Psychosomatic intelligence of young soccer players. Relationship with sports injuries prevention and self-regulation

Abstract

The athlete’s perception of internal and external information seems to be crucial for the prevention of sports injuries and the self-regulation of healthy states. The goal of this cross-sectional study was to explore the relationship of athlete’s psychosomatic intelligence with injuries and mind-body practices. After obtaining the ethical approval, 217 young soccer players responded to a Psychosomatic Competence questionnaire assessing six dimensions: stress experience and stress regulation (SER), body-related health literacy (BHL), body-related cognitive congruence (BCC), mentalization (M), interoceptive awareness (IA) and general self-regulation (GSR). Mann–Whitney analysis was performed to detect potential differences of the items of these dimensions with three factors: (i) previous serious injuries, (ii) current injuries and (iii) mind-body practices. The main findings showed higher item-rating of: (a) IA by those previously and currently injured, (b) M by those currently injured and (c) SER, BHL, BCC and M by those engaged in mind-body practices. In conclusion, previous and current injuries appear to act as protective mechanisms linked to heightened IA, while mind-body practices seem effective educational strategies to promote self-regulation, detection and communication of health-related symptoms. Future research is warranted to focus on strategies for developing psychosomatic intelligence to prevent sports injuries in young players.

Keywords:

• Interoceptive awareness
• subjective monitoring
• workload stress
• mind-body practices
• traumatic experiences
• football

Subject:

• Sport and Exercise Science
• Sport Psychology
• Physical Education
• Sports Coaching

Reviewing Editor:

• Mike Rayner, University of Portsmouth, Portsmouth, UK

1. Introduction

In the last years, it has been elucidated how pain, injuries, diseases and other traumatic or threatening experiences may increase athlete’s awareness of previously overlooked internal and external information (Edouard et al., 2024; Gray, 2015; Valenzuela-Moguillansky et al., 2017). This holds significant importance given the outperforming integration potential of subjective with respect to objective monitoring (Montull et al., 2022). Further, current objective metrics cannot provide an accurate indication of injury risk (Impellizzeri et al., 2020). However, it is still unclear whether injuries, affecting health and performance states, might ultimately lead to the development of interoceptive awareness (IA) and self-regulation competencies.

Athlete’s perception of internal and external information seems to be crucial for the prevention of sports injuries and the self-regulation of healthy states (Galambos et al., 2005; Johnson & Ivarsson, 2011; Junge, 2000). Self-perceptions, especially of expert athletes, may be more sensitive to detect acute and chronic internal training loads than the commonly used objective measures (e.g. blood markers, heart rate, etc.) (Saw et al., 2016). They compress and integrate multiple channels of information (e.g. physiological, psychological, biomechanical, sociological, etc.) and detect their nonlinear features (Montull et al., 2022). This is of relevance considering the complexity of injuries arising from the interaction among multiple factors (Fonseca et al., 2020; Pol et al., 2018).

The potential of subjective perceptions often remains undervalued and even anesthetized after a massive use of monitoring systems based on objective information (Montull et al., 2022; Woods et al., 2021). For instance, in sports like soccer injury prevention remains commonly monitored through medical screening, biochemical markers, heart rate or minutes played (McCall et al., 2015). Moreover, there is a growing interest in injury prediction models, such as those using artificial intelligence, but they currently lack validity due to their poor development to capture injuries complexity and their high risk of bias (Bullock et al., 2022).

In such context, it is essential to highlight the unique potential of perception and how it is related to attention, goals, motivation and values (Balagué et al., 2019). In fact, it has been widely evidenced that through mind-body practices¹ (e.g. yoga, mindfulness, meditation, etc.), which focus the attention on this information, IA, perception of bodily sensations and self-regulation increases (Bond et al., 2013; Brown et al., 2020; Kim et al., 2013). Conversely, a lack of attention, goals, motivation and values towards subjective perceptions and health may result in underdeveloped or imprecise perceptions, consequently impeding effective self-regulation (Bonaz et al., 2021; Locatelli et al., 2023; Schulz & Vögele, 2015).

The high susceptibility to injury risks in soccer, especially in young players with untapped potential to display, is a current concern for professionals (Mandorino et al., 2023). Given the integrative and sensitive capabilities of subjective perceptions in injury prevention, it might be interesting developing the so-called psychosomatic intelligence, fostering an adequate interpretation of interoceptive signals to drive health and well-being (Fazekas, Avian, et al., 2022; Fazekas, Linder, et al., 2022). In light of this, there is a noteworthy interest in examining how especially injuries, as well as the well-known mind-body practices, could impact the psychosomatic intelligence of young soccer players.

