Injury Prevention and Performance

Transcription

1 UNITED STATES SPORTS ACADEMY IMPLEMENTING AN INJURY PREVENTION SPORTS PSYCHOLOGY PROGRAM IN AN ELITE TRIATHLON TEAM A Class Paper Submitted for SAB 563 Psychological Aspects of Sports Medicine Professor: Marion Evans by: Claudia Beristain LLanes Daphne, Alabama October 2012

2 Table of Contents Title Page... i Section I. Introduction...2 Purpose...3 Thesis or Question...3 Definition of Terms...3 Audience or Significance...4 Section II. Review of Literature...5 Epidemiology in triathlon...5 Injury prevention...6 Injury intervention...7 Psychology and triathlon...9 Section III. Summary and Conclusions...10 Assessment...11 Consent form...12 Anthropometrics...12 Psychological evaluation...12 Implementation...13 Analysis...13 Conclusions...14 References

3 Introduction High performance sports deal with a high incidence of sports related injuries due to higher risk taking, uncontrolled environmental conditions while racing or training, higher physical demand placed on the body and equipment failure and accidents among other causes (Pargman, 2007). These injuries cause an inordinately amount of stress to the athlete, can be career ending and in the worst of cases even life changing or life threatening. They also incur into high costs for the athlete and institution. According to de Loes, Dahlstedt and Thomee (2000), the mean cost of knee injury per hour of sport participation in 12 youth sports is 0.13 USD/hour for females and 0.06 USD/hour for males. More studies are needed to cover other sports, high performance teams and other injuries. One of the main problems in injury research is the lack of definition and report of sport injuries. Among the causes of injury, intrapersonal psychological factors have been related to frequency of sports injury and time taken in return to play (Pargman, 2007).... Self concept and locus of control have been shown to be associated with success in sport injury rehabilitation (Grove and Bianco, 1999), as well as severity and incidence of injury (Pargman and Lunt, 1989) (Pargman, 2007, pp. xix). Injuries disrupt the training program and have a negative effect on training and racing. The possibility of implementing a holistic sports injury prevention program including biomechanical, physiological and psychological knowledge already available in the sports and medical community is sound and should certainly be considered. A high performance program that takes into account all these factors may result in a better environment for the athletes, improved results and better coaching practices. 2

4 This holistic approach will certainly come across difficulties: Athlete/Coach resistance to the program Time available for implementing and follow-up Need of experts and professionals in the field Relationship between coaching staff, psychologists, therapists and athletes. The objective is to implement a system that can be followed in the future by all the staff, athletes and personnel working on the elite program. Coaches, psychologists, therapists and management need to understand the main reason and advantages of implementing the program. Purpose. The purpose of this study is to assess the feasibility of implementing an overall prevention program that can reduce the incidence of sport injury and time needed to return to play. The prevention program should promote safe practices while returning to play, improve understanding of the athlete and communication skills between staff and athletes in an elite triathlon team. Thesis. What are the steps needed to implement a program based in psychological skills that aims to prevent injuries in an active elite triathlon team? Definition of Terms. Sport injury. For the purpose of this study, sport injury will be defined as any injury sustained during the practice of sport that results in an inability to function as competently as before the occurrence of physical trauma (Pargman, 2007), with an inability to practice or race for at least one day and requiring medical assistance. Sport injury risk: As De Loes, Dahlstedt and Thomee (2000) and Knowles, Marshall and Guskiewiczstate (2006), state that a relationship should be established 3

5 between incidence of sport injuries and exposure. Sport injury risk will be defined dividing the number of sports injuries during a calendar year and hours of training. In the implementation of this program, the hours of training will be reported with GPS and heart rate monitors on a TrainingPeaks platform in order to use reliable data. Trainingpeaks: software used to report and analyze training sessions. Elite Athlete. An athlete that is already selected as part of the national team or working to be selected complying with characteristics that determine national team selection. Triathlon. Endurance sport comprised of three events: swimming, cycling and running, practiced in this order, with no pause in between and using transitions to switch between events. Psychological skills training (PST): Practice of mental skills in order to enhance performance and enjoy sport. These areas included behavior modification, cognitive theory and therapy, rational emotive therapy, goal setting, attention control, progressive muscle relaxation, and systematic desensitization (Weinberg and Gould, 2011). Audience or Significance This work is designed for sports medicine professionals working with elite or competitive athletes interested in injury prevention. The aim of this paper is to implement a system that promotes better practices with elite or competitive athletes in order to avoid the economical, emotional and time loss resulting from injuries that might have been prevented. It is also important to understand the current relationship between physiology and biomechanical teams, psychologists and coaches. A working alliance needs to be created. Research could include variables from all these disciplines in order to enhance injury prevention, performance and provide a better 4

