Sources of stress in elite football players

Sources of stress in elite football players Sources of stress in elite football players. Abstract In this piece we shall look at stress, its definition, and its potential occurrence in the world of the professional football player. We will examine the possible sources and use current literature sources to support our assertions. Having done that we shall examine in detail the case of Mr Vasey, a youngster who embarked on a professional football career but did not make it onto the elite circuit. We shall examine his personal account for evidence to support or refute our assessment. If you read some of the tabloid newspapers, you could be forgiven for thinking that an elite footballer’s life is little more than huge amounts of money, fast cars, a succession of pretty women and endless adulation from mindlessly adoring fans when performing on the football pitch. Some of the more disreputable papers may also dwell on a slightly different (but generally equally false) aspect of their life, the drink, drugs, sordid sex romps in hotel rooms and gambling. The truth of the matter, in the vast majority of cases, is that the elite footballer is a finely honed athlete at the peak of his training. He is required to perform daily in training routines and in the gym, less frequently on the pitch, and put himself at risk of career threatening injuries on a regular basis. All this is done in the full knowledge that he has worked his way up a professional ladder to a comparatively short window of elite performance and that there are always many more hopefuls who are climbing up behind him either waiting to push him off or to watch him as he falls. You may regard the introduction as rather melodramatic, but it is intended to illustrate the very different perceptions that are commonly held about the lifestyles of the elite footballer. In this piece we are going to review the stresses and pressures that are commonly experienced by this elite group and also how they (generally) manage to cope with them. We also intend to illustrate the theoretical problems faced by the elite footballer with a real case study of a young man, Mr Peter Vasey who has gone a long way to becoming one of the elite group and then, for various reasons, which we shall discuss, decided not to pursue it further. Stress and Stress management We all think that we know what stress is and that we can easily recognise it. It actually proves to be a very hard item to define as firstly, it is important to distinguish between physical (biological) stress and psychological stress. The two are clearly related but fundamentally different. Secondly, stress is a multitude of different responses to a multitude of different potential causes. In this piece we are going to consider the various causes of psychological stress on elite footballers. In this context we can look for a definition of stress in a particularly informative article by Crampton et al. (1995) . She reviews the various definitions of stress. â€Å"Hans Selye (1956), a pioneer in stress research, has defined stress as the non-specific response of the body to any demands made upon it (Kreitner Kinicki, 1992, p. 597). It is considered to be an internal state or reaction to anything we consciously or unconsciously perceive as a threat, either real or imagined (Clarke, 1988). Stress can evoke feelings of frustration, fear, conflict, pressure, hurt, anger, sadness, inadequacy, guilt, loneliness, or confusion (Cavanagh, 1988). Individuals feel stressed when they are fired or lose a loved one (negative stress) as well as when they are promoted or go on a vacation (positive stress). While many individuals believe they must avoid stress to live longer, Freese (1976) argues that it is the salt and spice of life and that to have no stress we would have to be dead.† Selve defines the basic â€Å"biological† interpretation of stress while the Kreitner definition starts to incorporate the possible psychological elements that generate the biological responses. Clarke adds to our understanding by considering the psychological responses that can be produced by various stresses and Cavanagh modifies the definition further by introducing the concept of positive and negative stress. Freese makes the very perceptive comment that stress is an integral and inevitable feature of life itself. This particular insight can be taken rather further insofar as there are some individuals who find stress hard to cope with (non-copers) and others who appear to positively thrive in stressful situations (copers) In terms of our footballers under consideration, we must accept that stress can, and does affect performance as we shall discuss (see on). Basic psychological   theory shows us that individuals who are less than optimally stressed may not make enough effort to achieve their designated goal whereas those who are overstressed may not be able to concentrate on the task in hand and perform to their maximum capacity. In either eventuality it is clear that optimal performance is impaired. Equally it follows that there is an optimal amount of stress to achieve optimum performance. In practical terms, that â€Å"optimal amount† is only really possible to quantify