Introduction
Although elite athletes experience high numbers of both acute and overuse injuries, questions regarding which athletes are at risk remain largely unanswered due to limitations in current risk prediction models.1 While the focus often has been to target physiological and biomechanical parameters when investigating risk factors for sports injuries, there has also been an increasing interest to examine the potential influence of psychosocial factors.2 A recent meta-analysis on the investigation of psychosocial factors and their association to injury risk concluded that high levels of negative life event stress and strong stress responsivity were the two variables that had the strongest associations with injury risk in athletes.3 European football studies, involving male elite players and female junior players, have reported high levels of perceived stress to be associated with injury risk.4–6 Also among youth players, there was a moderate, positive association between injury risk during the 8 months season and perception of a mastery climate.
So far, most of the published studies on psychosocial risk factors for sport injuries have been focusing on acute injuries.7 However, researchers have suggested that there might be different psychosocial risk factors for acute versus overuse injuries. According to the Stress and Injury model, it is suggested that acute injuries are related to the athletes’ cognitive appraisal of a potentially stressful situation.8 On the other hand, risk factors for overuse injuries might be more related to stress responses stemming from lack of recovery.9–11 In line with these suggestions, van der Does et al 11 found decreased general recovery to be associated with an increased risk for acute injuries, while decreased sport recovery was a statistically significant risk factor for overuse injuries among elite and subelite team sport players, including both genders.
Focusing on causes of stress responses, environmental factors (eg, interpersonal relationships such as a poor coach–athlete relationship, culture and norms) will have impact on the athletes’ stress levels and consequently on the magnitude of the stress responses.7 9 Environmental factors may even have stronger negative impact on elite athletes than intrapersonal stressors, such as self-doubt and negative thoughts.12–15 This can be related to the perceived lack of control athletes experience when stress factors stem from the social context surrounding them, rather than their internal thought processes.16 Indeed, communication problems between athlete and coach were suggested, by both athletes and coaches, to be a contributing cause to develop overuse injuries.17
Given that different types of stressors might have different impact on both players’ cognitions and behaviours, it is surprising that previous studies have defined ‘stress’ in a very broad term. Negative life stress, for example, has been a summary of a diverse range of stressors such as harassments, moving, personal and social conflicts. We believe it can be more useful to break down these stressors into more specific sources. For example, when athletes perceive the coach–athlete relationship to be a source of stress, they experience higher levels of burn-out and fatigue symptoms, and hence are likely more at risk for overuse injuries.18 Additionally, when the athlete is neither able nor willing to share his or her current total burden with the coach, there might be an increased risk for insufficient recovery.19 Also, when stress is generated from the interaction between teammates, the stressor can be considered to be a daily hassle, and it is interesting to examine if this is the case if the source of stress stems from friends outside of sport also.20 In previous studies, daily hassles have been associated with an increased risk of acute injuries due to, for example, poorer cognitive capacity.3
To gain more knowledge of what type of stressors and psychosocial environment might increase the risk of sustaining an acute or overuse injury, we aimed to investigate whether three different potential stressors (coach, teammates and friends outside sports) as well as two environmental factors (task climate and ego climate) are related to the risk for acute and overuse injuries in Norwegian elite female football players. We hypothesised that: (a) when the source of stress was related to the interaction with teammates and friends outside sport, we expect an increased risk of acute injuries; (b) when a player perceived her relationship with her coach to be a source of stress, she would be at increased risk for overuse injuries; (c) a task climate would be related to an increased risk for acute injuries and an ego climate would be related to an increased risk for overuse injuries.