Mental Health Impact of Sports Injuries

19543 words (78 pages) Dissertation

13th Dec 2019 Dissertation Reference this

Tags: PsychologySportsMental Health

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Chapter 1 – Introduction

1.1 The Topic

This study will look at the mental health impacts on long term injuries of sportsmen aged between 18 and 25 who compete in amateur team sports. There is significant research in relation to the impact on mental health on elite sportsmen; however there is limited research in the field of amateur sportsmen. The argument at the crux of my dissertation is that anyone who competes in sport can hold a strong sense of athletic identity no matter their level.  Sport England (2016) state that almost 16 million people participate in sporting activities at least twice a week, the majority not to an elite level, this implies that a vast proportion of the population could benefit from this research.

1.2- Importance of Study

Mental health is politically, morally and socially important. Addis and Mahalik (2003) highlight that men heavily under use mental health services; they sort problems through participating in sport or drinking (Connolly 2015).  Hardy (2015) looks at the increased focus on men’s mental health in contemporary society in relation to a neoliberal society. Organizations and companies are more aware of the benefits of their workforce being both physically and mentally healthy. As a result of this there are more services and tools to help with mental health in place, an attempt to make it a more preventive measure to increase the productivity of men in the workplace (Hardy 2015). This section highlights that male mental health is a contemporary issue and is one of society’s foremost challenges (Bell 2015).

In a political sense, a healthy mental state is directly related to a more productive workforce (Hardy 2015). In my opinion the most important aspect of this study is to understand the moral and social implications that mental health can have on an individual. The more research and case studies that become accessible to society about male mental health, the greater the chance of a reduced negative stigma towards men having mental health issues. This might make them more willing to come forward to receive help and use the services in place (Addis and Mahalik 2003).

1.3- Personal Connection to the Research

I have a deep interest in this area as a result of an eight month period where I was unable to compete in sport because of an injury. I felt that I experienced negative impacts on my mental health as a result of this. I was and still am eager to understand experiences of others in relation to mine. I have always had a love for sport and for the teams that I have played in. Being a part of a team prior to my injury and on my return to fitness was vitally important to me. The support that I received coming back was amazing, however I struggled to be around my team and more broadly sport throughout my injury. I have always had a strong sense of athletic identity and I now know that I did not hold the same athletic identity throughout my injury; I did not meet the needs of my masculine identity across this period either. I chose to focus my research on male, amateur athletes from a team sport as a result of this.

The research question is: To what extent do long term injuries have a negative impact on men, aged between 18- 25 within competitive, amateur, team sport?

1.4- Summary of the Study

To utilise personal understanding and experiences an auto-ethnography was used along with four semi-structured interviews to provide the sample. This allowed the acquisition of ‘rich’ understandings of others experiences and pin them against that of the researcher. My experience enabled me to develop an interview guide to gain the in depth understandings that were vital to help map the understandings of the impact of long term injuries on mental health. The overarching findings highlighted that the impact of long term injuries were severe. Participants unveiled feelings of ‘distress’, ‘anxiety’, ‘depression’, ‘unhappy’, this highlights the importance of the study. I found that no matter their reasons for participating whether it be more extrinsic or intrinsic, each held a strong sense of athletic identity. In most cases the injury caused the individual a reduced sense of athletic identity and their masculine ideals were not being met as a result. I further found, that in most cases, being part of a team increased their sense of athletic identity. Most enjoyed being part of a team before and after the injury because of the support that they were given. But there were key findings that during the injury process itself, being a part of a team did not help the participants deal with their injuries.

1.5- Implications of the Study

It is an important area to research and exposes the experience of those willing to share. It provides the potential for people to understand the experiences of others. Learning about why they might be feeling certain emotions. It can enable readers to make a change to their attitude o routine as a result of this; with the intention of reducing the negative impact that they might feel as a result of their long term injury. Further to this and perhaps most importantly, this research has the power and the potential to highlight the need for a bigger focus on the mental health of athletes who compete in competitive sport at an amateur level.

Chapter 2- Review of the Literature

2.1- Identity

Before going into sport, masculinity and athletic identity, it is important to understand an individual’s ‘identity’ and how that can influence a person’s behaviour and frame of mind. Stryker (2002) explains identity as internal understandings, positional beliefs and values which are directed to participating in sport in the sense of a strong athletic identity. Carter (2013) argues that our sense of identity acts as stimuli to certain behaviours within certain situations. Also arguing that our identity can help us fit in to social surroundings and experiences. Individuals in this study will behave in different ways in a reaction to their injury. Inglehart and Baker (2000) explain that certain situations and matters are seen to hold more meaning to different people. Certain situational occurrences will have different levels of influence on an individual’s behaviour (Hardy and Carlo 2005). Adams et al (2010) state that identity is key to successfully moving between social situations and life changes. This shows that each individual will have their own unique experiences in relation to their injury.

2.2- Social Identity

An individual’s identity is of the upmost importance to this study, but the theory of social identity, also holds relevance and needs to be understood. The study is underpinned by the understanding of impacts on mental health in relation to team sports. Social identity differs from an individual’s identity, it is how an individual identifies and perceives their attachment and participation within a group (Bruner et al 2014) rather than their own innate identifications (Stryker 2002). It essentially comes down to how individuals see themselves in regards to a sense of belonging to that group (Hogg and Abrahams 2001). Nezlek and Smith (2005) talk of positive outcomes to individuals who have a strong social identity within a group; they face stronger social interaction and are more likely to express positive behaviour towards other group members. This is particularly important to understand and give thought to when studying mental health in relation to long term injuries from athletes within team sports. Rees et al (2015) highlight that within a sporting group those who have strong social interactions are likely to pursue and to uphold their part of the ‘we’ in the group and to engage in bettering themselves, working hard to be part of the ‘we’ rather than just the ‘I’(Cikara et al 2011; Sanderson 2013; Turner et al 1994). As a result of this there is a development of a sense of belonging because each of the members of the group identify and become satisfied with the role that members of the group play (Rees et al 2015).

2.3- Team Sport

In the case of this dissertation the ‘social identity’ refers to how the individual fits with the ‘we’ of their team.  It is important to understand the characteristics and social means of team sports in order to understand certain aspects of masculinity and athletic identity in relation to them. Baumeister and Leary (1995) argue that being a part of a sport team satisfies a human necessity for feeling a sense of belonging and fitting in, being a part of something. However, Klein and Heuser (2008) see how a team setting can be very difficult to understand and to fit into. They point out various different aspects of a team such as politics, hierarchies, and team dynamics. Particularly highlighted, are the difficulties of a new individual joining the group or in terms of this dissertation the challenges of returning to a team after a long absence due to injury (Bauer et al 2007 ;Kim et al 2005; Jones and Wallace 2005). Martin et al (2014) believe that each team is unique in its set environments, individuals may better suit different team environments, but ultimately a sports team does have the capabilities to provide the sense of belonging (Baumeister and Leary 1995) and teammate social identity (Bruner et al 2014).

2.3.1 – Positives of Team Sport

Participating in a team sport can have various positive impacts to the self, for example, reaffirming or developing moral values and self-awareness (Shields, LaVoi, Bredemeier and Power, 2007; Weiss, Smith, and Stuntz 2008). Identifying strongly within a team can meet specific personal needs that contribute to motivation for continual support from the individual to the team, and then after from the team to the individual (Rees et al 2015). There are further links with a strong social identity within a team, to the individual’s performance and ability to cope with challenges and certain issues that arise. Haslam et al (2008) and Haslam et al (2009) argue that this provides the support that enables individuals to cope with different life changes such as the impact of long term injuries and alterations in their general life processes. Further to this, Podlog and Eklund (2007) argue that social identity has an impact on the recovery of sport injuries. They suggest that those who have a strong social identity and sense of belonging to a group have a more positive experience because of support, relatedness and increased self-esteem, which inevitably helps an individual to adjust to the situations that arise and enables them to cope positively with them.

2.3.2 – Negatives of Team Sport

There are many seen positives to competing in sport and more specifically within team sports but there are also negatives, some of which are discussed here. Despite many academics highlighting the impact of sport in term of stress release. Arnold et al (2013) and Hanton et al (2005) point out ways in which being involved in a sport team can have  negative impacts on an individual’s stress levels; personal relationships can be a huge factor to increasing stress levels. For example, the stress of who gets chosen for the match day squad or, if you experience character clashes with the other members of the team or the coach. There are further stress factors associated with the pressures of meeting the demands of the team and performance heights that are expected of athletes. All of these can lead to negative impacts on an individual’s mental health such as anxiety and feeling distressed (Benson et al 2015). So although sport can be seen as great to be a part of, even I as an athlete accept that there can also be a negative impact of sport on an individual’s mental health.  