in retrospect, and that is why many would describe the work of the team manager, coach and trainer as an art rather than a science. Haspels (2004) looked specifically at the levels of stress in pre- and post-match footballers. Unsurprisingly, he found that the highest levels of stress were found pre-match in an International game. One of the standard measures of stress in the resting subject is the cortisol level. Unfortunately physical activity also puts up cortisol levels so one of the major predictors of stress was rendered useless in this study. Haspels also found that the players performed best when their stress levels were controlled before the game   Work by Anshel (2001) looked at the causes of acute stress on the playing field and came to the rather surprising conclusion that the major causes of stress in that particular situation was consistently found to be receiving what was perceived to be a bad call from the referee and making a major physical error (missed kick etc.) When these eventualities occurred, the athletes concerned tended to make negative cognitive appraisals followed by an avoidance coping strategy. The same study also found that approach coping was most commonly seen after positive appraisals. These observations clearly support the transactional coping model. The use of appraisals and coping strategy was directly dependent on the perceived nature of the stressful event. Stress is an inherent part of football. It may, in part, be added to by the unrealistic expectations of the coaches, managers and the fans. Every team in the league is told that â€Å"this year the cup will be ours† at the beginning of the season and all the training, playing and motivation will be directed towards winning it. The reality, of course, is that only one team will win it. Continued stress has been cited as the main reason for many of the younger players (including our study subject) for their lack of enjoyment and subsequently leaving the game. It is interesting to note that many sources cite youth as one of the causes of acute stress on the grounds that the youngster may not yet have developed the physical sports skills and coping strategies that the older, more experienced players have. We will not consider this element further as our concern in this piece is primarily the elite footballer who, by definition, has already mastered his game. In broad terms, according to Lazarus (1999), coping with stress consists of a person’s conscious attempt at managing the demands and intensity of events perceived as stressful or improving ones personal resources (e.g., positive affect, confidence, self-control) in attempting to reduce or manage ones perceived stress intensity. He also observes that one of the critical factors in an athlete’s adoption of a particular coping strategy is their cognitive appraisal of the stressful event or situation. Lazarus sums up his appreciation of the coping response as an athlete’s ability to accurately appraise the situation and the subsequent use of an appropriate coping strategy as the critical factor in explaining an athlete’s physiological and psychological adaptation to stress in sport.  Ã‚   Method Our method of investigation falls into two parts. In terms of the stresses faced by elite footballers and their coping mechanisms, we have consulted, appraised and quoted authoritative literature on the subject. In terms of the real problems faced by Mr. Vasey, we have interviewed him and the results of the interview are appended to this piece as appendix I Sources of potential stress Clearly there are a great many sources of potential stress that our hypothetical elite footballer may face. Broadly speaking they can be categorised into:- Sport related stress.  Ã‚  Ã‚   Performance anxiety  Ã‚  Ã‚   Alpha male problems in a team game  Ã‚  Ã‚   Age  Ã‚  Ã‚   Competition stress   Ã‚  Ã‚   Constant motivation  Ã‚  Ã‚   Exercise dependence   Ã‚  Ã‚   Constant levels of fitness  Ã‚  Ã‚   Injury concerns   Ã‚  Ã‚   Dietary concerns  Ã‚  Ã‚   Drug monitoring concerns  Ã‚  Ã‚   Premature retirement Financial  Ã‚  Ã‚  Ã‚   Living up to a perceived lifestyle  Ã‚  Ã‚  Ã‚   Transient nature of   income  Ã‚  Ã‚  Ã‚   Income dependent on continued performance Publicity related  Ã‚   Media attention  Ã‚   Family intrusion  Ã‚   Privacy intrusion Direct stress-related problems  Ã‚   Drink  Ã‚   Drugs  Ã‚   Relationship problems   Ã‚   Cognitive functioning   Let us consider each one of these potential stresses in turn Sports related stresses Performance anxiety In a well written and comprehensive article, Poczwardowski and Conroy (2002) discuss the stresses and coping mechanisms of elite performers. They categorise the various coping mechanisms into 36 sub-categories on the basis of direct interviews. The standard categorisations of problem-focused, emotion-focused, appraisal-focused, and avoidance-focused etc. were amplified and extended to cover a greater rang of detected strategies. For example   greater motivational changes after failure was reported by one athlete as a stimulus to train harder so as not to fail a second time. Stress can affect different sportsmen in different ways. Some appear to thrive and perform well, others find that it is a