Imagery Use and Sport-Related Injury Rehabilitation

Submitted by Matthew L. Symonds1* and Amanda S. Deml2*

1* Associate Professor, Department of Health and Human Services, Northwest Missouri State University

2* Intramural Sports Coordinator, University of Oregon

Amanda Deml is the Intramural Sports Coordinator at the University of Oregon. She earned both her BS and MS Ed degrees from Northwest Missouri State University in Maryville, Missouri. Matthew Symonds is an Associate Professor in the Department of Health and Human Services at Northwest Missouri State University and also serves as Department Chair.

ABSTRACT

This study sought to investigate mental imagery use among college athletes during the rehabilitation process, specifically examining the use of three functions of imagery – motivational, cognitive, and healing. The Athletic Injury Imagery Questionnaire-2 (AIIQ-2) was administered to varsity athletes representing 12 varsity sports at public, regional, Masters I institutions in the Midwestern United States. From the convenience sample, survey respondents included 61 males and 82 females.  The study examined imagery use by: (a) sport and gender of current varsity athletes at the institution, and (b) between groups of respondents self-reporting as injured on uninjured. Results indicated that motivational imagery was more commonly employed than cognitive and healing imagery in the rehabilitation process. In addition, males used each function of imagery more than females. Furthermore, differences among sports concerning cognitive and healing imagery existed. No significant differences among injured and uninjured athletes and imagery use were found. The results of this study provided insight and additional perspective as to imagery use in the rehabilitation process. We recommend athletes, coaches, and athletic training personnel develop and implement imagery practices to improve athletic performance and the effectiveness of the injury rehabilitation process.

Key words: imagery, injury, rehabilitation

 Introduction

The number of sport-related injuries that occur annually is staggering. A comprehensive collegiate injury study examining 15 major sports from the National Collegiate Athletic Association (NCAA) Division I, II, and III levels indicated that preseason injuries totaled 286,843 persons, in-season injuries impacted 4,736,057 players, and post-season injuries tallied 221,188 athletes (Hootman, Dick, & Agel, 2007).  The impact on, and concern for, the participants, affiliated teams, and the corresponding universities is substantial.  While new prevention and rehabilitation techniques continue to be introduced, injury and return to play remain a focus for sport practitioners.

Imagery – one type of mental practice – has been used for many years by athletes, musicians, students, and individuals looking for additional learning and practice opportunities in a particular field (Weinberg & Gould, 2007). Mental practice has been described as the use of imagery to rehearse a physical skill. Simply stated, the process of mental practice is completed in the mind, and no physical movement is required. Research has found that mental practice can be just as beneficial as actual practice (Hutson, 2009).

Mental imagery has been categorized into two main perspectives – external and internal. The external view involves the participant imaging his or her performance like an outsider would. On the other hand, in the internal view, the participant actually feels the performance of the desired task (Mahoney & Avener, 1977). Internal imagery is believed to have a kinesthetic component that allows the body to feel the processes of the movement that may result in improved motor performance (Corbin, 1972; Glisky, 1996). In other words, the brain may not know the difference between actually performing, or simply visualizing, the task. While the body will reflect the absence of the task, motor skills have been shown to improve.

Mental imagery typically serves one of two main functions, motivational or cognitive (Paivio, 1985).  Additionally, imagery often incorporates the visual, auditory, olfactory, and kinesthetic senses (Denis, 1985). Cognitive imagery involves the athletes using imagery to learn, develop, and cultivate specific performance enhancing tasks, such as certain movements or exercises relevant to a sport or activity (Paivio, 1985). Motivational imagery is used to enhance performance – through goal setting, confidence building, or mental toughness – rather than skill development as the primary objective (Paivio).  Athletes have shown more prevalent use of imagery techniques related to competition, rather than during training (Hall, Rodgers, & Barr, 1990).Furthermore, athletes have indicated predominantly using imagery prior to, as opposed to during or after an event (Barr & Hall, 1992; Weinberg & Gould, 2007).

Athletic performance and injury rehabilitation are similar processes. In both instances, competitors are striving to achieve an outcome and use both the mind and body to accomplish objectives.  Previous studies related to imagery type and injury rehabilitation have yielded mixed results. For example, some research has indicated that cognitive, motivational, and healing imagery were used at similar rates, while others have found that cognitive and motivational imagery use was more prevalent (Milne, Hall, & Forwell, 2005; Sordoni, Hall, & Forwell, 2002). Furthermore, athletes have noted utilizing imagery for healing reasons, such as coping with pain and injury and to aid with the rehabilitation process (Weinberg & Gould, 2007). Situational and individual factors, as well as the limitations of testing materials are thought to contribute to these differences (Evans, Hare, & Mullens, 2006).

