50 Years of Research on the Psychology of Sport Injury: A Consensus Statement.

Factors influencing sport injury risk, rehabilitation outcomes, and return to sport processes have been the focus in various research disciplines (sports medicine, psychology and sociology). One discipline, with over 50 years of scholarship, is the psychology of sport injury. Despite the research in this field, there is no evidence-based consensus to inform professional practice. The aim of this original and timely consensus statement is to summarise psychological sport injury research and provide consensus recommendations for sport practitioners seeking to implement psychological principles into clinical practice. A total of seven experts with extensive experience outlined the consensus objectives and identified three psychology of sport injury sub-domains: risk, rehabilitation and return to sport. The researchers, grouped in pairs, prepared initial drafts of assigned sub-domains. The group met in Stockholm, and the three texts were merged into a draft and revised in an iterative process. Stress responses are the strongest psychological risk factor for acute injuries. Intra- and interpersonal factors, as well as sociocultural factors, are demonstrated psychosocial risk factors for overuse injuries. Stress management and mindfulness interventions to prevent injuries have been successfully implemented. The rehabilitation process may influence athlete's cognitive, emotional, and behavioural responses. Social support, mindfulness, acceptance-based practices, and cognitive-behavioural based intervention programs reduce negative reactions. Return to sport includes various stages and different trajectories. Returning athletes typically experience concerns regarding competence, autonomy, and relatedness. It is recommended that athletes focus on the physical, technical, and psychological demands of their sport as they progress to increasingly intense activities. Interdisciplinary collaboration (e.g., sports medicine and psychology) would be beneficial in enhancing clinical practice and improving athlete outcomes.

The athlete psychological well-being inventory: Factor equivalence with the sport injury-related growth inventory.

Until now, research on growth following sport injury has relied exclusively on retrospective reports and nomothetic measures drawn from other fields of research. Therefore, to more objectively explore growth following sport injury pre- and post-injury, rather than retrospectively, this study adapts and examines the psychometric properties of the Athlete Psychological Well-Being Inventory (APWBI), which can be used throughout the sport injury process (i.e., prior to and following sport injury). A sample of 164 athletes free from injury (71.3 % men; M age = 19.7 years, SD = 2.1) were compared to a sample of 168 athletes with history of previous injury (73.2 % men; M age = 19.7 years, SD = 2.1). Multigroup Confirmatory Factor Analysis demonstrated the measurement and factor equivalence between the APWBI and a retrospective measure, the Sport Injury-Related Growth Inventory (SIRGI). The APWBI also showed satisfactory to excellent internal consistency reliability for all its sub-dimensions ("sense of mastery", "positive relations with others", "responsibility for one's health", "self-awareness", "emotional ability", "purpose in life", "purpose in sport", and "body awareness") and for the total score. Analysis of the relationships with other self-report measures (i.e., the Positive Functioning Inventory, the Rosenberg's Self-Esteem Scale, and the Lie Scale) provided convergent and discriminant evidence to support the construct validity of the instrument. To conclude, the APWBI is a valid and reliable instrument for use within English-speaking athletes of various competitive levels (from local/county to international level).

Optimising the Early-Stage Rehabilitation Process Post-ACL Reconstruction.

Outcomes following anterior cruciate ligament reconstruction (ACLR) need improving, with poor return-to-sport rates and a high risk of secondary re-injury. There is a need to improve rehabilitation strategies post-ACLR, if we can support enhanced patient outcomes. This paper discusses how to optimise the early-stage rehabilitation process post-ACLR. Early-stage rehabilitation is the vital foundation on which successful rehabilitation post-ACLR can occur. Without high-quality early-stage (and pre-operative) rehabilitation, patients often do not overcome major aspects of dysfunction, which limits knee function and the ability to transition through subsequent stages of rehabilitation optimally. We highlight six main dimensions during the early stage: (1) pain and swelling; (2) knee joint range of motion; (3) arthrogenic muscle inhibition and muscle strength; (4) movement quality/neuromuscular control during activities of daily living (5) psycho-social-cultural and environmental factors and (6) physical fitness preservation. The six do not share equal importance and the extent of time commitment devoted to each will depend on the individual patient. The paper provides recommendations on how to implement these into practice, discussing training planning and programming, and suggests specific screening to monitor work and when the athlete can progress to the next stage (e.g. mid-stage rehabilitation entry criteria).

