The injury rates in college athletes is high, with over half experiencing an injury in a single season. Psychological risk factors like stress have been linked to increased injury risk by causing muscle tension. This study examined whether self-reported stress and maladaptive coping predicted musculoskeletal injuries (MSI) in 245 college athletes. Questionnaires assessed stress and coping, while injuries were obtained from medical records. Logistic regression found no significant predictors of MSI, although high athletic stress trended toward increasing MSI risk. While psychological factors did not independently predict MSI in this study, injury prevention remains important given long-term health impacts of injuries sustained in college sports.

1. Measures
Methods
Ribs
2.4%
Fingers
2.4%
Hip
2.4%
Ankle
16.1%
Foot
2.4%
Knee
13.7%
Thigh
19.4%
Lower Leg
3.2%
Shoulder
17.7%
Cervical
Spine
7.3%
Thoracic
Spine
7.3%
Lumbar
Spine
3.2%
Nose
0.8%
Lower Back
1.6%
Elbow
0.8%
Wrist
2.4%
Upper Arm
0.8%
Figure 1.
Distribution of total MSI by body region
Methods (continued)
Introduction & Background
Abstract
Impact of Self-Reported Stress on Musculoskeletal Injuries
Brandi Krieg, Emily Kaier MA, Lisa D. Cromer PhD, Joanne L. Davis PhD, & Kathleen Strunk APRN, CNS
Research Aim
A special thanks to our athletes for taking time to participate in this study. Also,
thank you to Dr. Greg Gardner, Dr. Derrick Gragg, Dave Polanski and the athletic
trainers and support staff. We would also like to thank all the SPARTA lab
undergraduate research assistants.
Results
Discussion
References
Table 1.
Binary Logistic Regression Predicting Likelihood of MSI
To cite this poster use the following citation:
Krieg, B., Kaier, E., Cromer, L. D., Davis, J. L., & Strunk, K (2015, April). Impact of
Self-Reported Stress on Musculoskeletal Injuries. Poster presented at the meeting
of The 18th Annual Student Research Colloquium, Tulsa, OK.
• Categorizing of the medical conditions and injuries revealed that 29% (n = 72) of the sample
experienced a total of 126 MSI. See Figure 1.
• There were 20 different diagnoses of injuries categorized as MSI. See Table 2.
• A logistic regression revealed no significant factors for increased risk of MSI.
• Although it was not statistically significant, the most likely predictor of an athlete incurring a MSI
was high levels of stress associated with the CSALSS (p= .076). See Table 1.
• The purpose of this study was to investigate whether or not psychological factors including self-
reported stress and maladaptive coping styles would independently predict the likelihood that an
athlete would sustain a MSI.
• We predict that stress and maladaptive coping behavior would independently be able to predict the
occurrence of MSI.
These findings suggest that stress and coping may not independently predict injury specificity among
college athletes. This may be due to the fact that athletes are at a high risk of many kinds of injuries,
especially MSI, due to playing in an injury-prone environment, i.e., acute trauma in contact sports and
chronic overuse injuries in noncontact sports. Furthermore, athletes at the collegiate level tend to play
through a lot of injuries or come back to full participation without complete healing; this may be a
greater risk factor than fatigue, stress, and coping in predicting injury. Previous injury, especially when
tissue healing is incomplete, is one of the major risk factors for injury (Whiting & Zernicke, 2008). In
future research, we will be controlling for injury chronicity. In addition, the method used to collect injury
data could not account for transient injuries or injuries that do not involve time loss or are not reported
due to the ability to train through these injuries (Hodgson, Gissane, Gabbett, & King, 2007).
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Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A Global Measure of Perceived Stress. Journal of Health
& Social Behavior, 24(4), 385-396.
Corrigan, A. B., & Maitland, G. D. (1994). Musculoskeletal and Sports Injuries: Butterworth-Heinemann.
Delforge, G. (2002). Musculoskeletal Trauma: Implications for Sports Injury Management: Human Kinetics.
Hodgson, L., Gissane, C., Gabbett, T. J., & King, D. A. (2007). For debate: consensus injury definitions in
team sports should focus on encompassing all injuries. Clinical Journal of Sport Medicine, 17(3), 188-
191.
