Evaluation of Return to Sport and Anxiety in Injured Team Athletes: A Mixed Methods Study

Year 2025, Volume: 16 Issue: 1, 229 - 252, 30.04.2025

Canan Turgut , Serap Cavkaytar , Serdar Kocaekşi

https://doi.org/10.54141/psbd.1574316

Abstract

This study aimed to evaluate the return to sport and anxiety in athletes with anterior cruciate ligament injury. It was conducted using an exploratory sequential mixed design in mixed methods research. In the first phase of the study, 185 athletes (87 women and 98 men) with anterior cruciate ligament injuries were included in the quantitative dimension. In the qualitative dimension, semi-structured interviews were conducted with 18 athletes. In the quantitative and qualitative findings obtained, significant differences were obtained in terms of the return to sport and anxiety states of athletes with an anterior cruciate ligament injury in terms of the branch, league level, duration of return to sport, and age variables. Qualitative findings were used to support the results obtained from quantitative data. At this point, in the qualitative findings, the anxiety experienced by the athletes was very high. They emphasized that the change in the league level did not affect the process of return to sport. It was reported that athletes feared re-injury on return and were concerned that they would not be able to return to their previous performance. In other results related to qualitative findings, the importance of positive social support and physiotherapy support for injured athletes was emphasized. In their opinions about psychological support during the injury process, it was stated that psychological support is important for athletes in this process and that support should be obtained from expert sports psychologists, especially if needed.

Keywords

Anterior cruciate ligament injury, Anxiety, Explanatory sequential design, Return to sport