Behaviour change practices in exercise referral schemes: developing realist programme theory of implementation.

BACKGROUND: Exercise Referral Schemes have been delivered worldwide in developed countries to augment physical activity levels in sedentary patients with a range of health issues, despite their utility being questioned. Understanding the implementation mechanisms of behaviour change practices is important to avoid inappropriate decommissioning and support future service planning. The aim of this study was to develop initial theories to understand what influences the behaviour change practices of Exercise Referral practitioners within the United Kingdom. METHODS: An eight-month focused ethnography was undertaken, to carry out the first phase of a realist evaluation, which included participant observation, interviews, document analysis, and reflexive journaling. A comprehensive implementation framework (Consolidated Framework for Implementation Research) was adopted providing an extensive menu of determinants. Mechanisms were categorised based on the Theoretical Domains Framework (within the Capability, Opportunity, Motivation, Behaviour model) providing an explanatory tool linking the levels of the framework. RESULTS: Three programme theories are proposed. Firstly, motivation and capability are influenced when behaviour change oriented planning and training are in place. Secondly, motivation is influenced if leadership is supportive of behaviour change practice. Lastly, integration between health professionals and practitioners will influence motivation and capability. The conditions necessary to influence motivation and capability include a person-centred climate, cognizant practitioners, and established communities of practice. CONCLUSIONS: The findings are the first to articulate the necessary elements for the implementation of behaviour change practices in Exercise Referral services. These results outline emerging theories about the conditions, resources, and explanations of behaviour change implementation that can inform service development.

Prosthetic Rehabilitation in Practice: An Exploration of Experiential Knowledge in the Multidisciplinary Team.

The aim of this research was to explore the experiential knowledge of patient-facing staff working in a prosthetic rehabilitation center in the United Kingdom. Eleven members of staff with varied roles and levels of experience took part in semi-structured interviews. Transcripts were analyzed using thematic analysis. Six themes were identified: (a) defining successful rehabilitation, (b) the complex reality of patient-centered care, (c) organizational and interpersonal challenges, (d) who provides psychological support? (e) prosthetic as a panacea, and (f) crash landing. These findings highlight the impact of rotational roles in an environment reliant on experiential knowledge, the challenge of applying patient-centered care models, and the negative effect of unrealistic beliefs about prosthetics on patients and staff. This study contributes to a limited pool of literature articulating the experiential knowledge of staff in the context of rehabilitation after major lower limb loss, facilitating the translation of practice-based evidence into evidence-based practice.

Breast Education Improves Adolescent Girls' Breast Knowledge, Attitudes to Breasts and Engagement With Positive Breast Habits.

