Exam 1

Gender and pain

- males have higher pain tolerance, but no difference in pain threshold - individuals who strongly identify with their gender group fit the expected patters with pain

counseling

- meaningful understanding of self and environment and results in clarification of goals - counseling helps people identify and develop resources for coping with stress - can be formal or informal - often includes goal setting

Experimental research

- mixed results on injury risk reduction - positive results on self reported stress reduction

Psychosocial antecedents to injury

- models of sport injury occurrence: mutlifactoral model and stress injury model - both models evolved independently and have made valuable contributions

Role of psychosocial strategies for managing pain

- modify pain perception - lessen apprehension - motivate - educate - manage stress - promote healing - increase confidence - alter thinking and focus to increase and promote healing and mental well being

Reduce injury risk by monitoring stress

- monitor stress through: questionnaires, perceived stress scale, life events survey, hassles and uplifts - these DON'T diagnose

Emotional factors of pain

- mood state: temporary, less specific and intense than feelings - negative emotional are associated with higher levels of pain in athletes with injury

Physiology of Physical Pain

- nociceptors: afferent nerves (mechanical, thermal, and chemical) - spinal cord = dorsal horn - brain: thalamus, hypothalamus, brainstem, limbic system, cerebral cortex - Autonomic system is hypothalamus, limbic system, and cerebral cortex - hypothalamus is physical changes that occur with pain - Limbic system and cerebral cortex is emotional/memory of pain

Age and pain

- older individuals have higher pain tolerance compared to younger - older individuals have higher pain threshold compared to younger

Pain and injury

- pain is complex, individual, real - management of pain are pharmacological treatments - physical therapies and modalities - psychological treatment

Neuromatrix Theory

- pain is not the consequence of brain passively registering tissue trauma but rather the product of an active brain forming subjective experience in response to sensory signaling (tries to explain phantom limb pain) - pain is produced by networks of nerve impulses or neuromatrix - a neurosignature is developed

Physical pain definitions

- pain sensation: stimulus is received by nervous system - quality - intensity - pain perception: conscious interpretation of nociceptive stimulus as pain - pain threshold: point at which pain begins to be felt - pain tolerance: ability to withstand pain for a period of time

Stress injury model

- people make cognitive appraisals of: environmental demands, resources they posses, consequences of being successful or unsuccessful - cognitive appraisals are influences by physiological attentional changes

biofeedback

- people receive info about one or more of their bodily processes (EMG) - benefits on behavioral and physical outcomes - psychological intervention

Stress and cognitive appraisal

- personality and stressors may influence how individual appraises situation - stressors may not be modifiable or controlled - if you screen, talk to or observe athlete. you can incorporate psychosocial strategies

Under conformity

makes no sacrifices

Normal conformity

makes some sacrifices

Gate control theory

pain transmission to the brain can be blocked on afferent or efferent pathways

Physical therapies and modalities

psychosocial strategies: education, stress management, imagery, dissociative and associative

Force

push or pull acting on the body

Antecedents definition

risk factors

over conformity

sacrifices a lot

Sport Norms

standards, beliefs, models considered to be "normal" in a sport setting

Trauma

- macrotrauma: single force resulting in trauma to body's tissues (acute) - microtrauma: accumulation of subtraumatic forces that eventually cause injury to tissue (chronic)

Coping resources

- least studied of all 3 primary categories of predictors of stress response in stress injury model - high levels of coping skills are associated with fewer sport injuries

History of stressors

- life stress: big events (where to get food, death, divorce) - Daily stress or hassle: homework assignment - History of injury: higher risk if already had certain injury

Chronic pain

- linked to decrease quality of life and depression - may be at increased risk for suicide

Pain measurement scale

- 0 = no pain - 2-3 = mild pain - 5 = moderate pain - 7-8 = severe pain - 10 = worst pain possible

Race and pain

- African Americans have lower pain threshold compared to caucasians - A.A are more likely than non hispanic whites to underreport pain unpleasantness in clinical setting - medical professionals underestimate and under treat A.A. pain

Pain dimensions

- Anguish: emotional distress in the presence of or in the absence of any injury or tissue damage - Discomfort: mild distress or uncomfortable - nociception: activation of specialized peripheral nerves, damaged tissue - hurt: emotional - exertion: act of putting forth great mental and physical effort

Stressful situations

- Athletic: big game, championship - non athletic: anything else

Athletes and pain

- athletes have higher pain tolerance than non athletes - no difference in pain threshold

Cognitive factors of pain

- attentional focus: intensity and persistence - cognitive content: when athletes encounter painful circumstances, a variety of thoughts may cross their minds

Biopsychosocial model of health

- bio: study of body - Psych: how injury affects mind - soc: functions of human in society

Historical perspectives on health

- biomedical model of health - behavioral medicine - Biopsychosocial model of health

Pain

- both sensory and emotional - difficult to define: protective mechanism and localized sensation as a result of noxious stimulation - purpose: alert something is wrong either tissue damage or no tissue damage - no tissue damage could be referred pain, phantom limb pain, emotional pain - if pain <3 months its acute and >3 months its chronic

Effectiveness vs. efficacy

- bubblewrap is effective but not efficient whereas ankle tape is more efficient and less effective - these must be satisfied in order for a preventative measure to be effective: efficiency, compliance, avoidance of risk homeostasis

relationship prior to injury

- building a relationship before injury is critical because they are more likely to listen and adhere - following an injury its important to maintain a trusting and positive relationship