2.4- Masculinity- Hegemonic Masculinity

Having discussed how being part of a team sport can impact an individual and their mental health I believe it is important to discuss the more specific roles within an individual’s identity and athletic identity more directly. A specific part of an individual’s athletic identity that I am interested in is masculinity. Within competitive sport it is widely believed that hegemonic masculinity is allied with and fulfilled through sporting expertise and skill, a competitive nature and to have the capability of verifying yourself through physical strength and power (Coad 2002; Connell 2000). Sparkes (1997) argues that an individual’s body and masculinity are directly significant and a piece of your formed identity. Cole (2008) explains that the ideals of hegemonic masculinity are very hard to meet because of the constricted regulatory confines surrounding the theory. Leaving few who end up meeting the hegemonic ideals.

Masculinity is defined through personal socialization and communication through social experiences, in this sense within their team or more broadly entire club setting. Individuals have their own distinct culture and influences that hold them accountable to their own values, norms and what behaviours they see to be fit and adequate to their individual identity (Schwartz 1999; Schwartz 1997). According to Stets and Burke (2005), once an individual has formed their ideals of hegemonic masculinity within their athletic identity they will endeavour to be certified and approved by others within their situational surroundings, in this case a sport setting. Stets and Burke (2005) suggest that the individuals mostly seek the certification and approval from others who are significant to their surroundings such as a coach, most valuable player or team captain in a sporting sense. Showing how this can inform understandings of mental health pertaining from sport. Cast and Burke (2002) propose that when the ‘others’ in the social settings do not adhere and approve an individual’s hegemonic masculine athletic identity, problematic responses of strain and tension can occur.

Coakley (2009) highlights multiple features and issues with hegemonic masculinity from a sporting perspective. The main concept that I gain from Coakleys (2009) work is the concept that within athletic identity individuals that play competitively can be and often are extremely devoted and enthusiastic to their sport and will take multiple risks to achieve their aims. Coakley (2009) writes that a strong sense of athletic identity and hegemonic masculinity means that an individual will hold their sport above other aspects of their life and will devote significant amounts of their time to it.

2.4.1 – Masculine Capital

Within masculinity there are various different activities and ways in which one can be seen as masculine. De Visser and McDonnell (2013) understand that sporting activities are seen to be the highest forms of masculine behaviour and hold higher levels of ‘masculine capital’ than activities such as smoking or drinking. This is vitally important to understand, as this dissertation looks to understand the impact of long term injuries, which inevitably means a loss of participation in sporting activities. The research is important in trying to understand how athletes are able to meet their masculine needs when they are injured. Further to this, there is thought that the age group being researched in this dissertation have an increased sense of masculinity amongst their athletic identity (Arnett 2000; La Fontana and Cillessen 2009). De Visser et al (2009) argue that men do not have to employ all ideals of masculine behaviour for them to be considered masculine. ‘Masculine capital’ is a concept where individuals can ‘trade’ certain masculine behaviours for others to reach their ideal masculine level (De Visser et al 2009; De Visser and McDonnell 2012). In relation to the study this shows that individuals can see themselves as masculine and hold it strongly as part of their athletic identity even if they reject the forms of hegemonic masculinity.

Anderson (2005) suggests that ‘masculine capital’ acts as a compensatory tool to allow individuals to counter-act non-masculine behaviours. An example of this in a real life situation is an athlete who does not drink alcohol but is able to increase their seen masculinity by being a skilled athlete (Anderson 2005; De Visser et al 2009; McGuffey and Rich 1999). It provides individuals with the opportunity to combat potential negative attacks on their masculinity and more broadly, athletic identity (De Visser and Smith 2006; De Visser and McDonnel 2012) and therefore could be argued to help their mental health. De Visser and McDonnell (2013) argue the heightened importance with masculine capital and understanding of it as a concept alongside hegemonic masculinity. Seeking hegemonic, masculine adherence can have negative impacts as individuals can be willing to take part in dangerous or unhealthy behaviours to acquire hegemonic masculinity, which Cole (2008) states is unachievable for most.  Masculine capital can allow individuals to feel masculine as it enables individuals to reject specific unachievable forms of hegemonic masculinity.

2.4.2 – Masculinity- Mosaic Masculinity

Connell (1995) argues that despite hegemonic masculinity being just one view on masculinity as a subject, it is ranked higher than all others. Cole (2008) gained understanding that a significant percentage of male athletes saw hegemonic masculinity as part of their athletic identity and that they often used it as a form of criteria by which they would assess their performance as being masculine. Individuals can gain a sense of acceptance and seen to be of a higher standing in their social group when they are meeting ideals of hegemonic masculinity within their athletic identity. Cole (2008) suggests that hegemonic masculinity is a significant part of team sport and for the individuals participating in this. Masculinity is widely seen as being socially constructed within the environment. The team (social group) is seen to legitimate forms of masculinity, instilling the sense of acceptance and belonging to the individuals.

Cole (2008) identifies another concept of masculinity, identifying the idea of ‘mosaic masculinity’. He explains this as men drawing their own sense of masculinities from a wide range of areas that fit their ideals of masculinity and to their own athletic identity. Within this concept there is an understanding that not all men can meet the perfect ideals of hegemonic masculinity as a result of the ‘boundaries’ being so narrow. Coles (2008) argues that within ‘mosaic masculinity’ individuals construct their own ideals of what the perfect masculinity is. They construct this through their social settings, environment and experiences throughout life to create their own ideals to enact as part of their athletic identity. Individuals concentrate their ideals of masculinity on specific parts of hegemonic masculinity that they see to be specific to their needs of their athletic identity and performance within the group and within participation. Individuals discard other ideals of hegemonic masculinity that they do not see to benefit them and to be of a need to their athletic identity. An example of this is ideals of strength, within standard idealistic views of hegemonic masculinity the idea of strength is being physically strong however in the concept of mosaic masculinity the individual might understand their ideals of strength to being mentally tough and strong. The individual would reject the notion of being physically strong and not seek to adhere to this area of masculinity.

According to Coles (2008), when individuals conform to mosaic masculinity it enables them to still feel part of the group and to meet the masculine needs and ideals of the group as they still aim to meet certain ideals of hegemonic masculinities. They still feel a sense of belonging to the wider group. This helps to stop or reduce feelings of subordination within a group of individuals who do meet the ideals of hegemonic masculinity. It still allows the individual to get feelings of reassurance and approval from the group. Cole (2008) further argues that this allows a greater sense of achievement in everyday life as they feel self-assured and self- confident; feeling that they meet the needs of society and do not feel marginalized or subordinated from society. However if an individual gets injured it is possible that they will not be meeting the needs of their masculine capital. This can have an impact on their mental health.

2.5 – Injury

As stated throughout, this dissertation is seeking to understand the impact of long term injuries on mental health. We need to understand how the ideals and masculinity of an individual’s athletic identity are met without the participation of sport. There is a lot of research on injuries as shown below by various academics. Hootman et al (2007) describes an injury as an athlete who is hurt and therefore is incapable of participating in activity for any phase of time. Benson et al (2015) argue that all athletes should prepare themselves for the occurrence of picking up an injury. Maffuli et al (2005) suggest that injuries are so prevalent in athletes because, even from a young age countless amounts of athletes have taken part in exhaustive and rigorous training resulting in injuries as an outcome. Benson et al (2015) highlight the danger of psychological reactions to injuries and not being able to participate in sport. Suggesting that injuries can and often do uncover psychological and mental health issues than can be as serious as anxiety, depression and eating disorders. Benson et al (2015) argue that the reasons for such severity in issues within mental health from lay off from sport through injury is that many have not experienced injuries before and especially if the individual started participating at a young age then they have not established any methods and ways of dealing with absences from sport.

Johnson (2000) and Putukian (2015) highlight further issues with the psychological state of an injured athlete showing that injured athletes who are suffering from mental health issues take longer to recover from the injury. As a result of stress muscle tensions increase and so does the risk and severity of injuries. Putukian (2015) found that over twenty percent of the athletes within his study suffer from depression. Further to this Putukian (2015) gained understanding that from those who had informed the research of feelings of pain from sport had a considerably higher chance of suffering from symptoms of depression. Putukian (2015) is aware that there are other responses to injury and ones that are seen to be less serious than anxiety, depression and eating disorders. The ‘less’ serious emotional responses can quickly trigger more serious mental health issues (Putukian 2015). This shows the importance of returning from injury as quickly as possible as the impact on mental health can develop over time.

