Sports injury and stressor-related disorder in competitive athletes: a systematic review and a new framework

Abstract

Background: For professional athletes, sports injury has been considered one of the most influential factors determining their athletic careers’ duration and quality. High-intensity training and competitiveness of the sports competition are perhaps critical causes of sports-related stress. This article reviews the relevant research on sports injuries and stressor-related disorders. Further, it explores the following three issues in depth: (1) Do physical injuries caused by competitive sports lead to acute or posttraumatic stress disorder for athletes? What are the abnormal stress responses? (2) What diagnoses are currently available for sports injury related traumatic stress disorder? (3) What kinds of psychological rehabilitation are available for trauma-related symptoms in sports injury? How efficient are they in alleviating these symptoms? Methods: The study searched electronic databases, including PubMed, MEDLINE, CINAHL, etc. And reference lists of included papers were also screened. Two researchers selected the literature strictly according to the inclusion criteria and sorted them out. Based on the proved conclusions, the study established a new framework to manage traumatic stress disorders after the injury occurred. Results: 16 articles were included in the study. (Q1: N = 10; Q2: N = 3; Q3: N = 3 ) The findings of this review suggested that athletes who suffer from sports injuries are more likely to experience abnormal physiological or psychological stress responses, which may become a massive challenge for athletes to continue their sports careers at a competitive level. However, there is a minimal understanding of addressing sports injury-related traumatic stress disorder from a biological perspective. Thus, it is challenging to build a scientific basis for diagnosis, screening, and treatment. In addition, the current diagnostic tool for athletes stress disorder still heavily relies on subjective measurement, and the treatment plan is not different from that of the general population. Conclusions: It highlighted that sports-related stress disorder could be the greatest challenge to return to competition for injured athletes. The present study indicated the importance of systematically identifying the symptoms of sports-related stress disorder and improving the current diagnosis and treatment system.

Keywords

Stressor-related disorder / PTSD / Sports injury / Athletes

References

[1] Thatcher J, Jones M, Lavallee D. Coping and emotion in sport. Routledge. 2011. https://doi.org/10.4324/9780203852293.

[2] Chan DKC, Lee ASY, Hagger MS, Mok KM, Yung PSH. Social psychological aspects of ACL injury prevention and rehabilitation: an integrated model for behavioral adherence. Asia-Pacific J Sports Med Arthr Rehabil Technol. 2017; 10: 17-20. https://doi.org/10.1016/j.asmart.2017.10.001.

[3] Thomson P, Jaque S. Visiting the muses: creativity, coping, and PTSD in talented dancer and athletes. Am J Play. 2016; 8: 363-78.

[4] Clarsen B, Rønsen O, Myklebust G, Flørenes TW, Bahr R.The Oslo sports trauma research Center questionnaire on health problems: a new approach to prospective monitoring of illness and injury in elite athletes. Br J Sports Med. 2014; 48: 754-60. https://doi.org/10.1136/bjsports-2012-092087.

[5] Tian Y-X, Li J-L, Tian B. Sports post-traumatic stress disorder and It’s intervention (review). Chinese J Rehabilit Theory Practice. 2012; 944-7. https://doi.org/10.3969/j.issn.1006-9771.2012.10.014.

[6] Moss RA, Slobounov S. Neural, behavioral and psychological effects of injury in athletes. Foundations of Sport-Related Brain Injuries. 2006; 407-30. https://doi.org/10.1007/0-387-32565-4_18.

[7] McArdle S.Psychological rehabilitation from anterior cruciate ligament-medial collateral ligament reconstructive surgery: a case study. Sports Health. 2010; 2: 73-7. https://doi.org/10.1177/1941738109357173.

[8] Liu Zhongkai. Research on stress, burnout and social support of Ur17 male soccer players in China. Diss. Fujian Normal University. 2008. https://doi.org/10.7666/d.y1321615

[9] Du J-Z, Xia B-L. A review of study on acute stress disorder. Adv Psychol Sci. 2009; 17: 482-8 CNKI:SUN:XLXD.0. 2009-03-004.

[10] Zhang Y, Zhao R, Ren J, Luo Y, Su H, Zhang Y’n. Acute stress disorder and posttraumatic stress disorder: a review. Chinese Journal of Modern Nursing. 2018; 24: 1486-8. https://doi.org/10.3760/cma.j.issn.1674-2907.2018.12.032.

[11] Wiseman T, Foster K, Curtis K. Mental health following traumatic physical injury: an integrative literature review. Injury. 2013; 44: 1383-90. https://doi.org/10.1016/j.injury.2012.02.015.

[12] Maercker A, Brewin CR, Bryant RA, Cloitre M, van Ommeren M, Jones LM, et al. Diagnosis and classification of disorders specifically associated with stress: proposals for ICD-11. World Psychiatry. 2013; 12: 198-206. https://doi.org/10.1002/wps.20057.