6 overall training and competition experience to elite athletes. Competitive life might be extended and could become more rewarding. Review of literature Epidemiology in triathlon In order to establish if a prevention program is effective, retrospective studies regarding injury risk and epidemiology in triathlon were searched. The most comprehensive studies related to injuries in triathlon were from, Migliorini (2011), Vleck, Bentley, Millet and Cochrane (2010), and McHardy, Pollard and Fernandez (2006). De Loes et al. (2000) performed a study regarding sport injuries in Switzerland with youth population. This study is probably one of the most complete, even if it was retrospective, it carried a good definition of injury, compared to total hours of risk exposure (practice and competition) and all the data recollected was provided by a program of Youth and Sports using the Swiss Military Insurance Database where all medical assessments related to youth and sports are documented. The studies regarding injuries in triathlon are reviews of existing studies with different demographics, including elite athletes, standard distance athletes, ironman distance athletes, recreational athletes, athletes with experience and novice triathletes. In general most of the injuries in triathlon tend to stem from overuse during practice, in competition injuries tend to be acute (Migliorini, 2011). Most of the injuries are lower limb injuries and consistent with epidemiology of running injuries (McHardy et al. 2006). Vleck et al. (2010) found that knee injuries are most common across all distances and running injuries in triathlon are more severe when classified as time spent with no training, than cycling or swimming injuries. 5

7 A notable issue was found regarding specifically injuries in triathlon, they are treated from the standpoint of physiology or biomechanics, but studies were not found in relation to triathlon injuries and psychological state. In general triathlon and psychology studies tend to relate to performance and performance prediction for example Cerin (2003), Thelwell and Greenlees (2003) and Gucciardi, Mahoney, Jalleh, Donovan and Parkes (2006). Injury Prevention Several studies regarding injury prevention through psychosocial management techniques were found. Williams and Andersen (1988) designed a model of stress and athletic injury that prevails even to this day. The Williams and Andersen (1988) model states that personality, history of stressors and coping resources influence and determine the stress response when a potentially athletic stressful situation arises. If the stress response fails, injury arises. Mental skills interventions can modulate the stress response in order to avoid injury. This model is based on the fact that stress increases muscle tension and creates a deficit of attention. Stephan, Deroche, Brewer, Caudroit and Le Scanff, (2009) studied neuroticism among elite runners as one of the factors that can predict perceived susceptibility to injuries. In this case an intervention might me in order to lower sensibility in order to avoid training disruption. Kellmann (2010) uses a model of stress and recovery applying a questionnaire in order to assess the risk of overtraining, this study is interesting as it involves the work of a multidisciplinary team with coach and psychologists to assess the training status. Kellman finds that a small change in wording under recovery versus overtraining might make coaches more pliable to diagnosis as under recovery includes factors not always in control of the coach. In this case, a long period of under recovery will be the main cause of overtraining. Johnson and Ivarsson (2011) reviewed fifteen years of 6

8 literature and came to the conclusion that life stress and daily hassles have a direct and indirect relationship with injuries in high intensity training, they recommend taking into account that personality variables have inference on injury outcome and that coaches, trainers and athletes would benefit by acquiring psychological skills and techniques in order to prevent injury. In this case, in high performance sports in general, the field of psychology tends to focus on injury prevention through mental skills and technique, with low involvement in this type of prevention from biomechanics, physiologists or coaches. Johnson and Ivarsson (2011) propose the merging of an interdisciplinary team with physiologists, psychologists, trainers and coaches in order to implement successfully an injury prevention program. Allen, Frings, and Hunter (2012) studied the relationship between a challenge and a threat athlete s face during competition and their response depending on their personality. A perception of challenge arises when coping resources exceed the demand of competition; threat appears when the demand exceeds the coping resources of the athlete. One of the objectives of this study was to find the associations between coping and personality. During the study cardiovascular responses were generated for threat and challenge stimuli in a controlled setting. Even though no significant differences were found in this area, a relationship was found between coping and personality. Five dimensions of personality were studied: extraversion, neuroticism, openness, agreeableness and conscientiousness. This study is relevant to the implementation of an injury prevention program must take into account personality and coping. Injury intervention Specific interventions have been studied in order to determine their effectiveness regarding injury prediction, prevention or rehabilitation. Andersen and 7

