Psychoneuroimmunologie dans les blessures sportives et la réadaptation

The interaction of the psychological, neurological, endocrine and immune function and the influence on health is known as psychoneuroimmunology and has been studied since the mid-1970’s (Langley Fonseca, & Iphofen, 2006). Likewise, the stress-injury-stress model has been studied since the late 1980’s and includes the physical, environnemental, sociocultural, and psychological factors associated with injury (Wiese-Bjornstal & Shaffer, 1999). The following is an attempt to expose and inform the reader to the specific interactions that can play an important role in injury, illness, and recovery.

Le stress est une composante courante des blessures et des maladies. Le stress est un mot simple au sens complexe, qui peut être attribué à des facteurs physiologiques (changements physiques tels que la pression artérielle et la libération d'hormones), sociaux (relation avec les autres et avec l'environnement) et psychologiques (tracas quotidiens et stress lié aux événements de la vie) (Brown, 2016; Langley, et al., 2006; Spano, 2006; Williams, 2001). Les personnes qui font de l'exercice peuvent avoir une compréhension générale de la réponse au stress et à l'adaptation décrite par Seyle (Lovallo, 2016; Seyle, 1950). En général, Seyle Modèle de syndrome général d'adaptation (SGA) suggests that there are 3 stages: 1) alarm, 2) resistance, and 3) exhaustion. Essentially, individuals who have been exposed to short-term stress will immediately react to stress, which is known as the fight-or-flight response and prepares the body to protect itself from harm and maintain homeostasis in the cardiovascular, musculoskeletal, and neuroendocrine systems (Dhabhar, 2014; Lovallo, 2016). Depending on the situation, stress will prepare the immune system for injury and illnesses such as wounds, allergies, cardiovascular disease, obesity, or depression (Dhabhar, 2014). Prolonged psychological distress initially causes the body to release adrenaline. During the alarm stage there is sympathetic adrenal medulla (SAM) outflow. As a direct link the sympathetic nervous system neurons will release epinephrine and norepinephrine to bind with catecholamines. As an indirect link the hypothalamic-pituitary-adrenal (HPA) axis or HPAC system will release adrenocorticotropic hormone (ACTH), which causes the adrenal gland to release cortisol (hydrocortisone) into the blood (Seyle, 1950; Torpy & Chrousos, 1997). Cortisol is a primary catabolic hormone vital for muscle breakdown, which increases protein breakdown, inhibits amino acid intake, impairs cell proliferation, inhibits muscle cell differentiation, and inhibits testosterone production (Florini, 1987). Cortisol will go to an injured area, clean out the debris, and prepare the body for new construction. If le stress continue, le corps commence à sécréter d'hormones pour se défendre contre la menace. Fondamentalement, la défense prolongée rend le corps fatigué et incapable de se reposer, de se détendre et de lutter contre le stress. L'hypothalamus signale aux surrénales la libération de cortisol (Florini, 1987). Le cortisol supprime davantage le sys immunitaire et le corps perd la capacité de guérir. Par conséquent, si le stress est à long terme, alors le cortisol continuera la réponse catabolique et la déconstruction reprendra, inhibant la reconstruction (Florini, 1987).

As the stress continues, then the body will try to resist the breakdown to protect itself from harm to survive (resistance stage). This stage can last for as long as necessary, days or weeks or until death (Florini, 1987). Once death of the tissue has occurred, then the individual has reached the stage of exhaustion (Lovallo, 2106). At this point the stress has been ongoing and the body’s immune system is severely impaired and can cause adverse health responses including athletic injury and emotional distress (Dhabbar, 2014; Perna & McDowell, 1995). Inflammation increases in response to the threat (Kendall-Tackett, 2015). Therefore, the immune system becomes suppressed and injury and illness ensue (Kendall-Tackett, 2015; Langley, et al., 2006; Lovallo, 2016).

Sur une note positive, si les athlètes are exposed to moderate stressors with repeated exposure and the body learns to adapt to the threat, without releasing cortisol for long periods of , then the body will endure greater strength and endurance over , and muscle cell differentiation will take place (Forlini, 1985; Lovallo, 2016). It is when the athlete’s body is unable to adapt to the additional stressors that the body becomes susceptible to illness and injury (Forlini, 1985; Lovallo, 2016).