The early development of psychosomatic intelligence appears crucial for enhancing self-regulation and preventing injuries during a period in which such self-regulating abilities may even decrease (Erikstad et al., 2018). Accordingly, this research is relevant for studying the effects of mind-body practices on injury prevention in young players, and for recognizing injuries as protective mechanisms able to develop psyhosomatic intelligence.

The goal of this study was to explore the relationship of psychosomatic intelligence of young soccer players with injuries and mind-body practices. We hypothesized that psychosomatic intelligence will be rated higher in players with previous serious injuries, with current injuries, and in those performing mind-body practices.

2. Materials and methods

2.1. Participants

A total of 217 young soccer players (15.06 ± 2.12 y.o.; 1.72 ± 1.09 m; 62.46 ± 12.13 kg) participated voluntarily in this research. They were recruited from the categories under-16 and under-18 of two professional soccer clubs (n = 116 and n = 101, respectively). Participants trained regularly (at least three times per week) and competed at national level while continuing their academic education. As members of federated clubs they had season medical checks confirming their healthy state to play. The study was approved by the Local Research Ethics Committee (072015CEICEGC) and carried out according to the Helsinki Declaration. Parents or tutors signed an informed consent for the participation of young players in this research.

2.2. Procedures

The methodology department responsibles and psychologists of the clubs were informed about the goals of the study and the procedure to be followed for the administration of the questionnaire. After sending the information to the parents or tutors to get their signed consent, they organized a meeting with coaches and players to explain the procedure. All players from the categories under-16 and under-18 of the club were invited to respond the questionnaire, in a fully anonimous way, before a training session. The questionnaire was responded individually, and all doubts of interpretation were clarified by the psychologists.

Players responded to a psychosomatic intelligence questionnaire assessing six interrelated dimensions: stress experience and stress regulation (SER), body-related health literacy (BHL), body-related cognitive congruence (BCC), mentalization of interoceptive signals (M), IA and general self-regulation (GSR) (Fazekas, Avian, et al., 2022). All of them jointly contributing to measure the psychosomatic intelligence by assuming a mutual influence between interoception and self-regulation: from IA providing the foundational organismic signals that inform M (understanding and interpreting those signals), which supported by BHL (knowledge about bodily functions and health) and BCC (ensuring that interpretations align with actual physiological conditions), enable effective SER contributing to overall well-being and GSR (Fazekas, Linder, et al., 2022).

The questionnaire consisted of 44 items that were answered on a 6-point (0–5) scale: strongly disagree, disagree, somewhat disagree, somewhat agree, agree and strongly agree. Considering that every dimension measured a highly specific attribute of a construct, the internal consistency of the questionnaire was acceptable for the first five dimensions (Cronbach’s alpha: SER = 0.60; BHL = 0.68; BCC = 0.74; M = 0.70; IA = 0.69, respectively), however, GSR consistency was very low (Cronbach’s alpha = 0.35) for which reason it was excluded (Panayides, 2013).

The following dichotomous questions (yes or no) were requested after the administration of the psychosomatic competence questionnaire:

1. Have you ever experienced a serious musculoskeletal injury that restricted your physical activity and daily movements? If yes, please specify the nature of the injury.

2. Are you currently dealing with any musculoskeletal injuries? If yes, please specify the nature of the injury.

3. Do you engage in any mind-body practices, such as yoga, meditation, mindfulness, Tai Chi, Feldenkrais, Alexander Method, breath therapy or other body-oriented psychotherapy activity at least once a week?

Orchard Sports Injury Classification System Version 10 was used to check that the nature of injuries, from the two first questions, was in accordance with the Pathology Code for Musculoskeletal Diagnoses (Rae & Orchard, 2007). Injuries that were not in this classification system were excluded. Additionally, those injuries that were not severe (grade 3) were excluded as serious injuries.

2.3. Data analysis

Mann–Whitney test was performed to detect differences of questionnaire items between: (i) those who suffered previous serious injuries (n = 35) and those who did not (n = 81), (ii) those who were currently injured (n = 20) and those who did not (n = 197) and (iii) those who were engaged in mind-body practices (n = 137) and those who did not (n = 80). The level of significance was set at p ≤ .05 throughout the study. In addition, non-parametric effect size (ES) (McGraw & Wong, 1992), with confidence interval (CI) at 95%, was also performed to provide the magnitude of the difference between groups. Statistical analyses were performed with SPSS version 15 (SPSS Inc., Chicago, IL).

3. Results

As illustrated in Figure 1, players with previous serious injuries, current injuries, and mind-body practices rated higher some items of the psychosomatic intelligence questionnaire.

