Social support and sport injury recovery : An overview of empirical findings and practical implications

Epidemiologically-based evidence has demonstrated that a substantial number of athletes and exercisers are injured each year, which can result in physical disability as well as other negative physical, social and psychological consequences. Accumulated research has indicated that the prevalence of sport and physical activity-related injuries varies based on gender, age group, type of sport, level of participation, and role on the team, among other considerations. Although physical causes are the primary contributors to injury, a considerable number of studies have suggested that psychological and social factors also have importance in injury prevention and rehabilitation. Among the psychosocial factors investigated, social support has emerged as a significant buffering and coping resource in the recovery process from athletic injuries. However, research has also indicated that sources of social support tend to be less frequently available to athletes during some stages of rehabilitation and do not necessarily meet the athletes’ expectations and needs. Moreover, some studies have suggested that social support may have detrimental effects under certain circumstances. As such, coaches, athletic trainers and health care professionals should be aware of these complex forms of influence and develop and implement injury rehabilitation processes that are based on a holistic approach in order to promote the athletes’ recovery and well-being. first dimension refers to structural aspects and reflects “who” is able to provide social support. This includes the network of significant others, including family, friends, teammates and coaches. The second dimension pertains to functional characteristics of social support, in this case “how” social support is experienced through an exchange of resources and includes emotional, esteem, tangible, network and informational forms of social support. The third dimension represents a perceptual feature and refers to individuals’ appraisals of the available amount and quality of social support sources (Bianco and Eklund, 2001; Holt and Hoar, 2006). During rehabilitation, the athlete’s social support network should consist of the sport (coaches and teammates) and the medical team, alongside family and friends. However, research findings suggest that athletes report variable satisfaction levels with social support across the recovery phases and athletes frequently report that social support is limited from coaches, sports medicine professionals and teammates (Clement and Shannon, 2011; Corbillon, Crossman and Jamieson, 2008; Johnston and Carroll, 2000; Robbins and Rosenfeld, 2001; Udry, Gould, Bridges and Tuffey, 1997). The purpose of this paper is to review the research on social support forms of influence on recovery from sport injury and to discuss implications for practice in order to help coaches, athletic trainers and health care professionals facilitate the athlete’s recovery. This review is not exhaustive, but highlights three domains that emerge from the literature: i) the needs and patterns of social support preferred by injured athletes, ii) their perceptions and satisfaction with social support sources and processes, and iii) the psychological process that affects the athlete’s return to sport competition following injury. Social support and sport injury recovery The injured athlete’s needs and patterns of social support Sport injuries represent a significant form of stress for athletes, disrupt their training and competition and can lead to feelings of separation and isolation from their teammates and coaches (American College of Sports Medicine [ACSM] et al., 2006; Johnston and Carroll, 1998). Injured athletes usually experience negative emotions, including anger, sadness, tension, confusion, hostility, fear, irritability and anxiety and commonly develop negative appraisals regarding their return to sport participation (ACSM et al., 2006; Bianco, 2001; Podlog and Eklund, 2007; Tracey, 2003). However, research has also indicated that the recovery process of injured athletes is highly variable within and across individuals (ACSM et al., 2006; Tracey, 2003), which may reflect the characteristics of the injury (including type and severity), differential access to medical professionals or resources, and differential patterns of interpretation regarding the severity and control over the injury and accessibility to emotional support. Empirical evidence has demonstrated that social support effects are more beneficial when the provided support is consistent with the needs of the injured athletes (Bianco and Eklund, 2001; Robbins and Rosenfeld, 2001). However, the type and amount of support needed may vary depending on personal, situational and temporal characteristics (Robbins and Rosenfeld, 2001; Wiese-Bjornstal, 2010; Yang et al., 2010). Johnston and Carroll (1998) found that different forms of social support are preferred by athletes at distinct phases of the recovery period. Specifically, injured athletes customarily reported stronger needs for emotional support at the beginning of the rehabilitation process whereas needs for informational support from the medical team and sport-related help from coaches was more important at the final phases of the recovery process. Additional research has found that athletes would appreciate greater social support from the coaching staff at all phase of the injury recovery process (Robbins and Rosenfeld, 2001). Injured athletes are not always active in seeking out the social support that they desire, although research on this topic is limited. Research indicates, in general, that the expression of the need for support is likely to be affected by gender, stigmatizing problems (i.e., the athlete’s own use of performance-enhancing drugs), psychological problems, and the intimacy and quality of relationships with possible social support providers (Taylor, 2011). As a consequence, this evidence supports the need to assess and identify athletes’ social support preferences and needs during the rehabilitation process, preferably through sportspecific instruments (Bianco and Eklund, 2001; Holt and Hoar, 2006). The injured athlete’s perceptions and satisfaction with social