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Chapter 13:  Recognizing Different Sports Injuries

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Introduction, acute (traumatic) injuries.

• CHRONIC OVERUSE INJURIES
• THE IMPORTANCE OF THE HEALING PROCESS FOLLOWING INJURY
• SOLUTIONS TO CRITICAL THINKING EXERCISES
• REVIEW QUESTIONS AND CLASS ACTIVITIES
• RECOMMENDED REFERENCES
• ANNOTATED BIBLIOGRAPHY
• Full Chapter
• Supplementary Content

©Courtesy Chris Bartlett, Central Davidson High School, Lexington, NC

When you finish this chapter you will be able to:

Differentiate between acute and chronic injury.

Briefly describe acute traumatic injuries, including fractures, dislocations and subluxations, contusions, ligament sprains, muscle strains, muscle soreness, and nerve injuries.

Talk about chronic overuse injuries, and differentiate tendinitis, tendinosis, tenosynovitis, bursitis, osteoarthritis, and myofascial trigger points.

Have at least some understanding of the three phases of the healing process.

N o matter how much attention is directed toward the general principles of injury prevention, the nature of physical activity dictates that sooner or later injury will occur. 48 Traditionally, the terms acute and chronic have been used to describe injuries. 46 Health care professionals have debated the usefulness of these terms in defining injury. The concern has been that at some point all injuries can be considered acute—in other words, every injury has a beginning point. At what point does an acute injury become a chronic injury? 46 Generally, the mechanism of injury (MOI) is either from trauma or from overuse. Trauma is defined as a physical injury or wound that is produced by an external or internal force. 7 Acute injuries, also referred to as macrotrauma , are caused by trauma. Chronic injuries, also called microtrauma , can result from overuse such as the injuries that occur with the repetitive dynamics of running, throwing, or jumping. 48 In this chapter we discuss the more common traumatic and overuse injuries that the coach or fitness professional is likely to see.

Acute injuries = Trauma

Chronic injuries = Overuse

The information in this chapter is not meant to encourage fitness professionals, coaches, or others interested in areas related to exercise and sports science to attempt to diagnose injuries that may occur. This should be left to health care professionals, who have considerably more training and expertise . However, being familiar with the various injuries described in this chapter can help in understanding the course of both immediate care and long-term injury management.

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Sports Injuries

Prevention, Diagnosis, Treatment and Rehabilitation

• Reference work
• © 2015
• Latest edition
• Mahmut Nedim Doral 0 ,
• Jon Karlsson 1

Department of Orthopaedics and Traumatology and Department of Sports Medicine, Hacettepe University, Istanbul, Turkey

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Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden

• Brings readers up-to-date on the diagnosis and treatment of sports injuries
• Pays detailed attention to biomechanics and injury prevention
• Examines pediatric sports injuries, extreme sports injuries and the role of physiotherapy
• Evaluates sports injuries of each part of musculoskeletal System
• Includes supplementary material: sn.pub/extras

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About this book

Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation covers the whole field of sports injuries and is an up-to-date guide for the diagnosis and treatment of the full range of sports injuries. The work pays detailed attention to biomechanics and injury prevention, examines the emerging treatment role of current strategies and evaluates sports injuries of each part of musculoskeletal system. In addition, pediatric sports injuries, extreme sports injuries, the role of physiotherapy, and future developments are extensively discussed. All those who are involved in the care of patients with sports injuries will find this textbook to be an invaluable, comprehensive, and up-to-date reference.

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Table of contents (266 entries)

Front matter, introduction, collaboration with international sports federations.

• Lars Engebretsen

Clinical Challenges and Ethical Issues in Orthopedic Sports Medicine: Perspective from an Orthopedic Surgeon

• Myles R. J. Coolican, Kah Weng Lai

Measuring In Vivo Joint Motion and Ligament Function: New Developments

• Savio L.-Y. Woo, Kathryn F. Farraro, Jonquil R. Flowers, Connie Chen

Study Design, Reviewing, and Writing in Orthopedics, Arthroscopy, and Sports Medicine

• Mustafa Karahan, Taner Güneş, Hakan Özsoy, Nikolaos K. Paschos, Anastasios D. Georgoulis

Studies on Orthopedic Sports Medicine: New Horizons

• Cuneyt Tamam, Gary G. Poehling

Surgery in Sports Traumatology: Research Pearls

• Andreas B. Imhoff

Shoulder Injuries

Accelerated rehabilitation of shoulder injuries in athletes.

• Knut Beitzel, Andreas B. Imhoff

Acute Posterior Dislocations and Posterior Fracture–Dislocations of the Shoulder

• George M. Kontakis, Ioannis M. Stavrakakis, Ioannis V. Sperelakis

Acromioclavicular Joint Injuries and Reconstruction

• Sepp Braun, Frank Martetschläger, Andreas B. Imhoff

Anatomy and Portals in Shoulder Arthroscopy

• Pedro Álvarez, M. R. Morro, J. R. Ballesteros, M. Llusa, Ramón Cugat

Arthroscopic Repair of Rotator Cuff Disorders

• Miguel Ángel Ruiz Ibán, Jorge Díaz Heredia, Miguel García Navlet, Ricardo Cuellar, Jose Luis Ávila, Eduardo Sanchez Sãnchez Alepuz et al.

Biceps Tendon Injuries

• Achilleas Boutsiadis, Filon Aganthagelidis, Dimitrios Karataglis, Pericles Papadopoulos

Bone Deficiencies in Shoulder Instability

• Wolfgang Nebelung, Frank Reichwein, Sven Nebelung

Fractures of the Clavicle

• Andreas Lenich, Andreas B. Imhoff

Arthroscopic Suture Bridge Rotator Cuff Repair: Current Concept of Transosseous Equivalent Technique

• Mehmet Demirhan, Ata Can Atalar, Aksel Seyahi, Lutfu Ozgur Koyuncu

Humeral Avulsion of Glenohumeral Ligament Lesion

• Frank Reichwein, Wolfgang Nebelung

Internal Impingement

• T. Sean Lynch, Michael A. Terry

Editors and Affiliations

Mahmut Nedim Doral

Jon Karlsson

About the editors

Prof. Mahmut Nedim Doral , M.D., is internationally recognized for his expertise in orthopedic sports medicine. He has authored over 150 scientific articles in peer-reviewed journals and over 15 book chapters in internationally published books; he also acts as a referee for four national and five international journals. His last book, Sports Injuries: Prevention, Diagnosis, Treatment and Rehabilitation, was published by Springer in 2011. For over 30 years, Dr. Doral’s major research interests have been in sports injuries and rehabilitation, arthroscopic and endoscopic surgery, basic science research in tendon injuries, and knee arthroplasty.

He is the chairman of the Department of Orthopaedics and Traumatology and the Department of Sports Medicine at the Hacettepe University Medical School.

Dr. Doral is the medical chief and health system organizer of Galatasaray Sports Club Youth Teams.

He has been the director of the Hacettepe University Sports Medicine Center since 1995. He has been board member (2003–2009), program committee member (2004–2012), and membership committee chairman (2007–2011) of the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS). He is also a past member of the scientific committee of European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA). He currently serves in the Executive Council of the Turkish National Olympic Committee; as executive committee chair of and

Dr. Doral served as president of the Turkish Society of Orthopaedics & Traumatology (TOTBID) (2010–2011). He was the past president of EFOST (2000–2003), Asia-Pacific Knee Society (APKS/Knee Section of APOA) (2004–2006), and the Turkish Society of Sports Traumatology, Arthroscopy and Knee Surgery

Prof. Jon Karlsson , M.D., Ph.D., was born in Iceland, where he graduated from the medical school in Reykjavik in 1978 and moved to Gothenburg, Sweden, in 1981. He defended his Ph.D. thesis on “Chronic Lateral Ankle Instability” at the Gothenburg University in 1989 and was appointed associate professor in 1990. He has been senior consultant in the Orthopaedic Department of the Sahlgrenska University Hospital since 1991 and clinical head during 1997–2001. Since 2001, Dr. Karlsson has been the academic head at the Sahlgrenska Academy. In that capacity, he mentored 32 Ph.D. theses and was appointed chief of the orthopedic research laboratory. He is author of more than300 pe

Since 2008, Dr. Karlsson has been editor-in-chief of KSSTA ( Knee Surgery, Sports Traumatology, Arthroscopy ), the official journal of the European Society of Sports Traumatology Knee Surgery and Arthroscopy (ESSKA). He has been program chairman of the biannual ESSKA congress for 2006, 2008, and 2010 and board member of the International Society of Arthroscopy, Knee Surgery & Orthopaedic Sports Medicine (ISAKOS) since 2005. He is currently secretary of the ISAKOS Executive Board.

Active in sports, Dr. Karlsson played basketball and is currently the caretaking physician of the Swedish soccer team IFK Gothenburg.

Bibliographic Information

Book Title : Sports Injuries

Book Subtitle : Prevention, Diagnosis, Treatment and Rehabilitation

Editors : Mahmut Nedim Doral, Jon Karlsson

DOI : https://doi.org/10.1007/978-3-642-36569-0

Publisher : Springer Berlin, Heidelberg

eBook Packages : Medicine , Reference Module Medicine

Copyright Information : Springer-Verlag Berlin Heidelberg 2015

Hardcover ISBN : 978-3-642-36568-3 Published: 14 July 2015

eBook ISBN : 978-3-642-36569-0 Published: 29 June 2015

Edition Number : 2

Number of Pages : CXI, 3330

Number of Illustrations : 838 b/w illustrations, 901 illustrations in colour

Topics : Sports Medicine , Orthopedics , Traumatic Surgery

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Preventing Sports Injuries

Exercise is good for the body and with the proper precautions, sports injuries can often be prevented. The quality of protective equipment - padding, helmets, shoes, mouth guards - has helped to improve safety in sports. But, you can still be susceptible to injury. Always contact your healthcare provider before starting any type of physical activity, especially vigorous types of exercises or sports.

10 Tips for Preventing Sports Injuries in Kids and Teens

Young athletes today push themselves harder than ever before, which means they’re at greater risk for sports-related injuries. Pediatric sports medicine expert R. Jay Lee provides these 10 injury prevention tips to help keep your young athlete safe.

Causes of sports injuries may include:

• Improper or poor training practices
• Wearing improper sporting gear
• Being in poor health condition
• Improper warm-up or stretching practices before a sporting event or exercise

Common sports injuries include:

• Sprains and strains
• Joint injuries (knee)
• Muscle injuries
• Dislocations
• Achilles tendon injuries
• Pain along the shin bone

Seminar Common Sports and Activity Related Injuries: What to Consider from Pain to Breaks

How can I prevent a sports injury?

