psychosocial antecedents to injury there are physical environmental and psychosocial factors that must be considered when evaluating injury and injury risk physical factors may include physiological and biomechanical factors and environmental factors include things like playing surfaces and protective gear psychosocial factors include the psychological and social factors related to injury and injury risk we will focus on the sources of stress and stress monitoring to evaluate the association between injury and injury risk strategies to reduce stress and ultimately risk factors for injury will be explored not all stress is negative we need some stress in our lives and it is important to remember that stress cannot be eliminated altogether from people's lives or athletic participation some stress is actually a good thing stress drives us to take action be motivated to achieve and to avoid procrastination we will use the term distress to identify stress that has a negative implication the stress response has sometimes been referred to as fight or flight response no matter the stressor the body reacts with a physiological response more recent research has suggested that all responses are interrelated including physiological cognitively emotionally and behaviorally when we are stressed we have physiological symptoms these physiological symptoms include things like increased heart rate increased respiration increased blood pressure increased inflammation immunosuppression decreased healing and impaired sleep cognitive examples of stress include increased worries intrusive thoughts or images and attention and focus difficulties some emotional responses to stress include frustration depressed mood and anxiousness behavioral outcomes related to stress include poor choices sleeping difficulties self-medication and Rehabilitation non-adherence this last one is very important to us as athletic trainers the effects of accumulated stressors can take a physiological toll on an athlete or a patient in many different ways performance impaired sleep decreased ability to heal and depression of the immune system are all concerns to keeping athletes and patients healthy when an individual experiences stress a reaction starts and the cerebral cortex portion of the brain the hypothalamus releases the adrenocorticotropic hormones following stress there is a release of cortisol due to the adrenocorticotopic hormones stimulating the adrenal cortex an increase in cortisol is linked to adverse health effects including chronic stress depression and a suppressed immune system by controlling the cortisol and stress response individuals may experience a decrease in pain and re-injury anxiety as well as an increase in healing physiological differences in hormone variability for female athletes may result in reportedly higher levels of stress therefore it is important that athletic trainers are sensitive to the needs of their female athletes and recognize these differences are not just emotional sometimes they are physiological in nature athletic trainers should be aware of how stress May influence their professional practice we are exposed to a variety of on-the-job stressors each and every day burnout is extremely common in athletic training and is associated with personal characteristics including emotional exhaustion depersonalization and a decreased personal accomplishment level it is important to understand that athletic trainers need to pay attention to their own physical and mental health needs so that they can deliver the best care possible to the populations they serve we are a service-based profession and we are often better at taking care of others than ourselves however it is hard to take care of others if we are not taking care of ourselves first athletic trainers need to be able to identify sources of stress and then learn to use coping skills to handle common stressors by practicing self-care we can model effective behavior for our athlete or patient population as well the stress response the cognitive appraisal of a stressful event determines how the stressors affect the individual's attentional Focus emotional stability and General Health when an individual is exposed to a stressor they have two choices they can respond to solve the stressor or not respond and ignore the stressor when an individual ignores the stressor worry often results worry often causes renumination of negative thoughts and likely will increase negative self-talk in an individual if an individual participates in sports during a time of worry the risk of injury increases because of attentional focus being burdened by worry and negative thoughts associated with the stressor the stress injury relationship research suggests individuals with higher levels of psychological stress may have as much as two to five times greater risk of injury than those with lower levels of stress the stress injury model was developed by researchers Mark Anderson and John Williams in 1988. this has been the classic example demonstrating how stress influences athletic injury the psychosocial antecedents influence how an individual interprets stress cognitive appraisal influences the stress response and the stress response then influences the injury risk there are three major categories of antecedents that influence the interpretation of stressors and the stress response these are personality history of stressors and coping resources personality includes the constructs of hardiness optimism and pessimism personality is often considered a stable trait and therefore most individuals do not view this as a modifiable factor for most people an individual's response to stress is heavily influenced by previous stressors overall life stress and daily stressors can affect the response of an individual to a stressful situation previous injury history would also be included in the individual's history of previous stressors coping resources are tools that an individual can use to handle stressful situations such as social support and stress management techniques some examples of stressful situations that our patients or