It is important to understand that less serious reactions to injury such as depression, anxiety and eating disorders can still have a negative effect on an athlete’s life. Clement et al (2013) highlight strain and pressure, Udry et al (1997) highlight feelings of anger, Johnston and Carrol (1998) highlight feelings of astonishment and disbelief, and Vergeer (2006) highlights feelings of annoyance. Although these are initially seen as a less serious reaction to injury, they can build and manifest into the more ‘serious’ reactions. This can be caused as a result of the injury being long term or if the individual has reactions to new situations and surroundings. Wiese- Bjornstal et al (1998) suggest that each individual constructs their own meaning from their injury. They face different situational factors, which influence their reaction and response to injury in different ways.

Hudson et al (2014) found that within his study of injuries in Australian Rules Football, athletes who have been sidelined with a long term injury, isolate themselves away from their team and group. Prior research carried out by Ruddock- Hudson (2012) explains the importance and need for emotional support throughout the injury and highlighted its help in the healing process. This emotional support can come from teammates, physiotherapists or strength and conditioning coaches (Bianco and Eklund 2001; Tracey 2003).        

2.6 – Athletic Identity

Reactions to injury differ to each specific individual identity and experiences. Identities provide individuals with their own set of standards, which they then contrast in different social situations, activities and groups McGregor, Haji, Nah and Teper (2008).  An area of identity that I am extremely interested in is sport. Britton et al (1993) and Grove et al (1997) suggest that participation in physical activity normally goes together with feelings of obligation and commitment. Those who participate in sport can hold an athletic identity, which Britton et al (1993) describe as ones role as an athlete. It is constructed as holding high value to them through both their mind-set and their physical participation. Eldridge (1983) argues that a vast amount of individuals who participate in multiple activities have a strong sense of belonging and commitment to the athletic role that they perform. Heyman (1987) argues that allowing this to be given a social science based definition of athletic identity suggests that it can be heavily influenced by the different social surroundings and actors such as sports teams, coaches and friends. Hogg (2000) highlights the power that having an athletic identity can have; explaining that it can result in the individual’s perceived identity being a strong motivational impact on ones feelings and actions.

Baillie and Danish (1992) believe that those who feel a strong connection with athletic identity are likely to feel and experience a wide range of difficulties when attempting to change their emotional and social needs and perceptions when they are no longer able to participate in sport and fulfil their ideals of athletic identity. So far I have talked a lot about masculinity, being hegemonic, mosaic and masculine capital. Masculinity, in any form can be a large part of an individual’s athletic identity. Sparkes (1997) highlights the significance of masculinity to upholding an individual’s identity. Arguing that younger athletes often seek the ideals of a physically strong and fit body. This is significant because your sense of athletic identity guides your reactions in terms of emotions and behaviour to the direct situations that you are in; it enables you to interpret your experiences and certain events in your athletic career in a unique, personal way (Markus 1977). Injury will have a different impact on every individual but this shows that it has the potential to impact an individual’s mental health. 

Markus (1977) argues that those who hold a high sense of athletic identity will identify and feel stronger repercussions of the situation than someone who has a much lower sense of athletic identity.  Benson et al (2015) suggest that in the result of the end of an individual’s athletic career the individual will continue to try to uphold and endorse their athletic identity, including their ideals of masculinity in order to meet their understood role as an athlete. This belief upholds Baillie’s and Danish’s (1992) ideas of experiencing struggles of changing their emotional, social feelings and stance to meet the needs of new surroundings. Holding the potential to increase the impact on an individual’s mental health. Brewer et al (2010) explain that as a result of different settings in different group(s) the individual will attempt to distance themselves from their perceived athletic identity as they are unsure as to how they will now meet the perceptions of their identity. 

2.6.1 – Positives of a strong athletic identity

Having a strong sense of athletic identity can have positive, but also negative effects on an individual. It is important to understand both of these sides when looking at athletic identity. Both aspects can lead to drastic effects on an individual’s mental health. McPherson (1980) highlights the benefits of a strong athletic identity resulting in a strong understanding and sense of self. If athletes are meeting the ideals of their athletic identity they are more positive in other areas of their life because they have a strong sense of belonging within their athletic role. They feel that they are a part of something bigger than an individual and take their place happily amongst a specific social group, which can have a positive impact on an individual’s mental health. Petitpas (1987) further suggests that it allows more effective engagement in building social relationships and has the ability to add to an individual’s confidence, which has a knock on effect to their wider social interactions.

Additional positives of a strong sense of athletic identity are motivational and performance based positives. A strong athletic identity can have performance based positives (Danish 1983; Werthner and Orlick 1986). Britton et al (1993) argue that it can increase level of performance because of increased intrinsic motivation. They argue that it makes them more likely to attend every session, putting all of their effort into a session; resulting in a higher intensity at training over those who hold a lesser sense of athletic identity. From my auto- ethnography you can see that at University I train up to four times a week and have at least one game a week on top of that, which is a huge time commitment. The sessions are often at unsociable hours of the day with two training sessions at 07.30- 09.00 on Monday and Tuesday mornings. From this you can see the high levels of commitment and my sense of athletic identity. For example others in the squad that did not have such a strong sense of athletic identity might miss some of those early morning sessions. These performance benefits can add to my sense of masculinity and have an impact on my mental health at the time but also throughout my injury.

2.6.2 – Negatives of a strong athletic identity

Despite there being many positives of a strong athletic identity there are also negatives associated to them. Murphy et al (1996) argue that having a strong athletic identity can have negative repercussions for life beyond sport. They go as far to describe it as being ‘dysfunctional’. It can lead to a lack of ambition and lack of desire to locate and seek out careers after retirement. Stets and Burke (2005) suggest that those who hold ideals of masculinity within their athletic identity are often top performers at their level. Arguing that if the athletes career, post sport, is not at the top of the job ladder then they might struggle to deal with accepting their new masculine identity. This is just one example of the negative effects of a strong athletic identity in association with retirement (Alfermann, Stambulova and Zemaityle 2004).

Cecic et al (2004) further emphasise the risk of negative impacts of post retirement from sport for those who hold a strong athletic identity. Danish (1983) explains the strenuous burden of training and matches, more often than not mean that the athlete has to focus the majority of their time on this and have to reduce if not cut out other activities in order to achieve their highest level of performance. Danish (1983) regards this as why there is a seen lack of desire to seek out future career plans. Sparkes (1998) further explains the potential of limited career paths by suggesting that individuals with a strong sense of athletic identity immerse themselves so deep within their sport and competition that they are less likely to have recognised the importance of education and overall life potentials. Sparkes (1998) goes as far to say that this increases the risks of mental health issues when athletes retire or are forced to quit sport due to injury.

2.6.3 – Athletic Identity and the targeted group

It is important to understand the different impacts of a high sense of athletic identity on different ages of individuals. Houle et al (2010) found that the age of individuals who are participating in this study hold a much greater sense of athletic identity than other age groups. Houle et al (2010) suggests that this has an increased impact on their mental and physical state, some in a positive light and others in negative ways. Houle et al (2010) highlight that an individual’s social identity is a large part of the athletic identity for individuals of this age. In a sense of mosaic masculinity and masculine capital, it helps us to understand how social identities can be prevalent for those aged eighteen to twenty five. The social side of one’s athletic identity can help to reach the individual’s ideals and keep them feeling a sense of belonging even when injured. Benson et al (2015) argue that the greater sense of athletic identity in individuals of this age means that the end of a career, as a result of an injury, holds greater risk to an individual’s mental health.        

Chapter 3 – Methodology

3.1- Qualitative Methodology

This dissertation is underpinned by a qualitative research approach. Barnham (2014) states that this will enable me to gain a greater understanding of the attitudes, behaviours and responses to long term injuries by the participants of the study.  Sparkes and Smith (2014) describe qualitative research as an inquiry into social events or activities in an attempt to understand and interpret individual accounts and experiences of specific incidents. Barnham (2014) further justifies the use of a qualitative research approach in my research, as I am primarily interested in understanding the responses of the participants to long term injury and `why` the participants of the study have responded in their own unique way. A quantitative research approach would not allow me to gain the deep understandings that I seek throughout the dissertation as it provides data stems rather than understandings. Charmaz (2004) prompts us, that in order to gain the rich understandings of experiences of long term injuries on the individual’s mental health, it is important to gain the understandings from the “inside”.

Martin (2011) argues that there has been an over emphasis on the dissimilarities between the qualitative and quantitative research methods, which has led to an unfair comparison between them; each provide us with relevant and useful information. Walsh and Koelsch (2012) explain that qualitative research is a broadly used name for a large group of methods for carrying out research. Denzin and Lincoln (2005) highlight that there is not one form of qualitative research that is the `right` one to use, explaining that each method has its own benefits and limitations.