Many females experience breast-related issues that are considered to negatively impact health and well-being. These include breast cancer, issues related to incorrect bra fit, and issues related to breast movement including an increased incidence of breast pain, breast sag, and embarrassment, which can be a barrier to physical activity participation. Knowledge and awareness of these breast issues among females is low. Furthermore, these breast concerns are more prevalent in adolescent girls compared to adult females, with 87% of girls reporting ≥ one breast concern. This study evaluated the short- and longer-term impact of a 50 min breast education intervention on adolescent girls' (11 to 14 years) breast knowledge, attitudes to breasts and engagement with positive breast habits. A mixed methods, controlled, longitudinal, cohort design was employed, using two control schools (n: 412; receiving no intervention) and two intervention schools (n: 375; receiving the intervention) from privileged and less privileged areas. Adolescent girls in four schools completed a validated breast survey pre- and immediately post-intervention as well as 3 and 6 months post-intervention. Additionally, in one intervention school, six focus groups were conducted immediately and 4 months after the intervention. The intervention was equally effective in the two intervention schools. Following the intervention, participants in the intervention schools significantly improved their breast knowledge, their attitudes to breasts and their engagement with positive breast habits, compared to participants in the control schools, p < 0.01 (with large effect sizes). These improvements were sustained 6 months post-intervention. Participants described the session as "informative," it made them "feel less embarrassed" about their breasts; they also reported wanting to do more exercise and to change their bra purchasing and bra wearing habits. These novel, positive findings provide insight into the benefits of teaching adolescent girls about breasts from a young age and can be used to inform effective breast education in schools. It is recommended that education on multiple breast topics should be introduced in schools, preferably being first introduced in primary schools, with a modular structure and progressive information.

Narratives of Recovery Over the First Year After Major Lower Limb Loss.

The objectives of this research were to extend previous research by exploring the psychosocial experiences of patients over the first year after major lower limb amputation (MLLA) and identify implications for rehabilitation practice. This research took place at a United Kingdom-based National Health Service-operated prosthetic rehabilitation center. Thirty patients were recruited who had experienced MLLA within the last year and were undertaking prosthetic rehabilitation. Data were collected through semi-structured narrative interviews, observation, and a reflexive journal and analyzed using dialogical narrative analysis. The concept of well-being was used to map patients' recovery trajectories, and five narrative typologies were identified: accelerated decline, adaptation, illusory cure, muddling along, and projection. This article advances knowledge by opening up new possibilities for anticipating patients' future needs through the stories they are telling in the present and provides the basis for additional resources supporting psychosocial recovery.

Cognitive processing following acquired disability for para sport athletes: a serial mediation model.

Purpose: To understand the cognitive processing that occurs in relation to a disabling life event among para sport athletes, as well as the role of para sport participation in shaping these cognitions, and subsequent perceptions of posttraumatic growth or distress.Methods: Participants were 75 para sport athletes with acquired disability. Serial multiple mediation analysis was conducted to identify the various pathways through which posttraumatic growth or distress is experienced.Results: Findings suggested that a disabling event initiated challenges to one's core beliefs which influenced subsequent perceptions of posttraumatic growth and distress through cognitive processing at two separate time frames. Moreover, the utility of deliberate rumination (at both time points) was evident in experiencing posttraumatic growth, while intrusive rumination only appeared beneficial if it prompted deliberate ruminations.Conclusions: As several unique paths to posttraumatic growth were found, results suggest that a multitude of paths to growth may be possible. Para sport participation may have utility in facilitating deliberate ruminations and subsequent posttraumatic growth for those unable to deliberately ruminate in the immediate disability aftermath.Implications for rehabilitationAs challenges to core beliefs triggered ruminative thoughts that ultimately facilitated PTG, practitioners are encouraged to explicitly ask patients about how the adverse event might have influenced patients' self-perceptions and views about the meaning of life. Such questions may be revisited from injury onset throughout recovery and rehabilitation.Rehabilitation specialists should inform patients that intrusive ruminations may be salient in the post-trauma aftermath, but that such rumination may be facilitative if it gives way to more deliberate forms of rumination.Attempts to understand the meaning of a traumatic event may be instrumental in alleviating distress.Health practitioners should encourage individuals suffering physically disabling events to engage in activities such as para sport, given its potential to facilitate deliberate rumination and subsequent posttraumatic growth.

Can Preinjury Adversity Affect Postinjury Responses? A 5-Year Prospective, Multi-Study Analysis.