The following are some basic steps to prevent a sports injury:

• Develop a fitness plan that includes cardiovascular exercise, strength training, and flexibility. This will help decrease your chance of injury.
• Alternate exercising different muscle groups and exercise every other day.
• Cooldown properly after exercise or sports. It should take 2 times as long as your warm-ups.
• Stay hydrated. Drink water to prevent dehydration, heat exhaustion, and heatstroke.
• Stretching exercises can improve the ability of muscles to contract and perform, reducing the risk of injury. Each stretch should start slowly until you reach a point of muscle tension. Stretching should not be painful. Aim to hold each stretch for up to 20 seconds.
• Use the right equipment or gear and wear shoes that provide support and that may correct certain foot problems that can lead to injury.
• Learn the right techniques to play your sport.
• Rest when tired, Avoid exercise when you are tired or in pain.
• Always take your time during strength training and go through the full range of motion with each repetition.
• If you do sustain a sports injury, make sure you participate in adequate rehabilitation before resuming strenuous activity.

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Common Types of Sports Injuries

Common sports injuries, when to see a healthcare provider.

Whether you're an elite athlete or a weekend warrior, if you play sports, you've probably faced an injury at some point. Common sports injuries include sprains, strains, swollen muscles, shin splints, rotator cuff injuries, knee injuries, fractures, and dislocations. 

Some sports problems are acute injuries , the result of a sudden event that causes very noticeable symptoms. Others are chronic, overuse conditions  that may have more subtle signs, either at first or consistently over time.

This article discusses common types of sports injuries and how they happen. It also covers how sports injuries are diagnosed and treated.

Watch Now: How to Treat a Sports Injury with R.I.C.E. Technique

Muscle sprains and strains, tears of the ligaments and tendons, dislocated joints, fractured bones, and head injuries are all common injuries when playing sports. 

While joints are most vulnerable to sports injuries, any body part can get hurt on the court or field. Here is a closer look at common injuries for different parts of the body.

The most common athletic head injury is a concussion —an injury to the brain caused by a blow to the head, a collision, or violent shaking. A concussion is considered a traumatic brain injury and impacts cognitive functioning. Repeated concussions can cause long-term problems with memory and executive function. If you suspect you or your loved one has a concussion, seek medical attention.   

The most common shoulder problem is either inflammation or tearing of the rotator cuff. However, other conditions, such as a frozen shoulder or labral tear , can mimic symptoms of an injured rotator cuff and need to be considered as possible diagnoses.  

Tendon problems around the elbow, including lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow), are the most common sports-related problems of the elbow joint.

Wrist fractures are among the most common broken bones in athletes. Landing from a fall onto an outstretched arm, for example, can lead to a wrist fracture that requires treatment.  

Jammed fingers can describe many types of sports-related finger injuries . Dislocation of finger joints and finger swelling are common, especially in ball sports like basketball and soccer.

Low-back muscle strains are by far the most common spinal injuries in athletes (or non-athletes). The pain is often deep and severe, leading those affected to worry that a more serious structural problem may have occurred. While less typical spine problems should be considered, lumbar strains are by far the most common of them.

Hip and Groin

Groin strains or pulls have always been a common hip pain diagnosis. Many hip problems once attributed to a muscle strain, such as femoroacetabular impingement , or FAI , and labral tears , are becoming better understood, but groin strain injuries are still the most common.

A muscle strain, pull, or tear can occur in the hamstring, quadriceps, and adductor muscles in the thigh from a variety of different sports. Hamstrings and quadriceps are particularly at risk during high-speed activities like track and field, football, basketball, and soccer. The injury occurs when the muscle is stretched beyond its limit, tearing the muscle fibers.  

Anterior knee pain, also called patellofemoral pain syndrome , is a cartilage irritation on the underside of the kneecap that causes pain and grinding around it. Therapeutic exercises are almost always used as treatment.

Ankle sprains are by far the most common injury of the ankle joint . Once an ankle sprain has occurred, repeat injuries can be common. Proper rehab after these injuries can help prevent reinjuring the ankle joint.  

Plantar fasciitis involves irritation of the thick, tough tissue that creates the arch of the foot. This plantar fascia tissue can become contracted and painful, leading to difficulty stepping on the heel of the foot.

How Sports Injuries Happen

A sports injury can be caused by an accident, impact, poor training practices, improper equipment, lack of conditioning, or insufficient warm-up and stretching.

Sports injuries typically fall into two categories, acute or chronic, and can stem from direct impact, loading (putting more force on a joint than it can handle), or overuse.

An acute injury is the result of an incident or accident that results in noticeable symptoms. For example, a slip, fall, tackle, or collision can result in an acute injury. While some accidents are just a part of playing sports, others may be avoided by having proper gear and equipment and playing in safe conditions. For example, playing soccer on wet leaves can lead to slipping and falling.

A chronic injury is longer-term. It may begin as an acute injury that does not heal completely or may be caused by overuse or improper form. Many athletes play through pain, which can lead to chronic injuries.

What Are the Signs of a Sports Injury?

Sports injury symptoms can come on quickly at the point of injury or may appear gradually over the course of a few hours or days. When an athlete takes a hard fall, rolls an ankle, or gets otherwise banged up, the typical response is to shake it off and push through the pain, which can lead to longer-term problems.

Symptoms from a chronic or overuse injury tend to develop over time. However, acute flare-ups of old injuries can be common. Symptoms of a sports injury include the following.

Pain is the primary symptom of a sports injury.   It is the body's signal that something is wrong and can differ based on the type of injury.

The immediate onset of pain from an acute injury that does not subside should be seen by a sports physician. An example of this is rolling your ankle and not being able to put weight on it or colliding with a person or object and not being able to move your arm.

Other times, pain onset is delayed. This is particularly common in overuse injuries. A joint may feel a little tender immediately after a sport, but the pain continues to intensify over the course of hours. Tenderness when pressure is applied to the area can be an important indicator that a serious injury has occurred.

The location of the discomfort, the depth of pain, and a description of the type of pain you are experiencing can help your healthcare provider determine the possible cause.

Swelling is a sign of inflammation, which is your body's effort to respond to injury and initiate the healing response of the immune system. While swelling is not necessarily a bad thing, it can cause discomfort.

In the very early stages after injury, you may not notice swelling or any restriction in your ability to move. Swelling often occurs gradually as healing blood and fluid are sent to protect and heal damaged tissue or bone.

What you experience can tip your healthcare provider off as to the type of injury you have. There are a few types of swelling.

• Effusion :  Swelling within a joint
• Edema:  Swelling in the soft tissues
• Hematoma :  Swelling due to bleeding in the soft tissue

While pain can be difficult to quantify, mobility can often be measured by checking your range of motion. This is especially true in injuries to the limb, because you can compare the injured joint to its opposite healthy one.

A limited range of motion can be a clear indication of the severity of an injury. An initial period of rest is typically recommended for lack of mobility in acute injuries, followed by gentle movements that build up to more exercise. See a sports doctor or physical therapist to assess and treat mobility problems prior to resuming sports activity.

Instability

An unstable joint feels loose or like it wants to buckle or give out. This is often a sign of a ligament injury (like an ACL tear ), as the injured joint is not adequately supported after it has been damaged.

An injury that limits the strength of an injured area may signify structural damage to a muscle or tendon that prevents normal function. The inability to lift your arm or walk because of weakness should be evaluated by a medical professional, as there are other possible and concerning causes.

Numbness and Tingling

Numbness or tingling is a sign of nerve irritation or injury.   Sometimes nerves are directly damaged; at other times, a nerve can be irritated by surrounding swelling or inflammation. Mild tingling is usually not a major problem, whereas the inability to feel an injured body part is more of a concern.

Redness at the injury site can be due to inflammation, or to an abrasion, allergy, or infection. If you have unexplained skin redness, particularly if the area is also hot to the touch, you should be evaluated by a medical professional.

Confusion or Headache

Even a mild head trauma can lead to a concussion, which can result in cognitive symptoms, such as confusion, difficulty concentrating, and memory problems, as well as headache, dizziness, nausea, and irritability.

A concussion can have serious consequences and should not be ignored. If a blow to the head causes any immediate symptoms or loss of consciousness, seek medical attention, even if the symptoms pass.

Sports injuries are common, and seeing a healthcare provider for every ache and pain is not necessary or practical for most athletes. If you have an injury that is not improving with simple treatment steps, however, or if it is worsening despite your efforts, see a trained professional.

Some signs that you should be seen by a medical professional include:

• Difficulty using the injured area (walking, lifting your arm, etc.)
• Inability to place weight on an extremity
• Limited mobility of a joint
• Deformity of the injured area
• Bleeding or skin injury
• Signs of infection (fevers, chills, sweats)
• Headache, dizziness, confusion, or loss of consciousness following a head injury

How Sports Injuries Are Diagnosed

Acute and chronic injuries can be diagnosed by a sports physician or orthopedist, although non-physician professionals trained to diagnose and manage these injuries—such as athletic trainers and physical therapists —may also do so.

You will need to provide a medical history and information about how the injury occurred, and undergo a physical examination.

During the physical examination, your healthcare professional will palpate the area and ask about the degree of pain or tenderness. You will be asked to move the injured area to test its range of motion as well.

Depending on the suspected injury and level of pain or disability, your healthcare provider may take X-rays to rule out any broken bones. While some broken bones are evident on an initial X-ray, some fractures (e.g., a simple fracture of the wrist or hairline fracture in the foot ) may not be noticeable until a few days later, once healing of the injury has begun.

Additional diagnostic imaging tests may be ordered to determine soft-tissue damage. These may be ordered during the initial visit or after a period of treatment is ineffective, and include the following.

• Magnetic resonance imaging (MRI): This is often used for diagnostic imaging of muscle injuries, joint damage, sprains, fractures, and head injuries sustained during sports. MRIs use radio waves within a strong magnetic field to examine musculoskeletal structures, including bones, tendons, muscles, ligaments, and nerves.
• Ultrasound: Useful for assessing tendon damage, in an ultrasound, sound waves take real-time images of superficial soft tissues. During an ultrasound, the radiologist may ask you to move the joint to see how motion affects the tendon.
• Computed tomography (CT) scans: A CT scan provides a more detailed look at bones and soft tissues. This test can show hairline fractures and small irregularities within complex joints.

How Sports Injuries Are Treated

Your course of treatment will depend on the location and severity of your injury. Initial treatment for many sports injuries is aimed at controlling inflammation and promoting the healing response.

The acronym R.I.C.E. is a helpful guide for the immediate treatment of most acute injuries. When performing R.I.C.E. treatment, you will take the following steps:

• Rest: Limit the forces acting on the injured part of the body. This generally means stopping your sports activity, and it may mean using crutches, a sling, or another aid to fully rest the area.
• Ice: Ice is helpful at controlling swelling and inflammation, and it can also help tremendously with pain reduction. Many athletes who ice an acute injury find they don't need pain pills to help alleviate discomfort.
• Compress: Compression is performed by snugly, but not tightly, wrapping the injured part of the body with a compression bandage. Too-tight constriction can cause worsening of your symptoms and other problems.
• Elevate: Elevating the injured extremity can also help reduce swelling and inflammation and, in turn, reduce pain.