When an athlete has been exposed to extreme stress, whether physical, psychological, social, or a combination, and their system is unable to handle the amount of stress, then illness and injury can occur. The immune system is considered to be most unprotected or exposed 3-72 hours following an extreme workout. The window of susceptibility (WOS) is open and viruses and bacteria can settle into the cells and weaken the body (Nieman & Pederson, 1999). When the body is unable to adapt to the duration of the stress, recruitment of leukocytes, timing of the stress hormone exposure, or differential effects of glucocorticoids then the immune system become suppressed and injury or illness will transpire (Dhabha, 2014). Furthermore, repeated physical stress compounded with emotional stress sleep deprivation, malnutrition or body weight loss will make the individual more vulnerable to illness and prolong the recovery process (Nieman & Pederson, 1999).

Stress works in a cyclic fashion; when stress injury or illness occur, then the injury or illness may create additional stress, thus causing a delay in the healing process, and the pattern continues (stress-injury-stress cycle). Research has shown that the interaction of personality, history of stressors, and the coping resources will determine the stress response (Albinson & Petrie, 2003; Wiese-Bjornstal & Shaffer, 1999; Wiese-Bjornstal, Smith, Shaffer, & Morrey, 1998). The body will appraise the stress and determine whether it is a threat or not (primary cognitive appraisal). Once the body makes that determination, then the body must decide whether the coping resources available can handle the stress (secondary cognitive appraisal). These cognitive appraisals will determine whether the individual is experiencing eustress (pleasant stress) or distress (unpleasant stress) and the ability to meet or overcome the demands of the stress (Albinson & Petrie, 2003; Williams, 2000). If one is unable to handle the stress, then injury is likely to occur (Weise-Bjornstal & Shaffer, 1999; Wiese-Bjornstal, et al., 1998).

If an athlete has experienced injury, then it is not unlikely that psychological stress will emerge. Commonly reported stress following injury includes anger, depression, anxiety, tension, fear, and decreased self-esteem (Appaneal, Levine, Perna, & Roh, 2009; Appaneal, Perna, & Larkin, 2007; Reese, Pittsinger, & Yang, 2012; Wiese-Bjornstal, 2010).

Wound healing, whether associated with acute injury or post surgery, can be delayed when stress continues or is increased (Broadbent, Petrie, Alley & Booth, 2003; Brown, 2016; Cole-King & Harding, 2001). For example, research has shown that wound healing was delayed with elevated levels of depression and anxiety (Cole-King & Harding, 2001). Likewise, greater worry about surgery decreased the matrix and collagen development, increased pain, and lower levels of interleukin-1, poorer wound and slower wound healing, thus preventing regulation of the immune and inflammation responses (Broadbent, et al., 2003; Brown, 2016). Moreover, caregivers of family members with Alzheimer’s disease took significantly longer for the wound to heal than control subjects (Kiecolt-Glaser, Marucha, Malarkey, Mercado, & Glaser, 1995); and medical students with punch biopsies exposed to an exam and non-exam conditions took an average of 40% longer to heal under exam conditions (Marcucha, Kiecolt-Glaser, & Favagehi, 1998). This latter research shows that even normal stresses such as an exam can delay the wound healing process.

Once injury happens, then it is important to recognize any stressful situation and consider intervening. Various interventions such as stress inoculation training (SIT; Ross & Berger, 1996), cognitive behavioral stress management (CBSM; Perna, Antoni, Baum, Gordon & Schneiderman, 2003), stress management, goal-setting (Johnson, 2000; Wayda, Armenth-Brothers, & Boyce, 1998), relaxation (Johnson, 2000), guided imagery (Cupal & Brewer, 2001; Johnson, 2000), and social support (Williams & Appaneal, 2011) have all had successful outcomes by reducing post injury stressors and increasing psychological coping resources. Many of these interventions are employed regularly by applied sport psychologists and should be considered for referrals to assist with the recovery (Reese et al., 2012).

