Walden, Häglund and Ekstrand (2005) studied men's professional soccer ..... from 58 to 60 (out of a maximum score of 90) and those of the MIS from 58 to 57, in ...
Intervention based on Mindfulness for the Rehabilitation of an Injured Sportsperson: a Case in Professional Soccer
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RESUMEN:el gran número de lesiones en el deporte y concretamente en fútbol se está convirtiendo en un problema prioritario para los profesionales que trabajan con deportistas. El estudio de la epidemiologia de la lesión y de las complejas variables que intervienen el el proceso de recuperación del deportista lesionado nos obliga a incorporar nuevas técnicas de intervención. En este estudio se propone una intervención basada en mindfulness o atención plena como complemento al protocolo de rehabilitación de un futbolista lesionado. Durante ocho sesiones se trabajan aspectos teóricos y prácticos y se evalúan variables psicológicas y fisiológicas antes durante y después de la intervención. Con las limitaciones que presenta un estudio aplicado de caso único, podemos sugerir que, con los resultados obtenidos, este tipo de intervenciones pueden ser de utilidad en la rehabilitación de deportistas profesionales lesionados; ya que hay una mejora de la percepción subjetiva del estado y de mejora de la coherencia cardiaca entre otros componentes; debiéndose mejorar y ampliar la investigación en este ámbito de aplicación. PALABRAS CLAVE: lesión deportiva, psicología del deporte, fútbol, mindfulness ABSTRACT: The large number of sport injuries, especially in soccer, is becoming an important problem for the professionals who work with sportspeople. The study of sport’s injuries epidemiology and the complexity of the variables that are present in the sportsperson’s recovery process make us incorporate new intervention techniques. In this study a mindfulness-based intervention is proposed as a complement to rehabilitation of an injured soccer player. Over eight sessions, theoretical and practical aspects are worked on and psychological and physiological variables are evaluated before, during and after the intervention. With the limitations of a study like this, we can suggest that this kind of interventions can be useful in rehabilitation of injured sportspeople. There is an improvement in subjective perception of state and in cardiac coherence, among other variables, and it is therefore recommended to increase the research in this field. KEY WORDS: sport injury, sport psychology, soccer, mindfulness
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Intervention based on Mindfulness for the Rehabilitation of an Injured Sportsperson: a Case in Professional Soccer
A considerable amount of injuries occur on playing soccer. Historically, the epidemiology of soccer injuries has been studied in depth (Hawkins and Fuller, 1999; Hägglund, Walden and Ekstrand, 2003; Olmedilla, Andreu, Ortin and Blas, 2009; Llana, Pérez and Lledó, 2010; Palmi, 2014). In relation to high-performance soccer, there are many examples of the incidence and importance of the number of injuries: Hawkins, Hulse, Wilkinson, Hodson and Gibson (2001) carried out a study on 91 English professional soccer clubs and observed that the players lose between 24 and 40 days of training and that 78% of players lost at least 1 competition match due to injury. Walden, Häglund and Ekstrand (2005) studied men’s professional soccer matches in the 2001-2002 Champions League (sample of 266 soccer players) and found a total of 658 injuries (30.5 for every 1000 hours of match and 5.8 for every 1000 hours of training). In Spain, Noya and Sillero (2011) studied 28 Spanish professional teams in the 2008-09 league and recorded 2184 injuries (8.94 for every 1000 hours of sport exposure) with an average incidence of 909 days lost per team. To provide an idea of the size of the problem, according to Cos, Cos, Buenaventura, Pruna and Ekstrand (2010), in highlevel soccer there are 9 injuries for every 1000 hours of play (training and competition). This prevalence, according to the authors, would be comparable to having 9 employees off work each week in a company with 25 employees. This situation has a high impact on the well-being and performance of the sportsperson and also reflects their both family and sport environment. Tackling this situation requires a multidisciplinary approach, as the injury can have numerous and complex causes. Various authors (Abenza, 2010; Heil, 1993, Palmi, 2001; 2014) talk of two types of factors that could cause the injury: internal factors (medical-physiologicalbiomechanical and psychological aspects) and external factors (sport infrastructurematerial and conduct of other sportspeople). It is therefore noteworthy that this differentiation should be taken fully into account for intervention proposals to prevent injury.