3.2- Paradigm

Markula and Silk (2011) describe a paradigm as a set of rules that govern the research process; it guides every technique that you use throughout the study (Kuhn 1970). Understanding your paradigmatic stance is vitally important to your research (Lincoln 2010). I chose a humanist interpretive paradigm. It demonstrates my understanding of what is relevant and useable knowledge. I wish to gain understanding of rich and valid experiences opposed to numerical data stems that you find from using quantitative research methods (Lincoln 2010). It demonstrates my subjective and epistemological stance and the relationship that I will have with the interviewees; I understand that the participants and I are inter- dependant in the construction of the data produced (Sparkes and Smith 2014). I heavily value this stance throughout the research process. That is evident through not only the choice of paradigm but through my choice of using both an auto-ethnography and semi structured interviews to collect the data.

Guba and Lincoln (1994) explain that the paradigmatic stance is based on my own personal views and opinions on the world and my position within the world and the research project. The humanist interpretive paradigm supports the objectives of my research and strongly correlates the epistemological and ontological stance that I take throughout the research. I view the research from a relativist ontological stance.  The paradigm follows a subjective epistemological stance recognising my interactive position within the interview process and the use of auto- ethnography. Use of an auto-ethnography makes the research somewhat unique and adds a highly beneficial transcript to be analysed along with the information gained from interviewing the other participants. Markula and Silk (2011) understand that through this paradigm I will be able to find and understand the multiple meanings that individuals have attached to their experiences of long term injuries (Manning 1997).  I have chosen these qualitative research methods as they are designed to enable me to identify interpretations and understandings of the mental health issues associated with long term injuries (Creswell 2007).

Markula and Silk (2011) suggest that using a humanist interpretivist paradigm allows you to pin the individual experiences of the participants injuries together; enabling you to understand the different experiences to different situations and gain an in-depth understanding from a researcher’s perspective. This dissertation is a narrative that sets out to use an interpretivist paradigm to paint a picture and showcase participant’s experiences of injuries (Holstein and Gubrium 2005). It is important to compare and contrast the data collected but it is vital that the individual stories are told at the same time, the humanist interpretivist paradigm fits these needs.  

3.3- Sampling Procedure

The sample I used for my dissertation was heavily discussed with my dissertation supervisor; it consisted of my own auto-ethnography alongside four semi structured interviews (Markula and Silk 2011). Due to the resources and time to carry out the dissertation it was agreed that this would be a sufficient amount of data to explore the research question. The sample was selected and chosen ‘purposefully’ in order to gain understanding of specific information. This meant that I was able to seek out ‘rich’ case studies to gain an in depth understanding that I would not have achieved if I had used a random sampling method that many quantitative studies use (Markula and Silk 2011).Within ‘purposeful’ sampling Patton (2002) lists multiple variations that are suited to more specific studies. In choosing my sample based on criteria Patton (2002) suggests that I used ‘Criterion’ sampling. I chose individuals, to be a part of the sample, whom were male, between the ages of 18- 25 and had experienced an injury for a minimum of three months. In the discussion the four interviewees are referred to by their psydenyms, being Perice, Darwin, Sergei and Kenny.

3.4- Auto- ethnography

Auto- ethnographies are a relatively new method, described as an account of the self in the form of an assembly of narratives (Ellis and Bochner 2000); Cladinin and Connelly 2000). It encompasses your own experiences and understandings of events with the researcher at the crux of the inquest. The auto- ethnographic form of research in my dissertation provides a different viewpoint and perception of mental health issues associated with long term injuries in sport (Barone and Eisner 1997).  Ellis and Bochner (2000) argue that one of the main benefits of the method is the link between the personal understandings to the wider cultural world. It allows me as the researcher to fully unveil and divulge my experiences of mental health associated with my injury. Pinning them against the wider social issues, which I will gain understanding of through the use of semi- structured interviews.   

3.5- Semi- Structured Interviews

McIntosh and Morse (2015) explain that the purpose of semi structured interviews is to gain in-depth understandings of others’ experiences in relation to the study being carried out. The aim of the interview is to gain subjective understandings of the individual’s lived experiences of long term injuries. Richard and Morse (2013) explain the structure of semi structured interviews. I will take a guided question sheet into the interview, which will form the basis on the interview. The benefit of a semi structured interview is that as the researcher I can, at any point, go away from the guide if I want to probe around specific answers to gain greater understanding of specific areas (McIntosh and Morse (2015). Irvine et al (2013) take note of the benefit to probing and straying from the question guideline to seek greater understanding, however also suggest that it is key to keep a sense of the guideline throughout the interview process. They want to ensure that the data collected can be compared and contrasted with the data from the other interviews.

McIntosh and Morse (2015) suggest that my dissertation falls under the descriptive/ interpretive form of semi structured interviews. This is because the aim of the research is to discover and form social and cultural understandings of the mental health reactions and issues associated with long term injuries. This highlights the impact of a paradigm throughout the research process; this form of semi structured interviews is guided from the aim of ‘mapping’ in the humanist interpretivist paradigm that has been highlighted throughout the methodology section.Bartholomew et al (2000) point out the uniqueness of semi structured interviews due to the extent of relevant information and understanding that you can gain from it. Once again, highlighted through the capabilities of using open ended questions and being able to probe by asking follow up questions in areas where the researcher needs better understanding or just wants to know more about that specific area (McIntosh and Morse 2015; Irvine et al 2013).

3.6- Using a Mix of Qualitative Research Methods

The combined use of an auto-ethnography with four semi structured interviews, offers a unique angle when studying the mental health issues associated with long term injuries. It is important that I critically analyse this assumption before continuing further with the research, ensuring that it will benefit my understanding and the outcomes of the research (Creswell 2002). Further to this O`Bryne (2007) emphasises the need for both methods to fit with the guidelines of the paradigmatic stance.  Morgan (2007) strongly believes that there is no problem for the use of multiple methods as long as you are reflexive and ensure it fits. Mason (1996) argues that using mixed methods forms methodological triangulation, which increases the reliability of the data collected (Silverman 2013). Baker (2016) points out that paradigms are by no means static and despite having limits, are flexible. Mixed methods have the capability of providing a deeper, more detailed understanding of specific themes over using just one type of research method (Creswell and Plano 2011; Morse and Niehaus 2009). As a result of this I see the use of multiple methods as beneficial to the study.

3.7- Reflexive stance

Being reflexive is vitally important throughout study because of the relativist ontological and subjectivist epistemological stance that I have taken throughout; especially through my use of auto- ethnography (Sparkes and Smith 2014). Vannini et al (2012) define reflexivity as actions of looking back over your own actions and thought processes. Further to this, putting yourself in the role of the other(s) who are a part of the situation or transaction (Smith 2008).

My experience of injury, shown in my auto-ethnography enables me to develop an interview guide that will find the ‘rich’ data that I desire. It further allows me to ask specific follow up questions to ensure I do not miss out on valuable data.  I have to be aware, at all times, of my impact on shaping the answers of the participants. Ensuring that my questions and responses do not influence the participant’s future or previous answers is vital (Finlay and Gough 2003). I acknowledge and accept my role as the researcher in co-constructing the data but understand the limitation of letting my own understandings of my experience impact the validity of the findings across the other participants; I will distinguish between the two (Tedlock 1991).

3.8- Analysing the Data

Analysis of data is arguably the most important process within research. It inevitably governs the worth of findings (Markula and Silk 2011). Corbin and Straus (1990) highlight the differences between ‘pure’ data, ‘transcribed’ data and ‘interpreted’ data. ‘Pure’ data does not make sense by itself, neither do the transcripts.  To get to the ‘interpreted’ data and the end of the process Kvale and Brinkmann (2007) describes focussing on the specific meanings that each individual expresses throughout the interviews. Thus providing in-depth understandings and ‘rich’ findings at the end of the research process.  To gain the ‘rich’ findings that I seek for this study I will use a thematic analyses process.

3.8.1- Thematic Analysis

Braun and Clarke (2006) Argue that thematic analysis should be the basis for all qualitative analysis. It is the process of recognizing, evaluating and recording the themes produced by the data (Boyatzis 1998). Using the themes, I organised the understandings in a logical manner across the four interviews and the auto- ethnography (Boyatzis 1998). It is important to understand that themes do not necessarily have to be found multiple times across the data; themes are information that is deemed as important to answering the research question (Braun and Clarke 2006).

