Self-reported psychological characteristics as risk factors for injuries ...

Steffen et al.Coping strategies continue to be challenging factorsas it seems to be simplistic to analyze them aseither adaptive or maladaptive (Pensgaard & Duda,2002). In the future, a more fruitful approach mightbe to define coping as a positive response outcomeexpectancy (PROE) as in the Cognitive ActivationTheory of Stress (CATS), instead of looking atcoping strategies in general (Ursin & Eriksen,2004). High levels of PROE are, e.g. associatedwith lower levels of work stress and sick leave inthe general population, and even with high performancein a highly stressful environment such as theOlympic Games (Eriksen et al., 2005).Among the young female players, a relationshipbetween ‘‘worry anxiety’’ and previous injuries wasobserved, confirming the results from different prospectivestudies on other types of sport (Blackwell &McCullagh, 1990; Hanson et al., 1992; Petrie, 1993).Among male football players, a lower than averagenumber of previous injuries was related to fewerworries about their performance, less competitiveanxiety and peaking under pressure, a lower angertrait and less outward anger (Junge et al., 2000).However, perceived anxiety before the start of theseason could not predict new injuries in our cohort offemale football players.Methodological issuesThis is the first study in female football concerningthe relationship between personality characteristicsand injury risk. One obvious and also general limitationof research in sports psychology is the questionnairesand measurement tools available to assesscharacteristics of interest. Direct comparisons betweenthe present and previous investigations usingdifferent tools should be made with caution. Researchinvolving psychological factors and injuryrisk in (youth) sports is still limited.A further limitation of the present study was theresponse rate. About 71% of the players completedthe questionnaire, which means that there is a potentialfor a selection bias. For instance, players withprevious injuries and symptoms from the lower limbsmay be more likely to respond. However, injuryproportions have been compared between respondersand non-responders, and any difference in the proportionof injuries to the ankle, knee, thigh, or groincould be detected (Steffen et al., 2008b).However, compared with most other observationalinvestigations, the sample size is still large. Nevertheless,the observed numerical differences of specificpsychological characteristics were small (o0.5 SD)and reached statistical significance only because ofthe large sample size. Effect sizes (partial Z 2 values)were below 0.03.Another limitation deals with the collection ofexposure data. One theory is that extroverted playersreceive more playing time than introverted playerswho are low in self-esteem, and will therefore bemore likely to get injured due to increased playingexposure (Kelley, 1990). Here, we were unable torecord individual exposure data, as done by, e.g.,O¨ stenberg and Roos (2000), and therefore could notcorrect for exposure in the risk factor analyses.PerspectivesBesides the improvement of physical performance,technical and tactical skills and injury prevention,personality traits of the players in a team will beessential for team success and should be addressed.This study supports earlier investigations by demonstratingthat high life stress has an impact on newinjuries. In order to attenuate this risk factor amongyoung female football players, coaches must beaware of the total life stress situation of the player.A positive motivational climate in a team isconsidered to be favorable to help those playerswith a high perception of life stress (Pensgaard &Roberts, 2000). However, it may be that in certainsituations, a mastery climate can create a strongemphasis on individual improvement and development;a coach should avoid and, if present, bufferhigh levels of perfectionism among the players.Coaches will also have the responsibility to lessenlife- and sports-related stress by creating a positivemotivational climate, support improvement in playand playing intensity, concomitant with arranging arealistic ambition level for the team to protect theplayers from injuries and in the final stage fromburnout (Pensgaard & Roberts, 2002; Lemyreet al., 2008). Implementation of cognitive capabilitiessuch as stress-coping strategies may contribute tocreate a balance between psychological player characteristicsand injury risk (Johnson et al., 2005).Further observational studies among young and olderplayers are required to extend the present findings.In conclusion, in a cohort of young female footballplayers, a perceived mastery climate and high levelsof experienced life stress could significantly predictthe risk for new injuries.Key words: youth, soccer, psychology, risk factor,motivational climate, life stress, coping.AcknowledgementsWe thank the physical therapists involved in the injuryregistration, and the coaches and players for their cooperation.This study was supported by a grant from FIFA. Inaddition, financial support came from the Oslo Sports Trauma8