2.

Table5‐7:One‐sample t‐testcomparisonsbetween interventionsquadswimmers’changesinratingsontheIPMP‐Sfrompre‐topost‐interventionandcoachchangesinratings

IPMPcategory Swimmers Coach

InjuryPrevention ChangeMeanSD Changevalue t‐valueTrainingconsiderations 0.10.54 ‐0.14 1.981Healthconsiderations ‐0.13.84 0.80 ‐4.800***Preventioneducation 0.031.02 0.75 ‐3.102**

Communication ‐0.25.74 0.17 ‐2.436*Mentalskillstraining ‐0.381.03 0.20 ‐2.439*

Short‐TermInjuryManagement Immediateactions ‐0.13.54 0.33 ‐3.704**

Firstaid ‐0.421.02 1.00 ‐6.080***Communication ‐0.08.51 ‐0.20 0.983

Long‐TermInjuryManagement Trainingsupport 0.16.56 ‐0.40 4.383***Socialintegration ‐0.03.55 0.13 ‐1.260Esteemsupport 0.07.60 ‐0.17 1.683

Emotionalsupport 0.04.71 0.00 0.257Educationalsupport 0.03.73 0.20 ‐1.004

Networksupport 0.03.52 0.67 ‐5.332***Communication 0.07.74 0.00 0.390

Mentalskillstraining ‐0.29.85 ‐0.40 0.552ReturntoFullTraining

Trainingconsiderations 0.13.54 ‐1.00 9.203***Swimmerconsiderations ‐0.17.56 0.25 ‐3.281**Medicalconsiderations 0.451.07 ‐1.00 5.919***

Confidenceconsiderations ‐0.11.98 ‐0.50 1.756*denotesp<.05,**denotesp<.01,***denotesp<.001

95

Table 5‐8: One‐sample t‐test comparisons between control squad swimmers’ changes inratingsontheIPMP‐Sfrompre‐topost‐interventionandcoachchangesinratings

IPMPcategory Swimmers Coach

InjuryPrevention ChangeMeanSD Changevalue t‐valueTrainingconsiderations 0.07.51 0.43 ‐2.795*Healthconsiderations 0.111.16 0.30 ‐0.648Preventioneducation 0.33.98 0.38 ‐0.192

Communication 0.00.59 0.25 ‐1.686Mentalskillstraining ‐0.331.16 0.10 ‐1.499

Short‐TermInjuryManagement Immediateactions ‐0.05.58 ‐0.17 0.795

Firstaid 0.22.67 0.17 0.336Communication 0.03.51 ‐0.10 1.033

Long‐TermInjuryManagement Trainingsupport 0.29.52 ‐0.10 2.973**Socialintegration 0.15.61 0.25 ‐0.683Esteemsupport ‐0.03.78 0.33 ‐1.851

Emotionalsupport 0.09.75 0.30 ‐1.131Educationalsupport ‐0.081.04 0.10 ‐0.676

Networksupport 0.01.90 0.17 ‐0.696Communication ‐0.02.74 0.38 ‐2.115

Mentalskillstraining ‐0.31.99 0.70 ‐4.100**ReturntoFullTraining

Trainingconsiderations ‐0.06.59 0.88 ‐6.377***Swimmerconsiderations 0.17.71 0.38 ‐1.152Medicalconsiderations 0.03.96 0.50 ‐1.959

Confidenceconsiderations ‐0.13.76 0.75 ‐4.583****denotesp<.05,**denotesp<.01,***denotesp<.001

96

^denotesp<.05forcontrolgroupswimmers’comparedtocoaches’ratingsofchangefrompre‐topost‐intervention.*denotesp<.05,**denotesp<.01,and***denotesp<.001forinterventiongroupswimmers’comparedtocoaches’ratingsofchangefrompre‐topost‐intervention.IP=InjuryPrevention:IPtrain=trainingconsiderations,IPhealth=healthconsiderations,IPed=education,IPcomm=communication,IPment=mentalskillstraining.ST=Short‐termInjuryManagement:STimm=immediateactions,STaid=firstaid,andSTcomm=communication.Figure5‐1:Summaryofone‐samplet‐testsforchangesinscoresontheIPMP‐Sfrompre‐topost‐interventionforInjuryPreventionandShort‐termInjuryManagementBehaviours.

‐1.10

‐0.90

‐0.70

‐0.50

‐0.30

‐0.10

0.10

0.30

0.50

0.70

0.90

1.10

IPtrain^ IPhealth*** IPed** IPcomm* IPment* STimm* STaid*** STcommControlcoach Interventioncoach Controlswimmers Interventionswimmers

97

^^denotesp<.01,^^^denotesp<.001forcontrolgroupswimmers’comparedtocoaches’ratingsofchangefrompre‐topost‐intervention.**denotesp<.01and***denotesp<.001forinterventiongroupswimmers’comparedtocoaches’ratingsofchangefrompre‐topost‐intervention.LT=Long‐termInjuryManagement:LTtrain=trainingconsiderations,LTsoc=socialintegrationsupport,LTest=esteemsupport,LTemo=emotionalsupport,LTed=educationalsupport,LTnet=networksupport,LTcomm=communication,LTment=mentalskillstraining.RT=ReturntoFullTraining:RTtrain=trainingconsiderations,RTswim=swimmerconsiderations,RTmed=medicalconsiderations,andRTconf=confidenceconsiderations.Figure5‐2:Summaryofone‐samplet‐testsforchangesinscoresontheIPMP‐Sfrompre‐topost‐interventionforLong‐termInjuryManagementandReturntoFullTrainingbehaviours

‐1.10

‐0.90

‐0.70

‐0.50

‐0.30

‐0.10

0.10

0.30

0.50

0.70

0.90

1.10

Controlcoach Interventioncoach Controlswimmers Interventionswimmers

98

5.0.8 Coach evaluation

Inthepost‐interventioninterview,thecoachfromtheinterventionsquad

respondedwiththefollowingthemesontheefficacyoftheinjurypreventionand

managementplan:increasedpriorityofinjurypreventionandmanagement,

heightenedawarenessoftheprocessbothforherandforherswimmers,and

increasedaccountabilityandresponsibilityforherandherswimmersinmanaging

injury(seesection5.3forfulldiscussionoftheinterview).

Discussion

5.0.9 Life event stress and injury

Inthecurrentstudy,theresultsofthelogisticalregressionanalysisindicatedthat

bothlong‐termandshort‐termlifestresswerenotsignificantpredictorsofinjury

amongtheswimmers.Itisunclearastothelackofrelationshipfoundinthisstudy.

Numerousstudieshavefoundalinkbetweenhigherlifeeventstressandinjury

rate(Maddison&Prapavessis,2005;Rogers&Landers,2005;R.E.Smithetal.,

1990),andtheLESCAhasbeenusedasavalidandreliabletoolformeasuring

majorlifeeventstresstodeterminealinkbetweenlifestressandinjury(Gunnoe

etal.,2001;Petrie,1992).Measuresofminorlifestresshavealsobeenshowntobe

significantpredictorsofinjury(Fawkner,McMurrary,&Summers,1999;Ivarsson

&Johnson,2010),andtheRESTQ‐76Sportisavalidandreliabletooltomonitor

theshort‐termpsychosocialstatesofathletes(Grobbelaaretal.,2010;Kellmann&

Kallus,2001).However,thelifestress‐injuryrelationshiphasnotbeenfoundtobe

universalinallsituations,withsomestudiesfindingnorelationshipwithmajorlife

events(Rider&Hicks,1995;Williamsetal.,1986)orwithminorlifeevents

(Hansonetal.,1992;R.E.Smithetal.,1990).Forexample,Williamsetal.(1986),

speculatedthatthenon‐contactnatureofvolleyballmayhavemadeitdifficultto

determineapredictiverelationshipbetweenlifestressandinjuryintheirstudy.

Thisfindingmayberelevanttothecurrentresearchaswell.Swimmingisanon‐

contactsport,andassuch,itcarriesalowerinjuryriskthancontactsports.The

resultisasmallnumberofinjuriesamongtheparticipants(12injuriesoverthe

courseof3months).Withsuchasmallnumberofinjuries,itisdifficultto

determineapredictiverelationshipbetweenlifeeventstressandinjury.

99

Oneexplanationforthesmallnumberofreportedinjuriesmaylieinhowinjury

wasclassifiedforthisstudy.Perhapstheinjuryreportingmethodwasnot

adequatefortheuniquenatureofswimming.Overuseinjuriessuchastendonitis

arethemostcommontypesofinjuriesinswimming(Gaunt&Maffulli,2011).A

typicalcharacteristicofanoveruseinjuryisthattheonsetcanbequitegradual

(e.g.,aniggle)butcangetquiteseriousifleftunmanaged.Thereisthelikelihood

thattendonitisrarelygetsacteduponatitsoutset,butonlyreceivesattention

whenthepainissobadthatitcannolongerbeignored.Itispossiblethata

numberoftheathletesinthisstudywerecarryinginjuriesdespitenothavingto

modifytheirtrainingbehaviourorseeasportsmedicineprofessionalfor

treatment.InSeinetal.’s(2010)surveyof80youngeliteswimmers(aged13‐25),

64outofthe80reportedshoulderpainwithswimmingactivity.Amongthose

reportingpain,25feltpainonamonthlybasis,22onaweeklybasis,14onadaily

basis,and3swimmersreportedalwaysfeelingpain.Fifty‐twoofthe80swimmers

werefurtherexaminedwithaMRI,andtheresultsrevealedthat69%showed

supraspinatoustendinopathy.

Itcouldbethatswimmersinthecurrentstudywerenotreportinginjuriesbecause

injuriesweren’tbeingrecognisedduetotheswimmers’abilitytocontinue

training.Theywerestillabletocompletetheentiresession,unmodified,butthey

mayhavebeenswimmingundersomeamountofpain.Infuture,amoreadequate

reportingsystembasedonamoreapplicabledefinitionofwhatconstitutesan

injuryshouldbeappliedtothesportofswimmingsoearlyinjuriesarenotmissed.

Thesuggestionwouldbetohaveaninjuryreportformthattakesintoaccounta

dailypainratingscaleasopposedtoascalethatonlytakesintoaccounttheability

toperformallsportingactions.Perhapsaninjuryshouldbelabelledasaphysical

ailmentthatimpedesone’sabilitytoadequatelyperformathleticmovements

withoutpainorrestriction.Withanimprovedinjuryreportingsystem,itmaybe

thatarelationshipbetweenshort‐termorlong‐termlifestressandinjury

occurrencecouldbedetected.

5.0.10 Injury prevention and management plan intervention

SPANOVAresultssuggestthatswimmersintheinterventionsquaddidnot

perceiveachangeincoach‐implementedinjurypreventionandmanagement

behaviourasaresultoftheintervention.Inotherwords,theinterventionhadno

100

observableeffectontheswimmers.Itseemsthattheathletesdidnotassociatethe

coach’sbehaviouroractivitiesimplemented,anumberofwhichwerequite

explicit,aspartoftheinjurypreventionandmanagementstrategy.Itisunclear

whythisresultmighthaveoccurred.Previousresearchcomparingathletes’

perceptionsofcoachbehaviourscomparedtoself‐reportedcoachbehaviourshave

revealedathleteperceptionstobemoreaccuratewhencomparedtoobserver

ratings(R.E.Smith&Smoll,1991).However,giventheobservationalknowledgeof

theprimaryresearcherinthecurrentstudy,theself‐reportedbehavioursofthe

interventioncoachweredeemedtobemoreaccuratethantheswimmers’

perceptions.

Astowhytheswimmersdidnotperceivethechangesinbehaviour,therearea

numberofpossibilities.Thefirstpossibilityisthattheswimmersdidnotnotice

injurymanagementbecausetheyweren’tinjured.Theywouldnothavenoticed

Long‐termInjuryManagementbehavioursbecausethereweren’tanylong‐term

injuriesintheinterventionsquad.Forsimilarreasons,theywouldnothave

noticedstrategiesfortheReturntoFullTrainingsincenolong‐terminjured

athleteswouldhavemadethistransition.However,thisargumentdoesnotexplain

thefactthatswimmersdidnotnoticeInjuryPreventionorShort‐termInjury

Managementbehaviours.

Giventhattheresearchercontributedinthedesign,implementation,and

monitoringoftheinjurypreventionandmanagementprotocol,theresearcherwas

abletocontroltheamountandqualityofinjurypreventionandmanagement

activities.Assuch,theresearcherhadfirst‐handknowledgethecoachactually

implementedprotocolswithherswimmers,suchasteameducationsessionsfor

injurypreventionattheoutsetoftheseasonaswellasongoingmentalskillsand

copingskillseducationandusagethroughouttheseason.However,theswimmers

didnotsubsequentlyratetheircoachashavingdonemoreoftheinjuryprevention

andmanagementbehavioursfollowingtheintervention.Arguably,someofthe

strategieswerestillbehindthescenes.Theswimmerswouldnotknowthattheir

coachhadformedaprofessionalrelationshipwithalocalphysiotherapist,other

thanbymakingtheconnectionthatshereferredtothisspecificphysiotherapistas

thesquad’spointofreferralforallinjuriesinherinjurypreventionand

managementplanattheoutsetoftheseason.Theymayalsonothavebeen

101

perceptiveenoughtoknowthatthecoachhadaseason‐longtrainingplanwith

specificstrategiestobeawareofstressfultimesintheathletes’lives.They

probablywouldtakeitforgrantedthattrainingwasslightlyeasierduringexam

periods,andtheymightnotequatethiswithaninjurypreventionstrategy.

Furthermore,swimmersmayhaveperceivedtheinjurypreventionstrategies,but

notinthecontextofinjuryprevention.Becausethefocusoftheathleteison

competitionandtraining,theymightlookateverythingthroughthosecoloured

lenses.Particularlyforthoseathleteswhodidnotsustaininjuries,thisseemslikea

plausibleexplanation.Theymayhaveseenmentalskillstrainingorstrengthand

conditioningasstrategiestoenhanceperformanceratherthanasinjury

preventionstrategies.Whilethesestrategiesdidfulfilbothroles,theswimmers

mightnothaveperceivedthenuanceofinjuryprevention.However,hadthese

behavioursbeenaskedunderthecontextofperformancestrategy,theymighthave

recalledthattheircoachimplementedparticulartrainingstrategiestoaddress

issuessuchashealth,education,andmentalskills.

Thequestionisraised,then,isitnecessaryforswimmerstoperceivetheircoachto

beperformingallaspectsofaninjurypreventionandmanagementprogramin

orderforthatprogramtohavethedesiredeffectofloweringinjuryrateand

increasinginjurymanagementcapability?Orisitsufficientfortheswimmersjust

tofeelliketheircoachcaresaboutpreventinginjury,hasanopenlineof

communicationforaswimmertoapproachthemiftheygetinjured,andthatthey

willsupportanyswimmerwhosustainsaninjury?Doestheswimmerneedtobe

awareofalltheinsandouts,ordotheymerelyneedtohaveasensethattheir

coachisincontrolandhasaplan?

Researchintocoach‐athletedyadshasshownthatanathlete’sconfidenceintheir

coach’sabilityandtheircoach’ssupporthasanincreasedeffectonthedegreeof

relationshipcommitment,perceptionsofcloseness,andsatisfactionperceptions

(Jackson,Grove,&Beauchamp,2010;Jackson,Gucciardi,&Dimmock,2011).In

turn,thesefactorscanaffectanincreaseineffortandlongevityinthesport.In

otherwords,whenanathleteperceivestheircoachtocommunicatewell,support

them,andhaveclearplansfortrainingandperformance,thentheathleteworks

harderandfeelsbetterabouttherelationship.Whileacoachmayormaynothave

102

themostefficientormosteffectivetrainingplan,itmaybeenoughthatanathlete

perceivesthemtobedoingagoodjobtoaffectincreasedeffortandsatisfactionin

theirsport.Perhapsforinjurypreventionandmanagement,theswimmersdonot

needtoknowtheintricaciesoftheircoach’sstrategies,buttheyonlyneedtotrust

thattheircoachhasaplanfortheathletetoexperiencethepositiveeffectsof

injurypreventionandmanagement.

