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A BRIEF OVERVIEW OF
THE PSYCHOLOGICAL ASPECTS OF INJURY
by Lucinda Sharp
Research has shown that people with the same tissue damage can feel very
different levels of pain and that people with the same injuries recover
at different rates
From a psychological perspective, I believe there
are three very important issues that dance practitioners, teachers and
students need to recognise
about injuries:
- psychosocial factors can predispose a dancer to
injury;
- different people
have different psychological responses to injury, and
- certain responses
can be problematic for successful recovery from injury.
Factors that predispose dancers to injury
The likelihood of injury
tends to increase in times of general life stress (e.g. change in residence,
family problems, death of a loved
one) or
dance-related stress (e.g. troubled relationship with a teacher, upcoming
performances or exams). A possible explanation for this is that the
anxiety caused by such events leads to increased muscle tension, which
in turn
can reduce motor coordination and flexibility. This also suggests that
dancers who are generally anxious are at a higher risk of experiencing
injury.
Individual differences in response to injury
Individual responses to injury vary in accordance with several psychological
factors. For example, dancers whose sense of self is strongly defined
in terms of their identity as a dancer tend to experience a loss of
self-esteem when they cannot dance. For these dancers, the fact that
personal identity
has only one basis means that time out can cause feelings of anxiety,
depression, confusion and hopelessness – usually precipitating
a return to the studio before they are physically ready (young dancers
should be encouraged to entertain a range of interests in order to
develop a sense of self that is not totally reliant on identity as
a dancer).
The way in which dancers appraise their injury also plays a role in
injury response. For example, an anxious personality style is more
likely to
produce a catastrophic appraisal (‘this is the worst thing that’s
ever happened to me – it’ll probably mean the end of my career’).
This type of negative appraisal is likely to be followed by an overly
emotional or hysterical reaction whereas a more positive appraisal (‘this
sort of thing happens to most dancers – I’m sure I’ll
be OK soon if I get the right help’) is more likely to invoke
a more balanced emotional reaction.
secondary gain’. Although
dancers may only be conscious of the negative aspects of an injury,
there are
some benefits to being injured that can reinforce and maintain injuries.
For example, being injured may mean extra attention and social support
(which may boost self-esteem), an escape from the pressure of training,
exams, or performances (possibly associated with some insecurities
about technique), or a socially acceptable way of giving up dancing.
It is
important to remember that secondary gain is usually subtle and unconscious
and it is up to the individual dancer to take a close look at their
injury to see if there is any possibility that secondary gain is playing
a part
in keeping them away from the studio.
Individual differences in the recovery process
Recovery from injury is a function of the dancer’s personal response – a
positive outlook can enhance recovery while a negative response can
hamper recovery. The most common signs of problematic adjustment to
injury include
recommencing dance activities too soon (suggesting denial of, or an
inability to accept, the extent or severity of the injury); prolonged
negative
emotions such as anger, depression, confusion and apathy; behavioural
indicators of a depressive reaction such as irritability, rapid mood
swings, withdrawal from significant others (family, friends, teachers,
etc.) and remarks that reflect guilt and/or helplessness; and prolonged
over-dependence on a medical therapist (possibly reflecting an inability
to take personal responsibility for the rehabilitation process).
Factors that tend to facilitate recovery include healthy self-esteem
and an optimistic outlook (optimists have been shown to cope more effectively
after injury), taking personal responsibility for the rehabilitation
process (e.g. making the relevant appointments, developing a rehabilitation
schedule, engaging in discussion with rehab personnel, setting realistic
rehab goals), the ability to get involved in interests outside dance
or develop another role within the dance environment (e.g. assisting
with teaching or rehearsals) and appropriate social support from significant
others (typically, injured dancers do not want too much sympathy or
over-protection or to be seen as ‘disabled’. Rather, they
need to maintain contact with peers and be given practical and emotional
support, they
need to be able to talk about their situation and be motivated through
rehab).
For those who participate in dance activities, particularly in a full
time capacity, experiencing some form of acute or chronic injury is
probably inevitable. Dancers respond in different ways to injury, and
developing
an understanding of one’s personal response can serve to facilitate
recovery. For those interested in reading further on this topic there
was a good review article published in the Journal of Dance Medicine & Science,
Volume 5, Number 4 entitled And the dance goes on: Psychological Impact
of Injury (Mainwaring et al., 2001). Jean William’s book Applied
Sport Psychology: Personal Growth to Peak Performance (Mayfield Publishing
Co, 1993), also has a good chapter on injury among athletes.
Lucinda Sharp is a former dancer and a psychologist based at The Australian
Ballet School.
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