Solving Stress

Injury prevention doesn’t have to be limited to physical approaches. This author provides advice on setting up a stress management program as a way to lessen injuries and increase performance.

By Dr. Douglas Mann

Douglas Mann, DPE, ATC, is the Director of Athletic Training Education at Rowan University.

Training & Conditioning, 13.4, May/June 2003,

Participation in athletics has always involved the risk of injury. Athletic trainers and strength and conditioning coaches go to great lengths to protect athletes from the physical and environmental factors that put them at risk. But what about the psychosocial factors?

Studies show that those caring for athletes may be underestimating the effects of stress. Researchers have found that when confronted with an acute stressor, people already under a large amount of chronic negative life stress will have more muscle tension and less peripheral vision and attention. In athletes, this reaction can hinder their performance and make them more susceptible to injury.

Most people involved in athletics recognize that high school and college athletes face a lot of stress. Yet relatively few realize that a proactive stress management program may help prevent injury, increase performance, and improve the quality of their lives.

There are many myths about stress and stress management. For example, some athletes and coaches view stress management as total-body relaxation and fear it will produce a lethargic performance during competition. But stress is not inherently positive nor negative. The athlete’s reaction to the stress determines how it will affect him or her.

Running a successful stress management program starts with understanding the body’s response to stress as well as the effect of that stress response on the athlete (see “The Stress Response,” below). The next step involves understanding the two basic ways to deal with stress: You can either attack stress before it produces a physiologic response or you can try to combat or control the physiologic response when it arises. Effective programs tackle stress on both levels.

Reducing stress before it happens can be facilitated through educational sessions on life skills. Speakers can include financial advisors, nutritionists, experts on time management, and counselors. Team-building activities, which can be incorporated into practices, can also help prevent stress, as can individual meetings with athletes.

The program should also help athletes confront stress when it appears. Strategies include using biofeedback and mastering techniques for breathing, relaxation, and imagery. This can help them deal with their stress at the moment and allow them to refocus on the task at hand.

Being ready and able to refer is also key. Always refer athletes to specialists better equipped to handle athletes’ particular situations when they present with something that is beyond your comfort level.

Starting A Program
At Rowan University, an NCAA Division III institution, we initiated a stress management program with our women’s lacrosse team. This was sparked by some research I’d seen that found a link between stress and injuries in athletes, and observing that this squad had both a significant rate of injury and a high amount of negative stress.

The first step was to ascertain what stressors our athletes were facing. I asked the team’s coach if I could administer a life stress scale to her athletes with the aim of tracking their responses and their injury rates. She was enthusiastic about the potential of making such a connection and gave me the okay.

We conducted our survey during the first preseason team meeting in January so we could assess team chemistry, note trends, and address problem areas as soon as possible. There are several scales available to measure life stress, daily hassles, social support, and other psychosocial variables. We used the Life Events Survey for Collegiate Athletes, developed by Trent Petrie, PhD, a Professor of Psychology at the University of North Texas. It asks athletes to rate about 60 life circumstances on a scale of -4 (the event was a very negative one for the athlete) to +4 (the event was a positive one), and then allows them to list any other events that significantly affected them in a positive or negative way over the previous year. Events included such things as a change in grade point average, breaking up with a boyfriend or girlfriend, change in playing status, and situations concerning their finances.

On the survey, the athletes reported the following as being their most significant stressors: school work, sport participation, finances, friends/relationships, weight/nutrition, lack of free time, sleep habits, family, and work situations. We then tracked injuries over the course of the season. At the end of the season we compared injury rates to stress levels.

Initially, I was most interested in the link between stress and injuries, and we did find a significant correlation in that those athletes who had the highest levels of stress missed the most days of practice. However, after administering the survey and tracking the athletes over the course of a season, I found that stress was affecting some students’ lives in many more ways than I had anticipated. After speaking with as many of them as possible on an individual basis, I developed a program to begin to address their needs. I put the program into practice the following year.

I started by again administering the life stress survey to the team. Then, I approached those athletes who I felt needed the most assistance and asked them to see me when they had a chance. Because Rowan is a small university, the student-athletes get to know me pretty well, and I was able to make these appointments casually.

From these meetings, I was able to understand the common areas of concern in more detail than I could from the survey results. For this squad, I found that help was needed in nutrition, time management, and financial management, and I set up seminars for the athletes on these topics. I also planned a series of team-building exercises with their coach that they could do during practices. And I made sure they knew I was always available to talk about any concerns they had.

