Elsevier

Physical Therapy in Sport

Volume 32, July 2018, Pages 293-300
Physical Therapy in Sport

Literature Review
Psychosocial predictors and psychological prevention of soccer injuries: A systematic review and meta-analysis of the literature

https://doi.org/10.1016/j.ptsp.2018.05.006Get rights and content

Highlights

  • History of stressors and personality attributes are the main predictors of injury rates among soccer players.

  • Psychological-based prevention interventions might have potential to reduce the frequency of soccer injuries.

  • This review suggests that the player who can effectively manage life stress and anxiety will be less likely to be injured.

  • Since the effectiveness of psychological interventions was evident only in 1/3 of studies, further research is needed.

Abstract

Objectives

To examine (a) the relationships between the psychosocial risk factors and injury rates and (b) the effects of psychological-based prevention interventions on the injury risk of soccer players.

Design

Scholarly electronic databases (PubMed/MEDLINE, Google Scholar, Scopus) were searched on 1 January 2017, complemented by manual searches of bibliographies. Setting: Systematic review and meta-analysis.

Participants

We identified 13 eligible studies, including a total of 1149 injured soccer players aged between 14 and 36 years.

Main outcome measures

Psychosocial risk factors, psychological-based prevention interventions and injury risk in soccer players.

Results

Personality traits, such as trait anxiety and perceived mastery climate, along with a history of stressors, like negative-life-event stress or high level of life stress, daily hassle, and previous injury, are the main predictors of injury rates among soccer players. Also, from injury prevention studies, it has been shown that psychological-based interventions reduce injury rates (effect size = 0.96; 95% CI 0.34–1.58; p = 0.002) in senior soccer players.

Conclusions

Practitioners need to ensure injured soccer players are psychologically and socially ready to play. They should also employ psychological-based interventions (i.e., mindfulness, imagery, self-talk, stress management, relaxation, goal setting) when designing injury prevention programs.

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.

References (59)

  • M. Davis et al.

    The relaxation and stress reduction workbook

    (2008)
  • C. Devantier

    Psychological predictors of injury among professional soccer players

    Sport Science Review

    (2011)
  • M. Driediger et al.

    Imagery use by injured athletes: A qualitative analysis

    Journal of Sports Sciences

    (2006)
  • A. Edvardsson et al.

    Is a cognitive-behavioural biofeedback intervention useful to reduce injury risk in junior football players?

    Journal of Sports Science and Medicine

    (2012)
  • C. Edwards et al.

    A systematic review of the drive for muscularity research area

    International Review of Sport and Exercise Psychology

    (2014)
  • J. Ekstrand et al.

    Injury incidence and injury patterns in professional football: The UEFA injury study

    British Journal of Sports Medicine

    (2011)
  • M.D. Fox et al.

    Spontaneous neuronal activity distinguishes human dorsal and ventral attention systems

    Proceedings of the National Academy of Sciences of the U S A

    (2006)
  • T.J. Gabbett et al.

    Skill qualities as risk factors for contact injury in professional rugby league players

    Journal of Sports Sciences

    (2012)
  • S.A. Galambos et al.

    Psychological predictors of injury among elite athletes

    British Journal of Sports Medicine

    (2005)
  • R.D. Hawkins et al.

    Risk assessment in professional football: An examination of accidents and incidents in the 1994 world cup finals

    British Journal of Sports Medicine

    (1996)
  • R.D. Hawkins et al.

    The association football medical research programme: An audit of injuries in professional football

    British Journal of Sports Medicine

    (2001)
  • C. Heaney

    Physiotherapists' perceptions of sport psychology intervention in professional soccer

    International Journal of Sport and Exercise Psychology

    (2006)
  • L. Hedges

    Distribution theory for Glass's estimator of effect size and related estimators

    Journal of Educational Statistics

    (1981)
  • A. Ivarsson et al.

    Psychological factors as predictors of injuries among senior soccer players. A prospective study

    Journal of Sports Science and Medicine

    (2010)
  • A. Ivarsson et al.

    Psychological predictors of injury occurrence: A prospective investigation of professional Swedish soccer players

    Journal of Sport Rehabilitation

    (2013)
  • A. Ivarsson et al.

    It pays to pay attention: A mindfulness-based program for injury prevention with soccer players

    Journal of Applied Sport Psychology

    (2015)
  • A. Ivarsson et al.

    Psychosocial factors and sport injuries: meta-analyses for prediction and prevention

    Sports Medicine

    (2017)
  • U. Johnson et al.

    Injury prevention in Sweden: Helping soccer players at risk

    Journal of Sport & Exercise Psychology

    (2005)
  • U. Johnson et al.

    Psychological predictors of sport injuries among junior soccer players

    Scandinavian Journal of Medicine & Science in Sports

    (2011)
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