5.0.11 Coach evaluation

WhiletheSPANOVAresultssuggestedtheinterventiondidnothaveaneffecton

swimmerperceptionsofcoach‐implementedinjurypreventionandmanagement,

theirswasnottheonlyperspectiveontheefficacyoftheintervention.Afterthe

conclusionoftheintervention,theprimaryresearcherconductedaninterview

withtheinterventioncoachtodetermineherperceptionoftheintervention.

Question1:Whatweresomeofthestrengthsoftheinjurypreventionand

managementprogram?

Judgingfromherresponse,theinterventioncoachfelttheprogramwaseffectiveat

helpingherpreventandmanageinjuryinhersquad.Specifically,shefeltthat

havinganinjurypreventionandmanagementplanmadehermoreawareofher

behaviourandtheinjurymanagementprocess,anditwasparticularlyimportant

tohaveawrittenrecordofinjuryoccurrenceinordertohaveapreciseplanof

progressandfollow‐upwiththeathlete,theirparents,andthesportsmedicine

professionalAssheputit:

WellnumberoneitmademeveryawarebecausepriortothatIwasdoing

everythingverbally–makingverybriefnotes,thattobehonest,I

sometimesalwaysdidn’tfindwhereIputthem.Soyoubroughtthattomy

attentionthat,youknow,itwaswrittendown,itwascompletedbythe

athleteandbyme.Ihadarecordofit.Theathletehadarecordofit.Andso,

thereforedealingwiththeathlete,dealingwiththeparents,dealingwith

thehealthprofessional,madeitallveryclear.AndI,Ithinkitbroughtit

hometometoo,howimportantitwas.

DespiteevidencefromtheIPMP‐Sresults,sheseemedtothinkthatby

implementingtheinjurypreventionandmanagementintervention,theprocess

103

“madetheswimmers,theathletesmoreaware”.Furthermore,itincreased

swimmeraccountabilityandresponsibilityinpreventingandmanaginginjury,and

shefeltitreducedthelikelihoodthataswimmermight“fakeaninjury”togetout

ofworkinghard.Inherwords,

Ithinksometimesthere’sabitoffoxing.Andthat’sthehardestthingasa

coach,toworkoutwhat’sthetruthandwhat’salittlebendingofthetruth.

Sohaving[aninjurymanagementprocess]certainlyhelpedmebecauseI

hadtobemoreawareandmorehonest.Butalsotheathleteshadtobeabit

morehonestandabitmoreupfrontratherthanIjustwanttogetoutof

training,sortofthing.SoIthinkithadatwo‐wayeffect.…Youknow,it’sthe

sameoldstory,whenit’sinawrittenform,you’remoreaccountable,more

responsible.

Question2:Whatkindsofinjurypatternsdidyounoticewithyourswimmersthrough

theimplementationofyourinjurypreventionandmanagementprogram?

Alongwiththeaddedresponsibilityandaccountability,theinterventioncoachalso

sawachangeintheinjurypatternsofherswimmers.Accordingtoher

observations,she“[felt]likewehadalotmoreminorinjuries,butIdidn’tseeany

majorinjuriesthisseason”.Byencouragingcommunicationandproactive

behaviourattheonsetofpain,shealsoobservedthat“wecaughtthesethingsearly

on,andthekidsdidn’twaituntilthingsweretoobigtotellme”.Certainly,asa

coach,itwouldbemucheasiertomanagemoreminorinjurieslastinglessthanone

weekbutfewermajorinjuries,thantohavefewerreportedminorinjuriesbut

moreswimmerswhorequirelong‐terminjurymanagementoverweeksand

monthsofrecovery.

Question3:Whatcouldbedonetomaketheprogrammoreeffective?

Whileshesawanumberofstrengthswiththeimplementedprogram,theonly

drawbackwasthat“coachesarealwaystimepoor”.Thebiggesthurdleto

implementingtheinjurypreventionandmanagementprotocolswasin“tryingto

setasidethattimeandactuallydoit”.But“onceitwassetup,andshehadbecome

usedtoit”,itwas“easytorun”.Shealsoaddedthattheawarenessandpersonal

responsibilityshesawinherswimmerswasworththeamountoftimeittookto

setuptheinjurypreventionandmanagementprotocols.

104

Thebestindicatorofaneffectiveprogramisthecontinueduseofitsprotocols.The

coachoftheinterventionsquadindicatedshewouldcontinuetoimplementthe

injurypreventionandmanagementstrategiessetinplacebytheintervention.She

statedthatshewould“makeit[injurypreventionandmanagement]moreofa

priority”andthat“itwouldbepartofmydailyplan,myschedule”.Andthepositive

commentsfromparentsreinforcedtheefficacyoftheprotocolsandhercoaching,

asthey“showyouthatyou’redoingyourjobtothebestofyourability,almost

maybeevencloseto100%moremaybethanwhatyouweredoing6monthsago”.

Conclusions

TheaimofStudy3wastoimplementandevaluatetheefficacyofacoach‐

implementedinjurypreventionandmanagementinterventionwiththeirswim

squad.Whiletheresultsshowedthatswimmerswerenotexplicitlyawareofthe

changesintheircoach’sbehaviours,thecoachfelttheinterventionhadapositive

resultoninjuryoccurrenceandinjurymanagementwithinhersquad.Future

researchshouldinvestigatewhichfactorsofinjurypreventionandmanagement

aremostsalienttotheswimmersandworktohighlightthosefactors.

Thisresearchalsodrewattentiontotheimportanceofthecoachintheprocessof

injurypreventionandmanagement.Thecoachstandsasacriticalsourceofsocial

supportfortheirathletes,andtheyappeartobemuchmorepivotalforinjury

preventionandrehabilitationthanpreviousresearchhasdemonstrated.The

IPMP‐Sisapreliminarytooltomeasurecoachandswimmerperceptionsof

behaviourandimportance.Futureresearchcanworktomodifyitasamorevalid

andreliableprofilingtoolthatcanbeimplementedwithmultiplesportsto

measureinjurypreventionandmanagementbehaviours.Furthermore,an

opportunityexiststoinvestigatetheparticularrolescoachesfillintheinjury

preventionandmanagementprocess.

Intermsofthecoach‐athleterelationship,themostimportantfactorsofinjury

preventionandmanagementmaybethetrustandrespectanathletehasintheir

coachtoprotectthemfrominjuryasmuchaspossibleandtosupportthem

if/whenaninjurydoesoccur.Iftheycantrustthattheircoachhastheirbest

105

interestsbothintermsofsafetyandperformance,thentheymaybemoresatisfied

withtheirrelationshipandtheirtraining.

106

Chapter 6

6 Summary and Conclusions

Introduction

Thepurposeofthisresearchprojectwastoaddressgapsintheliterature

concerninginjurypreventionandmanagementplansinsport,particularlyin

regardstobehavioursimplementedbycoachesincompetitiveswimming.Three

studieswereconductedinthisprocess.StudyOneaimedtoidentifythecurrent

practicescoachesemploytopreventandmanageinjuryintheirsquads.StudyTwo

usedtheinformationgatheredfromStudyOne,aswellasknowledgefromextant

literature,todevelopaprofilingtooltomeasureuseofinjurypreventionand

managementbehavioursaswellastheperceivedimportanceofthosebehaviours.

StudyThreewasbuiltontheframeworkoftheAndersenandWilliams’(1988)

stress‐injurymodelandWiese‐Bjornstaletal.’s(1998)integratedmodelof

responsetosportinjury,aswellastheknowledgegainedfromthefirsttwo

studies.Theaimwastodevelop,implement,andevaluateacoach‐implemented

injurypreventionandmanagementprogramwithacompetitiveswimmingsquad.

Together,thethreestudiesworkedtoexpandtheknowledgebaseofinjury

preventionandmanagementpracticesincompetitiveswimming.Thestudies

culminatedwiththecreationofaninjurypreventionandmanagementprogram

thatcouldbeeasilyimplementedbycoachesandthatcoveredmajor

recommendationsforpsychosocialpreventionandmanagementofinjuryin

researchliterature.

Summary of Results

6.0.1 Study One – Injury Prevention and Management in Competitive Swimming:

Discovery of Current Practices

Thisstudyaimedtodiscoverthepracticesthatcoachesemploytopreventand

manageinjuryinhigh‐performancecompetitiveswimmingusingaprocessof

inductiveanddeductiveanalysis.Theintentionwastotakeacomprehensivelook

107

atthephenomenonofinjury,includinginjurypreventionstrategiesaswellas

planstomanageinjuryandsupportinjuredathletes.Thiswasaccomplished

throughsemi‐structuredinterviewsofelitecoaches(N=12),injuredswimmers

(N=5),andsportsmedicineprofessionals(N=6)experiencedwithtreatinginjured

athletes.

Responsesreflectedafour‐phasecycleofinjurypreventionandmanagement,

startingfromInjuryPreventionandcontinuingthroughShort‐termManagement,

Long‐termInjuryManagement,andculminatinginReturntoFullTraining.

Throughoutthiscycle,itbecameclearthecoachplaysapivotalrolenotonlyinthe

technicalcoachingaspectsofinjurypreventionandmanagement,buttheyalso

performacriticalroleinthesocialsupportofinjuredathletesastheyrehabilitate

andtransitionbacktofulltraining.

Becausethisstudywasqualitativeinnature,onemustbecarefulindrawingfirm

conclusionsfromthefindings.Furthermore,thedataanalysiswasinfluencedby

thepersonalinterpretationoftheprimaryresearcher.However,strategieswere

employedtolimitthisbiasincludingallowingintervieweesaccesstotheir

transcripts,andhavingmultipleresearchers(oneofwhomwasnotinvolvedinthe

study)workingtogetherduringthecodingprocess.

6.0.2 Study Two – Injury Prevention and Management in Competitive Swimming:

Confirmation of Current Practices

BuildingonknowledgegainedfromStudyOnecombinedwithknowledgefrom

extantliterature,theaimofthisstudywastodevelopaprofilingtooltomeasure

thedegreeofcoach‐implementedinjurypreventionandmanagementbehaviours

aswellastheperceivedimportanceofthosebehaviours.Thisprofilingtool,the

InjuryPreventionandManagementProfileforSwimming(IPMP‐S),wasbroken

intofoursections:InjuryPrevention,Short‐termInjuryManagement,Long‐term

InjuryManagement,andReturntoFullTraining.Thesesectionsreflectedthefour‐

phasecycleofinjurypreventionandmanagementproposedinStudyOne.

BehaviourslistedintheIPMP‐Sincludedspecifictrainingconsiderationsutilised

throughtheinjurypreventionandmanagementprocess,buttheyalsohighlighted

theneedforongoingcommunicationbetweencoachesandswimmers.Inaddition,

108

theIPMP‐Semphasisedtheimportanceofsocialsupportforinjuredathletes,

particularlyduringLong‐termInjuryManagement.

TheIPMP‐Swasadministeredtohighperformancecoaches(N=18)andswimmers

(N=135).ResultsoftheIPMP‐Srevealedagapbetweentheperceivedimportance

ofinjurypreventionandmanagementbehavioursandtheimplementationofthose

behavioursbycoaches.Thisfindingsuggeststhatdespiteperceivinginjury

preventionandmanagementtobeimportant,coachesarenotenactingbehaviours

tothesamedegreetoreflectthatimportance.Resultsalsorevealedagapbetween

coachself‐reportsofbehaviourandswimmerperceptionsofcoach‐enacted

behaviours.Inotherwords,swimmersperceivedtheircoachestoimplement

injurypreventionandmanagementbehaviourstoasignificantlylesserdegreethan

coachesreportedenactingbehaviours.

Limitationsincludeasmallsamplesize,particularlyforcoaches.Also,asa

preliminarymeasure,theIPMP‐Swaslengthyandcouldhaveresultedinpoor

qualityresponses,particularlytowardstheendofthemeasure.Giventhat

participantswerefromtheU.S.andAustralia,resultsmaynotbegeneralisableto

otherpopulations.

6.0.3 Study Three – Coach‐Implemented Injury Prevention and Management Plan

in Competitive Swimming: Implementation and Evaluation

TheaimofStudy3wastoimplementandevaluateacoach‐implementedinjury

preventionandmanagementinterventionwithacompetitiveswimsquadusing

knowledgegainedfromthefirsttwostudies.Theinterventionwasimplemented

withonehigh‐performanceswimclubwhilemembersoftwoothercomparable

clubsactedascontrolsoverthedurationofa3‐monthcompetitiveseason.Priorto

theoutsetoftheseason,thecoachoftheinterventionsquadunderwenta

consultationwiththeprimaryinvestigatortocreateaninjurypreventionand

managementprogramfortheirsquad.Specificstrategieswereoutlinedforeachof

the4phasesofinjurymanagement:InjuryPrevention,Short‐termInjury

Management,Long‐termInjuryManagement,andReturntoFullTraining.To

measuretheeffectivenessoftheinjurypreventionandmanagementprogram,all

swimmers(N=35)andtheircoaches(N=3)completedtheInjuryPreventionand

ManagementProfileforSwimming(IPMP‐S)priortoandatthecompletionofthe

109

intervention.SwimmersalsocompletedtheLifeEventsSurveyforCollegiate

Athletes(LESCA)(Petrie,1992)andtheRecoveryStressQuestionnaireforathletes

(RESTQ‐76Sport)(Kellmann&Kallus,2001).Thesemeasuresweretakento

determinearelationshipbetweenlifestressandinjuryrateinswimming.

WhiletheframeworkputforwardbyAndersenandWilliams(1988)predictsa

relationshipbetweenlifestressandinjury,resultsfromthisstudyrevealedno

relationshipbetweenlifestressandinjuryoccurrenceincompetitiveswimming.

However,therewereveryfewinjuriesoverthecourseoftheseasontoenterfor

analysis.It’spossiblethatthecoach’sbehavioursmanipulatingsocialsupportand

athletecopingresourceshelpedleadtofewerinjuries.Followingonfromthe

AndersenandWilliams’modelofstressandathleticinjury,thisstudyalsodrewon

aspectsofWiese‐Bjornstaletal.’s(1998)integratedmodelofresponsetoinjury

whichsuggeststhatpositiveappraisalsanduseofavailablecopingresourceswill

helpanathletethroughtherehabilitationprocess.Indeed,coachintervention

techniquesdrewonthisframework.EventhoughtheresultsoftheIPMP‐Sshowed

thatswimmerswerenotexplicitlyawareofthechangesintheircoach’s

behavioursforpreventinginjury,thecoachfelttheinterventionhadapositive

resultoninjuryoccurrenceandinjurymanagementwithinhersquad.

Furthermore,theinterventioncoachfelttheinterventionwaseasytoimplement

despitetheextratimeittooktosetup,andshehadplanstocontinueenactingthe

injurypreventionandmanagementprotocolsinherdailyscheduling.

Themajorlimitationtothisstudywasthedifficultyinadministeringquestionnaire

measures.Swimmerswereveryreluctanttofilloutanymeasures,anditwas

difficulttorecruitrequisitenumbers,particularlyforthecontrolsquad.Assuch,

thecontrolsquadneededtobemadeupoftwoseparatesquadswithdifferent

coaches.Thismayhaveaffectedresponsepatterns.

Practical Implications

Attheconclusionofthisresearchprogram,resultshavesupportedtheimportance

ofcomprehensiveinjurypreventionandmanagementplanesincompetitive

swimming,aswellastheimportanceofthecoach’sroleinthisprocess.Basedon

110

theseresultsaswellasliteratureoninjurypreventionandmanagement,following

aresomepracticalimplicationsforcoachesandswimmingclubs.

1. Coachawarenessofinjurypreventionandmanagementstrategiesshould

beraised.Thiscanbeaidedthroughbetterdisseminationofinformation

fromresearchintosportinggoverningbodiesandcoach‐specificeducation

resources.