bar to optimum performance. Those elite footballers in the first category do not need any intervention as far as their performance in the game is concerned but an interesting study by Solberg et al. (2000)   looked at the use of different relaxation techniques pre- and post performance in elite athletes. They found that athletes who practised meditation-related relaxation techniques had their blood lactate levels returning to normal quicker than their non-relaxed counterparts. Contrary to expectation however, they found no significant difference in their levels of pre-exercise anxiety. Alpha-male problems in a team game This is an anecdotally reported phenomenon which does not appear to have been investigated from a scientific perspective. The typical alpha-male personality type is over represented in the elite footballer community. Aggression, speed, firmness of decision making, independence and rapid responses are all prized attributes of the elite footballer. These are seldom attributes that are seen in the personality types that are happy playing as an integral part of a team. Football, by its very nature, is played by a team of eleven on the pitch and off the pitch, a very much larger team is involved. Prima Donna behaviour, typical of the alpha-male, cannot be easily accommodated in such circumstances. It may be tolerated as long as the player concerned is delivering the results, but it can be an enormous cause of stress when the results stop being delivered. Age Footballers get older. In terms of their professional use, they age perhaps faster than professionals in other fields. There is a very narrow   â€Å"window of opportunity† for them to be at the top of their chosen field. To play at elite level for more than a decade is considered to be quite unusual. Part of the reason for this is the natural ageing process which is present in every other individual, but also there is the ever-present problem of both career threatening injury and also the huge wear and tear on the joints (see on) which can give rise to significant health impairment in later life. Turner et al. (2000)   examined this problem in some detail and their results make impressive reading. Their cohort were all professional footballers. 32% of whom reported having surgery on at least one occasion. Of those, over half had knee surgery and a quarter of those had complete joint replacements. 15% reported having hip surgery with another 9% awaiting surgery. Others in the group were having non-invasive treatments. Nearly half had physiotherapy in one form or another for injuries sustained during their career and over a quarter were having some form of analgesia or anti-inflammatory drugs for pain associated with football injuries. Osteoarthritis (OA) was diagnosed in at least one site in nearly half of the respondents and the vast majority of those were hips and knees. Significantly nearly 10% were registered as disabled due to OA and, very significantly, 72% of all respondents agreed with the statement   I am concerned with how OA may affect my body in the future, clearly a major source of potential stress.(Barlow et al. 2000) Although joint problems were, predictably, seen as the most common pathology, other morbidity was found. Neuropsychological problems were not uncommon, presumably related to episodes of concussion or repeated trauma such as heading the football. 10 of the group reported problems such as memory complaints, dizziness and headaches. Sport related problems included early retirement, enforced reduction in working hours or even a change to a sedentary occupation. Not only can all of this be viewed as a major source of stress to those who are suffering because of it, but also it must be stressful for the still-active player who may know what may be in store for him. Competition stress This is an area that has been extensively studied. Competition stress can be an enhancer for some players but equally it can be an inhibitor for others. There is a distinction to be made between the trait of anxiety and the state of anxiety which is quite significant and, to a large extent, is a reflection of the ability of the individual to cope with and handle the stress levels. Sanderson and Reilly (1983)   did the classic study in this field. Their target group were elite athletes. They found that the group of athletes who had the anxiety trait correlated highly with those who had high pre-race anxiety states and this correlated highly with the actual race performance. Very significantly, the greatest reduction in post-race anxiety levels was seen in those runners who performed well in their races. Constant motivation In order to maintain elite footballer status a player must find a source of constant motivation. Initially, in his adolescent training days, the motivation may be personal glory and the goal orientated drive that comes with wishing to achieve professional status. Having achieved that goal however, the player must then find other motivational drives to maintain his progress. For some, it drive comes from considerations of status and wealth, for others it could be the need for adulation and fame, others may have personal goals of achieving the pinnacle of their chosen profession, these