After an initial period, rest should be replaced by protection and optimal loading. This technique is known as P.O.L.I.C.E. (protection, optimal loading, ice, compression, and elevation). Protecting the injured joint with an assistive device, such as crutches or a sling, while gently moving the joint and gradually putting weight on the injury will often help speed healing.

After the initial healing period, your healthcare provider will determine what, if any, additional treatment is needed and may refer you to a specialist for your specific injury.

Treatments for sports injuries include:

• Immobilization with a splint, cast, or brace
• Medication for pain
• Pain-relieving injections, such as a cortisone shot
• Physical therapy

Common sports injuries include muscle sprains, strains, ligament tears, dislocated joints, bone fractures, and head injuries. Acute injuries are caused by an accident or incident. Chronic injuries happen over a longer peeriod of time.

Some signs of sports injuries include pain, swelling, stiffness, redness, confusion, or headache. See your healthcare provider if you have a severe sports injury, one that isn't improving, or if you have any type of head injury.

Treatment for acute injuries may include the R.I.C.E. protocol (rest, ice, compress, and elevate). Other treatments may include splints, braces, pain medications, physical therapy, and surgery.

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By Jonathan Cluett, MD Dr. Cluett is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the U.S. national soccer teams.

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Psychosocial Responses During Different Phases of Sport-Injury Rehabilitation: A Qualitative Study

Damien clement.

* College of Physical Activity and Sport Sciences, West Virginia University, Morgantown

Monna Arvinen-Barrow

† Department of Kinesiology, University of Wisconsin–Milwaukee

Athletic trainers have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases; however, these phases appear to neglect athletes' psychosocial responses to their injuries.

To document injured athletes' psychosocial responses during the different phases of injury rehabilitation.

Qualitative study.

National Collegiate Athletic Association Division II university in the mid-Atlantic region of the United States.

Patients or Other Participants:

A total of 8 previously injured athletes (4 men and 4 women) participated in the study.

Data Collection and Analysis:

We collected participant data by using semistructured interviews, transcribed verbatim and analyzed by directed content analysis. Established themes were triangulated to determine trustworthiness.

Initially, athletes' cognitive appraisals were predominately negative in nature, leading to negative emotions. These appraisals changed after diagnosis and when moving to the reaction-to-rehabilitation phase and the reaction-to-sport phase. During the reaction-to-rehabilitation phase, athletes reported mixed cognitive appraisals and identified frustration as the main emotional response. When returning to sport, athletes reflected on the lessons learned, yet they expressed some doubts related to their ability to return to play. These cognitive appraisals served as a precursor to the resulting emotional responses of nervousness and reinjury anxiety, as well as excitement. Throughout the various phases of rehabilitation, athletes reported seeking out social support: initially from significant others and then from their athletic trainers during the reaction-to-rehabilitation phase.

Conclusions:

The results appear to support the use of the integrated model of psychological response to sport injury and the rehabilitation process and the 3 phases of rehabilitation as a framework for understanding how physical and psychosocial factors may interact during sport-injury rehabilitation. Understanding this interaction may help athletic trainers provide better care to their injured athletes.

• Injured athletes' cognitive appraisals and emotional and behavioral responses varied during the different phases of the injury-rehabilitation process.
• Understanding how athletes' psychosocial responses interact during the different phases of rehabilitation can help athletic trainers better understand how an athlete might react during the injury-rehabilitation process.

Athletic trainers (ATs) have traditionally conceptualized rehabilitation programs in terms of 3 distinct physiologic phases: acute injury phase, repair phase, and remodeling phase. 1 According to Prentice and Arnheim, 1 these phases, which are based on the 3 stages of the healing process, provide ATs with a potential blueprint for guiding treatment, using modalities, and implementing rehabilitation exercises. Although the use of these 3 stages has proven to be effective in facilitating injured athletes' physical return to the field of play, athletes' psychosocial responses to their injuries have not been considered. Indeed, evidence collected from ATs indicates that they appear to recognize the prevalence of psychosocial responses to athletic injuries, but their lack of education on how to appropriately deal with these responses limits their ability to properly incorporate athletes' reactions into their treatment plans and thereby provide holistic care. 2

Recently Kamphoff et al 3 suggested a variation of the phase-like approach to rehabilitation by integrating psychosocial components with physical characteristics of the healing process: reaction to injury, reaction to rehabilitation, and reaction to return to sport. 3 The development of these phases, guided by the physical healing process, has the potential to increase ATs' ability to provide holistic care to injured athletes. According to Kamphoff et al, 3 use of this phased approach could help ATs develop and implement psychosocial strategies to address some of the psychosocial challenges athletes may encounter during the recovery process.

Typically, injured athletes experience a range of psychosocial challenges, which may vary during the course of the recovery process. For example, Johnston and Carroll 4 found that during the early stages of rehabilitation, athletes often exhibited frustration and depression due to their sudden lack of sport involvement. As they moved into the middle stages of their rehabilitation programs, some athletes experienced apathy and poor adherence (ie, doing too much or too little), which could be a result of lack of motivation to complete the required rehabilitation exercises or a sign of impatience and eagerness to return to sport. Tracey 5 reported that injured athletes also experienced a variety of psychosocial challenges throughout the recovery process, including but not limited to decreased self-esteem, frustration, anger, and fear of injury. Kamphoff et al, 3 in developing the phased approach, indicated that each of the stages in their phase-like approach is associated with specific psychosocial challenges. More specifically, during the reaction-to-injury phase, athletes often experience anxiety and negative cognitive appraisals. In the reaction-to-rehabilitation phase, injured athletes may be faced with motivational challenges. Finally, in the reaction-to-return-to-play phase, athletes may encounter self-confidence concerns and fears or anxiety about the possibility of reinjury. Sport-injury rehabilitation is clearly a dynamic and evolving process during which athletes' psychosocial responses vary.

Although Kamphoff et al 3 suggested a shift toward approaching rehabilitation from both the physical and psychosocial perspectives, research in this area is still limited. However, the integrated model of response to the sport injury and rehabilitation process 6 provides theoretical support to the phased approach, thus validating the importance of addressing athletes' psychosocial responses for successful recovery. According to the integrated model, 6 athletes can respond to their injuries in a variety of ways, and a number of preinjury factors (eg, personality, coping resources, and previous history of stressors) can influence not only injury occurrence but also subsequent reactions to injury. In short, the integrated model 6 suggests that once injured, the athlete will often experience a range of thoughts, emotions, and feelings, which may have an effect on the athlete's behavior and vice versa (eg, behaviors can affect emotions, and emotions can affect cognitions). Moreover, these responses are all influenced by a range of personal (eg, individual differences) and situational (eg, sports medicine team influences) factors. 6

The integrated model 6 highlights the importance of being knowledgeable about injured athletes' psychosocial responses to injury, yet this concept has been limited in application to the different phases of injury rehabilitation. Wiese-Bjornstal et al 6 postulated that with the application of the integrated model across different phases of rehabilitation (as outlined by Kamphoff et al 3 ), ATs could potentially be more cognizant of athletes' psychosocial responses (ie, cognitive appraisals, emotional and behavioral responses) at each of these phases and be able to take the necessary steps to ensure successful recovery. Furthermore, understanding the theory underpinning psychosocial responses to injury may help ATs promote a more holistic approach in choosing appropriate psychosocial strategies to help athletes proceed through each phase and successfully back to the field of play. As a result, the aim of our study was to explore injured athletes' psychosocial responses (cognitive appraisals, emotional and behavioral responses) to sport injury at the different phases of rehabilitation: reaction to injury, reaction to rehabilitation, and reaction to return to sport. 3

Research Design

Because our goal was to explore the experiences of injured athletes and more specifically their psychosocial responses as they relate to sport-injury rehabilitation, we adopted a qualitative research design. Using this approach, we were able to focus on the participants' subjective experiences and interpretations of their injury experiences, and as such, to understand the injury experience from an athlete's personal perspective rather than our own. We collected the participants' data using semistructured interviews and analyzed the data using directed content analysis. 7

Participants

A convenience sample of 8 (4 male, 4 female) National Collegiate Athletic Association Division II athletes, aged 18 to 22 years, participated in interviews for this study. Each athlete was enrolled at a Division II university in the mid-Atlantic region of the United States and was a current member of a varsity athletic team at that institution (acrobatics and tumbling: n = 4; football, n = 3; baseball, n = 1). Participants reported their class year as freshman (n = 2), junior (n = 4), or senior (n = 2). All of the athletes had suffered an injury that restricted their sport participation for a minimum of 6 weeks in the past year and had since successfully returned to sport within the expected time period required for their injury recovery. The encountered injuries included anterior cruciate ligament reconstruction (n = 3), fractures (n = 3), rotator cuff repair (n = 1), and chondrocyte removal from the elbow (n = 1).

Interview Guide

The framework for the interview guide used in this study was adopted from the integrated model. 6 As shown in the Table , the first section contained general questions about the athlete and his or her background. As such, questions like “Could you tell me about yourself?” were used to act as an icebreaker. The following 3 sections were concerned with athletes' cognitive appraisals (ie, how the athlete viewed the situation), emotional responses (ie, how he or she felt about the injury), and behavioral responses to the injury (ie, how he or she acted and reacted to the injury situation) at different phases of rehabilitation (initial reactions, reactions during rehabilitation, and reactions related to return to sport).

Interview Questions

Before participant recruitment or data collection, we obtained institutional review board approval from West Virginia University. For the study, convenience sampling was used to recruit previously injured athletes who had since recovered from their injuries. Once potential participants were identified, they were approached by 1 of the researchers and given a cover letter explaining the nature of the study and requirements for participation. Those who expressed an interest in taking part were then scheduled for an interview at a convenient time and location for both the researcher and the participant. Interviews took place one on one in a private, quiet room within the athletic facilities of the university and averaged about 55 minutes. Once on location, the researcher explained the nature of the study. The researcher also informed participants about their right not to answer any questions they felt uncomfortable with, that they could deviate from the interview questions when necessary, and of their right to withdraw from the research at any point they chose. They also were informed that to ensure their confidentiality, pseudonyms would be used. Once participants understood the study, and any possible questions had been answered, they were asked to complete, sign, and return the consent form to the researcher. All participants also gave consent for the use of a voice-recording device.

