Abstract:

Social support is an important influence that has effects on athletes recovering from injury. Social support can be defined as “an exchange of resources between two individuals perceived by the provider or the recipient to be intended to enhance the well-being of the recipient” (as cited in Shumaker & Brownell, 1984, p. 11). Through process of rehabilitation and recovery, athletes have many providers of such support, these can include trainers, coaches, teammates, medical practitioners and significant others (Corbillion et al., 2008, p. 94). Reviewing current research on social support has shown that there are different types of support athletes receive by different providers, but due to the different data collecting styles comparing results is difficult.

Introduction:

Pain and injury is an inevitable part for most serious athletes. However, athletes respond to pain and injury differently. It has been argued that social support can be important in the experience of pain and injury (Nixon, 1994). It has been suggested that social support, from teammates, coaches and athletic trainers, helps athletes cope with injuries and has been said to be a factor in the rehabilitation process. Social support helps athletes gain the confidence they need to either push through the injury, get better quickly and adhering to rehabilitation exercises.  Although there is little research done on the subject, there have been six studies done in recent years. Four of these studies have an overall look at the social support available to injured athletes. The other two studies are based on a particular type of injury and the social support surrounding those who have had surgery because of this injury. The following is a literature review of these six studies in observing the effects of social support on athletes as they endure the rehabilitation process. 

Literature Review:

Of the six studies, four of the studies were either questionnaire or survey based and three of them dealing with university students. Nixon’s study happened in the spring of 1992 at a medium sized (11,500 students) southern university. This university competes at the NCAA Division I level (Nixon, 1994). Nixon’s study was questionnaire based, but the questionnaire used was not indicated. Those who responded to the questionnaire were 195 student-athletes who, at the time, were either competing or had competed in the college’s athletics. Out of this 195 there was a subsample of 156 student-athletes who have experienced significant injuries (Nixon, 1994). In this study, a significant injury is classified if the individual has to miss five consecutive days or miss a game or event due to the injury.

Corbillon, Crossman and Jamieson’s (2008) study also used questionnaires in their study of 72 student-athletes that all played an intercollegiate sport at a Canadian University in Northwestern, Ontario.  These questionnaires were a modified version of the Social Support Survey (SSS) to evaluate the social support the athletes received while recovering from an athletic injury. This survey evaluates eight different areas of social support; listening support, task appreciation support, task challenge support, emotional support, reality confirmation support, tangible support, and personal assistance (Corbillon, 2008).

Bone and Fry’s (2008) study consisted of 57 Division 1 athletes from a mid-southern university in the United States. This university has three ATCs and two ATC graduate assistants. To qualify for their study, participants needed to have been injured in the previous twelve months and had to have missed one week of training due to the injury. Thirty-two percent of the athletes were currently injured at the time of the study and sixty percent were injured during their competitive season (Bone & Fry, 2008).The participants were split into two groups. One group took the Social Support Survey (SSS) and the other group took the Sports Injury Rehabilitation Beliefs survey.

Mitchell, Neil, Wadey and Hanton’s (2007) study involved 207 athletes who completed the Social Support Inventory for Injured Athletes (SSIIA). This survey helped to tell which aspects of social support were available to the individual.

These studies were all well organized with criteria for choosing participants and defining injury for the use in their studies. The studies indicated where these athletes were from, except for the Mitchell et al. study. Except for the study done by Mitchell et al., these studies are each only based on a particular university in different parts of North America.  Because of so few studies done it will be difficult to generalize the results for North America as a whole. Also these results cannot be generalized to high school, middle school or elementary students because there is not yet research in these injured athletes. However, there are athletes from multiple sports involved in these studies, but not all sports are indicated.  The questionnaires or surveys involved in the studies were different except for the use of SSS in two of the studies. This creates a problem in directly comparing results.

The remaining two studies were based on athletes with ACL injuries and who have undergone surgery for this injury. Olofsson, Fjellman-Wiklund and Soderman (2010) conducted a study on four men and three women who all had ACL reconstructive surgery. Those chosen for the study had to have had the surgery, were over 18 and could communicate in Swedish.  Six of the seven participants were injured during exercise or playing a sport and the other was injured during an “ordinary everyday situation” (Olofsson et al., 2010, p. 51).  This study was done through various interviews that took place between 10 months and 31 months after surgery (Olofsson et al., 2010).

Ford and Gordan’s (1999) study included two men and two women participants. These participants are athletes who participate in either a national or regional sport for the continent of Australia. The study was bases on semi-structured interviews that consisted of both open-ended and closed questions.  These questions were designed to obtain an understanding of social support in coping with athletic-injury (Ford & Gordon, 1999). The two women were interviewed prior to their surgeries.  All four participants were interviewed after their surgery. They were interviewed four times in four months during their recovery.

