Pushing the limits of your athletic potential requires, as the author John L. Parker, Jr., once put it, 鈥渁 certain amount of time spent precisely on the Red Line, where you can lean over the manicured putting green at the edge of the precipice and see exactly nothing.鈥 Balancing on that edge is tricky, and it鈥檚 why top athletes get injured pretty frequently, having pushed just a little too far. Of course, some athletes get injured more than others. Is that just a matter of luck and biomechanics鈥攐r is there some degree of skill in managing the delicate balance between enough and too much?
That鈥檚 the question at the heart of a new study from researchers at the University Medical Centre Groningen in the Netherlands, 聽in the Scandinavian Journal of Medicine and Science in Sports. A group of 73聽tennis players in the country鈥檚 national high performance program, all between the ages of 11 and 14, completed a series of psychological tests at the beginning of the season, and were then tracked weekly for the rest of the year to see who got injured and how severely.
The researchers hypothesized that self-regulatory skills would help distinguish who got injured and who stayed healthy. In particular, they focused on four 鈥渕eta-cognitive鈥濃攚hich means thinking about thinking, basically鈥攅lements of self-regulation: planning (鈥淚 determine how to solve a problem before I begin鈥); self-monitoring (鈥淚 keep track of my progress鈥); evaluation (鈥淚 go back and check my work鈥); and reflection (鈥淚 often reappraise my experiences so I can learn from them鈥). In essence, the idea is that knowing which pains you can train through and which require some time off is a skill that requires careful and honest self-appraisal, and that you can get better at if you鈥檙e sufficiently reflective.
The results were pretty stark. During the season, the 73 players suffered a total of 88 overuse injuries, not including acute injuries and illnesses. For the most part, they were pretty good at self-regulation: 28 of them score highly on planning, 36 on self-monitoring, 48 on evaluation, and 43 on reflection. But the players with moderate or low overall self-monitoring scores were 4.6 times more likely to suffer an overuse injury that required missing training or competition compared to those with high self-monitoring skills. That鈥檚 a huge difference.
Knowing which pains you can train through and which require some time off is a skill that requires careful and honest self-appraisal.
There was an additional wrinkle when they broke the results down by gender. Among the 45 boys in the study, self-regulatory skills didn鈥檛 actually have a significant relationship to injury risk. Among the 38 girls, on the other hand, those with moderate or low self-regulation were a whopping 10.8 times more likely to lose time to overuse injuries. It鈥檚 worth looking a little more closely at that finding.
As it happens, the new study is actually a follow-up to in the same journal, where the authors analyzed the same dataset looking for links between risk-taking behavior and injuries. In that case, the results were the mirror image of the self-regulation data. Risk-taking, as assessed by a card-based betting game called the , was associated with increased risk of losing time to overuse injuries in the boys, but not the girls.
It鈥檚 tempting to combine these results into some sort of pseudo-evolutionary narrative about how the psychological traits that made males good hunters long ago now make them prone to tennis elbow, and how women evolved to ignore discomfort because of childbirth or whatever. Let鈥檚 resist that temptation. In a small study like this, it鈥檚 hard to know whether the gender-based differences they observe are generalizable differences, or simply reflect the particular characteristics of the 45 boys and 38 girls in the study. For example, the average international ranking for the boys was 436, compared to 281 for the girls鈥攕o maybe competitive level, or some other factor, is the real source of these differences.
Still, the overall data suggests that psychological traits do affect how likely you are to get injured, joining previous studies like the one I wrote about last year that found runners with perfectionist tendencies were 17 times more likely to miss training time with injuries. While this area of research is still in its infancy, it鈥檚 hard not to wonder what you can actually do about it. There鈥檚 plenty of research about how to improve self-regulation in the context of eating habits, and even about better self-regulation through mindfulness-based training. I don鈥檛 know how much of this we can apply to sports injuries, but I鈥檓 sure there are people working on it.
The authors of the study suggest that coaches and trainers should be on the lookout for athletes with weak self-monitoring skills, and try to help hold them back when necessary. This seems reasonable. But maybe the bigger point is simply that overuse injuries are not acts of god. They flow, at least in part, from the choices we make. For an athlete who is training hard, those choices are聽difficult. You鈥檙e always gambling, trying to guess which aches you can safely ignore and how much fitness you can afford to lose. And you鈥檒l inevitably guess wrong some of the time. But if you don鈥檛 gradually get better at that guessing game, perhaps you鈥檙e simply not paying close enough attention.
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