The evaluative tools for my research were two questionnaires containing the same questions and delivered once before the physiotherapy sessions which formed the intervention portion of my project and once following the sessions. On completion of the ‘after’ questionnaire three questions were asked of the six participants in my study in an interview setting. The questions allowed participants to say as much or as little as they wanted in response.
Comparison of Questionnaires
Q1: On a scale of 0-10 with 10 being the most painful and 0 being no pain at all, how much pain are you currently in when exercising?
Before – There was a range from 3-9 of recorded pain before physiotherapy. 7 was the most common response with 33.33% of respondents citing it as the degree of pain they were in. The mean was 6.2.
After – The range after physiotherapy was between 2 and 6 with an even split of two respondents each on 2, two on 4 and two on 6. The pain mean had dropped to 4.
Q2: On a scale of 0-10 with 10 being the most painful and 0 no pain at all, how much pain are you currently in when sitting?
Before – This question had a pain response rate range from 0-7, the mode figure was 3 (33.33% of respondents) and the mean is also 3.
After – The pain response rate range for this question was 0-4, the mean being 2.3.
Q3: My injury negatively affects my mood.
Before – Respondents were asked to rate this statement in accordance with their own experiences from a scale of strongly agree at one end, to strongly disagree at the other. The responses were split ranging from strongly agree to disagree but with nobody choosing strongly disagree perhaps suggesting that to some extent we are all negatively affected by injuries.
After – This time the results ranged from agree to disagree, no respondent choosing the two extreme ranges. The perhaps surprising result was that 50% of respondents said they agreed that the injury was still negatively affecting them – the same number as in the before survey.
Q4: My injury makes me frustrated.
Before – This was the strongest response so far with four respondents agreeing with this statement and two strongly agreeing.
After – Four respondents still agreed they were frustrated but the level of frustration overall decreased, nobody strongly disagreeing, one respondent with a neutral response and one disagreeing – they were effectively no longer as frustrated.
Q5: My injury negatively affects my self-esteem.
Before – This result was completely split down the middle with three respondents agreeing and three respondents disagreeing that their injury negatively affected self-esteem.
After – This was the most altered response so far with nobody now thinking their self-esteem was negatively affected. This seems to be the biggest influence the physiotherapy has had on the psychology of the injured dancers. 50% neither agreed nor disagreed, 33.33% disagreed and 16.67% strongly disagreed.
Q6: My injury motivates me positively.
Before – This statement generated a three way response: two respondents each for agree, neither agree nor disagree and strongly disagree.
After – One respondent now strongly agrees that their injury has motivated them positively, three neither agree nor disagree and two still disagree, although nobody now strongly disagrees so there does appear to have been a slight positive shift.
Q7: Do you believe physiotherapy will help the psychological aspects of your injury?
Before – 66.67% believed it would help, 33.33% that it wouldn’t.
After – The question was slightly altered on the after questionnaire to “Did physiotherapy help with the psychological aspects of your injury?” but interestingly the response was unchanged from the before.
Q8: On a scale of 0-10 with 10 being the most and 0 the least, how much do you think the physiotherapy will help you with the psychological aspects of your injury?
Before – Responses ranged from 3-7 with a mean of 5.2% which is right in the middle of the scale.
After – This question was also slightly altered for the after questionnaire to “…how much do you think the physiotherapy did help you with the psychological aspects of your injury?” This time the results did change with the responses now ranging from 5-9 giving a mean of 7 which is quite high.
Q1: Explain the nature of your injury and how it has made you feel.
Several of the participants expressed feelings of distress as the injury affected not only their ability to dance but to prepare for forthcoming examinations and competitions as demonstrated in the following two quotes:
“I had an ankle injury and I did that due to dance and it made me feel quite upset because it was before my exam and I felt a bit stressed out because I couldn’t do everything I needed to in order to prepare.”
“Torn ligaments on my ankle. It just made me feel upset because I couldn’t dance.”
Feeling of frustration came out strongly in response to this question as well:
“At the time of the injury it was quite annoying because I wasn’t allowed to do any sports. I couldn’t really do a lot on my feet because if I did it would just get worse so I just had to rest it. I had torn ligaments in my ankle.”
“I had badly sprained my ankle and was having mobility issues which was really difficult because I am a highland dancer and it meant performing certain steps was really painful and I couldn’t perform to the best of my ability. It was frustrating I guess.”
“I had a sore knee that hurt when I danced or ran. It made me a bit frustrated because it stopped me from doing things.”
This quotation supports evidence found in the literature that one of the difficulties in treating dance injuries is a failure to report it in many instances, which then results in additional difficulties:
“So it was at dancing I pulled my hamstring away from the bone. At first I didn’t know if I should do anything about it so I was just like getting on with it. Obviously it was sore but I was just like going to dancing. It obviously annoyed me but I just thought that it was just a small injury like it happens to most people that play sports and stuff so you just get on with it and it gets better.”
Q2: What causes you to feel negatively about your injury, if anything?
Respondents could see that their injuries were making things much more difficult for them although couldn’t always pinpoint what the specific difficulties were:
“Because I can’t like do everything to the best of my ability because my injuries are like making things a lot harder because I’m in a lot of pain.”
“Because it stopped you from doing certain stuff because it was like too sore to do or like you were worried it would maybe make it worse.”