Johnson, U., Tranaeus, U., & Ivarsson, A. (2014). Current Status and Future Challenges in Psychological
Research of Sport Injury Prediction and Prevention. Revista de psicología de deporte, 23(2), 401-409.
Lu, F. J.-H., Hsu, Y.-W., Chan, Y.-S., Cheen, J.-R., & Kao, K.-T. (2012). Assessing College Student-Athletes' Life
Stress: Initial Measurement Development and Validation. Measurement in Physical Education and
Exercise Science, 16(4), 254-267.
Nideffer, R. (1983). The injured athlete: psychological factors in treatment. The Orthopedic clinics of North
America, 14(2), 373-385.
Simon, J. E., & Docherty, C. L. (2013). Current health-related quality of life is lower in former Division I
collegiate athletes than in non–collegiate athletes. The American journal of sports medicine,
0363546513510393.
TITAN. (2012). Student Health, Athletic Performance, and Education Study: Annual Report. Unpublished
Manuscript. The University of Tulsa.
Whiting, W. C., & Zernicke, R. F. (2008). Biomechanics of musculoskeletal injury (2nd ed.): Human Kinetics.
• The injury rates in college athletes is high. One study found that in a single season, 57% of athletes at
an NCAA Division 1 school experienced at least one injury, according to training room and medical
records (The University of Tulsa Institute for Trauma, Adversity, and Injustice, 2012).
• Long-term effects of injuries are serious. Former college athletes have significantly lower health-
related post-collegiate quality of life, and this is in part due to the enduring impact of injuries
sustained in college sports (Simon & Docherty, 2013).
• Psychological risk factors have been found to increase injury risk. These risk factors include: high
stress, inattention, fatigue, depression, and poor coping resources (Whiting & Zernicke, 2008).
• Psychological stress leads to muscle tension (Anderson & Williams, 1988; Nideffer, 1983).
Theoretically, stress-related muscle tension could lead to a greater likelihood that a strain, sprain, or
other musculoskeletal injury (MSI) will occur (Anderson & Williams, 1988).
• MSI are defined in the literature as any injury that causes damage and/or dysfunction of the
musculoskeletal system and can affect muscles, tendons, ligaments, nerves, and bones (Corrigan &
Maitland, 1994; Delforge, 2002; Whiting & Zernicke, 2008).
• Understanding and managing precursors and vulnerabilities to athletic injury could help reduce injury
rates in college athletes. In the current study, we sought to examine stresses related to being a
college athlete and how well athletes managed their stress as it relates these to injury records. Our
hope is that if a relationship exists, that we could use this information to motivate athletes to manage
and reduce stress in healthy ways.
• To our knowledge, investigation of psychological stress factors as predictors of injury has not been
applied to specificity of injuries (Johnson, Tranaeus, & Ivarsson, 2014).
• Perceived Stress Scale (PSS) is a 10-item stress scale (Cohen, Kamarck, & Mermelstein, 1983) that
was used to assess life stress non-specific to athletics. For example, “In the last month, how often
have you been upset because of something that happened unexpectedly?” Responses to each
question are provided on a 0 (never) to 4 (very often) Likert scale. Responses are summed and total
scores can range from 0-40 where higher scores indicate more stress.
Coping
• The 28-item Brief COPE (Carver, 1997) was used to assess adaptive versus maladaptive coping
styles. The 14 subscales that make up the styles include eight adaptive styles (planning, positive
reframing, acceptance, active coping, humor, religion, using emotional support, using instrumental
support) and six maladaptive styles (self-distraction, denial, substance use, behavioral
disengagement, venting, and self-blame). An example of maladaptive coping questions include:
“I’ve been saying to myself ‘this isn’t real’” and “I’ve been giving up trying to deal with it.”
Responses to each question are ranked on a Likert scale of 1 (I haven’t been doing this at all) to 4 (I
have been doing this a lot). Scores are summed by each category and higher scores indicate more
use of the specific coping behavior(s). For the purposes of this study, we were only interested in
the overall maladaptive coping style as a predictor of MSI.