Pilot Interview

We pilot tested the interview guide on club-sport athletes (N = 2) who had since recovered from their injuries. The pilot interviews were conducted to determine if the questions on the interview guide were neutral (ie, not worded to influence answers) and clear (devoid of any scientific or sport psychology terminology) and if the order of the questions flowed well. Furthermore, pilot interviews allowed the interviewer to practice developing follow-up questions and to increase the interviewer's confidence in conducting interviews. Based on the feedback obtained from the pilot interviews, we revised some of the questions, and as a result, slightly modified the order of some questions. Upon the completion of pilot interviews, the interviewer participated in a bracketing interview with a researcher who had qualitative experience. The purpose of this bracketing interview was to allow the interviewer to gain additional insight into her own experiences relative to sport and injuries and to heighten the interviewer's awareness relative to personal biases that might influence the interview process. 8 , 9 Once this bracketing interview was completed, the interviewer reported being prepared to conduct the interviews knowing that her own experiences would not influence the process.

Data Analysis

After the interviews, the recordings were transcribed verbatim by the researcher and stored in a Word (version 97–2003; Microsoft Inc, Redmond, WA) document on a password-protected computer in a locked office. The research team (which consisted of 3 researchers, all of whom were involved in coding and data analysis) randomly selected 1 of the participants, Harry, to initiate the analysis process. What follows is a description of the data-analysis process, which was replicated with all participants until we felt that saturation had been reached.

Initially the data analysis was guided by the integrated model. 6 This allowed us to identify any possible cognitive appraisals and emotional and behavioral responses that might have emerged as a result of the injury and during the injury-rehabilitation process, as well as if any personal or situational factors influenced such processes. The analysis was not, however, restricted to the individual factors and responses listed in the integrated model 6 but rather open to alternative cognitive appraisals and emotional and behavioral responses that might emerge from the data. After this analysis, we identified such responses to each of the 3 stages of rehabilitation as identified by Kamphoff et al. 3 As noted earlier, the phases of rehabilitation acted as a framework to which we added as items emerged from the data.

During the analysis, each researcher identified a number of cognitive appraisals and emotional and behavioral responses to injuries in the participant's responses, which were then placed into the different phases of rehabilitation. After this process, we collated the emergent themes into a master list of themes and quotations from the transcript. This process allowed us to organize consistently across all analyses and to identify commonly occurring themes. These themes were reevaluated for any possible discrepancies and revised when necessary. Once the themes were established, we immersed ourselves in the remaining transcripts and allowed further themes to emerge inductively from the data.

During the analysis, it was evident that participants presented themselves with different cognitive appraisals and emotional and behavioral responses to injuries that were influenced by a range of personal and situational factors. It also became evident that the athletes' reactions to their injuries (phase 1) manifested in 2 distinct phases (initial reaction and reaction after diagnosis), which are not explicitly stated in the 3-stage model. Given the purpose and aim of this study, the emergence of such themes confirmed that we had reached the saturation point, and as such, we were confident that the sample size was sufficient for this study.

The trustworthiness of the data was established by triangulation, peer review, and participant checking. 8 , 10 Triangulation occurred when all members of the research team reviewed the transcripts and coding of emerging themes and supporting quotations to assure interrater reliability and consistency of analysis. An academician with qualitative research experience peer reviewed the themes to ensure they were consistent with the transcripts. Lastly, the findings and themes were explained and discussed with 2 participants to determine if they felt these were representative of their experiences. The participants agreed with the emergent themes and found them to be consistent with their experiences.

With the directed content analysis, we found commonalities in athletes' psychosocial responses to injuries across the 3 phases of rehabilitation. Overall, it appeared that athletes' cognitive appraisals of their injuries and subsequent emotional and behavioral responses varied across the rehabilitation process and were typically influenced by 4 distinct events (ie, initial reaction to injury, reactions to injury after diagnosis, reactions to rehabilitation, and reactions to return to sport). It was also evident that these reactions were influenced by reactions displayed during the earlier phases and by several prominent personal (ie, injury severity, recovery status, perceived length of time to return to sport) and situational (ie, teammate, coach, family, sport medicine professional influences) factors.

Phase 1: Reaction to Injury

Overall, athletes' initial cognitive appraisals of the injury were predominately negative. These had an effect on the subsequent emotional responses, which also were generally negative. Initially, the most common behavioral response was to seek social support from family and significant others. However, once the injury was formally diagnosed, athletes reported changes in their cognitive appraisals and emotional responses. However, seeking social support from family and significant others continued to be the most prominent behavioral response.

More specifically, athletes' initial cognitive appraisals were strongly influenced by the perceived severity of their injuries. In other words, initial cognitive appraisals were influenced by a common theme of perceived injury severity influencing appraisal , in that the more athletes perceived their injury to be severe or expected to be away from their sport for a significant period of time (or both), the more negative their cognitive appraisals were and vice versa. The athletes who initially perceived their injuries as severe typically appraised the injury as negative. For example, Harry reported, “I never really thought that I'd be able to come back out and throw again.” Similarly, Gabby stated, “As soon as it happened, I knew something was definitely wrong, like it was a serious injury. It wasn't a pain I'd ever felt before.” Furthermore, Faith commented, “I knew I was at least done for the year and I didn't really know if I would ever be able to come back.”

Other athletes appeared to hope their injuries were not serious, and as a result appraised the injury more positively. Eric noted, “My initial thoughts, I didn't think it was anything. I just thought I came down on it wrong. I thought it was just sore from the way I landed. I didn't think anything was wrong with it, so I just continued what I was doing.” Anthony explained, “I was just hoping that I could get back so we could have a better chance of winning.”

Athletes' emotional responses were underpinned by a common theme of negative thoughts leading to negative emotions . That is, athletes' initial emotional responses to their injuries also appeared to be negative to varying degrees. In essence, if the athlete had appraised the injury as really serious and devastating, his or her emotional response was also highly negative. For example, both Faith and Gabby, whose initial appraisals of their injuries were very negative, also described very negative emotions. Faith indicated she was hysterical: “I was just a little bit hysterical because I knew I was at least done for the year.” Gabby experienced anger: “Um, afterwards I was angry.” In a similar way, David reported being in shock: “I dropped to the floor in shock just processing”; and Candace, whose initial appraisal was negative, but not catastrophic, explained how she felt: “I was injured and I was just really, really upset.”

The theme that emerged as the most common behavioral response during this phase was seeking social support , particularly from significant others. Some emphasized the importance of the support received from family members. For example, David said, “I first turned to my family and asked them for advice.” Similarly, Candace indicated, “My mom and the rest of my family provided me with support.” Other athletes sought support from their teammates. For example, Beverly stated, “Umm I turned to my teammates,” and Harry explained, “I would probably say I turned to my teammates.” Some even reported receiving social support from their coaches, as Anthony remarked: “My coaches, they would call me and asked where I was at or ask me how the treatment was.” Similarly, Gabby noted, “I had a lot of support from my coach.” At the initial reaction-to-injury stage, only Beverly (“The [athletic] trainers, um, helped me to kinda get through everything”) and David (“With the support of the [athletic] trainers, they helped comfort me”) listed receiving and seeking social support from their ATs. The key responses to injuries immediately after injury are displayed in Figure 1 .

Initial psychosocial responses to injury immediately after injury.

Subsequent to initial reactions to injuries, a theme that emerged from the data was cognitive reappraisals after diagnosis . It appeared that after the initial reactions to the injury, the first major point of change in the initial appraisals was after diagnosis. That is, once athletes were fully aware of the injury severity (a personal factor), their initial response to injury changed depending on the diagnosis. In some cases, the news of the diagnosis fostered a positive outlook on the situation. Eric, for example, who had initially perceived the injury as minor, indicated, “I was glad it was the end of the season because I knew something was going to have to happen medical-wise, so I was just glad that it was the end of the season so I could focus on my shoulder.” Others expressed similar thoughts, such as Gabby, who stated, “I knew it was going to be a long recovery and I didn't want to waste that time not cheering.” After her diagnosis, Beverly reported, “I knew I could get back for my senior season.” Not all athletes reappraised their injury situation as positive. Anthony expressed negative thoughts: “I felt that I was letting everybody down.” David viewed his situation as a challenge: “I knew that it was a test that I had to pass. Everyone goes through tests and I felt that this was one of them.”

The knowledge of the diagnosis also affected athletes' resultant emotional responses: a common theme of knowing the severity changed emotions was evident in all of the participants' transcripts. Anthony commented that knowing the severity of the injury “made me real upset because I felt like I was letting my team down.” Harry stated it “kinda made, like, my emotions worse.” In a similar manner, Beverly indicated that she went through a “week of depression,” and “for a full solid week, I probably cried nonstop.” Candace reported, “I think I became, like, just really down about myself and about the sport that I was doing.” For some athletes, knowledge of the injury severity brought about different emotions. For example, Faith noted, “I thought everything was going to be torn, and then it was just my ACL [anterior cruciate ligament], and I felt a little bit better about it.” Eric, on the other hand, reported, “It didn't affect me emotionally that much.”

It also appeared that after diagnosis, the theme of seeking social support from a range of sources, particularly significant others, remained the most dominant behavioral response. Eric, who appeared to appraise his injury in a positive manner, said that his mother was the greatest source of support: “My mom is always there when I need support for anything…She would come out to the doctors' appointments and stuff to see how serious it was…It was mainly her; after surgery, I stayed with her. She took care of me.” The key responses to injuries after injury diagnosis are illustrated in Figure 2 .

Psychosocial responses to injury postdiagnosis.

Phase 2: Reaction to Rehabilitation

Moving from the reaction to injury to the reaction-to-rehabilitation phase, overall, athletes described varying cognitive appraisals that were mainly concerned with thoughts questioning the rehabilitation process. The most common emotional response to rehabilitation was frustration. Athletes also indicated being cautious about the rehabilitation and continued to seek social support from family and significant others. However, during rehabilitation, they also sought social support from the ATs.

More specifically, during the reaction-to-rehabilitation phase, the emergent theme in athletes' cognitive appraisals was characterized by thoughts that question the rehabilitation process . At the start of rehabilitation, it appeared that athletes' cognitive appraisals of their rehabilitation were mixed and underpinned with thoughts about the perceived value of their rehabilitation programs, their willingness to get on with the process, and the perceived difficulty of these programs. Anthony stated, “I mean it's good…[to] see their aspects on what they think is wrong with me, and it's just cool seeing how there's so many different things that can affect your body. They know exactly what to do to get you better.” Beverly's and Candace's cognitive appraisals of their rehabilitation were influenced by their willingness to get on with the process. Beverly indicated, “I loved to look forward to come to rehab. It gives me something to look forward to each day.” Similarly, Candace reported, “I'm just gonna push through it, and something bigger and better is gonna come along.” Other athletes' cognitive appraisals were influenced by the perceived difficulty of the rehabilitation programs. For example, David stated, “I didn't think I was going to make it.” Faith expressed similar thoughts: “After surgery, the rehab part was hard.”