Figure 1. Summary of the main findings: some items of the assessed dimensions of the psychosomatic competence questionnaire were rated higher by those with previous serious injuries, current injuries and mind-body practices.

26.72% of players had, at least once, serious musculoskeletal injuries that restricted their practice and daily movements. The main reported injuries were in the lower or mid body (e.g. anterior cruciate ligament sprain, meniscus tear, herniated disc, etc.). Such factor explained higher items of BHL and IA as shown in Table 1.

Table 1. Differences of items from psychosomatic competence questionnaire between group with previous serious musculoskeletal injuries (n = 35) and group without it (n = 81).

		Previous serious injuries	Without previous serious injuries
Dimension	Item	0–5 scale (mean ± SD)	0–5 scale (mean ± SD)	U	p	ES with 95% CI
BHL^1-8	I notice how different foods influence my physical state (positively or negatively)	4.03 ± 1.05	3.45 ± 1.44	1076	0.03	0.62 [0.04, 0.84]
IA^2-9	I sense many things intuitively	3.86 ± 1.12	3.44 ± 0.91	1050	0.02	0.62 [0.03, 0.83]

¹BHL: Body-related health literacy.

²IA: Interoceptive awareness.

U: Mann–Whitney test.

p: Significance level was set at values ≤0.05.

ES: non-parametric effect size.

CI: confidence interval.

9.22% of players were currently injured (e.g. hamstring tear, anterior cruciate ligament sprain, etc.) and they rated higher items of M and IA, see Table 2.

Table 2. Differences of items from psychosomatic competence questionnaire between group currently having musculoskeletal injuries (n = 20) and group without it (n = 197).

		Current injuries	Without current injuries
Dimension	Item	0–5 scale (mean ± SD)	0–5 scale (mean ± SD)	U	p	ES with 95% CI
M^1-2	I can describe my moods accurately	3.65 ± 1.04	3.09 ± 1.17	1458	0.04	0.63 [0.02, 0.94]
M-3	I know very well what my most important needs are (e.g., social contacts, closeness/distance, movement, change, etc.)	4.5 ± 0.51	4.00 ± 0.79	1285	< 0.01	0.68 [0.19, 1.11]
IA^2-2	I sense when something is beginning to strain me, a conversation, for example	4.55 ± 0.51	4.13 ± 0.77	1363	0.01	0.65 [0.1, 1.02]
IA-6	I notice different physical responses depending on the setting (e.g., pleasant or unpleasant social surroundings)	4.00 ± 0.86	3.56 ± 0.88	1428.5	0.03	0.64 [0.04, 0.96]
IA-8	When I feel something is unpleasant (e.g., conversations, touching), I recognize the causes	3.95 ± 1.00	3.49 ± 0.88	1375	0.02	0.64 [0.05, 0.98]
IA-9	I sense many things intuitively	4.10 ± 0.85	3.62 ± 1.00	1435.5	0.04	0.63 [0.02, 0.95]

¹M: Mentalization of interoceptive signals.

²IA: Interoceptive awareness.

U: Mann–Whitney test.

p: significance level was set at values ≤0.05.

ES; non-parametric effect size.

CI: confidence interval.

63.13% of players were engaged in mind-body practices like yoga, meditation, or other body-oriented psychotherapy activities. These players reported higher items of SER, BHL, BCC and M, see Table 3.

Table 3. Differences of items from psychosomatic competence questionnaire between group engaged in mind-body practices (n = 137) and group non-engaged (n = 80).

		Mind-body practices	Without mind-body practices
Dimension	Item	0–5 scale (mean ± SD)	0–5 scale (mean ± SD)	U	p	ES with 95% CI
SER^1-1	When I recognize that I have less energy than expected, I know why this is so	3.68 ± 0.87	3.32 ± 1.03	4348.5	<0.01	0.61 [0.11, 0.66]
SER-3	When I suddenly feel physically weak, I know why	3.58 ± 1.13	3.1 ± 1.25	4180	< 0.01	0.61 [0.13, 0.69]
SER-8	I know exactly how much stress I can take without overtaxing myself	3.17 ± 1.16	2.72 ± 1.25	4317.5	< 0.01	0.61 [0.1, 0.65]
BHL^2-1	I know exactly how much exercise I need in order to feel physically well	3.82 ± 1.02	3.57 ± 1.03	4659	0.04	0.57 [0.03, 0.52]
BHL-4	I know exactly what I can do in order to feel physically well	3.89 ± 0.86	3.61 ± 0.96	4590	0.03	0.59 [0.03, 0.59]
BCC^3-1	I am capable to recognize the causes behind my physical sensations	3.71 ± 0.83	3.26 ± 1.06	4030	< 0.01	0.64 [0.21, 0.77]
BCC-3	I know how to motivate myself with respect to my health goals	3.90 ± 0.75	3.57 ± 1.05	4616.5	0.04	0.61 [0.1, 0.66]
M^4-1	I can communicate my physical wellbeing precisely to others	3.39 ± 1.18	2.86 ± 1.39	4325.5	< 0.01	0.62 [0.14, 0.7]
M-2	I can describe my moods accurately	3.31 ± 1.12	2.86 ± 1.22	4339.5	< 0.01	0.61 [0.11, 0.67]
M-4	I can describe my various physical conditions (fitness, well-being, energy level) well using language	3.73 ± 0.90	3.15 ± 1.25	4006	< 0.01	0.65 [0.28, 0.84]