are the achievement-junkies that are seen in any professional walk of life. Whatever the motivation, success invariable comes at a cost. Decisions, and therefore usually sacrifices, have to be made along the route of attainment and achievement. In this piece we are considering specifically the elite footballer who, by definition, has managed to achieve the peak of his career. We should perhaps also consider the   other athletes who by virtue of circumstance, situation, lack of motivation or perhaps even random differences in pre-natal myelination patterns, do not actually achieve the top of their profession. We shall discuss one such case in the case-study at the end of this piece. For every elite footballer, there are many who do not make the top echelon of players. There are arguably even more stress factors in this group who what to achieve but for one reason or another, cannot. As far as motivation is concerned, this is a major concern of every coach and manager in the country for reasons that we have set out above. Most premier teams will have psychologists who are motivational   specialists. Motivational theory is evolving at a rapid rate and reversal theory is the current â€Å"idea of the moment†. A particularly good book on the subject is edited by Apter (2001) . It deals with not only the current thinking on the subject but also the actual evolution of the reversal theory from its conception in the 70’s through to the applications of the present day. Significantly it also deals with the specific subject of stress engendered by the motivational process. It is a highly technical book and therefore we do not propose to enter into detail about its contents, but it highlights the psychological issues of burn-out, apathy and depression that are commonly seen in constantly ( and inappropriately) motivated players. In the context of elite footballers, there is a fascinating and short article by McNair (1996)   which looked at the effect of verbal encouragement on maximal effort output.   The game of football is anecdotally renowned for the aggressive verbal abuse beloved by many trainers, coaches and managers. One may argue that it is only a manifestation of their own frustrations and stresses that causes them to behave in this way and it is certainly a cause of stress to the players (clearly it is intended to be). McNair’s paper produces a cast-iron rationale for this â€Å"encouragement† as he found, by means of a very simply designed study, that verbal encouragement does increase the maximal output of skeletal muscle. Interestingly, while measuring the actual power output, he also measured the EMG tracings of the afferent nerves supplying the relevant muscles and found that verbal encouragement did not change the EMG readings, so the actual cause of the improvement was not ascertained but it was nonetheless real. Constant levels of fitness Constant levels of fitness are clearly a pre-requisite for an elite footballer. There may well be periods of injury where the fitness levels fall, but they must be quickly re-established in order to achieve optimum performance levels. Fitness, in general terms equates with earning power and job security for a elite footballer, so the overriding goal must be to achieve peak fitness at all times. This, in certain circumstances, can become an obsession (See on – exercise dependence) Exercise dependence Many studies have shown the exercise can give rise to demonstrable health benefits – both chronic and acute. There are some people for whom exercise actually becomes an obsession (Hurst et al. 2000). This is a real disease entity resulting in behaviour patterns that compel an individual to exercise despite the presence of obstacles. It also can produce both psychological and physical symptoms of withdrawal, if exercise cannot be taken (Pierce, 1994) ( Veale, 1995) (Thaxton 1982). These patterns are commoner in women and often associated with eating disorders but they are also seen in male athletes. Bamber et al. (2000)   has authored a paper which   produced a qualitative analysis of the whole issue. She found that elements of an eating disorder were always present to a greater or lesser degree, but that this was hard to quantify as many athletes will pursue closely monitored dietary regimes in any event. This syndrome is commonest in women, but does occur in men, particularly   it seems in those who have low self-esteem or a poor self-image. It may be thought that such traits are unusual in the context of elite footballers but perceived body image does not always reflect the true physique. Any experienced healthcare professional will tell you about the anorexic or muscle dysmorphic who perceives something quite different when they look in the mirror. It is commonly believed that such conditions are a result of compensation syndromes. People may have a need to try to excel in one area if they feel that they are in some way failing in another.