References

• Afacan, E. & Demir., M. (2022). Profesyonel futbolcuların psikososyal (mental) destek gereksinimlerinin araştırılması. Akdeniz Spor Bilimleri Dergisi, 5(1), 403-413. https://doi.org/10.38021/asbid.1203609
• Alshetıwı, H. M. (2022). Amatör futbolcularda sakatlanma kaygı düzeylerinin bazı değişkenlere göre incelenmesi. Yüksek Lisans Tezi. İstanbul: İstanbul Gelişim Üniversitesi, Lisansüstü Eğitim Enstitüsü.
• Anderson, M. B. & Williams, J. M. (1988). A model of stress and athletic injury: Prediction and prevention. Journal of Sport and Exercise Psyhology, 10 (3), 294-306. https://doi.org/10.1123/jsep.10.3.294
• Ardern, C. L., Österberg. A., Tagesson. S., Gauffin. H., Webster. K. E., & Kvis. T. J. (2014). The impact of psychological readiness to return to sport and recreational activities after anterior cruciate ligament reconstruction. Br J Sports Med, 48 (22), 1613-1619. https://doi.org/10.1136/bjsports-2014-093842
• Aydoğan, Z., Kerkez, F. İ., Can, S. & Manav, G. (2022). Spor yaralanmalarının psikolojik etkilerinin değerlendirilmesi. Akdeniz Spor Bilimleri Dergisi, 5(2), 278-290. https://doi.org/10.38021/asbid.1122253
• Brewer, B. W., Van Raalte, J. L & Linder, D.E. (1991) Role of the sport psychologist in treating injured athletes: A survey of sports medicine providers. Journal of Applied Sport Psychology, 3(2), 183-190. https://psycnet.apa.org/doi/10.1080/10413209108406443
• Brewer, B. W. (2009). Injury prevention and rehabilitation. Sport Psychology. International. Brewer. B.W (Editor), Handbook of sports medicine and science sport psychology (s. 75-87). Blackwell publishing.
• Cassidy, C. M. (2006). Understanding sport injury anxiety. Sport psychology and counseling. Athletic therapy today. Human Kinetics, 11(4), 57-58.
• Clare, L., Joanna Kvist, & Kate E. (2015). Psychological aspects of anterior cruciate ligament injuries. Operative Techniques in Sports Medicine, 24 (1), 77-83. https://doi.org/10.1053/j.otsm.2015.09.006
• Creswell, J., Plano Clark. V. (2020). Karma yöntem araştırmaları tasarımı ve yürütülmesi. (Çev: Y. Dede ve S.B. Demir). Ankara: Anı yayıncılık.
• Clement, D., Arvinen-Barrow. M., & Fetty.T. (2015). Psychosocial responses during different phases of sport-injury rehabilitation: A qualitative study. Journal of Athletic Training, 50(1), 95–104. https://doi.org/10.4085/1062-6050-49.3.52
• Evans, L., Wadey, R., Hanton, S., & Mitchell, I. (2012). Stressors experienced by injured athletes, Journal of Sports Sciences, 30(9), 917-927. https://doi.org/10.1080/02640414.2012.682078
• Estepp, M. K. (2013). NCAA Division I athletic trainers' perceptions and use of psychological skills during injury rehabilitation. Master's Thesis, Konoxville: University of Tennessee.
• Forsdyke. D.M. (2020). Psychosocial factors and return to sport outcomes in football: A mixed methods approach. Degree of Doctor of Philosophy. London: York St John University.
• Golafshani, N. (2003). Understanding reliability and validity in qualitative research. The Qualitative Report, 8(4), 597-606. https://doi.org/10.46743/2160-3715/2003.1870
• Güler, Y.E. (2022). Hentbolcularda yaralanma kaygısı düzeyinin farklı değişkenler açısından incelenmesi. Spor Eğitim Dergisi, 6 (2). 99-108. https://doi.org/10.55238/seder.1147358
• Grinberg. A. (2023). Re-injury Fear and Anxiety Following Anterior Cruciate Ligament Injury. Let’s Get Our Constructs Straight!. JOSPT Open Published Online: October 27, 2(1) Pages4-7. https://doi.org/10.2519/josptopen.2023.0807
• Kabak, S. & Çelik, A. (2022). Spor alanı ile ilgili özel yetenek sınavına girecek olan bireylerin branşlarına göre spor yaralanma kaygı düzeylerinin incelenmesi. Akdeniz Spor Bilimleri Dergisi, 5(1), 444-454. https://doi.org/10.38021/asbid.1206245
• Kayhan, R. F., Yapıcı, A. & Üstün, D.Ü. (2019). Kadın sporcuların yaralanma kaygılarının çeşitli değişkenlere göre incelenmesi. Sportif Bakış: Spor ve Eğitim Bilimleri Dergisi, 6 (1), 276-287. https://doi.org/10.33468/sbsebd.109
• Kirk, J. & Miller, M. L. (1986). Reliability and validity in qualitative research. Sage Publications, Thousand Oaks, CA.
• King, J., Burgess, T. L., Hendricks, C., & Carson, F. (2023). The coach’s role during an athlete’s rehabilitation following sports injury: A scoping review. International Journal of Sports Science & Coaching, 18(3), 928-944. https://psycnet.apa.org/doi/10.1177/17479541221150694
• Liu, S., & Noh, Y. E. (2024). The effectiveness and applicability of mindfulness intervention in psychological adaptation after sports injury: a systematic review. Australian Journal of Psychology, 76(1). https://doi.org/10.1080/00049530.2024.2357627
• Maddison, R. (2006). Sport related injury: Prediction, prevention, and rehabilitation. A psychological approach. Doctor of Phılosophy Thesis. New Zealand: University of Auckland.
• McNeil D. G, Lindsay R. S., Worn R., Spittle, M., & Gabbett T. J. (2025). Could Motor Imagery Training Provide a Novel Load Management Solution for Athletes? Recommendations for Sport Medicine and Performance Practitioners. Sports Health. 17(1):156-163. https://doi.org/10.1177/19417381241297161
• Mills, G. E. (2003). Action research. A guide for the teacher researcher. Upper Saddle River, NJ: Pearson Education, Inc.
• Miles, M, B., & Huberman, A. M. (1994). Qualitative data analysis: An expanded Sourcebook. (2nd ed). Thousand Oaks, CA: Sage
• Namlı, S. & Buzdağlı, Y. (2020). Aktif sporcuların yaralanma sonrası kaygı düzeylerinin incelenmesi. Gazi Beden Eğitimi ve Spor Bilimleri Dergisi, 25(4), 469-480.