Braun and Clarke (2006) explain that thematic analysis is made up of multiple steps: familiarization, finding codes, transferring codes into themes and then writing the themes into the form of the discussion section of my research. As a result of conducting interviews I had to transcribe the data, which ensured that I familiarized myself with the data, which Riessman (1993) suggests is important. Markula and Silk (2011) argue that audio taping and transcribing are the preferred methods of collecting raw data from a qualitative researcher’s perspective as a result of the ease to and accessibility of analyzing the raw data.  Sacks (1984) argues that we should not settle for gaining data from our memory as it is not probable for us as researchers to remember all details of an interview. By using audio- tapes you can relive, time and time again the conversation that occurs throughout the interview process. Allowing you to transcribe; getting every detail down to pauses, breaths and overlaps that occur (Sacks 1992). It further enables you to study the rich raw data extendedly in order for you to gain deep understandings of the data (Sacks 1992).  

Bird (2005) further emphasises the importance of familiarizing yourself with the data and the benefits of transcribing interviews. Bird (2005) describes it as a further phase of data analysis in interpreting the qualitative data; I started to create meanings to put onto paper as a result of this (Lapadat and Lindsay 1999). Once I transcribed the data, I had to continue to make meanings of the experiences through coding the data that I had from the transcripts. Coding continues to be a part of the analysis process (Miles and Huberman 1994). As I was coding the data, I put the codes into organised and important groups of knowledge (Tucket 2005). From the groups of codes (knowledge) I started to create the main themes of my research. It was difficult to do as I was not only looking at the main themes but the time frames in which they occurred as well. I chose to break it down into three main themes, the ‘Perceived Benefits of Sport’, the ‘Identity of an Athlete’ and ‘Masculinity’. Through the discussion and interpretation section of the dissertation I then split these themes into before, during and after the injury.

3.9- Ethical Procedures

Silverman (2013) highlights universal guidelines that researchers should adhere to when thinking about ethical representation of the research project. Within this dissertation the ethical procedure is of utmost importance because mental health can be a sensitive topic and I will be exploring people’s very personal stories. (Markula and Silk 2011). I ensured that all participants were aware of the purpose, methods and the intended use of the research. The main and overall aim of ethical procedure is to ensure there is no harm caused as a result of the research. It was important that I safeguard the participants by ensuring confidentiality and pre assessing any risks of the research procedure. In gaining ethical approval from the University of Bath, Silverman (2013) suggests that I profited in two main ways. I had the experience and expertise of my supervisor. Further to this, in gaining ethical clearance from an institution, I increase the likelihood that the participants will be confident in my ability as a researcher. Support from a legitimate institution could help me to create a rapport, allowing me to gain rich data. I will be able to gain the understanding through the rich data that I was able to get through the rapport that I built with the participants as a result of this.

3.10- Judgement Criteria

Judgement criteria defines the trustworthiness of research (Abrams 2005). Within quantitative research there is a more fixed set of criteria, however in qualitative work a flexible set of judgement criteria is needed (Cohen and Crabtree 2008; Yardley 2000; Yardley 2008). The judgement criteria that I will adhere to is to ensure that the study is not disorderly, to ensure it is methodologically strong and understanding of my subjectivist stance (Denzin and Lincoln 2008; Long and Godfrey 2004). I want the findings to be credible and reliable (Cohen and Crabtree 2008); I believe that I have done this by telling the legitimate stories of the experiences of the interviewees throughout the study (Cooney 2011; Finlay 2006). Fossey et al (2002) argue that this gives me the opportunity to relay authentic conclusions on their experiences. It is important that I realise that not all readers will agree with my conclusions but that they can see why I have draw to the conclusions that I have (Finlay 2006). I will see the study as successful if it does one important thing. In line with De witt and Ploeg (2006) I want my research to be seen as meaningful. Savall et al (2008) argue that it will be meaningful if it can add to existing understandings, I aim for the study to further these understandings and to shed light on a confusing area.

3.11- Limitations

There are some limitations that can be associated to this study, relating to the sample size and the subjective stance of the research. The sample size can be argued as not representative of a wider population of amateur sport. However with the resources available to me in an undergraduate study, the size was discussed with my supervisor. We agreed that it was large enough to gain sufficient understanding to allow me to conclude, and answer the research question. I sacrificed sample size to allow me to delve deeper into each participants experiences to gain `rich` data that is high in validity. I would argue that the subjective nature of the research is not a limitation and has in fact, positively impacted the study. As mentioned previously, it has allowed me to develop an interview guide and meant that I knew, through my own experiences, when to probe and ask follow up questions. This gave me the opportunity to gain the `rich` data that I desire to be able to answer the research question. Further to this it allowed me to relate to the participants, building a rapport throughout the interviews that other researchers would not be able to build.

Chapter 4- Results and Discussion

Sport is a powerful tool in socialisation and can hold a huge part of individuals’ lives. I chose to study amateur competitive athletes as I found little research into their experiences of long term injuries within literature. I felt this to be strange, as such a large proportion of the sporting population do not compete at an elite level. Research has led me to understand that masculinity and athletic identity are seen to be two concepts within the field of sports. Within my dissertation I am looking at the two concepts as directly relating to and being a part of one another. An individual’s ideals of masculinity directly links to and can uphold or even be the main form of one’s athletic identity (Sparkes 1997). Therefore when I talk about the impacts of injury on athletic identity I am also referring to the individual’s ideals of masculinity (Coles 2008). I do not seek to hold all answers or rights, wrongs, truth and lies about injury just to map out the experiences of psychological impacts of long term injuries on athletes that compete in team sports.

4.1- Was the Study Still Important?

Throughout the dissertation I have stood by the principle that any sportsman can hold a sense of athletic identity. I argue that a long term injury can have a negative impact on anyone who participates. Peirce indicated that being an athlete is ‘about representation’. He eluded that it comes down to whether you feel you are representing something of importance using the example of ‘when I was a young kid representing my club or secondary school would have been a big thing so I would have associated myself with being an athlete. He went on to state that ‘Now I wouldn’t’. Darwin explained this in a non elitist way believing that ‘it doesn’t matter at what level you are, you could be a complete beginner but be an athlete in the sense that you are working hard to achieve what you want’.  What Peirce and Darwin have said here further emphasises the need for this research in order to help the majority who compete in sport at an amateur level.

The participants of the study, all explained that their lives heavily revolved around sport before their injury. They played at varying levels but there was no real difference in the amount of time that they spent around sport. They all started competing at a young age through their families being sport enthusiasts. Peirce did not remember exactly why he started to play sport but stated that ‘I just really enjoyed being competent at something’ and that he ‘would have played anything’. Similarly Darwin explained that he was involved from a young age because of his parents but highlighted that his friends were also sporty, which kept him involved. He further explained the ‘competitive nature within’ him, which he could not get rid of ‘anywhere apart from sport’. Both of those interviewees, along with Kenny and my auto-ethnography (see appendix 5 [1]) highlight a love and competitive nature around sport and participation.

4.2- Benefits of Participating in Sport

Before the interview process had begun I was very interested in the reasons why the interviewees, participated in sport, were they similar reasons to my own or did they see sport in a different light? Throughout the interviews I was able to understand various different reasons for why the interviewees continued to participate in sport as they got older. It was very interesting to me as I could relate to certain individuals’ experiences; it also made me think about other reasons that were explained and how they might have been relevant to my own experiences.

4.2.1- Extrinsic Benefits

Sergei highlighted that he did not have a love of sport but merely used it as a means to an end. He stated ‘sport was never for me’ (appendix 4, Q8.7). He highlighted that the reason that he participated in sport was not because he loved it or enjoyed playing with his teammates but ‘to lose weight’ (appendix 4, Q3.3) and ‘to be accepted socially by others’ (appendix 4, Q8.7). Further explaining that he wants to lose weight ‘so that when I’m out in public I don’t sweat because I think people are around me’ (appendix 4, Q8.7). He, unlike the other participants used it purely as a tool. Despite this, he still spent a similar amount of time to the other interviewees participating and had similar levels of impact throughout the injury process. He highlighted that he did not mind putting his ‘time into something else’ as he ‘was being rewarded in another way’ (appendix 4, Q3.7). I found this particularly interesting, often sport is just seen as something to get people active or as a hobby to keep people busy, however Sergei was using it as a tool for his own gain. I further found it interesting because I had not thought about this in as much detail in relation to my own participation in sport. I loved competing; I also loved the fact that I was losing weight (see appendix 5 [2])and it kept me from putting it back on; something that changed over the course of my injury. The experiences of Sergei made me think about my own experiences and how I also, to an extent used sport as a means to an end rather than for the intrinsic enjoyment I believed it to be.  Sergei potentially had a higher severity of impact to life once the initial injury process was over, which will be discussed later on in this section.