2. Alongwithraisingawarenessofinjurypreventionandmanagement

strategies,coachesmustworktofosteranenvironmentofinjury

preventionintheirsquads.Byencouragingopencommunicationwiththeir

swimmers,athleteswillbemorelikelytoapproachtheircoachwithsmall

injuriesbeforetheybecomelong‐termissuesrequiringweeksormonthsof

rehabilitation.

3. Aspartofinjurypreventionandmanagement,coachescanbenefitfrom

increasingsocialsupportavenues.Thiswouldincludesettingup

relationshipswithsportsmedicineprofessionals,includingsport

physiotherapistsandsportpsychologists,toensureathletescanbe

immediatelyreferredtoatrustedprofessional.Thiswouldalsomeanthat

thecoachwouldnotbeshoulderedwithalltheresponsibilityofsupporting

injuredswimmers.

4. Inherentintheinjurypreventionandmanagementprocessisincreased

educationofswimmers(andtheirparents).Byincreasingknowledgeof

injurypreventionandmanagementprotocols,swimmerswillbebetter

preparedtopreventinjuries,andtheymaybelessanxiousiftheybecome

injured.Theyalsomaybemorelikelytoapproachtheircoachforhelpwith

potentialinjuriesiftheyareawareoftheinjurymanagementprocess.

5. Coachesshouldworktoactivelyinvolvetheirswimmersintheinjury

preventionandmanagementprocess.Withincreasededucationcomes

increasedpersonalresponsibility,andbyinvolvingtheathlete,theywillbe

moreempoweredintheirownrehabilitationandrecoveryandmayhave

morepositiverehabilitationoutcomesasaresult.

111

Recommendations for Future Research

Basedontheresultsofthisresearchprogramaswellassuggestionsfrominjury

preventionandmanagementresearch,thissectionoutlinesrecommendationsfor

futureresearch.

1. Therolecoachesplayinthepreventionandmanagementofinjuryhasbeen

overlookedinliterature,andlittleisknownabouttheextentofbehaviours

theyimplement.Giventhedutyofcareacoachhasfortheirathletes,it

followsthattheyshouldbeinvolvedintheirathletes’safetythroughinjury

preventionandinjurymanagementprocess.Futureresearchshouldmore

thoroughlyinvestigatecoachplansforinjurypreventionandmanagement

usinglargersamplesizes,differinglevelsofathleteability(e.g.,elite,sub‐

elite,youth),andcomparingcoachrolesacrossdifferentsports.

2. Similarly,futureresearchshouldinvestigatedifferentstrategiesforthe

implementationofcomprehensiveinjurypreventionandmanagement

plansinsport.Toaccomplishthistask,avarietyofstrategiesand

interventionsforimplementationshouldbeinvestigatedtodeterminethe

strategiesthataremosteffectivefordifferentlevelsofswimmers(e.g.,

youth,sub‐elite,andelite).Thesestrategiesshouldalsobeexpandedto

investigateeffectiveinterventionsamongothersports.

3. Researchintoathlete‐coachperceptionsofinjurymanagementcouldalso

bebeneficial.Bydeterminingthedifferencesbetweencoachandathlete

perceptions,injurypreventionandmanagementplanscanbedesigned

whichwillgainmoresupportfrombothswimmersandcoaches.By

matchingswimmers’expectationsmoreclosely,theymayfeelmore

confidentintheinjurypreventionandmanagementprogram.Assuch,they

maybecomemoreinvolvedandempoweredtoasanactiveparticipantin

injurypreventionandmanagement.Athletesfromdifferentsportsmay

havedifferentperspectives,soitwouldbebeneficialtoinvestigatethose

differencestotailorinjurypreventionandmanagementprogramstothe

particularneedsofthesport.

4. TheIPMP‐Scanbefurtherdevelopedasavalidandreliabletooltomeasure

squadandclubprofilesofinjurypreventionandmanagement.Coachesand

112

sportingorganisationscoulduseittodetermineathleteperceptionsand

evaluationsofcoachbehaviour.Bydetermininggapsbetweencoachand

swimmerprofiles,injurypreventionandmanagementeducationand

protocolscanbetailoredtothespecificclubtoaccountforgapsin

behaviour.

5. TheIPMP‐Scanbedevelopedtomeasureinjurypreventionand

managementbehavioursandperceptionsofimportanceforothersports.

Differentsportsmayhavedifferentstrategiesforpreventingandmanaging

injuriesbasedonthedifferentrisksinherentinparticipation.Thiscould

meancreatingageneralsportIPMP,oritcouldmeandeveloping

independentsportspecificIPMPs.

6. Thecoachstandsinacriticalpositionintheirsquadtosettheperceptionof

injurypreventionandmanagementwiththeirswimmers.Aunique

opportunityinsportresearchliesinthesafetyclimateofanorganisation.

Safetyclimatehasbeenusedinworkindustrytomeasuretheattitudesand

behavioursofemployeestoemployersandhighermanagement.Ithasbeen

showntobeasignificantdeterminingfactorintherateofaccidentsand

injuriesintheworkplace.Inotherwords,whentheattitudesandclimateof

theworkplacereflectanemphasisonsafetyaswellasproduction,injury

ratesandaccidentsgodown.Perhapsforfutureresearch,similar

relationshipsmaybeseeninthesportingrealminregardstoputtingan

emphasisoninjurypreventionandmanagementaswellasperformance.

Separatefromthecurrentresearchprogram,datawascollectedwithswim

clubsusingamodifiedversionoftheSafeSystemClimateSurvey(Hogan

AssessmentSystems,2009).Themodifiedversionwascreatedin

collaborationwithresearchersatPeterberryConsultingtoreflectsport‐

specificsituations(e.g.,bosswaschangedtocoach,workwaschangedto

training,etc.).Basedonpreliminaryresults,alongitudinaldesignis

recommendedtolookintodifferencesinsafetyclimatewithmultiple

coachesandclubs,differentlevelsofcompetition(e.g.,eliteversussub‐

elite)andwithdifferentnations(e.g.,Australianswimmingversus

Americanswimming).Furthermore,acomparisonacrosssportsis

recommended(e.g.,individualversusteamsports,contactversusnon‐

contactsports).

113

References

Abernethy, L., & Bleakley, C. (2007). Strategies to prevent injury in adolescent sport: a systematic

review. British Journal of Sports Medicine, 41(10), 627-38.

Almquist, J., Mcleod, T. C. V., Cavanna, A., Jenkinson, D., Lincoln, A. E., Loud, K., Peterson, B. C., et

al. (2008). Summary statement: Appropriate medical care for the secondary school-aged athlete.

Journal of Athletic Training, 43(4), 416-427.

Andersen, M. B., & Williams, J. M. (1988). A model of stress and athletic injury: prediction and

prevention. Journal of Sport & Exercise Psychology, 10(3), 294-306.

Appaneal, R. N., Levine, B. R., Perna, F. M., & Roh, J. L. (2009). Measuring postinjury depression

among male and female competitive athletes. Journal of Sport & Exercise Psychology, 31(1), 60-

76.

Arvinen-Barrow, M., Penny, G., Hemmings, B., & Corr, S. (2010). UK chartered physiotherapists’

personal experiences in using psychological interventions with injured athletes: An Interpretative

Phenomenological Analysis. Psychology of Sport and Exercise, 11(1), 58-66. Elsevier Ltd.

Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social

psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality

and Social Psychology, 51(6), 1173-1182.

Bianco, T. (2001). Social support and recovery from sport injury: elite skiers share their experiences.

Research Quarterly for Exercise and Sport, 72(4), 376-88.

Bianco, T., Malo, S., & Orlick, T. (1999). Sport injury and illness: elite skiers describe their experiences.

Research Quarterly for Exercise and Sport, 70(2), 157-69.

Blackwell, B., & McCullagh, P. (1990). The relationship of athletic injury to life stress, competitive

anxiety and coping resources. Athletic Training, 25(1), 23-27.

Blanch, P. (2004). Conservative management of shoulder pain in swimming. Physical Therapy in Sport,

5(3), 109-124.

Bramwell, S. T., Masuda, M., Wagner, N. N., & Holmes, T. H. (1975). Psychosocial factors in athletic

injuries: Development and application of the Social and Athletic Readjustment Rating Scale

(SARRS). Journal of Human Stress, 1(2), 6-20.

Brewer, B. W. (1993). Self-identity and specific vulnerability to depressed mood. Journal of Personality,

61, 343-364.

Brewer, B. W., & Petrie, T. A. (1995). A comparison between injured and uninjured football players on

selected psychosocial variables. Academic Athletic Journal, 10(1), 11-18.

Brewer, B. W., Andersen, M. B., & Van Raalte, J. L. (2002). Psychological aspects of sport injury

rehabilitation: Toward a biopsychosocial approach. In D. L. Mostofsky & L. D. Zaichkowsky

(Eds.), Medical and Psychological Aspects of Sport and Exercise (pp. 41-54). Morgantown, W.V.:

Fitness Information Technology.

Brewer, B. W., Jeffers, K. E., Petitpas, A. J., & Van Raalte, J. L. (1994). Perceptions of psychological

interventions in the context of sport injury rehabilitation. The Sport Psychologist, 8(2), 176-188.

Brewer, B. W., Linder, D. E., & Phelps, C. M. (1995). Situational correlates of emotional adjustment to

athletic injury. Clinical Journal of Sport Medicine, 5(241-245).

114

Brown, R. B. (1971). Personality characteristics related to injuries in football. Research Quarterly for

Exercise and Sport, 42(2), 133-138.

Burton, D., & Raedeke, T. D. (2008). Sport Psychology for Coaches. Kingswood, SA: Human Kinetics.

Caine, D., Maffulli, N., & Caine, C. (2008). Epidemiology of injury in child and adolescent sports: injury

rates, risk factors, and prevention. Clinics in Sports Medicine, 27(1), 19-50.

Ciullo, J. V. (1986). Swimmer’s shoulder. Clinics in Sports Medicine, 5, 115-137.

Ciullo, J. V., & Stevens, G. G. (1989). The prevention and treatment of injuries to the shoulder in

swimming. Sports Medicine, 7(3), 182-204.

Clement, D., & Shannon, V. R. (2011). Injured athletes’ perceptions about social support. Journal of

Sport Rehabilitation, 20(4), 457-470.

Clover, J., & Wall, J. (2010). Return-to-play criteria following sports injury. Clinics in Sports Medicine,

29(1), 169-175. Elsevier Ltd.

Coddington, R. D., & Troxell, J. R. (1980). The effect of emotional factors on football injury rates.

Journal of Human Stress, 6(1), 3-5.

Courson, R., Navitskis, L., & Patel, H. (2005). Emergency-action planning. Athletic Therapy Today,

10(2), 7-15.

Cowley, H. R., Ford, K. D., Myer, G. D., Kernozek, T. W., & Hewett, T. E. (2006). Differences in

neuromuscular strategies between landing and cutting tasks in female basketball and soccer athletes.

Journal of Athletic Training, 41(1), 67-73.

Crossman, J. (2001). Coping with Sports Injuries: Psychological Strategies for Rehabilitation. New York:

Oxford University Press.

Cryan, P. O., & Alles, E. F. (1983). The relationship between stress and football injuries. Journal of

Sports Medicine and Physical Fitness, 23(1), 52-58.

Cumming, S. P., Smith, R. E., & Smoll, F. L. (2006). Athlete-perceived coaching behaviors: Relating two

measurement traditions. Journal of Sport & Exercise Psychology, 28(2), 205-213.

Cupal, D. D. (1998). Psychological interventions in sport injury prevention and rehabilitation. Journal of

Applied Sport Psychology, 10(1), 103-123.

Cupal, D. D., & Brewer, B. W. (2001). Effects of relaxation and guided imagery on knee strength,

reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Rehabilitation

Psychology, 46(1), 28-43. Educational Publishing Foundation.

Cutrona, C. E., & Russell, D. W. (1990). Type of social support and specific stress: Toward a theory of

optimal matching. In B. R. Sarason, I. G. Sarason, & G. R. Pierce (Eds.), Social Support: An

Interactional View (pp. 319-366). New York: Wiley.

Davis, J. O. (1991). Sports Injuries and stress management: An opportunity for research. The Sport

Psychologist, 5(2), 175-182.

DeWitt, D. J. (1980). Cognitive and biofeedback training for stress reduction with university athletes.

Journal of Sport Psychology, 2(4), 288-294.

Devantier, C. (2011). Psychological predictors of injury among professional soccer players. Sport Science

Review, XX(5-6), 25-56. doi:10.2478/v10237-

Driediger, M., Hall, C., & Callow, N. (2006). Imagery use by injured athletes: a qualitative analysis.

Journal of Sports Sciences, 24(3), 261-271.

115

Dunn, E. C., Smith, R. E., & Smoll, F. L. (2001). Do sport-specific stressors predict athletic injury?

Journal of Science and Medicine in Sport, 4(3), 283-291.

Emery, C. A., Meeuwisse, W., & Hartmann, S. E. (2005). Evaluation of risk factors for injury in

adolescent soccer: Implementation and validation of an injury surveillance system. American

Journal of Sports Medicine, 33(12), 1882–1891.

Evans, L., & Hardy, L. (1995). Sport injury and grief responses: A review. Journal of Sport & Exercise

Psychology, 17, 227-245.

Evans, L., & Hardy, L. (2002). Injury rehabilitation: a goal-setting intervention study. Research Quarterly

for Exercise and Sport, 73(3), 310-319.

Evans, L., Hardy, L., & Fleming, S. (2000). Intervention strategies with injured athletes: an action

research study. Sport Psychologist, 14(2), 188–206.

Fawkner, H. J., McMurrary, N. E., & Summers, J. J. (1999). Athletic injury and minor life events: a

prospective study. Journal of Science and Medicine in Sport, 2(2), 117-24.

Fields, J., Murphey, M., Horodyski, M., & Stopka, C. (1995). Factors associated with adherence to sport

injury rehabilitation in college-age recreational athletes. Journal of Sport Rehabilitation, 4(3), 172-

180.

Flint, F. A. (2007). Modeling in injury rehabilitation: Seeing helps believing. In D. Pargman (Ed.),

Psychological Bases of Sport Injuries (3rd ed., pp. 95-107). Morgantown: Fitness Information

Technology.

Ford, I. W., & Gordon, S. (1998). Perspectives of sport trainers and athletic therapists on the

psychological content of their practice and training. Journal of Sport Rehabilitation, 7(2), 79-94.

Ford, I. W., & Gordon, S. (1999). Coping with sport injury: Resource loss and the role of social support.

Journal of Personal and Interpersonal Loss, 4(3), 243-256.

Ford, I. W., Eklund, R. C., & Gordon, S. (2000). An examination of psychosocial variables moderating

the relationship between life stress and injury time-loss among athletes of a high standard. Journal

of Sports Sciences, 18(5), 301-12.

Gaunt, T., & Maffulli, N. (2011). Soothing suffering swimmers: A systematic review of the

epidemiology, diagnosis, treatment and rehabilitation of musculoskeletal injuries in competitive

swimmers. British Medical Bulletin, 1-44.

Gianotti, S. M., Hume, P. A., & Tunstall, H. (2010). Efficacy of injury prevention related coach education

within netball and soccer. Journal of Science and Medicine in Sport, 13(1), 32-5. Sports Medicine

Australia.

Gianotti, S. M., Quarrie, K. L., & Hume, P. a. (2009). Evaluation of RugbySmart: a rugby union

community injury prevention programme. Journal of Science and Medicine in Sport, 12(3), 371-

375.

Glazer, D. D. (2009). Development and preliminary validation of the Injury-Psychological Readiness to

Return to Sport (I-PRRS) scale. Journal of Athletic Training, 44(2), 185-189.

Goldsmith, W. (2007). How to deal with swimming injuries. Swimming World, 48(5), 23-24.

Gordon, S., Milios, D., & Grove, J. (1991). Psychological aspects of the recovery process from sport

injury: The perspective of sport phsyiotherapists. The Australian Journal of Science and Medicine

in Sport, 23, 53-60.

116

Greipp, J. F. (1985). Swimmer’s shoulder: The influence of flexibility and weight training. The Physician

& Sportsmedicine, 13(8), 92-105.