Multi interventions

- combine multiple interventions to provide a more comprehensive approach to treatment - offer athletes a variety of approaches and thus an opportunity to connect with an approach that suits them

Sport and pain

- contact sports have higher pain tolerance AND higher threshold than non contact - power athletes have higher pain threshold and endurance athletes have higher pain tolerance - endurance athletes have lower fear of pain

Sport injury

- culture of risk - around 8 million students participate in high school athletics

Relaxation techniques

- designed to reduce stress response - changes facilitated through relaxation training

Pain research limitations

- eliciting pain: cold, heat, pressure (not real pain) - recall: emotional state at time of injury, cognitive thoughts at time of injury - pain is multifactorial

individual team norms

- ex. being late to practice results in 100 push ups

implementing psychological interventions

- factors may be considered in determining if intervention is needed: competence, access and availability, interest

Social support

- feeling of being supported by others and social integration - general counseling skills - quality education has direct affect on cognitive appraisal

Benefits/downsides to Sports

- fun, friends, exercise, healthy mind - injury, time consuming, stress, anxiety

What does it take to succeed in sports

- hard work - skill - motivation and sacrifice - love for sport

The placebo affect

- if athlete believes the treatment is beneficial then pain can be reduced - change in perception of pain without any physiological change in tissue

The sport ethic

- influenced by parents, teammates, coaches, medical staff 1. make sacrifices for game 2. strive for distinction 3. accept no obstacles in the pursuit of success 4. accept risks and play though pain

Imagery

- intentionally generate internal representations - association: imagining pain (red) - dissociation: removing self away from pain (yellow)

Multifactorial model

- intrinsic risk factors: modifiable (strength, weight, diet) and non modifiable (genetics, height, age, injury history, sex) - extrinsic risk factors: modifiable (equipment, participation, your team) and non modifiable (weather, field condition, opponents)

personality characteristics

- personality differences place individuals at risk of injury, depending on how they view stressful situation - Anderson and Williams believed five personality characteristics contributed to the stress response: hardiness, locos of control, competitive trait anxiety, sense of coherence, achievement motivation

Stress response

- physiological: headaches, frequent infections, fatigue - cognitive: worrying, nightmares, hasty decisions - emotional: anxiety, loss of confidence, depression - behavioral: smoking more, insomnia, loss of appetite

Considerations for applying strategies (social support, counseling, etc.)

- preseason - team basis - individual basis

Cognitive appraisal

- primary appraisal: individual assesses situation as a threat or challenge (eustress and distress) - secondary appraisal: individual evaluators whether they have adequate coping resources

Antecedents and responses to stressors

- psychological antecedents influence how individual interprets stressful situation - how the individual appraises and interprets the situation determines stress response - how individual responds will influence injury risk

Clinical measurement of physical pain

- psychophysiological measures - behavioral measures - self report measures

non experimental research

- psychosocial interventions for performance enhancement have been shown to aid in injury prevention - such as relaxation techniques, stress management, etc.

Sport is regarded as a culture of what?

- risk - risk of losing, failing, injury, succeeding

models of sport injury prevention

- serve to guide research and practice (not always proven) - Tripp model (one with > > >) - efficacy: examines the success of intervention in controlled condition (step 4) - effectiveness: evaluates interventions success in a real world environment (step 6)

Examples of psychosocial strategies

- social support - stress management: relaxation techniques and biofeedback - imagery: dissociation and association - attention and concentration control - counseling - self talk expressive writing

Social and environmental factors of pain

- social: presence of people athletes underreport pain - environmental: exercise setting

relaxation for pain management

- somatic relaxation: deep breathing, diaphragmatic breathing, ratio breathing - cognitive relaxation: progressive muscle relaxation and guided imagery

thought stopping

- strategy to gain control over negative thoughts and change then into positive thoughts - identify what is currently being said to the self in the face of challenges

Types of prevention

- surest way to prevent sport injury is to not play at all - primary: efforts are extended to entire population of interest - secondary: efforts targeted for individuals deemed at elevated risk

sport culture

- the climate that surrounds sport - ex. toughness, obedience, masculinity

Personality traits: Locus of control

- the degree of control people perceive themselves having over events that occur in their lives - internal: lower risk - external: higher risk

Sport sociocultural

- the environment that surround sport and drive the way individuals act and relate to one another - influence how athletes respond to injury

Prevention considerations

- time - education - money - motivation

Attention and concentration control

- training the brain to bring attention back (after wondering) to a word, breathing, or activity - attentional cues and triggers

General sport norms

- unwritten rules of all sports - ex. smacking butt to congratulate

Specific sport norms

- unwritten rules of specific norms - ex. running out the clock in basketball

self talk

- what athletes say to themselves outlaid or internally and privately - positive self talk: internal and external statements to self - positive affirmations: statements that are positive and motivational in nature

Expressive writing

- write for 15-30 minutes over cause of 3 to 5 days - mixed results on effectiveness

Implementing psychosocial strategies

1. identify current stressors 2. pair stressors with athletes needs/resources 3. teach new coping strategies as needed 4. set a plan for use of strategies including when, where, how 5. evaluate use of strategy to minimize stressor

Competitive trait anxiety

tendency to become anxious in competitive situations

Personality Traits: Hardiness

tendency to respond to challenging situations with resilience