Informed by and drawing on both the integrated model of response to sport injury (Wiese-Bjornstal et al., 1998) and the biopsychosocial model of challenge and threat states (Blascovich, 2008), this multi-study paper examined whether preinjury adversity affected postinjury responses over a 5-year time period. Study 1 employed a prospective, repeated measures methodological design. Non-injured participants (N = 846) from multiple sites and sports completed a measure of adversity (Petrie, 1992); 143 subsequently became injured and completed a measure of coping (Carver et al., 1989) and psychological responses (Evans et al., 2008) at injury onset, rehabilitation, and return to sport. MANOVAs identified significant differences between groups categorized as low, moderate, and high preinjury adversity at each time phase. Specifically, in contrast to low or high preinjury adversity groups, injured athletes with moderate preinjury adversity experienced less negative psychological responses and used more problem- and emotion-focused coping strategies. Study 2 aimed to provide an in-depth understanding of why groups differed in their responses over time, and how preinjury adversity affected these responses. A purposeful sample of injured athletes from each of the three groups were identified and interviewed (N = 18). Using thematic analysis, nine themes were identified that illustrated that injured athletes with moderate preinjury adversity responded more positively to injury over time in comparison to other groups. Those with high preinjury adversities were excessively overwhelmed to the point that they were unable to cope with injury, while those with low preinjury adversities had not developed the coping abilities and resources needed to cope postinjury. Practical implications and future research directions are discussed.

Back to Normal Symmetry? Biomechanical Variables Remain More Asymmetrical Than Normal During Jump and Change-of-Direction Testing 9 Months After Anterior Cruciate Ligament Reconstruction.

BACKGROUND: After anterior cruciate ligament reconstruction (ACLR), athletes have demonstrated performance asymmetries as compared with healthy cohorts, but little research has investigated if biomechanical asymmetries are also different during jump and change-of-direction (CoD) tasks between groups. PURPOSE: To identify if differences in magnitude of asymmetry of biomechanical and performance variables exist between these groups. STUDY DESIGN: Controlled laboratory study. METHODS: Analysis was conducted between 156 male patients 9 months after surgery and 62 healthy participants. Three-dimensional motion capture and analysis were carried out on a double-legged drop jump, a single-legged drop jump, a single-legged hop for distance, and planned and unplanned CoD. Asymmetry between limbs was calculated for each variable with root mean square difference between limbs. Statistical parametric mapping was used to identify the between-group differences in magnitude of asymmetry of performance and biomechanical variables. RESULTS: There were differences in asymmetry of biomechanical variables across all jump and CoD tests, with greater asymmetries in the ACLR group. The majority of differences between groups were in the sagittal and frontal planes, with more differences found in the jump than CoD tests. The single-legged drop jump demonstrated large differences in performance asymmetry (effect size, 0.94) with small differences for both CoD tests (0.4) and none for the single-legged hop for distance. CONCLUSION: This study demonstrated greater asymmetry of biomechanical variables 9 months after ACLR as compared with healthy participants across all tests, suggesting insufficient rehabilitation. CLINICAL RELEVANCE: This study highlights the importance of including biomechanical as well as performance variables when assessing rehabilitation status after ACLR. REGISTRATION: NCT02771548 ( ClinicalTrials.gov identifier).

From core belief challenge to posttraumatic growth in para sport athletes: moderated mediation by needs satisfaction and deliberate rumination.