¹SER: Stress experience and stress regulation.

²BHL: Body-related health literacy.

³BCC: Body-related cognitive congruence.

⁴M: Mentalization of interoceptive signals.

U: Mann–Whitney test.

p: Significance level was set at values ≤0.05.

ES: Non-parametric effect size.

CI: Confidence interval.

As shown in Tables 1–3, the previous significant results showed intermediate ES between groups and very wide CI s ranges due to the different sample sizes between injured and non-injured players.

4. Discussion

The psychosomatic intelligence questionnaire, administered to young soccer players, showed higher item-rating of (a) IA by those previously and currently injured, (b) mentalization of interoceptive signals by those currently injured and (c) SER, BHL, BCC and mentalization by those engaged in mind-body practices.

Players with previous serious musculoskeletal injuries seemed to demonstrate the ability to sense risk factors associated with traumatic experiences. They were particularly sensitive to the influence of different foods. According to some authors, the IA and the organism memory ensures adaptation to future harmful or unpleasant situations (Korteling et al., 2021; Wahbeh et al., 2022). This means that all interconnected parts of the organism (e.g. cells, tissues, organs, amygdalae regulating emotions, encoding traumatic memories, etc.) react more effectively to traumatic or painful experiences, noting bodily sensations more accurately (McCarty, 2016; Osório et al., 2017). For example, it has been demonstrated how heart rate variability changes between one and ten seconds before an external stressful stimulus is visually perceived (McCraty et al., 2004).

Players currently injured also rated high in some items of the IA dimension, including they sensed intuitively. Further, they were more sensitive to recognize the causes of unpleasant situations, which suggests that current musculoskeletal injuries may heighten athletes’ awareness of previously overlooked internal and external information (Edouard et al., 2024; Gray, 2015; Venhorst et al., 2018). In contrast to players with previous serious injuries, currently injured players showed a higher mentalization dimension, accurately describing their moods and physical condition, and recognizing their most important needs for their daily life (e.g. social contacts, closeness/distance, movement, change, etc.). Likely, this was influenced by their current unpleasant situation, leading to emotional clarity and strong desire to recover a functional state to meet their sport-related goals. This may be affected by an increase of values, motivation and attention towards the prevention and recovery from musculoskeletal injuries to continue playing (Balagué et al., 2019). Therefore, current injuries appear to enhance the capacity to precisely communicate the state of well-being and essential feelings.

Players who trained their awareness through mind-body practices had higher psychosomatic dimensions related to stress regulation, body health, cognitive congruence and mentalization. Mind-body practices appeared beneficial in recognizing energy levels, physical sensations, as well as social or emotional stress. Our findings suggested that these players not only detected unpleasant or stressful situations but also interpreted their causes and effectively communicated the variety of their states. Mind-body practices seemed to provide educational resources for accurately perceiving, verbally explaining, and self-regulating internal and external information relevant to health and performance states. Therefore, such practices are widely recommended for health disorders in both, sports and clinical contexts (Bond et al., 2013; Brown et al., 2020). For example, they seem helpful to reduce anxiety or depression and increasing pain tolerance, self-esteem, energy levels, and the ability to cope with stressful situations after post-traumatic stress disorder-like injuries (Kim et al., 2013). However, it is essential to note that athletes, continuously exposed to a variety of body sensations (without specific mind-body practices), have better self-regulation, noticing, attention, emotion awareness, body listening and trust compared to non-athletes (Rogowska et al., 2023).

Based on our findings, some practical implications in relation to the psychosomatic intelligence of young soccer players can be discerned. First, athletes have unique perceptive abilities for sensing relevant changes related to health and performance states (Montull et al., 2022). Second, players who experience traumatic experiences like serious injuries can benefit from it, despite the misfortune, as potential drivers of awareness progression and contribute to preventing future injuries and enhancing performance (Edouard et al., 2024). Third, a personalized awareness practice-oriented to increase psychosomatic competencies can help to avoid traumatic experiences and assist in health and stress regulation. Fourth, the enhancement of psychosomatic intelligence, together with the development of subjective monitoring should be valued by coaches and athletes as an essential tool to prevent injuries and regulate workloads (Almarcha et al., 2022).