Grobbelaar, H. W., Malan, D. D. J., Steyn, B. J. M., & Ellis, S. M. (2010). Factors affecting the recovery-

stress, burnout and mood state scores of elite student rugby players. South African Journal for

Research in Sport, Phsyical Education and Recreation, 32(2), 41-54.

Grote, K., Lincoln, T. L., & Gamble, J. G. (2004). Hip adductor injury in competitive swimmers.

American Journal of Sports Medicine, 32(1), 104-108.

Grove, J., & Gordon, A. M. D. (1995). The psychological aspects of injury in sport. In J. Bloomfield, P.

A. Fricker, & K. D. Fitch (Eds.), Textbook of Science and Medicine in Sport (2nd ed., pp. 194-205).

Melbourne, VIC.

Gunnoe, A. J., Horodyski, M., Tennant, L. K., & Murphey, M. (2001). The effect of life events on

incidence of injury in high school football players. Journal of Athletic Training, 36(2), 150-155.

Hall, G. (1980). Hand paddles may cause shoulder pain. Swimming World, 21(10), 9-11.

Hamson-Utley, J., Martin, S., & Walters, J. (2008). Athletic trainers’ and physical therapists' perceptions

of the effectiveness of psychological skills within sport injury rehabilitation programs. Journal of

athletic training, 43(3), 258-64.

Hanson, S. J., McCullagh, P., & Tonymon, P. (1992). The relationship of personality characteristics, life

stress, and coping resources to athletic injury. Journal of Sport and Exercise Psychology, 14(3),

262-272.

Hardy, C. J., & Riehl, M. A. (1988). An examination of life stress-injury relationship among noncontact

sport participants. Behavioral Medicine, 14(3), 113-118.

Hardy, C. J., Richman, J. M., & Rosenfeld, L. B. (1991). The role of social support in the life stress/injury

relationship. The Sport Psychologist, 5(2), 128-139.

Hare, R., & Evans, L. (2008). Imagery use during rehabilitation from injury: A case study of an elite

athlete. The Sport Psychologist, 22(4), 405-422.

Heil, J. (1993). Psychology of Sport Injury. Kingswood, SA: Human Kinetics.

Hogan Assessment Systems. (2009). SafeSystem Climate Survey. Tulsa, OK: Hogan Assessment Systems.

Holmes, T. H., & Rahe, R. H. (1967). The Social Readjustment Rating Scale. Journal of Psychosomatic

Research, 11(2), 213-218.

Holt, N., & Dunn, J. (2004). Toward a grounded theory of the psychosocial competencies and

environmental conditions associated with soccer success. Journal of Applied Sport Psychology,

16(3), 199-219.

Hudson, V. J. (2010). Evaluation, diagnosis, and treatment of shoulder injuries in athletes. Clinics in

Sports Medicine, 29(1), 19-32, table of contents. Elsevier Ltd.

Ivarsson, A., & Johnson, U. (2010). Psychological factors as predictors of injuries among senior soccer

players: A prospective study. Journal of Sports Science and Medicine, 9(2), 347-352.

Jackson, B., Grove, J. R., & Beauchamp, M. R. (2010). Relational efficacy beliefs and relationship

quality within coach-athlete dyads. Journal of Social and Personal Relationships, 27(8), 1035-

1050. doi:10.1177/0265407510378123

Jackson, B., Gucciardi, D., & Dimmock, J. (2011). Tripartite efficacy profiles: a cluster analytic

investigation of athletes’ perceptions of their relationship with their coach. Journal of Sport &

117

Exercise Psychology, 33(3), 394-415. Retrieved from

http://www.ncbi.nlm.nih.gov/pubmed/21659670

Jackson, D. W., Jarrett, H., Barley, D., Kausch, J., Swanson, J. J., & Powell, J. W. (1978). Injury

prediction in the young athlete. American Journal of Sports Medicine, 6(1), 6-14.

Johnson, J. N., Gauvin, J., & Fredericson, M. (2003). Swimming biomechanics and injury prevention:

New stroke techniques and medical considerations. The Physician and Sportsmedicine, 31(1), 41-

46.

Johnson, U., Ekengren, J., & Andersen, M. B. (2005). Injury prevention in sweden: Helping soccer

players at risk. Journal of Sport & Exercise Psychology, 27(1), 32-38.

Junge, A. (2000). The influence of psychological factors on sports injuries: Review of the literature.

American Journal of Sports Medicine, 28(supp. 5), S10-S15.

Kaneoka, K., Shimizu, K., Hangai, M., Okuwaki, T., Mamizuka, N., Sakane, M., & Ochiai, N. (2007).

Lumbar intervertebral disk degeneration in elite competitive swimmers. The American Journal of

Sports Medicine, 35(8), 1341-1345.

Kelley, M. J. (1990). Psychological risk factors and sports injuries. Journal of Sports Medicine and

Physical Fitness, 30(2), 202-221.

Kellmann, M., & Kallus, K. W. (2001). Recovery-Stress Questionnaire for Athletes: User Manual.

Champaign, IL: Human Kinetics.

Kennedy, J. C., & Hawkins, R. J. (1974). Swimmer’s shoulder. The Physician & Sportsmedicine, 2, 34-

38.

Kerr, G. A., & Goss, J. (1996). The effects of a stress management program on injuries and stress levels.

Journal of Applied Sport Psychology, 8(1), 109-117.

Kerr, G. A., & Minden, H. (1988). Psychological factors related to the occurrence of athletic injuries.

Journal of Sport & Exercise Psychology, 10(2), 167-173.

Knapik, J. J., Bauman, C. L., Jones, B. H., Harris, J. M., & Vaughan, L. (1991). Preseason strength and

flexibility imbalances associated with athletic injuries in female collegiate athletes. American

Journal of Sports Medicine, 19(1), 76-81.

Krosshaug, T., Slauterbeck, J. R., Engebretsen, L., & Bahr, R. (2007). Biomechanical analysis of anterior

cruciate ligament injury mechanisms: Three-dimensional motion reconstruction from video

sequences. Scandinavian Journal of Medicine & Science in Sports, 17(5), 508-519.

Kubler-Ross, E. (1969). On Death and Dying. London: Tavistock.

Larson, G. A., Starkey, C., & Zaichowsky, L. D. (1996). Psychological aspects of athletic injuries as

perceived by athletic trainers. The Sport Psychologist, 10, 37-47.

Lavallee, L., & Flint, E. (1996). The relationship of stress, competitive anxiety, mood state, and social

support to athletic injury. Journal of Athletic Training, 31(4), 296-299.

Law, B., Driediger, M., Hall, C., & Forwell, L. (2006). Imagery use, perceived pain, limb functioning and

satisfaction in athletic injury rehabilitation. New Zealand Journal of Physiotherapy, 34, 10-16.

Leddy, M. H., Lambert, M. J., & Ogles, B. M. (1994). Psychological consequences of athletic injury

among high-level competitors. Research Quarterly for Exercise and Sport, 65(4), 347-354.

Lynch, G. P. (1988). Athletic injuries and the practicing sport psychologist: Practical guidelines for

assisting athletes. The Sport Psychologist, 2, 161-167.

118

Maddison, R., & Prapavessis, H. (2005). A psychological approach to the prediction and prevention of

athletic injury. Journal of Sport & Exercise Psychology, 27(3), 289-310.

Maddison, R., & Prapavessis, H. (2007). Preventing sport injuries: A case for psychology intervention. In

D. Pargman (Ed.), Psychological Bases of Sport Injuries (3rd ed., pp. 25-38). Morgantown, W.V.:

Fitness Information Technology.

Maniar, S. D., Curry, L. A., Sommers-Flanagan, J., & Walsh, J. A. (2001). Student-athlete preferences in

seeking help when confronted with sport performance problems, 15(2), 205-223.

Mann, B., Grana, W., Indelicato, P., O’Neill, D., & George, S. (2007). A survey of sports medicine

physicians regarding psychological issues in patient-athletes. American Journal of Sports Medicine,

35, 2140-2147.

Manuel, J. C., Shilt, J. S., Curl, W. W., Smith, J. A., Durant, R. H., Lester, L., & Sinal, S. H. (2002).

Coping with sports injuries: An examination of the adolescent athlete. The Journal of Adolescent

Health, 31(5), 391-393.

May, J. R., & Brown, L. (1989). Delivery of psychological services to the U.S. Alpine Ski Team prior to

and during the Olympics in Calgary. The Sport Psychologist, 3(4), 320-329.

May, J. R., Veach, T. L., Reed, M. W., & Griffey, M. S. (1985). A psychological study of health, injury

and performance in athletes on the U.S. alpine ski team. The Physician and Sports Medicine,

13(10), 111-115.

McMaster, W. C. (1999). Shoulder injuries in competitive swimmers. Clinics in Sports Medicine, 18(2),

349-359.

McMaster, W. C., & Troup, J. (1993). A survey of interfering shoulder pain in United States competitive

swimmers. The American journal of sports medicine, 21(1), 67-70.

Morrey, M. A., Stuart, M. J., Smith, A. M., & Wiese-Bjornstal, D. M. (1999). A longitudinal examination

of athletes’ emotional and cognitive responses to anterior cruciate ligament injury. Clinical Journal

of Sport Medicine, 9, 63-69.

Nicholls, A. R., & Polman, R. C. (2007). Stressors, coping, and coping effectiveness among players from

the England Under-18 Rugby Union Team. Journal of Sport Behavior, 30(2), 199-218.

Nideffer, R. M. (1989). Psychological aspects of sports injuries: Issues in prevention and treatment.

International Journal of Sport Psychology, 20, 241-255.

Nippert, A. H., & Smith, A. M. (2008). Psychologic stress related to injury and impact on sport

performance. Physical Medicine and Rehabilitation Clinics of North America, 19(2), 399-418.

Niven, A. (2007). Rehabilitation adherence in sport injury: sport physiotherapists’ perceptions. Journal of

Sport Rehabilitation, 16(2), 93-110.

O’Donnell, C. J., Bowen, J., & Fossati, J. (2005). Identifying and managing shoulder pain in competitive

swimmers: How to minimize training flaws and other risks. The Physician and Sportsmedicine,

33(9), 27-35.

Pargman, D., & Lunt, S. D. (1989). The relationship of self-concept and locus of control to the severity of

injury in freshmen collegiate football players. Sports Training, Medicine and Rehabilitation, 1, 203-

208.

Pargman, David (Ed.). (1993). Psychological Bases of Sport Injuries. Morgantown, W.V.: Fitness

Information Technology.

119

Parkkari, J., Kujala, U. M., & Kannus, P. (2001). Is it possible to prevent sports injuries? Review of

controlled clinical trials and recommendations for future work. Sports Medicine, 31(14), 985-995.

Passer, M. W. (1982). Psychological stress in youth sports. In R. A. Magill, M. J. Ash, & F. L. Smoll

(Eds.), Children in Sport (pp. 153-177). Champaign, IL: Human Kinetics.

Passer, M. W., & Seese, M. D. (1983). Life stress and athletic injury: Examination of positive versus

negative events and three moderator variables. Journal of Human Stress, 9(1), 11-16.

Perna, F. M., & McDowell, S. L. (1995). Role of psychological stress in cortisol recovery from

exhaustive exercise among elite athletes. International Journal of Behavioral Medicine, 2(1), 13-

26.

Perna, F. M., Antoni, M. H., Baum, A., Gordon, P., & Schneiderman, N. (2003). Cognitive behavioral

stress management effects on injury and illness among competitive athletes: A randomized clinical

trial. Annals of Behavioral Medicine, 25(1), 66-73.

Petrie, T. A. (1992). Psychosocial antecedents of athletic injury: the effects of life stress and social

support on female collegiate gymnasts. Behavioral Medicine, 18(3), 127-139.

Petrie, T. A. (1993). Coping skills, competitive trait anxiety, and playing status: Moderating effects on the

life stress-injury relationship. Journal of Sport & Exercise Psychology, 15(3), 261-274.

Petrie, T. A., & Hamson-Utley, J. (2011). Psychosocial antecedents of and responses to athletic injury. In

T. Morris & P. Terry (Eds.), The New Sport and Exercise Psychology Companion (pp. 531-551).

Morgantown, W.V.: Fitness Information Technology.

Pink, M. M., & Tibone, J. E. (2000). The painful shoulder in the swimming athlete. Orthopedic Clinics of

North America, 31(2), 247-261.

Podlog, L., & Eklund, R. C. (2006). A longitudinal investigation of competitive athletes’ return to sport

following serious injury. Journal of Applied Sport Psychology, 18(1), 44-68.

Podlog, L., & Eklund, R. C. (2007). Psychosocial considerations of the return to sport following injury. In

D. Pargman (Ed.), Psychological Bases of Sport Injuries (3rd ed., pp. 109-130). Morgantown,

W.V.: Fitness Information Technology.

Podlog, L., & Eklund, R. C. (2009). High-level athletes’ perceptions of success in returning to sport

following injury. Psychology of Sport and Exercise, 10(5), 535-544. Elsevier Ltd.

Podlog, L., Dimmock, J., & Miller, J. (2011). A review of return to sport concerns following injury

rehabilitation: Practitioner strategies for enhacing recovery outcomes. Physical Therapy in Sport,

12(1), 36-42.

Powell, J. W., & Barber-Foss, K. D. (1999). Injury patterns in selected high school sports: a review of the

1995-1997 seasons. Journal of Athletic Training, 34(3), 277-84.

Rees, T., Hardy, L., & Evans, L. (2007). Construct validity of the social support survey in sport.

Psychology of Sport and Exercise, 8(3), 355-368.

Richman, J. M., Hardy, C. J., Rosenfeld, L. B., & Callanan, R. A. E. (1989). Strategies for enhancing

social support networks in sport: a brainstorming experience. Journal of Applied Sport Psychology,

1(2), 150-159.

Rider, S. P., & Hicks, R. A. (1995). Stress, coping, and injuries in male and female high school basketball

players. Perceptual and Motor Skills, 81(2), 499-503.

120

Rogers, T. J., & Landers, D. M. (2005). Mediating effects of peripheral vision in the life event

stress/athletic injury relationship. Journal of Sport & Exercise Psychology, 27(3), 271-288.

Rose, J., & Jevne, R. F. J. (1993). Psychosocial Processes Associated With Athletic Injuries. The Sport

Psychologist, 7(3), 309-328.

Rosenfeld, L. B., & Richman, J. M. (1997). Developing effective social support: Team building and the

social support process. Journal of Applied Sport Psychology, 9(1), 133-153.

Rosenfeld, L. B., Richman, J. M., & Hardy, C. J. (1989). Examining social support networks among

athletes: Description and relationship to stress. The Sport Psychologist, 3(1), 23-33. Human

Kinetics.

Santomier, J. (1983). The sport-stress connection. Theory into Practice, 22(1), 57–63. Taylor & Francis.

Sarason, I. G., Johnson, J. H., & Siegal, J. M. (1978). Assessing the impact of life changes: Development

of the Life Experiences Survey. Journal of Consulting and Clinical Psychology, 46(5), 932-940.

Scherzer, C. B., Brewer, B. W., Cornelius, A. E., Van Raalte, J. L., Petitpas, A. J., Sklar, J. H., Pohlman,

M. H., et al. (2001). Psychological skills and adherence to rehabilitation after reconstruction of the

anterior cruciate ligament. Journal of Sport Rehabilitation, 10(3), 165-172.

Seff, M. A., Gecas, V., & Ray, M. P. (1992). Injury and depression: The mediating effects of self-

concept. Sociological Perspectives, 35(4), 573-591.

Sein, M. L., Walton, J., Linklater, J., Appleyard, R., Kirkbride, B., Kuah, D., & Murrell, G. a C. (2010).

Shoulder pain in elite swimmers: primarily due to swim-volume-induced supraspinatus

tendinopathy. British journal of sports medicine, 44(2), 105-113.

Smith, A. M. (1996). Psychological impact of injuries in athletes. Sports Medicine, 22, 391-405.

Smith, A. M., Stuart, M. J., Wiese-Bjornstal, D. M., Milliner, E. K., O’Fallon, W. M., & Crowson, C. S.