Purpose: To examine how deliberate rumination and psychological need satisfaction interact to facilitate posttraumatic growth for para sport athletes with acquired disability. Methods: Utilizing a sample of 70 para sport athletes, the hypothesized mediating role of deliberate rumination was examined via a simple mediation model. The interaction between needs satisfaction and deliberate rumination and their effect on posttraumatic growth was examined utilizing a moderated mediation procedure. Results: Disruption to one's core beliefs was significantly associated with posttraumatic growth. This relationship, was in part, explained by the deliberate rumination engaged in soon after the trauma. Needs satisfaction, while a significant predictor of posttraumatic growth, did not moderate the indirect effect. Conclusions: Although deliberate rumination at both timeframes and needs satisfaction were independently associated with posttraumatic growth, they did not interact in the hypothesized manner to influence posttraumatic growth. There remains a need to better understand how the experience of posttraumatic growth is achieved amongst individuals with acquired disability, and the role that para sport may play in this process. Implications for rehabilitation The disruption to one's core beliefs caused by acquiring a physical disability is not only a natural experience but also a necessary antecedent to posttraumatic growth. As such, rehabilitation practitioners ought to normalize these types of challenges when working with individuals with acquired disability. Practitioners may help to facilitate growth outcomes by encouraging individuals to deliberately ruminate about their acquired disability. That is, practitioners can help those with acquired disability to seek meaning and understanding about their disability or the precipitating event. For those who struggle to deliberately ruminate in the immediate disability aftermath, practitioners may encourage para sport participation to potentially prompt constructive cognitive processing. Individuals with acquired disabilities would also be well served by rehabilitation practitioners and para sport organizations that provide opportunities for basic psychological needs satisfaction. Specifically, individuals with acquired disabilities should be given the opportunity to demonstrate physical competence, make meaningful relationships, and feel a sense of volitional control over their rehabilitation or para sport participation. For example, practitioners and para sport organizations could establish mentorship programs wherein individuals with more recent disabilities can be mentored by those with greater disability experience.

Living with limb loss: everyday experiences of "good" and "bad" days in people with lower limb amputation.

Purpose: To provide an understanding of the everyday experiences of individuals with a limb amputation. Methods: Twenty-two participants (14 female, 8 male) with a mean-age of 42 years (SD = 10 years) were recruited to take part in two focus groups. The participants reported a range of lower-limb amputations (i.e., congenital, acquired, transfemoral, trantibial, unilateral, and bilateral) and on an average were 5 years post-surgery (SD = 7 years). Each focus group comprised of 11 participants and was moderated by either the first or second author. The moderator asked participants to discuss their everyday experiences of life with an amputation using Charmaz's good day/bad day approach. Focus groups were transcribed verbatim and analyzed using an inductive thematic analysis. Results: Four themes were identified: pain, organization and planning, the embodied experience after amputation, and interactions with others. Conclusions: These themes provide a key resource for understanding daily fluctuations in physical, social, and psychological functioning. Implications for Rehabilitation Lower limb amputation can result in daily fluctuations in physical, social, and psychological functioning. These fluctuations can be illustrated through experiences of pain, planning and organization, embodied experiences, and interactions with others. At a policy level, evaluations of daily living after an amputation should be based on a longitudinal assessment.

Understanding posttraumatic growth of paratriathletes with acquired disability.

PURPOSE: To examine the relevance of key components of Organismic Valuing Theory of Growth through Adversity in understanding posttraumatic growth amongst paratriathletes with acquired disability. METHODS: Semi-structured interviews informed by organismic valuing theory of growth through adversity were conducted with 14 elite paratriathletes (eight male, six female). To increase the likelihood that participants had experienced posttraumatic growth, a short form of the Posttraumatic Growth Inventory was completed prior to interview participation. Interview data were analyzed using directed content analysis. RESULTS: Although the initial response to disability was largely negative, paratriathlon experiences were reported to be a mechanism through which growth was facilitated. In particular, participants suggested that social, competence, empowerment, and identity development processes were instrumental in facilitating posttraumatic growth. CONCLUSIONS: Analysis identified themes largely consistent with the main tenets of organismic valuing theory of growth through adversity, supporting its utility in understanding response to a traumatic event and subsequent growth. These findings also suggest that para sport may be an efficacious means for promoting posttraumatic growth, especially for individuals with severe initial reactions to their disability. Lastly, findings suggest that fostering perceptions of competence, autonomy, and social connection may promote posttraumatic growth. Implications for Rehabilitation Acquiring a physical disability may have a detrimental impact on the satisfaction of an individual's fundamental psychological needs. In order to foster posttraumatic growth, the para sport environment should allow for participants to feel competent, autonomous, and to have meaningful interactions with fellow athletes and coaches. Para sport may be particularly beneficial for individuals with previous sporting backgrounds and for those with severe initial reactions to their disability.