In future research endeavors, it is recommended to broaden the scope of participants by including women in the sample. Gender differences in IA have been noted, potentially stemming from distinct socialization processes (Rogowska et al., 2023). Additionally, it is crucial to encompass individuals with diverse training expertise, as variations in attention and self-regulation may influence outcomes (Saw et al., 2015). Further research should reduce the recall bias, as a limitation of this study, considering interviews for a more accurate information about previous experiences or even longitudinal studies to follow the long-term impact of injuries on psychosomatic intelligence. In this regard, it would interesting to distinguish between types of musculoskeletal injuries (e.g. contact or non-contact) to evaluate their specific effect. Furthermore, careful consideration should be given to controlling the type and implementation of mind-body practices, due to their potential impact on the results (Mehling et al., 2011).

Future research initiatives should also focus on exploring strategies to enhance IA, with special attention to the potential influence of previous traumatic experiences on the observed outcomes. For a more in-depth assessment of IA, the Brief MAIA-2 questionnaire can also be used (Rogowska et al., 2023). In the realm of objective analysis as effective complement to subjective information to accurately discern organismic changes, the application of multilevel network analyses is encouraged to facilitate the recognition of physiological connectivity changes over time (Pol et al., 2018; Balagué et al., 2020).

Finally, highlight that the untapped potential of human perceptions necessitates both scientific and social reevaluation for improving the regulation of health and performance (Sturmberg et al., 2019). For example, there is a need to expand research endeavors that examine the capability to perceive environmental information, such as detecting changes in the electromagnetic field or discerning people’s moods, and explore the potential to anticipate future phenomena by observing physiological signs (Wahbeh et al., 2022; Mossbridge et al., 2014). This line of inquiry could shed light on the extent of human capabilities and contribute to a deeper understanding of the intricate relationship between awareness, physiological responses and cognitive functioning.

In conclusion, previous and current injuries appear to act as protective mechanisms linked to heightened IA, while mind-body practices seem effective educational strategies to promote self-regulation, detection and communication of health-related symptoms. Future research is warranted to focus on strategies for developing the potential of psychosomatic intelligence to prevent sports injuries in young players.

Ethics approval and informed consent

This study was approved by the Research Ethics Committee from the Catalan Sport Administration (072015CEICEGC) and carried out according to the Helsinki Declaration. A signed informed consent was delivered by all participant’s parents or tutors.

Author contributions

Conceptualization: L.M. and N.B.; Data curation: L.M.; Formal analysis: L.M.; Investigation: J.F. and J.P.G.; Methodology: L.M. and N.B.; Project administration: L.M. and N.B.; Resources: L.M., J.F., J.P.G. and N.B.; Software: L.M.; Supervision: L.M. and N.B.; Validation: L.M.; Visualization: L.M.; Writing-original draft: L.M. and N.B.; Writing-review and editing: L.M., J.F., J.P.G. and N.B. All authors have read and agreed to the published version of the manuscript.

Code availability statement

The codes used for the statistical analyses that support the findings of this study are available on request from the corresponding author.

Acknowledgments

We would like to thank the participants and coaches for their willingness to take part in this research. Further, to Prof. Saül Alcaraz for his support.

Disclosure statement

The authors report there are no competing interests to declare.

Data availability statement

The data that support the findings of this study are available on this link: 10.6084/m9.figshare.25272913.

Additional information

Notes on contributors

Lluc Montull

Lluc Montull (PhD) is professor of Exercise Physiology in INEFC Pirineus. His research focuses on monitoring complex systems using tools of Network Physiology of Exercise.

Jordi Fernández

Jordi Fernández is affiliated to the methodological department of Venezia F.C. and is pursuing a professional PhD. His research focuses on studying the theoretical basis and practical applications of training methodologies in professional football.

Juan Pablo García

Juan Pablo García is responsible of research development and innovation of the club Estudiantes de la Plata. He is interested in a complex systems approach to sports training.

Natàlia Balagué

Natàlia Balagué (PhD) is professor of Exercise Physiology in INEFC Barcelona. Her research focuses on the application of a complex systems approach to sport and the Network Physiology of Exercise.

Notes

1 Although so-called mind-body practices, the trained awareness is an inseparable aspect of embodied self-awareness realized in action and interaction with the environment and world [16].