Thus, the current study sought to inform practitioners by answering questions in the following categories: (1) imagery use by sport; (2) imagery use by gender; and (3) imagery use among injured and uninjured athletes from the past academic year. The intent was that these data would provide guidance in developing imagery-related rehabilitation strategies.

Methodology

Participant selection was based on convenience. All varsity athletes from the institution were solicited to participate in a voluntary survey administered via electronic mail. The study group included 366 athletes from the rosters of the 2009-2010 athletic teams. Sports represented included 14 intercollegiate teams: baseball, men’s and women’s basketball, men’s and women’s cross country, football, women’s golf, women’s soccer, softball, men’s and women’s tennis, men’s and women’s track and field, and women’s volleyball. From the study group, 130 (35%) participants completed the survey. Sixty-one males (42.7%) and 82 females (57.3%) participated. Ages ranged from 18 to 24 years (M= 20.45, SD= 1.39), class ranged from freshman to first-year graduate student, and each sport had at least one participant.

Brief demographic questions (gender, age, class, sport, recent injury) prefaced the Athletic Injury Imagery Questionnaire-2 (AIIQ-2) survey instrument. The AIIQ-2 questioned participants’ use of imagery during the rehabilitation process (Sordoni et al., 2002). The questions targeted three specific functions of imagery: motivational, cognitive, and healing. Each of the 12 items corresponds to one of the three functions of imagery. Survey responses were rated on a nine point Likert-type scale, ranging from 1 (never) to 9 (always). Participants were allowed 21 days to complete the survey. Permission to use the survey was granted by its authors and the study was approved by the university’s Institutional Review Board. For data analyses purposes, demographic information was treated as categorical data and survey responses were treated as scale data.

Results

Mean scores for each function of imagery (motivational, cognitive, and healing), by sport, are found in Table 1. While members from twelve varsity sports responded to the survey, men’s (n=1) and women’s (n=2) tennis were excluded from some data analyses due to the limited number of participants. Football participants (n=29) reported the highest average motivational imagery score (M=7.07) and healing imagery (M=7.01) scores, while baseball participants (n=9) reported the highest mean score (M=7.70) in cognitive imagery.

Table 1

Mean Scores of Imagery Use by Sport

Motivational Imagery Cognitive Imagery Healing Imagery
Women’s Track & Field (n=21) 5.86 5.57 5.89
Volleyball (n=12) 4.43 3.78 2.93
Men’s Track & Field (n=18) 6.25 5.75 5.81
Softball (n=12) 5.15 4.55 4.13
Soccer (n=19) 5.97 5.69 5.64
Golf (n=7) 4.96 4.64 4.5
Football (n=29) 7.07 6.79 7.01
Women’s Cross Country (n=11) 4.55 4.68 4.58
Men’s Cross Country (n=13) 6.34 5.77 6.3
Women’s Basketball (n=9) 5.71 5.13 5.96
Men’s Basketball (n=4) 6.19 6.5 5.81
Baseball (n=9) 7.14 7.07 7

Note: Study group included only one men’s tennis player (MI=8.25 , CI=5.25, HI=8) and two women’s tennis players (MI=5.13, CI=4.0, HI=5.5)

Independent t test analyses uncovered a statistically significant difference between gender for all of the three functions of imagery (motivational, cognitive, and healing). Males reported higher imagery use mean scores than females in each of the three functions of imagery. Results of this analysis are shown in Table 2.

Table 2

T-test Analysis of Imagery Use by Gender

Imagery Use   N Mean SD Mean D t-test df p-value
Motivational Imagery Men 54 6.76 1.82
Women 74 5.32 2.46 -1.44 -3.64 126 0.00
Cognitive Imagery Men 54 6.49 1.75
Women 72 4.88 2.34 -1.61 -4.23 124 0.00
Healing Imagery Men 55 6.54 2.07
Women 71 4.82 2.54 -1.71 -4.06 124 0.00

Note: Significant at 0.05

Analysis of variance indicated statistically significant main effects for cognitive (F(11)=2.50, p=0.008) and healing (F(11)=2.91, p=0.002) imagery at the 0.05 alpha level.  Motivational imagery was found to hold no statistical significance.

