CHAPTER ONE INTRODUCTION
Background of the study
Whereas 39% of ankle sprain injuries are sustained during non-contact-mechanisms, 54% are observed during tackle scenarios (Farquharson & Greig, 2017). Akodu et al. (2012) found that, out of the 89 injuries recorded during the 2011 West African Football Union (WAFU) tournament, 82% of the injuries were sustained through contact with another player, with 19.1% resulting in time-loss (loss of competition activity). Major muscle groups of the lower extremities account for 92% of muscle injuries, with 23%, 13%, 37%, and 17% being the abductors, the calf muscles, hamstring, and quadriceps respectively (Ekstrand, Hagglund, & Walden, 2011; Pfirrmann, Herbert, Ingelfinger, Simon,& Tug, 2016; Svensson, Alricsson, Karmeback, Magounakis, & Warner, 2016).
High injury incidence in football and other sporting disciplnes is a function of contact between players and substantial physiological demands (Mauntel et al., 2017; Shalaj et al., 2016). Rago et al. (2018) noted that during a football match, high-intensity actions decrease, leading to match-induced fatigue that brings about muscle damage after a football match (Pavin et al., 2018). A common injury in football is ankle sprain (Farquharson, & Greig, 2017; Smpokos, Mourikis, Theos, & Linardakis, 2018). Injuries to muscles, bone, knees, hamstring, joint ligament, nerve, tendon, and soft tissue are caused by repetitive stress or direct trauma (Adjei, Moses, Nutakor, & Gyinaye, 2015; Longo et al., 2010).
The ever so threatening problem of whether one can reach the earlier levels of performances again, can affect his or her quality of life (Gouttebarge, Aoki & Kerkhoffs, 2018). Involuntary retirement or break due to a career-ending injury is difficult to deal with due to its unexpected nature (Wylleman, Alfermann, & Lavallee, 2004). This in turn
causes stress (Kerr & Dacyshyn, 2000; Stoltenburg, Kamphoff & Bremer, 2011), thereby affecting the quality of life of footballers.
Also, match exposure, minutes of playing, poor running performance, recurrence of injury, and days of rehabilitation have been noted to be risk factors for injury (Bengtsson, Ekstrand, & Hagglund, 2013; Del Coso, Herrero, & Salinero, 2018; Ekstrand et al, 2011; Hagglund, Walden, & Ekstrand, 2012; Stubbe et al. 2015). Contrary to Woods et al. (2004) who indicated that defenders sustain 15% more hamstring strains compared with forwards, Dadebo, White, and George (2004) showed that forwards sustained 10% superior amount of hamstring strains. In addition, Hagglund, Walden, and Ekstrand (2005), and Jacobson and Tegner (2007) showed that injury risk in football is higher in male adults than in female adults. These injuries stem from a complex interaction of both intrinsic and extrinsic risk factors (Akinbo, Salau, Odebiyi, & Ibeabuchi, 2007).
Culture of risk
Frey (1991) used the term “a culture of risk” to explain an environment within which athletes normally compete or train injured and take risks in order to succeed. The “culture of risk” legitimizes an athlete’s acceptance of pain, aggression and risk-taking behaviour as a normal aspect of participation (Safai, 2003). This has been established in a number of studies (Crossman, 1977; Frey, 1991; Hale, 2008; Howe, 2001; Johnson, 2000; Leddy, Lambert, & Ogles, 1994; Pargman, 1999; Roderick, Waddington, & Parker, 2000; Tracey, 2003; Young, White & Mcteer, 1994). Persons desiring to be professional or elite athletes often give in to a sport ethic that encourages long hours of training, risk taking, pushing through pain, and long playing seasons in order to succeed (Messner, Dunbar, & Hunt, 2000; Richardson, Anderson, &Morris, 2008). Most under-recovered or injured athletes try to continue competing due to the possibility of professional pride, personal ambition or
team pressure, guilt, or being replaced (McGannon, Cunningham, & Schinke, 2013). Young et al. (1994) suggested that money, praise, attention, and the perceived/real risk of being dropped from the team are some of the incentives that encourage athletes to take greater risks in competition/training, and to play in the state of injury.
