As health professionals and also in sports performance I think it becomes clear early on that our brain and the psychology that goes with it affects performance and injury in weird and wonderful ways. None more so has this been evident in the last 20 months of COVID. Now don’t get me wrong I’m not going to start complaining about how hard COVID has been for anyone or everyone. We know that it hasn’t been fun. And much of the difficulty has been uneven in its distribution of punishment. Some people have clearly had a better time of it from an individual situational point of view (health, financial, work, social, societal etc). 

But something that I wanted to discuss  was the observations that have become apparent as both a health professional and a coach as to how this has been expressed in both performance and with presentation of injuries over this time. 

There has been evidence for a significant amount of time that has discussed  life stress and the impact athletic injuries, Andersen and Williams 1988, Hardy et al 1991, Petrie 1992. And more recently there has been investigation in student athletes into the effect of academic stress periods and the presentation of injury risk increases, Mann 2016. I had always noticed this latter presentation in university age athletes. Around exam or high assignment load periods, these athletes would be more likely to under perform and present with injury patterns or even just increased soreness and restrict the quality of their training. And not surprisingly the ups and downs associated with COVID have appeared to amplify this on two levels. 

Firstly I have started to take note of these episodes and how they are often linked with the changing restrictions, the alterations in the general mood of the community and how hopeful we are as a collective of having access to a normalised lifestyle. When things get worse, training, niggles increase in presentation, when things get better, these concerns start to evaporate. Now its clear that these are not the only factors and these areas affect individuals differently but nonetheless it has had us considering the greater effect of life stress on performance and injury under sustained stressful environments. I have a number of the athletes that I coach openly discuss their ongoing anxiety around the uncertainty of the situation, and how it has affected many areas of their life, including their training. 

The second area that has become apparent in regards to the evolving situation is the changes in training loads due to access to facilities (different surfaces etc), equipment, social support structures and active coaching environments. It is without doubt that a significant number of the injuries that we have seen in our clinical setting are clearly linked to this yoyo of training stressors and loads that for the most part are difficult to control or assess the exact effect on the physiological stress on the body. And of course this is compounded by the background psychological stress of the situation. And it is the combination of the two that has likely contributed to these presentations. 

So what can be done about it?

More than anything the understanding that these areas affect performance and injury has created much greater incentive to investigate with clients and athletes about how these items have affected them over the course of the last year. It is clear that it has an effect, but asking about how specifically this may be impacting has changed the approach to a number of problems. Digging deeper and assessing with some level of granularity items such as sleep quality, training qualities, perceived exertion, social interaction time and diet have created more benefit to the outcomes of performance and injury recovery than many of the traditional areas that we approach such as tissue capacities, training loads and biomechanical aberrations. And this is type of approach is supported by research that suggests that athlete burnout is often mediated by counter stress factors (that is areas that reduce perceived stress), Chyi et al 2018. If you can improve some of these features such as sleep quality, diet and quality social interactions you open up the possibility of having counter stress features in your approach. 

With this final thought in mind here are some take away’s.

  1. Perceived stress is a clear influence on both performance, injury and burnout in sport.
  2. During periods of increased perceived stress (life, academic, COVID) investigate the perceived stress of the people that you work with and look to find what counter stress behaviours they have in their life
  3. In periods of high stress look to address counter stress features (improving sleep, quality social interactions, dietary intake) and reduce drivers of perceived stress along with the physiological drivers of performance and injury (training loads, tissue capacity, biomechanics etc).