Follow up tests were conducted to evaluate pairwise differences among the means. Tukey Post hoc analysis indicated statistically significant differences at the 0.05 alpha level between two sports for cognitive imagery use: volleyball and football (MD=-3.08). Significant healing imagery differences were found between volleyball and football (MD=-4.01) and volleyball and men’s cross country (MD=-3.37).

Previous research has supported the use of imagery during the rehabilitation process (Driediger, Hall & Callow, 2006; Hare, Evans & Callow, 2008; Milne et al., 2005). In this vein, the current study sought to determine whether injured and uninjured athletes were utilizing imagery strategies differently. However, an independent samples t test revealed no statistically significant differences among imagery use and recent injury status at alpha 0.05.

Discussion

The purpose of this study was to investigate imagery use during sport-related injury rehabilitation among athletes. Research questions investigated imagery use differences by sport, by gender, and by injury status. Previous research has supported that imagery use occurs during the rehabilitation process (Driediger et al., 2006; Hare et al., 2008; Milne et al., 2005). While studies have focused on the imagery use setting, such as practice versus competition, this study sought to focus on imagery during the rehabilitation process.

Motivational imagery was utilized most frequently by participants surveyed. While these results contrast some prior research (Sordoni et al., 2002), they mirror other findings (Milne et al., 2005). These inconsistencies have been noted as a matter of concern by Hare et al., (2008) and provide an opportunity for future research. Moreover, although little research provides supporting evidence as to why males reported higher average imagery use scores, the point remains and provides another area for further research.

The current study did not uncover imagery use differences among injured and uninjured athletes in the study. However, numerous studies support the effectiveness of imagery use during the rehabilitation process (Driediger et al., 2006; Hare et al., 2008; Naylor, 2009; Sordoni et al., 2002). Imagery use as a rehabilitation tool has been shown to be effective not only in the sport environment, but in other areas of rehabilitation as well. Mental imagery has been supported to decrease pain, promote healing, and improve self-motivation and adherence (Hamson-Utley, 2008). As individuals, situations, and instrumentation continually evolve, studies of this nature provide instructive information for practitioners at a given point in time and, therefore, may not reflect imagery use during the rehabilitation process over time.

Conclusions

It is recommended that practitioners investigate and implement best practices regarding the design, delivery, and evaluation of mental imagery techniques. Since coaches and athletic trainers have the most frequent and direct contact with athletes, they provide an influential role in the rehabilitation process. Assuming the role of mental coach, sport coaches and athletic trainers can assist athletes with development of imagery strategies that can aid in the rehabilitation process and enhance sport performance in general. While not every coach or athletic trainer may be comfortable teaching imagery skills, it is recommended that practitioners act as a conduit to refer athletes to trained sport psychologists or mental coaches.

Applications in Sport

Improved performance is a primary goal of athletes and coaches alike. Ultimately, encouraging athletes to develop an imagery tool box can lead to improved psychological skills. These skills can then be implemented to maximize performance when healthy, aid in injury prevention, and assist with the rehabilitation process.

Acknowledgments

            None.

References

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TABLES

Table 1

Mean Scores of Imagery Use by Sport

Motivational Imagery Cognitive Imagery Healing Imagery
Women’s Track & Field (n=21) 5.86 5.57 5.89
Volleyball (n=12) 4.43 3.78 2.93
Men’s Track & Field (n=18) 6.25 5.75 5.81
Softball (n=12) 5.15 4.55 4.13
Soccer (n=19) 5.97 5.69 5.64
Golf (n=7) 4.96 4.64 4.5
Football (n=29) 7.07 6.79 7.01
Women’s Cross Country (n=11) 4.55 4.68 4.58
Men’s Cross Country (n=13) 6.34 5.77 6.3
Women’s Basketball (n=9) 5.71 5.13 5.96
Men’s Basketball (n=4) 6.19 6.5 5.81
Baseball (n=9) 7.14 7.07 7

Note: Study group included only one men’s tennis player (MI=8.25 , CI=5.25, HI=8) and two women’s tennis players (MI=5.13, CI=4.0, HI=5.5)

 

Table 2

T-test Analysis of Imagery Use by Gender

Imagery Use   N Mean SD Mean D t-test df p-value
Motivational Imagery Men 54 6.76 1.82
Women 74 5.32 2.46 -1.44 -3.64 126 0.00
Cognitive Imagery Men 54 6.49 1.75
Women 72 4.88 2.34 -1.61 -4.23 124 0.00
Healing Imagery Men 55 6.54 2.07
Women 71 4.82 2.54 -1.71 -4.06 124 0.00

Note: Significant at 0.05