(1993). Competitive athletes: preinjury and postinjury mood state and self-esteem. Mayo Clinic

Proceedings, 68(10), 939-947.

Smith, R. E., & Smoll, F. L. (1991). Behavioral research and intervention in youth sports. Behaviour

Therapy, 22(3), 329-344.

Smith, R. E., Smoll, F. L., & Ptacek, J. T. (1990). Conjunctive moderator variables in vulnerability and

resiliency research: Life stress, social support and coping skills, and adolescent sport injuries.

Journal of Personality and Social Psychology, 58(2), 360-370.

Stavrianeas, S. (2009). Aquatics. In D. J. Caine, P. A. Harmer, & M. A. Schiff (Eds.), Epidemiology of

Injury in Olympic Sports, Volume XVI. Oxford, UK: WIley-Blackwell.

Steffen, K., Pensgaard, a M., & Bahr, R. (2009). Self-reported psychological characteristics as risk factors

for injuries in female youth football. Scandinavian Journal of Medicine & Science in Sports, 19(3),

442-51.

Strauss, A., & Corbin, J. (1998). Basics of Qualitative Research: Techniques and Procedures for

Developing Grounded Theory (2nd ed.). Thousand Oaks, CA: Sage Publications.

Surve, I., Schwellnus, M. P., Noakes, T., & Lombard, C. (1994). A fivefold reduction in the incidence of

recurrent ankle sprains in soccer players using the Sport-Stirrup orthosis. American Journal of

Sports Medicine, 22(5), 601-606.

Taylor, J., & Taylor, S. (1997). Psychological Approaches to Sports Injury Rehabilitation. Gaithersburg,

MD: Aspen Publishers.

121

Thelwell, R., Weston, N. J. V., Greenlees, I., & Hutchings, N. V. (2008). A qualitative exploration of

psychological-skills use in coaches. The Sport Psychologist, 22(1), 38-53.

Tropp, H., Askling, C., & Gillquist, J. (1985). Prevention of ankle sprains. American Journal of Sports

Medicine, 13(4), 259-262.

Udry, E. (1997). Coping and social support among injured athletes following surgery. Journal of Sport &

Exercise Psychology, 19, 71-90.

Udry, E. (1999). The paradox of injuries: Unexpected positive consequences. In D. Pargman (Ed.),

Psychological Bases of Sport Injuries (2nd ed., pp. 79-88). Morgantown: Fitness Information

Technology.

Udry, E., Gould, D., Bridges, D., & Beck, L. (1997). Down but not out: Athlete responses to season-

ending injuries. Journal of Sport & Exercise Psychology, 19, 229-248.

Udry, E., Gould, D., Bridges, D., & Tuffey, S. (1997). People helping people? Examining the social ties

of athletes coping with burnout and injury stress. Journal of Sport & Exercise Psychology, 19(4),

368-395.

Valiant, P. M. (1981). Personality and injury in competitive runners. Perceptual and Motor Skills, 53(1),

251-253.

Wadey, R., & Evans, L. (2011). Working with injured athletes: Research and practice. In S. Hanton & S.

D. Mellalieu (Eds.), Professional practice in sport psychology: A review (pp. 107-132). London:

Routledge.

Wadey, R., Evans, L., Evans, K., & Mitchell, I. (2011). Perceived benefits following sport injury: A

qualitative examination of their antecedents and underlying mechanisms. Journal of Applied Sport

Psychology, 23(2), 142-158.

Wadey, R., Evans, L., Hanton, S., & Neil, R. (2012). An examination of hardiness throughout the sport

injury process. British Journal of Health Psychology, 17(1), 103-128.

Wehlage, D. F. (1980). Managing the emotional reaction to loss in athletics. Athletic Training, 15, 144-

146.

Weiss, M. R., & Troxel, R. K. (1986). Psychology of the injured athlete. Journal of Athletic Training, 15,

144-146.

Wiese, D. M., Weiss, M. R., & Yukelson, D. (1991). Sport psychology in the training room: A survey of

athletic trainers. The Sport Psychologist, 5(1), 15-24.

Wiese-Bjornstal, D. M. (2002). To play or not to play? That is the question. Athletic Therapy Today, 7(2),

24-26.

Wiese-Bjornstal, D. M. (2009). Sport injury and college athlete health across the lifespan. Journal of

Intercollegiate Sports, 2, 64-80.

Wiese-Bjornstal, D. M., Smith, A. M., Shaffer, S., & Morrey, M. A. (1998). An integrated model of

response to sport injury: Psychological and sociological dynamics. Journal of Applied Sport

Psychology, 10(1), 46-69.

Williams, J. M., & Andersen, M. B. (1998). Psychosocial antecedents of sport injury: Review and critique

of the stress and injury model. Journal of Applied Sport Psychology, 10(1), 5-25.

Williams, J. M., Tonymon, P., & Wadsworth, W. A. (1986). Relationship of stress to injury in

intercollegiate volleyball. Journal of Human Stress, 12(1), 38-43.

122

Wolf, B. R., Ebinger, A. E., Lawler, M. P., & Britton, C. L. (2009). Injury patterns in Division I collegiate

swimming. The American Journal of Sports Medicine, 37(10), 2037-2042.

Worrell, T. W. (1992). The use of behavioral and cognitive techniques to facilitate achievement of

rehabilitation goals. Journal of Sport Rehabilitation, 1(1), 69-75.

Yang, J., Peek-Asa, C., Lowe, J. B., Heiden, E., & Foster, D. T. (2010). Social support patterns of

collegiate athletes before and after injury. Journal of Athletic Training, 45(4), 372-9.

123

APPENDIX A: Study One

1. InformationSheet

2. ConsentForm

3. CoachInterviewGuide

4. SwimmerInterviewGuide

5. SportsMedicineProfessionalInterviewGuide

124

PreventionandManagementofInjuryinCompetitiveSwimmingPhDThesisproject,Study1

JulieHardt,MSc— ParticipantInformationSheet—

PURPOSEThisstudyaimstodiscoverthemosteffectivepracticethatcoachesshouldemploytopreventandmanageinjuryincompetitiveswimmingfromapsycho‐socialstandpoint.Theintentionwillbetotakeacomprehensivelookatthephenomenonofinjury,includinginjurypreventionstrategiesandplansdesignedtoaddressthepsychologicalresponsestoinjuryrehabilitationandreturntotrainingandcompetition.Preventionandmanagementpracticeswillbeformulatedthroughinformationgatheredfromfocusgroupsandoneononeinterviewswithcoaches,swimmers,andsportsmedicineprofessionals.

PROCEDURESAsaparticipant,youmaybeinterviewedinafocusgroupformatalongwith5‐6otherparticipants,orinaoneononesessionwiththeinvestigator.Thisinterviewwilllastapproximately45minutesbutwillnotexceedonehour.Theinterviewschedulewillbesuppliedtoyouoneweekbeforethefocusgrouporinterviewinwhichyouwillparticipate.Withyourpermissiontheinterviewwillbesoundrecordedtofacilitatetranscriptionforlateranalysis.

RISKSTherearenorisksforeseenaspartoftheinterviewprocess.Thequestionsaskedwillnotbeofasensitivenature,andtheinterviewswillbeconductedatatimeandlocationthatisconvenienttoyou.

BENEFITSBenefitsofthisresearchmayincludegainsinknowledgeandunderstandingofthepsycho‐socialaspectsofinjurywhichmayimprovetheinjurypreventionandmanagementpracticesincompetitiveswimming.Theknowledgegainedregardingthesepracticeswillbemadeavailabletoyouattheconclusionofthestudy.

CONFIDENTIALITYAllinformationwillbekeptstrictlyconfidential.Datawillbede‐identifiedfollowingcollectionandwillbekeptinasafeandsecurelocationattheSchoolofSportScience,ExerciseandHealth,TheUniversityofWesternAustralia.Anyinformationthatisobtainedinconnectionwiththisstudyandthatcanbeattributedtoyouwillremainconfidentialandwillnotbeaccessibletoanyotherpartiesexcepttheprimaryinvestigatorunlessrequiredbylaw.Anyinformationgatheredfromswimmerswillnotbesharedwiththeircoach.

School of Sport Science, Exercise & Health M 408, The University of Western Australia 35 Stirling Highway, Crawley, WA, 6009 Phone + 61 8 6488 2375 Fax + 61 8 6488 1039 Email [email protected]

Dr. Sandy Gordon, FAPSSenior Lecturer

PARTICIPANTRIGHTSParticipationinthisresearchisvoluntaryandyouarefreetowithdrawfromthestudyatanytimewithoutprejudice.Youcanwithdrawforanyreasonandyoudonotneedtojustifyyourdecision.IfyouwithdrawfromthestudyandyouareanemployeeorstudentatTheUniversityofWesternAustralia(UWA)thiswillnotprejudiceyourstatusandrightsasanemployeeorstudentofUWA.Ifyouareaswimmerofacompetitiveswimclub,withdrawalwillnotprejudiceyourstatusorrightsasaswimmerofthatclub.

Ifyoudowithdrawwemaywishtoretainthedatathatwehaverecordedfromyoubutonlyifyouagree,otherwiseyourrecordswillbedestroyed.

Yourparticipationinthisstudydoesnotprejudiceanyrighttocompensationthatyoumayhaveunderstatuteofcommonlaw.

Ifyouhaveanyquestionsconcerningtheresearchatanytimepleasefeelfreetoasktheresearcherwhohascontactedyouaboutyourconcerns.

Furtherinformationregardingthisstudymaybeobtainedfrom:

Investigator Email PhoneNumber

Ms.JulieHardt,MSc [email protected] +61420502925(mobile)

+61864887409(office)

Dr.SandyGordon,FAPS [email protected] +61864882375

Mr.NatBenjanuvatra,BSc(Hons)

[email protected] +61864882437

126

PreventionandManagementofInjuryinCompetitiveSwimming

PhDThesisproject,Study1

JulieHardt,MSc

—ConsentForm—

I___________________________havereadtheinformationprovided,andanyquestionsIhaveaskedhavebeenansweredtomysatisfaction.Iagreetoparticipateinthisactivity,realisingthatImaywithdrawatanytimewithoutreasonandwithoutprejudice.

Iunderstandthatallinformationprovidedistreatedasstrictlyconfidentialandwillnotbereleasedbytheinvestigatorunlessrequiredtobylaw.Ihavebeenadvisedastowhatdataisbeingcollected,whatthepurposeis,andwhatwillbedonewiththedatauponcompletionoftheresearch.

Iagreethatresearchdatagatheredforthestudymaybepublishedprovidedmynameorotheridentifyinginformationisnotused.

________________________________________

ParticipantSignatureDate

Forparticipantslessthan18yearsofage:

________________________________________

Parent/GuardianSignatureDate

TheHumanResearchEthicsCommitteeatTheUniversityofWesternAustraliarequiresthatallparticipantsareinformedthatiftheyhaveanycomplaintregardingthemannerinwhicharesearchprojectisconducted,itmaybegiventotheresearcheror,alternativelytotheSecretary,HumanResearchEthicsCommittee,Registrar’sOffice,TheUniversityofWesternAustralia,35StirlingHighway,Crawley,WA6009(telephonenumber6488‐3703).AllstudyparticipantswillbeprovidedwithacopyoftheInformationSheetandConsentFormfortheirpersonalrecords.

School of Sport Science, Exercise & Health

TheUniversityofWesternAustralia35StirlingHighway,CrawleyWA6009

Phone+ 61 8 6488 2375

Fax+ 61 8 6488 1039

[email protected]


Prevention and Management of Injury in Competitive Swimming


JulieHardt,MSc

— CoachInterviewQuestions—

1. Whatarethetypicalinjuriesthatyoudealwithfromseasontoseason?

2. Forswimmerswhoareconsistentlyinjuredfromseasontoseason,whatisdifferentaboutthemincomparisontotheirhealthyteammates?

3. Whattypesofissuessurfacewhenmanaginginjuredswimmers?

a. Howdoyoudealwiththeseissues?

4. Whatdoyouperceiveyourroletobeintheinjuryrehabilitationprocess?

5. Areyouawareofanyinjurymanagementprogramsincompetitiveswimming,ordoyouactivelyuseaninjurymanagementprogram?

a. Whatarethecharacteristicsofyourinjurymanagementprogram(orwhatshouldtheybe)?

i. Whatspecificallydoyoudotopreventinjury(orwhatshouldyoudo)?

ii. Whatspecificallydoyoudowhenaswimmergetsinjured(orwhatshouldyoudo)?

iii. Whatspecificallydoyoudoduringtheirrehabilitation(orwhatshouldyoudo)?

iv. Howspecificallydoyoudetermineif/whentheyarereadytoreturntotrainingandcompetition?

6. Whattypesofskillsdoyouseeinjuredswimmersemploythataresuccessfulathelpingthemdealwithandrecoverfrominjury?

a. Whattypesofskillsdoyouseeinjuredswimmersemploythatareunsuccessfulathelpingthemdealwithandrecoverfrominjury?

7. Whattypesofskillsdoyouteachyourswimmersorwouldlikeyourswimmerstolearninordertodealwithandrecoverfrominjury?

8. Whattypesofswimmerbehavioursorattitudespositivelyornegativelyaffectyourresponsetothemandtheirinjury?

SchoolofSportScience,Exercise&HealthM408,TheUniversityofWesternAustralia35StirlingHighway,Crawley,WA,6009Phone+61864882375Fax+61864881039Email:[email protected],

Dr.SandyGordon,FAPSSeniorLecturer

128



JulieHardt,MSc

— SwimmerInterviewQuestions—

1. Whattypesofinjurieshaveyouhadtodealwithinthepast2years?

2. Forteammateswhoareconsistentlyinjuredfromseasontoseason,whatisdifferentaboutthemincomparisontoyourhealthyteammates?

3. Whathavebeenthehardestissuesforyoutodealwithasaresultofinjury?

4. Whattypesofskillshaveyouemployedthathavehelpedyoudealwithyourinjury?

a. Whattypesofskillshaveyouemployedthathaven’thelpedyoudealwithyourinjuryorhavemadethingsworse?

5. Whattypesofcoachbehavioursorattitudeshavepositivelyornegativelyaffectedyouoryourresponsetoyourinjury?

6. Whatdoyouperceiveyourcoach’sroletobeintheinjuryrehabilitationprocess?

7. Areyouawareofanyinjurymanagementprogramsinswimming,ordoesyourcoachactivelyuseaninjurymanagementprogram?

a. Iftherewereanidealinjurymanagementprogram,whatcharacteristicswouldithave?

i. Whatspecificallyshouldbedonetopreventinjury?

ii. Whatspecificallyshouldbedonewhenaswimmergetsinjured?

iii. Whatspecificallyshouldbedoneduringrehabilitation?

iv. Howshoulditbedeterminedwhenaninjuredswimmerisreadytoreturntotrainingandcompetition?

SchoolofSportScience,Exercise&HealthM408,TheUniversityofWesternAustralia35StirlingHighway,Crawley,WA,6009Phone+61864882375Fax+61864881039Email:[email protected],


129



JulieHardt,MSc

— SportsMedicineProfessionalInterviewQuestions—

1. Whatisyourroleintheinjuryrehabilitationprocess?

2. Whatarethetypicalinjuriesforwhichyoutreatswimmersfromyeartoyear?

3. Foryou,whattypesofissuessurfacewhenmanaginginjuredswimmers?

a. Howdoyoudealwiththeseissues?

4. Forswimmerswhoareconsistentlyinjuredfromseasontoseason,whatisdifferentaboutthemincomparisontotheirhealthyteammates?

5. Areyouawareofanycoachimplementedinjurymanagementprogramsincompetitiveswimming?

a. Iftherewasanidealinjurymanagementprogram,whatcharacteristicsdoyouthinkitshouldithave?

i. Whatspecificallyshouldbedonetopreventinjury?

ii. Whatspecificallyshouldbedonewhenaswimmergetsinjured?

iii. Whatspecificallyshouldbedoneduringtheirrehabilitation?

iv. Howshoulditbedeterminedwhenaninjuredswimmerisreadytoreturntotrainingandcompetition?