Psychosocial well-being of sportsmen
Depression as defined by the National Institute of Mental Health (2012) is “a common but serious mental illness typically marked by sad or anxious feelings. Untreated depression lasts for a long time, interferes with day-to-day activities, and is much more than just being ‘a little down’ or ‘feeling blue’.” (p. 2). Gulliver, Griffiths, Mackinnon, Batterham, and Stanimirovic (2015) noted that recurrent or severe injuries in professional footballers are deemed to be major psychosocial and physical stressors. Warriner, and Lavallee (2008) observed that severe injuries are likely to trigger involuntary or early retirement from professional football, becoming a probable risk for psychosocial and mental health problems after retirement. Kristiansen, Halvari and Roberts (2012) noted that public and media interest in players, and organisational pressure with regards to financial and sporting success are some sources of the psychosocial stressors professional footballers encounter. As well, fear, anxiety, anger, depression, decrease in vigour, and confusion are some common emotions recorded after an injury (Tracey, 2003). Clement and Shannon (2011) explained that athletes’ re-evaluation of their capabilities, their personal identity, and their role on the team are the sources of these emotions.
Quality of life (QOL) is a general well-being of individuals and societies, outlining negative and positive features of life, which observes life satisfaction, including physical and mental health, and social belonging (family, friends, and religious beliefs) (Barcaccia, Esposito, Matarese, Bertolaso & De Marinis, 2013). Stoltenburg et al. (2011) showed that
sportsmen experience a wide array of both negative and positive emotions triggered by the understanding that their sport career had been truncated. Other works had previously suggested that the way an athlete copes with the end of her or his career can be a determining factor in how an athlete moves out of their respective sport (Gardner & Moore, 2006).
Freeman, Coffee, and Rees (2011, p.54) defined perceived social support within the athletic context to be “one’s potential access to social support and is a support recipient’s subjective judgement that friends, team-mates, and coaches would provide assistance if needed”. Anderson and Williams (1988) list friends, family, coaches, team-mates, and sports medicine staff to be examples of social support. Williams and Galliher (2006) asserted that high levels of social support, physical activity, and self-esteem often protect athletes from depression. Wheeler (2007) adds that social support is considered a protective influence on mood, physical function of the body, and overall well-being. Though emotional social support has proven to be an effective form of support for athletes, informational social support is the most preferred form of social support later in the injury process (Yang, Peek- Asa, Lowe, Heiden, & Foster, 2010).
Spiritual or religious coping
Religiosity is a multifaceted concept encompassing emotional, cognitive, motivational as well as behavioural dimensions (Hackney & Sanders, 2003). Richards and Bergin (1997) added that it is a subset of spirituality since one could be spiritual and not be religious. However, it is also possible to be religious and not be spiritual. Whereas being religious entails adopting to particular sets of religious creed, spirituality connotes a knowledge and connection with the transcendent (Rusu & Turliuc, 2011). There is a great impact of
religion on the individual, since it is considered a vital source of social support (Frey &
Stutzer, 2002). Krause and Wulff (2005) have suggested that church-based relationships could advance one’s sense of belonging and consequently enhance his or her mental and physical health.
Statement of the problem
Sportsmen in Africa suffer serious injuries. For example, Akodu et al. (2012) indicated that 89 injuries were recorded during the 2011 WAFU cup tournament. They showed that 82% of the injuries were sustained through contact with another player. Recently, Omoniyi, Kwaku, and Francis (2016) found that there was an increase in the number of injuries among footballers in Ghana. They also revealed that 83 midfielders in the premier league suffered serious injuries, with 20.5% sustaining knee injuries. These injuries stem from a complex interaction of both intrinsic and extrinsic risk factors (Akinbo, Salau, Odebiyi, & Ibeabuchi, 2007), with consequences ranging from re-injury to career-ending (Kohrt, Bloomfirld, Little, Nelson, & Yingling, 2004). Consequently, Omoniyi et al. (2016) suggested that the provision of preventive therapy could sustain the careers of upcoming footballers.