athletes may find themselves in such as a playoff game competing for a starting role having a family member attend in the audience having intense practice schedules having scouts or Recruiters in the audience or many other examples these stressful situations are somewhat personal in nature the cognitive appraisal of a situation when an individual encounters a stressful situation they cognitively appraise whether they perceive it as a threat or as a challenge often referred to as a primary appraisal if the individual assesses the situation as a threat then they next evaluate whether they have an adequate resource to deal with the situation this is also referred to as a secondary appraisal if the individual perceives the situation as a threat and does not have the tools to handle the situation then they will have an increased stress response leading to increased risk of injury in contrast an individual with high trait anxiety may experience significant life stress and many daily hassles and have inadequate coping resources in a case such as this the person may have a great stress response but still be at an increased risk of injury an athletic trainer is in a prime position to help athletes to manage their stress as we are frequently in daily contact with these individuals and we often get to know our patients very well providing social support and opportunities to identify stressors and then applying appropriate coping responses we can help our athletes to manage their stressful situations in a more positive manner and hopefully decrease the risk of injury the stress response and injury risk some examples increased muscle tension which is a physiological response results in decreased range of motion an incidence of muscle strain attentional difficulties which is a cognitive response may result in a limited ability to pay attention to what is happening on the field of play or even other individuals within your environment decreased peripheral vision is a physiological response and may result in a limited ability to see other players or objects in our periphery thus increasing our risk of injury reducing injury risk the psychosocial strategy intervention model the psychosocial strategy intervention model serves as a visual representation of where athletic trainers can intervene with psychosocial strategies related to stress stress contributes to a variety of physical outcomes including increased tightness spasm and guarding of the muscles these conditions contribute to other outcomes including decreased range of motion and increased pain both of which may cause the rehabilitation process to be delayed athletic trainers should recognize the interplay between spasms and pain as this is the pain spasm cycle and therapeutic intervention so how can athletic trainers intervene to reduce injury risk first we can help our athletes to monitor their levels of stress to do this we can use different tools including the life events survey for Collegiate athletes the perceived stress scale the stresso meter or even the stress symptom checklist we can also assess our athlete or patient's coping skills with the cope assessment cope assessment we can also assess their psychosocial strategies to assess their effectiveness some psychosocial strategies we can understand the relationship of stress with personality in an individual's coping resources to help an athletic trainer to incorporate psychosocial strategies to reduce injury risk for our patients athletic trainers frequently help athletes to try to prevent injuries by discussing and educating them about nutrition hydration appropriate training techniques providing prehabilitation and screening for potential injury risks providing preventative taping and bracing and by monitoring playing surface and Equipment conditions we can also address some antecedents that contribute to injury such as stress and helping our patients to develop appropriate coping strategies implementing some coping strategies to reduce stress common techniques include relaxation positive self-talk and thought stoppage social support and positive affirmations can also help support an individual social support may include family friends significant others coaches teammates counselors and even athletic trainers athletic trainers hopefully provide social support including a positive Rehabilitation environment and have fostered positive relationships in which patients trust in the care that they will receive if they are injured positive affirmations can help to build the patient's confidence in their ability to perform one Stress Management technique that we can use is relaxation relaxation techniques can either be cognitive or somatic in nature cognitive relaxation includes guided approaches that may include imagery scripts that lead the participant through specific situations to induce relaxation somatic relaxation focuses on the physiological techniques such as breathing or muscle tension to promote relaxation positive self-talk can help to increase relaxation by combating negative stress producing thoughts dot stopping encourages individuals to identify and stop any negative thoughts and change them into positive self-reducing cognitions when patients are focused and preoccupied with negative thoughts they can become distracted which then results in increased risk of injury our Stress Management toolkit athletic trainers can employ some Stress Management Tools in their professional practice the stress symptom checklist increases awareness about levels and sources of stress athletic trainers can employ this checklist as a screening tool with otherwise healthy or injured athletes to identify sources of stress once an individual is identified as having high levels of stress then employing a psychosocial strategy can help to address that stress and provide tools to help our patients to manage their stress levels relaxation podcasts both with or without visual cues can help positive self-talk podcasts can help to identify stressors and negative self-talk simple breathing exercise podcasts are also available as our sleep induction podcasts