Biomechanical but not timed performance asymmetries persist between limbs 9 months after ACL reconstruction during planned and unplanned change of direction.

Whilst anterior cruciate ligament injury commonly occurs during change of direction (CoD) tasks, there is little research on how athletes execute CoD after anterior cruciate ligament reconstruction (ACLR). The aims of this study were to determine between-limb and between-test differences in performance (time) and joint kinematics and kinetics during planned and unplanned CoD. One hundred and fifty-six male subjects carried out 90° maximal effort, planned and unplanned CoD tests in a 3D motion capture laboratory 9 months after ACLR. Statistical parametric mapping (2 × 2 ANOVA; limb × test) was used to identify differences in CoD time and biomechanical measures between limbs and between tests. There was no interaction effect but a main effect for limb and task. There was no between-limb difference in the time to complete both CoD tests. Between-limb differences were found for internal knee valgus moment, knee internal rotation and flexion angle, knee extension and external rotation moment and ankle external rotation moment with lower values on the ACLR side (effect size 0.72-0.5). Between test differences were found with less contralateral pelvis rotation, distance from centre of mass to the ankle in frontal plane, posterior ground reaction force and greater hip abduction during the unplanned CoD (effect size 0.75-0.5). Findings demonstrated that kinematic and kinetic differences between limbs are evident during both CoD tests 9 months after surgery, despite no statistical differences in performance time. Biomechanical differences between tests were found in variables, which have previously been associated with ACL injury mechanism during unplanned CoD.

Whole-body biomechanical differences between limbs exist 9 months after ACL reconstruction across jump/landing tasks.

INTRODUCTION: Previous studies examining jump tasks after anterior cruciate ligament reconstruction (ACLR) have focused on performance measures without examining joint kinematic and kinetic variables. The aim of this study was to identify differences in biomechanical and performance measures between limbs across tests 9 months after surgery. METHODS: Four jump tests (double-leg drop jump (DLDJ), single-leg drop jump (SLDJ), single-leg hop for distance (SLHD) and hurdle hop (HH)) were carried out on 156 male subjects in a 3D motion capture laboratory 9 months after surgery. Statistical parametric mapping was used to identify differences in jump performance and biomechanical variables between limbs. RESULTS: Biomechanical measures were lower on the ACLR side across all four tests for internal knee valgus moment (effect size 0.78-0.96, knee internal rotation angle 0.59-0.73, and 0.60-0.83), respectively. [corrected].The timing of the largest difference between limbs was not at the same % stance between variables within a test or for any variable across tests. Large ES differences were observed in performance in the SLDJ (ES 0.73-0.81; LSI 78%) and small differences in the SLHD (ES 0.36; LSI 94%) between the limbs. CONCLUSION: Findings highlighted biomechanical differences between limbs which are consistent across jump tasks suggesting insufficient rehabilitation at 9 months post surgery. Results indicate that the SLDJ may identify greater performance deficits between limbs than SLHD, which may over-estimate rehabilitation status.

Reinjury anxiety, coping, and return-to-sport outcomes: a multiple mediation analysis.

