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The psychological factor ‘self-blame’ predicts overuse injury among top-level Swedish track and field athletes: a 12-month cohort study
  1. Toomas Timpka1,2,3,
  2. Jenny Jacobsson1,2,
  3. Örjan Dahlström1,4,
  4. Jan Kowalski1,5,
  5. Victor Bargoria1,2,6,
  6. Joakim Ekberg1,2,3,
  7. Sverker Nilsson1,2,
  8. Per Renström1,7
  1. 1Athletics Research Center, Linköping University, Linköping, Sweden
  2. 2Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
  3. 3Unit for Health Analysis, Centre for Healthcare Development, County Council of Östergötland, Linköping, Sweden
  4. 4Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
  5. 5Department of Clinical Science, Intervention and Technology, Pediatric Unit, Karolinska Institutet, Stockholm, Sweden
  6. 6Department of Orthopaedics and Rehabilitation, Moi University, Eldoret, Kenya
  7. 7Department of Molecular Medicine and Surgery, Center for Sports Trauma Research and Education, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Professor Toomas Timpka, Department of Medical and Health Sciences, Linköping University, SE-581 83 Linköping, Sweden; toomas.timpka{at}


Background Athletes’ psychological characteristics are important for understanding sports injury mechanisms. We examined the relevance of psychological factors in an integrated model of overuse injury risk in athletics/track and field.

Methods Swedish track and field athletes (n=278) entering a 12-month injury surveillance in March 2009 were also invited to complete a psychological survey. Simple Cox proportional hazards models were compiled for single explanatory variables. We also tested multiple models for 3 explanatory variable groupings: an epidemiological model without psychological variables, a psychological model excluding epidemiological variables and an integrated (combined) model.

Results The integrated multiple model included the maladaptive coping behaviour self-blame (p=0.007; HR 1.32; 95% CI 1.08 to 1.61), and an interaction between athlete category and injury history (p<0.001). Youth female (p=0.034; HR 0.51; 95% CI 0.27 to 0.95) and youth male (p=0.047; HR 0.49; 95% CI 0.24 to 0.99) athletes with no severe injury the previous year were at half the risk of sustaining a new injury compared with the reference group. A training load index entered the epidemiological multiple model, but not the integrated model.

Conclusions The coping behaviour self-blame replaced training load in an integrated explanatory model of overuse injury risk in athletes. What seemed to be more strongly related to the likelihood of overuse injury was not the athletics load per se, but, rather, the load applied in situations when the athlete's body was in need of rest.

  • Athletics
  • Psychology
  • Injuries
  • Epidemiology

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