It has been suggested that injuries sustained by Ghanaian footballers are often addressed using biomedical approaches (Omoniyi et al., 2016). However, athletic performance is affected by numerous factors including physiological, biomechanical, and psychological factors (Aritan, 2015). In a resource poor setting as Ghana, the preponderance of biomedical healing systems might obscure the psychological challenges athletes go through and thus sideline the role of psychocentric practitioners such as psychologists, counsellors, psychotherapists, and psychiatrists. Pain from injuries, the duration of treatment, cost of treatment, perceived lack of social support, feelings of hopelessness following the injury etc., can all create a psychological distress in the athlete. The
lamentation of Ali Jarrah, who was a prodigy in his days is one of the best illustrations one can have. He said:
“I just wanted to share this with friends. Life has never treated me fairly; siblings and friends have also never treated me fairly. Those you treat well will turn their backs on you. Why will people judge you with your disability and turn their backs on you? This world is a journey, why will people suffer and toil which is no fault of theirs. Friends and brothers who are supposed to comfort that fellow neglects him. This is a little story I have to share with you, friends. I started as a footballer (goalkeeper to be specific) I’ve played 3 juvenile World Cups and 1 African Cup of Nations. I’ve won one juvenile world cup, two silvers and one African Cup of Nations. I also played for Accra Hearts of Oak. I won all the 3 awards in the 1992/1993 season. I got paralyzed in 1993. I started training goalkeepers to give back to the society, which I’ve helped over 30 goalkeepers to be in the premiership and the national teams both male and female. I coach people with disability; I’ve been able to help 7 amputees to play in Turkey. Why is it that I’ve been able to change peoples’ lives and no one cares about me? I am dying slowly. Ministers, philanthropists, football authorities executives, parliamentarians can’t they come to my aid? In Ghana, if you don’t have a push you can’t survive. Day in and out, I am heading towards my grave. They will wait till I die before they remember me. If I got paralyzed at 17 dying for my nation, what does the nation expect me to do now after 23 years? I leave this to the world to judge. You can share my little story amongst friends and brothers so they know. When I die, I died because of pain” (Ghanaweb, 2015).
Another promising Ghanaian footballer who sustained an injury that kept him away from the field of play for over nine years is Opoku Agyemang who tore his knee ligament after an impressive performance during the 2010 African Cup of Nations in Angola. He also played for the Ghana national team at all age levels: the 2005 U-17 team, and went on to win the 2009 FIFA U-20 World Cup in Egypt. His story also gives us a hint as to the challenges footballers with career threatening injuries go through;
“Despite being out these past nine years, I have always felt confident that I will recover fully and play again. I’m still on rehabilitation full of hope that I return soon,… Growing up, I had dreams of playing top level football… I will be 30 in June (2019) and I have given up on that because the agents shy away saying age is not on my side coupled with the fact that I have been out for over 8 years. Like I said, I have not given up on playing again. When I finally feel there is no chance, I will surely announce the end of my playing career. “I love to play football. It is my source of happiness and I give it my all…,” (Ghanaweb, 2019)
The present study is thus an attempt to examine some of these psycho-emotional factors and provide evidence that will guide a holistic provision of intervention and treatment for footballers in Ghana. The study will seek to bring into the treatment package for footballers the role of psychocentric practitioners.
Further, approaches that have been used to study the experiences of injured players have been predominantly quantitative. Studies that investigated incidence of injuries sustained by athletes employed systematic reviews which make it quite difficult to firmly conclude that the rates and types of injuries recorded are true reflections of the picture on the ground (e.g., Del Buono, Volpin t, & Maffulli, 2014; Robertson & Wood, 2015). This method is
likely to exclude other relevant studies due to the search words or phrases that are used. In essence, there is the need to conduct studies that will explore the lived experiences of footballers with career threatening injuries.
Relevance of the study
To the best of my knowledge, the study is the first of its kind that seeks to explore the experiences of Ghanaian footballers with career threatening injuries. Thus, it will add to the extant literature on the career threatening injuries worldwide, and the experiences of footballers with career threatening injuries in Ghana. This will provide the basis upon which other studies could be done in the area of footballers with career threatening injuries. Further, the study will provide knowledge about what footballers with career threatening injuries go through, highlighting the psychological peoblems they encounter during injuries, and the recovery process. Such knowledge will inform clinical interventions.
Aims and Objectives of the study
The study seeks to explore the lived experiences of footballers with career threatening injuries in Ghana. Specifically, the study seeks to explore;
- The psychosocial problems footballers with career threatening injuries in Ghana face.
- How these problems affect their well-being.
- Resources accessible for rehabilitation.
- The kinds of coping strategies they adopt in dealing with those psychosocial problems.