Si vous souhaitez en savoir sur les diplômes en ligne de science de l'exercice de Cal U, cliquez sur ici.

Les références

Albinson, C.B. & Petrie, T.A. (2003). Cognitive appraisals, stress and coping: Preinjury and postinjury factors influencing psychological adjustment to sport injury. Journal of Sport Rehabilitation, 12, 306-322. Récupéré de https://www.ncbi.nlm.nih.gov/pubmed/?term=journal+of+sport+rehabilitation

Appaneal, R.N., Perna, F.M., & Larkin, K.T. (2007). Psychophysiological response to severe sport injury among competitive male athletes: A preliminary investigation. Journal de psychologie clinique du sport, 1, 68-88. Récupéré de http://journals.humankinetics.com/journal/jcsp

Appaneal, R.N., Levine, B.R., Perna, F.M., & Roh, J.L. (2009). Measuring postinjury depression among male and female competitive athletes. Journal of Sport & Exercise Psychology, 31, 60-76. Récupéré de http://journals.humankinetics.com/journal/jsep

Broadbent, E., Petrie, K.J., Alley, P.G., & Booth, R.J. (2003). Psychological stress impairs early wound repair following surgery. Médecine psychosomatique, 65 ans, 865-869. doi: 10.1097/01.PSY.0000088589.92699_30.

Brown, J. (2016). L'impact du stress sur la cicatrisation aiguë des plaies. British Journal of Community Nursing, 21 ans. Récupéré de http://www.jcn.co.uk

Cole-King, A., & Harding, K.G. (2001). Psychological factors and delayed healing in chronic wounds. Médecine psychosomatique, 63(2), 216-220. doi: 0033-3174 / 01 / 6302-0216

Cupal, D., & Brewer, B. (2001). Effects of relaxation and guided imagery onknee strength, reinjury anxiety, and pain following anterior cruciate ligament reconstruction. Psychologie de la réadaptation, 46 ans (4), 28-43. est ce que je: http://dx.doi.org/10.1037/0090-5550.46.1.28

Dhabhar, F.S. (2014). Effets du stress sur la fonction immunitaire: le bien, le mal et le beau. Recherche Immunologique, 58, 193-210. doi: 10.1007 / s12026-014-8517-0.

Florini, J. (1987). Contrôle hormonal de la croissance musculaire. Muscle & Nerve, 10, 577-598. doi: 10.1002 / mus.880100702.

Johnson, U. (2000). Intervention psychologique à court terme: étude des athlètes de compétition blessés à long terme. Journal of Sport Rehabilitation, 9, 207-218. Récupéré de http://journals.humankinetics.com/jsr

Kendall-Tackett, K. (2015). Enraciné dans notre biologie: la psychoneuro-immunologie et les frontières de la médecine corps-esprit. Beginnings (American Holistic Nurses 'Association), 35 ans(2), 6-11. Récupéré de https://www.ncbi.nlm.nih.gov/pubmed?term=%22Beginnings+(American+Holistic+Nurses'+Association)%22%5BJournal%5D

Kiecolt-Glaser, J.K., Marucha, P.T., Malarkey, W.B., Mercado, A.M., & Glaser, R. (1995). Slowing of wound healing by psychological stress. Lancette, 346, 1194-1196. Récupéré de http://thelancet.com

Kiecolt-Glaser, J., Page, G., Marucha, P., MacCallum, R., & Glaser, R. (1998). Psychological influences on surgical recovery: Perspective from psychoneuroimmunology. Psychologue américain, 53 ans (11)., 1209-1218. doi: http://dx.doi.org/10.1037/0003-066X.53.11.1209.

Langley, P., Fonseca, J., & Iphofen, R. (2006). Psychoneuroimmunology and health from a nursing perspective. British Journal of Nursing, 15 ans(20), 1126-1129. Récupéré de http://info.britishjournalofnursing.com

Lovallo, W.R. (2016). Stress et santé: interactions biologiques et psychologiques. Los Angeles, Californie: Sage.