9 Williams (1999) confirmed that individuals with a high life events stress tended to show peripheral narrowing which exposed them to injury. In this study, Andersen and Williams (1999) used a population of athletes with low social support. Wiese- Bjornstal (2010) recommends a bio psychological understanding of injury, injury prevention and injury rehabilitation as pre-injury there are biological, physical, psychological and sociocultural factors that predispose athletes to injury. Once an injury appears, it also causes additional stress to the athlete that will affect the emotional, cognitive, behavior and outcome of the injured athlete Wiese-Bjornstal (2010). Andersen and Gates (2000) used POMS in order to detect overtraining, they conclude that POMS along other psychosocial measurements need to be taken into account on an individual basis for each athlete and compared to performance, where the variable is performance. The main objective of measuring these scales in relation to training is to be able to modulate training towards a performance improvement. Wilgen, Kaptein and Brink (2010) used the illness perception questionnaire (IPQ-R) to relate illness perception, mood state and outcome, there was variation between acute and chronic injury. The athletes perception varied when suffering to chronic injury with the therapist perception. Therapists find that psychological factors have a high influence in chronic injuries; athletes feel that psychological factors are not as important. The authors recommend using a modified IPQ-R that takes into account the particular stress felt by athletes. In general, Wilgen et al. (2010) found that athletes have stronger coping skills, and perceive more control over their injuries. Athletes are better at focusing on the problem and tend to have adaptive outcomes. When athletes agree with their therapists on the causes, degree and perception of the 8

10 illness, therapists and medical personnel will be able to improve treatment; adherence and the outcome will be better (Wilgen et al., 2010). Lines, Schwartzman, Tkachuk, Leslie-Toogood and Martin (1999) concur that a behavior assessment in conducts an athlete needs can help determine the areas that need help. In this papers the authors provide a behavior checklist for swimmers and basketball. It is relevant as the swimming checklist might be easily adapted to triathlon and used as an assessment tool of skills that need to be worked on. In order to adapt a checklist for another sport, Lines et al. (1999) recommend that the checklist contains items important for the sport, detects deficits in these items, deficits are revealed and no important items are missing. The authors present a specific questionnaire for swimmers including behavior and self-talk before a meet, immediately after competition and for training. The checklist is consistent with areas triathletes need to work on and can be easily adapted to triathlon. Following this behavior might lead to purposeful and mindful training. Psychology and Triathlon Most of the literature found in psychology related journals or studies with a direct relationship to triathlon tended to be more performance enhancement oriented or tended to be related to racing and psychology. Research might find interesting data in relation to triathlon, psychological skills and injuries, specifically as triathlon is a sport that tends towards overuse injuries. Cerin (2003) compared anxiety against emotions to determine the functionality of pre-competitive emotional states, Cerin worked only with individual sports and triathlon was one of the sports used in this research. Through research Cerin (2003) found that a significant number of athletes showed positive patterns of emotions before a successful competition and debilitating emotions prior to an unsuccessful or as she termed a neutral or worst competition. 9

11 Emotional states leading to the worst competition were anxiety, fear, and guilt, less interest. Anxiety and fear were the dominant emotions. The study of emotions will express the relationship the athlete has between the individual, competition and performance. The test used to determine anxiety was the Competitive State Anxiety Inventory (CSAI-2) but this should not be the only emotion measured, as other emotions tend to be more important previous to competition. Thelwell and Greenlees (2003), researched the use of mental skills training for performance enhancement in endurance sports competition. This research results show that when and how mental skills are practiced matters on the outcome in performance enhancement during competition. The skills practiced were goal setting, relaxation, imagery and self -talk. Mental skills were assessed by a mental skills questionnaire (MMSQ). A social validation questionnaire was also administered. The triathlon was an indoor gym triathlon that doesn t really show what a triathlon is like. In a real triathlon the massive open water swim start tends to be psychological and physiologically stressful to most participants. Qualitative data was analyzed, this is consistent with recommendations from reviews Wiese-Bjornstal (2010), as psychological experimentation most show consistent qualitative research in order to have more reliable data on mental skills sports training. The study had a very small sample with only four participants racing in 10 triathlons in a weekly manner and certainly in the future needs to be double blind, with some participants receiving the mental skills package treatment and some receiving other type of training. Summary and Conclusions Assessment. The first step towards implementation will be assessment of the athletes. Consent form. 10

12 Before the implementation program begins a consent form will be given to the athletes to sign, and those athlete under 18 years old (legal age in Mexico) will receive a consent form for their parents to sign. Before consent the objectives, consequences, risks and benefits from the program will be thoroughly explained. Once the consent form is signed, and the athletes agree to treatment, physiological and psychological assessment will begin. Anthropometry. Full name, date of birth, anthropometric measurements like age, gender, height, weight, percent body fat, time in sport, swimming, cycling and running tests sets, injury history including if medical treatment was received, training and or competition days lost, sequels or lingering issues. Psychological assessment. Psychological tests will be applied: Profile of mood states (POMS), Sport Anxiety Scale (SAS), Eating Disorders inventory -2 (EDI-2), Coping Resources Inventory (CRI), Life Experience Survey Athletes (LES-A) (Pargman, 2007 pp. 174). Implementation A licensed sport psychologist will direct the implementation of this program. The coach and trainer will attend theory sessions, be informed of the homework and will have a weekly session to discuss the tasks for key workouts and results of previous sessions. The athletes will receive training in goal setting, imagery, arousal regulation, self-confidence, self-talk and concentration (Weinberg, 2011). The training will include theory, practice and practice while training, special exercises will be planned 11