4.2.2- Intrinsic

There are a variety of different benefits highlighted from a more intrinsic form of motivation for participating in sport. Darwin talks of participating in sport for his enjoyment but also, to meet the ‘competitive nature within’ him which he could not get rid of ‘anywhere apart from sport’. But, he also explains that being involved in sport acted as a form of ‘stress relief’ for him; therefore accepting sport as having an impact on his mental health. I hold similar ideals of sport, which you can see in my auto-ethnography (see appendix 5 [3]). Similarly seeing sport as an avenue to ease the pressures of wider life. Peirce stated that sport was something that he was ‘motivated’ by ‘everyday’, as he felt he was ‘really achieving something’. This can clearly add to feelings of self worth and his sense of athletic identity.

I want to now highlight further, benefits that 80% of the participants deemed as particularly important. In particular with Kenny, his experiences of interaction within sport and a team environment upholds Petitpas (1987) and his research. Kenny explained his strong social benefits from participating in sport. He emphasised that participating in sport gave him a lot more confidence and the ability to interact with others. Kenny stated the fact that ‘he finds it easier to make friends in a sporting environment’.

4.3- Team Sport

The interview from Sergei, my auto-ethnography and Darwin reaffirm Beumeister and Leary’s (1995) claim that being a part of a sport team meets fundamental needs of humans.  I mention (appendix 5 [2][4]), as does Sergei, ways in which participating in team sports allowed us to lose weight and then ‘fit’ into society. Sergei further talked about sport becoming ‘something that was mine’ (appendix 4, Q3.6). In this sense I take understanding that he met his needs of seeking popularity through participating and competing to a certain level. Through Darwin and again my auto-ethnography (see appendix 5 [1]) we gain understanding of the competitiveness that is only met through participating in team sports, which highlights another need of us as individuals, being met. An overall assumption that I have made throughout the analysis process is that team sport provides a sense of belonging, which upholds the research carried out by Rees et al (2015). Kenny pointed out his love of spending so much time around sport and ‘especially the team atmosphere’, however Sergei stated that he had not developed any ‘really meaningful relationships’ (appendix 4, Q3.8) in his team. This promotes Martin et al (2014) who argue that specific teams have their own environment and individuals suit different team settings better. I take understanding from Sergei that he did enjoy certain aspects of the team environment and argue that if he had found a different team with a different fit, there is the potential that he could have had more enjoyable experiences.

The experiences of a team between Sergei and the other interviewees are interesting to understand within the process of returning to sport after their each individual injury. Team sport meeting the needs and identifying with the other participants can provide continued support and reassurance for the injured participants giving them a greater sense of motivation to return from injury and to be a part of a team again (Rees et al 2015). Kenny believed that he worked just as hard when he was injured to recover as he did when he was fit, ‘I went to the gym every morning to do the physio activities to get myself back into a position to play sport again’, he further explained how he ‘missed the team sport atmosphere so much and that it was so good to be back and to be a part of it’. He mentioned that all of the other players on the team knew that he had had a bad injury and that they were all really helpful and welcoming for him to come back. Being a part of a team and valuing that helped  Kenny   to come back after the injury whereas Sergei did not find himself as heavily involved within the team atmosphere and highlighted not getting on with some of the players and the coaches. Some of the experiences that Sergei spoke of uphold Haslam et al (2009) in arguing that the support from the team can help the reaction to long term injuries and the process of that. Sergei did not feel the same belonging (Rees et al 2015) and sense of fitting in within his team environment and ended up giving up sport all together.

4.4- Before the Injury

Research and understanding of the athletic role by Eldridge (1983) accentuates the interviewees “strong sense of commitment to the athletic role”. Whether that is through the love of sport and sport meeting the competitive needs for Darwin or Sergei intensely participating in sport to lose weight and to meet his masculine ideals. Peirce highlighted that before his injury, sport ‘gave him something to wake up for in the mornings’. Furthermore Sergei demonstrates the ability of a strong athletic identity in helping with wider aspects of life, which McPherson (1980) highlights trends of throughout his research. Sergei mentioned that he did not mind being so heavily involved in sport because he was being  ‘rewarded’(appendix 4, Q3.7) by ‘putting my time into something else’ (appendix 4, Q3.7). The ‘else’ was hanging around in ‘groups of 20’ probably ‘scaring old ladies, unintentionally obviously’ (appendix 4, Q3.7). He was using sport as a ‘means’ to an ‘end’ but sport being the only tool that he could use to help reach his ‘end’ of having the perfect body image to make him feel ‘accepted socially by others’ (appendix 4, Q8.7). Despite not holding the same intrinsic desire to participate in sport, participation is still vital to his identity and desires.

Sergei accepted that for him; sport ‘was very egotistical’ (appendix 4, Q3.6). Sport enabled Sergei to meet his desires of becoming popular, he lost weight and became good at something; he found ‘something that was mine’ (appendix 4, Q3.6). Through this he felt more comfortable in himself, was getting acknowledgement that he had lost weight and that he was actually quite good at something. He was ‘envious of the cool kids who were always being talked to by the fit girls’ (appendix 4, Q4.2) and he wanted that. ‘So the moment they started coming up to me saying well done and saying oh I’ve heard you have been going here and there and saying they are coming to watch me play tonight, suddenly, I had achieved what everyone else had and what I wanted’ (appendix 4, Q4.2). His masculine ideals and needs were now being met.

The interview with Darwin was extremely interesting in understanding athletic identity in relation to team sports. Darwin previously played individual sports to county level but wanted to be a part of a team to experience sport in a different way mentioning that it’s ‘been nice playing a team sport’. Darwin picked up the vice- captaincy role meaning that he was a leader in the team. He described his participation in socials within the club as ‘being vice-captain has meant that I go there for the benefits of the team as well as just going to be social. It’s important to me that I help put the other, newer people in the team in social situation to help give them the opportunity to socialise that I didn’t get in my first few years’. Before Darwin’s injury sport was becoming an even bigger part of his life and he held responsibility.

As you can see, not only from my auto-ethnography but from the interviews with Peirce and Darwin as well… before their injury sporting performance was increased through a part of ‘a group of people aspiring to the same aims as each other yeah just a group of ambitious people… that was what I enjoyed most about it.’ Darwin highlighted increased performance as he became more prominent in the social scene. He trained more to meet goals that were not only his own but his teammates as well. He stated that he liked being a part of a team sport because he was ‘bettering yourself through athletic means and both making some really high quality friends in the process so yeah that was sort of where I want to be at, that level is where I want to be’. Particularly interesting to hear it from Darwin, who had previously participated in individual sports and highlighted these benefits to participating in a team sport.

Being a part of sport and their team is evidently a significant part of these individuals. This pin points the importance of participation in sport and their team to their identity. It is clear to see that there is potential for negative impacts through long term injuries to them when they cannot participate. They all talk of the rigorous training that they have done from a young age. Both Peirce and Sergei highlight the amount of exercise that they took part in. Peirce talked of training at 7am multiple times a week, going to the gym during his lunch and going straight to his tennis club straight after school to train. Roughly estimating that he was participating two to six hours of exercise every day. Sergei highlighted that he would cycle every morning, play sport during lunch and train multiple evenings a week. There is no surprise that these ‘athletes’ suffered from injury as a result of extensive training from a young age as Maffuli et al (2005) previously suggested.

4.5- Why might the participants struggle to deal with an injury?

It is clear that these participants have held their athletic identity strongly throughout their lives. They have pinned this strong sense of athletic identity and ideals of masculinity against their identity more than other activities throughout their wider life (Coakley 2009).  Particularly in these participants, sport can be seen as the richest way of achieving masculine capital and to help meet the needs of the participant’s athletic identity (De Visser and McDonnell 2013). This is shown through Darwin who states that the ‘competitive nature within you and you can’t get rid of competitive nature anywhere apart from sport’ or through Peirce who stated that he just didn’t know what to do with himself. Further stating, that he felt ‘much better’ in himself once he re-joined a sports team after his injury. Highlighting the importance of this research because of the ways in which it can help others who have and will go through similar experiences.

This study concurs with Cole (2008), whose research suggests that these ideals and the impact of them are increased through team sport. Gaining understanding of this through Peirce who states enjoyment of being a part of a team, whom are all ‘aspiring to be the best that they can be’. Making an assumption from this regarding Peirce, he stayed involved socially within his club but struggled and found it hard to stay a part of the team set up because he could not play. I understand this through my own experiences (see appendix 5 [5]) and the interview with Peirce that we both struggled to be on the outside of the atmosphere, seeing the other members of his team continuing to work hard to reach their aims that were no longer his due to injury. Despite this, the experience of Sergei rejected the usual positives of participating in team sports (Rees et al 2015) as he stated that he did not enjoy or develop ‘any meaningful relationships’ (appendix 4, Q3.8). However he still had very significant and serious psychological impacts as a result of no longer being able to participate in sporting activities because of his injury.