Marucha, P., Kiecolt-Glaser, J., & Favagehi, M. (1998). Mucosal wound healing is impaired by examination stress. Médecine psychosomatique, 60 ans(3), 362-365. Récupéré de http://journals.lww.com/psychosomaticmedicine/pages/default.aspx

Nieman, D. & Pederson, B. (1999). Exercise and immune function: Recent developments. Médecine du sport, 27 ans(2), 73-80. doi: 10.2165 / 00007256-199927020-00001.

Perna, F., Antoni, M., Baum A., Gordon, G., & Schneiderman, N. (2003). Cognitive behavioral stress management effects on injury and illness among competitive athletes: A randomized clinical trial. Annuel de médecine comporntale, 25(1), 66-73. doi: 10.1207 / S15324796ABM2501_09

Perna, F.M. & McDowell, S.L. (1995) Role of psychological stress in cortisol recovery from exhaustive exercise among elite athletes. Journal international de médecine comporntale, 2(1), 13-26. doi: 10.1207 / s15327558ijbm0201_2.

Reese, L.M.S., Pittsinger, R. & Yang, J. (2012). Effectiveness of psychological intervention following sport injury. Journal des sciences du sport et de la santé, 1(2), 71-79. est ce que je: http://dx.di.org/10.1016/j.jshs.2012.06.003.

Ross, M. & Berger, R. (1996). Effects of stress inoculation training on athletes’ postsurgical pain and rehabilitation after orthopedic injury. Journal de consultation et de psychologie clinique, 64 (2), 406-410. est ce que je: http://dx.doi.org/10.1037/0022-006X.64.2.406

Seyle, H. (1950). Le stress et le syndrome général d'adaptation. Journal médical britannique, 1383-1392. Extrait de: http://www.bmj.com

Spano, J.L. (2008). Impact des facteurs de stress de la vie sur les athlètes. Thérapie du sport aujourd'hui, 13(2), 42-43. Récupéré de https://www.oakwood.edu/library/index.php/joomla-extensions/92-database-info/189-athletic-therapy-today

Torpy, D.J., & Chrousos, G.P. (1997). General adaptation syndrome. In Endocrinologie des maladies critiques (pages 1 à 24). New York, NY: Humana Press.

Wayda, V., Armenth-Brothers, F., & Boyce, B. (1998). Goal setting: A key to injury rehabilitation. Thérapie sportive aujourd'hui, 3(1), 21-25. Récupéré de http://www.oakwood.edu/library/index.php/joomla-extensions/92-database-info/189-athletic-therapy-today

Weise-Bjornstal, D.M. (2010). La psychologie et la socioculture affectent le risque de blessure, la réponse et la récupération chez les athlètes de haute intensité: une déclaration de consensus. Scandinavian Journal of Medicine & Science in Sports, 20, 103-111. doi: 10.1111 / j.1600-0838.2010.01195.x.

Wiese-Bjornstal, D.M., & Shaffer, S.M. (1999). Psychosocial dimensions of sport injury. In R. Ray & D.M. Wiese-Bjornstal (Eds.). Conseil en médecine du sport (23-40). Champaign, IL: Cinétique humaine.

Wiese-Bjornstal, D.M., Smith, A.M., Shaffer, S.M., & Morrey, M.A. (1998). An integrated model of response to sort injury: Psychological and sociological dynamics. Journal of Applied Sport Psychology, 10 (1), 46-69. Récupéré de http://www.tandfonline.com/loi/uasp20

Williams, J. (2000). Comment identifier et prévenir les blessures résultant de facteurs psychosociaux. Thérapie sportive aujourd'hui, 5(6), 36-37. https://www.oakwood.edu/library/index.php/joomla-extensions/92-database-info/189-athletic-therapy-today

Williams, J. (2001). Psychology of injury risk and prevention. In R. Singer, H. Hausenblas, & C. Janelle (Eds.). Manuel de psychologie du sport (2^nd ed), 766-786. New York, NY: John Wiley & Sons, Inc.

Williams, J., & Appaneal, R.N. (2011). Social support and sport injury. Thérapie sportive aujourd'hui, 15(4), 46-49. Récupéré de http://www.oakwood.edu/library/index.php/joomla-extensions/92-database-info/189-athletic-therapy-today