Such mixed thoughts on the rehabilitation process resulted in changes in emotional responses. In the reaction-to-rehabilitation phase, the emergent theme among the athletes was feeling frustrated . Most notably, Gabby explained, “I definitely got frustrated, frustrated when I first started to walk again. I was frustrated that my weight was down.” Harry also reported feelings of frustration: “I said starting out, you know, because all you're doing is 2-pound weights, or just arm exercises where it's no weights or just bands or something, so it's frustrating because you can't lift any weights. You know your arm feels so weak.” Other athletes also expressed similar feelings. Beverly said, “Not being able to do what you were doing right before you tore it and kind of having, like, people having to pick up your leg for you isn't really the best feeling.” Faith indicated feeling frustrated, as evidenced by her comment that “it was just a sad thing when you couldn't even bend your leg, when it was something that you never really thought about before.”

These feelings of frustration could have influenced the ways in which the athletes reacted behaviorally to the rehabilitation. The first emergent theme in the reaction-to-rehabilitation phase was being cautious . For example, Anthony reported, “I mean at first it started off slow.” Beverly shared Anthony's approach: “I started off slow and then within a couple weeks, I began progressing more and more.” Eric indicated he “just took it day by day,” and Gabby stated, “You just have to take baby steps, a little at a time really.” Candace's approach to her rehabilitation was comparable: “At first I was hesitant.”

Very similar to the aforementioned phases, during the reaction-to-rehabilitation phase, the theme seeking and receiving social support was evident. All the athletes reported receiving good social support during rehabilitation. For Candice and Beverly, their family and friends continued to be the main source of support. Candace recalled,

I'd go home every weekend, and they'd (mainly, my parents, my family) comfort me and I'd tell them about everything throughout the process of being injured like the treatment, everything I would explain it all to them [and] they could comfort me.

However, it appeared that during the reaction-to-rehabilitation phase, the role of sports medicine professionals as a source of social support became amplified. Of the athletes in this study, all but Candace indicated that the social support they received from their sports medicine professional was vital for their rehabilitation and recovery. Anthony commented that his sport medicine professionals “helped me to stay positive; they pushed me to work hard and helped me to see the bigger picture.” Moreover, during the rehabilitation stage, social support from coaches and teammates was imperative to some athletes, as “they know what you are going through” and they are “always there for you” (Harry). Harry also noted, “They (the coaches) would talk to me every day after practice…and ask how my rehab was going.…They had faith in me to rehab and come back strong…and that gave me faith in myself.” The key responses to injuries during rehabilitation are shown in Figure 3 .

Psychosocial responses to rehabilitation.

Phase 3: Reaction to Return to Sport

During the reaction-to-return-to-sport phase, athletes reported both positive and negative cognitive appraisals. These cognitive appraisals served as precursors to their emotional responses because the athletes described feelings of nervousness and reinjury anxiety, as well as positive excitement. Such feelings were also reflected in their behavioral responses, as the athletes described cautiousness in their actions as they returned to play.

In particular, during the return-to-sport phase, it appeared that all of the athletes in this study had gained perspective as a result of the injury and rehabilitation process. This seemed to manifest itself as an overall theme of lessons learned , which was characterized by personal reflections on having learned a lesson during the process of dealing with their injuries and the rehabilitation process. For example, Harry stated that the injury had made him “love the game more because I realize, you know, at any moment, it can be taken away.” Anthony reported that being injured “kinda made me stronger in a sense because I had to battle through that adversity.” David believed that after injury, he gained “an appreciation for the simplicity of just having all of your body parts.” Gabby observed that as a result of her injury, “It makes me work harder. It makes me stay stronger because I know how easily things like that happen.”

Although lessons learned appeared to be a general theme in athletes' cognitive appraisals regarding their return to play, negative appraisals were also present. Beverly said, “I wasn't sure of how my knee could hold up since I do, do a really contact sport. I do a lot on my knee, um, I wasn't sure how it could hold up.” Faith also expressed a similar sentiment: “It made me more cautious about what I do, and I see things now like this, this, and this can happen, whereas before I could have cared less before I did that.”

Subsequent to the above cognitive appraisals, feelings of excitement and reinjury anxiety was a common theme among the emotional responses during the return-to-sport phase. Some athletes were very excited about returning to sport, whereas others felt insecure about their abilities to return to sport and the possibility of reinjuring themselves. Gabby commented, “I was just anxious to be back, excited.” David was really “excited to see what we can do as a team,” and Eric felt that “it was real exciting to get back. I just wanted to have fun and do what I could do.” Conversely, Beverly was “a little nervous to just, um, jump back into it.” Candace had a similar feeling, being afraid that doing the same buildup that hurt her in the first place was going to injure her again.

These cognitive appraisals and emotional responses acted as a foundation for athletes' behavioral responses, in that they predominately reported being “cautious in their return to play.” For example, Anthony indicated, “It just caused me to be more cautious and look at the little things more than the big things.” Beverly planned a similar approach, as she said, “I know I'll take it slow, and I know that my coach will let me take it slow at first.” Candace reported, “I had to be really careful 'cause I didn't want to be out any longer.” Similarly, Faith said, “I knew that I was going to be able to pace myself. I wasn't going to be pushed to do something that I wasn't ready to do.” The key responses to injuries during return to sport are displayed in Figure 4 .

Psychosocial responses to return to sport.

Overall, it appeared that injured athletes' cognitive appraisals and emotional and behavioral responses varied during the different phases of the injury-rehabilitation process. These cognitive appraisals and emotional and behavioral responses seemed to evolve in a cyclical manner and were distinct at each of the phases of rehabilitation and recovery. In other words, athletes' psychosocial responses during the different phases of rehabilitation, as identified by Kamphoff et al, 3 were influenced by earlier responses.

Athletes' psychosocial responses to injury, rehabilitation, and return to sport appeared to follow clear themes throughout the rehabilitation process. More specifically, athletes' initial cognitive appraisals of their injuries were predominately negative in nature and primarily influenced by perceived severity and ability to return to sport. Such thoughts seemed to influence the resulting emotional responses, which also were generally negative, including being upset, angry, in shock, and hysterical. The most common behavioral response athletes exhibited in this early stage of the injury process was to seek social support from their significant others. Significant others in this instance varied from family members to teammates, coaches, and to a lesser extent, ATs. Such findings are not surprising. Existing literature indicates that injured athletes typically report negative thoughts at injury onset 5 , 11 and that these negative thoughts can often lead to negative emotions. 4 , 12 – 14 Moreover, the resulting behavioral responses were also consistent with previous research findings, which typically indicated that injured athletes often gravitated toward their significant others for social support. 11 , 14 However, more recently, Yang et al 15 found that athletes, once injured, tended to seek social support from their ATs and physicians, as opposed to significant others such as family members and teammates. This finding might have been influenced by the different settings in which the studies were conducted. Yang et al 15 collected their data at a Division I university, whereas we collected our data at a Division II university. The differences in access to and structure of sport medical services between Division I and II universities may have accounted for the fact that athletes in the study by Yang et al 15 sought social support primarily from their ATs and physicians instead of from family and significant others. Typically, Division I universities have large sports medicine staffs, whereas smaller Division II universities may lack such services. Therefore, athletes in our study may have gravitated toward their family and significant others for social support because of AT and physician staff shortages and the increased demands on those who were available.

After initial reactions to injury, the next significant stage when psychosocial responses were easily identifiable and likely to change from initial responses was after diagnosis. In this study, the athletes reported changes in their cognitive appraisals and heightened emotional responses as a result of their diagnoses. That is, some athletes indicated that knowing the severity of their injuries fostered a positive outlook on the situation, whereas others expressed negative thoughts or viewed the situation as a challenge they needed to overcome. Furthermore, knowledge of their diagnoses amplified some of the previously reported negative emotions (ie, being upset, angry, in shock). Athletes also still sought social support, with the primary source continuing to be their significant others.

These findings appear to be consistent with previous literature, as Leddy et al 12 affirmed that the greatest fluctuations in mood as a result of injury occurred in the initial stages of the injury-recovery process. Udry 16 further commented that mood fluctuations were often more pronounced in the earlier stages of the injury process than in the later stages. The importance of the diagnosis as a point at which initial responses to injuries are reevaluated and changed has also been supported by Johnston and Carroll. 4 They found that injured athletes who initially presented with a positive cognitive appraisal often reported feelings of belief and encouragement after diagnosis; however, those with negative appraisals as a result of their diagnoses reported negative emotions such as shock, disbelief, anger, and confusion.

After the initial reaction-to-injury phase, we found that once athletes transitioned into injury rehabilitation, their cognitive appraisals varied and often contained both positive and negative thoughts. These thoughts were primarily influenced by the perceived value of the rehabilitation programs, their personal willingness to get on with the process, and the perceived difficulty of these programs. The most common emotional reaction to rehabilitation appeared to be frustration. Consistent with the earlier phases of the rehabilitation process, athletes continued to report seeking social support as their main behavioral response. However, unlike during the earlier phases, they now appeared to seek social support from their ATs, as opposed to their significant others alone. Another dominant behavioral response reported by athletes in this phase was the tendency to adopt a hesitant and cautious approach to their rehabilitation programs.

In support, Johnston and Carroll 4 agreed that cognitive appraisals during the actual rehabilitation process could be a mixture of positive or negative appraisals and that these appraisals can play a significant role in the resulting emotions and behavioral responses. Johnston and Carroll 4 found that those athletes who had a positive appraisal of their injury rehabilitation reported being happy and relieved, and these emotions fostered increased adherence. However, as revealed in our study, those who had negative appraisals reported frustration, which may have led to hesitancy and cautiousness toward their rehabilitation programs. Moreover, this hesitancy and cautiousness could have also been directly related to the subsequent negative cognitive appraisals and their resulting emotions.

Previous research 14 also supports the transition to seek social support from ATs in place of significant others. Carson and Polman 14 identified “a change in the importance of social support, moving away from the family and becoming more focused on the staff in charge of rehabilitation.” Yang et al 15 reported that injured athletes often perceived that ATs and physicians could better help them deal with the stress associated with injury and provide them with the necessary guidance regarding their rehabilitation when compared with significant others. Moreover, their unique understanding and ability to relate to injured athletes, coupled with their capacity to provide emotional and informational support, could also have been responsible for the shift.

Similar to earlier phases, in the return-to-sport phase of the injury process, athletes continued to report both positive and negative cognitive appraisals. Many athletes reflected on the lessons learned as a result of the injury process and were grateful for the opportunity to be able to play their sport again. At the same time, they expressed some doubts related to their return to play. For some, these thoughts were more unidirectional—they were either appreciative of the ability to play again or they felt doubtful about their readiness to return to play. These cognitive appraisals served as precursors to their emotional responses, and as such, athletes described feelings of nervousness, reinjury anxiety, and positive excitement. Finally, similar to the behaviors during the rehabilitation phase, the athletes expressed being cautious in their return to play.

