ذهن مهم است: اثر روانی آسیب مچ پا در ورزش ها Mind Does Matter: The Psychological Effect of Ankle Injury in Sport

Introduction Doing sports, itself, constitutes the risk of injuries. The most common, and at the same time most frequent sport injuries relate to the ankle [1,2]. There were 3.1 million sports related ankle injury in the United States of America between 2002 and 2006 most of them in the 15-19 year age group. Beyond young age other influential risk factors were recognized; ankle ligament rupture was more common among men between 15 and 25 and in case of women beyond 30 years of age [3]. Women more often suffer ankle injury. Of children, teenage and adult athletes, children are most while adults are the least likely to suffer ankle injury [4]. Ligament rapture is faced by the majority of athletes who check into ER and only 10% of them have ankle fracture. Ligament raptures mostly occur while playing basketball or football and regarding fractures hiking is considered the other dangerous sport beyond the two games mentioned above [5]. Sport injuries happen three times more often during matches than in training sessions and about half of them are related to the lower limbs. 50% of the cases contact between players is the cause of the injury and in this respect footballers and ice hockey players are the most affected [6]. The highest number of incidents for ligament rupture is typical with team sports and indoor sports, so rugby, football, basketball, handball and volleyball players are the most exposed to this kind of injury [7]. A Hong Kong study presented data that ligament rupture is twice more frequent with the dominant leg and 73% of the injuries are recurrative resulting in the chronic instability of the ankle joint [8]. The ankle injuries of athletes mean a significant burden for the health care system as well: according to studies in the Netherlands, the treatment of a single ankle ligament rupture cost 360 EUR in the country in 2001. Another study on soldiers from the United States of America showed that the treatment of musculoskeletal injuries cost 1billion USD in 1994 [4]. Sport psychology is considered a relatively new field of science and many would question its relevance even today. Even 19% of athletes can meet the negative psychological impact of their suffered sport injury that increases the risk of a repeated injury in itself [9,10]. The stress triggered by the accident goes along with the athlete from the very moment of the injury through the process of rehabilitation to the moment of their return to competition [11]. The very frustration is not generated by the seriousness of the injury, but the insecurity whether how long the recovery would take and to what extent their daily routine would change due to the injury [12]. Stress and anxiety significantly hinders complete recovery, thus a proper rehabilitation process should comprise the treatment of anxiety, fear and lack of self-confidence the athlete faces [9]. The emotion of fear is also related to the possible recurrence of the injury notably influencing the efficiency and intensity of training sessions, since the athlete does not dare to train with proper self-confidence and devotion [13]. In addition athletes are put under great stress by coaches and mates who push them to return and start their full training programme as soon as possible [14]. The experience of the rehabilitation programme in the perception of athletes may also continually change greatly influenced by the personality of the individual as well [15]. According to a study the majority of athletes come through three stages after suffering an injury: the first stage is of negation, the next is about experiencing increased stress, finally, high levels of coping characterize the stages. In the first days that follow the injury, athletes cannot show proper insight and understanding of their injury or its consequences, thus negation is typical at this stage. Later, stress appears with increased levels of anxiety, fear, anger, loss and depression coupled with low self-esteem. These negative emotions may even appear as a consequence of yearning for return at the end of the rehabilitation process. As soon as athletes go through these lows, they are able to cope with the new situation: they are determined, motivated and set new targets and can cooperate with the therapeutic team. The order and length of the mentioned stages vary according to individuals and can be easily tackled by applying diverse psychological methods [16]. To handle the injury, a specific strategy should be chosen –in which the personality traits of the athlete such as adaptation and optimistic attitudes are considered protective factors against the environmentthus athletes of the mentioned qualities can better cope with and accept their situation, as well as move on after the injury [17]. The mentioned idea is supported by a survey conducted among injured swimmers according to which athletes with pessimistic attitudes regarding their future carrier performed lower at later competitions in comparison with their peers who were optimistic [18]. Moreover, the age of the injured athlete also influences the success of tackling their situation. Teenagers can handle injury related issues best and they show the least signs of depression among the studied age groups [19], while older athletes often complained about depression, being exhausted, stressed or being in doubt besides somatic symptoms such as insomnia, lack of appetite and stomachache [20]. The gender of athletes is also decisive: it is more difficult to cope with injuries for female and they often demonstrate mechanisms of avoidance, anxiety and various states of stress [9]. Those athletes who did not have properly developed coping skills, or did not receive proper support by their families, had a need for a longer rehabilitation process compared to those individuals who had a more intense psychosocial support [21,22]. The supportive role of social background is apparent as well: injured athletes receive most support from their families and friends they turn to their coaches and team physicians with greater confidence in comparison with their habit during the pre-injury period [23]. This finding has also been supported by another study according to which the three most important sources of social support in case of a sport injury are the team physician, the team –including the coach- and the family with the circle of friends [24]. Support promotes coping, reduces stress, the fear of being injured in the future, moreover and increases self-confidence and motivation [15] (Figure 1). The emotional temperament and psychological state of individuals can be objectified by applying questionnaires during the rehabilitation process. There are various tests available and mostly “The Emotional Response of Athletes to Injury Questionnaire (ERAIQ)”, the “Tampa Scale of Kinesiophobia (TSK)” and “The Return to Sport after Serious Injury Questionnaire (RSSIQ)” are used [25-27]. In the ERAIQ individuals who complete the test provide an account on the circumstances, the type of the injury, on the characteristic features of the training programme and their feelings regarding the actual or previous injuries. A range of question types are applied in order to collect all data such as: yes-no questions, open questions, scales from 1 to 5 or 1 to 10, as well as supported questions occur in the test [13]. TSK is a test composed of 17 statements to estimate the rate of fear regarding reinjury. Athletes provide answers on a 4-point Likert scale whether to what extent they agree with a given statement. The higher scores gained indicates more fear of a possible reinjury [27]. RSSIQ consists of 21 questions to examine the cognitive, emotional and behavioural responses of athletes to an injury with scores gained from a 7-point Likert scale as well [26].