[13] Shuer ML, Dietrich MS. Psychological effects of chronic injury in elite athletes. West J Med. 1997; 166: 104.

[14] Kmet, L. M., Cook, L. S., Lee, R. C. Standard quality assessment criteria for evaluating primary research papers from a variety of fields. 2004. https://doi.org/10.7939/R37M04F16

[15] Geracioti TD, Jr, Baker DG, Ekhator NN, West SA, et al. CSF norepinephrine concentrations in posttraumatic stress disorder. Am J Psychiatry. 2001; 158: 1227-30. https://doi.org/10.1176/appi.ajp.158.8.1227.

[16] Appaneal RN, Perna FM, Larkin KT. Psychophysiological response to severe sport injury among competitive male athletes: a preliminary investigation. J Clin Sport Psychol. 2007; 1: 68-88. https://doi.org/10.1123/jcsp.1.1.68.

[17] Sommer JL, Reynolds K, El-Gabalawy R, Pietrzak RH, Mackenzie CS, Ceccarelli L, et al. Associations between physical health conditions and posttraumatic stress disorder according to age. Aging Ment Health. 2021; 25: 234-42. https://doi.org/10.1080/13607863.2019.1693969.

[18] Newcomer RR, Perna FM. Features of posttraumatic distress among adolescent athletes. J Athl Train. 2003; 38: 163.

[19] Padaki AS, Noticewala MS, Levine WN, Ahmad CS, Popkin MK, Popkin CA. Prevalence of posttraumatic stress disorder symptoms among young athletes after anterior cruciate ligament rupture. Orthop J Sports Med. 2018; 6: 2325967118787159. https://doi.org/10.1177/2325967118787159.

[20] Jin Y, Xu J, Liu D. The relationship between post traumatic stress disorder and post traumatic growth: gender differences in PTG and PTSD subgroups. Soc Psychiatry Psychiatr Epidemiol. 2014; 49: 1903-10. https://doi.org/10.1007/s00127-014-0865-5.

[21] Olff M, Langeland W, Witteveen A, Denys D. A psychobiological rationale for oxytocin in the treatment of posttraumatic stress disorder. CNS Spectr. 2010; 15: 522-30. https://doi.org/10.1017/S109285290000047X.

[22] O’Neill DF. Injury contagion in alpine ski racing: the effect of injury on teammates’ performance. J Clin Sport Psychol. 2008; 2: 278-92. https://doi.org/10.1123/jcsp.2.3.278.

[23] Bateman A, Morgan KA. The postinjury psychological sequelae of high-level Jamaican athletes: exploration of a posttraumatic stress disorder-self-efficacy conceptualization. J Sport Rehabil. 2019; 28: 144-52. https://doi.org/10.1123/jsr.2017-0140.

[24] Xu S, Li J, Zhu H, Xu X. Effect of Degree of Sport Injure on Sports Post-Traumatic Stress Disorder: A Mediated Mediation Model. The 20th Chinese Conference on Psychology. 2018. http://cpfd.cnki.com.cn/Article/CPFDTOTAL-ZGXG201811001A5A.htm. Last access on 7 June 2022.

[25] O’Connor JW, Sr.Emotional trauma in athletic injury and the relationship among coping skills, injury severity, and post traumatic stress. Diss: Walden University, 2010. https://www.proquest.com/openview/4e08b966af3bfa4fd6467c2ae47d7853/1?pq-origsite=gscholar&cbl=18750. Last access on 7 June 2022.

[26] Brassil HE, Salvatore AP. The frequency of post-traumatic stress disorder symptoms in athletes with and without sports related concussion. Clin Transl Med. 2018; 7: 1-9. https://doi.org/10.1186/s40169-018-0200-y.

[27] Kong L, Li L. A research review of neuromuscular training for rehabilitation and prevention of athletes’ ACL injury. China Sport Sci Technol. 2019; 055: 6. https://doi.org/10.16470/j.csst.2019870.

[28] Jaffee MS, Winter WC, Jones CC, Ling G. Sleep disturbances in athletic concussion. Brain Inj. 2015; 29: 221-7. https://doi.org/10.3109/02699052.2014.983978.

[29] Edmed SL, Sullivan KA. Diagnostic terminology is not associated with contact-sport players’ expectations of outcome from mild traumatic brain injury. Brain Inj. 2015; 29: 623-32. https://doi.org/10.3109/02699052.2014.998709.

[30] Aron CM, Harvey S, Hainline B, Hitchcock ME, Reardon CL. Post-traumatic stress disorder (PTSD) and other trauma-related mental disorders in elite athletes: a narrative review. Br J Sports Med. 2019; 53: 779-84. https://doi.org/10.1136/bjsports-2019-100695.