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The aim of the intervention presented in this study is to assess the effectiveness of mindfulness in the recovery of an injured professional soccer player. Kabat-Zinn (1990) defines mindfulness as awareness that arises from intentionally paying attention to experience as it is in the present moment, without judgment, without evaluating it or reacting to it. This methodology is being used with good results in sport psychology to improve sport performance, as it demonstrates its effectiveness on reducing variables such as anxiety and/or helping to manage stress factors (Gardner and Moore, 2012). Our proposal is that work based on mindfulness can help in the recovery of an injured sportsperson, given that factors such as anxiety, acceptance, body awareness, fear of relapse or treatment adherence are of vital importance in the correct rehabilitation of a sportsperson and their subsequent re-adaptation to competition (Maddisson and Prapavessis, 2005; Olmedilla, Ortega, Abenza and Boladeras, 2011; Palmi and Solé, 2014) Methodology Design Single case study (N=1), with 3 phases: pre-test, intervention and post-test. The injury and intervention process shown thus follows the following timeframe: March
April
June
October
2014
2014
2014
2014
Injury
16/3
Surgery
28/3
Start interv. End interv. Medical
November February 2014
2015
24/4 17/6 25/10
discharge First match Monitoring
2/11 26/2
Table 1: Timeframe of the injury and intervention process
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Sample The intervention is carried out with a 28-year-old professional soccer player, from a Second Division B team (Spanish league), who suffered from a torn anterior cruciate ligament of the right knee, having undergone a surgical operation. When the intervention with the soccer player began, he was beginning a program of conventional physiotherapy treatment following the surgery. Variables and material Physiological variables: systolic and diastolic blood pressure (BP) and heart rate (HR), evaluated with Omron M3 from OMRON Healthcare Co. (Japan) and cardiac coherence (CC), evaluated with Emwave technology (Emwave Pro ® Coherence System, Healmath). Environmental variables: temperature and humidity, evaluated with the weather station Oregon Scientific ©, model BAR826. Psychological variables: mood, evaluated with the Profile of Mood States (POMS) questionnaire of McNair, Norr and Droppleman (1971), validated in Spanish by Andrade, Arce and Seaoane (2002). This questionnaire consists of 58 items and evaluates six dimensions (stress, depression, anger, vigor, fatigue and confusion) on a Likert scale from 0 to 4. Socio-sport values: these were evaluated using the Sport Injury Questionnaire (SIQ) created specifically for this study, which consists of 3 parts: personal data, sport data and injury background. It includes the emotional variables perceived: daily stress factors, anxiety level, trainer demands, motivation, attention and psychological resources on the day of the injury, evaluated on a Likert scale from 1 to 5 (Appendix 1). Mindfulness Level: evaluated with the Mindful Attention Awareness Scale (MAAS), created by Brown and Ryan (2003) and validated in Spanish by Soler, Tejedor, FeliuSoler, Pascual, Cebolla, Soriano, Álvarez and Pérez (2012). It is comprised of 15 items (Likert scale 1-6); and the Mindfulness Inventory for Sport (MIS), the first scale for the evaluation of mindfulness in sportspeople, created by Thienot, Jackson, Dimmock, Grove, Bernier and Fournier (2013) and currently being validated in Spanish by our
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team. It consists of 15 items which evaluate 3 dimensions (capacity to be aware, not to judge and to know how to refocus), evaluated on a Likert scale from 1-6. Emotions: evaluated with the Positive and Negative Affect Schedule (PANAS), a scale of emotional states created by Watson, Clark and Tellegen (1988) and validated in Spanish by Sandin, Chorot, Lostao, Joiner, Santed and Valiente (1999). It is made up of 20 items (Likert scale from 1-5) which evaluate positive and negative effects. Assessment of the session (AS): subjective assessment carried out by the soccer player, rating from 0 to 10 (with criteria of learning carried out, interest, intra-session comfort), also asking him in a qualitative manner what he liked the most and what he found the most tedious/difficult. Field diary (FD): in each session, the therapist recorded the evolution of the work carried out and of the signs of evolution of the sportsperson (goals of each session, work carried out and evaluation of the session by the therapist. Procedure Ten work sessions were initially planned, based on mindfulness complementing conventional physiotherapy treatment and a further 2 sessions of post-intervention evaluation. Due to prior commitments of the soccer player, only 9 sessions of the intervention program initially foreseen could be held, in addition to a tenth post-test evaluation session and an eleventh monitoring evaluation 8 months after the end of the intervention. All the sessions were held in the medical services area of the club, with the consent both of the player and of the medical and technical team. Each session consisted of a work time of some 50 minutes, distributed as follows: 5 minutes to discuss aspects of the week or of the work carried out at home. 5 minutes to take pre-session measurements (for BP, HR and CC 2 recordings). 10 minutes to set out the theoretical part. 20 minutes to carry out the practical part. 5 minutes to take the post-session measurements (for BP, HR and CC 2 recordings). 6
5 minutes for final comments. Apart from this, daily work at home of 15-20 minutes is recommended, the proposal varying in accordance with the sessions.