• Newton, C., & Chu, T. L. (Alan). (2024). Rehabilitation Profiling for Injured Elite Athletes: A Case Study with Implications for Rehabilitation, Recovery, and Return-to-Sport Transitions. Journal of Sport Psychology in Action, 16(1), 5–17. https://doi.org/10.1080/21520704.2024.2359699
• Noh, Y. E. (2005). Psychosocıal intervention for the prevention of injury in dance. Doctor of Phılosophy Thesis. Melbourne: Vıctorıa University.
• Patton. M. Q. (2002). Qualitative research and evaluation methods (3rd ed.). Thousand Oaks, CA: Sage Publications.
• Patton, M. Q. (2014). Qualitative Research & Evaluation Method. Sage Publication.Page: 520
• Putukian, M. (2016). The psychological response to injury in student athletes: a narrative review with a focus on mental health. Br J Sports Med, 50, 145–148. https://doi.org/10.1136/bjsports-2015-095586
• Podlog, L., Eklund, R. C. (2009). High-level athletes’ perceptions of success in returning to sport following injury. Psychology of Sport and Exercise, 10, 535–544. https://psycnet.apa.org/doi/10.1016/j.psychsport.2009.02.003
• Podlog, L., Banham, S. M., Wadey, R., & Hannon. J. C. (2015). Psychological readiness to return to competitive sport following injury: A Qualitative Study. The Sport Psychologist, 29, 1-14. https://psycnet.apa.org/doi/10.1123/tsp.2014-0063
• Piussi, R., Berghdal, T., Sundemo, D., Grassi, A., Zaffagnini, S., Sansone, M., Samuelsson, K., & Senorski. E.H. (2022). Self reported symptoms of depression and anxiety after ACL Injury. The Orthopaedic Journal of Sports Medicine,10(1),1-9. https://doi.org/10.1177/23259671211066493
• Rex. C. C & Metzler. J. N. (2016). Development of the sport injury anxiety scale. Measurement in Physical Education and Exercise Science, 20(3), 146-158. https://psycnet.apa.org/doi/10.1080/1091367X.2016.1188818
• Saki, U & Çankaya, S. (2022). Üniversite oyunlarına katılan futbolcularda spor yaralanması kaygı düzeyi ile çok alanlı kararlılık arasındaki ilişkinin incelenmesi. Spor Bilimleri Araştırmaları Dergisi, 7(2), 498-514. https://doi.org/10.25307/jssr.1120485
• Saldana, J. (2022). Nitel araştırmacılar için kodlama el kitabı. (Çev: A. Tüfekçi., S.N. Şad). Ankara: Pegem Akademi.
• Scherzer, C. B., Brewer, B. W., Cornelius, A. E., Van Raalte, J. L., Petitpas, A. J., Sklar, J. H., Pohlman, M. H., Krushell, R. J., & Ditmar. T. D. (2001). Psychological skills and adherence to rehabilitation after reconstruction of the anterior cruciate ligament. J Sport Rehabil, 10, 165-172.
• Russel. H.C., Arendt. E.A., Wiese Bjornstal.D.M. (2024) Psychological Responses During Latter Rehabilitation and Return to Sport After Anterior Cruciate Ligament Reconstruction Surgery. J Athl Train. 59 (6): 627–632. https://doi.org/10.4085/1062-6050-0058.23
• Şahin, M. & Türksoy, A. (2017). Ön çapraz bağ yaralanması geçiren futbolcuların psikolojik sağlamlıklarının İncelemesi üzerine nitel bir araştırma. The Journal of Social Science, 16, 51-65. http://dx.doi.org/10.16990/SOBIDER.3870
• Tanyeri, L. (2019). Farklı branş sporcularında yaralanma kaygısının incelenmesi. Uluslararası Toplum Araştırmaları Dergisi, 9 (13), 577-591. https://doi.org/10.26466/opus.588668
• Tomalski, J. L. (2013). The relatıonshıp between coping and sport injury anxıety among college athletes. Degree Master of Science. North Carolina: The University of North Carolina.
• Tjong, V. K., Murnaghan, L., Nyhof-Young, J. M., & Ogilvie-Harris, D. J. (2013). A qualitative investigation of the decision to return to sport after anterior cruciate ligament reconstruction. The American Journal of Sports Medicine, 20(10),1-7. https://doi.org/10.1177/0363546513508762
• Trainor, L. R. (2018). The rebalancing act: Women’s experiences of psychological well-being during serious sport injury. Degree of Master of Arts. Vancover: The University of British Columbia.
• Tranaeus. U., Gledhill. A., Johnson. U., Podlog.L., Wadey. R., Bjornstal. D.W., & Ivarsson. A. (2024). 50 Years of Research on the Psychology of Sport Injury: A Consensus Statement. Sports Medicine 54:1733–1748. https://doi.org/10.1007/s40279-024-02045-w
• Truong, L. K., Mosewich, A. D., Miciak, M., Losciale, J. M., Li, L. C., & Whittaker, J. L. (2025). Social support and therapeutic relationships intertwine to influence exercisebehavior in people with sport-related knee injuries. Physıotherapy Theory And Practıce Vol. 41, No. 1, 139–152. https://doi.org/10.1080/09593985.2024.2315520
• Ünver, Ş., Şimşek E., İslamoğlu İ. & Arslan H. (2020). Universite takımlarında yer alan sporcuların yaralanma kaygı düzeylerinin Iincelenmesi. Beden Eğitimi ve Spor Bilimleri Dergisi, 14(3), 400-410.
• Webster, K.E., Feller, J.A., Lambros, C. (2008). Development and preliminary validation of a scale to measure the psychological impact of returning to sport following anterior cruciate ligament reconstruction surgery. Phys Ther Sport, 9(1), 9–15. https://doi.org/10.1016/j.ptsp.2007.09.003
• Williams, D. M. (2019). Pshychological health of injured college athletes. Master of Arts in Psychology, Houston: Houston Baptist University.
• Quan, G., Xiao, H. & Chen, Y. Exploring the mechanisms influencing psychological adaptation in athletes in high-risk sports: a moderated mediation model. Sci Rep 15, 2259 (2025). https://doi.org/10.1038/s41598-025-86432-x
• Yao, Z., Al-Hashimy, H. N. H., & Yao, J. (2025). Psychosocial impact and rehabilitation strategies for basketball-related injuries: SEM-PLS analysis. WORK, 0(0). https://doi.org/10.1177/10519815241300290
• Yıldırım, A & Şimşek, H. (2006). Nitel araştırma yöntemleri. Ankara: Seçkin Yayıncılık.