The notion that athletes reflected on their injury as a lesson learned appears to be supported in the literature. 5 , 17 – 19 For example, Tracey 5 stated that when injured, athletes often reflected on their injuries, and that doing so enabled them to learn about “oneself, inner strength and commitment, and learning not to take being healthy for granted.” Although the participants' experiences of lessons learned have been supported in the literature, so has their tendency to report doubts about their ability to return to play. 20 – 22 Additionally, previous research 17 – 21 provides more support for the emotional response of fear of reinjury when compared with the emotion of excitement, as noted by some athletes in the current sample. The resulting behavioral response, cautiousness in their return to play, appears to be directly related to athletes' fear of reinjury. 4 Johnston and Carroll 4 observed that athletes' fear of reinjury often resulted in a number of behavioral responses, including but not limited to “being hesitant, holding back, not giving 100% effort, and being wary of injury-provoking situations.”

The process of psychosocial responses seemed to be cyclical in nature (ie, cognitions influencing emotions and behaviors and vice versa) and influenced by distinct personal (ie, severity of injury diagnosis) and situational (ie, source of social support and timing of injury) factors. This is consistent with the integrated model, 6 which assumes that a number of situational and personal factors will influence the athletes' cognitive appraisal and emotional and behavioral responses (also known as the “dynamic core”) to the injury. When proposing the model, Wiese-Bjornstal et al 6 posited that these interactions are bidirectional but that they would be more dominant in the clockwise direction (ie, cognitive appraisals affect emotions, emotions affect behavior, behaviors affect cognitive appraisals), which was the case among the participants in this study.

Consistent with the original model of Wiese-Bjornstal et al, 6 these interactions among the different components of the dynamic core also appeared to be 3-dimensional and spiral-like in nature. That is, the psychosocial recovery for the athletes in this study had an “upward spiral,” meaning that as the rehabilitation advanced, their overall thoughts, emotions, and behaviors became more positive as they progressed toward successful recovery from their injuries. Also, the most notable points of change in athletes' cognitive appraisal, as well as emotional-response inclines and declines in athletes' recovery spirals, were identifiable at the different phases of recovery: initial reactions to injury (including after diagnosis), reactions to rehabilitation, and reactions to return to sport.

However, throughout the process of recovery, one factor that remained consistent was the athletes' need for social support. Injured athletes in this study sought and received social support throughout the different phases of recovery and this appeared to have a huge effect on these individuals during the course of their rehabilitation. This finding is also consistent with the model of Wiese-Bjornstal et al, 6 as the integrated model posits that social support (ie, use or disuse of social support), a situational factor, and a behavioral response are vital parts of successful recovery. Seeking and receiving support from different people (eg, parents, siblings, coach, and AT) was also evident in this study, and as such, highlighted the importance of identifying a range of sources that may be useful for injured athletes during recovery.

Application of Findings

Based on our results, we believe that in order to best assist injured athletes in their rehabilitation process, ATs should be equipped to understand and use psycho-education in their work with injured athletes. Understanding how athletes' cognitive appraisals and emotional and behavioral responses interlink during the different phases of rehabilitation can better equip ATs to understand and relate to athletes and their resulting psychosocial responses during injury rehabilitation. More importantly, ATs will then be able to use this information to better help their athletes navigate the injury-recovery process from a psychosocial standpoint. Among the areas in which we feel that ATs could be further educated is their ability to understand how individual psychosocial responses to injuries vary from 1 person to another. For example, personal factors, such as a history of stressors, self-motivation, athletic identity, and self-perceptions, and situational factors, such as teammate influences, coach influences, sport ethic, and the rehabilitation environment, can all potentially influence how 2 athletes with seemingly similar injuries may react completely differently throughout the course of their injury rehabilitation. We believe that an increased understanding of how these 2 concepts interact during the entire injury-recovery process can potentially help ATs tailor their approach to working with each athlete based on his or her psychosocial responses, which reflect different personal and situational factors.

In addition to educating athletes about the injury process from a psychosocial standpoint, athletes should also be educated about how their thoughts, emotions, and behaviors are likely to evolve in a cyclical manner throughout the entire process. More specifically, athletes should be educated that as they move through the different phases of rehabilitation, they may be faced with new challenges that could potentially require them to engage in new behaviors and will affect their thinking and emotions. Above all, we believe that it is imperative to let athletes know that as they progress through the injury-recovery process, it is normal to experience fluctuations in thoughts, emotions, and behaviors, which, on occasion, can also be negative in nature.

Finally, as social support was seen as the most constant behavioral response by the athletes in this study (they sought social support throughout the process), we believe that ATs could benefit from being further educated about social support. Understanding the mechanisms of social support and who is best suited to provide different types of social support, as well as the significance of their own role as a potential source of social support, can help ATs to work more effectively with their athletes. 23 Specifically, ATs, in conjunction with other allied health professionals, such as a sport psychologist, could educate the athletes about the importance of social support in the rehabilitation process, the different types of social support available, 23 , 24 the differences between perceived and received social support, 23 , 25 and from whom they should seek the different types of social support throughout the injury-recovery process. 23 , 26 We believe that increased education in these areas could increase injured athletes' ability to make use of the variety of social-support sources they have at their disposal. Moreover, with increased education, the effectiveness of the social support sought could also potentially increase.

Limitations and Future Directions

Although our results provided meaningful findings with regard to athletes' psychosocial responses during the various phases of injury rehabilitation, the study is not without limitations. First, the participants were a convenience sample of Division II athletes who were not representative of athletes who compete at varying levels of competition. Given the sample size, unique characteristics, and the different situational and personal factors (as stipulated by Wiese-Bjornstal et al 6 ) associated with Division II athletes, these results cannot be generalized to all settings. Additionally, participants were interviewed retrospectively; this may have resulted in poor recall of their emotions during the different phases of rehabilitation. Finally, the responses reported in this study represent only athletes with more severe injuries, and as such, cannot be generalized to athletes who sustain less severe injuries.

Nevertheless, future researchers in this area should investigate the psychosocial responses of injured athletes who compete at a variety of levels, including but not limited to high school, Divisions I and III, professional, Olympic, and senior. Additionally, it may be useful to ascertain athletes' psychosocial states before injury and possibly at a 6-month follow-up after return to play. Finally, it may also be worthwhile to use a mixed-methods approach involving the use of instruments such as the Emotional Responses of Athletes to Injury Questionnaire 27 and the Profile of Mood States. 28 , 29

In summary, injured athletes' cognitive appraisals and emotional and behavioral responses varied during the different phases of the injury-rehabilitation process. Our findings provide support for both the integrated model 6 and the different phases of rehabilitation, 3 as well as understanding how these 2 interlink. Recognizing how athletes' cognitive appraisal and emotional and behavioral responses interact during the different phases of rehabilitation can help ATs better comprehend athletes' reactions during the process and thus help them provide better care to their patients. Moreover, understanding how individual psychosocial responses to injuries are often affected by injury diagnosis warrants increased awareness from those treating injured athletes.

Sports injuries

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• Sports injuries are commonly caused by overuse, direct impact, or the application of force that is greater than the body part can structurally withstand.
• Common injuries include bruises, sprains, strains, joint injuries and nose bleeds.
• Medical investigation is important, as leaving an injury untreated can have far more severe consequences.

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Types of sports injuries, first aid for sprains, strains and joint injuries, first aid for nose bleeds, first aid for dislodged teeth, emergency situations, treatment for sports injuries, prevention of sports injuries, where to get help.

Sports injuries are commonly caused by overuse, direct impact, or the application of force that is greater than the body part can structurally withstand. There are two kinds of sports injuries: acute and chronic. An injury that occurs suddenly, such as a sprained ankle caused by an awkward landing, is known as an acute injury. Chronic injuries are caused by repeated overuse of muscle groups or joints. Poor technique and structural abnormalities can also contribute to the development of chronic injuries. Medical investigation of any sports injury is important, because you may be hurt more severely than you think. For example, what seems like an ankle sprain may actually be a bone fracture.

Some of the more common sports injuries include:

• Ankle sprain – symptoms include pain, swelling and stiffness.
• Bruises – a blow can cause small bleeds into the skin.
• Concussion – mild reversible brain injury from a blow to the head, which may be associated with loss of consciousness. Symptoms include headache, dizziness and short term memory loss.
• Cuts and abrasions – are usually caused by falls. The knees and hands are particularly prone.
• Dehydration – losing too much fluid can lead to heat exhaustion and heat stroke.
• Dental damage – a blow to the jaw can crack, break or dislodge teeth.
• Groin strain – symptoms include pain and swelling.
• Hamstring strain – symptoms include pain, swelling and bruising.
• Knee joint injuries – symptoms include pain, swelling and stiffness. The ligaments, tendons or cartilage can be affected.
• Nose injuries – either blood nose or broken nose, are caused by a direct blow.
• Stress fractures – particularly in the lower limbs. The impact of repeated jumping or running on hard surfaces can eventually stress and crack bone.

Suggestions on immediate treatment for sprains, strains and joint injuries, to prevent further damage include:

• R est – keep the injured area supported and avoid using for 48-72 hours.
• I ce – apply ice to the injured area for 20 minutes every two hours for the first 48-72 hours.
• C ompression – apply a firm elastic bandage over the area, extending above and below the painful site.
• E levation – raise the injured area above the level of the heart at all times.
• R eferral – as soon as possible, see a doctor.
• No H eat – heat will increase bleeding.
• No A lcohol – alcohol increases bleeding and swelling.
• No R unning – running or exercise increases blood flow, delaying healing.
• No M assage – massage increases swelling and bleeding, also delaying healing.

Suggestions include:

• Stop the activity.
• Sit with your head leaning forward.
• Pinch your nostrils together and breathe through your mouth.
• Hold your nose for at least 10 minutes.
• If bleeding continues past 30 minutes, seek medical advice.

It may be possible to save a tooth that has been knocked out with prompt dental treatment. Rinse the tooth in water or milk, and see your dentist immediately.

Call an ambulance for:

• prolonged loss of consciousness
• neck or spine injuries
• broken bones
• injuries to the head or face
• eye injuries
• abdominal injuries.

Treatment depends on the type and severity of the injury. Always see your doctor if pain persists after a couple of days. What you may think is a straightforward sprain may actually be a fractured bone. Physiotherapy can help to rehabilitate the injured site and, depending on the injury, may include exercises to promote strength and flexibility. Returning to sport after injury depends on your doctor’s or physiotherapist’s assessment. Trying to play before the injury is properly healed will only cause further damage and delay recovery. The biggest single risk factor for soft tissue injury is a previous injury. While the injury heals, you can maintain your fitness by choosing forms of exercise that don’t involve that part of your body, if possible.