6. Whattypesofskillsdoyouseeinjuredswimmersemploythataresuccessfulathelpingthemtodealwithandrecoverfrominjury?

a. Whattypesofskillsdoyouseeinjuredswimmersemploythatareunsuccessfulathelpingthemdealwithandrecoverfrominjury?

7. Whattypesofskillsdoyouthinkswimmersshouldlearninordertosuccessfullydealwithandrecoverfrominjury?

8. Whattypesofswimmerbehavioursorattitudespositivelyornegativelyaffectyourresponsetothemandtheirinjury?


SchoolofSportScience,Exercise&HealthM408,TheUniversityofWesternAustralia35StirlingHighway,Crawley,WA,[email protected]

130

APPENDIX B: Study Two

1. InformationSheet/ImpliedConsentForm

2. InjuryPreventionandManagementProfileforSwimming(IPMP‐S):Coach

form

3. IPMP‐S:Swimmerform

131

PreventionandManagementofInjuryinCompetitiveSwimmingPhDThesisproject,Study2

JulieHardt,MSc— ParticipantInformationSheet—

PURPOSEThisstudyaimstodiscoverthemosteffectivepracticethatcoachesshouldemploytopreventandmanageinjuryincompetitiveswimmingfromapsycho‐socialstandpoint.Theintentionwillbetotakeacomprehensivelookatthephenomenonofinjury,includinginjurypreventionstrategiesandplansdesignedtoaddressthepsychologicalresponsestoinjuryrehabilitationandreturntotrainingandcompetition.Preventionandmanagementpracticeswillbeformulatedthroughinformationgatheredfromaquestionnairesurveyingcoachesandswimmers.

PROCEDURESAsaparticipant,youwillbeaskedtocompleteaquestionnaireaboutpreventionandmanagementofinjuryincompetitiveswimming.Youwillbeaskedforgeneralbackgroundinformationofyourexperiencewitheliteswimmingaswellasyourexperiencewithinjury,includinginjuryprevention,occurrence,andmanagement.Youwillalsobeaskedforyouropiniononproposedinjurymanagementpractices.Thisquestionnairewilltakeapproximately20minutestocomplete,andyouwillbesurveyedonceonly.

RISKSTherearenorisksforeseenaspartofthequestionnaireprocess.Thequestionsaskedwillnotbeofasensitivenature,andresponseswillbekeptstrictlyconfidential.

BENEFITSBenefitsofthisresearchmayincludegainsinknowledgeandunderstandingofthepsycho‐socialaspectsofinjurywhichmayimprovetheinjurypreventionandmanagementpracticesincompetitiveswimming.Theknowledgegainedregardingthesepracticeswillbemadeavailabletoyouattheconclusionofthestudy.

CONFIDENTIALITYAllinformationwillbekeptstrictlyconfidential.DatawillbekeptinasafeandsecurelocationattheSchoolofSportScience,ExerciseandHealth,TheUniversityofWesternAustralia.Anyinformationthatisobtainedinconnectionwiththisstudyandthatcanbeattributedtoyouwillremainconfidentialandwillnotbeaccessibletoanyotherpartiesexcepttheprimaryinvestigatorunlessrequiredbylaw.Anyinformationgatheredfromswimmerswillnotbesharedwiththeircoach.

PARTICIPANTRIGHTSParticipationinthisresearchisvoluntaryandyoucandeclinetoparticipateinthisstudyatanytimeandwithoutprejudice.Youcanwithdrawforanyreasonandyoudonotneedtojustifyyourdecision.Ifyoudeclinetoparticipateinthisstudyand



132

youareanemployeeorstudentatTheUniversityofWesternAustralia(UWA)thiswillnotprejudiceyourstatusandrightsasanemployeeorstudentofUWA.Ifyouareaswimmerofacompetitiveswimclub,withdrawalwillnotprejudiceyourstatusorrightsasaswimmerofthatclub.Ifyoudowithdrawwemaywishtoretainthedatathatwehaverecordedfromyoubutonlyifyouagree,otherwiseyourrecordswillbedestroyed.Yourparticipationinthisstudydoesnotprejudiceanyrighttocompensationthatyoumayhaveunderstatuteofcommonlaw.Ifyouhaveanyquestionsconcerningtheresearchatanytimepleasefeelfreetoasktheresearcherwhohascontactedyouaboutyourconcerns.Furtherinformationregardingthisstudymaybeobtainedfrom:Investigator Email PhoneNumberMs.JulieHardt,MSc [email protected] +61420502925(mobile)

+61864887409(office)Dr.SandyGordon,FAPS [email protected] +61864882375Mr.NatBenjanuvatra,BSc(Hons)


Bycontinuingwiththisquestionnaire,youareagreeingthatyouhavereadandunderstandtheaboveinformation,andyouaregivingyourconsenttoparticipateinthisstudy.

133


The items in this questionnaire relate to actions and behaviours coaches enact for the prevention and management

of injury in competitive swimming. Following a brief survey on your personal demographic information, the

questionnaire is divided into four sections: injury prevention, short‐term injury management, long‐term injury

management, and return to full training.

Please answer these demographic items as they pertain to you and your coaching.

Please select your country of residence, your state or territory, and whether you live in an urban, suburban, or rural area.

Country Australia Other (please specify) : ___________________________

State ACT NSW NT QLD SA TAS VIC WA N/A

City Type Urban Suburban Rural

Please list your date of birth.

Day

Month

Year

Please select your gender:

Male Female

What is the highest coaching qualification you have held?

AUSTSWIM Junior Squad and Assistant

Coach

Bronze Silver

Gold

Platinum

Other (please specify):

______________________________________________

How many years of experience do you have as a swim coach?

1‐5 years 6‐10 years 11‐15 years 16‐20 years 21+ years

What is your current coaching position on your team?

Head Club

Coach

Assistant

Club coach

Head University

Coach

Assistant University

Coach

Other (please specify):

______________________

What is the typical age range of swimmers you coach?

12 years old and

younger

13‐17 years old 18‐25 years

old

Masters swimmers Other (please specify):

______________________

Do you have any personal competitive swimming experience?

No Yes

If YES: How many years did you compete as a swimmer?

1‐5

years

6‐10

years

11‐15

years

16+

years

134

What was the highest level you achieved as a competitive swimmer?

Interschool

competitions

State

Championships

NationalAge

Championships

NationalOpen

Championships

International(e.g.Olympics,World

Championships,CommonwealthGames)

Other(pleasespecify):

________________________________________________________

Please select the highest level of education you have achieved: HighSchool

Graduate

University

Graduate

University

Postgraduate

If you attended university, was your degree in Human Movement / Sport Science? No

Yes

When a swimmer in your squad sustains an injury…

Who is the primary manager of their training as they rehabilitate?

Myself HeadCoach Assistant

Coach


________________________

Which of the following sports medicine professionals would you send them to (select all that apply)?

Sports

physiotherapist/

Athletictrainer

Sports

physician

Massagetherapist Chiropractor

General

Practitioner(family

doctor)


__________________________________________

How much time would you spend with them in comparison to their healthy teammates?

Lesstimewiththeinjured

swimmerthantheirhealthy

teammates

Equaltimewiththeinjuredswimmer

andtheirhealthyteammates

Moretimewiththe

injuredswimmerthantheir

healthyteammates

Have you ever personally sustained a sports injury that limited your participation for more than 21 days?

No Yes

135

Section I: INJURY PREVENTION

In this section, you will be presented with a series of items related to injury prevention behaviours. Once you have

read each item, you will be asked how well that item matches your coaching behaviour: To A Great Extent, A Lot,

Somewhat, A Little, or Not At All. You will also be asked how important you believe that action is for the prevention

of injury: Very Important, Important, Moderately Important, Of Little Importance, or Unimportant.

Please answer both sides of the statement. Select the response that best describes your behaviour.

EXAMPLE:

How well does this match your

behaviour?

How important is this for injury prevention?

To a great

extent A lot

Some‐

what A little Not at all I…

Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

take daily attendance.

INJURY PREVENTION:


behaviour?


To a great

extent A lot

Some‐


Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

Monitor the daily training intensity of my

squad.

include proper warm‐up techniques in the

daily training of my squad.


behaviour?


To a great

extent A lot

Some‐


Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

include proper warm‐down techniques in the daily training of my squad.

monitor the volume of equipment use in my squad (e.g. paddles).

monitor and correct the stroke technique of swimmers in my squad.

incorporate dry‐land exercises in my weekly training schedule (e.g. sit‐ups, push‐ups, jumps, weight training, stretch cords).

136

incorporate stretching in my weekly training schedule.

teach my swimmers to maintain a balanced diet.

teach my swimmers to hydrate properly.

teach my swimmers the importance of adequate sleep.

teach my swimmers to develop body awareness (e.g. knowing the difference between soreness and injury).

ensure all the swimmers get a pre‐season clinical assessment for injury risk by a sports medicine professional (e.g. sports physiotherapist, athletic trainer, sports physician).

teach my squad injury prevention protocols (e.g. stretching, rest, stress management, proper technique).

teach the parents injury prevention protocols.

develop my own knowledge about injury prevention protocols (e.g. reading articles, attending conferences, etc.).

formally introduce injury management protocols with my squad at the beginning of the season.

encourage my swimmers to openly communicate with me.

work to develop a good coach‐to‐swimmer relationship with each swimmer.

communicate with the parents.

communicate with other members of staff on my team.


behaviour?


To a great

extent A lot

Some‐


Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

have a specific sports medicine professional (sports physiotherapist, sports physician) to whom I refer all the injured swimmers in my squad.

In my opinion, my swimmers feel free to talk to me about injuries.

implement goal setting procedures with my swimmers.

implement imagery techniques (e.g. visualization skills) with my swimmers.

implement coping skills with my swimmers.

implement relaxation techniques with my swimmers.

implement time management techniques with my swimmers.

137

Section II: SHORT‐TERM INJURY MANAGEMENT

(0‐3 days post‐injury)

In this section, you will be presented with a series of items related to short‐term injury management behaviours,

which are enacted immediately following an injury up to 2‐3 days afterward.

Once you have read each item, you will be asked how well that item matches your coaching behaviour: To A Great

Extent, A Lot, Somewhat, A Little, or Not At All. You will also be asked how important you believe that action is for

short‐term injury management: Very Important, Important, Moderately Important, Of Little Importance, or

Unimportant.


SHORT‐TERM INJURY MANAGEMENT:


behaviour?

How important is this for short‐term injury

management?

To a great

extent A lot

Some‐


Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

determine what part of the body is injured.

determine how the swimmer got injured.

determine whether the reported injury is

pain or just soreness.

tell the injured swimmer to stop

swimming.

tell the injured swimmer to keep

swimming.

tell the injured swimmer to adjust their

swimming (e.g. change strokes, stop or add

equipment use).

tell the injured swimmer to ice the area.

tell the injured swimmer to stretch.

tell the injured swimmer to rest the area.

tell the injured swimmer to take an over

the counter anti‐inflammatory medication

(e.g. ibuprofen).

tell the injured swimmer to see a sports

medicine professional (e.g. sports

physiotherapist, sports physician).

138

tell the injured swimmer to see a sports

medicine professional whom I specifically

recommend.

remain sceptical about the swimmer’s

reported injury.

believe the injured swimmer is in pain.

encourage the injured swimmer to openly

communicate with me about their injury.

communicate with the injured swimmer’s

parents about their injury.

communicate with the sports medicine

professional about the injured swimmer’s

diagnosis.

Please comment on your short‐term injury management protocol. What is really

important for you to implement? What are some of the obstacles to implementing

other items? (optional)

139

Section III: LONG‐TERM INJURY MANAGEMENT

(Behaviours enacted from 3 days post‐injury lasting through full recovery.)

In this section, you will be presented with a series of items related to long‐term injury management behaviours,

which are enacted after an injury has already been assessed and last through the duration of the rehabilitation

phase.

Once you have read each item of long‐term injury management, you will be asked how well that item matches your

coaching behaviour: To A Great Extent, A Lot, Somewhat, A Little, or Not At All. You will also be asked how

important you believe that action is for long‐term injury management: Very Important, Important, Moderately

Important, Of Little Importance, or Unimportant.



behaviour?

How important is this for long ‐term injury

management?

To a great

extent A lot

Some‐

what A little Not at all

For swimmers with long‐term

injuries, I…

Very

importantImportant

Moderately

important

Of little

importance

Un‐

important

create a modified season training plan for

them.

adjust their daily training based on the

progress of their injury.

assess their swimming technique.

provide them with training challenges (e.g.

create kicking specific test sets).

leave it up to the injured swimmers to

modify their own training.

go out of my way to keep the injured

swimmers socially connected to the team.

ensure they start their training session at

the same time as their healthy teammates.

ensure they finish their training session at

the same time as their healthy teammates.

keep them training in the same lane as

their healthy teammates.

have them do the same sets as their

healthy teammates.

give the injured swimmers personalised

training sets to complete.

have them help out with on‐deck activities

(e.g. timing, assistant coaching, etc.).

140

organise team social activities (e.g. team

dinners, movie nights, etc.) outside of

training to include all swimmers in the

squad.

provide them with encouragement.

motivate them to work hard.

emphasise the importance of the

rehabilitation process.

help them view their injury as an

opportunity to improve other aspects of

their swimming.

emphasise the importance of the


help them view their injury as an

opportunity to improve other aspects of

their swimming.

convey a belief to the injured swimmers

that they will improve despite their injury.

inspire them with examples of other

successful swimmers who have overcome

injuries.

set aside extra time to talk with them.

help them manage negative emotions.

help them keep a positive attitude.

personally keep a positive attitude.

am patient with the injured swimmers

throughout the rehabilitation process.

encourage them to seek support from their

parents.

encourage the injured swimmer's parents

to show their support.


teammates.

encourage the teammates to show support

for the injured swimmers.


friends.

encourage them to see a sport

psychologist.

141

continually communicate with them about

their training and rehabilitation plan.

encourage the injured swimmers to openly

communicate with me.

communicate with the sports medicine

professional (e.g. sports physiotherapist,

athletic trainer, sports physician).

openly communicate with the injured

swimmer's parents.

continually educate the injured swimmers

about the rehabilitation process.

educate them about maintaining personal

health.

educate the parents about the injury


educate the squad about why injured

swimmers must follow a different training

plan.

provide the injured swimmers with

material about injury management

techniques (e.g. articles, pamphlets, etc.).

help the injured swimmer set goals.

help the injured swimmer implement

imagery techniques (i.e. visualisation).

help the injured swimmer implement

coping skills.

help the injured swimmers implement

relaxation techniques.

help the injured swimmer implement time

management techniques.

Please comment on your long‐term injury management protocol. What is really



143

Section IV: RETURN TO FULL TRAINING

In this section, you will be presented with a series of items regarding an injured swimmer’s return to full training. At

the end of the rehabilitation phase of an injury, an athlete must make the transition from modified training back

into full, healthy training, and this section relates to those behaviours enacted to facilitate this process of returning

to sport.

Once you have read each item regarding the return to full training, you will be asked how well that item matches

your coaching behaviour: To A Great Extent, A Lot, Somewhat, A Little, or Not At All. You will also be asked how

important you believe that action is for the return to full training: Very Important, Important, Moderately

Important, Of Little Importance, or Unimportant.


RETURN TO FULL TRAINING:


behaviour?

How important is this for return to full

training?

To a great

extent A lot Some‐what A little Not at all I…

Very

important Important

Moderately

important

Of little

importance

Un‐

important

progressively increase training levels until the

injured swimmer is healthy.

implement high performance expectations for the

injured swimmer.

restrain the injured swimmer from returning too

quickly.

put extra encouragement on the swimmer to

return to full training.

increase training levels dependent upon feedback

from the injured swimmer.

allow the injured swimmer to decide the pace at

which they return to full training.

increase training levels only when the injured

swimmer is pain free.

have the injured swimmer push through some pain

in their return to full training.

increase training levels dependent upon feedback

from the sports medicine professional.

increase training levels dependent upon results

from clinical tests.

help the injured swimmer build their confidence as

they return to full training.

help the injured swimmer manage anxiety as they

return to full training.