These two studies help give different views on injury compared to the other four located in North America. Ford and Gordan’s (1999) study was done in Australia and the Olofsson et al. (2010) study included those who spoke Swedish (country was not indicated in the literature). The researchers in both studies also used interviews instead of surveys. Like surveys, interviews are based on memory recall, but interviews include can include probe questions and participant reactions. Interviews also can give a lot more information.  However these studies can be limiting because of the small number of participants and the fact that only one type of injury is being evaluated.

The Results:

The results of Nixon’s study were based on the 156 student-athletes who were classified as having been significantly injured.  Of these student-athletes 93.6% said they played hurt with their significant injury and 45.5% stated they had lingering effects due to playing hurt with the injury (Nixon,, 1994). At the time the survey was taken 29.5% reported currently playing with an injury (Nixon, 1994). Of these athletes who reported playing hurt, 49.4% felt pressed by the coach to play, 41% by their teammates and 17.3% by the trainers (Nixon, 1994)

However, it was also reported that 58.1% of the athletes felt sympathy due to their injury from their coaches, 68.1% from their teammates and 55.8% from the trainers (Nixon, 1994). Upon getting injured, the student –athletes in this study turned to others for support and sympathy to deal with their injury. The questionnaire results reported that 55.8% turned to their coaches, 61.5% turned to their teammates and 75% turned to the trainers (Nixon, 1994).  This indicates contradicting data. Almost half of the athletes who reported playing hurt felt pressed by the coaches to play, but over half felt sympathy. What classifies as “sympathy”? This is not defined in Nixon’s report. Also the report lacks to indicate if the athletes filling out the survey could say they felt pressure from more than one source or if they picked the source which showed the most pressure.

These results break down what influence social support has in the decision of the athlete to play hurt or not. But the report lacks the analysis of the athlete. Would the athlete play hurt with or without pressure from their social support?

Corbillon, Crossman Jamieson (2008) and Bone and Fry (2008) used the SSS as their data collecting tool. The Corbillion et al. study results indicated that the most available support for the 72 athletes was listening support from coaches and teammates, whereas the least available was tangible support.  The athletes expressed that they were satisfied with the amount of listening and task challenge support they received from their coaches and teammates. They were least satisfied with tangible support and reality confirmation support and emotional support (from teammates only) (Corbillon, 2008). Coaches contributed the most to task appreciation and task challenge support for the injured athletes, whereas teammates contributed the most to listening support and task appreciation support.

Through the analysis of the two surveys in the Bone and Fry (2008) study, it became apparent that listening support was the most important for the athletes. The results did not show that the support from ATCs helped with rehabilitation for the athletes as a whole, but when analyzing only those athletes with severe injuries, support from ATCs was apparent in their rehabilitation. Bone and Fry believe that the reason for this is “that for athletes with mild or moderate injuries, their beliefs in their rehabilitation programs as likely to be high regardless of the level of social support they may receive from their ATC” (Bone & Fry, 2008, p. 163). The athletes believed that they had more support when the ATC gave them some type of tangible assistance such as a brace.

These two studies used the same type of surveys. Therefore it is easier to compare directly than some of the other studies. Both studies found that listening support was the most available and apparent to the athletes from their coaches, teammates and ATCs. In the Corbillion et al. study the availability tangible support was the least satisfying for the athletes but in the Bone and Fry study, tangible support from ATCs gave the athletes what was viewed as more support.  These results are, however, highly subjective because the athletes who filled out the survey are using recall of memory. Therefore, they may remember times of the coach listening to their frustrations about their injury, but do not remember when a teammate or coach gave them personal assistance.

The results from Olofsson, Fjellman-Wiklund and Soderman (2010) and Ford and Gordan’s (1999) studies give more light on how social support can help athletes. In the Olofsson et al. (2010) study the interviews indicated that the participants sought out family/relatives, friends, others with similar injuries, physicians and physiotherapists to help them cope (Olofsson et al., 2010). Another study the authors refer to is the Johnston & Carroll (1998) study. The focus of this study was to measure the different needs for support that those in rehabilitation need. The results of this study showed that coping strategies effect people differently and those who had ACL surgery need more social support than other types of injuries resulting in surgery.

The Ford and Gordan (1999) study results showed that the participants were included into their team or club after their surgery. This helped to develop a “sense of involvement” for these participants. It was also found that “social support can have a positive outcome on health habits, since individuals afforded appropriate types of support are more likely to practice effective health behaviors and be more compliant with medical regimens” (Ford & Gordan, 1999, p. 253). The athletes also expressed that their relationships with their friends, teammates and medical personnel was strengthened.

Unlike the other studies, these athletes cannot participate in their sports at the moment. They are recovering from ACL surgeries and need the social support to cope. These studies help readers to understand what the participants have gone through and who they rely on to help them recover. These two studies were different from the first four in that they interviewed their participants multiple times in different parts of their recovery process unlike the other studies which only had a one-time measure. Therefore, athletes were at different points in the rehabilitation process and their perception on their social support would have varied.