Musculoskeletal Injury (MSI)
• Injuries were coded to be either MSI or non-MSI. Injuries considered to be musculoskeletal in
nature were defined as damage to the muscles, nerves, tendons, joints, cartilage, or skeletal
system resulting in time loss from participation and/or treatment sought out and treated through
the athletic training department. All injury coding was verified by an athletic training staff
member. Eleven athletes were excluded because the injuries that they incurred were either not
MSI or could not be determined as MSI or another form of injury.
Evidence suggests that as many as 57% of athletes will experience an injury within an athletic season.
Furthermore, recent evidence has shown that former college athletes have significantly lower health-
related quality of life long after the competition years are over, and that this is influenced by the
enduring impact of injuries that occurred while playing college sports. Injury prevention, therefore, is
a worthwhile pursuit. Although most research is dedicated to the physiological (e.g., prior injury,
health status) and environmental (e.g., weather, sport type) risk factors of injury, evidence suggests a
potential relationship exists between psychological stress and athletic injuries. Psychological stress
could lead to an increase in generalized muscle tension which in turn may lead to greater likelihood of
a strain, sprain, or other musculoskeletal injury (MSI). The current study examined psychological risk
factors for sport injury incidence. Specifically, we investigated whether self-reported stress and
maladaptive coping with stress predicted MSI occurrence. As part of a longitudinal study examining
the connections between stress and health, athletes (N = 245) completed questionnaires assessing
current perceived stress, athletic stress, and maladaptive coping (e.g., drinking). Objective injury data
were collected from electronic medical records and revealed that 29% (n = 72) of the sample
experienced a MSI. A logistic regression revealed no increase in risk of MSI; however, a trend emerged
for high levels of athletic stress increasing risk for MSI (p = .076). The implications of these findings
suggest that the psychological risk factors do not independently predict MSI for college athletes.
• The sample (N=245) consisted of male and female collegiate athletes of a Division I university
participating in a range of both contact (e.g. football, basketball) and noncontact (e.g. volleyball, cross
country) sports.
• As part of a longitudinal study examining the connections between stress and health, athletes
completed questionnaires assessing current perceived stress, athletic stress, and maladaptive coping.
Athletes were recruited before and after practices. A researcher explained the nature of the study,
risks and benefits. Athletes could then voluntarily participate in the study by completing a consent
form and the questionnaires.
• Objective injury data (with consent) were collected from electronic medical records maintained by the
athletic training staff of the university.
S.E. Wald Sig.
Odds
Ratio
95% C.I. for
Odds Ratio
Lower Upper
CSALSS .010 3.159 .076 1.017 .998 1.057
PSS .029 .004 .952 .998 .943 1.057
COPE (maladaptive) .035 1.526 .217 1.044 .975 1.117
Table 2.
Distribution of total MSI specified by injury diagnosis
Athletic Stress
• The College Student Athlete’s Life Stress Scale (CSALSS) is a 24-item scale that includes a global score
comprised of 8 subcategories of stress including sport injury, performance demand, training
adaptations, coaching relationships, interpersonal relationships, romantic relationships, family
relationships, and academic requirements (Lu, Hsu, Chan, Cheen, & Kao, 2012). A sample
performance demand item is: “I worry about my unstable performance.” A sample injury item is: “I
worry about frequently being injured.” Responses to each question are provided on a 0 (never) to 5
(always) Likert scale; higher scores indicate more stress.
Diagnosis Percent of All MSI
Strain 26.2%
Sprain 25.4%
Contusion 11.9%
Tendonitis 8.7%
Spasm(s) 7.9%
Brachial Plexus Stinger 5.6%
Glenoid Labrum Tear (Non-SLAP) 2.4%
Dislocation 1.6%
Fracture 1.6%
The following occurred in less than 1% of total diagnoses: bursitis, impingement, inflammation
(lower extremity), labral tear, multidirectional instability, non-specific cartilage tear, sacroiliac
dysfunction, scaplothoracic dysfunction, scoliosis, shin splints, and spinal stenosis.