You can reduce your risk of sports injuries if you:

• Warm up thoroughly by gently going through the motions of your sport and performing slow, sustained stretches.
• Wear appropriate footwear.
• Tape or strap vulnerable joints, if necessary.
• Use the appropriate safety equipment, such as mouth guards, helmets and pads.
• Drink plenty of fluids before, during and after the game.
• Try to avoid exercising in the hottest part of the day, between 11 am and 3 pm.
• Maintain a good level of overall fitness, particularly in the off season (in the months between playing seasons for a sport).
• Cross-train with other sports to ensure overall fitness and muscle strength.
• Ensure training includes appropriate speed and impact work so muscles are capable of the demands of a game situation.
• Don’t exert yourself beyond your level of fitness. Gradually increase intensity and duration of training.
• Use good form and technique.
• Cool down after sport with gentle, sustained stretches.
• Allow adequate recovery time between sessions.
• Have regular medical check-ups.
• In an emergency, always call 000 for an ambulance
• Your GP (doctor)
• Sports medicine clinic
• Physiotherapist
• Hospital emergency department
• Injury Factsheets External Link , Smartplay, Sports Medicine Australia (SA Branch), South Australia.

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Athletic training Hacks for sports Injury prevention

• January 29, 2021

For those of us in active populations, we all want to feel great and perform our best. However, it is very common for athletes and active individuals to experience pain and injury. While these create unfortunate experiences, there are a number of ways in which you can help prevent them before they ever happen!

What are common injuries?

In my experience, sprains, strains, and contusions are easily the “top 3” that I’ve encountered in my clinical practice. While these injuries appear to be simple, they can be experienced throughout various parts of the body to varying degrees of severity. Ankle sprains, “deep bruises,” and other injuries are very common occurrences that no patient should ever feel concerned about seeking treatment. Despite their frequency, finding ways to prevent sports injury is a very feasible goal to pursue. Sports injury prevention programs can be created by certified athletic trainers to do just that!

How can I prevent athletic injuries?

Sports injury prevention starts with a simple question – “How can I help prevent ___ injury from happening?” For the average person, knowing how and where to start a sports injury prevention program may be confusing. An excellent first step would be contacting your team’s certified athletic trainer! Injury prevention and wellness promotion are key components of an athletic trainer’s education and qualification. They see, evaluate, and treat athletic and active patients on a daily basis which makes them keenly aware of the “ins and outs” of sports injuries.

When should I seek help to prevent sports injuries?

Quite honestly, athletes and active individuals can start their injury prevention programs at any point in time! However, injury prevention programs may be most easily implemented in the off seasons and then maintained throughout an athlete “in season” period of time. Just as an athlete would start a training, weightlifting, and conditioning program when they aren’t in competition, these same athletes can implement an injury prevention program in that same timeframe. By incorporating the program earlier on in one’s training, they likely improve their chances of reducing the risk of sustaining a preventable major injury later on in the season.

Who should I see to start an injury prevention program?

Looking at the entire sports medicine team, athletic trainers are an excellent person to reach out to first. As it was mentioned earlier, these health care professionals are well trained and equipped to implement evidence-based injury prevention strategies for active populations.

Each of these injury prevention strategies for athletes and active populations can take shape in many different ways.

Sport Specific Injury Prevention Programs

Certain sports and populations often sustain particularly common injuries. Athletic trainers can help prevent athletic injuries by designing a program that is tailored to the needs and demands that a team or particular sport experiences. For example, are you playing soccer? Then your athletic trainer may help create an injury prevention program focused on training and strengthening your lower extremities to handle the extended demands of your sport.

Position Specific Injury Prevention Programs

American football is a prime example of how a single sport can have many different types of common injuries. Take a moment and think about what injuries are most common for an NFL team. It may be easy to come up with a few but it really depends on more factors than which sport an athlete is participating in. A football team is made up of many different sub-groups of athletes with different demands and needs. The injuries commonly experienced by linemen often vary in nature when compared to common injuries for “skill positions” like wide receivers and quarterbacks.

Injury Specific Prevention Programs

Have you ever suffered an ACL sprain or rupture? Do you want to prevent that from ever happening (or happening again)? Athletic trainers are well trained and educated in recognizing the contributing factors to an ACL sprain/rupture. With this training, athletic trainers can design injury prevention strategies for athletes specific to these factors and concerns.

Individualized Injury Prevention Programs

Looking at your overall wellness, athletic trainers are often aware of key signs and conditions that may pre-dispose an athlete or active person to particular kinds of injuries. After completing a thorough evaluation, athletic trainers can tailor a sports injury prevention program to the specific needs of an individual.

Don’t allow the conversation to stop there, though! Preventing athletic injuries and illnesses is best done in a teamed approach. Incorporating team physicians, physical therapists, strength and conditioning coaches, and trained diet & nutrition experts (just to name a few) can help provide insight and direction on whole-athlete wellness.

Is it ever too late to start a sports injury prevention program?

The short answer is NO! Even if you’ve sustained an injury already, the number one predictor of future injury is having a previous history of injuries. Whether you’re already injured or are wanting to prevent a sports injury in the future, take the opportunity to speak with your athletic trainer now!

The injury prevention process can be tough to navigate at times. If you’re interested in a career in helping prevent sports injuries, athletic training is an excellent place to start! Here at the University of Idaho, our athletic training programs uniquely prepare you to start your career in Sports Medicine and help contribute to solving complex solutions in the health care world! If you’re interested in a career in sports medicine, reach out and let us know! We’d love to chat with you!

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Periodization and Programming in Sports

Affiliations.

• 1 Faculty of Sport, Health and Social Sciences, Solent University, E Park Terrace, Southampton SO14 0YN, UK.
• 2 Strength and Conditioning Society, Via del Fontanile Anagnino 159, 00118 Rome, Italy.
• 3 Research Unit for Orthopaedic Sports Medicine and Injury Prevention, ISAG, UMIT Tirol, Eduard-Wallnöfer-Zentrum 1, 6060 Hall, Austria.
• PMID: 33498350
• PMCID: PMC7909405
• DOI: 10.3390/sports9020013

Periodization is a generally accepted approach to manage athletic performance by the sub-division of training programs into sequential, specifically focused training periods [...].

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Conflict of interest statement

The authors declare no conflict of interest. James Fisher and Robert Csapo did not receive any funding in support of this editorial piece or special issue.

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ARIZONA CARDINALS INJURY REPORT

Cardinals injury report: Kyler Murray good to go, Rams O-line depth clears up

Sep 13, 2024, 1:26 PM | Updated: 1:28 pm

Arizona Cardinals QB Kyler Murray (Jeremy Schnell/Arizona Sports)

(Jeremy Schnell/Arizona Sports)

BY ARIZONA SPORTS

The Arizona Cardinals’ injury report before their Week 2 home game against the Los Angeles Rams includes three players, including quarterback Kyler Murray (knee).

Murray’s name showing up on the team’s initial injury report was a surprise, but he was a full participant in practices and is cleared to play.

Cornerback Max Melton is questionable having spent the week in concussion protocols but was a full-go without a non-contact jersey at practice on Friday. He sat out Wednesday’s practice and got limited run on Thursday while wearing a yellow non-contact jersey before another upgrade Friday.

Rookie wide receiver Xavier Weaver is questionable after missing Week 1 with an oblique injury. He was limited this week but “should be good to go,” Cardinals head coach Jonathan Gannon said on Friday.

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As for the Rams, they placed receiver Puka Nacua, as well as offensive linemen Steve Avila and Joe Noteboom, on injured reserve, leaving a thin roster ahead of their matchup against the Cardinals, who had their own struggles rushing the passer against the Buffalo Bills in Week 1 .

Tight end Davis Allen, right guard Kevin Dotson and cornerback Cobie Durant all did not participate on Wednesday or Thursday.

Dotson is expected to play.

Starting right tackle Rob Havenstein, who missed Week 1’s loss to Detroit, will play after being limited with an ankle issue until going full-go Friday, Rams head coach Sean McVay told reporters Friday . That will flip last week’s starting right tackle, Warren McClendon, to left tackle after struggling with five pressures and three quarterback hits allowed last week. He also had two penalties.

Here is the injury report for the Arizona Cardinals:

Arizona Cardinals injury report vs. Rams – Week 2

Here is the Los Angeles Rams’ injury report:

Los Angeles Rams injury report

Injury Report presented by:

Arizona Cardinals Injury Report

Arizona Sports

Arizona Cardinals injury report: Rookie WR Xavier Weaver out vs. Bills

Xavier Weaver, Tip Reiman and Joey Blount are the only players listed on the Arizona Cardinals injury report for a game against the Buffalo Bills.

Cardinals-Eagles injury report: Kyler Murray questionable with illness

Arizona Cardinals quarterback Kyler Murray and receiver Hollywood Brown did not participate in practice for the second straight day.

9 months ago

Injury report: Cardinals WR Hollywood Brown, CB Garrett Williams ruled out

The Arizona Cardinals were battling injuries at wide receiver leading into their Christmas Eve game against the Chicago Bears.

Cardinals-49ers injury report: Hollywood Brown, Michael Wilson questionable

The Arizona Cardinals are back from the bye and listed several starters on the injury report for Sunday's game against the 49ers.

Cardinals-Steelers injury report: Arizona’s Michael Wilson, 2 others out

The Arizona Cardinals will be without wide receiver Michael Wilson and cornerbacks Starling Thomas and Antonio Hamilton against the Steelers.

10 months ago

Cardinals-Texans injury report: Arizona RB Emari Demercado out Sunday

The Houston Texans had a much longer injury report than the Arizona Cardinals ahead of their Week 11 matchup on Sunday.

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Conner Weigman injury update: Texas A&M QB not starting vs Florida due to reported shoulder issue

Texas A&M quarterback Conner Weigman is available in an emergency backup role against Florida on Saturday, as the second-year starter popped up on the SEC's availability report for the game as questionable prior to the matchup.

Weigman, whose injury is to his right throwing shoulder according to multiple reports, missed nearly the entirety of the 2023 season with a foot injury he suffered against Auburn in Week 4. The junior quarterback would be replaced by redshirt freshman Marcel Reed if he's unavailable.

REQUIRED READING: Texas A&M's Mike Elko: Florida QBs DJ Lagway, Graham Mertz provide unique challenges

The former five-star recruit has been shaky at times this season, completing 23 of 44 passes for 225 yards with two touchdowns to two interceptions in two starts. He was especially inconsistent in the season opener against Notre Dame, completing only 12 of 30 passes for a lackluster 100 yards with two interceptions.

Here's everything to know about Weigman's injury and his status for the Aggies ' upcoming game against the Gators on Saturday:

Conner Weigman injury update

This section will be updated as more information comes available.