Some of the studies also looked at different aspects of social support, such as effects based on gender, holding a scholarship, non-starters, etc. In Nixon’s study an important result of this study is that there were no effects seen in the results that were based on gender or holding a scholarship. In Corbillion’s et al. study only one area of social support showed gender differences. Females received more emotional support compared to males in the study. This study’s results also showed that those who were non-starters, those with more experience, and those who have had more injuries received less social support when recovering from an injury than starters, those with less experience and less sustained injuries.

Mitchell, Neil, Wadey and Hanton’s (2007) study approached the aspect of social support on the rehabilitation process a little differently. Their main premise was studying gender difference when it came to social support and injury.  Results of this study indicated that female athletes receive more support exchanges and also perceive more support available to them than male athletes. The results showed that females received more emotional and esteem support, but there was no gender difference when it came to tangible and information support.

These studies showed mixed results when it came to gender. There seemed to be only certain aspects of support that differed between males and females. More research should be done on gender and social support before attributing an actual differenced based on a person being a male or female. These studies also limit gender to two different genders, and do not recognize those who do not associate themselves with either gender.  There were no effects of scholarship shown in any of the studies.

Unlike the other studies, Nixon’s study also incorporated another questionnaire but this was directed towards the coaches. The questionnaire had some compelling results worth noting, “First, coaches overwhelmingly denied that the physical welfare of the athletes were ignored” (Nixon, 1994, p. 350). Also the results stated, “[Coaches] disagreed that athletes should hide pain and injuries or feel guilty about them” and “disagreed that athletes should risk long-term disability consequences of playing hurt” (Nixon, 1994,  p. 350). However, a large percentage of the coaches agreed that “injury and pain should be expected by athletes, that athletes were likely to do everything possible to play [and] that they respected athletes who played hurt and tried comebacks from serious injuries” (Nixon, 1994,  p. 351).This creates confusion among athletes in deciphering what the coach would have them do.

Something the studies failed to address was the other sources of social support that the athletes could have had, like family, friends, professors, religious leaders, etc. Therefore the power that social support can have over the rehabilitation process is still not fully understood. Yes, the research shows that the social support from teammates, coaches and trainers does have some effects on those who are dealing with pain and injury, but the research does not clarify to what extent these effects have. Also like Bone & Fry observed, social support from ATCs had more influence on those with more serious injuries. But definitions of a “serious” injury can vary among different individuals. None of the other studies differentiated between those with such “serious” injuries and those with mild injuries

After reviewing all the results of the research, there is little evidence proving that social support has a major effect on the injured athlete. A way in which researchers might be able to understand how important social support really is in the recovery process would be to try and limit the support and see how well the athlete copes. The lack of support will show how influential others can be. This however is almost impossible to do; therefore the current research is doing well in trying to understand the types and role of social support.

Research has been done and still is being done on the effects of social support in dealing with pain and injury in the recovery process. Aspects like population from which participants are from, number of participants, severity of injuries, different times within the recovery process, people involved in social support and etc. should all be considered to help us more fully understand what effects social support has on injured athletes in the rehabilitation stage.

References:

Bone, J., & Fry, M. (2006). The influence of injured athletes' perceptions of social support from ATC son their beliefs about rehabilitation. Journal of Sport Rehabilitation, 15(2), 156-167. Retrieved from Academic Search Premier database.

Corbillon, F., Crossman, J., & Jamieson, J. (2008). Injured athletes' perceptions of the social support provided by their coaches and teammates during rehabilitation. Journal of Sport Behavior, 31(2), 93-107. Retrieved from Academic Search Premier database.

Ford, I., & Gordon, S. (1999). Coping with sport injury: Resource loss and the role of social support. Journal of Personal & Interpersonal Loss, 4(3), 243. Retrieved from Academic Search Premier database.

Mitchell, I., Neil, R., Wadey, R., & Hanton, S. (2007). Gender differences in athletes' social support during injury rehabilitation. Journal of Sport & Exercise Psychology, 29S189-S190. Retrieved from Academic Search Premier database.

Nixon II, H. (1994). Social pressure, social support, and help seeking for pain and injuries in college sports networks. Journal of Sport & Social Issues, 18(4), 340-355. Retrieved from Academic Search Premier database.

Olofsson, L., Fjellman-Wiklund, A., & Söderman, K. (2010). From loss towards restoration: Experiences from anterior cruciate ligament injury. Advances in Physiotherapy, 12(1), 50-57. doi:10.3109/14038190903165120.

Shumaker, S.A., & Brownell, A. (1984). Toward a theory of social support: Closingconceptual gaps. Journal of Social Issues, 40, 11-36.