Ten Guidelines
From our efforts with the women’s lacrosse team, I’ve found there are several important issues to address with this type of program, which I detail below. This is by no means an exhaustive list, but a good set of guidelines to get you started and guide you through the process.

1. Devote Time
Running a stress management program is very rewarding, but it is also very time consuming. Not only is time needed to set up educational programs, but you and your staff will need to make time for personal interactions with student-athletes. The athletes need to feel comfortable with you before they will share personal information with you or buy into your program. Many of your interventions may occur outside of practice time, which will require more time from both you and your athletes.

2. Get Help
For the reasons mentioned above, and because there is no way you are going to be an expert in team building, mental imagery, relaxation, nutrition, time management, and financial management, it is essential to have help in implementing your program. Solicit help from colleagues, campus counselors, staff from the health clinic, and community members off-campus.

Often, people will be more than happy to help for little or no fee. For example, you may have a nutrition professor or graduate student assist with the athletes’ diets, a psychologist from the school’s health clinic serve as your expert on behavior, a specialist from the community come in and talk about breathing techniques and imagery for relaxation, and a booster who is an expert on time management work with athletes on juggling their many roles efficiently. Using qualified school and community members will not only take some of the onus off you, but also lends credence to your program. You can also enlist help from the athletes themselves. For example, team captains can help facilitate sessions or even help poll teammates to suggest speakers.

As you recruit all the help you can get, keep in mind that it is important to make sure there is a program leader who can coordinate the schedule and be the contact person for the athletes. This person must communicate with all parties involved in the program so that common themes and goals are taught and reinforced.

3. Work For Department Support
Coaches need to support this program for it to succeed. They must be willing to use some practice time for the interventions and, when appropriate, attend sessions to give credence to what is being done. They need to view the program as being as important as their strength and conditioning work. The same goes for assistant coaches and strength and conditioning coaches.

In fact, strength and conditioning coaches can often be called as a resource to address the team. For example, they may have some experience using and training athletes in visual imagery techniques or getting the most out of their time in the weightroom.

Getting administrators on board can also be very helpful. Having your athletic director attend sessions and talking about the importance of the program will certainly help, as will having his or her financial support for such things as speakers and retreats.

Exactly how you get their support may be challenging. Research articles and stories about how this type of program has worked at other schools can help to sell your program. It may also help to implement the program in stages, starting with infrequent meetings on topics that hold the most meaning to the athletes. This may get the athletes to buy into your program and help persuade coaches to implement a full program the following season. Do not be discouraged if you have to start small. Just make sure you are building a solid foundation.

Another strategy is to administer a life stress scale to the athletes at your school and use this information, without names, to show coaches the need for a stress management program. Prior to starting our program, I was able to show the coach, without breaking confidentiality, that her team was extremely stressed out and would probably benefit from a stress management program. In addition, I tracked injury rates and showed her that the athletes with the highest levels of negative life stress missed more practices and games than those with less stress, or who were better able to manage their stress.

4. Keep Doors—and Minds—Open
Individually meeting with athletes helps to establish trust and assure them that you have their best interests at heart. Therefore, it is a key component of the program. Due to time constraints, it can be difficult to meet with all the athletes regularly, even at a small school. But try to schedule appointments throughout the season for those who are interested. And make sure the athletes know your door is always open.

I have had many athletes just drop by to chat for a few minutes, which kept the meetings informal, non-threatening, and open to the sort of discussion that leads to getting at the root of their problems. With our women’s lacrosse team, issues surrounding team chemistry, disagreements between players and coaches, and personal lives were most typically brought forward during informal individual or two-person meetings.

When student-athletes do need to share sensitive information with you, take the time to listen and understand each athlete’s situation. In one case, several athletes believed that their coach was unfairly singling them out. Although I didn’t agree with their analysis, it was still important that I not judge them, but instead offer solutions for them to resolve their conflict. It is very important for your student-athletes to understand that, even though it may be difficult, it is more important for them to be problem solvers than simply problem identifiers. This goes for the coaches, too—they need to make sure they’re not judging the situation according to their own values and belittling an athlete’s concerns. Whatever is concerning their athletes needs to be seen as legitimate, and the common goal is to find a solution, not get bogged down in who is right.

5. Solve Problems Before They Start
Good team chemistry is not often thought of as falling under the umbrella of stress management, but in collegiate athletics, I found they are clearly linked. Because teammates spend so much time together, when there are any problems among team members, stress levels go up quickly. On the other hand, good team chemistry helps athletes who are stressed to relax much more easily.