The contents of each session can be seen in table 2: Explanation of the program, informed consent, pre-intervention
Session 1
evaluation: Sport Injury Questionnaire (SIQ), Mindfulness Inventory for Sport (MIS), planning the schedule of sessions with the player. Session 2
Mindfulness and sport. Mindful breathing, body scan (1).
Session 3
Automatic pilot vs mindfulness. Mindful stretching.
Session 4
Breathing and body. Body-Scan
Session 5
Analysis of the video of the day of the injury.
Session 6
Emotions and thoughts in the sport situation. Sitting meditation (2).
Session 7
Pain management through mindfulness. Proprioception exercises using mindfulness (3)
Session 8
Observing and identifying bodily sensations. Body-Scan
Session 9
Management of emotions through mindfulness. Meditation of emotions (4).
Session 10
Post-intervention evaluation.
Session 11
Monitoring evaluation after 8 months.
Table 2. Protocol for the intervention sessions. (1) Body Scan: body awareness exercise with mindfulness (2) Sitting meditation: focus on listening to the body and breathing in seated position (3) Proprioception with mindfulness: carry out proprioceptive exercises in support of lower extremities with maximum mindfulness in relation to the body, breathing and sensations. (4) Meditation of emotions: focusing on the observation of emotions during a body exercise
Table 3 below details the evaluation elements of each variable:
S. 1 S. 2
SIQ
MIS
X
X
MAAS
POMS
PANAS
X
X
BP and HR
CC
SE
FD
Dif 𝑋𝑋� *
X X
X X
7
S. 3 S. 4 S. 5 S. 6 S. 7 S. 8 S. 9 S. 10 S. 11
X
Dif 𝑋𝑋�
X X
X
Dif 𝑋𝑋�
X
X X
X
Dif 𝑋𝑋� Dif 𝑋𝑋� Dif 𝑋𝑋�
X X
Dif 𝑋𝑋� Dif 𝑋𝑋� Dif 𝑋𝑋� Dif 𝑋𝑋�
X X X X X X X X X
X X X X X X X X X
Table 3: Evaluation of the different variables over the sessions. All the sessions recorded the environmental variables temperature, atmospheric pressure and humidity with the aim of evaluating their possible effect on the physiological variables recorded. (*) Dif 𝑋𝑋�: Difference of averages of the 2 pre-session and the 2 post-session recordings. Results
The results found are set forth below: Blood pressure (BP) and heart rate (HR): these were measured in sessions 2, 3, 6, 8, 10 and 11, carrying out two pre-session recordings (of which the arithmetic mean 𝑋𝑋� pre
was taken) and two post-session recordings (mean 𝑋𝑋� post). Table 4 presents the values and the differences found: Systolic BP
Diastolic
� pre/𝑿𝑿 � post 𝑿𝑿
BP
Difference Difference systolic
� pre/𝑿𝑿 � post BP 𝑿𝑿
diastolic
HR
Difference
XPre/Xpost HR
BP
S. 2
11/ 10.65
7.4/ 7.3
-0.35
-0.1
68.5 / 73.5
+5
S. 3
10.9/ 9.8
7.1/ 5.9
-1.1
-1.2
68/ 69
+1
S. 6
11/ 9.8
7.45/ 6.4
-1.2
-1.05
70/ 70
0
S. 8
11.2/11.8
7.3/ 6.9
+0.6
-0.4
64/ 63
-1
S. 10
11/ 10.8
7.05/ 7
-0.2
-0.05
70/ 70
0
S. 11
12.2/11.8
6.5/ 6.8
-0.4
+0.3
63.5/ 61.5
-2
Table 4: Results of blood pressure (BP) and heart rate (HR).
