Literature ReviewPsychosocial predictors and psychological prevention of soccer injuries: A systematic review and meta-analysis of the literature
Introduction
Soccer is the most common sport in the world and has high mental and physical demands (Slimani & Nikolaidis, 2017; Slimani et al., 2016). It is one of the most complex contact sports whose frequency of practices during the season varies depending on the training phase or competing level (Kirkendall, 2011, p. 71; Scott & Anderson, 2013). Accordingly, as competitive level rises, it is a common practice for some football teams to play one or two matches per week, and take part in international tournaments, such as world championships and the Olympic Games (Slimani & Nikolaidis, 2017). These heavy schedules of practice, matches, and high psychophysical demands, lead to high risks and rates of injury in professional (Hawkins & Fuller, 1996; Hawkins, Hulse, Wilkinson, Hodson, & Gibson, 2001) and amateur players (Junge, Cheung, Edwards, & Dvorak, 2004; Kofotolis, Kellis, & Vlachopoulos, 2007). Furthermore, soccer players in an overreaching phase of training or intense competition would appear to be particularly vulnerable to injuries and psychophysical stress (Ekstrand, Hägglund, & Walden, 2011). In other words, this intensive phase may lead to the accumulation of stress, fatigue and its concomitants (i.e., non-functional overreaching or overtraining), and, consequently, can increase the risk of injury and illness to the athlete (Meeusen et al., 2013). For this reason, because the potential to eliminate physical stressors is limited in sport, a potential avenue for decreasing injury rates is to help players cope psychologically with stressors (Galambos, Terry, Moyle, Locke, & Lane, 2005). Previous studies suggest that psychosocial factors could affect injury risk among athletes. To provide a theoretical framework to explain the relationship between psychological variables and injury occurrence, the model of stress and athletic injury was developed (Williams & Andersen, 1998). Williams and Andersen (1998) provided a comprehensive, interactional model explaining the psychological antecedents (hardiness, sense of coherence, achievement motivation, sensation seeking, locus of control, and trait anxiety as personality traits) of sport injuries. In this model the stress response has a bidirectional relationship with the athlete's cognitive appraisals of potentially stressful situations (e.g., practice, game competition). Both the magnitude of the stress response and the athlete's appraisals of the situation may be influenced by the interplay between various psychosocial factors, which are divided into three broad categories: personality factors, history of stressors, and coping resources. Initially Andersen and Williams (1988) included hardiness, sense of coherence, achievement motivation, sensation seeking, locus of control, and trait anxiety as personality traits. Some authors have also included daily hassles, life events, and previous injuries as history of stressors (van Mechelen et al., 1996; Williams & Andersen, 1998) . Furthermore, in the model (Williams & Andersen, 1998) intervention approaches targeted to influence/buffer the stress response through psychosocial, physiological, and attentional pathways may reduce injury rates. A recent meta-analysis (Ivarsson et al., 2017) showed that including psychological training programs into other types injury prevention programs (e.g., biomechanical, strength training) within sports has the potential to reduce the risk of sport injuries and may have positive outcomes for athletes, clubs, and communities.
The aforementioned model (Williams & Andersen, 1998) and meta-analysis review (Ivarsson et al., 2017) were limited by several methodological issues. First, some psychological variables, not included in the model of stress and athletic injury (Williams & Andersen, 1998), have been found to be related to increased injury risk, such as poor visual and verbal memory, high levels of psychophysiological fatigue, behaviors related to ignorance of stressors and/or neglecting recovery (Liederbach & Compagno, 2001; Richardson, 2008; Swanik, Covassin, Stearne, & Schatz, 2007). Second, the meta-analysis review (Ivarsson et al., 2017) in this area included studies that evaluated the psychosocial predictors and the effects of prevention interventions on injury rates in different sports, limiting applicability to specific sporting contexts. Thus, more review is required in order to single out those specific psychological risk factors targeting the many different groups of athletes, such as soccer players. More specifically, for example, Johnson and Ivarsson (2011) found that increased injury risk among players in junior soccer was predicted by players having ineffective coping skills, such as worry.
In the last two decades, the effectiveness of psychological interventions on injury rate reduction has also been demonstrated (Driediger, Hall, & Callow, 2006; Edvardsson, Ivarsson, & Johnson, 2012). Some studies have shown that psychological preventive interventions, such as goal setting, positive self-talk, imagery, relaxation, mindfulness, and cognitive-behavioral biofeedback, contribute positively to the prevention of injuries, physical recovery from injury, improved self-confidence levels and the decrease of cognitive and physical anxiety (Driediger et al., 2006; Edvardsson et al., 2012; Johnson, Ekengren, & Andersen, 2005). A review of soccer-specific intervention studies will complement the focus on psychosocial risk factors in this sport and together the two aims may present a broader knowledge base on which to generate practice guidelines and identify future research needs. Therefore, attempting to extend the previous studies, the aims of the present systematic review and meta-analysis were to examine (1) the psychosocial risk factors of soccer injuries and (2) the effects of psychological prevention interventions on the injury risk in soccer players.
Section snippets
Search strategy
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) Statement guidelines (Moher, Liberati, Tetzlaff, & Altman, 2009, Fig. 1). Scholarly electronic databases (PubMed/MEDLINE, Google Scholar, Scopus) were searched from inception up to 1st January 2017. Moreover, we performed manual searches of relevant journals and reference lists obtained from published articles. Electronic databases were searched using the following
Search results
The initial search yielded 102 items, which, after removing the duplicates, reduced to 67. A number of studies (N = 37) were discarded and the full text of 19 studies was assessed for eligibility. Finally, only 13 studies were included concerning the psychosocial predictors and the effects of psychological prevention interventions of soccer injuries (Fig. 1). More specifically, ten investigations studied the psychosocial predictors of injury rates among soccer players (Table 1). Three
Discussion
With regards to the purpose of the current review, the present data showed moderately large effect of psychological prevention interventions on reducing of injury rates in soccer players. Moreover, the review found that trait anxiety, perceived mastery climate, negative-life-event stress or high level of life stress, previous injury, and daily hassle were the main psychosocial predictor variables of injury risk among soccer players.
In professional soccer it has been estimated there are 11.2
Conclusion
The present review shows that history of stressors and personality attributes are the psychosocial variables with the most consistent evidence in predicting injury rates among soccer players. The data also suggests that psychological prevention interventions may reduce the frequency of soccer injuries. Psychological skills training, particularly somatic and cognitive relaxation, stress management skills, goal setting skills, attribution and self-confidence training, and identification and
Funding
This article was not funded.
Declaration of interests
The authors would like to affirm that they have no conflict of interest that is directly or indirectly relevant to the content of the present review.
Ethical approval
None declared.
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