Some dancers, however, were able to give more specific negative side effects inclusing upset, boredom and once again, frustration:
“The fact that I can’t dance because I was out for weeks. It makes me feel upset.”
“It had quite a negative effect because I wasn’t allowed to do anything so I was just sitting about and just waiting for it to get better for about 6-8 weeks so it obviously led to me being bored and just feeling like there was nothing I could really do to help it.”
“Not being able to dance to the best of my ability makes me feel bad and I guess frustrated because I know I am better than my performances with the injury were showing. Does that make sense?”
“I felt negatively because I couldn’t do things. I had to stop doing a lot. It was frustrating.
Q3: Do you feel the physiotherapy has helped you cope psychologically with your injury? Explain.
Motivation and the confidence to get back to dancing were the two positive psychological effects highlighted by the responses to this question:
“Yes because after I got the physio it made me feel a lot more confident because I knew that it helped me so I was a lot more confident with my dancing.”
“Yes, because it made me more motivated to get back up and dance.”
“ I feel that physio definitely did help in a sense because if I didn’t have it it would probably have taken a bit longer for my ankle to get better but then again there was nothing really that I could do much about, even with physio I just had to wait for it to get better.”
“Yes because I could see and feel that I was making good progress and so I felt like I was on the right track and would eventually get better.”
“Yeah because you had someone there to help you and show you things. She gave you things that would help and told you like if you do this this might make you feel better. I suppose it did a wee bit.”
However, some respondents were once again unable to recognise what may have been an effect. As a researcher I have to consider whether this was something to do with the wording of the questions:
“Yeah, a bit. It just did, I don’t really know how.”
Having compared the results from the two questionnaires and transcribed interview responses the following themes stood out: pain, frustration, sadness and motivation.
Pain – There was a range from 3-9 of recorded pain before physiotherapy with a mean of 6.2. After six physiotherapy sessions the range was 2-6 and the degree of pain mean had dropped to just 4. We know already that physiotherapy can have a positive impact on the pain presenting clients are in from scientific reports such as that from the Chartered Society of Physiotherapy (http://www.csp.org.uk/publications/physiotherapy-works-chronic-pain). It would therefore be appropriate to comment on the fact that there is a subsequent correlation between levels of pain and levels of psychological impact. Although none of my interview questions specifically asked about pain (this was mentioned in questions one and two of the questionnaires) a number of respondents mentioned it as they associated it with negative psychological feeling: “things (are) a lot harder because I’m in a lot of pain.” How much pain correlates to psychological impact would be an interesting potential research area for further development.
Frustration – During my initial research of associated literature frustration was a common theme which emerged which was the reason for individually categorising it in my questionnaire. 100% of respondents reported being frustrated to some degree in the before questionnaire but in the after questionnaire the level of frustration had decreased. A majority of participants physically mentioned frustration in their interview responses: “it was quite annoying”, “it was frustrating”, “a bit frustrated”, “frustrating”, “it obviously annoyed me.” The results show an agreement therefore with the literature (Hemmings and Povey, 2002) that frustration is a key psychological element when dealing with a dance injury and physiotherapy did, in this instance, have a positive effect on this negative emotion.
Upset – As well as frustration I had also asked specifically about self-esteem. According to the quantitative data 50% felt their self-esteem was negatively affected by injury. After the series of physiotherapy sessions not one respondent reported a negative effect on self-esteem. This would appear to be a large positive effect, however, in the interview nobody commented on this. Instead a number of comments were based around feeling upset about the injury which was interesting. Did this feeling of sadness subsequently effect the self-esteem? “It made me feel quite upset”, “it just made me feel quite upset”, “Not being able to dance to the best of my ability makes me feel bad”.
Motivated – A lot of the data gathered focussed on the before effects, however, my initial intention was to see if there was any positive impact that physiotherapy could have on these negativities. According to my data the physiotherapy did help, 66.67% agreeing outright on that topic. In the interview responses motivation seemed to be the biggest specific effect, comments including: “after I got the physio it made me feel a lot more confident because I knew that it helped me so I was a lot more confident with my dancing”, “it made me more motivated to get back up and dance”, “I could see and feel that I was making good progress and so I felt like I was on the right track and would eventually get better.”
The overarching aims of my research were to better understand the psychological impact of injury and to find out whether physiotherapy can alleviate any negative psychological impact. The results show that there are a number of potential negative effects associated with dance injury, most notably a feeling of frustration. The physiotherapy did go some way to alleviating this and in doing so motivated dancers positively to improve. This supports my initial aims and expectations.
What was difficult, however, was to tell if this was associated with specific injuries and personalities as I chose to make my initial data anonymous. In hindsight I would have been more specific with respondent 1, respondent 2 and so on to see if there were any particular patterns. For example, did those who felt the most frustrated initially feel there had been more or less benefit to them?
I am pleased the results showed that physiotherapy can have a positive overall effect as it can now be recommended as a solid treatment option for students presenting with dance injuries to keep them on track and alleviate possible negative psychological effects which may arise from being unable to perform and compete in the short-term.
If I was to conduct this research again I would try to get more information from my interviews. This could involve more questions or rewording the questions so that they were easier for my participant to answer. In hindsight I should have conducted a pilot study of the questions. I also didn’t focus enough on the how the physiotherapy had helped which may inform future research.