(Bamber 2003) Injury concerns Injury is the footballer’s constant fear. Football is a fast and occasionally violent game with frequent body contact being an intrinsic part of the game plan. Injury can vary from trivial to catastrophic or even life-threatening. Most injuries will have an impact on the elite footballer either at the time of the injury or, as we have seen above, at a later stage in his life. We have referred earlier to the comparatively short earning window of the elite footballer and clearly there will be considerable stresses involved if that window is cut short for any reason. Because of the huge investment that the average elite footballer represents to any club, a huge amount of energy and resources are employed to get an injured player back onto the field of play. It has to be said that the vast majority of professional clubs act responsibly in allowing injuries to heal properly before returning the player to training, but there will be the inevitable pressure on the less-than-scrupulous coach to get the player back on the field before full recovery has taken place. This has costs to the player in terms of impaired performance and also in terms of long term problems arising from an incompletely healed injury. Ekstrand et al. (2004)   looked at the problem as a result of the 2002 World Cup. They cite one of the major reasons for injury as being the frequency of the matches in a packed calendar for the top players. Injuries which would normally be regarded as comparatively minor did not get the usual chance to heal completely before the next game was due to be played. This resulted in a rising accumulative total of injuries above what might otherwise be expected over a comparatively short period. The study found that, over the ten months of the World Cup games the average player played 36 matches. The top players form each team played, on average, 46 matches over the same period. The survey showed that the players who played in the World Cup matches sustained 29% more injuries than players from the same teams who did not play. 32% underperformed when compared to their normal standard. These players had played statistically more matches than those who were felt to have played better than expected. One major finding was that 60% of the players who had played more than one match in the week before a World Cup match were either injured or underperformed during the World Cup game. The clear inference from this study is that tiredness and physical burnout affects performance in elite footballers. At the highest levels, players, clubs and coaches should be aware that this is a real phenomenon. And, at the very least, is a considerable cause of stress to the players. Orchard and Seward (2002)   Took this concept a stage further and looked at the injuries sustained by the entire Australian Football League over seasons from 1997-2000. Their findings are a major source of concern to the elite footballer world. In a season each team of 40 players would expect to receive 39 separate injuries. Clearly some players would be injured more than once (The major predisposing factor for injury is a pre-existing injury). The injury prevalence of players missing through injury in a week was 16% with a recurrence rate of 17%. They found that the commonest injury was to the hamstrings, followed by ACL strains and then groin injuries. For an elite footballer who depends upon his ability to play for his income, these figures represent a great cause of potential stress. Before leaving this area, we should consider one other area of injury which we touched upon earlier, and that is the sequelae of concussion. Bloom et al (2004) looked at this particular problem in great detail with particular reference to the psychological changes that were observed to occur after the injury. After suffering a concussive injury, the elite footballer was found to suffer from a greater incidence of symptoms of isolation, pain,anxiety, and disruption of daily life as a result of the injury. The investigators found that a source of added stress was, unexpectedly, from other team members who appeared to be giving support but were subliminally putting pressure on the injured athlete to return to play. The investigators found a worrying number of unexpected psychological symptoms including anger, denial, depression, distress, bargaining, and shock. Clearly this needs to be both recognised and addressed if the impact of the injury is not to be a further source of stress to the injured footballer Dietary concerns The elite footballer must always be at peak fitness and as a result his diet must always be under scrutiny. Fitness generally needs a BMI in the region of 20-23. Significant weight gains beyond this range not only reduce performance levels but also increase the wear and tear on the joints. We have already discussed the extent to which the knee joint is stressed during football training and playing. Adding weight to this joint is clearly only going to add to the degenerative changes that occur. An elite footballer needs to be able to accelerate his body mass rapidly in a given direction. It follows that the greater the body weight, the greater effort is needed. He will know this both at a cerebral level and also at an instinctive level. He will know that if his weight goes up significantly then it becomes harder for him to run as fast and to turn as efficiently. The average elite footballer is therefore very careful with regard to his diet. The average man in the population can