PURPOSE/OBJECTIVE: This study aimed to examine whether the dimensions of reinjury anxiety (i.e., intensity, frequency, and direction) predicted perceived return-to-sport outcomes and whether coping mediated this relationship. RESEARCH METHOD/DESIGN: Using a cross-sectional research design, 335 participants (M age = 23.5; SD = 6.6) who had sustained a sports-related injury preventing participation in training and competition for a minimum of 4 weeks (M time loss = 98 days; SD = 96.8) completed measures of reinjury anxiety (RIA-RE subscale of the Reinjury Anxiety Inventory (RIAI); Walker, Thatcher, & Lavallee, 2010), coping (MCOPE; Crocker & Graham, 1995), and perceived return-to-sport outcomes (RSSIQ; Podlog & Eklund, 2005). Pearson product-moment correlation and Preacher and Hayes's (2008) bootstrapping procedure were used to analyze the data. RESULTS: Consistent with our hypotheses, results indicated a positive relationship between reinjury anxiety (intensity and frequency) and heightened return concerns, whereas reinjury anxiety interpreted as facilitative toward postinjury performance was associated with a positive renewed perspective on sport participation. Significant indirect effects for coping were found for wishful thinking, venting of emotions, denial, and behavioral disengagement. CONCLUSIONS/IMPLICATIONS: Future avenues of research that aim to provide a greater knowledge and understanding of the relationship between reinjury anxiety and return-to-sport outcomes are discussed, including the need for alternative theoretical perspectives and diverse methodologies.

Effect of dispositional optimism before and after injury.

PURPOSE: This study examined the direct, moderating, and indirect effects of dispositional optimism on the prediction of, and athletes' responses to, injury. METHODS: A 2-yr longitudinal design was conducted with a baseline sample of 694 asymptomatic participants (389 men, 305 women; mean ± SD age = 19.17 ± 1.69 yr), 104 of which subsequently became injured. Logistic regression, Pearson product-moment correlations, and a bootstrapping procedure were used to analyze the data. RESULTS: Findings revealed a significant direct effect (i.e., as optimism increased, the likelihood of injury occurrence decreased) and a nonsignificant moderating effect for optimism before injury. Significant direct and indirect effects for optimism after injury were found. CONCLUSIONS: These findings have important implications for practitioners who have a vested interest in reducing the likelihood of injury and expediting the rate and quality of recovery from injury. Future avenues of research that include the need to embrace more objective indicators of recovery from injury are discussed.

An examination of hardiness throughout the sport-injury process: a qualitative follow-up study.

OBJECTIVES: This qualitative follow-up study aimed to enhance the interpretability and meaningfulness of the findings that emerged from a quantitative study that explored the effect of hardiness on the prediction of, and response to, sport injury (i.e., Wadey, Evans, Hanton, & Neil, 2012). DESIGN: Using theory-based and maximum-variation sampling to contextualize and provide an in-depth understanding of the previous findings, the participants comprised a purposeful sample of 10 athletes from the quantitative study (M age = 21.7; SD= 1.06). METHODS: Data were derived through semi-structured interviews, and analysed and displayed using composite sequence analysis (Miles & Huberman, 1994). RESULTS: The findings extended Wadey et al.'s (2012) study by identifying the perceived mechanisms by which athletes high and low in hardiness exacerbated or attenuated the impact of pre-injury negative major life events (i.e., a significant predictor of sport injury) and post-injury responses. Specifically, the findings demonstrate that athletes high in hardiness possessed a refined repertoire of problem- and emotion-focused coping strategies that they used pre- and post-injury. Those athletes low in hardiness used avoidance coping strategies that had long-term negative implications. CONCLUSIONS: These findings have important implications for the structure, timing, and content of hardiness interventions that aim to reduce rates of injury occurrence and expedite injured athletes' return to competitive sport.

Stressors experienced by injured athletes.

The purpose of this study was twofold: (a) to examine the stressors experienced by injured athletes during three phases of their recovery from sport injury, and (b) to explore the differences in the stressors experienced by team as compared to individual-sport athletes. Participants comprised previously injured high-level rugby union players (n = 5) and golfers (n = 5). Semi-structured interviews were used to explore the stressors participants experienced during three phases of injury (onset, rehabilitation and return to competitive sport). Within- and cross-case analyses showed that athletes experienced sport, medical/physical, social and financial stressors. There were a number of differences in the stressors experienced across the three phases and between team and individual-sport athletes. Findings have important implications for the design and implementation of interventions aimed at managing the potentially stressful sport injury experience and facilitating injured athletes' return to competitive sport.