Are perfectionistic and stressed athletes the main victims of the «silent epidemic»? A prospective study of personal and interpersonal risk factors of overuse injuries in sport

Background: Overuse injuries (OI) account for a substantial part of sport injury incidence among athletes of various sports and levels. They lead to serious consequences for athletes’ physical and mental health, as well as athletic performance. Despite the gradual onset of symptoms, athletes often persevere in training and competing. The present study aimed to identify psychological risk profiles suggested to explain maladaptive behaviors prior or in response to first signs of overuse injuries. Design: Prospective cohort study. Methods: 149 athletes representing 10 individual and team sports responded to a range of questionnaires regarding personal (athletic identity, perfectionistic concerns, grit and negative life stress) and interpersonal (coach-athlete relationship) psychological traits. By using the mobile application Briteback®, participants subsequently answered the OSTRC Overuse Injury Questionnaire on a weekly basis during a 10 weeks period. A latent profile analysis was used in order to identify different psychological profiles. Results: Athletes were classified into 3 latent profiles regarding their psychological characteristics: profile 1 was labelled a “perfectionistic OI risk profile”, profile 2 a “negative stress OI risk profile” whereas profile 3 was called a “low risk profile for OI”. Indeed, athletes in profile 1 and 2 were found to be significantly more often affected by overuse problems than individuals in profile 3 (71% of the time, χ² (2) = 9.62, Hedges’ g = (0.71), p < .01 and 70% of the time χ² (2) = 9.13, Hedges’ g = (0.68), p < .01 vs 45% of the time), with athletes in profile 1 also experiencing more substantial overuse problems than for profile 3 (35% vs 21% of the time; χ² (2) = 4.12, Hedges’ g = (0.50), p < .05). Conclusions: Our findings support the existence of two “risk profiles” in which athletes are characterized either by elevated perfectionistic concerns or by high negative stress. These findings could be explained by the perseverative and rigid personality of perfectionistic concerns individuals and by the hypothesis of a synergy between psychological and physiological stress for negative stressed athletes. Coaches should pay particular attention to the psychological characteristics of their athletes in order to prevent overuse injury occurrence and worsening, especially those with high perfectionistic concerns and negative life stress. Cognitive behavioral interventions supporting at-risk athletes in reframing their rule-governed behaviors might decrease the risk of overuse problems