13 for key workouts and competition. Monthly lectures will be given in team cohesion, leadership skills, communication and chores in order to work on team dynamics. Every week there will be a 30-minute theory session, 15-minute task setting session and a ten-minute homework. This will last for the fist four months. If needed more time will be allocated to training. Once training is resumed and the athletes are skilled, every week there will be a different task to practice during the key workouts and practice races. After four months a full reevaluation will be scheduled. The incredibly POMS test can be performed several times, particularly after high intensity weeks of training. The athletes will need to fill the metrics source daily at Trainingpeaks which includes but is not limited to weight (weekly data), sleep quality, sleep hours, overall feeling, fatigue, injury, mood, pulse, sickness, soreness, stress and motivation all in a continuum to best to worst. Weekly heart rate monitors with GPS information will be uploaded to the Trainingpeaks platform in order to have a reliable record of kilometers and time in training for each of the three sports. Data will be measured in order to have reliable data of intensity factor and training stress score, which might be relevant once the metrics, injury and exposure time are analyzed. Injuries recorded by each athlete will be reviewed and documented by the medical personnel working with the team; the coach and athletic trainer will work in close contact with medical team, sport psychologist and athletes in order to detect any disability in function even if the athletes do not report injury. Analysis Injury data will be compared to exposure time, intensity factor and training stress score by sport: swimming, cycling, running, strength training, racing, and combination workouts. The formulas provided by Knowles, Marshall and 12

14 Guskiewiccz (2006) to estimate risks and rates en epidemiology will be used for all treatments. Risk, rates and epidemiology will be then compared by statistical analysis to existing data pertinent to triathlon, swimming, cycling and running injuries. Data will also be compared to the individual injury history of each athlete to measure success in the program and review case by case. There is awareness related to the fact that retrospective collection of data may not be exact but this work does not intend to be used as research, the main objective is to provide a multidisciplinary prevention program for the benefit of the elite triathletes. If the program is successful it might be implemented with age group competitors as well after the pertinent modifications. Conclusions After reviewing the existent bibliography it is clear that it is unusual to have multidisciplinary teams that include biomechanics specialists, psychologists, coaches and trainers. Time is usually one of the main constraints as different motivation and expectations. Each specialist feels each area of competence is the most important and crucial for athlete development. Each specialist feels more time should be spent in any given area of expertise. Triathletes in general although time-constrained, tend to seek innovation in training methods that might give an extra edge and advantage in becoming skilled in three sports and transitions. Triathletes usually tend to have little resistant to innovative techniques. Triathletes also tend to come from highly educated parts of society, in general triathletes read and study subjects related to the sport. These idiosyncrasies tend to help in the implementation of a multidisciplinary program as the one proposed. In this particular case, the coach is seeking to implement the program and is aware that a sport psychology specialist is needed for the assessment, training and task setting. This will give credibility and will formalize the program. Current technology like the Trainingpeaks workout analysis software 13

15 and heart rate monitors with GPS tend to facilitate data recollection and analysis on a day-to-day or weekly basis. During the implementation of this program, there will probably be some resistance from the elite athletes regarding time-constraints. Elite triathletes might feel vulnerable with the psychological and personality testing. They will probably feel self-conscious about the coping resources test. Confidentiality has to be guaranteed and a statement regarding that letting them out of the team due to personality factors will not be an issue. The training program must be designed around the implementation of the psychological and biomechanical model (theory and video analysis already in use). Mental skills training will need to take into account the race calendar in order to avoid setting tasks in the week previous to competition when athletes are already aroused, nervous and with a huge load of pre-race preparation. When athletes already have skills in arousal or relaxation, these techniques will be invaluable for such events. All the techniques used in order to prevent injuries will be techniques already in use for performance enhancement, athletes might be motivated to know and understand that not only they will avoid injuries that might be career ending but they will also be able to perform to their best of their abilities. References Pargman D., (2007). Psychological bases of sports injuries. Florida: Fitness Information Technology. Weinberg, R., Gould, D., (2011). Foundations of Sport and Exercise Psychology. Human Kinetics, Champaign, Ill. De Loes, M. M., Dahlstedt, L. J., & Thomee, R. R. (2000). A 7-year study on risks and costs of knee injuries in male and female youth participants in 12 sports. Scandinavian Journal Of Medicine & Science In Sports, 10(2),

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