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It can be observed that the blood pressure goes down slightly in almost all the sessions recorded. It would therefore be a variable sensitive to the work carried out, especially diastolic BP. On the contrary clear results were not found with the heart rate, which was not a variable sensitive to this protocol. Cardiac coherence (CC): this was evaluated in sessions 2, 3, 4 (viewing of the video of the day of the injury), 7, 10 and 11. The evolution is shown below, with the low, average and high coherence values (%) in their pre- and post-session means and the difference between the two (before the session two recordings were made, carrying out the arithmetic mean, and the same was performed after the session). � pre-session 𝑿𝑿
Low/average/high
� post-session 𝑿𝑿
Low/average/high
Difference Low/average/high
Session 2
61 / 33.5/ 5.5
66 / 34/ 0
+5/ +0.5/ -5.5 (worsens)
Session 3
61.5 / 22/ 16.5
94.5 / 0/ 5.5
+33/ -22/ -11 (worsens)
Session 5
48 / 31/ 20
100 / 0/ 0
+52/ -31/ -20 (worsens)
Session 7
94.5 / 5.5/ 0
58 / 39.5/ 2.5
-36.5/ +34/ +2.5 (improves)
Session 10
86.5 / 8/ 8
18.5 / 36.4/ 45
-68/ +28.4/ +37 (improves)
Session 11
65 / 24.5/ 10.5
2.5 / 12.5/ 85
-62.5/ -12/+74.5 (improves)
Table 4: Results of the estimated cardiac coherence values, showing the percentage of low, average and high coherence. As can be observed, cardiac coherence is a variable which was sensitive. This is, for example, especially evident in session 5, where the viewing of the time of the injury greatly affected the player and 100% of the recording registered low coherence. The recordings gradually improved as the player internalized the work proposed. This capacity for improvement continued to be maintained in session 11, involving monitoring 8 months after the end of the intervention, starting from good initial values in pre-session recordings.
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To see this more clearly, the charts obtained during the second post-session measurements of the first and last day are set out below (in brackets the values corresponding to the average of post-recordings). It is easy to observe the large difference obtained by the soccer player in his cardiac coherence values.
Figure 1. Second post-session measurement of the first day using Emwave® technology (the post-session average being: 66 / 34 / 0)
Figure 2. Second post-session measurement of the last day carrying out an abdominal breathing exercise (the post-session average being: 2.5 / 12.5/ 85) 10
Mood (POMS): evaluated in sessions 2, 3, 5, 7, 10 and 11. Table 5 below shows the results obtained: Stress
Depression
Anger
Vigor
Fatigue
Confusion
Session 2
31
34
23
20
17
14
Session 3
29
27
24
20
13
18
Session 5
17
10
14
22
7
9
Session 7
18
4
11
25
7
8
Session
24
20
25
18
8
14
10
4
5
25
8
7
10 Session 11
Table 5. Results of the measurements of the 6 dimensions of the POMS questionnaire. This questionnaire was sensitive on picking up the changes in the emotional state of the sportsperson. A progressive improvement is observed over the intervention, except in session 10, where there was a series of stressful factors in the player’s environment which we believe influenced the recordings of that day. In session 7 and in the recording of monitoring session 11, however, a clear improvement of all the values can be seen (good performance moment). Socio-sport values (Sport Injury Questionnaire): this was only completed once (session 1), the main results being: with stable partner, university education. Position pivot / center-back. Ten years of semi-professional/professional practice with a total of over 6 injuries during his sport career. Psychological state on the day of the injury (Likert scale result 1-5: 1 little, 5 a lot), degree of trainer demands (4: high), personal motivation (5: very high), self-demand (5: very high), attention to the task (4: high) and perception of psychological resources (3: average). Mindfulness Level (MAAS and MIS questionnaires): a pre-test (session 1) and another post-test measurement (session 10) were performed. Moreover, with the MIS, a measurement was performed in monitoring session 11. The values of the MAAS went from 58 to 60 (out of a maximum score of 90) and those of the MIS from 58 to 57, in
11
the post-test, and to 56 in the monitoring (out of a maximum score of 90), not therefore being sensitive to the work carried out. Emotions (PANAS): this was only carried out in session 5, when the video of the day of the injury was seen and the emotional state of the sportsperson was evaluated. The negative emotions totaled 24 points compared with 13 for positive emotions. The questionnaire was sensitive to the time of recording with an evaluation of 11 points of difference between negative and positive emotions. Maximum scores (3 and 4) were obtained in the items “interested, tense, upset, angry and worried”. Subjective evaluation by the sportsperson (SE): each session was evaluated by the soccer player, who on average gave them a score of 7.8 out of 10 (6.5 being the