4.6- During the Injury

Here are a few quotes from across the interviews that highlight the impact of not being able to participate in sport; “it felt weird”, “unhappy”, “frustration”, “anger”, “anxiety”, “panic attacks”, “depressed”, “hero to zero”, “demoralizing”, “distressed”, “emasculated” and “life became sedentary”. All of these phrases came from four out of the five participants, only one of the participants, Kenny accepted the injury and ‘just got on with it’ as ‘there was nothing that I could do’. However, Kenny acknowledged that it was through a very busy time in his life so he did not ‘really have time to think about it’. Further to this, he also accepted that when he came back to sport after his injury that he ‘missed it all, competing, and the team atmosphere, everything about sport.’

4.6.1- Isolation

It is clear that throughout the injury process feelings of isolation were evident in all participants. The majority found isolation quite severe whereas Kenny knew that he missed the team atmosphere but was very busy starting a new job and moving to a new area so was given the time to think about those feelings. Peirce highlighted that he did ‘not know what to with himself’ throughout the injury process. Similarly I ‘lost my sense of team feeling’, I ‘struggled to be around sport and to not play’ (see appendix 5 [6]); I stopped all together. Showing that I was isolating myself away from wider society. Peirce started to get ‘panic attacks’ as a result of ‘not knowing what to with himself. It led into feelings of ‘depression’ and ‘anxiety’.

Peirce and Darwin found it difficult to be around sport but not be able to compete. Darwin stated that it ‘wasn’t the most enjoyable experience of my life, it was a bit resented’. He found it even more difficult to be around the team because ‘they’d talk to me about my injury’. The team were trying to support Darwin by asking about the injury but he ‘didn’t seek social activities nearly as much’ because he ‘didn’t want to talk about it to be honest; he then felt like he ‘missed out quite a lot’ and it was not as ‘involving’. When he went to training he did not have the same rapport as he used to. He highlighted that in his new coaching role, a ‘coach never has the same comradery with the team as the team have with each other. I understood the difficulties they faced to being around sport whilst injured. I faced similar struggles and did not enjoy watching from the side-lines as my team continued to compete because I wanted to be on the court with them helping them to win and I knew that I could if I had not been injured (see appendix 5 [7]).

Haslam et al (2008) and Haslam et al (2009) suggest that participating in team sports enables individuals to cope with injuries and changes in the athlete’s life. Through the understandings above, it is clear, especially from Darwin experiences that though his team were trying to support him, they were actually negatively impacting him. Darwin, Peirce and I felt isolated from the team (see appendix 5 [7] [8]; Peirce suggested this because he ‘wasn’t sure what my role was or if I belonged anymore’. They were no longer able to be a part of the group who were ‘aspiring to the same aims as each other’, which as Peirce spoke about left him not knowing ‘what to do with myself’ having ‘panic attacks’, leading to ‘anxiety’ and feelings of ‘depression’. It left ‘Darwin’ feeling ‘distressed’, none were coping better with an injury as a result of competing in a team.  Sergei did not feel the support from his teammates. He explained how being sat on the side-line meant that ‘the people who I didn’t really get on with before, they now didn’t have to converse with me but then at the same time I didn’t have to be in the mix with them either’ (appendix 4, Q7.2). Haslam et al (2008) and Haslam et al (2009) argue that this is because he did not hold a strong social identity. Despite this, both research projects identify that a strong social identity within a team enhances an individual’s capabilities of coping with injuries, which is clearly outlined through the experiences of these athletes to be untrue. It does however uphold Ruddock- Hudson (2012) and his research that highlights elite athletes isolating themselves away from their teams through long term injuries. Despite all of these observations, I cannot dispute the importance of the teammates in returning to sport after the injury, from my experiences (see appendix 5 [9]), Kenny and Peirce, life has been ‘more enjoyable’ once involved within a team again. All three highlighting that we missed the atmosphere a huge amount and that the feeling of it was like no other.

4.6.2 – Athletic identity in the form of masculinity Masculinity

Each of the interviewees named the ideals of masculinity that Coad (2002) and Connell (2000) express. Explaining their understanding of hegemonic masculinity in terms of skill set, power and strength. This is a very stereotypical understanding of masculinity as a broad subject area. Each highlighted further ideals that they associated with being masculine (Schwarts 1999). Darwin and Kenny highlighted the need of being a leader and having a ‘powerful persona’ within a team. Peirce explained it as being ‘the boy’ on the team and highlighted attributes of drinking and pushing yourself over limits. Sergei highlighted being the ‘talked about thing’ (appendix 4, Q4) and being ‘popular’ (appendix 4, Q4). He highlighted having girls coming up to him and wanting to talk to him as a result of his achievement in his sport. These understandings help to inform the concept of ‘mosaic masculinity’. All of the participants pointed out that they did not meet the stereotypical ideals of hegemonic masculinity (De Visser et al 2009; De Visser and McDonnell 2012). Mosaic Masculinity and Masculine Capital

The interviewees demonstrate an understanding that they can make up for not having the stereotypical hegemonic masculine ideals by being able to do other things (Anderson 2005; Connell 1995; Coles 2008). Peirce pointed out that he has always tried to meet the ideals of masculinity by going to the gym and working hard at training. However, he also highlighted that he is ‘a small lad’ but he ‘just did training that I didn’t need to do and pushed my body above certain limits’ to be seen as masculine. This upholds the concept of mosaic masculinity that is suggested by Cole (2008). Peirce rejects being able to meet the ideals of hegemonic masculinity here because he is a `small lad` but highlights that he was still accepted within his team and as masculine because of the hard work that he put in to become the best that he can be (De Visser et al 2009). As a result of ‘mosaic’ masculinity and ‘capital’ the interviewees have been able to identify strongly with their ideals of masculinity, making it a large part of their athletic identity. Identity of Masculinity and its Negative Impact

Throughout the interview process it was clear that ideals of masculinity were imbedded within the athletic identity of the interviewees (Sparkes 1997). Darwin and Kenny less so but it was still clearly there to see. Sergei gave the most detailed description of his experiences of masculinity within his athletic identity however did not state that it was ideals of masculinity where as Peirce mentioned that he felt ‘emasculated’. Multiple participants, including myself explained that within the team environment and the club, more broadly (Cole 2008), they struggled to go from ‘someone of importance’ to ‘nothing’ (Peirce). Peirce, Sergei and I, quoted the difficulties of going from ‘hero to zero’ (appendix 4, Q8.2; appendix 5 [10]) as a result of the injury. You can read in my auto- ethnography (see appendix 5 [11]) that I have struggled to look back on ‘what I used to be’- someone who was looked up to around the club, whereas after the injury, I was seen as a role player instead of one of the key players in the squad. I have struggled to deal with that and it is clear through the experiences of others that they have as well. This upholds Coles (2008) research as they are informing us of their socialisation from within their team and club environments in the form of masculinity and athletic identity.

Sergei held ideals of masculinity amongst his athletic identity to a much greater extent than the other participants. They all suffered from the impact of injury and not being able to uphold certain masculine traits, though Sergei ‘s motivation for participating in sport was to meet his masculine needs of losing weight, being popular and trying to be ‘accepted socially’. Whereas the other participants, despite holding strong masculine ideals, participated in sport for their love of competing and being a part of the team as well. Sergei had an understanding that participating in sport and meeting the hegemonic masculine ideals would allow him to feel self- assured and confident in a wider social context (Cole 2008).

As discussed, before the injury Sergei’s athletic identity was being met through the form of masculinity as he ‘had achieved what everyone else had and what I wanted’ (appendix 4, Q4.2).  I argue that Sergei felt the largest impact because of injury. He highlighted that he struggled to go from ‘hero to zero’ (appendix 4, Q8.2), he had lost the one thing that had met his masculine and identity needs. He ‘put weight on’ (appendix 4, Q8.2) again and became less confident. His masculine ideals, no longer being met left him feeling that he was no longer a part of any social group, which increased feelings of subordination, which is in direct contrast to Cole (2008) who relentlessly argues that holding masculine ideals within team sports help to reduce these feelings.

Sergei lost further sense of masculinity as ‘being injured and leaving the team showed me I was incapable and wasn’t necessary, I left the team and the team still won’ (appendix 4, Q6.4) he went on to say that this just confirmed his feelings that he ‘was not supposed to be there’ (appendix 4, Q6.4). These statements uphold the research carried out firstly by Klein and Heuser (2008) who mention the uniqueness of individual teams, perhaps if Sergei played for a different team he would have felt different feelings of when he was injured and returning from injury to his team, which is suggested to be difficult (Bauer et al 2007 and Kim et al 2005, Jones and Wallace 2005). If he had felt that the team needed him to be successful and reaffirmed some of his masculine ideals perhaps he would have being able to come back from injury strongly.