afford to go out for an occasional extravagant meal or the odd evening or two at the pub without worrying too much about the consequences. The consequences for the elite footballer are that, in doing such things he would have to reduce his calorie intake over the next few days in order to maintain the status quo. This again can become a major source of stress for many. As the years go by, the average male tends to become slower and to put on weight as a natural process. This insidious reduction in the body’s efficiency is obviously a concern to a footballer who will often try to combat this trend with ever more aggressive training programmes and dietary regimes – again another source of stress. Drug monitoring concerns A number of elite footballers have hit the headlines lately as a result of random drug tests, either through failing or missing them. Doping and drug-enhanced training is a fact of professional football life in the current climate. It follows that the regulatory powers have to be ruthless in their quest for a drug-free sport. The fact that some players do gamble against the odds and take performance enhancing medications and drugs is a reflection of the stress and pressure that they feel under to constantly perform. It equally follows that they must feel that their performance is not good enough if they need to resort to such measures. The problems do not stop at performance enhancing drugs. Stress and other factors may tempt a player to use drugs of a different sort. Recreational drugs are common in elite footballer circles. In support of this statement we would consider the paper by Turner (2003)   In which he states that a recently retired elite footballer claimed that 80% of elite footballers in Australia had either been offered or used recreational drugs. This statement was extensively reported in the Press and other sources quoted the figure as being nearer 30%. The truth of the matter will clearly never be known but it can be contrasted with the figure from the UK which shows that over 18% of all the positive drugs screening tests done on athletes are currently for recreational drugs. This can be put in perspective against the 35% positive findings for stimulants and 25% for anabolic agents Premature retirement Retirement is a fact of life for all workers.   As we have discussed earlier, retirement from active playing – and therefore from a high earning capacity tends to come at a much earlier age for a footballer. It is therefore a major incentive to keep playing at a high level for as long as possible. Retirement through the natural ageing process is something that the elite footballer obviously has to come to terms with. It is comparatively unusual for a top rank footballer to be playing into his forties. He may have the experience to play well, but he is always judged on his results, and the fact of the matter is that there will always be younger players who will generally be faster and filled with raw enthusiasm ready to jump into any vacant slot at the top. The elite footballer therefore knows that his playing days are always numbered. We have discussed earlier the problems faced by the elite footballer in respect of the ever-present danger of injury. Clearly a career-ending injury can come at any time. It can be career-ending because of a dramatic incident such as a major fracture of a major bone or it can be a more subtle process, a bad tackle gives rise to an ankle injury which, in turn gives rise to an unstable ankle that does not allow the pivoting action necessary for efficient play. It becomes obvious that the player is not performing as well as another player in the squad and therefore he is replaced with greater frequency and then he becomes dispirited and eventually dropped from the team. The end process is just the same in either eventuality – cessation of an active playing career and the concurrent loss of high earning capacity. The result can be devastating for a man who, in order to achieve elite footballer status, may well have devoted a substantial proportion of his adolescent and adult life to improving and perfecting his football skills. He finds himself effectively out of a job at an age where most men are still looking forward to at least twenty more years of productive work. The immediate openings for him are limited to training, coaching or managing, all of which are highly competitive as they have been filled by his footballing predecessors and generally, they are not as well paid as his previous career. The stresses and psychological traumas are all too easy to see if the elite footballer has not been particularly level-headed in his approach to the profession. The unlikely body of Windsor Insurance Brokers Ltd. published a study of an investigation into the career-ending incidents of professional footballers in the UK (1997)   which makes interesting reading. They did not analyse the actual levels of stress that we are concerned about in this piece, but their findings make sobering reading to the current generation of elite footballers.   It would appear that few elite footballers actually reach retirement age without a significant injury. That injury is responsible (either directly or indirectly) for the eventual d