minimum score and 9 the maximum; standard deviation of 0.6). The soccer player valued most highly learning abdominal breathing and learning to let negative thoughts pass by without judging them. Environmental variables: these showed fairly stable values of temperature and humidity, with an average temperature of 24.3 degrees (standard deviation of 1.6) and 41.3% humidity (standard deviation of 4.2). Field diary (FD): a field diary was written in each of the sessions with all the work carried out, the evaluations of the therapist being an average of 8.4 out of 10 (minimum score of 6 and maximum of 9; standard deviation of 0.9). The receptive attitude of the player and the evolution observed over the intervention process were valued most highly. The importance of the monitoring session (carried out 8 months after the intervention) should also be stressed. It allowed the whole process of return to competition, shown in table 6, to be covered. Other qualitative variables: it was intended to perform a qualitative evaluation of variables in the monitoring session, which could give us additional information about the subject. He thus rates his satisfaction with performance in the field with a 7, his playing time with a 6.5, and his satisfaction with re-adaptation to sport with a 2. He rates the usefulness of the intervention carried out with a 6, highlighting the learning of abdominal breathing and its usefulness for relaxing. An exhaustive qualitative evaluation was moreover performed of the soccer player’s return to competition, assessing the playing time, his subjective sensations, related to 12
the performance of the team, in order to gain an idea of the general evolution of the soccer player, both in relation to himself and to the team. The results can be seen in table 6:
13
Date
Day
Place
Result
Selected
Time Played
Performance Evaluation
2 November
11
away
1-1
Yes
0’
8 November
12
home
0-3 (defeat)
Yes
0’
16 Nov.
13
away
2-0 (defeat)
Yes
3’
Not assessable
22 Nov.
14
home
3-1 (victory)
Yes
8’
8
30 Nov.
15
away
3-2 (defeat)
Yes
1’
7 December
16
home
2-0 (victory
Yes
0’
14 December 20 December
17
home
0-2 (defeat)
18
away
0-0
No (Depressed State) No
4 January 2015
19
home
5-1 (victory)
Yes
15’
8
11 January
20
home
2-1 (victory)
Yes
70’
10
17 January
21
away
1-1
Yes
Played
6
Emotional State Evaluation
High anxiety Fear High motivation, E Instability Frustration Anger Happiness
Not assessable Frustration Anger Helplessness in competition Sadness Demotivation Anger High motivation Happiness Peace of mind Flow State Uneasy
Observations
Banners in the stands. Good sensations Warming up 20’ without playing. High motivation in training. Disciplined for bad behavior in training. Dropped from the team for 1 week. “ I celebrate goals with my colleagues“ Substitution due to injury of regular player. Comes on with result 0-1 and come back to 2-1.
14
25 January
22
home
3-0 (victory)
Yes
1 February 7 February
23 24
away home
1-1 1-0 (victory)
No Yes
15 February
25
away
0-2 (victory)
Yes
22 February
26
home
2-1 (victory)
Yes
90’ Played 90’ Played 90’ Played 90’ Played
7.5
Motivated Happy
8
Motivated Uneasy
7
Conservative
Due to pain in abductor. Slight pains abductor Slight pains abductor
7
Table 6: Summary of return to team
15
1
Discussion
2
With the experiment carried out and the results obtained, we can say that the
3
intervention performed was positive in the evolution of the injured soccer player. The
4
improvements in blood pressure are in line with that found by various authors following
5
a mindfulness protocol in another type of sample (Chen, Xueling, Liyuan and Xiaoyuan,
6
2013). In relation to cardiac coherence, this is a variable not very frequently evaluated
7
but which presents a good potential with a view to future studies. It is essential to
8
complement the psychological self-assessment with questionnaires, this being the most
9
common type of evaluation in sport psychology, with physiological measures which
10
help us to have a more objective view of the process.
11
The questionnaires to evaluate mindfulness were not very sensitive. Their psychometric
12
validity and effectiveness in applied interventions should be assessed, proposing
13
specific mindfulness evaluation questionnaires for each sport context and possibly
14
specialized for sport injury.
15
On the contrary, the POMS and PANAS questionnaires were shown to be valid and
16
sensitive in this intervention. Their use in future studies can therefore be recommended
17
(Solé, Carrança, Serpa and Palmi, 2014).
18
The player was shown to be satisfied with the intervention carried out both on a
19
quantitative and qualitative level, thanks to its usefulness and applicability in the
20
rehabilitation process. Future lines of work can be opened up on mindfulness-based
21
interventions as a complement to the more traditional physiotherapy and psychological
22
protocols.
23
One clear limitation was not being able to complete the program. More interventions
24
will therefore be required with a larger number of sessions before increasing the sample.