What was surprising to me as the researcher was that previously Sergei had mentioned that he played regional level sport and had previously attended national team trials. He was competent at his sport but I believe did not get the right fit in the team. These experiences through injury have left Sergei with very severe negative impacts. I gained understanding that through this and later on in life, even up to 3 years after the injury Sergei does not feel that he fits into society and does not feel like he is good at anything. Further to this he highlights difficulties of trying to now meet his needs. Stating that he struggles to exercise for multiple reasons, one of them: ‘I cannot go swimming because I cannot take my top off’ (appendix 4, Q8.5). If Sergei did not hold such a strong masculine, athletic identity then he may still be able to do some activities to lose weight and fit into his ideals of societal norms. However, as a result of it being so strong and unable to perform activities because of this he stated that ‘life changed and very quickly, having nothing to do meant that it became very sedentary’ (appendix 4, Q8.2).

4.7- Athletic identity

All of the participants highlighted the amount of and the importance of the training that they undertook before their injury. For the majority being out injured took away a huge part of their life and on various occasions Peirce highlighted that ‘he did not know what to do with himself’. His identity and sense of belonging was heavily revolved around sport and he struggled with that part of his identity changing and no longer able to be a part of whom he was. He highlighted that before the injury had occurred that sport ‘gave him something to wake up for’, he stated that after the injury he struggled to gain motivation to get up and became quite lazy. He mentioned that this continued until he re-joined a sports team 3 years later where he once again became more motivated to get out of bed in the mornings. This highlights my assumptions previously and work by De Visser and McDonnell (2013) that sport was the richest part of the individuals identity.

Darwin highlighted the importance of his athletic identity early on stating that he had developed a ‘competitive nature within you and you can’t get rid of competitive nature anywhere apart from sport’. This became stronger when he became the vice- captain as his athletic role was now topped up by the importance of his social identity in helping the team have the social experiences that he didn’t get in my first few years’ (appendix 4, Q4.6). Darwin showed that he lost his sense of athletic identity when he was injured because he got ‘frustrated’ with not being able to do even the easiest of tasks, like going swimming, so he stopped everything all together, including going to the gym to work on the exercises that the physiotherapist had given him. He took the mind-set that if he ‘couldn’t do everything then he wouldn’t do anything’. This is a huge hole to fill especially as Darwin highlighted that before his injury he was training up to 4 hours every day. He explained how he became ‘unhappy’ and ‘distressed’ because he now was looking back on a ‘better version of himself’ and that he wasn’t doing anything to rectify that. He normally prided himself on being someone who got on with issues and sorted them out rather than just letting it manifest.

Chapter 5 – Conclusion

5.1 – Summary

The study uncovered severe impacts to the individuals as a result of their long term injuries. As mentioned earlier the participants of the study unveiled a lot of their feelings around their injuries and some were quite sever. Some of the emotions and feelings that are important to highlight are: “it felt weird”, “unhappy”, “frustration”, “anger”, “anxiety”, “panic attacks”, “depressed”, “hero to zero”, “demoralizing”, “distressed”, “emasculated” and “life became sedentary”. All of these individuals played at an amateur, but competitive level. They all, throughout their interviews, highlighted the heavy extent to which they participated in sport through training, fixtures and previously within their schooling environments of playing sports at lunch times and before they had to attend school. It is important to acknowledge that despite not being elite athletes all of the individuals held a strong sense of athletic identity.

It is important to highlight that there were both intrinsic and extrinsic forms of motivation for the individual’s engagement in sport but all felt that it was an important part of their athletic identity and as an overarching entity, their identity of who they are. Whether their motivation was for intrinsic or extrinsic reasons, the impact of the long term injury on their mental health was still severe. Kenny was a bit of an anomaly regarding his experiences of the process of the injury as the understanding I gained from his interview, although he was upset that he could not compete in sport for a while. He accepted it and was able to focus on the physiotherapist work he was given and the other aspects of his life that were going on at the time such as starting a new placement job from university and moving to a new area.

As I have shown in the first part of this chapter, there were some poignant expressions of feelings across the interview process, which highlights the overall trend of negative impacts on mental health to an extreme extent. Particularly highlighted through Sergei, who alluded to his thoughts of not being socially accepted because of his body image and not seen as being successful at anything. He highlighted that even 3-5 years on, of not competing, he has not found ‘happiness’ in his life yet. All stemming from his now, inability to participate in sport and gaining his own understanding that he was never very good at the one thing that made him feel that he had finally found something to allow him to fit in and become popular. I gained this understanding partly through this statement: ‘being injured and leaving the team showed me I was incapable and wasn’t necessary, I left the team and the team still won’ (appendix 4, Q6.4).

It was further evident through the experiences of Peirce who expressed a lot of negative impacts throughout the interview. The most staggering that I want to revisit and highlight here is how he expressed that sport ‘motivated him to wake up in the mornings’. When he was injured and not a part of a team he highlighted that he struggled to wake up in the mornings and that this negatively impacted his life until he joined a sports team again in his final year of university two years on. This highlights not only an intense impact on his life but highlights how it impacted him for a significant period of time. Finally it is important to highlight the rejection of so much literature across this study that emphasises the importance of a team throughout the experiences of injuries or life changes Haslam et al (2008) and Haslam et al (2009). Instead it upholds the research carried out by Ruddock- Hudson (2012) who explains that within his study of elite sportsmen, individuals distanced themselves from their team setting throughout the course of their injury. However the study did highlight the importance of a team atmosphere in returning to sport after a long term injury, this was especially highlighted through Kenny’s account of his injury process.   

5.2 – Reflection

I believe that the study will be highly useful in bridging the gap in the literature for men that are suffering with mental health issues as a result of a long term injury within team sport environments. It enables others to understand their experiences in relation to others without specifically speaking to close friends and family which could be largely beneficial especially to the male population who are seen to not use the support systems (Addis and Mahalik 2003). Further to this, the research might encourage other male athletes who participate at an amateur, competitive level to seek out help and be confident in themselves still whilst doing it. I hope it can shed light on the understanding of one’s own ideals of masculinity and athletic identity more broadly in relation to its role in impacting the negative impacts of long term injuries.

5.3- Benefits and Limitations

The study uncovered some rich data and I believe that I was able to tell the story of the individuals experiences of long term injuries well as a result of this. I argue that despite my subjective involvement within the study I managed to allow the readers to fully understand the experiences of the individuals in a lone capacity. But I further believe that I successfully managed to compare and contrast the experiences of not only the individuals but myself through the use of my auto-ethnography as well. I stand by my previous statement that my use of an auto-ethnography along with the four interviews offers the research a unique angle; I believe that it has benefited the study in multiple ways. It enabled me to ask the important questions at the interview stage to gain the ‘rich’ data that I desired. But it also gave an extended account of the feelings and experiences that I went through. This was important in upholding not only the literature but some of the experiences that the individuals had as well. It demonstrated the level of detail that they were exposing their experiences to. This further demonstrates the validity and reliability of the overall study.

There were however limitations to the research. As I have just stated, I argue that the auto-ethnography was a benefit to the study. It had potential to persuade the interviews and findings however through my reflexive stance I strongly argue that it did not. A further limitation of the study could be shown in only four interviews being conducted. The amount of amateur athletes even within the institution where I conducted the study reaches the thousands. The study could be seen to be more representative if it were to have a larger sample size. Despite this, as eluded to in the methodology section, after discussion with the supervisor and assessing the resources that I had, four semi- structured interviews was deemed to develop enough data and understanding to successfully answer the research question.

5.4 – Future Research

I would love to follow this study on in two different routes, the first be through researching female athletes who participate in team sports. This interests me because of the difference in hegemonic masculinity and how much the impact of that would change the findings through male and female sport. As we can see through this study, masculinity held a large proportion of the athletic identity for Sergei, Perice and I. Our strong sense of masculinity within our athletic identity was huge in increasing the negative impacts as a result of our injuries.

The second route that interests me is researching male athletes who compete within individual sports.  As I have detailed, the individuals that I interviewed highlighted their enjoyment of being around team sports before the injury and the majority highlighted that being a part of a team after the injury helped them to get back into the sport and back to performing. Despite the fact that being a part of a team did not help them over the course of the injury itself it was, in most cases vital in returning from injury. I am eager to understand the experiences of athletes from individual sports, still at an amateur level. To understand how they experience their return from injury. Do they seek the support from other individuals or are they able to go back to their sport and training without the same support systems.

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