I also found that a team can go from exceptional unity to chaos very quickly. During the season of our test program, team chemistry was very high until a spring break trip to Florida. Upon return, the team was in shambles and never recovered. One athlete felt another had broken her trust, and soon people were taking sides. It quickly escalated to a point where athletes weren’t able to leave their problems behind when they were on the playing field.

I suggest that team building be included as part of stress management programs, even if chemistry appears fine in the preseason. I had suggested a series of team-building exercises to the women’s lacrosse coach at the beginning of the season, but I may not have put enough of an emphasis on it. Perhaps if a stronger foundation of team building had been established on the team, the athletes would have been better able to handle the interpersonal stresses they found themselves under. Stresses can’t always be avoided, but how they affect athletes and the team can be controlled.

6. Know When To Refer
Refer when necessary—it’s the golden rule for athletic trainers. Resources such as student counseling centers, social workers, and psychologists are invaluable to the athletic trainer and anyone running a stress management program. Fully investigate what resources are at your disposal both on and off campus and invite these people in to talk with the team. Each can either do a formal presentation or just meet and greet. The athletes within your program need to know who this person is, what he or she does, and how they can get a hold of him or her. They also need to know that and that any discussions with that person will be confidential.

Each school and institution will have different resources available both on and off campus. If none are available within your school, contact administrators to inquire what professionals may be available as independent contractors.

7. Follow Through
Follow up with athletes you refer and do what you say you are going to do. When dealing with athletes with emotional instabilities, following through on your promises and regularly checking in with them can offer some important stability in their lives.

8. Be Flexible
It is important to be organized and map out a stress management program. However, do not be afraid to change things based on what the individual athletes and the team need. For example, if time management is fine but the athletes feel a lot of pressure figuring out how to manage their finances, time management seminars may not be as important as speakers on money management.

9. Assess Program Annually
At the end of each year or season, take the time to assess how the program went and how it can be improved. When I did this with the women’s lacrosse team, athletes ranked the hands-on activities the highest, as opposed to straight lectures. Also, the most beneficial were those things that directly addressed their concerns. For example, several athletes said that getting proper nutrition was stressful—how much food, when to eat, and what kinds of foods. Accordingly, they praised a nutrition seminar that answered those exact questions.

10. Have Fun
Don’t stress over your stress management program. This should be a very rewarding and positive experience for both you and your student-athletes. If it becomes overwhelming, stop and re-evaluate what you are doing. If the facilitator of the program is stressed out, you can be sure the athletes are as well.

For copies of the Life Events Survey for Collegiate Athletes, contact the author at (856) 256-4500, ext. 3706, or

For an article on the benefits of controlled breathing, see Breathing Easy in the May/June 2002 issue of T&C, or go to our Web site,, and type “breathing” into the search field.

Sidebar: The Stress Response

The body’s response to stress is the same regardless of whether the stressor is physiological or psychological, positive or negative. The physical response to a stressor is described by the general adaptation syndrome model and includes three stages: alarm reaction, resistance, and exhaustion.

The alarm reaction stage is also known as the fight or flight response. In this stage, the body is immediately preparing for activity. The stress response during this stage includes the secretion of adrenocorticotrophic hormone (ACTH), corticoids, and epinephrine, which cause decreased digestive activity, salivation, and peripheral vision, and increased heart rate, respiratory rate, metabolic rate, oxygen utilization, body temperature, perspiration, cardiac function, and blood flow to muscles, causing muscle tension.

Many of these physiological effects of the stress response may, in fact, be beneficial prior to competition. On the other hand, some won’t be. Muscle tightness and decreased peripheral vision may not only be detrimental to performance, but may also lead to injury. Effective stress management techniques should be targeted to control the stress response to keep the positive effects and remove the negative.

The resistance stage reflects the body’s attempt to maintain homeostasis. An individual’s success in the resistance stage is a direct result of how effective his or her coping mechanisms are. Coping mechanisms include, but are not limited to, social support, hardiness, anxiety level, and locus of control.

If during the resistance stage an athlete is able to control his or her stress response, he or she can experience the positive effects without the negative. For example, if they allow themselves to reach some level of muscle readiness without it becoming muscle tension, the stress they feel before a competition can be beneficial.

An athlete under chronic negative life stress may be at risk of entering the exhaustion stage. This stage is reached when an individual is unable to cope with the stressors in his or her life. The person may experience ulcers, psychological breakdown, damage to specific organs and body systems, and in extreme situations, death. Recognizing stress well before it gets to this level is a must. Giving athletes the tools to manage their stress and referring them when needed can keep them from ever getting here.