144

Please comment on your protocol for returning to full training. What is really



THANK YOU FOR YOUR PARTICIPATION. YOU HAVE AIDED THE PROCESS OF REDUCING AND MANAGING

INJURIES IN COMPETITIVE SWIMMING.

145


The items in this questionnaire relate to actions and behaviours your coach enacts for the prevention and

management of injury in competitive swimming. Following a brief survey on your personal demographic

information,thequestionnaireisdividedintofoursections:injuryprevention,short‐terminjurymanagement,

long‐terminjurymanagement,andreturntofulltraining.

Pleaseanswerthesedemographicitemsastheypertaintoyouandyourswimmingexperience.

Pleaseselectyourcountryofresidence,yourstateorterritory,andwhetheryouliveinanurban,suburban,or

ruralarea.

Country Australia Other(pleasespecify):___________________________

StateACT NSW NT QLD SA TAS VIC WA N/A

CityType Urban Suburban Rural

Please list your date of birth.

Day

Month

Year

Please select your gender:

Male Female

Whatisthehighestlevelyouhaveachievedasacompetitiveswimmer?

InterschoolCompetitions StateChampionships NationalAge

Championships

NationalOpen

Championships

International(e.g.Olympics,World

Championships,CommonwealthGames)

Other(pleasespecify):_______________________________

Haveyoubeeninjuredatallinthelast0‐24months?

No Yes

IFYES:

BodyPartInjured

shoulder,knee,groin,etc.

TypeofInjury:

tendonitis,pulledmuscle,brokenbone,etc.

SeverityofInjury:

minor=limitedtrainingless

than7days/moderate=

limitedtraining7‐21days/

major=limitedtrainingmore

than21days

Injury1:

Injury2:

Injury3:

146

Injury4:

Areyoucurrentlyinjured?No

Yes

Ifyouweretobeseriouslyinjured(morethan21days),howmuchtimewouldyouexpectyourcoachtospendwith

youincomparisontoyourhealthyteammates?

Lesstimewithmethanmyhealthy

teammates

Equaltimewithmeandmyhealthy

teammates.

Moretimewithmethanmyhealthy

teammates.

SectionI:INJURYPREVENTION

Inthissection,youwillbepresentedwithaseriesofitemsrelatedtoinjurypreventionbehaviours.Onceyou

havereadeachitem,youwillbeaskedhowwellthatitemmatchesyourcoach’scurrentbehaviour:ToAGreat

Extent,ALot,Somewhat,ALittle,orNotAtAll.Youwillalsobeaskedhowimportantyoubelievethatactionis

for the prevention of injury: Very Important, Important, Moderately Important, Of Little Importance, or

Unimportant.

Pleaseanswerbothsidesofthestatement.Selecttheresponsethatbestdescribesyourcoach.

EXAMPLE:

Howwelldoesthismatchyourcoach? Howimportantisthisforinjuryprevention?

Toagreat

extentAlot

Some‐

whatAlittle Notatall Mycoach…

Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

takesdailyattendance.

INJURYPREVENTION:


Toagreat

extentAlot

Some‐


Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

monitorsthedailytrainingintensityofmysquad.

includesproperwarm‐uptechniquesinthedaily

trainingofmysquad.

includesproperwarm‐downtechniquesinthedaily

trainingofmysquad.

147

monitorsthevolumeofequipmentuseinmysquad

(e.g.paddles).

monitorsandcorrectsthestroketechniqueof

swimmersinmysquad.

incorporatesdry‐landexercisesinmyweekly

trainingschedule(e.g.sit‐ups,push‐ups,jumps,

weighttraining,stretchcords).

incorporatesstretchinginmyweeklytraining

schedule.

teachesmetomaintainabalanceddiet.

teachesmetohydrateproperly.

teachestheimportanceofadequatesleep.

teachesmetodevelopbodyawareness(e.g.

knowingthedifferencebetweensorenessand

injury).

ensuresalltheswimmersgetapre‐seasonclinical

assessmentforinjuryriskbyasportsmedicine

professional(e.g.sportsphysiotherapist,athletic

trainer,sportsphysician).


Toagreat

extentAlot

Some‐


Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

teachesmeinjurypreventionprotocols(e.g.

stretching,rest,stressmanagement,proper

technique).

teachestheparentsinjurypreventionprotocols.

developshis/herownknowledgeaboutinjury

preventionprotocols(e.g.readingarticles,

attendingconferences,etc.).

formallyintroducesinjurymanagementprotocols

withmysquadatthebeginningoftheseason.

encouragesmetoopenlycommunicatewith

her/him.

workstodevelopagoodcoach‐to‐swimmer

relationshipwithme.

communicateswithmyparents.

148

communicateswithothermembersofstaffonmy

team.

hasaspecificsportsmedicineprofessional(sports

physiotherapist,athletictrainer,sportsphysician)

towhoms/herefersalltheinjuredswimmersinmy

squad.

Ifeelfreetotalktomycoachaboutinjuries.

goalsettingprocedureswithme.

imagerytechniqueswithme(e.g.visualization

skills).

copingskillswithme.

relaxationtechniqueswithme.

timemanagementtechniqueswithme.

Pleasecommentonanystrengthsorweaknessesyourcoachhaswithinjury

prevention.Whatdoesyourcoachdowell?Whatcouldyourcoachdobetter?

(optional)

149

SectionII:SHORT‐TERMINJURYMANAGEMENT

(0‐3dayspost‐injury)

In this section, you will be presented with a series of items related to short‐term injury management

behaviours,whichareenactedimmediatelyfollowinganinjuryupto2‐3daysafterward.

Onceyouhavereadeachitem,youwillbeaskedhowwellthatitemmatchesyourcoach’scurrentbehaviour:

ToAGreatExtent,ALot,Somewhat,ALittle,orNotAtAll.Youwillalsobeaskedhowimportantyoubelieve

that action is for short‐term injurymanagement:Very Important, Important,Moderately Important,OfLittle

Importance,orUnimportant.

Pleaseanswerbothsidesofthestatement.Selecttheresponsethatbestdescribesyourcoach.(Ifyou’venever

beeninjured,pleasebaseyourresponsesonwhatyouthinkyourcoachwoulddo.)

Howwelldoesthismatchyourcoach?Howimportantisthisforshort‐terminjury

management?

Toagreat

extentAlot

Some‐

whatAlittle Notatall

Whenaninjuryisreportedtomycoach,

s/he…

Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

determineswhatpartofthebodyisinjured.

determineshowtheswimmergotinjured.

determineswhetherthereportedinjuryispainor

justsoreness.

tellstheinjuredswimmertostopswimming.

tellstheinjuredswimmertokeepswimming.

tellstheinjuredswimmertoadjusttheirswimming

(e.g.changestrokes,stoporaddequipmentuse).

tellstheinjuredswimmertoicethearea.

tellstheinjuredswimmertostretch.

tellstheinjuredswimmertorestthearea.

tellstheinjuredswimmertotakeanoverthe

counteranti‐inflammatorymedication(e.g.

ibuprofen).

tellstheinjuredswimmertoseeasportsmedicine

professional(e.g.sportsphysiotherapist,sports

physician).

tellstheinjuredswimmertoseeasportsmedicine

professionalwhomtheyspecificallyrecommend.

remainsscepticalabouttheswimmer’sreported

injury.

believestheinjuredswimmerisinpain.

150

encouragestheinjuredswimmertoopenly

communicatewiththemabouttheirinjury.

communicateswiththeinjuredswimmer’sparents

abouttheirinjury.

communicateswiththesportsmedicine

professionalabouttheinjuredswimmer’sdiagnosis.

Pleasecommentonanystrengthsorweaknessesyourcoachhaswithshort‐

terminjurymanagement.Whatdoesyourcoachdowell?Whatcouldyour

coachdobetter?(optional)

151

SectionIII:LONG‐TERMINJURYMANAGEMENT

(Behavioursenactedfrom3dayspost‐injurylastingthroughfullrecovery.)

In this section, you will be presented with a series of items related to long‐term injury management

behaviours,whichareenactedafteraninjuryhasalreadybeenassessedandlastthroughthedurationofthe

rehabilitationphase.

Onceyouhavereadeachitemoflong‐terminjurymanagement,youwillbeaskedhowwellthatitemmatches

yourcoach’sbehaviour:ToAGreatExtent,ALot,Somewhat,ALittle,orNotAtAll.Youwillalsobeaskedhow

importantyoubelievethatactionisforlong‐terminjurymanagement:VeryImportant,Important,Moderately

Important,OfLittleImportance,orUnimportant.


beeninjured,pleasebaseyourresponsesonwhatyouthinkyourcoachwoulddo).

Howwelldoesthismatchyourcoach?Howimportantisthisforlong‐terminjury

management?

Toagreat

extentAlot

Some‐


Forswimmerswithlong‐terminjuries,my

coach…

Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

createsamodifiedseasontrainingplanforthem.

adjuststheirdailytrainingbasedontheprogressof

theirinjury.

assessestheirswimmingtechnique.

providestrainingchallenges(e.g.createkicking

specifictestsets).

leavesituptotheswimmertomodifytheirown

training.

goesoutofhis/herwaytokeeptheinjured

swimmerssociallyconnectedtotheteam.


management?

Toagreat

extentAlot

Some‐



coach…

Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

ensurestheystarttheirtrainingsessionatthesame

timeastheirhealthyteammates.

ensurestheyfinishtheirtrainingsessionatthe

sametimeastheirhealthyteammates.

keepsthemtraininginthesamelaneastheir

healthyteammates.

152

hasthemdothesamesetsastheirhealthy

teammates.

givestheinjuredswimmerspersonalizedtraining

setstocomplete.

hasthemhelpoutwithon‐deckactivities(e.g.

timing,assistantcoaching,etc.).

organizesteamsocialactivities(e.g.teamdinners,

movienights,etc.)outsideoftrainingtoincludeall

swimmersinthesquad.

providesthemwithencouragement.

motivatesthemtoworkhard.

emphasizestheimportanceoftherehabilitation

process.

helpsthemviewtheirinjuryasanopportunityto

improveotheraspectsoftheirswimming.

conveysabelieftotheinjuredswimmersthatthey

willimprovedespitetheirinjury.

inspiresthemwithexamplesofothersuccessful

swimmerswhohaveovercomeinjuries.

setsasideextratimetotalkwiththem.

helpsthemmanagenegativeemotions.

helpsthemkeepapositiveattitude.

personallykeepsapositiveattitude.

ispatientwiththeinjuredswimmersthroughout

therehabilitationprocess.

encouragesthemtoseeksupportfromtheir

parents.

encouragestheinjuredswimmer'sparentstoshow

theirsupport.

encouragesthemtoseeksupportfromtheir

teammates.

encouragestheteammatestoshowsupportforthe

injuredswimmers.

encouragesthemtoseeksupportfromtheirfriends.

encouragesthemtoseeasportpsychologist.

continuallycommunicateswiththemabouttheir

trainingandrehabilitationplan.

153


management?

Toagreat

extentAlot

Some‐



coach…

Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

encouragestheinjuredswimmerstoopenly

communicatewiththem.

communicateswiththesportsmedicine

professional(e.g.sportsphysiotherapist,athletic

trainer,sportsphysician).

openlycommunicateswiththeinjuredswimmer's

parents.

continuallyeducatestheinjuredswimmersabout

therehabilitationprocess.

educatesthemaboutmaintainingpersonalhealth.

educatestheparentsabouttheinjuryrehabilitation

process.

educatesthesquadaboutwhyinjuredswimmers

mustfollowadifferenttrainingplan.

providestheinjuredswimmerswithmaterialabout

injurymanagementtechniques(e.g.articles,

pamphlets,etc.).

helpstheinjuredswimmersetgoals.

helpstheinjuredswimmerimplementimagery

techniques(i.e.visualisation).

helpstheinjuredswimmerimplementcopingskills.

helpstheinjuredswimmersimplementrelaxation

techniques.

helpstheinjuredswimmerimplementtime

managementtechniques.

Pleasecommentonanystrengthsorweaknessesyourcoachhaswithlong‐terminjury

management.Whatdoesyourcoachdowell?Whatcouldyourcoachdobetter?(optional)

154

SectionIV:RETURNTOFULLTRAINING

In this section, youwill be presentedwith a series of items regarding an injured swimmer’s return to full

training.Attheendoftherehabilitationphaseofaninjury,anathletemustmakethetransitionfrommodified

trainingbackintofull,healthytraining,andthissectionrelatestothosebehavioursenactedtofacilitatethis

processofreturningtosport.

Once you have read each item regarding the return to full training, youwill be asked howwell that item

matchesyourcoach’sbehaviour:ToAGreatExtent,ALot,Somewhat,ALittle,orNotAtAll.Youwillalsobe

asked how important you believe that action is for the return to full training: Very Important, Important,

ModeratelyImportant,OfLittleImportance,orUnimportant.


beeninjured,pleasebaseyourresponsesonwhatyouthinkyourcoachwoulddo).

Howwelldoesthismatchyourcoach? Howimportantisthisforreturntofull

training?

Toagreat

extentAlot

Some‐


Very

importantImportant

Moderately

important

Oflittle

importance

Un‐

important

progressivelyincreasestraininglevelsuntilthe

injuredswimmerishealthy.

implementshighperformanceexpectationsforthe

injuredswimmer.

restrainstheinjuredswimmerfromreturningtoo

quickly.

putsextraencouragementontheswimmerto

returntofulltraining.

increasestraininglevelsdependentuponfeedback

fromtheinjuredswimmer.

allowstheinjuredswimmertodecidethepaceat

whichtheyreturntofulltraining.

increasestraininglevelsonlywhentheinjured

swimmerispainfree.

hastheinjuredswimmerpushthroughsomepain

intheirreturntofulltraining.

increasestraininglevelsdependentuponfeedback

fromthesportsmedicineprofessional.

155

increasestraininglevelsdependentuponresults

fromclinicaltests.

helpstheinjuredswimmerbuildtheirconfidenceas

theyreturntofulltraining.

helpstheinjuredswimmermanageanxietyasthey

returntofulltraining.

Pleasecommentonanystrengthsorweaknessesyourcoachhasinregards

totheprocessofreturningtofulltraining.Whatdoesyourcoachdowell?

Whatcouldyourcoachdobetter?(optional)

THANKYOUFORYOURPARTICIPATION.

YOUHAVEAIDEDTHEPROCESSOFREDUCINGANDMANAGINGINJURIESINCOMPETITIVE

SWIMMING.

156

APPENDIX C: Study Three

1. InformationSheet

2. ConsentForm

3. LifeEventsSurveyforCollegiateAthletes(LESCA)

4. Recovery‐StressQuestionnaireforAthletes(RESTQ‐76Sport)

5. SocialSupportSurvey(SSS)

157


PhDThesisproject,Study3JulieHardt,MSc

‐ParticipantInformationSheet‐

PURPOSEThisstudyaimstotakeacomprehensivelookatthephenomenonofinjury,includinginjurypreventionstrategiesandplansdesignedtoaddressthepsychologicalresponsestoinjuryrehabilitationandreturntotrainingandcompetition.Specifically,theaimistodesignandimplementacoachtrainingprogramforthepreventionandmanagementofinjuryincompetitiveswimming.

PROCEDURESAsacoachparticipant,youmaybeaskedtoparticipateinacoachtrainingprogramfocusedonteachingadaptivecopingskillsandprovidingappropriatesocialsupporttoyourinjuredathletes.Periodicallythroughoutthecompetitiveseason,theresearchinvestigatorwillconductoneononeinterviewswithyoutotracktheincidenceofinjuriesaswellastheprogressofthemanagementofinjuredswimmers.Withyourpermission,theseinterviewswillbesoundrecordedtofacilitatetranscriptionforlateranalysis.Alldatawillbekeptstrictlyconfidential.Ifyouarethecoachofaclubthatdoesnotreceivethecoachtrainingprogramatthebeginningofthestudy,itwillbemadeavailabletoyouattheconclusion.