[31] Thomson P, Kibarska LA, Jaque SV. Comparison of dissociative experiences between rhythmic gymnasts and female dancers. Int J Sport Exercise Psychol. 2011; 9: 238-50. https://doi.org/10.1080/1612197x.2011.614850.

[32] Kaier E, Cromer LD, Johnson MD, Strunk K, Davis JL. Perceptions of mental illness stigma: comparisons of athletes to nonathlete peers. J College Student Development. 2015; 56: 735-9. https://doi.org/10.1353/csd.2015.0079.

[33] Biggin IJ, Burns JH, Uphill M. An investigation of athletes’ and coaches’ perceptions of mental ill-health in elite athletes. J Clin Sport Psychol. 2017; 11: 126-47. https://doi.org/10.1123/jcsp.2016-0017.

[34] Yu DM. New progress of clinical research tp acute stress disorder. Chin J Health Psychol. 2016; 24: 1761-9. https://doi.org/10.13342/j.cnki.cjhp.2016.12.001.

[35] Miller-Aron, C., LeFay, S. M. Best Practices for Diagnosis and Management of Trauma-Related Disorders in Athletes. In The Routledge Handbook of Clinical Sport Psychology. 2021: 306-20. https://doi.org/10.4324/9780429330971-29

[36] Gouttebarge V, Bindra A, Blauwet C, Campriani N, Currie A, Engebretsen L, et al. International Olympic Committee (IOC) sport mental health assessment tool 1 (SMHAT-1) and sport mental health recognition tool 1 (SMHRT-1): towards better support of athletes’ mental health. Br J Sports Med. 2021; 55: 30-7. https://doi.org/10.1136/bjsports-2020-102411.

[37] Lynch JH. Posttraumatic stress disorder in elite athletes. Curr Sports Med Rep. 2021; 20: 645-50. https://doi.org/10.1249/JSR.0000000000000918.

[38] Gao J, Wang L, Guo Y, Feng Z, Li S, Li Q, et al. New progress in diagnosis and treatment of post-traumatic stress disorder. Health Med Res Practice. 2019; 16: 4. https://doi.org/10.11986/j.issn.1673-873X.2019.03.020.

[39] Mankad A, Gordon S, Wallman K. Psycho-immunological effects of written emotional disclosure during long-term injury rehabilitation. J Clin Sport Psychol. 2009; 3: 205-17. https://doi.org/10.1123/jcsp.3.3.205.

[40] Chen F, Fan W, Li Y. Influence of psychological supervision on athletes’ compliance, mental elasticity characteristics and acute stress disorder in traumatic fracture rehabilitation training. Iran J Public Health. 2022; 51: 133-41. https://doi.org/10.18502/ijph.v51i1.8304.

[41] Shapiro F. EMDR, adaptive information processing, and case conceptualization. J EMDR Practice Res. 2007; 1: 68-87. https://doi.org/10.1891/1933-3196.1.2.68.

[42] Gregor K. Emotional reprocessing of negative performance experience using the EMDR-technique. J Tianjin Univ Sport. 2008; 023: 193.

[43] Ozer EJ, Best SR, Lipsey TL, Weiss DS. Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Psychol Bull. 2003; 129: 52-73. https://doi.org/10.1037/0033-2909.129.1.52.

[44] Zhou Z, Zhong X, Zhen Y, Liu W. A systematic review of the relationship between ASD and PTSD. J Int Psychiat. 2015; 42: 18-22.

[45] Junfeng Q, Haibin H, Bo T. Research progress in the treatment of post-traumatic stress disorder. J Psychiatry. 2019; 032: 69-72. https://doi.org/10.3969/j.issn.2095-9346.2019.01.020.

[46] Kaufman KR.Anticonvulsants in sports: ethical considerations. Epilepsy Behav. 2007; 10: 268-71. https://doi.org/10.1016/j.yebeh.2006.12.004.

[47] Dai X. Post-injury emotional response and PST intervention strategy on rehabilitation. Sichuan Sports Science. 2006; 000: 91-4. https://doi.org/10.3969/j.issn.1007-6891.2006.03.027.

[48] Merz J, Schwarzer G, Gerger H. Comparative efficacy and acceptability of pharmacological, psychotherapeutic, and combination treatments in adults with posttraumatic stress disorder: a network meta-analysis. JAMA Psychiat. 2019; 76: 904-13. https://doi.org/10.1001/jamapsychiatry.2019.0951.

[49] Schellong J, Lorenz P, Weidner K. Proposing a standardized, step-by-step model for creating post-traumatic stress disorder (PTSD) related mobile mental health apps in a framework based on technical and medical norms. Eur J Psychotraumatol. 2019; 10(1): 1611090. https://doi.org/10.1080/20008198.2019.1611090.

[50] Zhang M, He Y. Research on the impact of juvenile male athletes’ maturity or sports injury rate. Bull Sci Technol. 2015; 1: 5. https://doi.org/10.3969/j.issn.1001-7119.2015.01.018.