Weigman won't start for the Aggies on Saturday with an injury, coach Mike Elko told the ESPN broadcast on Saturday. The updated pregame report listed Weigman as a game-time decision.

Weigman was, however, spotted warming up on the field prior to the game on Saturday, throwing passes to Texas A&M receivers. Redshirt freshman Marcel Reed will start, with Weigman serving as an emergency backup, per Elko.

Conner Weigman with his first throws on the field to Jabre Barber. (Apologies for being far away. Middle of field) pic.twitter.com/oHMN6lGNRw — David Nuño (@DavidNuno) September 14, 2024

The SEC availability report did not specify what Weigman's injury is, however, 247Sports' Carter Karels reported Saturday that his throwing shoulder is the issue. Karels added Weigman didn't look comfortable in warmups.

Weigman missed Texas A&M's final nine games last season after suffering a season-ending foot injury against Auburn in the conference opener.

What is Conner Weigman's injury?

Weigman's injury is to his right throwing shoulder, 247Sports reported Saturday. The ESPN broadcast later confirmed those reports, mentioning he was receiving injections for the pain.

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Dolphins' Mike McDaniel on Tua Tagovailoa injury: 'We just need to evaluate' after 'proper' concussion tests

The quarterback suffered another head injury thursday.

Tua Tagovailoa exited the Miami Dolphins ' Thursday night loss to the Buffalo Bills with a concussion , the quarterback's third documented head injury since 2022. Some NFL greats have already urged the 26-year-old to retire , citing his long-term health beyond football. Dolphins coach Mike McDaniel, meanwhile, told reporters after the game that Tagovailoa will "drive the ship" of his recovery after further tests.

"Right now ... it's more about getting a proper procedural evaluation [Friday], and taking it one day at a time," McDaniel said. "The furthest thing from my mind is what is the timeline. We just need to evaluate."

Tagovailoa was in "good spirits" in the postgame locker room, McDaniel said, despite leaving Thursday's contest in the third quarter, during which the quarterback's concussed "fencing" posture evoked images of his previous head injuries. The coach was "just worried about my guy" in the immediate aftermath of the injury, McDaniel said, though he declined to say whether he believes it'd be safe for Tagovailoa to continue playing, given his history of head trauma.

"For me, I'm not worried about anything that's out of my hands," he said. "I'm just worried about the human being. He'll drive the ship when we get the appropriate information. Right now, it's day-by-day health. ... From a medical standpoint, I don't approach things that I'm far inferior of expertise, I'm just there to support my teammate, like I said. For me to forecast things that I don't know in my non-field of expertise, I don't think that's appropriate."

As for what Tagovailoa's loss means to Miami's season, along with the Dolphins' blowout defeat at the hands of the Bills, McDaniel struck a more optimistic tone.

"We'll have plenty of opportunities to really take the sheer frustration and anger out on the way we approach our jobs," he said. "It's very much Week 2, and our first division game, and it feels way bigger than that because there's a lot of history to this matchup, and there was a lot of things that we thought we were gonna take care of that are definitely not taken care of. It's a gut check for the team early in the season.

"It's one loss that really cuts deep," McDaniel continued, "but that can either be a good thing or a bad thing depending on how you respond to it. I really believe in the locker room. ... And I better believe it, because it's gonna be a while before it's gonna be anybody but us believing that."

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'I feel more like myself': Bryan Mata feeling healthy as deadline looms for Red Sox return

WORCESTER — Bryan Mata is finally feeling like himself again. 

Or at least the 2022 version of the Boston Red Sox pitcher. 

After beginning the season on Boston’s injured list, Mata made his third appearance with Triple-A Worcester on Saturday at Polar Park. 

Mata pitched the final two innings of Worcester’s 4-0 win over Syracuse, allowing one hit while walking one and striking out one. He threw 30 pitches, 17 for strikes.

And with his rehab assignment set to expire on July 15, the Red Sox will have to decide what to do with the right-hander roster-wise since the club used options on Mata in 2021, 2022 and 2023 and can’t send him down to the minors again without clearing waivers. 

So just nine days away from that decision, the 25-year-old from Venezuela is feeling fortunate to be healthy.

“I’m feeling really good. I’m (happy) with where I am physically right now, and I’m just going to keep doing my thing and keep getting better,” Mata said. “I’m going to keep doing the same thing I’ve been doing for the last couple of games, throwing my pitches in the strike zone, keep being aggressive, keep competing and controlling what I can control.” 

Over the past three years, Mata hasn’t felt in control of his body. 

'I'm a mama's boy': Red Sox prospect Nick Yorke relishes his mom's first visit to Worcester

After being signed by the Red Sox in January 2016 and being ranked by Baseball America as one of the top prospects in the Red Sox system in 2018, 2019 and 2020, Mata missed all of 2021 and half of 2022 following Tommy John surgery.  

Two years ago, the righty impressed in stints across Class A, Double A and Triple A as Mata finished 7-3 (18 starts) across 83 innings to along with a 2.49 ERA and 105 strikeouts. 

But last year, a right teres major strain limited him to 27 innings with the Worcester Red Sox and a 0-3 record and 6.33 ERA.  

“I was kind of trying to find a way to put myself in a good position to pitch every five or six days here or in the big leagues, but it didn’t happen,” Mata said. “I got hurt, but now I feel more like myself. Like 2022 Bryan.” 

In 91 career minor league games (87 starts), Mata is 25-23 with a 3.52 ERA with 392 strikeouts in 383 innings. 

Chatted with Bryan Mata after his third rehab outing with Triple-A Worcester. The 25-year-old righty has 9 days to either be called up to the Boston Red Sox or be put on waivers (he’s out of minor league options). Mata (2 IP, 1 H, 1 BB, 1 K) talks about his relief appearance. pic.twitter.com/q5PZ5UOAQj — Tommy Cassell (@tommycassell44) July 6, 2024

Mata started this season on the IL (since March 25) after suffering a right hamstring strain. His first rehab stint began with the Florida Complex Red Sox (one start on May 13), Class-A Greenville (one start on May 18), and one more start with Double-A Portland on May 23 before going back on the injured list with a lat issue.  

His latest rehab assignment began June 16 with Portland, and in two starts for the Sea Dogs (June 16 and 21), Mata tossed five scoreless innings. He has allowed five hits and three runs in 6⅓ innings and three appearances with Worcester.   

“His arm looks like the Mata of old,” WooSox manager Chad Tracy said, “which is nice to see.” 

“I think being able to get through outings, being able to maintain his (velocity) has been great in the outings,” Red Sox director of player development Brian Abraham said. “You know, we haven't stretched him out too far, but multiple innings to me is a huge positive, and then I think the ability to be in the zone consistently, he's got really good stuff, above average stuff when he's healthy. I think being able to throw that in the zone has been really, to me, the difference between getting outs and not.” 

The plan for Mata, for now, is probably to pitch at least one more time before the looming deadline of his potential recall to the Red Sox in a few weeks.  

“For us, the most important thing is getting him through the rehab stint and having him feel like he can compete and make an impact at that major league level,” Abraham said. “And then, like I said, you know, the leadership group and (Red Sox chief baseball officer Craig Breslow) will get together and decide what is ultimately best for Bryan and best for the organization.” 

No matter the decision, Bryan Mata is just glad to be back pitching and feeling healthy again. 

“I just want to be able to help the team win, either here or with the high level with the big-league team. If I feel good, I just want to play. Even if I’m pitching one inning, two innings, six innings, I just want to compete and be there with my teammates,” Mata said. “It’s been a couple crazy years. It’s hard because nobody wants to be hurt or without being on the field, but I took time to (learn) more about myself and get strong in my mind in the right way. 

“Like I said before, control what I can control. When I’m healthy, I know what I can do.” 

—Contact Tommy Cassell at [email protected]. Follow him on X, formerly known as Twitter, @tommycassell44. 

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Mets ‘concerned’ with francisco lindor’s back but confident injury isn’t serious.

PHILADELPHIA — If there’s one thing the Mets can’t afford as they try to secure a playoff spot, it’s losing Francisco Lindor. 

Though the shortstop and Carlos Mendoza are confident the lower back soreness that knocked Lindor out of Friday’s 11-3 win over the Phillies isn’t serious, the Mets will no doubt be holding their collective breath until he’s back on the field. 

“It takes a lot to get Francisco out of a game,” Brandon Nimmo said. “We’re definitely concerned for him. We know he’s obviously a huge part of this team. We wouldn’t be here without him.” 

Lindor suffered the injury in the top of the sixth when he stepped awkwardly onto second base after his base hit to center scored Harrison Bader to give the Mets a 7-0 lead. 

Lindor said he didn’t expect the throw to get to second as quickly as it did and by the time he realized it was coming, it was too late for him to slide. 

He stepped off the base and got caught in a rundown between second and third before he slipped and was tagged out. 

Lindor remained in the game and played defense in the bottom of the sixth before he was removed the next inning. 

On whether he expected to play Saturday, Lindor said, “I hope so. I pride myself on being available every day.” 

In a closer game, Lindor said he probably would have stayed on the field, but the team opted not to push it. 

Mendoza called Lindor day-to-day. He’s played in every game this season. 

Asked if he was worried the soreness might cost him time, Lindor said, “I hope not,” adding it was still “tight” following the win. 

He received treatment during the latter part of the game and said he would see how he felt when he woke up Saturday before he and the Mets decided whether he would be back in the lineup. 

With Lindor out of the game, Jose Iglesias moved from second base to short and newcomer Eddy Alvarez entered the game at second. 

The Mets don’t have a true backup shortstop and are already monitoring Iglesias’ playing time at second base with Jeff McNeil out for the rest of the regular season.

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Russian attack on village in Ukraine's Kharkiv region kills three, injures nine

(Reuters) -Russian shelling on Thursday killed three people and injured nine in a village in northeastern Ukraine's Kharkiv region, regional prosecutors said.

A statement said one person died of his injuries in hospital after the attack on the village of Borova, southeast of Kharkiv. Kharkiv is Ukraine's second largest city and a frequent target of Russian strikes.

The Interior Ministry had earlier reported emergency services were working at the site of the initial attack when Moscow's troops shelled it again. Three rescuers were among the injured.

Prosecutors also reported that five people were injured in a Russian airstrike on the city of Kharkiv's Kyivskyi district.

Officials in the adjacent border region of Sumy said Russian forces had pounded border areas 57 times throughout the day, with an attack by glide bombs killing one person near the town of Yampil.

Sumy region lies opposite southern Russia's Kursk region, where Ukrainian forces are engaged in an incursion launched last month.

(Reporting by Yuliia Dysa; Editing by Andrew Cawthorne, Ron Popeski, Jonathan Oatis and Diane Craft)