Asaswimmer,youwillbeaskedtocompleteaseriesofquestionnairesatperiodictimesthroughoutthecompetitiveseason.Altogether,thesequestionnaireswilltakeapproximately30‐45minutestocompleteoneachoccasion.Youmayalsobeaskedtoparticipateinaoneononeinterviewwiththeresearchinvestigatorifyousustainanyinjuriesduringtheseason.Withyourpermission,theseinterviewswillbesoundrecordedtofacilitatetranscriptionforlateranalysis.Datawillbekeptstrictlyconfidential.Specifically,anyinformationgatheredfromyouwillnotbesharedwithyourcoach.

RISKSTherearenorisksforeseenaspartoftheinterviewprocess.Thequestionsaskedintheinterviewsandtheitemsonthequestionnaireswillnotbeofasensitivenature,andtheinterviewswillbeconductedatatimeandlocationthatisconvenienttoyou.

BENEFITSBenefitsofthisresearchmayincludegainsinawarenessaswellasknowledgeandunderstandingofthepsycho‐socialaspectsofinjury.Thisawarenessandunderstandingmaylowertheincidenceofinjuryandaidintheinjurymanagementpracticesforyour


Dr. Sandy Gordon, FAPS Senior Lecturer

158

clubandcompetitiveswimmingingeneral.Theknowledgegainedfromthestudyregardinginjurypreventionandmanagementpracticeswillbemadeavailabletoyouattheconclusionofthestudy.

CONFIDENTIALITYAllinformationwillbekeptstrictlyconfidential.Datawillbede‐identifiedfollowingcollectionandwillbekeptinasafeandsecurelocationattheSchoolofSportScience,ExerciseandHealth,TheUniversityofWesternAustralia.Anyinformationthatisobtainedinconnectionwiththisstudyandthatcanbe

attributedtoyouwillremainconfidentialandwillnotbeaccessibletoanyotherpartiesexcepttheprimaryinvestigatorunlessrequiredbylaw.Anyinformationgatheredfromswimmerswillnotbesharedwiththeircoach.

PARTICIPANTRIGHTSParticipationinthisresearchisvoluntaryandyouarefreetowithdrawfromthestudyatanytimewithoutprejudice.Youcanwithdrawforanyreasonandyoudonotneedtojustifyyourdecision.IfyouwithdrawfromthestudyandyouareanemployeeorstudentatTheUniversityofWesternAustralia(UWA)thiswillnotprejudiceyourstatusandrightsasanemployeeorstudentofUWA.Ifyouareaswimmerofacompetitiveswimclub,withdrawalwillnotprejudiceyourstatusorrightsasaswimmerofthatclub.

Ifyoudowithdrawwemaywishtoretainthedatathatwehaverecordedfromyoubutonlyifyouagree,otherwiseyourrecordswillbedestroyed.

Yourparticipationinthisstudydoesnotprejudiceanyrighttocompensationthatyoumayhaveunderstatuteofcommonlaw.

Ifyouhaveanyquestionsconcerningtheresearchatanytimepleasefeelfreetoasktheresearcherwhohascontactedyouaboutyourconcerns.

Furtherinformationregardingthisstudymaybeobtainedfrom:

Investigator Email PhoneNumberMs.JulieHardt,MSc [email protected] +61420502925(mobile)

+61864887409(office)ProfessorSandyGordon,FAPS


Mr.NatBenjanuvatra,BSc(Hons)


159



JulieHardt,MSc

—ConsentForm—

I___________________________havereadtheinformationprovided,andanyquestionsIhaveaskedhavebeenansweredtomysatisfaction.Iagreetoparticipateinthisactivity,realisingthatImaywithdrawatanytimewithoutreasonandwithoutprejudice.

Iunderstandthatallinformationprovidedistreatedasstrictlyconfidentialandwillnotbereleasedbytheinvestigatorunlessrequiredtobylaw.Ihavebeenadvisedastowhatdataisbeingcollected,whatthepurposeis,andwhatwillbedonewiththedatauponcompletionoftheresearch.

Iagreethatresearchdatagatheredforthestudymaybepublishedprovidedmynameorotheridentifyinginformationisnotused.

________________________________________

ParticipantSignatureDate

Forparticipantslessthan18yearsofage:

________________________________________

Parent/GuardianSignatureDate

TheHumanResearchEthicsCommitteeatTheUniversityofWesternAustraliarequiresthatallparticipantsareinformedthatiftheyhaveanycomplaintregardingthemannerinwhicharesearchprojectisconducted,itmaybegiventotheresearcheror,alternativelytotheSecretary,HumanResearchEthicsCommittee,Registrar’sOffice,TheUniversityofWesternAustralia,35StirlingHighway,Crawley,WA6009(telephonenumber6488‐3703).AllstudyparticipantswillbeprovidedwithacopyoftheInformationSheetandConsentFormfortheirpersonalrecords.

School of Sport Science, Exercise & Health

TheUniversityofWesternAustralia35StirlingHighway,CrawleyWA6009

Phone+ 61 8 6488 2375

Fax+ 61 8 6488 1039

[email protected]


160

LifeEventsScaleForCollegiateAthletes

Listedbeloware69eventsthatsometimesoccurinthelivesofstudentathletes.Theseeventsoftenproducechangewithinanindividual’slifethatrequiresomeadjustmentbytheindividual.Foreacheventthatyouhaveexperiencedwithinthelastyear(12months):

1. Indicatewhetheryouexperiencedthateventwithinthelastyearbyselectingeitherthe“yes”or“no”option.Remember,onlyrespond“yes”tothoseeventsthatyouhaveexperiencedwithinthelastyear.Ifyouhavenotexperiencedaneventwithinthelastyear,selectthe“no”option.

2. Indicatewhatkindofaneffectithadonyourlifewhentheeventoccurredfromextremelynegativetoextremelypositive.Forthoseeventsthathavehappenedmorethanonce,indicatetheaverageeffectacrossalloccurrences.

Theeventsarelistedinnoparticularorder,andtherearenorightorwronganswers.Pleaserespondtoeacheventhonestlyasappliestoyou.

Has this event occurred in the last

0-12 months? What effect did this event have on your life when it occurred? (Only fill in an option if the event

occurred in the last 0-12 months.)

Yes No Extremely Negative Negative

Moderately Negative

Somewhat Negative

Somewhat Positive

Moderately Positive Positive

Extremely Positive

Marriage

Death of mate (boyfriend, girlfriend, spouse, significant other)

Major change in sleeping habits (increase or decrease in amount of sleep)

Death of close family member(s) (please specify below: father, mother, brother, sister, grandfather, grandmother, etc.)

Major change in eating habits (increase or decrease in food intake)

Death of close friend(s)

Outstanding personal achievement

Male: mate pregnant

Female: becoming pregnant

Sexual difficulties

161

Indicatewhetheryouexperiencedeacheventwithinthelastyearandwhatkindofaneffectithadonyourlifewhentheeventoccurred.





Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Being fired from a job

Being apart from mate (boy/girlfriend, spouse, etc.) due to sport

Serious illness or injury of close family member(s) (please specify below: father, mother, brother, sister, grandfather, grandmother, etc.)

Major change in the number (more or less) of arguments with mate

Major personal injury or illness

Major change in the frequency (increased or decreased) of social activities due to participation in sport

Serious injury or illness of close friend

Breaking up with mate (boy/girlfriend, etc.)

Beginning a new school experience (beginning university, transferring schools, etc.)

Engagement

162





Yes No

Extremely Negative Negative

Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Academic probation/ineligibility

Being dismissed from a school or home residence

Failing an important exam

Major change in relationship with coach (better or worse)

Failing a course

Major change in the length and/or conditions of practice/training (better or worse)

Financial problems concerning school

Major change in relationship with family member(s) (better or worse)

Conflict with roommate

Male: mate having abortion

Female: having an abortion

163





Yes No


Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Major change in the amount (more or less) of academic activity (homework, class time, etc.)

Pressure to gain/lose weight – due to participation in sport

Discrimination from teammates/coaches

Major change in relationship(s) with teammate(s) (better or worse)

Suspended from team for nonacademic reasons

Trouble with academic counselor

Major change in use of alcohol/drugs (increased or decreased)

Beginning sexual activity

Major change in relationship(s) with friend(s) (better or worse)

Recovery from illness/injury/operation

164





Yes No


Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Major change in level of athletic performance in actual competition (better or worse)

Divorce or separation of your parents

Major change in level of responsibility on team (increased or decreased)

Receiving an athletic scholarship

Not attaining personal goals in sport

Major change in playing status on team

Injury to teammates

Being absent from school (classes) because of participation in sport

Troubles with athletic association and/or athletic director

Difficulties with physiotherapist/physician

165






Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Major change in playing time (playing more or less) – due to injury

Major errors/mistakes in actual competition

Losing your athletic scholarship

No recognition/praise of accomplishments from coaching staff

Pressure from family to perform well

Loss of confidence due to injury

Unable to find a job

Change in coaching staff

Female: menstrual period/PMS

Major change in level of academic performance (doing better or worse)

166





Yes No


Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Making career decisions (applying to graduate school, interviewing for jobs, etc.)

Being cut/dropped from the team

Continual poor performance of team

Change in graduation schedule

Major change in family finances (increased or decreased)

Major change in attitude toward sport (like/enjoy more or less)

Victim of harassment/abuse (sexual, emotional, physical)

Victim of personal attack (rape, robbery, assault, etc.)

Othereventsmighthaveoccurredtoyouinthepastyear(andaffectedyouinapositiveornegativemanner)butwerenotincludedonthislist.Ifthereweresuchevents,pleaselistthembelow.

Please specify

What effect did this event have on your life when it occurred? (Only fill in an option if the event occurred in the last 0-12 months.)


Moderately Negative

Somewhat Negative

Somewhat Positive


Extremely Positive

Event 1

Event 2

Event 3

Event 4

Event 5

167

RESTQ‐76SPORT

Thisquestionnaireconsistsofaseriesofstatements.Thesestatementspossiblydescribeyourmental,emotional,orphysicalwell‐beingoryouractivitiesduringthepastfewweeks.Pleaseselecttheanswerthatmostaccuratelyreflectsyourthoughtsandactivities.Indicatehowofteneachstatementwasrightinyourcaseinthepastfewweeks.Thestatementsrelatedtoperformanceshouldrefertoperformanceduringcompetitionaswellasduringpractice.Foreachstatementtherearesevenpossibleanswers.Pleasedonotleaveanystatementsblank.Ifyouareunsurewhichanswertochoose,selecttheonethatmostcloselyappliestoyou.Pleaserespondtothestatementsinorderwithoutinterruption.

Inthepastfewweeks... Never Seldom Sometimes Often More often Very often Always

I watched TV

I did not get enough sleep

I finished important tasks

I was unable to concentrate well

everything bothered me

I laughed

I felt physically bad

I was in a bad mood

I felt physically relaxed

I was in good spirits

I had difficulties in concentrating

I worried about unresolved problems

168

Inthepastfewweeks...

Never Seldom Sometimes Often More often Very often Always

I felt at ease

I had a good time with friends

I had a headache

I was tired from work

I was successful in what I did

I couldn't switch my mind off

I fell asleep satisfied and relaxed

I felt uncomfortable

I was annoyed by others

I felt down

I visited some close friends

I felt depressed

169


never seldom sometimes often more often very often always

I was dead tired from work

other people got on my nerves

I had a satisfying sleep

I felt anxious or inhibited

I felt physically fit

I was fed up with everything

I was lethargic

I felt I had to perform well in front of others

I had fun

I was in a good mood

I was overtired

I slept restlessly

170


I was annoyed

I felt as if I could get everything done

I was upset

I put off making decisions

I made important decisions

I felt physically exhausted

I felt happy

I felt under pressure

everything was too much for me

my sleep was interrupted easily

I felt content

I was angry with someone

171


I had some good ideas

parts of my body were aching

I could not get rest during the breaks

I was convinced I could achieve my set goals during performances

I recovered well physically

I felt burned out by my sport

I accomplished many worthwhile things in my sport

I prepared myself mentally for performance

my muscles felt stiff or tense during performance

I had the impression there were too few breaks

I was convinced that I could achieve my performance at any time

I dealt very effectively with my teammates' problems

172


Never Seldom Sometimes Often More often Very often Always

I was in a good condition physically

I pushed myself during performance

I felt emotionally drained from performance

I had muscle pain after performance

I was convinced I performed well

too much was demanded of me during the breaks

I psyched myself up before performance

I felt that I wanted to quit my sport

I felt very energetic

I easily understood how my teammates felt about things

I was convinced that I had trained well

the breaks were not at the right times


I felt vulnerable to injuries

I set definite goals for myself during performance

my body felt strong

I felt frustrated by my sport

I dealt with emotional problems in my sport very calmly

173

SocialSupportSurvey

Thefollowingquestionsfocusonindividualsinyoursportingenvironmentwhoprovideyouwithhelpand/orsupport.Readthedefinitionofthetypeofsupportbeingconsideredandrespondtothequestionsthatfollowit.Pleaseanswerallthequestionsasbestyoucan‐therearenorightorwronganswers.Allyourresponsesarestrictlyconfidential.

ListeningSupport‐Peoplewholistentoyouwithoutgivingadviceorbeingjudgemental.

Write the initials of all the individuals who provide you with listening support. If no one provides you with this support, please indicate “no one”. After each person, indicate the relationship you have with her or him (for example, teammate, friend, coach, assistant coach, physiotherapist, sport psychologist/counsellor, spouse/partner, parent, grandparent, brother/sister, other [please specify]).

Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of listening support you received?

How difficult would it be for you to obtain more listening support?

How important for your overall well being is it to have one or more persons provide you with listening support?

TaskAppreciation‐Peoplewhoacknowledgeyoureffortsandexpressappreciationforthework/sportingactivityyoudo.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of task appreciation you received?

How difficult would it be for you to obtain more task appreciation?

How important for your overall well being is it to have one or more persons provide you with task appreciation?

174

TaskChallenge‐Peoplewhochallengeyourwayofthinkingaboutyourwork/sportingactivityinordertostretchyou,motivateyou,andleadyouthegreatercreativity,excitementandinvolvementinyourworkorsportingactivity.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of task challenge you received?

How difficult would it be for you to obtain more task challenge?

How important for your overall well being is it to have one or more persons provide you with task challenge?

EmotionalSupport–Peoplewhocomfortyouandindicatetoyouthattheyareonyoursideandcareforyou.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of emotional support you received?

How difficult would it be for you to obtain more emotional support?

How important for your overall well being is it to have one or more persons provide you with emotional support?

175

EmotionalChallenge–Peoplewhochallengeyoutoevaluateyourattitudes,valuesandfeelings.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of emotional challenge you received?

How difficult would it be for you to obtain more emotional challenge?

How important for your overall well being is it to have one or more persons provide you with emotional challenge?

RealityConfirmation–Peoplewhoaresimilartoyou–seethingsthewayyoudo–whohelpyouconfirmyourperceptionsandperspectivesoftheworldandhelpyoukeepthingsinfocus.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of reality confirmation you received?

How difficult would it be for you to obtain more reality confirmation?

How important for your overall well being is it to have one or more persons provide you with reality confirmation?

176

Tangibleassistance–Peoplewhoprovideyouwitheitherfinancialassistance,productsand/orgifts.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of tangible assistance you received?

How difficult would it be for you to obtain more tangible assistance?

How important for your overall well being is it to have one or more persons provide you with tangible assistance?

Personalassistance–Peoplewhoprovideyouwithserviceorhelp,suchasrunninganerrandforyouordrivingyousomewhere.


Very dissatisfied

Very satisfied

In general, how satisfied are you with the overall quality of personal assistance you received?

How difficult would it be for you to obtain more personal assistance?

How important for your overall well being is it to have one or more persons provide you with personal assistance?

PREVENTION AND MANAGEMENT OF INJURY IN ......PREVENTION AND MANAGEMENT OF INJURY IN COMPETITIVE...

Documents

Transcript of PREVENTION AND MANAGEMENT OF INJURY IN ......PREVENTION AND MANAGEMENT OF INJURY IN COMPETITIVE...