25
However, given the preliminary results of this single case study, we may be faced with a
26
useful new tool in the field of sport psychology.
27
Conclusions
28
A mindfulness-based intervention for the rehabilitation of an injured professional soccer
29
player is a useful tool. With the work carried out, we observed the possibility of
30
intervening with a protocol different to the usual rehabilitation (physiotherapy and 16
1
psychology), since the work was well received by the health team responsible for the
2
recovery, by the technical staff and, above all, by the sportsman himself. Our
3
recommendation would be to continue to investigate in order to confirm the
4
applicability sought and to continue to work on a program of rehabilitation-recovery of
5
the injured soccer player using an integrated model, with physiotherapy work and
6
psychological work incorporating components of mindfulness. We will thus succeed in
7
expanding the spectrum of effective methodology for the intervention of the injured
8
sportsperson.
9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25
17
1 2 3
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Development and preliminary validation of the mindfulness inventory for sport.
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Watson, D., Clark, L.A. y Tellegen, A. (1988). Development and validation of brief
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18
cruciate ligamento in the professional football. Journal of Sport and Health
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1
Appendices
2
SPORT INJURY QUESTIONNAIRE (SIQ)
3
CLUB:
4
FAMILY STRUCTURE:
AGE:
Stable couple
Couple with
Couple
Alone with
with children
children
without
children
Alone
children 5 6
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
7 8
EDUCATIONAL
9
LEVEL:
Primary
Secondary
Voc. training
University
PART I: SPORT DETAILS 10 11
1. USUAL TACTICAL POSITION: . . . . . . . . . . . . . . . .
12 13
2. YEARS OF SPORTS PRACTICE . . . . . . . . . . . . .
14 15
3. HOURS OF TRAINING PER WEEK (circle the letter) A
Less than 5 per week
B
Between 5 and 10 per week
C
More than 10 per week
16 17
4. NUMBER OF MATCHES PLAYED THIS SEASON Less than
16 to 20
21 to 25
26 to 30
31 to 35
More than 36
de 15 18 21
1
5. GENERALLY PLAYED PER MATCH: Less than
From 11 to
From 20 to
One half
10’
20’
30’
(45’)
About 60 ‘
The whole match
2
PART II: INJURY BACKGROUND 3 4 5
6. HAVE YOU HAD
ANY KIND OF INJURY DURING
YOUR SPORT
NO
YES
CAREER?
HOW MANY?
6 7
1 8
2
3
4
5
6
+6
7. FILL IN THIS TABLE ABOUT YOUR LAST SPORT INJURY Context in which it
Affecting:
occurred:
Muscle
Usual sport:
Tendon
Not usual sport or free: Location:
Diagnosis:
Time:
Acute
Articulation Bone Others:
Chronic
Severity*
Phase of season Moment
Slight
Pre-season
Head and neck
Moderate
Mid
Trunk,
Serious
Post-season
Upper limbs
Very serious
Transition
Lower limbs
Competition
Training.
Leisure
How did the injury
Type of injury
occur?
Knock
Treatment
Lost playing time
Strain
9
22
1 2
8. HAVE YOU HAD ANY INFECTIOUS PROCESS WITH THIS INJURY RECENTLY? WHICH?.…………………………………...
3 4
9. IN GENERAL, HOW MANY HOURS A NIGHT DO YOU SLEEP? Less than 5
From 5 to 7
From 7 to 9
More than 9
5 6 7
10. RATE FROM 0 TO 5 (0 NOT AT ALL AND 5 A LOT) THE FOLLOWING VARIABLES IN RELATION TO THE TIME OF THIS INJURY (Circle answer) VARIABLES
SCORE
Stress or daily concerns
0
1
2
3
4
5
General Anguish / Anxiety
0
1
2
3
4
5
Degree of trainer demands
0
1
2
3
4
5
Personal motivation
0
1
2
3
4
5
Attention to the task that you were performing
0
1
2
3
4
5
Psychological resources (control that you
0
1
2
3
4
5
believe you had to confront the situations of that day) 8 9
*SLIGHT: requires treatment but the training is not interrupted.
10
MODERATE: requires treatment and obliges the soccer player to interrupt their participation in
11
training sessions, even the occasional match.
12
SERIOUS: one or two months without playing, sometimes requiring hospitalization and/or
13
surgery.
14
VERY SERIOUS: produces a permanent reduction in the sportsperson’s performance, requiring
15
constant rehabilitation to avoid deterioration.
16 17 18 19
23
